JMIR Publications

JMIR mHealth and uHealth

Mobile and tablet apps, ubiquitous and pervasive computing, wearable computing and domotics for health.

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Smartphone applications to support tuberculosis efforts: Review and evaluation

Background: Tuberculosis (TB) remains a major global health problem. TB is the second leading infectious disease following HIV with 14.1 million have active cases, 9 million are newly diagnosed per year, and 1.5 million deaths attributable to it annually. mHealth-based tools, such as smartphone applications (apps), have been suggested as potential tools to support TB control efforts (e.g., identification, contact tracing, case management). Objective: The purpose of this review was to identify and assess the functionalities of mobile apps focused on TB control efforts. Methods: We searched 3 online mobile app stores. Apps were included if they were focused on TB and were in English, Spanish, or Portuguese. For each included app, 11 functionalities were assessed (e.g., inform, instruct, record) and searches were conducted to identify published testing results. Grey literature was also searched for apps in development. Results: 1332 potentially relevant apps were identified, with 24 meeting our inclusion criteria. All of the apps were free to download, but 7 required login and password and were developed for specific clinics, regional sites, or research studies. Targeted users were mainly clinicians (n = 17); few (n = 4) apps were patient focused. Most apps (n=17) had a total of 4 or fewer functions out of 11 (range 1-6). The most common functionalities were inform and record (n=15). Although a number of apps were identified with various functionalities to support TB efforts, some had issues, such as incorrect spelling and grammar, inconsistent responses to data entry, problems with crashing, or links to features that had no data. Eight apps had not been updated for more than a year and may no longer be supported. Peer reviewed publications were identified for only two of the included apps. Three TB related apps were identified in the grey literature (not found in the app stores) as in progress, being launched, or tested. Conclusions: Apps identified for TB efforts had minimal functionality, primarily targeted frontline healthcare workers, and focused on TB information (e.g., general, guidelines, and news) or data collection (e.g., replace paper-based notification or tracking). Few targeted patients as end-users which limits the potential of these apps to facilitate patient centered care. None were developed to support TB patients’ involvement and management in their care (e.g., follow-up alerts/reminders, side effects monitoring), or to improve interaction with their healthcare providers. Given the complexity and challenges faced by patients with TB, there is a need for further app development targeting their needs. Involving TB patients in treatment in the design of these apps is recommended.

2015-08-28

(Toronto, June 30, 2015) We are excited to announce that JMIR Publications has partnered with the organizers of the 2015 mHealth Summit as a media partner.

The 2015 mHealth Summit (http://www.mhealthsummit.org) centers around the theme of “Anytime, Anywhere: Engaging Patients and Providers.” It is a premier conference and expo for exploring what’s new in mobile and connected health—from the impact on healthcare delivery and patient/consumer engagement to new technologies, investments, policy and shifts in the business environment. "We are very excited to partner with JMIR Publications again!" said Mary Sheridan, coordinator of the 2015 mHealth Summit.

JMIR Publications (http://jmirpublications.com) is the leading eHealth publisher, with over ten academic journals covering digital health, technology and innovation in health. In particular, JMIR mHealth and uHealth (http://mhealth.jmir.org) publishes on health and biomedical applications in mobile and tablet computing, pervasive and ubiquitous computing, wearable computing and domotics. "We are happy to serve as a partner of the mHealth Summit this year and look forward to being one of the major publishers of the work presented there," said Gunther Eysenbach, MD, MPH, FACMI, Publisher and Editor-in-Chief of JMIR Publications' journals.

The 2015 mHealth Summit will take place November 8-11 at the Gaylord National Resort and Convention Centre in Washington DC. This partnership brings JMIR readers a $100 discount to a full access pass (discount code: JMIR100). 

Visit http://www.mhealthsummit.org/registration to register today. 


JMIR Publications JMIR Publications is the leading eHealth publisher, advancing progress in the health, engineering and social sciences to ultimately help people to live happier and healthier lives using technology. JMIR Publications helps innovators in the health technology space to collaborate and disseminate their innovations, ideas, and research results to the widest possible audience, in a timely manner, adding value to the quality of the work and adhering to the highest ethical and quality standards. We achieve this by using the Internet and the latest available technologies as well as by producing conferences and social media, and other innovative knowledge translation products. We also innovate in the scholarly communication space itself, experimenting with new business models, new models of peer-review and dissemination, and new technologies. Visit http://www.jmir.org for details. 

