JMIR Publications

JMIR mHealth and uHealth

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

JMIR's Thomson Reuter Impact Factor of 4.636 for 2016

Journal Description

JMIR mHealth and uHealth (JMU, ISSN 2291-5222) is a sister journal of JMIR, the leading eHealth journal. JMIR mHealth and uHealth is indexed in PubMed, PubMed Central, and Science Citation Index Expanded (SCIE), and in June 2017 received an impressive inaugural Impact Factor of 4.636, which ranks the journal #2 (behind JMIR) out of over 20 journals in the medical informatics category indexed by the Science Citation Index Expanded (SCIE) by Thomson Reuters/Clarivate

The journal focusses on health and biomedical applications in mobile and tablet computing, pervasive and ubiquitous computing, wearable computing and domotics.

JMIR mHealth and uHealth publishes since 2013 and was the first mhealth journal in Pubmed. It publishes even faster and has a broader scope with including papers which are more technical or more formative/developmental than what would be published in the Journal of Medical Internet Research

JMIR mHealth and uHealth features a rapid and thorough peer-review process, professional copyediting, professional production of PDF, XHTML, and XML proofs.

JMIR mHealth and uHealth adheres to the same quality standards as JMIR and all articles published here are also cross-listed in the Table of Contents of JMIR, the worlds' leading medical journal in health sciences / health services research and health informatics.


Recent Articles:

  • Source: Image created by the Authors; Copyright: The Authors; URL:; License: Public Domain (CC0).

    User Acceptance of Wrist-Worn Activity Trackers Among Community-Dwelling Older Adults: Mixed Method Study


    Background: Wearable activity trackers are newly emerging technologies with the anticipation for successfully supporting aging-in-place. Consumer-grade wearable activity trackers are increasingly ubiquitous in the market, but the attitudes toward, as well as acceptance and voluntary use of, these trackers in older population are poorly understood. Objective: The aim of this study was to assess acceptance and usage of wearable activity trackers in Canadian community-dwelling older adults, using the potentially influential factors as identified in literature and technology acceptance model. Methods: A mixed methods design was used. A total of 20 older adults aged 55 years and older were recruited from Southwestern Ontario. Participants used 2 different wearable activity trackers (Xiaomi Mi Band and Microsoft Band) separately for each segment in the crossover design study for 21 days (ie, 42 days total). A questionnaire was developed to capture acceptance and experience at the end of each segment, representing 2 different devices. Semistructured interviews were conducted with 4 participants, and a content analysis was performed. Results: Participants ranged in age from 55 years to 84 years (mean age: 64 years). The Mi Band gained higher levels of acceptance (16/20, 80%) compared with the Microsoft Band (10/20, 50%). The equipment characteristics dimension scored significantly higher for the Mi Band (P<.05). The amount a participant was willing to pay for the device was highly associated with technology acceptance (P<.05). Multivariate logistic regression with 3 covariates resulted in an area under the curve of 0.79. Content analysis resulted in the formation of the following main themes: (1) smartphones as facilitators of wearable activity trackers; (2) privacy is less of a concern for wearable activity trackers, (3) value proposition: self-awareness and motivation; (4) subjective norm, social support, and sense of independence; and (5) equipment characteristics matter: display, battery, comfort, and aesthetics. Conclusions: Older adults were mostly accepting of wearable activity trackers, and they had a clear understanding of its value for their lives. Wearable activity trackers were uniquely considered more personal than other types of technologies, thereby the equipment characteristics including comfort, aesthetics, and price had a significant impact on the acceptance. Results indicated that privacy was less of concern for older adults, but it may have stemmed from a lack of understanding of the privacy risks and implications. These findings add to emerging research that investigates acceptance and factors that may influence acceptance of wearable activity trackers among older adults.

  • Source: National Cancer Center; Copyright: Daniel Sone; URL:; License: Public Domain (CC0).

    Uses of Mobile Device Digital Photography of Dermatologic Conditions in Primary Care


