JMIR mHealth and uHealth

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

Don’t Forget the Doctor: Key Opinion Leader Preferences on the Development of mHealth Tools for IBD Patients

Background: Inflammatory Bowel Disease (IBD) encompasses a number of disorders of the gastrointestinal tract. Treatment for IBD is lifelong and complex, and the majority of IBD patients seek information on the Internet. However, research has found existing digital resources to be of questionable quality, and that patients find content lacking. Gastroenterologists are front-line sources of information for North American IBD patients, but their opinions and preferences for digital content, design, and utility have not been investigated. Objective: The objective of this study is to systematically explore Key Opinion Leader (KOL) perceptions of, and design preferences, for mHealth tools. Methods: To critically assess these issues and elicit expert feedback, consensus was sought in a closed meeting with seven Canadian Key Opinion Leaders (KOLs) in the field of Gastroenterology. Using a qualitative approach, the meeting was audio recorded and field notes taken. To synthesize results, an anonymous questionnaire was collected at the end of the session. KOL-led discussion themes included methodological approaches to non-adherence, concordance, patient-centricity, and attributes of digital tools that would be actively supported and promoted by Gastroenterologists Results: Survey results indicated that 57% (n=4) of KOLs had experienced patients bringing digital resources to a visit, but 71% (n=5) found digital patient resources to be inaccurate or irrelevant. All KOLs agreed that digital tools were of increasing importance, and could be leveraged to aid in consultations and save time. When asked to assess digital attributes that they would be confident to refer patients to, 100% (n=7) indicated that the inclusion of evidence-based facts were of greatest importance. Patient peer support networks were deemed an asset, but only if closely monitored by experts. When asked about interventions 85% (n=6) preferred tools that addressed a mix of compliance and concordance, and 14% (n=1) supported the development of tools that focused on compliance. KOLs confirmed that they would actively refer patients and other physicians to digital resources. However, while a number of digital IBD tools exist, KOLs would be reluctant to endorse them. Conclusions: To our knowledge this is the first study that systematically explored Gastroenterologists perceptions of, and needs for, mHealth tools. Gastroenterologists appear eager to utilize digital resources that they believe benefit the physician-patient relationship but despite the trend of patient-centric tools that focus on concordance, KOLs would prefer digital tools that highlight compliance. This highlights an issue of disparity in digital health: patients may not use tools that physicians promote, and physicians may not endorse tools that patients need. Further research investigating concordance, and the gap between physician preferences and patient needs, is required

2014-08-17

JMIR mHealth and uHealth (JMU) http://mhealth.jmir.org is now the first #mhealth journal listed in PubMed: http://www.ncbi.nlm.nih.gov/pubmed?term=%22JMIR+Mhealth+Uhealth%22[jour] and PubMed Central: http://www.ncbi.nlm.nih.gov/pmc/journals/2531/ Please follow @JMedInternetRes on Twitter for JMU content updates and sign up for email alerts by creating a profile at http://mhealth.jmir.org/user/profile.

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Journal Description

JMIR mhealth and uhealth (mobile and ubiquitous health) (JMU, ISSN 2291-5222) is a new spin-off journal of JMIR, the leading eHealth journal (Impact Factor 2013: 4.7). The journal focusses on health and biomedical applications in mobile and tablet computing, pervasive and ubiquitous computing, wearable computing and domotics.

JMIR mHealth and uHealth publishes even faster and has a broader scope with including papers which are more technical or more formative/developmental than what would be published in the Journal of Medical Internet Research.
In addition to peer-reviewing paper submissions by researchers, JMIR mHealth and uHealth offers peer-review of medical apps itself (developers can submit an app for peer-review here).

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

JMIR mHealth and uHealth is indexed in PubMed Central/PubMed).

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:

  • Preferences for a Mobile HIV Prevention App for Men Who Have Sex With Men

    Abstract:

    Background: The Centers for Disease Control and Prevention recommends that sexually active men who have sex with men (MSM) in the United States test for human immunodeficiency virus (HIV) at least three times per year, but actual testing frequency is much less frequent. Though mHealth is a popular vehicle for delivering HIV interventions, there are currently no mobile phone apps that target MSM with the specific aim of building an HIV testing plan, and none that focuses on developing a comprehensive prevention plan and link MSM to additional HIV prevention and treatment resources. Previous research has suggested a need for more iterative feedback from the target population to ensure use of these interventions. Objective: The purpose of this study is to understand MSM’s preferences for functionality, format, and design of a mobile phone-based HIV prevention app and to examine MSM’s willingness to use an app for HIV prevention. Methods: We conducted focus group discussions with 38 gay and bisexual men, with two in-person groups in Atlanta, two in Seattle, and one online focus group discussion with gay and bisexual men in rural US regions. These discussions addressed MSM’s general preferences for apps, HIV testing barriers and facilitators for MSM, and ways that an HIV prevention app could address these barriers and facilitators to increase the frequency of HIV testing and prevention among MSM. During focus group discussions, participants were shown screenshots and provided feedback on potential app functions. Results: Participants provided preferences on functionality of the app, including the type and delivery of educational content, the value of interactive engagement, and the importance of social networking as an app component. Participants also discussed preferences on how the language should be framed for the delivery of information, identifying that an app needs to be simultaneously fun and professional. Privacy and altruistic motivation were considered to be important factors in men’s willingness to use a mobile HIV prevention app. Finally, men described the potential impact that a mobile HIV prevention app could have, identifying individual, interpersonal, and community-based benefits. Conclusions: In summary, participants described a comprehensive app that should incorporate innovative ideas to educate and engage men so that they would be motivated to use the app. In order for an app to be useful, it needs to feel safe and trustworthy, which is essential when considering the app’s language and privacy. Participants provided a range of preferences for using an HIV prevention app, including what they felt MSM need with regards to HIV prevention and what they want in order to engage with an app. Making an HIV prevention app enjoyable and usable for MSM is a difficult challenge. However, the usability of the app is vital because no matter how great the intervention, if MSM do not use the app, then it will not be useful.
  • Consumers' Perspectives on National Health Insurance in South Africa: Using a Mobile Health Approach

    Abstract:

    Background: Building an equitable health system is a cornerstone of the World Health Organization (WHO) health system building block framework. Public participation in any such reform process facilitates successful implementation. South Africa has embarked on a major reform in health policy that aims at redressing inequity and enabling all citizens to have equal access to efficient and quality health services. Objective: This research is based on a survey using Mxit as a mobile phone–based social media network. It was intended to encourage comments on the proposed National Health Insurance (NHI) and to raise awareness among South Africans about their rights to free and quality health care. Methods: Data were gathered by means of a public e-consultation, and following a qualitative approach, were then examined and grouped in a theme analysis. The WHO building blocks were used as the conceptual framework in analysis and discussion of the identified themes. Results: Major themes are the improvement of service delivery and patient-centered health care, enhanced accessibility of health care providers, and better health service surveillance. Furthermore, health care users demand stronger outcome-based rather than rule-based indicators of the health system’s governance. Intersectoral solidarity and collaboration between private and public health care providers are suggested. Respondents also propose a code of ethical values for health care professionals to address corruption in the health care system. It is noteworthy that measures for dealing with corruption or implementing ethical values are neither described in the WHO building blocks nor in the NHI. Conclusions: The policy makers of the new health system for South Africa should address the lack of trust in the health care system that this study has exposed. Furthermore, the study reveals discrepancies between the everyday lived reality of public health care consumers and the intended health policy reform.
  • User Preferences and Design Recommendations for an mHealth App to Promote Cystic Fibrosis Self-Management

    Abstract:

    Background: mHealth apps hold potential to provide automated, tailored support for treatment adherence among individuals with chronic medical conditions. Yet relatively little empirical research has guided app development and end users are infrequently involved in designing the app features or functions that would best suit their needs. Self-management apps may be particularly useful for people with chronic conditions like cystic fibrosis (CF) that have complex, demanding regimens. Objective: The aim of this mixed-methods study was to involve individuals with CF in guiding the development of engaging, effective, user-friendly adherence promotion apps that meet their preferences and self-management needs. Methods: Adults with CF (n=16, aged 21-48 years, 50% male) provided quantitative data via a secure Web survey and qualitative data via semi-structured telephone interviews regarding previous experiences using apps in general and for health, and preferred and unwanted features of potential future apps to support CF self-management. Results: Participants were smartphone users who reported sending or receiving text messages (93%, 14/15) or emails (80%, 12/15) on their smartphone or device every day, and 87% (13/15) said it would be somewhat or very hard to give up their smartphone. Approximately one-half (53%, 8/15) reported having health apps, all diet/weight-related, yet many reported that existing nutrition apps were not well-suited for CF management. Participants wanted apps to support CF self-management with characteristics such as having multiple rather than single functions (eg, simple alarms), being specific to CF, and minimizing user burden. Common themes for desired CF app features were having information at one’s fingertips, automation of disease management activities such as pharmacy refills, integration with smartphones’ technological capabilities, enhancing communication with health care team, and facilitating socialization within the CF community. Opinions were mixed regarding gamification and earning rewards or prizes. Participants emphasized the need for customization options to meet individual preferences and disease management goals. Conclusions: Unique capabilities of emerging smartphone technologies (eg, social networking integration, movement and location detection, integrated sensors, or electronic monitors) make many of these requests possible. Involving end users in all stages of mHealth app development and collaborating with technology experts and the health care system may result in apps that maintain engagement, improve integration and automation, and ultimately impact self-management and health outcomes.
  • Dietary Approaches to Stop Hypertension: Lessons Learned From a Case Study on the Development of an mHealth Behavior Change System

