JMIR mHealth and uHealth
Mobile and tablet apps, ubiquitous and pervasive computing, wearable computing and domotics for health.
JMIR mHealth and uHealth (JMU, ISSN 2291-5222) is a spin-off journal of JMIR, the leading eHealth journal (Impact Factor 2016: 5.175). JMIR mHealth and uHealth is indexed in PubMed, PubMed Central, and Science Citation Index Expanded (SCIE), and in June 2017 received a stunning inaugural Impact Factor of 4.636.
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 since 2013 and was the first mhealth journal in Pubmed. It 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.
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.
Sep 20, 2017
Sep 15, 2017
Sep 14, 2017
Sep 13, 2017
Sep 11, 2017
Sep 7, 2017
Aug 30, 2017
Aug 25, 2017
Aug 17, 2017
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Aug 15, 2017
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Developing sustainable and impactful mobile phone HIV testing interventions for Spanish-speaking men who have sex with men in the United States (US): Lessons learned from informative interviews
Date Submitted: Sep 18, 2017
Open Peer Review Period: Sep 20, 2017 - Nov 15, 2017
Background: While many gay, bisexual, and other men who have sex with men (MSM) test for HIV at least once in their lifetime, opportunities to improve regular HIV testing, particularly among Hispanic/...
Background: While many gay, bisexual, and other men who have sex with men (MSM) test for HIV at least once in their lifetime, opportunities to improve regular HIV testing, particularly among Hispanic/Latino MSM, are needed. Many mHealth interventions in development and that include HIV testing have primarily focused on English-speaking white, Black and MSM of other races. To date, no studies have assessed app use, attitudes and motivations for downloading and sustaining use of mobile apps, and preferences with respect to HIV prevention among Spanish-speaking, Hispanic MSM in the U.S. Objective: The primary objectives of this study were to answer the following questions: 1) What features and functions of smartphone apps do Hispanic, Spanish-speaking MSM believe are associated with downloading apps to their smartphones?; 2) What features and functions of smartphone apps are most likely to influence men’s sustained use of apps over time?; and 3) What features and functions do the men prefer in a smartphone app aimed to promote regular testing for HIV? Methods: Interviews (n=15) were conducted with a racially diverse group of sexually active, HIV-negative, Spanish-speaking, Hispanic MSM (Mean age of 32; 40% tested for HIV 6 months ago) in Miami, Florida. Interviews were digitally recorded, transcribed verbatim, translated back to English, and de-identified for analysis. A constant comparison method (i.e., grounded theory coding) was employed to examine and re-examine the themes that emerged from the interviews. Results: Personal interest was the primary reason associated with whether men downloaded an app. Keeping personal information secure, cost, influence by peers and posted reviews, ease of use, and functionality affected whether they downloaded and used the app over time. Men also reported that entertainment value and frequency of updates influenced whether they kept and continued to use an app over time. There were four reasons why participants chose to delete an app: dislike, lack of use, cost, and lack of memory/space. Participants’ also shared their preferences for an app to encourage regular HIV testing by providing feedback on test reminders, tailored testing interval recommendations, HIV test locator, and monitoring of personal sexual behaviors. Conclusions: The features and functions of mobile apps that Spanish-speaking MSM in this study believed were associated with downloading and/or sustained engagement of an app generally reflected the priorities mentioned in an earlier study with English-speaking MSM. However, unlike the earlier study, Spanish-speaking MSM prioritized personal interest in a mobile app and de-emphasized the efficiency of an app to make their lives easier in their decision to download an app to their mobile device. As such, tailoring mobile apps to the language and needs of Spanish-speaking MSM is critical to help appeal to their willingness to download a mobile app. Despite the growing number of HIV prevention apps in development, few are specifically tailored to Spanish-speaking MSM, representing an important gap that should be addressed in future research.