    Background: PhotoExam is a mobile app that incorporates digital photographs into the electronic health record (EHR) using iPhone operating system (iOS, Apple Inc)–based mobile devices. Objective: The aim of this study was to describe usage patterns of PhotoExam in primary care and to assess clinician-level factors that influence the use of the PhotoExam app for teledermatology (TD) purposes. Methods: Retrospective record review of primary care patients who had one or more photos taken with the PhotoExam app between February 16, 2015 to February 29, 2016 were reviewed for 30-day outcomes for rates of dermatology consult request, mode of dermatology consultation (curbside phone consult, eConsult, and in-person consult), specialty and training level of clinician using the app, performance of skin biopsy, and final pathological diagnosis (benign vs malignant). Results: During the study period, there were 1139 photo sessions on 1059 unique patients. Of the 1139 sessions, 395 (34.68%) sessions documented dermatologist input in the EHR via dermatology curbside consultation, eConsult, and in-person dermatology consult. Clinicians utilized curbside phone consults preferentially over eConsults for TD. By clinician type, nurse practitioners (NPs) and physician assistants (PAs) were more likely to utilize the PhotoExam for TD as compared with physicians. By specialty type, pediatric clinicians were more likely to utilize the PhotoExam for TD as compared with family medicine and internal medicine clinicians. A total of 108 (9.5%) photo sessions had a biopsy performed of the photographed site. Of these, 46 biopsies (42.6%) were performed by a primary care clinician, and 27 (25.0%) biopsies were interpreted as a malignancy. Of the 27 biopsies that revealed malignant findings, 6 (22%) had a TD consultation before biopsy, and 10 (37%) of these biopsies were obtained by primary care clinicians. Conclusions: Clinicians primarily used the PhotoExam for non-TD purposes. Nurse practitioners and PAs utilized the app for TD purposes more than physicians. Primary care clinicians requested curbside dermatology consults more frequently than dermatology eConsults.

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

    Electronic Brief Intervention and Text Messaging for Marijuana Use During Pregnancy: Initial Acceptability of Patients and Providers


    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: The objective of the study was 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 5-point Likert scale. Of the 10 participants, 5 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: The 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 in a randomized trial is appropriate.

  • The first page of DAY 1 Intervention of the study. Source: Image created by the Authors; Copyright: The Authors; URL:; License: Creative Commons Attribution (CC-BY).

    Mobile Phone Multilevel and Multimedia Messaging Intervention for Breast Cancer Screening: Pilot Randomized Controlled Trial


    Background: Despite the increasing breast cancer incidence and mortality rates, Korean American immigrant women have one of the lowest rates of breast cancer screening across racial groups in the United States. Mobile health (mHealth), defined as the delivery of health care information or services through mobile communication devices, has been utilized to successfully improve a variety of health outcomes. Objective: This study adapted the principles of mHealth to advance breast cancer prevention efforts among Korean American immigrant women, an underserved community. Methods: Using a randomized controlled trial design, 120 Korean American women aged 40 to 77 years were recruited and randomly assigned to either the mMammogram intervention group (n=60) to receive culturally and personally tailored multilevel and multimedia messages through a mobile phone app along with health navigator services or the usual care control group (n=60) to receive a printed brochure. Outcome measures included knowledge, attitudes, and beliefs about breast cancer screening, readiness for mammography, and mammogram receipt. The feasibility and acceptability of the mMammogram intervention was also assessed. Results: The intervention group showed significantly greater change on scores of knowledge of breast cancer and screening guidelines (P=.01). The intervention group also showed significantly greater readiness for mammography use after the intervention compared with the control group. A significantly higher proportion of women who received the mMammogram intervention (75%, 45/60) completed mammograms by the 6-month follow-up compared with the control group (30%, 18/60; P<.001). In addition, the intervention group rated satisfaction with the intervention (P=.003), effectiveness of the intervention (P<.001), and increase of knowledge on breast cancer and screenings (P=.001) significantly higher than the control group. Conclusions: A mobile phone app–based intervention combined with health navigator service was a feasible, acceptable, and effective intervention mechanism to promote breast cancer screening in Korean American immigrant women. A flexible, easily tailored approach that relies on recent technological advancements can reach underserved and hard-to-recruit populations that bear disproportionate cancer burdens. Trial Registration: NCT01972048; (Archived by WebCite at

  • Landmarks on frontal and profile views. Source: Figure 2 from; Copyright: the authors; License: Creative Commons Attribution (CC-BY).

    Obstructive Sleep Apnea in Women: Study of Speech and Craniofacial Characteristics


