JMIR Publications

JMIR mHealth and uHealth

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

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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 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 is indexed in PubMed Central/PubMed and also the Thomson Reuters Emerging Sources Citation IndexESCI

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:

  • REMOTE-CR mobile phone app screenshots.

    Remotely Delivered Exercise-Based Cardiac Rehabilitation: Design and Content Development of a Novel mHealth Platform

    Abstract:

    Background: Participation in traditional center-based cardiac rehabilitation exercise programs (exCR) is limited by accessibility barriers. Mobile health (mHealth) technologies can overcome these barriers while preserving critical attributes of center-based exCR monitoring and coaching, but these opportunities have not yet been capitalized on. Objective: We aimed to design and develop an evidence- and theory-based mHealth platform for remote delivery of exCR to any geographical location. Methods: An iterative process was used to design and develop an evidence- and theory-based mHealth platform (REMOTE-CR) that provides real-time remote exercise monitoring and coaching, behavior change education, and social support. Results: The REMOTE-CR platform comprises a commercially available smartphone and wearable sensor, custom smartphone and Web-based applications (apps), and a custom middleware. The platform allows exCR specialists to monitor patients’ exercise and provide individualized coaching in real-time, from almost any location, and provide behavior change education and social support. Intervention content incorporates Social Cognitive Theory, Self-determination Theory, and a taxonomy of behavior change techniques. Exercise components are based on guidelines for clinical exercise prescription. Conclusions: The REMOTE-CR platform extends the capabilities of previous telehealth exCR platforms and narrows the gap between existing center- and home-based exCR services. REMOTE-CR can complement center-based exCR by providing an alternative option for patients whose needs are not being met. Remotely monitored exCR may be more cost-effective than establishing additional center-based programs. The effectiveness and acceptability of REMOTE-CR are now being evaluated in a noninferiority randomized controlled trial.

  • A girl responding the questions in Sisom. Photo copyright belongs to co-author Jens Nygren.

    Redesign and Validation of Sisom, an Interactive Assessment and Communication Tool for Children With Cancer

    Abstract:

    Background: Children with cancer undergo intensive and long treatment periods that expose them and their families to a number of difficult physical, mental, and social challenges. Empowering children by actively involving them in their care can help them to cope with these challenges. It can, however, be difficult for children to be involved and talk about their illness experiences in a “traditional” conversation with health care professionals, especially for younger children. Sisom (Norwegian acronym “Si det som det er” or “Tell it how it is”) is an interactive computer-based assessment and communication tool to give children (aged 6-12 years) with cancer a “voice” in their care. Because of technological advances and widespread use of mobile devices Sisom had to be redesigned to better meet the needs of children of today. Objective: To redesign Sisom for use on mobile devices and to validate and adapt it for use in a Swedish population of children with cancer. Methods: A user-experience design was used. Content adaptation included forward-backward translation by Swedish and Norwegian translators. Healthy children (n=5), children with experiences of cancer treatment (n=5) and their parents (n=5), and pediatric nurses (n=2) were then involved in culturally adapting Sisom to the Swedish context. The iterative low- and high-fidelity evaluation was supported by a think aloud method, semistructured interviews, and drawings to capture children’s views of Sisom. The redesign and evaluation continued until no further changes or improvements were identified by the participants or the researchers. Results: Children, parents, and pediatric nurses offered many suggestions for improvements to the original version in terms of content, aesthetics, and usability of Sisom. The most significant change that emerged through user input was a modification that entailed not using problem-focused statements in the assessment items. The parents and pediatric nurses considered the revised assessment items to be general and less diagnosis specific. The evaluation of aesthetics resulted in brighter colors and more positive and exciting details in the animations. The evaluation of usability included improvements of the verbal instructions on how to navigate in Sisom 2, and also that the answers to assessment items in Sisom 2 should be saved to provide the children with the option to pause and to continue answering the remaining assessment items at a later stage. Conclusions: Overall, this paper describes the process of using user-experience design with children in order to redesign and validate an interactive assessment and communication tool and how the outcomes of this process resulted in a new version, Sisom 2. All participants confirmed the usability and qualities of using the final version. Future research should be directed toward the implementation of Sisom 2 in clinical practice and to evaluate outcomes from individual and organizational levels.

  • Author using app. Source and copyright: the authors.