    Abstract:

    Background: Evidence-based solutions for changing health behaviors exist but problems with feasibility, sustainability, and dissemination limit their impact on population-based behavior change and maintenance. Objective: Our goal was to overcome the limitations of an established behavior change program by using the inherent capabilities of smartphones and wireless sensors to develop a next generation mobile health (mHealth) intervention that has the potential to be more feasible. Methods: In response to the clinical need and the growing capabilities of smartphones, our study team decided to develop a behavioral hypertension reduction mHealth system inspired by Dietary Approaches to Stop Hypertension (DASH), a lifestyle modification program. We outline the key design and development decisions that molded the project including decisions about behavior change best practices, coaching features, platform, multimedia content, wireless devices, data security, integration of systems, rapid prototyping, usability, funding mechanisms, and how all of these issues intersect with clinical research and behavioral trials. Results: Over the 12 months, our study team faced many challenges to developing our prototype intervention. We describe 10 lessons learned that will ultimately stimulate more effective and sustainable approaches. Conclusions: The experiences presented in this case study can be used as a reference for others developing mHealth behavioral intervention development projects by highlighting the benefits and challenges facing mHealth research.
  • Digital Technology Ownership, Usage, and Factors Predicting Downloading Health Apps Among Caucasian, Filipino, Korean, and Latino Americans: The Digital Link...

    Abstract:

    Background: Interventions using mobile health (mHealth) apps have been effective in promoting healthy lifestyle behavior change and hold promise in improving health outcomes to thereby reduce health disparities among diverse racial/ethnic populations, particularly Latino and Asian American subgroups (Filipinos and Koreans) at high risk for diabetes and cardiovascular disease. Latinos and Asian Americans are avid digital technology owners and users. However, limited datasets exist regarding digital technology ownership and use, especially among specific racial/ethnic subgroups. Such information is needed to inform development of culturally tailored mHealth tools for use with lifestyle interventions promoting healthy behaviors for these at-risk racial/ethnic populations. Objective: The intent of the study was to examine (1) digital technology ownership and usage, and (2) factors predicting downloading health apps for Caucasian, Filipino, Korean, and Latino American subgroups. Methods: A cross-sectional survey conducted in August 2013 through December 2013 recruited 904 participants (Caucasians n=172, Filipinos n=250, Koreans n=234, and Latinos n=248), age >18 years, from California community events, clinics, churches, and online. English, Spanish, and Korean surveys were administered via paper or online. Descriptive statistics characterized the sociodemographics and digital technology ownership/usage of the 904 participants. Differences among groups in categorical variables were examined using chi-square statistics. Logistic regression was used to determine factors predicting downloading health apps. Results: Overall, mean age was 44 years (SD 16.1), with 64.3% (581/904) female. Only 44.7% (404/904) of all participants reported English as their primary language (Caucasian 98.3%, 169/172; Filipino 67.6%, 169/250; Korean 9.4%, 22/234, and Latino 17.7%, 44/248. Overall, mobile phone ownership was 92.8% (839/904). Compared to all groups, Koreans were more likely to own a mobile phone (82.8%, 194/234), computer (91.4%, 214/234), or tablet (55.2%, 129/234), whereas Latinos (67.5%, 167/248; 65.3%, 162/248; 24.4%, 61/248, respectively) were least likely. Internet access via mobile phones (90.5%, 818/904) was higher than computers (78.6%, 711/904). Odds of downloading health apps increased with college (OR 2.62, 95% CI 1.44-4.80) or graduate school (OR 2.93, 95% CI 1.43-6.00) compared to some high school; and family history of heart attack (OR 2.02, 95% CI 1.16-3.51). Odds of downloading health apps were reduced with: race/ethnicity, Latino (OR 0.37, 95% CI 0.20-0.69), and Korean (OR 0.52, 95% CI 0.31-0.88) compared to Caucasians; increasing age (OR 0.96, 95% CI 0.95-0.97); and completing paper surveys (OR 0.50, 95% CI 0.34-0.75). Conclusions: This survey study uniquely targeted specific racial/ethnic subgroups. Results indicated that despite a narrowing racial/ethnic “digital divide”, some disparities still exist, particularly among racial/ethnic groups with less education and whose primary language is not English. Findings will be used to inform development and evaluation of culturally tailored mHealth apps for use with interventions promoting healthy behavior change for Filipinos, Koreans, and Latinos.
  • Mobile Technologies: Expectancy, Usage, and Acceptance of Clinical Staff and Patients at a University Medical Center