JMIR mHealth and uHealth JMIR mHealth and uHealth is a spin-off journal of JMIR. The journal focusses on health and biomedical applications in mobile and tablet computing, pervasive and ubiquitous computing, wearable computing and domotics. Published by JMIR Publications, JMIR mHealth and uHealth publishes even faster and has a broader scope including papers which are more technical or more formative than what would be published in JMIR. In addition to peer-reviewing paper submissions by researchers, JMIR mHealth and uHealth offers peer-review of medical apps itself (we will write and publish a peer-review report for you - please submit your proposal at http://tinyurl.com/appsform). 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 (http://www.jmir.org/issue/current). Visit http://mhealth.jmir.org for details.

mHealth Summit The mHealth Summit is one of three innovative events that comprise the HIMSS Connected Health Conference – an all-inclusive opportunity for learning, sharing and engaging how technology is enabling the positive transformation of this critical area of health and healthcare. It is the largest and most diverse event of its kind where mobile technology and healthcare thought-leaders gather to explore new collaborations, initiatives and business opportunities. Visit http://www.mhealthsummit.org for details.

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Journal Description

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 2013: 4.7). 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 is indexed in PubMed Central/PubMed).

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.

 

Recent Articles:

  • Screenshot of Diabetes App Lite by BHI Technologies, Inc.   https://itunes.apple.com/us/app/diabetes-app-lite-blood-sugar/id387337850?mt=8.

    Popular Glucose Tracking Apps and Use of mHealth by Latinos With Diabetes: Review

    Abstract:

    Background: Diabetes mellitus in the United States is an increasingly common chronic disease, costing hundreds of billions of dollars and contributing to hundreds of thousands of deaths each year. The prevalence of diabetes is over 50% higher in Latinos than in the general population, and this group also suffers from higher rates of complications and diabetes-related mortality than NHWs. mHealth is a promising new treatment modality for diabetes, though few smartphone apps have been designed specifically for Latinos. Objective: The objectives of our study were: (1) to identify the most common features of the most popular diabetes apps and consider how such features may be improved to meet the needs of Latinos; (2) to determine the use of diabetes apps among a sample of online Hispanics in the US. Methods: Our study consisted of two parts. First, 20 of the most popular diabetes apps were reviewed in order to ascertain the most prevalent features and functionalities. Second, an online survey was fielded through a popular health website for Latinos (HolaDoctor) inquiring about respondents’ use of diabetes apps. Results: Approximately one-third of apps reviewed were available in Spanish. The most common features were blood glucose recording/annotation and activity logs. The majority of apps permitted exportation of data via e-mail but only a third enabled uploading to an online account. Twenty percent of apps reviewed could connect directly with a glucometer, and 30% had reminder functionalities prompting patients to take medications or check blood glucose levels. Over 1600 online surveys were completed during the second half of April 2014. More than 90% of respondents were from the United States, including Puerto Rico. The majority of respondents used a device running on an Android platform while only a quarter used an iPhone. Use of diabetes apps was approximately 3% among diabetic respondents and 3.6% among diabetic respondents who also had a smartphone. Among app users, blood glucose and medication diaries were the most frequently used functionalities while hemoglobin A1c and insulin diaries were the least used. A significant majority of app users did not share their progress on social media though many of these were willing to share it with their doctor. Conclusions: Latino diabetics have unique needs and this should be reflected in diabetes apps designed for this population. Existing research as well as our survey results suggest that many Latinos do not possess the prerequisite diabetes knowledge or self-awareness to fully benefit from the most prevalent functionalities offered by the most popular diabetes apps. We recommend developers incorporate more basic features such as diabetes education, reminders to check blood glucose levels or take medications, Spanish language interfaces, and glucometer connectivities, which are relatively underrepresented in the most popular diabetes apps currently available in Spanish.

  • The SmartCare app.

    The Effectiveness of Mobile Phone-Based Care for Weight Control in Metabolic Syndrome Patients: Randomized Controlled Trial

    Abstract:

    Background: Overweight and obesity, due to a Westernized diet and lack of exercise, are serious global problems that negatively affect not only personal health, but national economies as well. To solve these problems, preventative-based approaches should be taken rather than medical treatments after the occurrence of disease. The improvement of individual life habits, through continuous care, is thus a paramount, long-term treatment goal. This study describes the effects of ubiquitous health care (uHealth care) or SmartCare services in the treatment of weight loss and obesity. Objective: The aim of this study is to evaluate the effect of SmartCare services on weight loss compared to the effects of existing outpatient treatments in obese patients with metabolic syndrome. Methods: Metabolic syndrome patients who met the inclusion/exclusion criteria were enrolled in the study and randomized into an intervention or control group. The intervention group was provided with remote monitoring and health care services in addition to the existing treatment. The control group was provided with only the existing treatment. Pedometers were given to all of the patients. Additionally, mobile phones and body composition monitors were provided to the intervention group while body weight scales were provided to the control group. The patients visited the hospitals at 12 and 24 weeks following the baseline examination to receive efficacy and safety evaluations. Results: Mean weight reduction from baseline to week 24 was measured as a primary efficacy evaluation parameter and was found to be 2.21 kg (SD 3.60) and 0.77 kg (SD 2.77) in the intervention and control group, respectively. The intervention group had a larger decrement compared to the control group (P<.001). Among the secondary efficacy evaluation parameters, body mass index (BMI) (P<.001), body fat rate (P=.001), decrement of waist measurement (P<.001), and diet habit (P=.012) improvement ratings from baseline to week 24 were found to be superior in the intervention group compared with the control group. The proportion of patients whose body weight decreased by ≥10%, lipid profiles, blood pressure, prevalence of metabolic syndrome, change in the number of metabolic syndrome elements, smoking rate, drinking rate, and physical activity were not statistically significant between the groups. Conclusions: The efficacy of SmartCare services was confirmed as the intervention group that received both SmartCare services and the existing treatment had superior results compared with the control group that only received the existing treatment. Importantly, no specific problems with respect to safety concerns were observed. SmartCare service is thus an effective way to control the weight of obese patients with metabolic syndrome. Trial Registration: Clinicaltrials.gov NCT01344811; https://clinicaltrials.gov/ct2/show/NCT01344811 (Archived by Webcite at http://www.webcitation.org/6alT2MmIB)

  • Feature image for homepage.

    Review and Evaluation of Mindfulness-Based iPhone Apps

    Abstract:

    Background: There is growing evidence for the positive impact of mindfulness on wellbeing. Mindfulness-based mobile apps may have potential as an alternative delivery medium for training. While there are hundreds of such apps, there is little information on their quality. Objective: This study aimed to conduct a systematic review of mindfulness-based iPhone mobile apps and to evaluate their quality using a recently-developed expert rating scale, the Mobile Application Rating Scale (MARS). It also aimed to describe features of selected high-quality mindfulness apps. Methods: A search for “mindfulness” was conducted in iTunes and Google Apps Marketplace. Apps that provided mindfulness training and education were included. Those containing only reminders, timers or guided meditation tracks were excluded. An expert rater reviewed and rated app quality using the MARS engagement, functionality, visual aesthetics, information quality and subjective quality subscales. A second rater provided MARS ratings on 30% of the apps for inter-rater reliability purposes. Results: The “mindfulness” search identified 700 apps. However, 94 were duplicates, 6 were not accessible and 40 were not in English. Of the remaining 560, 23 apps met inclusion criteria and were reviewed. The median MARS score was 3.2 (out of 5.0), which exceeded the minimum acceptable score (3.0). The Headspace app had the highest average score (4.0), followed by Smiling Mind (3.7), iMindfulness (3.5) and Mindfulness Daily (3.5). There was a high level of inter-rater reliability between the two MARS raters. Conclusions: Though many apps claim to be mindfulness-related, most were guided meditation apps, timers, or reminders. Very few had high ratings on the MARS subscales of visual aesthetics, engagement, functionality or information quality. Little evidence is available on the efficacy of the apps in developing mindfulness.

  • Junior Doctor interacting with patient with a mobile device on the patient's table. (cc) Patel et al. CC-BY-SA 2.0, please cite as http://mhealth.jmir.org/article/viewFile/4388/1/63297.

    Use of Mobile Clinical Decision Support Software by Junior Doctors at a UK Teaching Hospital: Identification and Evaluation of Barriers to Engagement

    Abstract:

