JMIR Publications

JMIR mHealth and uHealth

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


Journal Description

JMIR mhealth and uhealth (mobile and ubiquitous health) (JMU, ISSN 2291-5222) is a spin-off journal of JMIR, the leading eHealth journal (Impact Factor 2015: 4.532). For JMIR mHealth and uHealth we are expecting the first impact factor in 2017 which will be at least 2.84. 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 is indexed in PubMed Central/PubMed, and Thomson Reuters' Science Citation Index Expanded (SCIE), and is expecting its first official impact factor in July 2017.

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:

  • Source: iStock by Getty Images; Copyright: kupicoo; URL:; License: Licensed by the authors.

    Perceptions of Patient Engagement Applications During Pregnancy: A Qualitative Assessment of the Patient’s Perspective


    Background: With growing demand for medical information and health applications in pregnancy, the potential of electronic health (eHealth) and mobile health (mHealth) solutions in clinical care is increasingly unfolding. However, we still do not know how pregnant women engage with mobile apps, how such apps impact routine medical care, and whether benefit expectations are met. Whereas recent research has raised the subject of user distribution and analyzed the content of pregnancy applications, there is still a significant knowledge gap regarding what pregnant women like and dislike about pregnancy tools, along with how such interventions could be improved. Objective: The aim of the study was to examine the perceptions and expectations of mobile and Web-based patient-engagement pregnancy applications. We assessed usability requirements, general acceptance of eHealth, and the impact of eHealth and mHealth pregnancy applications on the doctor-patient interaction and daily clinical routine. Methods: A qualitative study was conducted at the maternity department of a major German university hospital. The sample included 30 women with low- to medium-risk pregnancies. Half of the patients were seen during outpatient care and half were hospitalized for several days. The extent and frequency of Web- and mobile phone app usage were assessed. Semistructured interviews were conducted and analyzed using systematic thematic analysis. Results: Patients had a high demand for Web-based pregnancy applications. Study findings suggested a strong request for personalization, monitoring, and accessibility for frequent use as main themes derived from the interviews. Fostering patient empowerment in the doctor-patient relationship was also highly valued for a pregnancy app. Participants favored further integration of medical apps in their daily routine and pregnancy care. However, concerns were raised about content quality, trustworthiness of Web sources, and individual data security. Conclusions: eHealth and mHealth applications are a highly frequented source of information. Expectations and usability requirements for those applications are also high, thus posing a challenge to interdisciplinary service providers. Patients’ attitude toward integrating apps in routine care settings was positive with a favorable influence on patient empowerment. Health care professionals should guide pregnant women toward a successful integration of these educational tools in pregnancy care.

  • Source: iStock by Getty Images; Copyright: vgajic; URL:; License: Licensed by the authors.

    An mHealth App for Supporting Quitters to Manage Cigarette Cravings With Short Bouts of Physical Activity: A Randomized Pilot Feasibility and Acceptability...


    Background: While gains in reducing smoking rates in Finland have been made, prevalence rates are still substantial. Relapse rates among smokers engaged in quit-smoking programs are high. Physical activity has been proposed as one means to help smokers manage cravings. Software and apps on mobile phone and handheld devices offer an opportunity to communicate messages on how to use physical activity to manage cravings as part of quit-smoking programs. Objective: We aimed to test the feasibility, acceptability, usability, and preliminary efficacy of an mHealth mobile phone app, Physical activity over Smoking (PhoS), to assist smokers in quitting smoking in a randomized controlled trial. The app was designed to prompt smokers to engage in physical activities to manage their smoking cravings. Methods: Regular smokers (n=44) attended a group-based behavioral counselling program aimed at promoting physical activity as an additional aid to quit. After quit day, participants were randomly allocated to an intervention (n=25) or to a comparison (n=19) group. Participants in the intervention group were provided with the PhoS app and training on how to use it to assist with relapse prevention. Participants in the comparison condition were provided with generalized relapse prevention training. Results: Some participants reported that the PhoS app was useful in assisting them to successfully manage their cigarette cravings, although compliance across the sample was modest and participants reported low levels of usability. Participants receiving the PhoS app did not report greater abstinence than those who did not receive the app. However, participants receiving the app were more likely to report greater abstinence if they did not use pharmacological support, while those who did not receive the app reported greater abstinence when using pharmacological support. Participants receiving the app reported greater levels of physical activity than those who did not. Results revealed that the app resulted in better retention. Conclusions: The PhoS app showed some potential to reduce abstinence among participants not using pharmacological therapy and to increase physical activity. However, problems with usability and lack of effects on abstinence raise questions over the app’s long-term effectiveness. Future research should prioritize further development of the app to maximize usability and test effects of the intervention independent of quit-smoking programs. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 55259451; (Archived by WebCite at

  • Old man with an assistant. Source:; Copyright: Matthias Zomer; URL:; License: Public Domain (CC0).