    Background: Obstructive sleep apnea (OSA) is a common sleep disorder characterized by frequent cessation of breathing lasting 10 seconds or longer. The diagnosis of OSA is performed through an expensive procedure, which requires an overnight stay at the hospital. This has led to several proposals based on the analysis of patients’ facial images and speech recordings as an attempt to develop simpler and cheaper methods to diagnose OSA. Objective: The objective of this study was to analyze possible relationships between OSA and speech and facial features on a female population and whether these possible connections may be affected by the specific clinical characteristics in OSA population and, more specifically, to explore how the connection between OSA and speech and facial features can be affected by gender. Methods: All the subjects are Spanish subjects suspected to suffer from OSA and referred to a sleep disorders unit. Voice recordings and photographs were collected in a supervised but not highly controlled way, trying to test a scenario close to a realistic clinical practice scenario where OSA is assessed using an app running on a mobile device. Furthermore, clinical variables such as weight, height, age, and cervical perimeter, which are usually reported as predictors of OSA, were also gathered. Acoustic analysis is centered in sustained vowels. Facial analysis consists of a set of local craniofacial features related to OSA, which were extracted from images after detecting facial landmarks by using the active appearance models. To study the probable OSA connection with speech and craniofacial features, correlations among apnea-hypopnea index (AHI), clinical variables, and acoustic and facial measurements were analyzed. Results: The results obtained for female population indicate mainly weak correlations (r values between .20 and .39). Correlations between AHI, clinical variables, and speech features show the prevalence of formant frequencies over bandwidths, with F2/i/ being the most appropriate formant frequency for OSA prediction in women. Results obtained for male population indicate mainly very weak correlations (r values between .01 and .19). In this case, bandwidths prevail over formant frequencies. Correlations between AHI, clinical variables, and craniofacial measurements are very weak. Conclusions: In accordance with previous studies, some clinical variables are found to be good predictors of OSA. Besides, strong correlations are found between AHI and some clinical variables with speech and facial features. Regarding speech feature, the results show the prevalence of formant frequency F2/i/ over the rest of features for the female population as OSA predictive feature. Although the correlation reported is weak, this study aims to find some traces that could explain the possible connection between OSA and speech in women. In the case of craniofacial measurements, results evidence that some features that can be used for predicting OSA in male patients are not suitable for testing female population.

  • uMotif App (montage). Source: The Authors /; Copyright: JMIR Publications; URL:; License: Creative Commons Attribution (CC-BY).

    Recruitment and Ongoing Engagement in a UK Smartphone Study Examining the Association Between Weather and Pain: Cohort Study


    Background: The huge increase in smartphone use heralds an enormous opportunity for epidemiology research, but there is limited evidence regarding long-term engagement and attrition in mobile health (mHealth) studies. Objective: The objective of this study was to examine how representative the Cloudy with a Chance of Pain study population is of wider chronic-pain populations and to explore patterns of engagement among participants during the first 6 months of the study. Methods: Participants in the United Kingdom who had chronic pain (≥3 months) and enrolled between January 20, 2016 and January 29, 2016 were eligible if they were aged ≥17 years and used the study app to report any of 10 pain-related symptoms during the study period. Participant characteristics were compared with data from the Health Survey for England (HSE) 2011. Distinct clusters of engagement over time were determined using first-order hidden Markov models, and participant characteristics were compared between the clusters. Results: Compared with the data from the HSE, our sample comprised a higher proportion of women (80.51%, 5129/6370 vs 55.61%, 4782/8599) and fewer persons at the extremes of age (16-34 and 75+). Four clusters of engagement were identified: high (13.60%, 865/6370), moderate (21.76%, 1384/6370), low (39.35%, 2503/6370), and tourists (25.44%, 1618/6370), between which median days of data entry ranged from 1 (interquartile range; IQR: 1-1; tourist) to 149 (124-163; high). Those in the high-engagement cluster were typically older, whereas those in the tourist cluster were mostly male. Few other differences distinguished the clusters. Conclusions: Cloudy with a Chance of Pain demonstrates a rapid and successful recruitment of a large, representative, and engaged sample of people with chronic pain and provides strong evidence to suggest that smartphones could provide a viable alternative to traditional data collection methods.

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

    Mobile Phone Use in Psychiatry Residents in the United States: Multisite Cross-Sectional Survey Study


    Background: Mobile technology ownership in the general US population and medical professionals is increasing, leading to increased use in clinical settings. However, data on use of mobile technology by psychiatry residents remain unclear. Objective: In this study, our aim was to provide data on how psychiatric residents use mobile phones in their clinical education as well as barriers relating to technology use. Methods: An anonymous, multisite survey was given to psychiatry residents in 2 regions in the United States, including New Orleans and Boston, to understand their technology use. Results: All participants owned mobile phones, and 79% (54/68) used them to access patient information. The majority do not use mobile phones to implement pharmacotherapy (62%, 42/68) or psychotherapy plans (90%, 61/68). The top 3 barriers to using mobile technology in clinical care were privacy concerns (56%, 38/68), lack of clinical guidance (40%, 27/68), and lack of evidence (29%, 20/68). Conclusions: We conclude that developing a technology curriculum and engaging in research could address these barriers to using mobile phones in clinical practice.

  • Source: Flickr; Copyright: Dwight Sipler, adapted by Sander Hermsen; URL:; License: Creative Commons Attribution + Noncommercial (CC-BY-NC).