Design of an mHealth tool for self-management and care engagement of cardiovascular disease patients: enhancing user experience through user study
Date Submitted: Sep 20, 2017
Open Peer Review Period: Sep 20, 2017 - Sep 29, 2017
Background: As patient communication, engagement, personal health data tracking, and up-to-date information became more efficient through mobile health (mHealth), cardiovascular diseases (CVD) and oth...
Background: As patient communication, engagement, personal health data tracking, and up-to-date information became more efficient through mobile health (mHealth), cardiovascular diseases (CVD) and other diseases that require behavioral improvements in daily life are now capable of being managed and prevented more effectively. However, in order to increase patient engagement through mHealth, it is important for the initial design to consider functionality and usability factors and accurately assess user demands during the developmental process so that the application (app) can be used continuously. Objective: This study designed a user-friendly, personalized mHealth service for patients with CVD based on user research to help enhance communication between patients and doctors. Methods: In order to drive the mobile functions and services that are needed to manage diseases in CVD patients, user research was conducted on CVD patients and doctors at a tertiary general hospital. Interviews and a survey were conducted on patients (35 subjects) and a focus group interview was conducted on doctors (5 subjects). A mock-up mobile app was developed based on the user survey results, and a usability test was conducted (8 subjects) to find the factors that need to be considered in order to improve usability. Results: The majority of patients showed a positive response in terms of their interest or intent to use an app for managing CVD. Communication with doctors, self-risk assessment, exercise, tailored education, blood pressure (BP) management, health status recording, and other related functions had a score of 4.0 or higher on a 5-point Likert scale, showing that these functions were useful to patients. The medical staff requested a function that offers a comprehensive view of the patient’s daily health status by linking a regular health examination service with the hospital’s electronic medical records system. The results of the mock-up usability test showed that the ease of inputting and visualizing BP and other health conditions was required. Conclusions: Insights derived from a user study for developing an mHealth tool for CVD management, such as self-assessment and a communication channel, would be helpful to improve patient engagement in care.
The Development of a Mobile Social Networking-Based Relatedness Intervention Condition among Young, First-Time Blood Donors
Date Submitted: Sep 15, 2017
Open Peer Review Period: Sep 17, 2017 - Nov 12, 2017
Background: Increasing repeat blood donation behavior is a critical public health goal. According to self-determination theory, the process of developing internal motivation to give blood and an assoc...
Background: Increasing repeat blood donation behavior is a critical public health goal. According to self-determination theory, the process of developing internal motivation to give blood and an associated self-identity as a blood donor may be promoted by feelings of “relatedness” or connection to other donors, which may be enhanced through social relations and interaction. Objective: The purpose of this report it to describe the development and pilot testing of a social networking-based (Facebook) intervention condition designed to increase feelings of relatedness via virtual social interaction and support. Methods: To develop the intervention condition content, images, text, polls, and videos content was assembled. Ohio University college students (N = 127) rated the content (82 images/text) presented by computer in random order using a scale of one to five on various dimensions of relatedness. Mean ratings were calculated and ANOVA was conducted to assess associations among the dimensions. Based on these results, the relatedness intervention was adapted and evaluated for feasibility, acceptability, and preliminary efficacy among 24 first-time donors, aged 18 to 24, in a 30-day pilot. Paired t-tests were conducted to examine change over time in relatedness and connectedness. Results: The intervention condition developed was acceptable and feasible. Results of the uncontrolled, pre- and post-intervention evaluation revealed that feelings of individual-level relatedness increased significantly after the intervention. Conclusions: By promoting first-time donor relatedness our goal is to enhance internal motivation for donating and the integration of the blood donor identity, thus increasing the likelihood of future repeat donation. Clinical Trial: Clinical Trial Registration: NCT02717338
Mobile Diabetes Health Intervention: Impact on Diabetes Distress and Depression Among Adults
Date Submitted: Sep 6, 2017
Open Peer Review Period: Sep 8, 2017 - Nov 3, 2017
Background: Diabetes is a complex, demanding disease that requires the constant attention of patients. The burden of self-management, including different medication regimens, routine self-care activit...