    Cognitive Testing in People at Increased Risk of Dementia Using a Smartphone App: The iVitality Proof-of-Principle Study


    Background: Smartphone-assisted technologies potentially provide the opportunity for large-scale, long-term, repeated monitoring of cognitive functioning at home. Objective: The aim of this proof-of-principle study was to evaluate the feasibility and validity of performing cognitive tests in people at increased risk of dementia using smartphone-based technology during a 6 months follow-up period. Methods: We used the smartphone-based app iVitality to evaluate five cognitive tests based on conventional neuropsychological tests (Memory-Word, Trail Making, Stroop, Reaction Time, and Letter-N-Back) in healthy adults. Feasibility was tested by studying adherence of all participants to perform smartphone-based cognitive tests. Validity was studied by assessing the correlation between conventional neuropsychological tests and smartphone-based cognitive tests and by studying the effect of repeated testing. Results: We included 151 participants (mean age in years=57.3, standard deviation=5.3). Mean adherence to assigned smartphone tests during 6 months was 60% (SD 24.7). There was moderate correlation between the firstly made smartphone-based test and the conventional test for the Stroop test and the Trail Making test with Spearman ρ=.3-.5 (P<.001). Correlation increased for both tests when comparing the conventional test with the mean score of all attempts a participant had made, with the highest correlation for Stroop panel 3 (ρ=.62, P<.001). Performance on the Stroop and the Trail Making tests improved over time suggesting a learning effect, but the scores on the Letter-N-back, the Memory-Word, and the Reaction Time tests remained stable. Conclusions: Repeated smartphone-assisted cognitive testing is feasible with reasonable adherence and moderate relative validity for the Stroop and the Trail Making tests compared with conventional neuropsychological tests. Smartphone-based cognitive testing seems promising for large-scale data-collection in population studies.

  • Source: Flickr; Copyright: zenjazzygeek; URL:; License: Creative Commons Attribution (CC-BY).

    What to Build for Middle-Agers to Come? Attractive and Necessary Functions of Exercise-Promotion Mobile Phone Apps: A Cross-Sectional Study


    Background: Physical activity is important for middle-agers to maintain health both in middle age and in old age. Although thousands of exercise-promotion mobile phone apps are available for download, current literature offers little understanding regarding which design features can enhance middle-aged adults’ quality perception toward exercise-promotion apps and which factor may influence such perception. Objectives: The aims of this study were to understand (1) which design features of exercise-promotion apps can enhance quality perception of middle-agers, (2) whether their needs are matched by current functions offered in app stores, and (3) whether physical activity (PA) and mobile phone self-efficacy (MPSE) influence quality perception. Methods: A total of 105 middle-agers participated and filled out three scales: the International Physical Activity Questionnaire (IPAQ), the MPSE scale, and the need for design features questionnaire. The design features were developed based on the Coventry, Aberdeen, and London—Refined (CALO-RE) taxonomy. Following the Kano quality model, the need for design features questionnaire asked participants to classify design features into five categories: attractive, one-dimensional, must-be, indifferent, and reverse. The quality categorization was conducted based on a voting approach and the categorization results were compared with the findings of a prevalence study to realize whether needs match current availability. In total, 52 multinomial logistic regression models were analyzed to evaluate the effects of PA level and MPSE on quality perception of design features. Results: The Kano analysis on the total sample revealed that visual demonstration of exercise instructions is the only attractive design feature, whereas the other 51 design features were perceived with indifference. Although examining quality perception by PA level, 21 features are recommended to low level, 6 features to medium level, but none to high-level PA. In contrast, high-level MPSE is recommended with 14 design features, medium level with 6 features, whereas low-level participants are recommended with 1 feature. The analysis suggests that the implementation of demanded features could be low, as the average prevalence of demanded design features is 20% (4.3/21). Surprisingly, social comparison and social support, most implemented features in current apps, were categorized into the indifferent category. The magnitude of effect is larger for MPSE because it effects quality perception of more design features than PA. Delving into the 52 regression models revealed that high MPSE more likely induces attractive or one- dimensional categorization, suggesting the importance of technological self-efficacy on eHealth care promotion. Conclusions: This study is the first to propose middle-agers’ needs in relation to mobile phone exercise-promotion. In addition to the tailor-made recommendations, suggestions are offered to app designers to enhance the performance of persuasive features. An interesting finding on change of quality perception attributed to MPSE is proposed as future research.

