JMIR mHealth and uHealth
Mobile and tablet apps, ubiquitous and pervasive computing, wearable computing and domotics for health.
JMIR mhealth and uhealth (mobile and ubiquitous health) (JMU, ISSN 2291-5222) is a new spin-off journal of JMIR, the leading eHealth journal (Impact Factor 2014: 3.4). JMIR mHealth and uHealth has a projected impact factor (2015) of about 2.03. The journal focusses on health and biomedical applications in mobile and tablet computing, pervasive and ubiquitous computing, wearable computing and domotics.
JMIR mHealth and uHealth publishes even faster and has a broader scope with including papers which are more technical or more formative/developmental than what would be published in the Journal of Medical Internet Research.
In addition to peer-reviewing paper submissions by researchers, JMIR mHealth and uHealth offers peer-review of medical apps itself (developers can submit an app for peer-review here).
JMIR mHealth and uHealth features a rapid and thorough peer-review process, professional copyediting, professional production of PDF, XHTML, and XML proofs.
JMIR mHealth and uHealth adheres to the same quality standards as JMIR and all articles published here are also cross-listed in the Table of Contents of JMIR, the worlds' leading medical journal in health sciences / health services research and health informatics.
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Exploratory Study of funding and commercialization strategies for sustainable adoption and scale-up of mHealth initiatives in the LMICs.
Date Submitted: May 20, 2016
Open Peer Review Period: May 25, 2016 - Jul 20, 2016
Background: The new Sustainable Development Goals consist of 17 goals among which Universal Health Coverage (SDG3) and Partnerships for the Goals (SDG17) are two of the most relevant for our purposes....
Background: The new Sustainable Development Goals consist of 17 goals among which Universal Health Coverage (SDG3) and Partnerships for the Goals (SDG17) are two of the most relevant for our purposes. (1) With rapid growth and daily innovations, Information and Communication Technology (ICT) has become the cornerstone of transforming global health care industry all around the world. Wide penetration of internet and mobile networks in many low and middle income countries (LMICs) has brought about new ideas and promises for better access, lower costs and higher quality of health services in remote areas. To make this promise come true, the ICT and global health industry along with a vast number of user and provider stakeholders have developed hundreds of transboundary mHealth ecosystems to leverage the provision and distribution of equitable health services operation, management and control through various mHealth initiatives. However, the lack of empirical evidence supporting the cost, performance and health outcomes of mHealth initiatives have impeded post pilot scale up, implementation and integration of mobile technologies in many health systems. On the same note, with limited financial and structural resources and without supporting empirical evidence the LMICs which are most likely to benefit from sustainable mHealth interventions, often do not manage to grab the attention of public and private partners to secure sustainable investments for scale up phase. Results of this study show that in agreement with the SDG17 and the comparative Net Utility equation, some elemental components for a successful business partnership, i.e.; “balance in value gain for the economic buyer and the funder”, “use of value capturing commercialization strategies with attention to stakeholders, Technology and contextual requirements, and “insurers’ contributions” need to get more concentrated attention before the sustainability of scale-up of mHealth projects can be achieved. Objective: This study is to show the necessity of ongoing market analyses to investigate the best practices for keeping mHealth initiatives sustainable for its adopters throughout its life cycle. Methods: The novel nature of our paper’s subject along with the authors’ concern to study a larger number of variables that could influence the paper’s suggested strategies, have encouraged us to use the Qualitative Exploratory Research method as the best way to address the new and undisclosed problems within the commercial scope of the mHealth industry. Results: The results of this exploratory review suggest that there are certain factors that may directly or indirectly contribute to an affordable and sustainable scale-up and adoption of mHealth initiatives especially within resource-poor contexts. Interestingly, some elemental components for a successful business partnership, i.e.; “balance in value gain for the economic buyer and the funder”, “use of value capturing commercialization