Background: Diabetes is a complex, demanding disease that requires the constant attention of patients. The burden of self-management, including different medication regimens, routine self-care activities, and provider visits, has an impact on patients’ emotional well-being. Diabetes distress and depression are two important components of emotional well-being that may negatively affect diabetes outcomes. Objective: To determine impact of a one-year mobile phone diabetes intervention (MDIS) cluster randomized clinical trial (RCT) on emotional well-being measured by diabetes distress and depression among adults with type 2 diabetes (T2D). Methods: 163 adults with less than well-controlled T2D were enrolled from community primary care practices. Primary care practices were cluster-randomized into either a usual care control group or intervention group. Intervention participants were given a mobile phone with coaching software including a web-portal to communicate with physicians/diabetes educators. A priori established secondary outcomes included distress measured by Diabetes Distress (DD) Scale (DDS); subscales measuring emotional burden (EB), interpersonal distress (ID), physician-related distress (PD), and regimen-related distress (RD); and depression, measured by Patient Health Questionnaire-9 (PHQ-9). Linear mixed models were used to calculate the effect of the intervention on diabetes distress levels over time both overall and separately by sex, and to determine if the intervention affected total DD, DD subscales, or depression. The impact of total DDS on changes in HbA1c was also studied. Results: There were no significant treatment group effects for DDS total (baseline P = .07, differences over time P = .38) or for depression (P = .06 over time). Significant declines in total DD were observed over the 12-month intervention period (P = .01). Regimen-related distress significantly decreased for all study participants (P < .001) but no significant change over time was observed for EB (P = .83), ID (P = .64), or PD (P = .73). Women in both the usual care and intervention groups were more likely to have higher overall DDS, EB, PD, and RD, but not ID. Women also reported higher baseline depression compared to men (P = .006). Overall, depression decreased over the treatment period (P =.007), but remained unaffected by group assignment (P =.06) or by sex (P = .97). Diabetes distress had no effect on the change in HbA1c (P = .91) over the treatment period. Conclusions: We found no definitive overall or sex-specific effect of the intervention on diabetes distress or depression; this study makes an important contribution to the understanding of mobile health interventions and the impact on emotional health. Our study verified previous work that although diabetes distress and depression are highly correlated, these measures are not evaluating the same construct. Mobile technology provides an opportunity to personalize, contextualize and intervene in the emotional well-being of persons with diabetes.
Development of Just-in-time Adaptive Intervention for Insomnia: Usability Study
Date Submitted: Sep 5, 2017
Open Peer Review Period: Sep 7, 2017 - Nov 2, 2017
Background: Healthy sleep is a fundamental component of physical and brain health. Insomnia, however, is a prevalent sleep disorder that compromises functioning, productivity, and health. Therefore, d...