  • Source: Max Pixel; Copyright:; URL:; License: Public Domain (CC0).

    Smart Devices for Older Adults Managing Chronic Disease: A Scoping Review

    Authors List:


    Background: The emergence of smartphones and tablets featuring vastly advancing functionalities (eg, sensors, computing power, interactivity) has transformed the way mHealth interventions support chronic disease management for older adults. Baby boomers have begun to widely adopt smart devices and have expressed their desire to incorporate technologies into their chronic care. Although smart devices are actively used in research, little is known about the extent, characteristics, and range of smart device-based interventions. Objective: We conducted a scoping review to (1) understand the nature, extent, and range of smart device-based research activities, (2) identify the limitations of the current research and knowledge gap, and (3) recommend future research directions. Methods: We used the Arksey and O’Malley framework to conduct a scoping review. We identified relevant studies from MEDLINE, Embase, CINAHL, and Web of Science databases using search terms related to mobile health, chronic disease, and older adults. Selected studies used smart devices, sampled older adults, and were published in 2010 or after. The exclusion criteria were sole reliance on text messaging (short message service, SMS) or interactive voice response, validation of an electronic version of a questionnaire, postoperative monitoring, and evaluation of usability. We reviewed references. We charted quantitative data and analyzed qualitative studies using thematic synthesis. To collate and summarize the data, we used the chronic care model. Results: A total of 51 articles met the eligibility criteria. Research activity increased steeply in 2014 (17/51, 33%) and preexperimental design predominated (16/50, 32%). Diabetes (16/46, 35%) and heart failure management (9/46, 20%) were most frequently studied. We identified diversity and heterogeneity in the collection of biometrics and patient-reported outcome measures within and between chronic diseases. Across studies, we found 8 self-management supporting strategies and 4 distinct communication channels for supporting the decision-making process. In particular, self-monitoring (38/40, 95%), automated feedback (15/40, 38%), and patient education (13/40, 38%) were commonly used as self-management support strategies. Of the 23 studies that implemented decision support strategies, clinical decision making was delegated to patients in 10 studies (43%). The impact on patient outcomes was consistent with studies that used cellular phones. Patients with heart failure and asthma reported improved quality of life. Qualitative analysis yielded 2 themes of facilitating technology adoption for older adults and 3 themes of barriers. Conclusions: Limitations of current research included a lack of gerontological focus, dominance of preexperimental design, narrow research scope, inadequate support for participants, and insufficient evidence for clinical outcome. Recommendations for future research include generating evidence for smart device-based programs, using patient-generated data for advanced data mining techniques, validating patient decision support systems, and expanding mHealth practice through innovative technologies.

  • College students on cell phones. Source: iStock by Getty Images; Copyright: nensuria; URL:; License: Licensed by the authors.

    Effect of a Counseling Session Bolstered by Text Messaging on Self-Selected Health Behaviors in College Students: A Preliminary Randomized Controlled Trial


    Background: The college experience is often the first time when young adults live independently and make their own lifestyle choices. These choices affect dietary behaviors, exercise habits, techniques to deal with stress, and decisions on sleep time, all of which direct the trajectory of future health. There is a need for effective strategies that will encourage healthy lifestyle choices in young adults attending college. Objective: This preliminary randomized controlled trial tested the effect of coaching and text messages (short message service, SMS) on self-selected health behaviors in the domains of diet, exercise, stress, and sleep. A second analysis measured the ripple effect of the intervention on health behaviors not specifically selected as a goal by participants. Methods: Full-time students aged 18-30 years were recruited by word of mouth and campuswide advertisements (flyers, posters, mailings, university website) at a small university in western Pennsylvania from January to May 2015. Exclusions included pregnancy, eating disorders, chronic medical diagnoses, and prescription medications other than birth control. Of 60 participants, 30 were randomized to receive a single face-to-face meeting with a health coach to review results of behavioral questionnaires and to set a health behavior goal for the 8-week study period. The face-to-face meeting was followed by SMS text messages designed to encourage achievement of the behavioral goal. A total of 30 control subjects underwent the same health and behavioral assessments at intake and program end but did not receive coaching or SMS text messages. Results: The texting app showed that 87.31% (2187/2505) of messages were viewed by intervention participants. Furthermore, 28 of the 30 intervention participants and all 30 control participants provided outcome data. Among intervention participants, 22 of 30 (73%) showed improvement in health behavior goal attainment, with the whole group (n=30) showing a mean improvement of 88% (95% CI 39-136). Mean improvement in any behavioral domains was not seen in the control group. Intervention participants also increased their exercise significantly compared with controls, regardless of their self-selected goal category. The increased exercise was paralleled by significantly lower fasting glucose levels. Conclusions: The health coaching session plus tailored SMS text messages improved self-selected health behaviors with a modest ripple effect to include unselected health behaviors. Trial Registration: NCT02476604; (Archived by WebCite at

  • Homepage of PulsePoint Website. Copyright: PulsePoint Foundation; URL:; License: Creative Commons Attribution (CC-BY).