    Abstract:

    Background: Despite their increasing popularity, little is known about how users perceive mobile devices such as smartphones and tablet PCs in medical contexts. Available studies are often restricted to evaluating the success of specific interventions and do not adequately cover the users’ basic attitudes, for example, their expectations or concerns toward using mobile devices in medical settings. Objective: The objective of the study was to obtain a comprehensive picture, both from the perspective of the patients, as well as the doctors, regarding the use and acceptance of mobile devices within medical contexts in general well as the perceived challenges when introducing the technology. Methods: Doctors working at Hannover Medical School (206/1151, response 17.90%), as well as patients being admitted to this facility (213/279, utilization 76.3%) were surveyed about their acceptance and use of mobile devices in medical settings. Regarding demographics, both samples were representative of the respective study population. GNU R (version 3.1.1) was used for statistical testing. Fisher’s exact test, two-sided, alpha=.05 with Monte Carlo approximation, 2000 replicates, was applied to determine dependencies between two variables. Results: The majority of participants already own mobile devices (doctors, 168/206, 81.6%; patients, 110/213, 51.6%). For doctors, use in a professional context does not depend on age (P=.66), professional experience (P=.80), or function (P=.34); gender was a factor (P=.009), and use was more common among male (61/135, 45.2%) than female doctors (17/67, 25%). A correlation between use of mobile devices and age (P=.001) as well as education (P=.002) was seen for patients. Minor differences regarding how mobile devices are perceived in sensitive medical contexts mostly relate to data security, patients are more critical of the devices being used for storing and processing patient data; every fifth patient opposed this, but nevertheless, 4.8% of doctors (10/206) use their devices for this purpose. Both groups voiced only minor concerns about the credibility of the provided content or the technical reliability of the devices. While 8.3% of the doctors (17/206) avoided use during patient contact because they thought patients might be unfamiliar with the devices, (25/213) 11.7% of patients expressed concerns about the technology being too complicated to be used in a health context. Conclusions: Differences in how patients and doctors perceive the use of mobile devices can be attributed to age and level of education; these factors are often mentioned as contributors of the problems with (mobile) technologies. To fully realize the potential of mobile technologies in a health care context, the needs of both the elderly as well as those who are educationally disadvantaged need to be carefully addressed in all strategies relating to mobile technology in a health context.
  • Sexual and Reproductive Health for Young Adults in Colombia: Teleconsultation Using Mobile Devices

    Abstract:

    Background: Sexual risk behaviors associated with poor information on sexuality have contributed to major public health problems in the area of sexual and reproductive health in teenagers and young adults in Colombia. Objective: To report our experience with the use of DoctorChat Mobile to provide sexual education and information among university students in Bogota, Colombia, and knowledge about the sexual risk factors detected among them. Methods: A mobile app that allows patients to ask about sexual and reproductive health issues was developed. Sexual and reproductive risk behaviors in a sample of young adults were measured before and after the use of the app through the validated survey Family Health International (FHI) Behavioral Surveillance Survey (BSS) for Use With Adults Between 15 and 49 Years. A nonprobabilistic convenience recruitment was undertaken through the study´s webpage. After completing the first survey, participants were allowed to download and use the app for a 6-month period (intervention), followed by completion of the same survey once again. For the inferential analysis, data was divided into 3 groups (dichotomous data, discrete quantitative data, and ordinal data) to compare the results of the questions between the first and the second survey. The study was carried out with a sample of university students between 18 and 29 years with access to mobile phones. Participation in the study was voluntary and anonymous. Results: A total of 257 subjects met the selection criteria. The preintervention survey was answered by 232 subjects, and 127 of them fully answered the postintervention survey. In total, 54.3% (69/127) of the subjects completed the survey but did not use the app, leaving an effective population of 58 subjects for analysis. Of these subjects, 53% (31/58) were women and 47% (27/58) were men. The mean age was 21 years, ranging between 18 and 29 years. The differences between the answers from both surveys were not statistically significant. The main sexual risk behaviors identified in the population were homosexual intercourse, nonuse of condoms, sexual intercourse with nonregular and commercial partners, the use of psychoactive substances, and lack of knowledge on symptoms of sexually transmitted diseases and HIV transmission. Conclusions: Although there were no differences between the pre- and postintervention results, the study revealed different risk behaviors among the participating subjects. These findings highlight the importance of promoting high-impact educational strategies on this matter and the importance of providing teenagers and young adults with easily accessible tools with reliable health information, regardless of their socioeconomic status.
  • FoodSwitch: A Mobile Phone App to Enable Consumers to Make Healthier Food Choices and Crowdsourcing of National Food Composition Data