    Cardiorespiratory Improvements Achieved by American College of Sports Medicine’s Exercise Prescription Implemented on a Mobile App

    Abstract:

    Background: Strong evidence shows that an increase in cardiorespiratory fitness (CRF) and physical activity (PA) reduces cardiovascular disease risk. Objective: To test whether a scientifically endorsed program to increase CRF and PA, implemented on an easy-to-use, always-accessible mobile app would be effective in improving CRF. Methods: Of 63 healthy volunteers participating, 18 tested the user interface of the Cardio-Fitness App (CF-App); and 45 underwent a 2-week intervention period, of whom 33 eventually concluded it. These were assigned into three groups. The Step-based App (Step-App) group (n=8), followed 10,000 steps/day prescription, the CF-App group (n=13), and the Supervised Cardio-Fitness (Super-CF) group (n=12), both followed a heart rate (HR)-based program according to American College of Sports Medicine (ACSM) guidelines, but either implemented on the app, or at the gym, respectively. Participants were tested for CRF, PA, resting systolic and diastolic blood pressures (SBP, DBP), resting, exercise, and recovery HR. Results: CRF increased in all groups (+4.9%; P<.001). SBP decreased in all groups (-2.6 mm Hg; P=.03). DBP decrease was higher in the Super-CF group (-3.5 mm Hg) than in the Step-App group (-2.1 mm Hg; P<.001). Posttest exercise HR decreased in all groups (-3.4 bpm; P=.02). Posttest recovery HR was lower in the Super-CF group (-10.1 bpm) than in the other two groups (CF-App: -4.9 bpm, Step-App: -3.3 bpm; P<.001). The CF-App group, however, achieved these improvements with more training heart beats (P<.01). Conclusions: A 10,000 steps/day target-based app improved CRF similar to an ACSM guideline-based program whether it was implemented on a mobile app or in supervised gym sessions.

  • Source: http://tinyurl.com/h3cz4nm; CC0 public domain.

    Optimizing a Text Message Intervention to Reduce Heavy Drinking in Young Adults: Focus Group Findings

    Abstract:

    Background: Recent trial results show that an interactive short message service (SMS) text message intervention, Texting to Reduce Alcohol Consumption (TRAC), is effective in reducing heavy drinking in non-treatment-seeking young adults, but may not be optimized. Objective: To assess the usability of the TRAC intervention among young adults in an effort to optimize future intervention design. Methods: We conducted five focus groups with 18 young adults, aged 18-25 years, who had a history of heavy drinking and had been randomized to 12 weeks of the TRAC intervention as part of a clinical trial. A trained moderator followed a semistructured interview guide. Focus groups were audiotaped, transcribed, and analyzed to identify themes. Results: We identified four themes regarding user experiences with the TRAC intervention: (1) ease of use, (2) comfort and confidentiality, (3) increased awareness of drinking behavior, and (4) accountability for drinking behavior. Participants’ comments supported the existing features of the TRAC intervention, as well as the addition of other features to increase personalization and continuing engagement with the intervention. Conclusions: Young adults perceived the TRAC intervention as a useful way to help them reduce heavy drinking on weekends. Components that promote ease of use, ensure confidentiality, increase awareness of alcohol consumption, and increase accountability were seen as important.

  • TXT2BFiT. Image created and copyright owned by Authors Margaret Allman-Farinelli et al.

    A Mobile Health Lifestyle Program for Prevention of Weight Gain in Young Adults (TXT2BFiT): Nine-Month Outcomes of a Randomized Controlled Trial

    Abstract:

    Background: The unprecedented rise in obesity among young adults, who have limited interaction with health services, has not been successfully abated. Objective: The objective of this study was to assess the maintenance outcomes of a 12-week mHealth intervention on prevention of weight gain in young adults and lifestyle behaviors at 9 months from baseline. Methods: A two-arm, parallel, randomized controlled trial (RCT) with subjects allocated to intervention or control 1:1 was conducted in a community setting in Greater Sydney, Australia. From November 2012 to July 2014, 18- to 35-year-old overweight individuals with a body mass index (BMI) of 25-31.99 kg/m2 and those with a BMI ≥ 23 kg/m2 and a self-reported weight gain of ≥ 2 kg in the past 12 months were recruited. A 12-week mHealth program “TXT2BFiT” was administered to the intervention arm. This included 5 coaching calls, 96 text messages, 12 emails, apps, and downloadable resources from the study website. Lifestyle behaviors addressed were intake of fruits, vegetables, sugar-sweetened beverages (SSBs), take-out meals, and physical activity. The control group received 1 phone call to introduce them to study procedures and 4 text messages over 12 weeks. After 12 weeks, the intervention arm received 2 further coaching calls, 6 text messages, and 6 emails with continued access to the study website during 6-month follow-up. Control arm received no further contact. The primary outcome was weight change (kg) with weight measured at baseline and at 12 weeks and self-report at baseline, 12 weeks, and 9 months. Secondary outcomes were change in physical activity (metabolic equivalent of task, MET-mins) and categories of intake for fruits, vegetables, SSBs, and take-out meals. These were assessed via Web-based surveys. Results: Two hundred and fifty young adults enrolled in the RCT. Intervention participants weighed less at 12 weeks compared with controls (model β=−3.7, 95% CI −6.1 to −1.3) and after 9 months (model β=− 4.3, 95% CI − 6.9 to − 1.8). No differences in physical activity were found but all diet behaviors showed that the intervention group, compared with controls at 9 months, had greater odds of meeting recommendations for fruits (OR 3.83, 95% CI 2.10-6.99); for vegetables (OR 2.42, 95% CI 1.32-4.44); for SSB (OR 3.11, 95% CI 1.47-6.59); and for take-out meals (OR 1.88, 95% CI 1.07-3.30). Conclusions: Delivery of an mHealth intervention for prevention of weight gain resulted in modest weight loss at 12 weeks with further loss at 9 months in 18- to 35-year-olds. Although there was no evidence of change in physical activity, improvements in dietary behaviors occurred, and were maintained at 9 months. Owing to its scalable potential for widespread adoption, replication trials should be conducted in diverse populations of overweight young adults. Trial Registration: Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12612000924853; (Archived by WebCite at http://www.webcitation.org/6i6iRag55)

  • Automated 4-Day Text Messaging Guidance. Copyright held by authors Benjamin Michael Walter.

    Development and Testing of an Automated 4-Day Text Messaging Guidance as an Aid for Improving Colonoscopy Preparation

    Abstract:

    Background: In gastroenterology a sufficient colon cleansing improves adenoma detection rate and prevents the need for preterm repeat colonoscopies due to invalid preparation. It has been shown that patient education is of major importance for improvement of colon cleansing. Objective: Objective of this study was to assess the function of an automated text messaging (short message service, SMS)–supported colonoscopy preparation starting 4 days before colonoscopy appointment. Methods: After preevaluation to assess mobile phone usage in the patient population for relevance of this approach, a Web-based, automated SMS text messaging system was developed, following which a single-center feasibility study at a tertiary care center was performed. Patients scheduled for outpatient colonoscopy were invited to participate. Patients enrolled in the study group received automated information about dietary recommendations and bowel cleansing during colonoscopy preparation. Data of outpatient colonoscopies with regular preparation procedure were used for pair matching and served as control. Primary end point was feasibility of SMS text messaging support in colonoscopy preparation assessed as stable and satisfactory function of the system. Secondary end points were quality of bowel preparation according to the Boston Bowel Preparation Scale (BBPS) and patient satisfaction with SMS text messaging–provided information assessed by a questionnaire. Results: Web-based SMS text messaging–supported colonoscopy preparation was successful and feasible in 19 of 20 patients. Mean (standard error of the mean, SEM) total BBPS score was slightly higher in the SMS group than in the control group (7.3, SEM 0.3 vs 6.4, SEM 0.2) and for each colonic region (left, transverse, and right colon). Patient satisfaction regarding SMS text messaging–based information was high. Conclusions: Using SMS for colonoscopy preparation with 4 days’ guidance including dietary recommendation is a new approach to improve colonoscopy preparation. Quality of colonoscopy preparation was sufficient and patients were highly satisfied with the system during colonoscopy preparation.

  • Photo credit: Rafael Castillo, https://www.flickr.com/photos/miggslives/7892279962/, licensed under Creative Commons Attribution 2.0 Generic.