    North American Public Opinion Survey on the Acceptability of Crowdsourcing Basic Life Support for Out-of-Hospital Cardiac Arrest With the PulsePoint Mobile...


    Background: The PulsePoint Respond app is a novel system that can be implemented in emergency dispatch centers to crowdsource basic life support (BLS) for patients with cardiac arrest and facilitate bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator use while first responders are en route. Objective: The aim of this study was to conduct a North American survey to evaluate the public perception of the above-mentioned strategy, including acceptability and willingness to respond to alerts. Methods: We designed a Web-based survey administered by IPSOS Reid, an established external polling vendor. Sampling was designed to ensure broad representation using recent census statistics. Results: A total of 2415 survey responses were analyzed (1106 from Canada and 1309 from the United States). It was found that 98.37% (1088/1106) of Canadians and 96% (1259/1309) of Americans had no objections to PulsePoint being implemented in their community; 84.27% (932/1106) of Canadians and 55.61% (728/1309) of Americans said they would download the app to become a potential responder to cardiac arrest, respectively. Among Canadians, those who said they were likely to download PulsePoint were also more likely to have ever had CPR training (OR 1.7, 95% CI 1.2-2.4; P=.002); however, this was not true of American respondents (OR 1.0, 95% CI 0.79-1.3; P=.88). When asked to imagine themselves as a cardiac arrest victim, 95.39% (1055/1106) of Canadians and 92.44% (1210/1309) of Americans had no objections to receiving crowdsourced help in a public setting; 88.79% (982/1106) of Canadians and 84.87% (1111/1309) of Americans also had no objections to receiving help in a private setting, respectively. The most common concern identified with respect to PulsePoint implementation was a responder’s lack of ability, training, or access to proper equipment in a public setting. Conclusions: The North American public finds the concept of crowdsourcing BLS for out-of-hospital cardiac arrest to be acceptable. It demonstrates willingness to respond to PulsePoint CPR notifications and to accept help from others alerted by the app if they themselves suffered a cardiac arrest.

  • Adolescents using mobile phones. Source: Bigstock by Shutterstock; Copyright: dolgachov; URL:; License: Licensed by the authors.

    Text Messaging and Mobile Phone Apps as Interventions to Improve Adherence in Adolescents With Chronic Health Conditions: A Systematic Review


    Background: The number of adolescents with chronic health conditions (CHCs) continues to increase. Medication nonadherence is a global challenge among adolescents across chronic conditions and is associated with poor health outcomes. While there has been growing interest in the use of mHealth technology to improve medication adherence among adolescents with CHCs, particularly text messaging and mobile phone apps, there has been no prior systematic review of their efficacy. Objective: The purpose of this review was to systematically evaluate the most recent evidence for the efficacy of text messaging and mobile phone apps as interventions to promote medication adherence among adolescents with CHCs. Methods: PubMed, Embase, CENTRAL, PsycINFO, Web of Science, Google Scholar, and additional databases were searched from 1995 until November 2015. An additional hand search of related themes in the Journal of Medical Internet Research was also conducted. The Preferred Reporting Results of Systematic Reviews and Meta-Analyses guidelines were followed. Two reviewers independently screened titles/abstracts, assessed full-text articles, extracted data from included articles, and assessed their quality using Grades of Recommendation, Assessment, Development, and Evaluation criteria. Included studies were described in original research articles that targeted adherence in adolescents with CHCs (12-24 years-old). Results: Of the 1423 records examined, 15 met predefined criteria: text messaging (n=12) and mobile phone apps (n=3). Most studies were performed in the United States (11/15, 73%), were randomized-controlled trials (8/15, 53%), had a sample size <50 (11/15, 73%), and included adherence self-report and/or biomarkers (9/15, 60%). Only four studies were designed based on a theoretical framework. Approaches for text messaging and mobile phone app interventions varied across studies. Seven articles (7/15, 47%) reported significant improvement in adherence with moderate to large standardized mean differences. Most of the included studies were of low or moderate quality. Studies varied in sample size, methods of adherence assessment, and definition of adherence, which prohibited performing a meta-analysis. Conclusions: The use of text messaging and mobile phone app interventions to improve medication adherence among adolescents with CHCs has shown promising feasibility and acceptability, and there is modest evidence to support the efficacy of these interventions. Further evaluation of short- and long-term efficacy and cost-effectiveness of these interventions is warranted given the early and evolving state of the science.