    Determinants for Sustained Use of an Activity Tracker: Observational Study


    Background: A lack of physical activity is considered to cause 6% of deaths globally. Feedback from wearables such as activity trackers has the potential to encourage daily physical activity. To date, little research is available on the natural development of adherence to activity trackers or on potential factors that predict which users manage to keep using their activity tracker during the first year (and thereby increasing the chance of healthy behavior change) and which users discontinue using their trackers after a short time. Objective: The aim of this study was to identify the determinants for sustained use in the first year after purchase. Specifically, we look at the relative importance of demographic and socioeconomic, psychological, health-related, goal-related, technological, user experience–related, and social predictors of feedback device use. Furthermore, this study tests the effect of these predictors on physical activity. Methods: A total of 711 participants from four urban areas in France received an activity tracker (Fitbit Zip) and gave permission to use their logged data. Participants filled out three Web-based questionnaires: at start, after 98 days, and after 232 days to measure the aforementioned determinants. Furthermore, for each participant, we collected activity data tracked by their Fitbit tracker for 320 days. We determined the relative importance of all included predictors by using Random Forest, a machine learning analysis technique. Results: The data showed a slow exponential decay in Fitbit use, with 73.9% (526/711) of participants still tracking after 100 days and 16.0% (114/711) of participants tracking after 320 days. On average, participants used the tracker for 129 days. Most important reasons to quit tracking were technical issues such as empty batteries and broken trackers or lost trackers (21.5% of all Q3 respondents, 130/601). Random Forest analysis of predictors revealed that the most influential determinants were age, user experience–related factors, mobile phone type, household type, perceived effect of the Fitbit tracker, and goal-related factors. We explore the role of those predictors that show meaningful differences in the number of days the tracker was worn. Conclusions: This study offers an overview of the natural development of the use of an activity tracker, as well as the relative importance of a range of determinants from literature. Decay is exponential but slower than may be expected from existing literature. Many factors have a small contribution to sustained use. The most important determinants are technical condition, age, user experience, and goal-related factors. This finding suggests that activity tracking is potentially beneficial for a broad range of target groups, but more attention should be paid to technical and user experience–related aspects of activity trackers.

  • Preparing to perform the testing protocol of the 30-second Chair Stand Test using the developed iPhone app. Source: Image created by the Authors; Copyright: The Authors; URL:; License: Creative Commons Attribution (CC-BY).

    iPhone Sensors in Tracking Outcome Variables of the 30-Second Chair Stand Test and Stair Climb Test to Evaluate Disability: Cross-Sectional Pilot Study


    Background: Performance tests are important to characterize patient disabilities and functional changes. The Osteoarthritis Research Society International and others recommend the 30-second Chair Stand Test and Stair Climb Test, among others, as core tests that capture two distinct types of disability during activities of daily living. However, these two tests are limited by current protocols of testing in clinics. There is a need for an alternative that allows remote testing of functional capabilities during these tests in the osteoarthritis patient population. Objective: Objectives are to (1) develop an app for testing the functionality of an iPhone’s accelerometer and gravity sensor and (2) conduct a pilot study objectively evaluating the criterion validity and test-retest reliability of outcome variables obtained from these sensors during the 30-second Chair Stand Test and Stair Climb Test. Methods: An iOS app was developed with data collection capabilities from the built-in iPhone accelerometer and gravity sensor tools and linked to Google Firebase. A total of 24 subjects performed the 30-second Chair Stand Test with an iPhone accelerometer collecting data and an external rater manually counting sit-to-stand repetitions. A total of 21 subjects performed the Stair Climb Test with an iPhone gravity sensor turned on and an external rater timing the duration of the test on a stopwatch. App data from Firebase were converted into graphical data and exported into MATLAB for data filtering. Multiple iterations of a data processing algorithm were used to increase robustness and accuracy. MATLAB-generated outcome variables were compared to the manually determined outcome variables of each test. Pearson’s correlation coefficients (PCCs), Bland-Altman plots, intraclass correlation coefficients (ICCs), standard errors of measurement, and repeatability coefficients were generated to evaluate criterion validity, agreement, and test-retest reliability of iPhone sensor data against gold-standard manual measurements. Results: App accelerometer data during the 30-second Chair Stand Test (PCC=.890) and gravity sensor data during the Stair Climb Test (PCC=.865) were highly correlated to gold-standard manual measurements. Greater than 95% of values on Bland-Altman plots comparing the manual data to the app data fell within the 95% limits of agreement. Strong intraclass correlation was found for trials of the 30-second Chair Stand Test (ICC=.968) and Stair Climb Test (ICC=.902). Standard errors of measurement for both tests were found to be within acceptable thresholds for MATLAB. Repeatability coefficients for the 30-second Chair Stand Test and Stair Climb Test were 0.629 and 1.20, respectively. Conclusions: App-based performance testing of the 30-second Chair Stand Test and Stair Climb Test is valid and reliable, suggesting its applicability to future, larger-scale studies in the osteoarthritis patient population.