    Mobile Phone Use and its Association With Sitting Time and Meeting Physical Activity Recommendations in a Mexican American Cohort

    Abstract:

    Background: The benefits of physical activity (PA) are well-documented. Mobile phones influence PA by promoting screen-based sedentary time, providing prompts or reminders to be active, aiding in tracking and monitoring PA, or 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 nonusers. Objective: To determine the associations between mobile phone use, PA, and sitting time and how these behaviors differ from mobile phone nonusers in a sample of 2982 Mexican-American adults from the Mano a Mano cohort. Methods: Differences in meeting PA recommendations and sitting time between mobile phone users and nonusers were examined using chi-square and analysis of variance 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 criteria (≥30 kg/m2), younger, born in the United States and lived there longer, more educated, and sit more hours per day but more likely to meet PA recommendations than nonusers. Males (odds ratio [OR] 1.42, 95% CI 1.16-1.74), use of text messaging (OR 1.26, 95% CI 1.03-1.56), and having a higher acculturation score (OR 1.27, 95% 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, born in the United States, a former alcohol drinker, and having at least a high school education. Among nonusers, being born in the United States 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 using text messages could be tailored to promote PA in less acculturated and female Mexican American mobile phone users.

  • Exercise App, Image source: Voth, Oelke, & Jung. Copyright owned by Voth, Oelke, & Jung.

    A Theory-Based Exercise App to Enhance Exercise Adherence: A Pilot Study

    Abstract:

    Background: Use of mobile health (mHealth) technology is on an exponential rise. mHealth apps have the capability to reach a large number of individuals, but until now have lacked the integration of evidence-based theoretical constructs to increase exercise behavior in users. Objective: The purpose of this study was to assess the effectiveness of a theory-based, self-monitoring app on exercise and self-monitoring behavior over 8 weeks. Methods: A total of 56 adults (mean age 40 years, SD 13) were randomly assigned to either receive the mHealth app (experimental; n=28) or not to receive the app (control; n=28). All participants engaged in an exercise goal-setting session at baseline. Experimental condition participants received weekly short message service (SMS) text messages grounded in social cognitive theory and were encouraged to self-monitor exercise bouts on the app on a daily basis. Exercise behavior, frequency of self-monitoring exercise behavior, self-efficacy to self-monitor, and self-management of exercise behavior were collected at baseline and at postintervention. Results: Engagement in exercise bouts was greater in the experimental condition (mean 7.24, SD 3.40) as compared to the control condition (mean 4.74, SD 3.70, P=.03, d=0.70) at week 8 postintervention. Frequency of self-monitoring increased significantly over the 8-week investigation between the experimental and control conditions (P<.001, partial η2=.599), with participants in the experimental condition self-monitoring significantly more at postintervention (mean 6.00, SD 0.93) in comparison to those in the control condition (mean 1.95, SD 2.58, P<.001, d=2.10). Self-efficacy to self-monitor and perceived self-management of exercise behavior were unaffected by this intervention. Conclusions: The successful integration of social cognitive theory into an mHealth exercise self-monitoring app provides support for future research to feasibly integrate theoretical constructs into existing exercise apps. In addition, findings provide preliminary support for theory-based apps to increase self-monitoring and exercise behavior in comparison to a control, no-app condition.

  • Image Source: IMG_0371, copyright N i c o l a,
http://tinyurl.com/juc8ee2,
Licensed under Creative Commons Attribution cc-by 2.0 https://creativecommons.org/licenses/by/2.0/.

    Review and Analysis of Existing Mobile Phone Apps to Support Heart Failure Symptom Monitoring and Self-Care Management Using the Mobile Application Rating...

    Abstract:

    Background: Heart failure is the most common cause of hospital readmissions among Medicare beneficiaries and these hospitalizations are often driven by exacerbations in common heart failure symptoms. Patient collaboration with health care providers and decision making is a core component of increasing symptom monitoring and decreasing hospital use. Mobile phone apps offer a potentially cost-effective solution for symptom monitoring and self-care management at the point of need. Objective: The purpose of this review of commercially available apps was to identify and assess the functionalities of patient-facing mobile health apps targeted toward supporting heart failure symptom monitoring and self-care management. Methods: We searched 3 Web-based mobile app stores using multiple terms and combinations (eg, “heart failure,” “cardiology,” “heart failure and self-management”). Apps meeting inclusion criteria were evaluated using the Mobile Application Rating Scale (MARS), IMS Institute for Healthcare Informatics functionality scores, and Heart Failure Society of America (HFSA) guidelines for nonpharmacologic management. Apps were downloaded and assessed independently by 2-4 reviewers, interclass correlations between reviewers were calculated, and consensus was met by discussion. Results: Of 3636 potentially relevant apps searched, 34 met inclusion criteria. Most apps were excluded because they were unrelated to heart failure, not in English or Spanish, or were games. Interrater reliability between reviewers was high. AskMD app had the highest average MARS total (4.9/5). More than half of the apps (23/34, 68%) had acceptable MARS scores (>3.0). Heart Failure Health Storylines (4.6) and AskMD (4.5) had the highest scores for behavior change. Factoring MARS, functionality, and HFSA guideline scores, the highest performing apps included Heart Failure Health Storylines, Symple, ContinuousCare Health App, WebMD, and AskMD. Peer-reviewed publications were identified for only 3 of the 34 apps. Conclusions: This review suggests that few apps meet prespecified criteria for quality, content, or functionality, highlighting the need for further refinement and mapping to evidence-based guidelines and room for overall quality improvement in heart failure symptom monitoring and self-care related apps.

  • Source: https://www.pexels.com/photo/marketing-iphone-smartphone-notebook-34070; CC0 Public Domain, modified using image from authors.

    Evaluation of the Use of Home Blood Pressure Measurement Using Mobile Phone-Assisted Technology: The iVitality Proof-of-Principle Study

    Abstract:

    Background: Mobile phone-assisted technologies provide the opportunity to optimize the feasibility of long-term blood pressure (BP) monitoring at home, with the potential of large-scale data collection. Objective: In this proof-of-principle study, we evaluated the feasibility of home BP monitoring using mobile phone-assisted technology, by investigating (1) the association between study center and home BP measurements; (2) adherence to reminders on the mobile phone to perform home BP measurements; and (3) referrals, treatment consequences and BP reduction after a raised home BP was diagnosed. Methods: We used iVitality, a research platform that comprises a Website, a mobile phone-based app, and health sensors, to measure BP and several other health characteristics during a 6-month period. BP was measured twice at baseline at the study center. Home BP was measured on 4 days during the first week, and thereafter, at semimonthly or monthly intervals, for which participants received reminders on their mobile phone. In the monthly protocol, measurements were performed during 2 consecutive days. In the semimonthly protocol, BP was measured at 1 day. Results: We included 151 participants (mean age [standard deviation] 57.3 [5.3] years). BP measured at the study center was systematically higher when compared with home BP measurements (mean difference systolic BP [standard error] 8.72 [1.08] and diastolic BP 5.81 [0.68] mm Hg, respectively). Correlation of study center and home measurements of BP was high (R=0.72 for systolic BP and 0.72 for diastolic BP, both P<.001). Adherence was better in participants measuring semimonthly (71.4%) compared with participants performing monthly measurements (64.3%, P=.008). During the study, 41 (27.2%) participants were referred to their general practitioner because of a high BP. Referred participants had a decrease in their BP during follow-up (mean difference final and initial [standard error] −5.29 [1.92] for systolic BP and −2.93 [1.08] for diastolic BP, both P<.05). Conclusion: Mobile phone-assisted technology is a reliable and promising method with good adherence to measure BP at home during a 6-month period. This provides a possibility for implementation in large-scale studies and can potentially contribute to BP reduction.

  • Photo credit: Chesi - Fotos CC via Foter.com / CC BY-SA.

    Stepwise Development of a Text Messaging-Based Bullying Prevention Program for Middle School Students (BullyDown)

    Abstract:

    Background: Bullying is a significant public health issue among middle school-aged youth. Current prevention programs have only a moderate impact. Cell phone text messaging technology (mHealth) can potentially overcome existing challenges, particularly those that are structural (e.g., limited time that teachers can devote to non-educational topics). To date, the description of the development of empirically-based mHealth-delivered bullying prevention programs are lacking in the literature. Objective: To describe the development of BullyDown, a text messaging-based bullying prevention program for middle school students, guided by the Social-Emotional Learning model. Methods: We implemented five activities over a 12-month period: (1) national focus groups (n=37 youth) to gather acceptability of program components; (2) development of content; (3) a national Content Advisory Team (n=9 youth) to confirm content tone; and (4) an internal team test of software functionality followed by a beta test (n=22 youth) to confirm the enrollment protocol and the feasibility and acceptability of the program. Results: Recruitment experiences suggested that Facebook advertising was less efficient than using a recruitment firm to recruit youth nationally, and recruiting within schools for the pilot test was feasible. Feedback from the Content Advisory Team suggests a preference for 2-4 brief text messages per day. Beta test findings suggest that BullyDown is both feasible and acceptable: 100% of youth completed the follow-up survey, 86% of whom liked the program. Conclusions: Text messaging appears to be a feasible and acceptable delivery method for bullying prevention programming delivered to middle school students.