Background: Healthy sleep is a fundamental component of physical and brain health. Insomnia, however, is a prevalent sleep disorder that compromises functioning, productivity, and health. Therefore, developing efficient treatment delivery methods for insomnia can have significant societal and personal health impacts. Cognitive behavioral therapy for insomnia (CBTI) is the recommended first-line treatment of insomnia but access is currently limited for patients, since treatment must occur in specialty sleep clinics, which suffer from an insufficient number of trained clinicians. Smartphone-based interventions offer a promising means for improving the delivery of CBTI. Furthermore, novel features such as real-time monitoring and assessment, personalization, dynamic adaptations of the intervention, and context awareness can enhance treatment personalization and effectiveness, and reduce associated costs. Ultimately, this “Just in Time Adaptive Intervention” (JITAI) for insomnia—an intervention approach that is acceptable to patients and clinicians, and is based on mobile health (mHealth) platform and tools—can significantly improve patient access and clinician delivery of evidence-based insomnia treatments. Objective: This study aims to develop and assess the usability of a JITAI application platform called iREST (“interactive Resilience Enhancing Sleep Tactics”) for use in behavioral insomnia interventions. iREST can be used by both patients and clinicians. Methods: The development of iREST was based on the interactive and incremental (IID) software development model. Requirement analysis was based on the case study’s description, workflow and needs, clinician inputs, and a previously conducted BBTI military study/implementation of the JITAI architecture. To evaluate the usability of the iREST mHealth tool, a pilot usability study was conducted. Additionally, this study explores the feasibility of using an off-the-shelf wearable device to supplement the subjective assessment of patient sleep patterns. Results: The iREST app was developed from the mobile logical architecture of JITAI. It consists of a cross-platform smartphone app, a clinician portal, and secure 2-way communications platform between the app and the portal. The usability study comprised 19 Active Duty Service Members (ADSM) and Veterans between the ages of 18 and 60. Descriptive statistics based on in-app questionnaires indicate that on average, 12 (mean=12.23, SD=8.96) unique devices accessed the clinician portal per day for more than two years, while the app was rated as “highly usable”, achieving a mean System Usability Score (SUS) score of 85.74 (SD =12.37), which translates to an adjective rating of “Excellent”. The participants also gave high scores on “ease of use and learnability” with an average score of 4.33 (SD=0.65) on a scale of 1 to 5. Conclusions: iREST provides a feasible platform for the implementation of JITAI in mHealth-based and remote intervention settings. The system was rated highly usable and its cross-platformness made it readily implemented within the heavily segregated smartphone market. The use of wearables to track sleep is promising; yet the accuracy of this technology needs further improvement. Ultimately, iREST demonstrates that mHealth-based JITAI is not only feasible, but also works effectively.
Combining fitness trackers with motivational interviewing and mutual support to increase physical activity in adolescent/parent dyads
Date Submitted: Sep 5, 2017
Open Peer Review Period: Sep 7, 2017 - Nov 2, 2017
Background: An essential component of any effective adolescent weight management program is physical activity (PA). The growing field of health technology provides potential solutions for addressing c...
Background: An essential component of any effective adolescent weight management program is physical activity (PA). The growing field of health technology provides potential solutions for addressing chronic health issues and lifestyle change, such as adolescent obesity. Activity trackers, used in conjunction with smart phone apps, can engage, motivate, and foster support, among users while simultaneously providing feedback on their PA progress. Objective: To evaluate the effect of a 10 week pilot study utilizing smartphone-enabled activity tracker data to tailor motivation, goal setting on physical activity (PA) for overweight/obese adolescents and their parents. Methods: Eligible adolescents, ages 13-16 with BMI >85th percentile, and one of their parents were queried as to behaviors, barriers to change, perceptions about exercise and health pre- and post-intervention. We captured daily step count and active minutes via fitness trackers. Staff made phone calls to dyads at weeks 1, 2, 4, 8 post enrollment to set daily personalized step count/active minutes goals based upon their prior data, age specific Center for Disease Control and Prevention (CDC) goals. Dyad correlations were evaluated using the non-parametric Spearman rank order correlations. Results: 9 parent adolescent dyads were enrolled. Mean adolescent age was 15 years (range 14-16) (4 female/5 male); mean parent age was 47 years (range 36-66). On average, adolescents met their personalized daily step count goals 35% (11-62%) of the days they wore their trackers; parents did so 40% (3-68%) of the days they wore their tracker. Adolescents met their active minute goals 56% (27-85%) of the days they wore their tracker; parents did 83% (52-97%) of the days. Parent and adolescent success was strongly correlated: step count r=0.36, P=.001, active minutes r=0.30, P=.007. Parental age was inversely correlated with step count success (r=-0.78, P=.01). Conclusions: Our findings that parent-adolescent dyads have highly correlated physical activity success rates suggest that further investment in family-centered weight management strategies merit consideration by policy makers, insurers, and health care providers.