    Background: Clinical decision support (CDS) tools improve clinical diagnostic decision making and patient safety. The availability of CDS to health care professionals has grown in line with the increased prevalence of apps and smart mobile devices. Despite these benefits, patients may have safety concerns about the use of mobile devices around medical equipment. Objective: This research explored the engagement of junior doctors (JDs) with CDS and the perceptions of patients about their use. There were three objectives for this research: (1) to measure the actual usage of CDS tools on mobile devices (mCDS) by JDs, (2) to explore the perceptions of JDs about the drivers and barriers to using mCDS, and (3) to explore the perceptions of patients about the use of mCDS. Methods: This study used a mixed-methods approach to study the engagement of JDs with CDS accessed through mobile devices. Usage data were collected on the number of interactions by JDs with mCDS. The perceived drivers and barriers for JDs to using CDS were then explored by interviews. Finally, these findings were contrasted with the perception of patients about the use of mCDS by JDs. Results: Nine of the 16 JDs made a total of 142 recorded interactions with the mCDS over a 4-month period. Only 27 of the 114 interactions (24%) that could be categorized as on-shift or off-shift occurred on-shift. Eight individual, institutional, and cultural barriers to engagement emerged from interviews with the user group. In contrast to reported cautions and concerns about the impact of clinicians’ use of mobile phone on patient health and safety, patients had positive perceptions about the use of mCDS. Conclusions: Patients reported positive perceptions toward mCDS. The usage of mCDS to support clinical decision making was considered to be positive as part of everyday clinical practice. The degree of engagement was found to be limited due to a number of individual, institutional, and cultural barriers. The majority of mCDS engagement occurred outside of the workplace. Further research is required to verify these findings and assess their implications for future policy and practice.

  • (cc) Ramo et al, CC-BY-SA 2.0, please cite as http://mhealth.jmir.org/copyeditor/downloadFile/4405/63951.

    Cannabis Mobile Apps: A Content Analysis

    Abstract:

    Background: Mobile technology is pervasive and widely used to obtain information about drugs such as cannabis, especially in a climate of rapidly changing cannabis policy; yet the content of available cannabis apps is largely unknown. Understanding the resources available to those searching for cannabis apps will clarify how this technology is being used to reflect and influence cannabis use behavior. Objective: We investigated the content of 59 cannabis-related mobile apps for Apple and Android devices as of November 26, 2014. Methods: The Apple and Google Play app stores were searched using the terms “cannabis” and “marijuana.” Three trained coders classified the top 20 apps for each term and each store, using a coding guide. Apps were examined for the presence of 20 content codes derived by the researchers. Results: Total apps available for each search term were 124 for cannabis and 218 for marijuana in the Apple App Store, and 250 each for cannabis and marijuana on Google Play. The top 20 apps in each category in each store were coded for 59 independent apps (30 Apple, 29 Google Play). The three most common content areas were cannabis strain classification (33.9%), facts about cannabis (20.3%), and games (20.3%). In the Apple App Store, most apps were free (77%), all were rated “17+” years, and the average user rating was 3.9/5 stars. The most popular apps provided cannabis strain classifications (50%), dispensary information (27%), or general facts about cannabis (27%). Only one app (3%) provided information or resources related to cannabis abuse, addiction, or treatment. On Google Play, most apps were free (93%), rated “high maturity” (79%), and the average user rating was 4.1/5. The most popular app types offered games (28%), phone utilities (eg, wallpaper, clock; 21%) and cannabis food recipes (21%); no apps addressed abuse, addiction, or treatment. Conclusions: Cannabis apps are generally free and highly rated. Apps were most often informational (facts, strain classification), or recreational (games), likely reflecting and influencing the growing acceptance of cannabis for medical and recreational purposes. Apps addressing addiction or cessation were underrepresented in the most popular cannabis mobile apps. Differences among apps for Apple and Android platforms likely reflect differences in the population of users, developer choice, and platform regulations.

  • Untitled.

    Mobile Phone-Connected Wearable Motion Sensors to Assess Postoperative Mobilization

    Abstract:

    Background: Early mobilization after surgery reduces the incidence of a wide range of complications. Wearable motion sensors measure movements over time and transmit this data wirelessly, which has the potential to monitor patient recovery and encourages patients to engage in their own rehabilitation. Objective: We sought to determine the ability of off-the-shelf activity sensors to remotely monitor patient postoperative mobility. Methods: Consecutive subjects were recruited under the Department of Neurosurgery at Columbia University. Patients were enrolled during physical therapy sessions. The total number of steps counted by the two blinded researchers was compared to the steps recorded on four activity sensors positioned at different body locations. Results: A total of 148 motion data points were generated. The start time, end time, and duration of each walking session were accurately recorded by the devices and were remotely available for the researchers to analyze. The sensor accuracy was significantly greater when placed over the ankles than over the hips (P<.001). Our multivariate analysis showed that step length was an independent predictor of sensor accuracy. On linear regression, there was a modest positive correlation between increasing step length and increased ankle sensor accuracy (r=.640, r2=.397) that reached statistical significance on the multivariate model (P=.03). Increased gait speed also correlated with increased ankle sensor accuracy, although less strongly (r=.444, r2=.197). We did not note an effect of unilateral weakness on the accuracy of left- versus right-sided sensors. Accuracy was also affected by several specific measures of a patient’s level of physical assistance, for which we generated a model to mathematically adjust for systematic underestimation as well as disease severity. Conclusions: We provide one of the first assessments of the accuracy and utility of widely available and wirelessly connected activity sensors in a postoperative patient population. Our results show that activity sensors are able to provide invaluable information about a patient’s mobility status and can transmit this data wirelessly, although there is a systematic underestimation bias in more debilitated patients.