  • Source: https://www.pexels.com/photo/google-nexus-4-lg-smartphone-technology-12829; CC0 Public Domain.

    Development and Validation of the User Version of the Mobile Application Rating Scale (uMARS)

    Abstract:

    Background: The Mobile Application Rating Scale (MARS) provides a reliable method to assess the quality of mobile health (mHealth) apps. However, training and expertise in mHealth and the relevant health field is required to administer it. Objective: This study describes the development and reliability testing of an end-user version of the MARS (uMARS). Methods: The MARS was simplified and piloted with 13 young people to create the uMARS. The internal consistency and test-retest reliability of the uMARS was then examined in a second sample of 164 young people participating in a randomized controlled trial of a mHealth app. App ratings were collected using the uMARS at 1-, 3,- and 6-month follow up. Results: The uMARS had excellent internal consistency (alpha = .90), with high individual alphas for all subscales. The total score and subscales had good test-retest reliability over both 1-2 months and 3 months. Conclusions: The uMARS is a simple tool that can be reliably used by end-users to assess the quality of mHealth apps.

Citing this Article

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  • Mobile telephone technology use by people experiencing Multiple Sclerosis fatigue.

    Date Submitted: Jun 13, 2016

    Open Peer Review Period: Jun 16, 2016 - Aug 11, 2016

    Background: Fatigue is one of the most commonly reported symptoms of Multiple Sclerosis (MS). It has a profound aspect on all spheres of life, both for the person with MS and their relatives. It is on...

    Background: Fatigue is one of the most commonly reported symptoms of Multiple Sclerosis (MS). It has a profound aspect on all spheres of life, both for the person with MS and their relatives. It is one of the key precipitants of early retirement. Individual, group and internet cognitive behavioural therapy based approaches to supporting people with MS to manage their fatigue have been shown to be effective. Objective: The aim of this project was to: 1) survey the types of mobile devices people with MS use or would consider using for a health intervention, together with the level of internet access they have, and 2) characterise the levels of fatigue severity and its impact experienced by the people in our sample, to provide an estimate of fatigue severity of people with MS in New Zealand. The ultimate goal of this work was to support the future development of a mobile intervention for the management of fatigue for people with MS. Methods: People with MS were surveyed using an online questionnaire. Results: This survey has demonstrated that NZ respondents with MS experienced high levels of both fatigue severity and fatigue impact. The majority of participants have a mobile device and access to the internet. Conclusions: These factors, alongside limited access to face-to-face cognitive behavioural therapy based interventions, create an opportunity to develop a mobile technology platform for delivering a cognitive behavioural therapy based intervention to improve the severity and impact of fatigue in people with MS.

  • Formative work to develop a tailored HIV testing smartphone application for diverse, at-risk HIV-negative men who have sex with men

    Date Submitted: Jun 7, 2016

    Open Peer Review Period: Jun 10, 2016 - Aug 5, 2016

    Background: Although gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV, few test for HIV at regular intervals. Smartphone applications (or “apps”) may...