  • OA Go mobile app. Source: Figure 1 from doi:10.2196/mhealth.7179; Copyright: The Authors; URL:; License: Creative Commons Attribution (CC-BY).

    Assessing the Impact of a Novel Smartphone Application Compared With Standard Follow-Up on Mobility of Patients With Knee Osteoarthritis Following Treatment...


    Background: Osteoarthritis (OA) is a leading cause of disability in the United States. Although no disease-modifying therapies exist, patients with knee OA who increase walking may reduce risk of functional limitations. Objective: The objective of the study is to evaluate the impact of a mobile app (OA GO) plus wearable activity monitor/pedometer (Jawbone UP 24) used for 90 days on the mobility of patients with knee OA treated with hylan G-F 20. Methods: Patients with knee OA aged 30 to 80 years who were eligible to receive hylan G-F 20 and were familiar with smartphone technology were enrolled in this randomized, multicenter, open-label study. Patients who had a body mass index above 35 kg/m2 were excluded. All patients received a single 6-mL injection of hylan G-F 20 and wore the Jawbone monitor. The patients were then randomized 1:1 to Jawbone and OA GO (Group A; n=107) with visible feedback (unblinded) or Jawbone only (Group B; n=104) with no visible feedback (blinded). The primary endpoint was mean change from baseline in steps per day at day 90 between Groups A and B. Results: Baseline characteristics were similar between groups. There were significant differences between the increases in least squares (LS) mean number of steps per day (1199 vs 467, P=.03) and the mean percentage change (35.8% vs 11.5%, P=.02) from baseline in favor of Group A over Group B. There was a greater reduction in pain from baseline during the 6-minute walk test in Group A versus Group B. (LS mean change: −55.3 vs −33.8, P=.007). Most patients (65.4%) and surveys of physicians (67.3%) reported they would be likely or very likely to use/recommend the devices. Patient Activity Measure-13 scores improved from baseline (LS mean change for Groups A and B: 5.0 vs 6.9), with no significant differences between groups. The occurrence of adverse events was similar in the 2 groups. Conclusions: Use of a novel smartphone app in conjunction with a wearable activity monitor provided additional improvement on mobility parameters such as steps per day and pain with walking in the 6-minute walk test in patients with knee OA who were treated with hylan G-F 20. Results also highlight the amenability of patients and physicians to using mobile health technology in the treatment of OA and suggest further study is warranted.

  • Source: Image created by the authors; Copyright: The authors; License: Creative Commons Attribution (CC-BY).

    eTEST: Developing a Smart Home HIV Testing Kit that Enables Active, Real-Time Follow-Up and Referral After Testing


    Background: Men who have sex with men (MSM) are the group at highest risk for contracting human immunodeficiency virus (HIV) in the United States, but many do not test as frequently as recommended. Home-based self-testing (HBST) for HIV holds promise for promoting regular testing among these individuals, but currently available HBSTs have limited follow-up options, providing only a 1-800 number that participants can call. Failure to actively conduct follow-up counseling and referrals after HBST use could result in delays in seeking confirmatory testing and care among users receiving reactive (preliminary positive) test results. HBST also fails to connect users who test negative with other prevention services that can reduce their future risk for HIV. Objective: The aim of our study was to use qualitative research methods with high-risk MSM to inform development of a “smart” HBST kit. The kit utilizes existing Internet-of-Things (IoT) technologies to monitor HBST use in real-time and enable delivery of timely, active follow-up counseling and referrals over the phone. Methods: In phase 1, individual interviews (n=10) explored how participants might use HBST and their views and preferences for conducting counseling and referral after HBST. Based on these perspectives, we developed a smartphone app (iOS, Android) that uses data from light sensors on Bluetooth low energy (BLE) beacons to monitor when HBST kits are opened, facilitating timely follow-up phone contact with users. In phase 2, a usability study conducted among high-risk MSM (n=10) examined the acceptability and feasibility of this system and provided user perspectives after using the system along with HBST. Results: Phase 1 themes suggested that MSM preferred HBST, that most thought active follow-up after HBST would be valuable, and that doing so over the phone within 24 h after testing was preferable. Phase 2 results showed that the eTEST system successfully detected HBST use in nearly all cases. Participant perspectives also suggested that the timing, method (ie, phone call), and duration of follow-up were appropriate and helpful. Conclusions: Using BLE beacons and a smartphone app to enable follow-up counseling and referral over the phone after HBST use is feasible and acceptable to high-risk MSM. Future research is needed to compare the effects of follow-up counseling on rates of repeat testing and receipt of referral services (eg, testing for sexually transmitted infections and initiation of preexposure prophylaxis) and to explore the acceptability of the eTEST system over longer periods of time.

