JMIR mHealth and uHealth
Mobile and tablet apps, ubiquitous and pervasive computing, wearable computing and domotics for health.
JMIR mhealth and uhealth (mobile and ubiquitous health) (JMU, ISSN 2291-5222) is a 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 adheres to the same quality standards as JMIR and all articles published here are also cross-listed in the Table of Contents of JMIR, the worlds' leading medical journal in health sciences / health services research and health informatics.
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Dec 22, 2016
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Latest Submissions Open for Peer-Review:View All Open Peer Review Articles
Beta Testing of a Smartphone Application for WIC-Participating Families with Preschool-Aged Children
Date Submitted: Feb 9, 2017
Open Peer Review Period: Feb 9, 2017 - Apr 6, 2017
Background: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in the U.S. provides free supplemental healthy foods and nutrition education to limited-resource, nutritio...
Background: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in the U.S. provides free supplemental healthy foods and nutrition education to limited-resource, nutritionally at-risk mothers, infants, and children under age 5. Childhood obesity prevalence is higher among low-income preschool children participating in the WIC program compared to children in the general population in the U.S. The Children Eating Well (CHEW) smartphone application (“app”) was developed in English and Spanish for WIC-participating families with preschool-aged children as a home-based intervention to reinforce WIC nutrition education. Objective: This paper describes the development and beta testing of the CHEW smartphone app. The objective of beta testing was to test the CHEW app prototype with target users, focusing on usage, usability, and perceived benefits of the app. Methods: The goals of the CHEW app were to make the WIC shopping experience easier, maximize WIC benefit redemption, and improve parent snack feeding practices. The CHEW app prototype consisted of: (1) WIC shopping tools, including a barcode scanner and calculator tools for the cash value voucher for purchasing fruits and vegetables, and (2) nutrition education focused on healthy snacks and beverages, including a Yummy Snack Gallery and Healthy Snacking Tips. Mothers of 63 black and Hispanic WIC-participating children ages 2-4 tested the CHEW app prototype for three months and completed follow-up interviews. Results: Over three months, 81% reported using the WIC shopping tools, 68% used the snack gallery, 75% viewed the snacking tips, and 91% used at least one of these features. Indicators of usability, ranging from 1 (lowest) to 5 (highest), were rated moderately high to high (3.81-4.40) for the WIC shopping tools. Mothers of black children rated the helpfulness of the produce calculators lower than mothers of Hispanic children (3.86 vs. 4.53, P=.04). The WIC shopping tools scored high on most of the perceived benefits for targeted behaviors (4.10-4.51 on scale of 1 to 5), with the exception of helping them to spend more on the cash value voucher (3.57). Mothers who used the Yummy Snack Gallery and Healthy Snacking Tips consistently scored them high on all dimensions of usability (4.34-4.95), with relatively lower scores for perceived benefits (3.20-3.96). For the healthy snacking tips, seven of the eight perceived benefit items were lower for mothers of black children, ranging 3.17-3.73, compared to mothers of Hispanic children, ranging 4.30-4.68 (all P<.05). Conclusions: The prototype study successfully demonstrated feasibility of using the CHEW app prototype with mothers of WIC-enrolled black and Hispanic preschool-aged children, with moderate to high usability and perceived benefits for the three main components of the app. Future versions with enhanced shopping tools and expanded nutrition content should be implemented in WIC clinics to evaluate adoption and behavioral outcomes.
Controlling Your "App"etite: How Diet and Nutrition-Related Mobile Applications Lead to Behavior Change
Date Submitted: Jan 26, 2017
Open Peer Review Period: Jan 26, 2017 - Mar 23, 2017
Background: In recent years, obesity in America has become a serious public health crisis. While the problem of obesity is being addressed through a variety of strategies, the use of mobile applicatio...