  • (cc) Subhi et al. CC-BY-SA 2.0, please cite as (http://mhealth.jmir.org/article/viewFile/4169/1/54184).

    Expert Involvement and Adherence to Medical Evidence in Medical Mobile Phone Apps: A Systematic Review

    Abstract:

    Background: Both clinicians and patients use medical mobile phone apps. Anyone can publish medical apps, which leads to contents with variable quality that may have a serious impact on human lives. We herein provide an overview of the prevalence of expert involvement in app development and whether or not app contents adhere to current medical evidence. Objective: To systematically review studies evaluating expert involvement or adherence of app content to medical evidence in medical mobile phone apps. Methods: We systematically searched 3 databases (PubMed, The Cochrane Library, and EMBASE), and included studies evaluating expert involvement or adherence of app content to medical evidence in medical mobile phone apps. Two authors performed data extraction independently. Qualitative analysis of the included studies was performed. Results: Based on inclusion criteria, 52 studies were included in this review. These studies assessed a total of 6520 apps. Studies dealt with a variety of medical specialties and topics. As much as 28 studies assessed expert involvement, which was found in 9-67% of the assessed apps. Thirty studies (including 6 studies that also assessed expert involvement) assessed adherence of app content to current medical evidence. Thirteen studies found that 10-87% of the assessed apps adhered fully to the compared evidence (published studies, recommendations, and guidelines). Seventeen studies found that none of the assessed apps (n=2237) adhered fully to the compared evidence. Conclusions: Most medical mobile phone apps lack expert involvement and do not adhere to relevant medical evidence.

  • 7 Minute Workout app screenshots.

    Low Quality of Free Coaching Apps With Respect to the American College of Sports Medicine Guidelines: A Review of Current Mobile Apps

    Abstract:

    Background: Low physical activity level is a significant contributor to chronic disease, weight dysregulation, and mortality. Nearly 70% of the American population is overweight, and 35% is obese. Obesity costs an estimated US$ 147 billion annually in health care, and as many as 95 million years of life. Although poor nutritional habits remain the major culprit, lack of physical activity significantly contributes to the obesity epidemic and related lifestyle diseases. Objective: Over the past 10 years, mobile devices have become ubiquitous, and there is an ever-increasing number of mobile apps that are being developed to facilitate physical activity, particularly for active people. However, no systematic assessment has been performed about their quality with respect to following the parameters of sound fitness principles and scientific evidence, or suitability for a variety of fitness levels. The aim of this paper is to fill this gap and assess the quality of mobile coaching apps on iOS mobile devices. Methods: A set of 30 popular mobile apps pertaining to physical activity programming was identified and reviewed on an iPhone device. These apps met the inclusion criteria and provided specific prescriptive fitness and exercise programming content. The content of these apps was compared against the current guidelines and fitness principles established by the American College of Sports Medicine (ACSM). A weighted scoring method based on the recommendations of the ACSM was developed to generate subscores for quality of programming content for aerobic (0-6 scale), resistance (0-6 scale), and flexibility (0-2 scale) components using the frequency, intensity, time, and type (FITT) principle. An overall score (0-14 scale) was generated from the subscores to represent the overall quality of a fitness coaching app. Results: Only 3 apps scored above 50% on the aerobic component (mean 0.7514, SD 1.2150, maximum 4.1636), 4 scored above 50% on the resistance/strength component (mean 1.4525, SD 1.2101, maximum 4.1094), and no app scored above 50% on the flexibility component (mean 0.1118, SD 0.2679, maximum 0.9816). Finally, only 1 app had an overall score (64.3%) above 50% (mean 2.3158, SD 1.911, maximum 9.0072). Conclusions: There are over 100,000 health-related apps. When looking at popular free apps related to physical activity, we observe that very few of them are evidence based, and respect the guidelines for aerobic activity, strength/resistance training, and flexibility, set forth by the ACSM. Users should exercise caution when adopting a new app for physical activity purposes. This study also clearly identifies a gap in evidence-based apps that can be used safely and effectively to start a physical routine program, develop fitness, and lose weight. App developers have an exciting opportunity to improve mobile coaching app quality by addressing these gaps.

