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 2015: 4.532). 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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Latest Submissions Open for Peer-Review:View All Open Peer Review Articles
How best to obtain valid, verifiable data online from male couples? Lessons learned from an eHealth HIV prevention intervention for HIV-negative male couples
Date Submitted: Jul 22, 2016
Open Peer Review Period: Jul 25, 2016 - Sep 19, 2016
Background: As interest increases in the development of eHealth HIV preventive interventions for gay male couples, web-based methods must also be developed to help increase the likelihood that couples...
Background: As interest increases in the development of eHealth HIV preventive interventions for gay male couples, web-based methods must also be developed to help increase the likelihood that couples enrolled and data collected from them represent true, unique dyads. However, methods to recruit and collect reliable and valid data from both members of a couple (i.e., dyadic data) are lacking yet are crucial for uptake of novel sexual health and HIV prevention eHealth interventions. Methods to describe best practices to recruit male couples using targeted advertisements placed on Facebook are also lacking in the literature yet could also help in the uptake of referring male couples to new and novel eHealth, HIV preventive interventions. Objective: Experiences pertaining to recruitment and eligibility, enrollment data from two phases (formative, development phase and online randomized control trial) of an eHealth HIV prevention intervention for concordant HIV-negative male couples are used to describe challenges and lessons learned associated with: 1) recruiting male couples using targeted advertisements on Facebook; 2) validating that data came from two partners of the couple; and 3) verifying that the two partners of the couple are in a relationship with one another. Methods: The developmental phase refined the intervention via in-person focus groups whereas the pilot-testing phase included an online randomized control trial. For both phases, couples were recruited via Facebook advertisements targeting adult (e.g., >18) males interested in men, in a relationship, and had an interest in the LGBT community and/or gay news. Advertisements directed men to a study webpage and screener; once eligible, participants provided consent electronically. A partner referral system was embedded in the consenting process to recruit the relationship partner of the participant. Both men of the couple had to meet all eligibility criteria – individually and as a couple – before they could enroll into the study. Verification of couples’ relationships was assessed via the concurrence of pre-determined screener items from both partners, done manually in the developmental phase and electronically in the pilot-testing phase. A system of decision rules was developed to assess the validity that data came from two unique partners of a couple. Results: Several important lessons were learned from these experiences, resulting in recommendations for future eHealth studies involving male couples. Use of certain ‘interests’ and types of images (e.g., shirtless) in targeted Facebook advertisements should be avoided or used sparingly as these interests and types of images may generate adverse reactions from a broader audience. Development of a systematic approach with pre-determined criteria and parameters to verify male couples’ relationships is strongly recommended. Further, researchers are encouraged to develop a system of decision rules to detect and handle suspicious data (e.g., suspicious email addresses/names, multiple entries, same IP address used in multiple entries) to help validate the legitimacy of male couples’ relationships online. Conclusions: These lessons learned combined with recommendations for future studies aim to help enhance recruitment efforts and the validity and reliability of collecting dyadic data from male couples for novel, eHealth preventive interventions.
Evaluation of Diet Related Infographics on Pinterest for use of Behavior Change Theories; a content analysis
Date Submitted: Jul 17, 2016
Open Peer Review Period: Jul 20, 2016 - Sep 14, 2016
Background: There is increasing interest in Pinterest as a method of disseminating health information, however it is unclear whether the health information promoted on Pinterest is evidence-based or p...
Background: There is increasing interest in Pinterest as a method of disseminating health information, however it is unclear whether the health information promoted on Pinterest is evidence-based or promotes behavior change. Objective: To determine the presence of Health Behavior Theory (HBT) constructs in pins found on Pinterest and to assess the relationship between various pin characteristics and the inclusion of HBT. Methods: A content analysis was conducted on pins collected from Pinterest identified with the search terms “nutrition infographic” and “healthy eating infographic.” The coding rubric included HBT constructs, pin characteristics, and visual communication tools. Each HBT construct was coded as present or not present (yes = 1/no = 0). A total theory score was calculated by summing the values for each of the 9 constructs (range 0 - 9). Adjusted regression analysis was used to identify factors associated with the inclusion of health behavior change theory in pins (P < .05). Results: The mean total theory score was 2.03 (SD = 1.2). Perceived benefits were present most often (72.03%), followed by behavioral capacity (51.68%) and perceived severity (33.47%). The construct that appeared the least was self-regulation/self-control (0.84%). Pin characteristics associated with the inclusion of HBT included a large amount of text (P=.01), photographs of real people (P = .001), cartoon pictures of food (P = .01) and the presence of references (P = .001). The number of repins (P = .04), likes (P = .01) and comments (P = .01) were positively associated with the inclusion of HBT. Conclusions: These findings suggest that current Pinterest infographics targeting healthy eating contain little HBT elements. Health professionals and organizations need to create and disseminate infographics that contain more elements of HBT to better influence healthy eating behavior. This may be accomplished by creating pins that utilize both text and images of people and food in order to portray elements of HBT and convey nutritional information.