  • Source: Shutterstock; Copyright: Kjetil Kolbjornsrud; URL:; License: Licensed by the authors.

    Ownership and Use of Commercial Physical Activity Trackers Among Finnish Adolescents: Cross-Sectional Study


    Background: Mobile phone apps for monitoring and promoting physical activity (PA) are extremely popular among adults. Devices, such as heart rate monitors or sports watches (HRMs/SWs) that work with these apps are at sufficiently low costs to be available through the commercial markets. Studies have reported an increase in PA levels among adults with devices; however, it is unknown whether the phenomena are similar during early adolescence. At a time when adolescents start to develop their own sense of independence and build friendship, the ease of smartphone availability in developed countries needs to be investigated in important health promoting behaviors such as PA. Objective: The objective of this study was to investigate the ownership and usage of PA trackers (apps and HRM/SW) among adolescents in a national representative sample and to examine the association between use of devices and PA levels. Methods: The Finnish school-aged physical activity (SPA) study consisted of 4575 adolescents, aged 11-, 13-, and 15-years, who took part in a web-based questionnaire during school time about PA behaviors between April and May 2016. Binary logistic regression analyses were used to test the associations between moderate to vigorous physical activity (MVPA) and devices, after controlling for gender, age, disability, and family affluence. Results: PA tracking devices have been categorized into two types, which are accessible to adolescents: (1) apps and (2) HRM/SW. Half the adolescents (2351/4467; 52.63%) own apps for monitoring PA, yet 16.12% (720/4467) report using apps. Fewer adolescents (782/4413; 17.72%) own HRM/SW and 9.25% (408/4413) use HRM/SW. In this study, users of HRM/SW were 2.09 times (95% CI 1.64-2.67), whereas users of apps were 1.4 times (95% CI 1.15-1.74) more likely to meet PA recommendations of daily MVPA for at least 60 min compared with adolescents without HRM/SW or without apps. Conclusions: To our knowledge, this is the first study that describes the situation in Finland with adolescents using PA trackers and its association with PA levels. Implications of the use of apps and HRM/SW by adolescents are discussed.

  • Source: Flickr; Copyright: California Cow; URL:; License: Creative Commons Attribution (CC-BY).

    Mobile Technology Interventions for Asthma Self-Management: Systematic Review and Meta-Analysis


    Background: Mobile technology interventions (MTI) are becoming increasingly popular in the management of chronic health behaviors. Most MTI allow individuals to monitor medication use, record symptoms, or store and activate disease-management action plans. Therefore, MTI may have the potential to improve low adherence to medication and action plans for individuals with asthma, which is associated with poor clinical outcomes. Objective: A systematic review and meta-analysis were conducted to evaluate the efficacy of MTI on clinical outcomes as well as adherence in individuals with asthma. As the use of evidence-based behavior change techniques (BCT) has been shown to improve intervention effects, we also conducted exploratory analyses to determine the role of BCT and engagement with MTI as moderators of MTI efficacy. Methods: We searched electronic databases for randomized controlled trials up until June 2016. Random effect models were used to assess the effect of MTI on clinical outcomes as well as adherence to preventer medication or symptom monitoring. Mixed effects models assessed whether the features of the MTI (ie, use of BCT) and how often a person engaged with MTI moderated the effects of MTI. Results: The literature search located 11 studies meeting the inclusion criteria, with 9 providing satisfactory data for meta-analysis. Compared with standard treatment, MTI had moderate to large effect sizes (Hedges g) on medication adherence and clinical outcomes. MTI had no additional effects on adherence or clinical outcomes when compared with paper-based monitoring. No moderator effects were found, and the number of studies was small. A narrative review of the two studies, which are not included in the meta-analysis, found similar results. Conclusions: This review indicated the efficacy of MTI for self-management in individuals with asthma and also indicated that MTI appears to be as efficacious as paper-based monitoring. This review also suggested a need for robust studies to examine the effects of BCT use and engagement on MTI efficacy to inform the evidence base for MTI in individuals with asthma.

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  • Comment on Wu et al. Mobile App-Based Interventions to Support Diabetes Self-Management: A Systematic Review of Randomized Controlled Trials to Identify Functions Associated with Glycemic Efficacy. JMIR Mhealth Uhealth. 2017;5(3):e35

    Date Submitted: Apr 20, 2017

    Open Peer Review Period: May 17, 2017 - Jul 12, 2017



  • Mobile Apps for Suicide Prevention: Review in Virtual Stores and Literature

    Date Submitted: May 12, 2017

    Open Peer Review Period: May 13, 2017 - Jul 8, 2017

    Background: The best manner to prevent suicide is to recognize the suicidal signs and signals, and know how to respond to them. Objective: To study the existing mobile apps for suicide prevent in the...