  • Mobile phone mast in Uganda. Picture taken by Daniel Strachan, one of the authors.

    Potential Roles of Mhealth for Community Health Workers: Formative Research With End Users in Uganda and Mozambique

    Abstract:

    Background: Community health workers are reemerging as an essential component of health systems in low-income countries. However, there are concerns that unless they are adequately supported, their motivation and performance will be suboptimal. mHealth presents an opportunity to improve support for community health workers; however, most interventions to date have been designed through a top-down approach, rarely involve the end user, and have not focused on motivation. Objective: To use formative research to explore the views of community health workers in Uganda and Mozambique on the potential role of mHealth in their work delivering integrated community case management of children. Methods: We conducted 24 in-depth interviews and 5 focus group discussions with community health workers in Uganda and Mozambique. Data were collected on: current phone use, preferred phone and charger characteristics, and perceptions of a range of potential mHealth interventions. Interviews were conducted in the local language, were audio recorded and converted into expanded notes. Interviews were coded for key thematic areas using both deductive and inductive codes. Deductive codes included mHealth’s potential impact on motivation and performance. Results: The most salient roles of mHealth in improving performance and motivation were reducing the need for travel, improving efficiency and planning, receiving feedback and information, and improving communication with supervisors and other community health workers. This was mostly through improved voice and short message service (SMS) text communication. Specific components of mHealth interventions that participants felt could improve motivation included increasing their visibility and credibility through branding of phones; providing an SMS response to data submission; and sending SMS messages about the importance of their work and achievements, rather than just reminders or technical messages. Participants identified feasibility issues related to the language of SMS messages, network coverage, and the need for a balance between phone function and battery life. Phones with a dual SIM cards would ameliorate network problems but would reduce battery life. The provision of a solar charger was viewed as beneficial. Conclusions: Conducting formative research with end users is likely to improve mHealth interventions by: (1) identifying interventions that are likely to have the greatest impact and be the most acceptable, (2) developing salient SMS messages, and (3) identifying feasibility issues. mHealth interventions also could have an important impact on health worker motivation, which should be considered by intervention developers and in evaluations, especially as small modifications could have a significant impact. Our study suggests that using phones to improve direct communication should be considered, even when planners aim to focus on the provision of a specific application.

  • DEPIC.
©Kasemsak Jandee, Jaranit Kaewkungwal, Amnat Khamsiriwatchara, Saranath Lawpoolsri, Waranya Wongwit, Peerawat Wansatid.

    Effectiveness of Using Mobile Phone Image Capture for Collecting Secondary Data: A Case Study on Immunization History Data Among Children in Remote Areas of...

    Abstract:

    Background: Entering data onto paper-based forms, then digitizing them, is a traditional data-management method that might result in poor data quality, especially when the secondary data are incomplete, illegible, or missing. Transcription errors from source documents to case report forms (CRFs) are common, and subsequently the errors pass from the CRFs to the electronic database. Objective: This study aimed to demonstrate the usefulness and to evaluate the effectiveness of mobile phone camera applications in capturing health-related data, aiming for data quality and completeness as compared to current routine practices exercised by government officials. Methods: In this study, the concept of “data entry via phone image capture” (DEPIC) was introduced and developed to capture data directly from source documents. This case study was based on immunization history data recorded in a mother and child health (MCH) logbook. The MCH logbooks (kept by parents) were updated whenever parents brought their children to health care facilities for immunization. Traditionally, health providers are supposed to key in duplicate information of the immunization history of each child; both on the MCH logbook, which is returned to the parents, and on the individual immunization history card, which is kept at the health care unit to be subsequently entered into the electronic health care information system (HCIS). In this study, DEPIC utilized the photographic functionality of mobile phones to capture images of all immunization-history records on logbook pages and to transcribe these records directly into the database using a data-entry screen corresponding to logbook data records. DEPIC data were then compared with HCIS data-points for quality, completeness, and consistency. Results: As a proof-of-concept, DEPIC captured immunization history records of 363 ethnic children living in remote areas from their MCH logbooks. Comparison of the 2 databases, DEPIC versus HCIS, revealed differences in the percentage of completeness and consistency of immunization history records. Comparing the records of each logbook in the DEPIC and HCIS databases, 17.3% (63/363) of children had complete immunization history records in the DEPIC database, but no complete records were reported in the HCIS database. Regarding the individual’s actual vaccination dates, comparison of records taken from MCH logbook and those in the HCIS found that 24.2% (88/363) of the children’s records were absolutely inconsistent. In addition, statistics derived from the DEPIC records showed a higher immunization coverage and much more compliance to immunization schedule by age group when compared to records derived from the HCIS database. Conclusions: DEPIC, or the concept of collecting data via image capture directly from their primary sources, has proven to be a useful data collection method in terms of completeness and consistency. In this study, DEPIC was implemented in data collection of a single survey. The DEPIC concept, however, can be easily applied in other types of survey research, for example, collecting data on changes or trends based on image evidence over time. With its image evidence and audit trail features, DEPIC has the potential for being used even in clinical studies since it could generate improved data integrity and more reliable statistics for use in both health care and research settings.