strategies with attention to stakeholders, Technology and contextual requirements, and “insurers’ contributions” need to get more profound attention before the sustainability of scale-up mHealth projects could be achieved. Conclusions: Discussed as the “Technology, Context and Commercialization Triangle”, the study suggests that for mHealth projects to be sustainable, three main aspects need to be taken into consideration at the same time. The first two aspects, which have been more commonly discussed in the body of literature, are cultural norms and technical infrastructure. Designing systems that would strengthen and integrate with the pre-existing technologies would motivate LMICs’ health authorities to support new mHealth projects. Also for the LMICs to be receptive to mHealth technologies, the applications should agree with the community’s culture and believes. The third aspect however, is beyond the technical and contextual requirements and looks more carefully into mHealth projects financing and commercialization models. It seems that even in the LMICs, the era of one-way donor-receiver relationship in development projects is coming to its end and for the mHealth projects to experience sustainable scale-up phases, donor-receiver relationship should turn into more “gain” oriented business partnerships with variety of public and private investors. Choosing the right partner at different stages of the projects’ life cycle is one of the delicate moments of mHealth business which has failed to be thoroughly discussed in the context of academia and industry. This study shows that not all stages of mHealth projects’ life cycle would respond equally to a single donor-based financing model, but specific financing strategies and engagement with different types of investors, businesses and technical partners; i.e. “public, private, NGOs and foundations” at infancy, development and maturity stages of mHealth projects may increase the chances for more sustainable scale-up phases in resource-poor countries. Last but not least, similar to their movement in the developed countries, supportive financial systems such as health insurers should start to consider the LMICs’ population as a new segment. The authors suggest that further studies are needed to assess the relevance of these findings within the contextual realities that permeate the LMIC sphere.
The quality and accuracy of mobile applications to prevent driving after drinking alcohol
Date Submitted: May 10, 2016
Open Peer Review Period: May 16, 2016 - Jul 11, 2016
Background: Driving after the consumption of alcohol represents a significant public health problem globally. Individual prevention countermeasures such as personalised mobile applications aimed at p...
Background: Driving after the consumption of alcohol represents a significant public health problem globally. Individual prevention countermeasures such as personalised mobile applications aimed at preventing the behaviour are widespread but there is little research on their accuracy and evidence-base. There has been no known assessment investigating the quality of such apps. Objective: This study aimed to determine the quality and accuracy of apps for drink driving prevention by conducting a review and evaluation of relevant mobile apps. Methods: A systematic app search was conducted following PRISMA guidelines. App quality was assessed using the Mobile Application Rating Scale (MARS). Apps providing blood alcohol calculators (hereafter ‘calculators’) were reviewed against current alcohol advice for accuracy. Results: A total of 58 apps (30 iOS and 28 Android) were included in the final analysis. Drink driving prevention apps had significantly lower engagement and overall quality scores than alcohol management apps. Most calculators provided conservative BAC time until sober calculations. None of the apps had been evaluated to determine efficacy in changing either drinking or driving behaviours. Conclusions: This novel study demonstrates that drink driving prevention apps lack quality as a function of low engagement. This could be improved by increasing engagement features, such as gamification. Further research should examine the context and motivations for using apps to prevent driving after drinking in at-risk populations. Development of drink driving prevention apps should incorporate evidence based information and guidance, and this is lacking in current apps.
Beyond the RCT: a review of alternatives in mHealth clinical trial methods.
Date Submitted: May 9, 2016
Open Peer Review Period: May 13, 2016 - Jul 8, 2016
Background: Randomized controlled trials (RCTs) have long been considered the primary research study design capable of eliciting causal relationships between health interventions and consequent outcom...