    Background: The best manner to prevent suicide is to recognize the suicidal signs and signals, and know how to respond to them. Objective: To study the existing mobile apps for suicide prevent in the literature and the most important virtual stores. Methods: Two reviews are carried out. The first is done by searching the most used commercial app stores such as iTunes and Google Play. The second is a review of mhealth apps in the published articles from the following 7 scientific databases: Science Direct, Medline, PsycINFO, Embase, The Cochrane Library, IEEE Xplore and Google Scholar from the last 10 years. Results: A total of 124 apps related to suicide were found in the cited virtual stores but only 20 apps were specifically for suicide prevention. All them are free and most are for Android. Furthermore, 6 relevant papers were found in the indicated scientific databases. Pilot experiences were commented where physicians and families have an important work. Conclusions: The number of apps about suicide prevention is small, mainly in literature. There was little information. Many of these apps provide no interactive features. It is important to verify the accuracy of the results of different apps that are available on iOS and Android. The confidence generated by these applications can benefit users who use it, either by improving their health monitoring or only to verify their body condition.

  • The Beliefs and Usage of Social Media among General Practitioner Trainers in China: A Cross-Sectional Survey

    Date Submitted: May 5, 2017

    Open Peer Review Period: May 9, 2017 - Jul 4, 2017

    Background: It has become a new lifestyle of using SM to acquiring all kinds of information. Objective: The objectives of this study were to determine GP trainers’ current use of SM and their belief...

    Background: It has become a new lifestyle of using SM to acquiring all kinds of information. Objective: The objectives of this study were to determine GP trainers’ current use of SM and their beliefs and attitudes regarding use of social media in China. Methods: A cross-sectional questionnaire survey was taken in China. Data probing GP trainers’ use of SM, attitudes toward use of SM in clinical work and education were collected and analyzed. Results: 407 GP trainers participated in the survey, the response rate was 61.4%. All the respondents reported that they have at least a SM account, with the most common type is Wechat. (1) 99.3% respondents replied that they would add a colleague as a friend via SM; however, only 68.6% of them would add a patient. The respondents who worked for a long time were more likely to add a colleague as a friend (χ2 =48.030, P = 0.000). There is a significant difference between different gender (χ2 =5.540, P = 0.019) and working experience levels (χ2 =89.638, P = 0.000) on adding a patient as a friend. (2) More than half of respondents have been contacted by a patient more than 5 times per year, whereas 67.2% attempted to contact a patient by SM less than 3 times per year, and 52.3% of respondents have never visited their patients’ SM page to gather information. (3) 140 of 407 (34.4%) of respondents used SM daily to explore medical information, whereas 42 of 407 (10.3%) contributed new information via SM on a daily basis. There is a significant difference among different areas on using SM to seeking specific medical problems (χ2 =25.835, P = 0.011). (4) Most of respondents believed that the use of SM is useful and beneficial, but they took a neutral attitude on the quality of information from SM. Conclusions: SM is widely used among GP trainers in China. Most of the participants believed that SM is useful and beneficial on their work, but there are still some problems for them to use SM in health care and medical education.

  • ADHD: is there an app for that? A suitability assessment of apps for the parents of children and young people with ADHD

    Date Submitted: Apr 28, 2017

    Open Peer Review Period: Apr 30, 2017 - Jun 25, 2017

    Background: Attention Deficit Hyperactivity Disorder (ADHD) is a highly co-morbid disorder that can impact hugely on the individual and their family. ADHD is managed via pharmacological and non-pharma...