  • Medication Application.

    The Prevalence and Characteristics of Emergency Medicine Patient Use of New Media

    Abstract:

    Background: Little is known about “new media” use, defined as media content created or consumed on demand on an electronic device, by patients in emergency department (ED) settings. The application of this technology has the potential to enhance health care beyond the index visit. Objective: The objectives are to determine the prevalence and characteristics of ED patients’ use of new media and to then define and identify the potential of new media to transcend health care barriers and improve the public’s health. Methods: Face-to-face, cross-sectional surveys in Spanish and English were given to 5,994 patients who were sequentially enrolled from July 12 to August 30, 2012. Data were collected from across a Southern Connecticut health care system’s 3 high-volume EDs for 24 hours a day, 7 days a week for 6 weeks. The EDs were part of an urban academic teaching hospital, an urban community hospital, and an academic affiliate hospital. Results: A total of 5,994 (89% response rate) ED patients reported identical ownership of cell phones (85%, P<.001) and smartphones (51%, P<.001) that were used for calling (99%, P<.001). The older the patient, however, the less likely it was that the patient used the phone for texting (96% vs 16%, P<.001). Income was positively associated with smartphone ownership (P<.001) and the use of health apps (P>.05) and personal health records (P<.001). Ownership of iPhones compared to Android phones were similar (44% vs 45%, P<.05). Race and ethnicity played a significant role in texting and smartphone ownership, with Hispanics reporting the highest rates of 79% and 56%, respectively, followed by black non-Hispanics at 77% and 54%, respectively, and white non-Hispanics at 65% and 42%, respectively (P<.05). Conclusions: There is a critical mass of ED patients who use new media. Older persons are less comfortable texting and using smartphone apps. Income status has a positive relationship with smartphone ownership and use of smartphone apps. Regardless of income, however, texting and ownership of smartphones was highest for Latinos and black non-Latinos. These findings have implications for expanding health care beyond the ED visit through the use of cell phones, smartphones, texting, the Internet, and health care apps to improve the health of the public.

  • Color design concepts of the My Interventional Drug-Eluting Stent Educational App: (A) Concept 3 and (B) Concept 4.

    My Interventional Drug-Eluting Stent Educational App (MyIDEA): Patient-Centered Design Methodology

    Abstract:

    Background: Patient adherence to medication regimens is critical in most chronic disease treatment plans. This study uses a patient-centered tablet app, “My Interventional Drug-Eluting Stent Educational App (MyIDEA).” This is an educational program designed to improve patient medication adherence. Objective: Our goal is to describe the design, methodology, limitations, and results of the MyIDEA tablet app. We created a mobile technology-based patient education app to improve dual antiplatelet therapy adherence in patients who underwent a percutaneous coronary intervention and received a drug-eluting stent. Methods: Patient advisers were involved in the development process of MyIDEA from the initial wireframe to the final launch of the product. The program was restructured and redesigned based on the patient advisers’ suggestions as well as those from multidisciplinary team members. To accommodate those with low health literacy, we modified the language and employed attractive color schemes to improve ease of use. We assumed that the target patient population may have little to no experience with electronic tablets, and therefore, we designed the interface to be as intuitive as possible. Results: The MyIDEA app has been successfully deployed to a low-health-literate elderly patient population in the hospital setting. A total of 6 patients have interacted with MyIDEA for an average of 17.6 minutes/session. Conclusions: Including patient advisers in the early phases of a mobile patient education development process is critical. A number of changes in text order, language, and color schemes occurred to improve ease of use. The MyIDEA program has been successfully deployed to a low-health-literate elderly patient population. Leveraging patient advisers throughout the development process helps to ensure implementation success.