  • Source: Pixabay; Copyright: Steve Buissinne; URL:; License: Public Domain (CC0).

    A New Tool for Nutrition App Quality Evaluation (AQEL): Development, Validation, and Reliability Testing


    Background: The extensive availability and increasing use of mobile apps for nutrition-based health interventions makes evaluation of the quality of these apps crucial for integration of apps into nutritional counseling. Objective: The goal of this research was the development, validation, and reliability testing of the app quality evaluation (AQEL) tool, an instrument for evaluating apps’ educational quality and technical functionality. Methods: Items for evaluating app quality were adapted from website evaluations, with additional items added to evaluate the specific characteristics of apps, resulting in 79 initial items. Expert panels of nutrition and technology professionals and app users reviewed items for face and content validation. After recommended revisions, nutrition experts completed a second AQEL review to ensure clarity. On the basis of 150 sets of responses using the revised AQEL, principal component analysis was completed, reducing AQEL into 5 factors that underwent reliability testing, including internal consistency, split-half reliability, test-retest reliability, and interrater reliability (IRR). Two additional modifiable constructs for evaluating apps based on the age and needs of the target audience as selected by the evaluator were also tested for construct reliability. IRR testing using intraclass correlations (ICC) with all 7 constructs was conducted, with 15 dietitians evaluating one app. Results: Development and validation resulted in the 51-item AQEL. These were reduced to 25 items in 5 factors after principal component analysis, plus 9 modifiable items in two constructs that were not included in principal component analysis. Internal consistency and split-half reliability of the following constructs derived from principal components analysis was good (Cronbach alpha >.80, Spearman-Brown coefficient >.80): behavior change potential, support of knowledge acquisition, app function, and skill development. App purpose split half-reliability was .65. Test-retest reliability showed no significant change over time (P>.05) for all but skill development (P=.001). Construct reliability was good for items assessing age appropriateness of apps for children, teens, and a general audience. In addition, construct reliability was acceptable for assessing app appropriateness for various target audiences (Cronbach alpha >.70). For the 5 main factors, ICC (1,k) was >.80, with a P value of <.05. When 15 nutrition professionals evaluated one app, ICC (2,15) was .98, with a P value of <.001 for all 7 constructs when the modifiable items were specified for adults seeking weight loss support. Conclusions: Our preliminary effort shows that AQEL is a valid, reliable instrument for evaluating nutrition apps’ qualities for clinical interventions by nutrition clinicians, educators, and researchers. Further efforts in validating AQEL in various contexts are needed.

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

    Posttraumatic Stress Disorder and Mobile Health: App Investigation and Scoping Literature Review


    Background: Posttraumatic stress disorder (PTSD) is a prevalent mental health issue among veterans. Access to PTSD treatment is influenced by geographic (ie, travel distance to facilities), temporal (ie, time delay between services), financial (ie, eligibility and cost of services), and cultural (ie, social stigma) barriers. Objective: The emergence of mobile health (mHealth) apps has the potential to bridge many of these access gaps by providing remote resources and monitoring that can offer discrete assistance to trauma survivors with PTSD and enhance patient-clinician relationships. In this study, we investigate the current mHealth capabilities relevant to PTSD. Methods: This study consists of two parts: (1) a review of publicly available PTSD apps designed to determine the availability of PTSD apps, which includes more detailed information about three dominant apps and (2) a scoping literature review performed using a systematic method to determine app usage and efforts toward validation of such mHealth apps. App usage relates to how the end users (eg, clinicians and patients) are interacting with the app, whereas validation is testing performed to ensure the app’s purpose and specifications are met. Results: The results suggest that though numerous apps have been developed to aid in the diagnosis and treatment of PTSD symptoms, few apps were designed to be integrated with clinical PTSD treatment, and minimal efforts have been made toward enhancing the usability and validation of PTSD apps. Conclusions: These findings expose the need for studies relating to the human factors evaluation of such tools, with the ultimate goal of increasing access to treatment and widening the app adoption rate for patients with PTSD.