Designing a mobile health application for patients with dysphagia following head and neck cancer
Date Submitted: Jul 13, 2016
Open Peer Review Period: Jul 16, 2016 - Sep 10, 2016
Background: Adherence to swallowing rehabilitation exercises is important to develop and maintain functional improvement, yet more than half of head and neck cancer (HNC) patients report having diffic...
Background: Adherence to swallowing rehabilitation exercises is important to develop and maintain functional improvement, yet more than half of head and neck cancer (HNC) patients report having difficulty adhering to prescribed regimens. Health applications (apps) with game elements have been used in other health domains to motivate and engage patients. Understanding the factors that impact adherence may allow for more effective gamified solutions. Objective: (1) Identify self-reported factors that influence adherence to conventional home therapy without a mobile device in HNC patients, and (2) identify appealing biofeedback designs that could be used in a health app. Methods: Ten (4 females) HNC patients (M = 60.1 years) with experience completing home-based rehabilitation programs were recruited. Thematic analysis of semi-structured interviews was used to answer the first objective. Convergent interviews were used to obtain reactions to biofeedback designs. Results: Facilitators and barriers of adherence to home therapy were described through six themes: patient perceptions on outcomes and progress; clinical appointments; cancer treatment; rehabilitation program; personal factors; and connection. App visuals that provide feedback on performance during swallowing exercises should retain the chief goals of biofeedback (e.g., immediate representation of effort relative to a goal). Simple, intuitive graphics were preferred over complex, abstract ones. Conclusions: Continued engagement with the app could be facilitated by tracking progress and by using visuals that build or create structures with each subsequent use.
Women’s Perceptions of Participation in an Extended Contact Text Message Weight Loss Intervention
Date Submitted: Jul 7, 2016
Open Peer Review Period: Jul 11, 2016 - Sep 5, 2016
Background: Extending contact with participants after the end of an initial weight loss intervention has been shown to lead to maintained weight loss and related behavior change. Mobile phone text mes...
Background: Extending contact with participants after the end of an initial weight loss intervention has been shown to lead to maintained weight loss and related behavior change. Mobile phone text messaging offers a low cost and efficacious method to deliver extended contact. In this rapidly developing area, formative work is required to understand user perspectives of text message technology. An extended contact intervention delivered by text messages following an initial telephone-delivered weight loss intervention in breast cancer survivors provided this opportunity. Objective: To qualitatively explore women’s perceptions of participation in an extended contact intervention using text messaging to support long-term weight loss, physical activity and dietary behavior change Methods: Following the end of an initial 6-month randomized controlled trial of a telephone-delivered weight loss intervention (versus usual care), participants received a 6-month extended contact intervention via tailored text messages. Participant perceptions of the different types of text messages, the content, tailoring, timing and frequency of the texts and the length of the intervention were assessed through semi-structured interviews conducted after the extended contact intervention. The interviews were transcribed verbatim and analysed with key themes identified. Results: Participants (n=27) were Caucasian with a mean age of 56.0 years (SD 12.0), mean BMI of 30.0kg/m2 (SD 4.2) and were a mean of 16.1 months (SD 3.1) post-diagnosis at study baseline. Participants perceived the texts to be useful behavioral prompts and felt the messages kept them accountable to their behavior change goals. The individual tailoring of the text content and schedules was a key to the acceptability of the messages, however some women preferred the support and real-time discussion via telephone (during the initial intervention) compared to the text messages (during the extended contact intervention). Conclusions: Text message support was perceived as acceptable for the majority of women as a way of extending intervention contact for weight loss and behavioral maintenance. Texts supported the maintenance of healthy behaviors established in the intervention phase and kept the women accountable to their goals. A combination of phone and text support was suggested as a more acceptable option for some of the women for an extended contact intervention. Clinical Trial: Not registered
How Accurate Is Your Activity Tracker? A Comparative Study of Step Counts in Low-Intensity Physical Activities
Date Submitted: Jul 6, 2016
Open Peer Review Period: Jul 8, 2016 - Sep 2, 2016
Background: Tracking physical activity is crucial for monitoring individuals diagnosed with a range of chronic conditions including heart failure, diabetes, and cancer. One simple, yet effective, appr...