    Background: Attention Deficit Hyperactivity Disorder (ADHD) is a highly co-morbid disorder that can impact hugely on the individual and their family. ADHD is managed via pharmacological and non-pharmacological interventions. Parents also gain support from parent support groups, which may include chat rooms as well as face-to-face meetings. With the growth of technology use over recent years, parents have access to more resources that ever before. A number of mobile applications (apps) have been developed to help parents manage ADHD in their children and young people. Unfortunately many of these apps are not evidence based and little is known of their suitability for the parents or whether they are helpful in ADHD management. Objective: To explore: 1.parents’ views of the suitability of the top ten listed apps for parents of children and young people (YP) with ADHD. 2. The views of clinicians that work with them on the suitability and value of the apps. Methods: The top ten listed apps specifically targeted towards the parents of children and YP with ADHD were identified via the Google Play (n=5) and iTunes Store (n=5). Interviews were then undertaken with seven parents of children/YP with ADHD and six clinicians who specialise in working with this population to explore their opinions of the ten apps identified and what they believe the key components are for apps to be suitable and valuable for this population. Results: Results: Four themes emerged from clinician and parent interviews: • the importance of relating to the app, • apps that address ADHD related difficulties, • how the apps can affect family relationships, • apps as an educational tool. Two additional themes emerged from the clinician interviews alone; monitoring ADHD symptoms and that apps should be practical. Parents also identified an additional theme; the importance of the technology. Overall, the characteristics of the currently most popular apps did not appear to match well to the views of our sample. Conclusions: Findings suggest that these apps may not fully meet the complex needs of this parent population. Further research is required in order to explore the value of apps with this population and how they can be tailored to their very specific needs. Clinical Trial: N/A

  • Does using plain language and adding communication technology to an existing health related questionnaire help to generate accurate information?

    Date Submitted: Apr 28, 2017

    Open Peer Review Period: Apr 29, 2017 - Jun 24, 2017

    Background: Low educated patients are disadvantaged in using questionnaires within the health care setting, because most health related questionnaires are not taking educational background of patients...

    Background: Low educated patients are disadvantaged in using questionnaires within the health care setting, because most health related questionnaires are not taking educational background of patients into account. The ‘Dutch Talking Touch Screen Questionnaire’ (DTTSQ) was developed in an attempt to meet the needs of low educated patients by using plain language and adding communication technology to an existing paper-based questionnaire. For physical therapists to use the DTTSQ as part of their intake procedure it needs to generate accurate information from all of their patients, independent from educational level. Objective: The aim of this study was to get a first impression of the information that is generated by the DTTSQ. To achieve this goal, response processes of physical therapy patients with diverse levels of education were analyzed. Methods: The qualitative Three Step Test Interview method was used to collect observational data on actual response behavior of twenty-four physical therapy patients with diverse levels of education. The interviews included both think-a-loud and retrospective probing techniques. Results: Twenty of the twenty-four respondents encountered one or more problems during their response process. Almost three quarters of all problems were generated by two of the total of eight questions. No problems were experienced with comprehension of text or wording. No educational group in this research population stood out from the rest in the sort or amount of problems that arose. In spite of the fact that twenty respondents did not respond to each question in the way that was intended by its developers, all respondents recognized themselves in the outcomes of the questionnaire. Conclusions: The results of this study show that the DTTSQ, except for two questions, was reasonably successful in generating the information that it was meant to generate. On the basis of the results of this study developers are recommended to pre-test both the effects of formulation of text and the design of the user-interface on the response processes of the target population during the development of digital(ized) health related questionnaires.

  • Acceptability of Electronic Brief Intervention and Text Messaging for Marijuana Use During Pregnancy

    Date Submitted: Apr 26, 2017

    Open Peer Review Period: Apr 26, 2017 - Jun 21, 2017

    Background: Marijuana is the most widely used illicit substance during pregnancy. Technology-delivered brief interventions and text messaging have shown promise in general and pregnant samples, but ha...

    Background: Marijuana is the most widely used illicit substance during pregnancy. Technology-delivered brief interventions and text messaging have shown promise in general and pregnant samples, but have not yet been applied to marijuana use in pregnancy. Objective: To evaluate, among pregnant women and prenatal care providers, the acceptability of an electronic brief intervention and text messaging plan for marijuana use in pregnancy. Methods: Participants included patients (n= 10) and medical staff (n = 12) from an urban prenatal clinic. Patient-participants were recruited directly during a prenatal care visit. Those who were eligible reviewed the interventions individually and provided quantitative and qualitative feedback regarding software acceptability and helpfulness during a one on one interview with research staff. Provider-participants took part in focus groups in which the intervention materials were reviewed and discussed. Qualitative and focus group feedback was transcribed, coded manually, and classified by category and theme. Results: Patient-participants provided high ratings for satisfaction, with mean ratings for respectfulness, interest, ease of use, and helpfulness ranging between 4.4 and 4.7 on a 1-5 Likert scale. Five of ten participants reported that they preferred working with the program versus their doctor and 9 of 10 said the intervention made them more likely to reduce their marijuana use. Provider-participants received the program favorably, stating the information presented was both relevant and important for their patient population. Conclusions: These findings support the acceptability of electronic brief intervention and text messaging for marijuana use during pregnancy. This, combined with their ease of use and low barrier to initiation, suggests that further evaluation is justified. Clinical Trial: NC702191605