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

    Mobile Technology Use Across Age Groups in Patients Eligible for Cardiac Rehabilitation: Survey Study


    Background: Emerging evidence indicates mobile technology–based strategies may improve access to secondary prevention and reduce risk factors in cardiac patients. However, little is known about cardiac patients’ use of mobile technology, particularly for health reasons and whether the usage varies across patient demographics. Objective: This study aimed to describe cardiac patients’ use of mobile technology and to determine variations between age groups after adjusting for education, employment, and confidence with using mobile technology. Methods: Cardiac patients eligible for attending cardiac rehabilitation were recruited from 9 hospital and community sites across metropolitan and rural settings in New South Wales, Australia. Participants completed a survey on the use of mobile technology devices, features used, confidence with using mobile technology, willingness and interest in learning, and health-related use. Results: The sample (N=282) had a mean age of 66.5 (standard deviation [SD] 10.6) years, 71.9% (203/282) were male, and 79.0% (223/282) lived in a metropolitan area. The most common diagnoses were percutaneous coronary intervention (33.3%, 94/282) and myocardial infarction (22.7%, 64/282). The majority (91.1%, 257/282) used at least one type of technology device, 70.9% (200/282) used mobile technology (mobile phone/tablet), and 31.9% (90/282) used all types. Technology was used by 54.6% (154/282) for health purposes, most often to access information on health conditions (41.4%, 117/282) and medications (34.8%, 98/282). Age had an important independent association with the use of mobile technology after adjusting for education, employment, and confidence. The youngest group (<56 years) was over 4 times more likely to use any mobile technology than the oldest (>69 years) age group (odds ratio [OR] 4.45, 95% CI 1.46-13.55), 5 times more likely to use mobile apps (OR 5.00, 95% CI 2.01-12.44), and 3 times more likely to use technology for health-related reasons (OR 3.31, 95% CI 1.34-8.18). Compared with the older group, the middle age group (56-69 years) was more than twice as likely to use any mobile technology (OR 2.42, 95% CI 1.27-4.59) and mobile technology for health-related purposes (OR 1.92, 95% CI 1.04-3.53). Participants who had completed high school were twice as likely to use mobile technology (OR 2.62, 95% CI 1.45-4.70), mobile apps (OR 2.05, 95% CI 1.09-3.84), and mobile technology for health-related reasons (OR 5.09, 95% CI 2.89-8.95) than those who had not completed high school. Associations were also present between participants living in metropolitan areas and mobile technology use (OR 1.07, 95% CI 1.07-4.24) and employment and mobile app use (OR 2.72, 95% CI 1.44-5.140). Conclusions: Mobile technology offers an important opportunity to improve access to secondary prevention for cardiac patients, particularly when modified to suit subgroups. High levels of mobile technology use and health motivation need to be harnessed for secondary prevention.

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    Date Submitted: Nov 17, 2017

    Open Peer Review Period: Nov 17, 2017 - Nov 25, 2017

    Background: Multiple sclerosis (MS) is one of the world’s most common neurologic disorders. Fatigue is one of most common symptoms that persons with MS experience, having significant impact on their...

    Background: Multiple sclerosis (MS) is one of the world’s most common neurologic disorders. Fatigue is one of most common symptoms that persons with MS experience, having significant impact on their quality of life and limiting their activity levels. Self-management strategies are used to support them in the care of their health. Mobile health (mHealth) solutions are a way to offer persons with chronic conditions tools to successfully manage their symptoms and problems. Gamification is a current trend among mHealth apps used to create engaging user experiences and is suggested to be effective for behavioral change. To be effective, mHealth solutions need to be designed to specifically meet the intended audience needs. User-centered design (UCD) is a design philosophy that proposes placing end-users’ needs and characteristics in the center of software design and development and involving users early in the different phases of the software life cycle. There is a current gap in mHealth apps for persons with MS which presents an interesting area to explore. Objective: The purpose of this study is to describe the design and evaluation process of a gamified mHealth solution for behavioral change in persons with MS using user-centered design. Methods: Building on previous work of our team where we identified needs, barriers and facilitators for mHealth apps for persons with MS; we followed UCD to iteratively design and evaluate a mobile application prototype aimed to help persons with MS self-manage their fatigue. Design decisions were evidence-driven and guided by behavioral change models. Usability was assessed through inspection methods using Nielsen’s heuristic evaluation. Results: The mHealth solution More Stamina was designed. It is a task organization tool designed to help persons with MS manage their energy to minimize the impact of fatigue in their day to day life. The tool acts as a to-do list where users can input tasks in a simple manner and assign Stamina Credits, a representation of perceived effort, to the task to help energy management and energy profiling. The app also features personalization and positive feedback. The design process gave way to relevant lessons to the design of a gamified behavioral change mHealth application like the importance of metaphors in concept design, negotiate requirements with the behavioral change models constructs, and tailoring of gamified experiences among others. Several usability problems were discovered during heuristic evaluation and guided the iterative design of our solution. Conclusions: In this paper, we designed an application targeted for helping persons with MS in their fatigue management needs. We illustrate how user-centered design can help in designing mobile health applications, and the benefits and challenges that designers might face when using this approach. We followed a design through research process where user requirements were obtained considering stakeholders’ perspectives and the available scientific literature; design decisions were driven by evidence and behavioral change models resulting in an application targeted for helping persons with MS in their fatigue management needs.