Background: In recent years, obesity in America has become a serious public health crisis. While the problem of obesity is being addressed through a variety of strategies, the use of mobile applications (apps) is a relatively new development that could prove useful in helping people to develop healthy dietary habits. While such apps might lead to healthy behavior change, especially when relevant behavior change theory constructs are integrated into them, the mechanisms by which those apps facilitate behavior change are largely unknown. Objective: The purpose of this study is to identify which behavior change mechanisms are associated with use of diet- and nutrition-related health apps and whether the use of diet- and nutrition-related apps is associated with health behavior change. Methods: A cross-sectional survey was administered to a total of 217 participants. Participants responded to questions on demographics, use of diet/nutrition app(s) in the past 6 months, engagement and likeability of app(s), and changes in the participant’s dietary behaviors. Regression analysis was used to identify factors associated with reported changes in theory and separately for reported changes in actual behavior, after controlling for potential confounding variables. Results: The majority of study participants agreed or strongly agreed with statements regarding app use increasing their motivation to eat a healthy diet, improving their self-efficacy, and increasing their desire to set and achieve health diet goals. The majority of participants strongly agreed that using diet/nutrition apps led to changes in their behavior, namely increases in actual goal setting to eat a healthy diet (58.5%), increases in their frequency of eating healthy foods (57.6%), and increases in their consistency of eating healthy foods (54.4%). Participants also responded favorably to questions related to engagement and likability of diet/nutrition apps. A number of predictors were also positively associated with diet-related behavior change. Theory (p<.001), app engagement (p<.001), app use (p<.003), and education (p<.010) were all positively associated with behavior change. Conclusions: Study findings indicate that the use of diet/nutrition apps is associated with diet-related behavior change. Hence, diet- and nutrition-related apps that focus on improving motivation, desire, self-efficacy, attitudes, knowledge, and goal setting may be particularly useful. As the number of diet- and nutrition-related apps continues to grow, developers should consider integrating appropriate theoretical constructs for health behavior change into newly developed mobile apps.
Incorporation of a stress reducing mobile app in the care of patients with type 2 diabetes
Date Submitted: Jan 25, 2017
Open Peer Review Period: Jan 25, 2017 - Mar 22, 2017
Background: Emotional stress has been shown to contribute to the onset, progression and control of type 2 diabetes (T2D). Stress management and biofeedback assisted relaxation have been shown to impro...
Background: Emotional stress has been shown to contribute to the onset, progression and control of type 2 diabetes (T2D). Stress management and biofeedback assisted relaxation have been shown to improve glycemic control. Use of a mobile app for stress management may enhance the scalability of such an approach. Objective: The study was designed to assess the effect of using a mobile app of biofeedback assisted relaxation on weight, blood pressure and glycemic measures of patients with T2D. Methods: Adult patients with type 2 diabetes and inadequate glycemic control (HbA1c>7.5%) were recruited from the outpatient diabetes clinic. Baseline weight, blood pressure, HbA1c, fasting plasma glucose, triglycerides and 7-point self-monitoring of blood glucose were measured. Patients were provided with a stress reducing, biofeedback mobile app and instructed to use it three times a day. The mobile app - Serenita© - is an interactive relaxation app based on acquiring a photoplethysmography signal from the Smartphone's camera lens, where the user places his finger. The app collects information regarding the user's blood flow, heart rate and heart rate variability and provides real-time feedback and individualized breathing instructions in order to modulate the stress level. All clinical and biochemical measures were repeated at 8 and 16 weeks of the study. The primary outcome was changes in measures at 8 weeks. Results: Seven patients completed 8 weeks of the study, and four completed 16 weeks. At week 8 weight dropped by an average of 4.0±4.3 kg; systolic blood pressure by 8.6±18.6 mmHg; HbA1c by 1.3±1.6%; fasting plasma glucose by 4.3±4.2 mmol/l and serum triglycerides were unchanged. Conclusions: Stress reduction using a mobile app based on biofeedback has the potential of improving glycemic control, weight and blood pressure. Clinical Trial: 02691273
Usability of a culturally informed mHealth intervention for anxiety and depression: Feedback from young sexual minority men
Date Submitted: Jan 24, 2017
Open Peer Review Period: Jan 25, 2017 - Mar 22, 2017
Background: To date, we are aware of no interventions for anxiety and depression developed as smartphone applications (apps) and tailored to young sexual minority men, a group especially at risk for a...