    Background: Although gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV, few test for HIV at regular intervals. Smartphone applications (or “apps”) may be an ideal tool to increase regular testing among MSM. However, the success of apps to encourage regular testing among MSM will depend on how frequently they are downloaded, whether they are continued to be used over months or years, and the degree to which such apps are tailored to the needs of this population. Objective: The primary objectives of this study are to answer the following questions: 1) What features and functions of smartphone apps do MSM believe are associated with downloading apps to their mobile phones?; 2) What features and functions of smartphone apps are most likely to influence MSM’s sustained use of apps over time?; and 3) What features and functions do MSM prefer in a HIV testing smartphone app? Methods: Focus groups (n=7 with 34 participants) were conducted with a racially and ethnically diverse group of sexually active HIV-negative MSM (Mean age of 32; 42% tested for HIV ≥10 months ago in Miami, Florida and Minneapolis, Minnesota. Focus groups were digitally recorded, transcribed verbatim, 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 focus groups. Results: Men reported cost, security, and efficiency as their primary reasons influencing whether they download an app. Usefulness and perceived necessity, as well as peer and posted reviews, affected whether they downloaded and used the app over time. Factors that influenced whether they keep and continue to use an app over time included reliability, ease of use, and frequency of updates. Poor performance and functionality and lack of use were the primary reasons why men would delete an app from their phone. 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: Mobile apps for HIV prevention have proliferated, despite relatively little formative research to understand best practices for their development and implementation. The findings of this study suggest key design characteristics that should be used to guide development of a HIV testing app to promote regular HIV testing for MSM. The features and functions identified in this and prior research, as well as existing theories of behavior change, should be used to guide mobile app development in this critical area.

  • Crafting health messages with knowledge translation to provoke interest, raise awareness, inspire change, impart knowledge and transform practice: Short Paper

    Date Submitted: May 31, 2016

    Open Peer Review Period: Jun 3, 2016 - Jul 29, 2016

    Background: There is growing use of technology supported knowledge translation (KT) strategies like social media in health promotion and in Indigenous health. However, little is known about how indivi...

    Background: There is growing use of technology supported knowledge translation (KT) strategies like social media in health promotion and in Indigenous health. However, little is known about how individuals use technologies and the evidence base for the impact of these health interventions on health behaviour change is weak. Objective: We examine how Facebook is used to promote health messages to Indigenous people and discuss how KT can support planning and implementing health messages to ensure chosen strategies are fit for purpose and achieve impact. Methods: Conducted a desktop audit of health promotion campaigns on smoking prevention and cessation for Australian Indigenous people. Results: Our audit of health promotion campaigns on smoking prevention and cessation for Australian Indigenous people identified thirteen out of 21 eligible campaigns used Facebook. Facebook pages with the highest number of likes (greater than 5000) linked to a website and to other social media applications and demonstrated stickiness characteristics by posting frequently (triggers and unexpected), recruiting sporting or public personalities to promote campaigns (social currency and public), recruiting Indigenous people from the local region (stories and emotion), and sharing stories and experiences based on real life events (credible). Conclusions: KT planning may support campaigns to identify and select KT strategies that are best suited and well aligned to the campaigns’ goals, messages and target audiences. KT planning can also help to mitigate unforeseen and expected risks, reduce unwarranted costs and expenses, achieve goals, and limit the peer pressure of using strategies that may not be fit for purpose. One of the main challenges in using KT systems and processes involves coming to an adequate conceptualisation of the KT process itself.

  • An Evaluation of a Smartphone-Assisted Behavioral Weight Control Intervention for Adolescents: Pilot Study

    Date Submitted: May 26, 2016

    Open Peer Review Period: May 29, 2016 - Jul 24, 2016

    Background: The efficacy of adolescent weight control treatments is modest and effective treatments are costly and are not widely available. Smartphones may be an effective method for delivering criti...

    Background: The efficacy of adolescent weight control treatments is modest and effective treatments are costly and are not widely available. Smartphones may be an effective method for delivering critical components of behavioral weight control treatment, including behavioral self-monitoring. Objective: This study examined the efficacy and acceptability of a smartphone-assisted adolescent behavioral weight control intervention. Methods: Sixteen overweight/obese adolescents (M age = 14.29, SD = 1.12) received 12 weeks of combined treatment consisting of weekly in-person group behavioral weight control treatment sessions plus smartphone self-monitoring and daily text messaging. Subsequently they received 12 weeks of electronic-only intervention, totaling 24 weeks of intervention. Results: On average participants attained modest but significant reductions in body mass index standard score (zBMI; .08 standard deviation units, t(13) = 2.22, P = .04, d = 0.63) over the in-person plus electronic intervention period but did not maintain treatment gains over the electronic-only intervention period. Participants self-monitored on approximately half of combined intervention days but less than 20% of electronic-only intervention days. Conclusions: Smartphones likely hold promise as a component of adolescent weight control interventions but they may be less effective in helping adolescents maintain treatment gains after intensive interventions. Clinical Trial: none

  • 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.

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