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    Date Submitted: Aug 11, 2015

    Open Peer Review Period: Aug 13, 2015 - Oct 8, 2015

    Background: Tuberculosis (TB) remains a major global health problem. TB is the second leading infectious disease following HIV with 14.1 million have active cases, 9 million are newly diagnosed per ye...

    Background: Tuberculosis (TB) remains a major global health problem. TB is the second leading infectious disease following HIV with 14.1 million have active cases, 9 million are newly diagnosed per year, and 1.5 million deaths attributable to it annually. mHealth-based tools, such as smartphone applications (apps), have been suggested as potential tools to support TB control efforts (e.g., identification, contact tracing, case management). Objective: The purpose of this review was to identify and assess the functionalities of mobile apps focused on TB control efforts. Methods: We searched 3 online mobile app stores. Apps were included if they were focused on TB and were in English, Spanish, or Portuguese. For each included app, 11 functionalities were assessed (e.g., inform, instruct, record) and searches were conducted to identify published testing results. Grey literature was also searched for apps in development. Results: 1332 potentially relevant apps were identified, with 24 meeting our inclusion criteria. All of the apps were free to download, but 7 required login and password and were developed for specific clinics, regional sites, or research studies. Targeted users were mainly clinicians (n = 17); few (n = 4) apps were patient focused. Most apps (n=17) had a total of 4 or fewer functions out of 11 (range 1-6). The most common functionalities were inform and record (n=15). Although a number of apps were identified with various functionalities to support TB efforts, some had issues, such as incorrect spelling and grammar, inconsistent responses to data entry, problems with crashing, or links to features that had no data. Eight apps had not been updated for more than a year and may no longer be supported. Peer reviewed publications were identified for only two of the included apps. Three TB related apps were identified in the grey literature (not found in the app stores) as in progress, being launched, or tested. Conclusions: Apps identified for TB efforts had minimal functionality, primarily targeted frontline healthcare workers, and focused on TB information (e.g., general, guidelines, and news) or data collection (e.g., replace paper-based notification or tracking). Few targeted patients as end-users which limits the potential of these apps to facilitate patient centered care. None were developed to support TB patients’ involvement and management in their care (e.g., follow-up alerts/reminders, side effects monitoring), or to improve interaction with their healthcare providers. Given the complexity and challenges faced by patients with TB, there is a need for further app development targeting their needs. Involving TB patients in treatment in the design of these apps is recommended.

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    Date Submitted: Jul 10, 2015

    Open Peer Review Period: Jul 11, 2015 - Sep 5, 2015

    Background: Physical activity (PA) benefits are well-documented. PA is influenced by mobile phones via promoting screen-based sedentary time or by providing entertainment during PA. It is not known ho...

    Background: Physical activity (PA) benefits are well-documented. PA is influenced by mobile phones via promoting screen-based sedentary time or by providing entertainment during PA. It is not known how mobile phone use is associated with PA and sitting time in Mexican-Americans, and how mobile phone users may differ from non-users. Objective: To examine this, 2,982 adults in the Mexican-American Mano A Mano cohort were interviewed regarding their mobile phone use and activity behaviors. Methods: Differences in meeting physical activity recommendations and sitting time between mobile phone users and non-users were examined using Chi-square and ANOVA tests. Logistic regression was used to examine associations between mobile phone use, PA and sitting. Results: Mobile phone users were more likely to be obese by Body Mass Index (BMI; ≥30 kg/m2), younger, born in the United States (US) and lived there longer, more educated, sit more hours per day but more likely to meet PA recommendations than non-users. Males (OR = 1.42, CI: 1.16, 1.74), use of text messaging (OR = 1.26; CI: 1.03, 1.56), and having a higher acculturation score (OR = 1.27; CI: 1.07, 1.52) were associated with higher odds of meeting PA recommendations. Sitting more hours per day was associated with being male, obese, US-born, a former alcohol drinker, and having at least a high school education. Among non-users, being US-born was associated with higher odds of more sitting time, and being married was associated with higher odds of meeting PA recommendations. Conclusions: Mobile phone interventions could be tailored to promote PA in Mexican-American mobile phone users. Clinical Trial: n/a

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