Background: To date, we are aware of no interventions for anxiety and depression developed as smartphone applications (apps) and tailored to young sexual minority men, a group especially at risk for anxiety and depression. We developed TODAY!, a culturally informed smartphone intervention for young men who are attracted to men and who have clinically significant symptoms of anxiety and/or depression. The core of the intervention consists of daily psychoeducation informed by transdiagnostic cognitive-behavioral therapy and a set of tools to facilitate putting these concepts into action, with regular mood ratings that result in tailored feedback (e.g. tips for current distress, visualizations of mood by context). Objective: We conducted usability testing to understand how young sexual minority men interact with the app, to inform later stages of intervention development. Methods: Participants (n = 9) were young sexual minority men aged 18-20 (M = 19.00, SD = 0.71; 44% Black, 44% White, 11.1% Latino), who endorsed at least mild depression and anxiety symptoms. Participants were recruited via flyers, emails to college LGBT organizations, online advertisements, another researcher’s database of sexual minority youth interested in research participation, and word of mouth. During recorded interviews, participants were asked to think out loud while interacting with the TODAY! app on a smartphone. Feedback identified from these recordings and from associated field notes were subjected to analysis. To aid interpretation of results, methods and results are reported according to the consolidated criteria for reporting qualitative research (COREQ). Results: Thematic analysis of usability feedback revealed six broad recurring themes: 1) Functionality (e.g., highlight new material when available); 2) Personalization (e.g., more tailored feedback); 3) Presentation (e.g., keep content brief); 4) Aesthetics, (e.g., use brighter colors); 5) LGBT/Youth Content (e.g., add content about coming out); and 6) Barriers to Use (e.g., perceiving psychoeducation as homework). Conclusions: Feedback from usability testing was vital to understanding what young sexual minority men desire from a smartphone intervention for anxiety and depression and was used to inform the ongoing development of such an intervention.
Design of Mobile Health Tools to Promote Goal Achievement in Self-Management Tasks
Date Submitted: Jan 20, 2017
Open Peer Review Period: Jan 21, 2017 - Mar 18, 2017
Background: Goal setting within rehabilitation is a common practice ultimately geared toward helping patients make functional progress. Objective: The purposes of this study were to design a basic goa...
Background: Goal setting within rehabilitation is a common practice ultimately geared toward helping patients make functional progress. Objective: The purposes of this study were to design a basic goal setting module within a mobile health system and to determine what functionality could be added to this goal setting module to support the complex goal setting routines desired by patients. Methods: A total of 750 goals were analyzed from patients with spina bifida and spinal cord injury enrolled in a wellness program. Results: A goal setting module was successfully developed. Checklists, data tracking and fact finding tools were identified as three functionalities that could be added to existing mobile health systems to support goal setting and achievement. Additional lessons learned provide a detailed list of recommendations for software development. Conclusions: Goals commonly set by individuals with disabilities can be supported by innovative mobile health tools.
Semantic location from mobile phones: Going beyond GPS
Date Submitted: Jan 10, 2017
Open Peer Review Period: Jan 16, 2017 - Mar 13, 2017
Background: Is someone at home, at their friend’s place, at a restaurant, or enjoying the great outdoors? Knowing the semantic location matters for delivering medical interventions, recommendations,...
Background: Is someone at home, at their friend’s place, at a restaurant, or enjoying the great outdoors? Knowing the semantic location matters for delivering medical interventions, recommendations, and other context-aware services. This knowledge is particularly useful in mental healthcare for monitoring the behavioral indicators of mood states and improving treatment delivery. Local search-and-discovery services such as Foursquare can be used to detect semantic locations based on GPS coordinates, but GPS alone is often inaccurate. Smartphones can also sense other signals, such as movement, light, and sound, and using these signals promises to lead to a better estimation of the semantic location. Objective: To examine the ability of smartphone sensors in estimating semantic locations, and to evaluate the relationship between semantic location visit patterns and mental health. Methods: 208 participants across the United States were asked to log the type of locations they visited daily, including home and work, for a period of 6 weeks, while their phone sensor data was recorded. Based on the sensor data and Foursquare queries, we trained models to predict these logged locations, and evaluated their prediction accuracy on participants not seen by the model. We also evaluated the relationship between the amount of time spent in each semantic location and depression and anxiety, assessed at the baseline, in the middle, and at the end of the study. Results: While Foursquare queries detected the true semantic locations with an average area under the curve (AUC) of 0.60, using phone sensor data increased the AUC to 0.72. When we used Foursquare and sensor data together, the AUC further increased to 0.78. We found a few significant relationships between the time spent in certain locations and depression and anxiety, although these relationships were not consistent. Conclusions: The accuracy of location services such as Foursquare can significantly benefit from using phone sensor data besides their location databases. Our results suggest that the nature of the places we go to explains only a small part of the variance of anxiety and depression.