Background: Randomized controlled trials (RCTs) have long been considered the primary research study design capable of eliciting causal relationships between health interventions and consequent outcomes. However, with a prolonged duration from recruitment to publication, high-cost trial implementation, and a rigid trial protocol, RCTs are perceived as an impractical evaluation methodology for most mHealth apps. Objective: Given the recent development of alternative evaluation methodologies and tools to automate mHealth research, we sought to determine the breadth of these methods and the extent that they were being used in clinical trials. Methods: We conducted a review of the ClinicalTrials.gov registry to identify and examine current clinical trials involving mHealth apps and retrieved relevant trials registered between November 2014 and November 2015. Results: Of the 137 trials identified, 71 were found to meet inclusion criteria. The majority used an RCT trial design (77.5%; 55/71). Alternate designs included 3 one-shot case study designs (4.2%; 3/71), 2 one-group pretest posttest designs (2.8%;2/71), and 1 static-group comparison (1.4%; 1/71). Seventeen trials included a qualitative component to their methodology (23.9%). Complete trial data collection required 20 months on average to complete (M=20.75, SD=12.49). For trials with a total duration of two years or more (30.6%; 22/71), the average time from recruitment to complete data collection (M=35.45 months, SD=9.73) was two years longer than the average time required to collect primary data (M=10.68, SD=7.95). Trials had a moderate sample size of 115 participants. Two trials automated their data collection (2.9%) and seven trials collected data continuously (10.3%); on-site study implementation was heavily favoured (69/71, 97.1%). Frequent manual data collection extended trial duration, but automated continuous data collection did not. Academic sponsorship was the most common form of trial funding (73.2%; 52/71). Only seven trials had been completed at the time this retrospective review was conducted (9.9%; 7/71). Conclusions: mHealth evaluation methodology has not deviated from common methods, despite the need for more relevant and timely evaluations. There is a need for clinical evaluation to keep pace with the level of innovation of mHealth if it is to have meaningful impact in informing payers, providers, policy makers, and patients. Clinical Trial: n/a
Engaging Gatekeeper-stakeholders in Development of a Mobile Health Intervention to Improve Medication Adherence among African American and Pacific Islander Elderly Patients with Hypertension
Date Submitted: Apr 25, 2016
Open Peer Review Period: Apr 29, 2016 - Jun 24, 2016
Background: Approximately 70 million people in the US have hypertension. While antihypertensive therapy can reduce the morbidity and mortality associated with hypertension, often patients do not take...
Background: Approximately 70 million people in the US have hypertension. While antihypertensive therapy can reduce the morbidity and mortality associated with hypertension, often patients do not take their medication as prescribed. Objective: The goal of this study was to better understand issues affecting the acceptability and usability of mobile health technology (mHealth) to improve medication adherence for elderly African American (AA) and Native Hawaiian and Pacific Islander (NHPI) patients with hypertension. Methods: In-depth interviews were conducted with 20 Gatekeeper-stakeholders using targeted open-ended questions. Interviews were de-identified, transcribed, organized and coded manually by two independent coders. Analysis of patient interviews used largely a deductive approach because the targeted open-ended interview questions were designed to explore issues specific to the design and acceptability of a mHealth intervention for seniors. Results: A number of similar themes regarding elements of a successful intervention emerged from our two groups of AA and NHPI Gatekeeper-stakeholders. First was the need to teach participants both about the importance of adherence to antihypertensive medications; second, the use of smart/cell phones for messaging and patients need to be able to access ongoing technical support; third, messaging needs to be short and simple, but personalized, and to come from someone the participant trusts and with whom they have a connection. There were some differences between groups. For instance, there was a strong sentiment among AA that the church be involved and that the intervention begin with group workshops, while NHPI seemed to believe that the teaching could occur on a one-to-one basis with the health care provider. Conclusions: Information from our Gatekeeper-stakeholder (key informant) interviews suggests that the design of the mHealth intervention to improve adherence to antihypertensives among the elderly could be very similar between AAs and NHPIs. The main difference might be in the way in which the program is initiated (possibly through church-based workshops for AA and by individual providers for NHPIs). Another difference might be who sends the messages with AA wanting someone outside the health care system, but NHPI preferring a provider.
Investigating the Perceptions of Care Coordinators on Using Behavior Theory-Based Mobile Health Technology with Medicaid Populations: A Grounded Theory Study
Date Submitted: Apr 20, 2016
Open Peer Review Period: Apr 22, 2016 - Jun 17, 2016
Background: Medicaid populations are less engaged in their healthcare than the rest of the population, translating to worse health outcomes and increased healthcare costs. Since theory-based mobile he...