Background: Tracking physical activity is crucial for monitoring individuals diagnosed with a range of chronic conditions including heart failure, diabetes, and cancer. One simple, yet effective, approach to monitor the amount of daily physical activity that individuals perform is to count the number of steps taken throughout a day. Several commercially available activity trackers have been tested for reliability and validity in many research studies in various exercise activities such as walking and running at a wide range of speeds. However, there have been only a few studies within healthcare research. Currently, there exists a gap in our knowledge regarding the performance of these trackers facing low intensity activities. In this study, we evaluate the reliability of the Fitbit step counters during a number of moderate and light everyday physical activities, and we investigate whether or not using the trackers on different body locations affect their performance. Objective: This paper answers the four following questions: (1) which activities are certain motion sensor based trackers more accurate at monitoring? (2) to what extent does body location affect step counting accuracy? (3) for each activity, which particular body location results in the best step counting performance? (4) how does the intensity of certain physical activities and the physical characteristics of the users affect the performance of activity trackers in counting steps? Methods: We recruited 15 healthy young adults (aged 21-33) to perform six physical activities while wearing three Fitbits (i.e., Zip, One, and Flex) on different body locations (i.e., chest, pocket, and wrist). These activities include walking at 1.5, 3, and 4.5 mph, walking with a shopping cart, walking with aid of a walker, and eating while sitting. We compared the number of steps counted by each tracker with the ground truth (video recorded during the experiments). Results: Our results show that these trackers are most accurate in the treadmill experiment with an average margin of error of five steps per minute from the actual step counts. On the other hand, in the walker experiment, the average error over the three body locations is significantly higher than the other activities, which demonstrates the poor performance of the activity trackers in detecting movements in slow and abnormal walking patterns. However, there was no significant difference between the step counts of the trackers in the treadmill and shopping cart experiments and the ground truth. The wrist-band tracker, Flex, counted several steps when eating (p < .01), showing that the Flex is inaccurate when encountering vigorous stationary tasks. Looking at different locations, pants pocket is the most promising location to capture steps in high intensity PAs, while wrist is the best choice to wear the activity tracker on in lower intensity PAs. Conclusions: Accelerometer-based activity monitoring devices such as Fitbit trackers are most accurate in exercise activities, such as walking on treadmill, and least accurate in lower intensity activities, which has a significantly different pattern from the normal gait, such as walking with walking aids. Compared to the wrist-band and pocket trackers, the activity tracker on the chest is superior in tracking more intense physical activities (e.g., walking on treadmill), but oversensitive in light activities such as walking with a walker and eating. These results demonstrate that the body location significantly affects the accuracy of the trackers. This result demonstrates the need for activity recognition algorithms to consider the locations of trackers and intensity of activities.
Efficacy of mobile applications to support the care of patients with diabetes mellitus: systematic review and meta-analysis
Date Submitted: Jul 4, 2016
Open Peer Review Period: Jul 7, 2016 - Sep 1, 2016
Background: Diabetes Mellitus (DM) is a chronic disease that is considered a global public health problem. Education and self-monitoring by diabetic patients help to optimize and make possible a satis...
Background: Diabetes Mellitus (DM) is a chronic disease that is considered a global public health problem. Education and self-monitoring by diabetic patients help to optimize and make possible a satisfactory metabolic control enabling improved management and reduced morbidity and mortality. The global growth in the use of mobile phones makes them a powerful platform to help provide tailored health, delivered conveniently to patients through health applications (apps). Objective: Evaluate the efficacy of mobile apps through a systematic review and meta-analysis to assist diabetes mellitus patients in treatment. Methods: We conducted searches in the electronic databases MEDLINE (Pubmed), CENTRAL/ Cochrane Register of Controlled Trials and LILACS, manual search in references of publications included, systematic reviews, specialized journals and gray literature. We considered eligible randomized controlled trials (RCTs) conducted after 2008 with participants of all ages, diabetes mellitus patients and users of apps to help manage the disease. The meta-analysis of glycated hemoglobin (HbA1c) was performed in Review Manager Software 5.3. Results: The literature search identified 1036 publications. From these, 10 studies were included that evaluated 980 patients. In four RCTs, there were a statistical significant reduction (P < 0.03) of HbA1c at the end of studies in the intervention group. The HbA1c data were evaluated by meta-analysis with the following results (MD = - .42; CI: - .60, - .25; P < .11; I² = 34%).The evaluation favored the treatment in patients who used apps without significant heterogeneity. Conclusions: The use of apps by diabetic patients could help improve the control of HbA1c. In addition, the apps seem to strengthen the perception of self-care contributing better information and health education to patients. Patients also become more self-confident to deal with their diabetes, mainly, by reducing fear of not knowing how to deal with potential hypoglycemic episodes that may occur.