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    Date Submitted: Nov 10, 2017

    Open Peer Review Period: Nov 11, 2017 - Jan 6, 2018

    Background: Personalized blood glucose prediction for diabetes patients is an important goal that is pursued by many researchers worldwide. Despite many proposals for blood glucose prediction algorith...

    Background: Personalized blood glucose prediction for diabetes patients is an important goal that is pursued by many researchers worldwide. Despite many proposals for blood glucose prediction algorithms, only a few projects are dedicated to the development of complete recommender system infrastructures that incorporate blood glucose prediction algorithms for diabetes patients. The development and implementation of such a system aided by mobile technology is of particular interest to patients with gestational diabetes mellitus (GDM), especially considering the significant importance of quickly achieving adequate blood glucose control for these patients in a short period, i.e., during pregnancy, and a typically higher acceptance rate for mHealth solutions for short-to-mid-term usage. Objective: This study was conducted with the objective of developing an infrastructure comprising data processing algorithms, blood glucose prediction models, and an appropriate mobile application for patients’ electronic records management to guide blood glucose prediction-based personalized recommendations for GDM patients. Methods: The prediction results by the models for blood glucose levels one hour after food intake were RMSE: 0.87 mmol/L, MAE: 0.69 mmol/L, and MAPE: 12.8%, which correspond to an adequate prediction accuracy for blood glucose control decisions. Results: The implemented software and methods were used in a clinical study, in which 62 (49 GDM / 13 healthy) participants were involved in a 1-week monitoring trial, in which they used the mobile app to track records on their meals and self-measurements of BG, and CGMS for continuous blood glucose monitoring. The data on 909 food intakes and corresponding postprandial blood glucose curve as well as the set of patients’ characteristics (such as HbA1C, BMI, age, lifestyle parameters etc.) were selected as inputs for the blood glucose prediction model. The model predicting blood glucose levels one hour after food intake showed the result of RMSE 0.87 mmol/L, MAE 0.69 mmol/L, MAPE 12.8%, which corresponds to an adequate prediction accuracy for blood glucose control decisions. Conclusions: A mobile application for collection and processing of relevant data, appropriate software for CGMS signals processing, and blood glucose prediction models were developed for a recommender system. The developed system may help to improve blood glucose control in patients with GDM; this will be the subject of evaluation in a subsequent study. Clinical Trial: АААА-А16-116012210374-0 at

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    Open Peer Review Period: Nov 9, 2017 - Jan 4, 2018

    Background: Tobacco smoking is a major risk factor for a wide range of respiratory and circulatory diseases in active and passive smokers. Well-designed campaigns are raising awareness to the problem...

    Background: Tobacco smoking is a major risk factor for a wide range of respiratory and circulatory diseases in active and passive smokers. Well-designed campaigns are raising awareness to the problem and an increasing number of smokers seek medical assistance to quit their habit. In this context, there is the need to develop mHealth Apps that assist and manage large smoke quitting programs in efficient and economic ways. Objective: To analyse and evaluate the results of using a mobile application (TControl) on a smoking cessation program. Methods: Analysis of 197 patients were we wanted to find out the effectiveness of the application on decreasing the number of relapses and the success cases of patients using it. Results: Actually, the difference between using TControl or not have been the number of relapses which is way lower than not using it, and it could considerably retain more patients on the treatment than the conventional treatment. Conclusions: TControl was designed and successfully implemented in the context of an anti-smoking treatment in a public hospital in Catalunya, Spain. TControl can be successfully deployed in medical centers to keep track of smoke-quitting patients.

  • Development of a Comprehensive Mobile Care System for Patients with Advanced Gastrointestinal Cancer: The Life Manager App

    Date Submitted: Nov 8, 2017

    Open Peer Review Period: Nov 9, 2017 - Jan 4, 2018

    Background: Chemotherapy is the most common treatment plan for individuals with advanced cancer. Although this treatment improves the survival of patients, their quality of life is still poor because...