Background: Medicaid populations are less engaged in their healthcare than the rest of the population, translating to worse health outcomes and increased healthcare costs. Since theory-based mobile health (mHealth) interventions have been shown to increase patient engagement, mobile phones may be an optimal strategy to reach this population. There is a deep disconnect between developers of mHealth technology and health behavior researchers, so there is a lack of data on what components of theory-based mHealth increase patient engagement. Objective: This study aims to address this gap between academia and practice by conducting research using the health behavior-theory based patient-provider text-messaging platform, Sense Health, which integrates Transtheoretical Model and Stages of Change (TTM), Social Cognitive Theory (SCT), Supportive Accountability, and Motivational Interviewing. Methods: Interviews based in grounded-theory methodology were conducted with 10 care managers to triangulate the findings of internal user activity data and to further understand perceptions of the relationship between mHealth and patient engagement. Results: The interviews with care managers yield a grounded theory model including four intertwined relationships revolving around patient engagement: between Sense Health, client-care manager relationships, and communication; Sense Health, literacy, and access to care; support, Sense Health, and communication; and Sense Health, patient accountability, and patient motivation. Conclusions: Sense Health features tied to health behavior theory appear to be effective in improving patient engagement. Two-way communication (Supportive Accountability), trusted relationships (Supportive Accountability, SCT), personalized messages (TTM), and patient input (TTM, SCT, Motivational Interviewing) appeared as the most relevant components in achieving desired outcomes. Additionally, reminder messages were noted as especially useful in making Medicaid patients accountable, and in turn engaging them in their health and healthcare. These findings expose how this theory-centered platform drives engagement, allowing Sense Health, and future mHealth interventions that aim to improvement patient engagement in Medicaid populations, to improve their technology. Clinical Trial: Columbia University Medical Center Institutional Review Board (IRB-AAAQ5254)
SMS-Based Intervention Targeting Alcohol Consumption Among University Students: Findings from a Formative Development Study
Date Submitted: Apr 12, 2016
Open Peer Review Period: Apr 12, 2016 - Jun 7, 2016
Background: Drinking of alcohol among university students is a global phenomenon with heavy episodic drinking being accepted despite several potential negative consequences. Half of all young adults i...
Background: Drinking of alcohol among university students is a global phenomenon with heavy episodic drinking being accepted despite several potential negative consequences. Half of all young adults in Sweden attend university making the health and well-being of this group a public health concern. There is emerging evidence that text messaging (SMS) interventions are effective to promote behaviour change among students. However, it is still unclear how effectiveness can be optimized through intervention design or how user interest and adherence can be maximised. Objective: To develop an SMS-based intervention targeting alcohol drinking among university students using formative research. Methods: A formative research design was used including an iterative revision process based on input from end users and experts. Data were collected via focus groups (n=7) with students and a panel evaluation involving students (n=15) and experts (n=5). Student participants were recruited from five universities in Sweden. A semi-structured interview guide was used in the focus groups and included questions on alcohol culture, message content and intervention format. The panel evaluation asked participants to rate to what degree preliminary messages were understandable, usable and had a good tone on a scale from 1 to 4 (1 = very low degree; 4 = very high degree). Participants could also write their own comments for each message. Qualitative data were analysed using qualitative descriptive analysis. Quantitative data were analysed using descriptive statistics. The SMS messages and the intervention format were revised continuously, in parallel with data collection. A behaviour change technique analysis was conducted on the final version of the program. Results: The focus group data showed that, overall, students were positive towards the SMS intervention. Messages that were neutral, motivated, clear and tangible engaged students. Students expressed that they preferred short, concise messages and confirmed that a 6-week intervention was an appropriate duration. However, there was limited consensus regarding SMS frequency, personalization of messages and timing. Overall, messages scored high on understanding (3.86, SD 0.43), usability (3.70, SD 0.61) and tone (3.78, SD 0.53). Participants added comments to 67 of 70 messages, including suggestions for change in wording, order of messages, and feedback on why a message was unclear or needed major revision. Comments also included positive feedback that confirmed the value of the messages. Twenty-three behaviour change techniques, aimed at, for example, addressing self-regulatory skills, were identified in the final program. Conclusions: The formative research design was valuable and resulted in significant changes to the intervention. All the original SMS messages were changed and new messages were added. The findings showed that, overall, students were positive towards receiving support through SMS and that neutral, motivated, clear and tangible messages promoted engagement. However, limited consensus was found on the timing, frequency and tailoring of messages.