    Background: Chemotherapy is the most common treatment plan for individuals with advanced cancer. Although this treatment improves the survival of patients, their quality of life is still poor because of its adverse effects. Mobile health applications (apps) have emerged as an alternative in managing this condition. However, only few apps have self-monitoring features, and they are not standardized and validated by health experts. Objective: This study aimed to develop a comprehensive mobile care system with self-monitoring features that can be useful in providing information and facilitating communication in patients with advanced cancer. Methods: In this context, the establishment of a comprehensive mobile health management system was divided into three steps. First, the service scope was set up, and the measurement tools were standardized. Second, the service flow of the mobile care system was organized. Third, the mobile app (Life Manager) was developed. Results: The general services can be used for the management of chemotherapy side effect, nutrition, and rehabilitation. To effectively identify patient symptoms using the mobile app, we used the modified PROCTCAE (Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events) questionnaire to determine the patients’ condition. To measure the clinical effect of the mobile app, the following survey tools were used: PGSGA (Scored Patient-Generated Subjective Global Assessment), distress, EORTC-QLQ (European Organisation for Research and Treatment of Cancer - Quality-of-Life questionnaire), IPAQ-SF (International Physical Activity Questionnaire-short form), LARS score (Low anterior resection syndrome score), and measurement of satisfaction. The service protocol is based on the medical information that is communicated by a patient to a medical provider in the hospital. A patient can enter a question or information anytime and anywhere using the app service, and they can obtain real-time and accurate health information from medical personnel based on clinical evidence. Healthcare providers meet the participants in person to explain the online research service process and the use of the daily-life app with a wearable device in person. Online programs are established based on the patient’s initial information, such as results of physical examination and laboratory tests and health domain. The main themes of the application are: To-do-list, Health information, and In-app-chat service. When a patient logs into the app, the “To-do-list” theme first appears on the screen. The patient can check the “Daily tasks” on this screen. The common contents of the health information consist of drug explanation, general side effects, and countermeasures against the side effects of chemotherapy. Using the “In-app-chat service” the patient can communicate with experts anytime and anywhere. The wearable device that is linked to the app via Bluetooth can measure performed activities. Conclusions: In terms of service flow, a clinical evidence-based care system was established, which can provide high-quality care and run both offline and online. In terms of life-manager app development, a mobile health app with multidisciplinary effects for patients with advanced gastrointestinal cancer patients was created.

  • E-Health as the Next Generation Obstetric Care: a Review of the Literature

    Date Submitted: Nov 2, 2017

    Open Peer Review Period: Nov 3, 2017 - Dec 29, 2017

    Rapid development in digital technology has provided healthcare with numerous devices, systems and services to support daily care by e-health. In the reproductive age, women are particularly frequent...

    Rapid development in digital technology has provided healthcare with numerous devices, systems and services to support daily care by e-health. In the reproductive age, women are particularly frequent users of Internet, social media and smartphone apps. This makes the obstetric patient a prime candidate for e-health supported health care. This review describes the current state of affairs on e-health developments in obstetrical care. We evaluate the effect on healthcare quality, discuss legal and privacy barriers and identify possibilities for future directions. Several studies show that e-health applications in gestational diabetes and mental health are good alternatives to standard practice. Examples are interactive blood glucose management with remote care using smartphones, telephone screening for postnatal depression and web-based cognitive behavioral therapy. A number of applications and exercise programs show a direction towards less gestational weight gain, increase in step count and increase in smoking abstinence. Multiple studies describe novel systems to enable home fetal monitoring with cardiotocography and uterine activity. However, only few studies assess outcomes in terms of fetal monitoring safety and efficacy in high risk pregnancy. Patients and clinicians report good overall satisfaction with new strategies that enable the shift from hospital-centered to patient-centered care. This active involvement of patients to their health has been widely acknowledged to improve commitment to treatment and thus health outcomes. In general, the combination of increased patient empowerment and home pregnancy care could lead to more efficiency and reduction of costs. E-health will continue to grow and this will not be limited to the obstetric department. We accentuate the need for evidence for health outcomes, patient satisfaction and the impact on costs of the possibilities of e-health interventions in obstetric care. The link between this specific group of patients and their digital mindset cannot be ignored.

  • What Predicts Patients’ Adoption of Mobile Health Services in China?

    Date Submitted: Oct 31, 2017

    Open Peer Review Period: Nov 2, 2017 - Dec 28, 2017

    Background: With the increasing concern of Healthy China and the development of information technology, mobile health enables patients access health information and interacting with doctors anytime an...

    Background: With the increasing concern of Healthy China and the development of information technology, mobile health enables patients access health information and interacting with doctors anytime and anywhere. Since the success of mobile health would depend on the adoption of patients, examining patients’ willingness to use it is considered critical. Objective: This study aims to explore the determinants of mobile health services adoption among Chinese patients by an extended TAM with trust and perceived risk. Methods: We conducted a questionnaire-based survey in three large Chinese hospitals, and analyzed the data with structural equation model. Results: The results reveal that the proposed model fits well. Specifically, trust, perceived usefulness and perceived ease of use positively correlate with mobile health services adoption. While, privacy risk and performance risk negatively correlate with the patients’ trust and adoption intention toward mobile health. In addition, age and chronic condition of patients could predict their trust level and adoption intention towards mobile health respectively. Conclusions: We conclude that TAM works for the context of mobile health adoption in general, though the significance has declined. Supplementary to technical factors, trust and perceived risk are critical in explaining mobile health services adoption among Chinese patients.