    Abstract:

    Background: Front-of-pack nutrition labeling (FoPL) schemes can help consumers understand the nutritional content of foods and may aid healthier food choices. However, most packaged foods in Australia carry no easily interpretable FoPL, and no standard FoPL system has yet been mandated. About two thirds of Australians now own a smartphone. Objective: We sought to develop a mobile phone app that would provide consumers with easy-to-understand nutrition information and support the selection of healthier choices when shopping for food. Methods: An existing branded food database including 17,000 Australian packaged foods underpinned the project. An iterative process of development, review, and testing was undertaken to define a user interface that could deliver nutritional information. A parallel process identified the best approach to rank foods based on nutritional content, so that healthier alternative products could be recommended. Results: Barcode scanning technology was identified as the optimal mechanism for interaction of the mobile phone with the food database. Traffic light labels were chosen as the preferred format for presenting nutritional information, and the Food Standards Australia New Zealand nutrient profiling method as the best strategy for identifying healthier products. The resulting FoodSwitch mobile phone app was launched in Australia in January 2012 and was downloaded by about 400,000 users in the first 18 months. FoodSwitch has maintained a 4-plus star rating, and more than 2000 users have provided feedback about the functionality. Nutritional information for more than 30,000 additional products has been obtained from users through a crowdsourcing function integrated within the app. Conclusions: FoodSwitch has empowered Australian consumers seeking to make better food choices. In parallel, the huge volume of crowdsourced data has provided a novel means for low-cost, real-time tracking of the nutritional composition of Australian foods. There appears to be significant opportunity for this approach in many other countries.
  • Commercially Available Mobile Phone Headache Diary Apps: A Systematic Review

    Abstract:

    Background: Headache diaries are often used by headache sufferers to self-monitor headaches. With advances in mobile technology, mobile electronic diary apps are becoming increasingly common. Objective: This review aims to identify and evaluate all commercially available mobile headache diary apps for the two most popular mobile phone platforms, iOS and Android. Methods: The authors developed a priori a set of 7 criteria that define an ideal headache diary app intended to help headache sufferers better understand and manage their headaches, while providing relevant data to health professionals. The app criteria were intended as minimum requirements for an acceptable headache diary app that could be prescribed by health care professionals. Each app was evaluated and scored against each criterion. Results: Of the 38 apps identified, none of the apps met all 7 app criteria. The 3 highest scoring apps, meeting 5 of the app criteria, were iHeadache (developed by Better QOL), ecoHeadache (developed by ecoTouchMedia), and Headache Diary Pro (developed by Froggyware). Only 18% of the apps were created with scientific or clinical headache expertise and none of the apps reported on psychometric properties. Conclusions: Despite the growing market and demand, there is a concerning lack of scientific expertise and evidence base associated with headache diary apps.
  • ClereMed: Lessons Learned From a Pilot Study of a Mobile Screening Tool to Identify and Support Adults Who Have Difficulty With Medication Labels

    Abstract:

    Background: In order to take medications safely and effectively, individuals need to be able to see, read, and understand the medication labels. However, one-half of medication labels are currently misunderstood, often because of low literacy, low vision, and cognitive impairment. We sought to design a mobile tool termed ClereMed that could rapidly screen for adults who have difficulty reading or understanding their medication labels. Objective: The aim of this study was to build the ClereMed prototype; to determine the usability of the prototype with adults 55 and over; to assess its accuracy for identifying adults with low-functional reading ability, poor ability on a real-life pill-sorting task, and low cognition; and to assess the acceptability of a touchscreen device with older adults with age-related changes to vision and cognition. Methods: This pilot study enrolled adults (≥55 years) who were recruited through pharmacies, retirement residences, and a low-vision optometry clinic. ClereMed is a hypertext markup language (HTML)-5 prototype app that simulates medication taking using an iPad, and also provides information on how to improve the accessibility of prescription labels. A paper-based questionnaire included questions on participant demographics, computer literacy, and the Systems Usability Scale (SUS). Cognition was assessed using the Montreal Cognitive Assessment tool, and functional reading ability was measured using the MNRead Acuity Chart. Simulation results were compared with a real-life, medication-taking exercise using prescription vials, tablets, and pillboxes. Results: The 47 participants had a mean age of 76 (SD 11) years and 60% (28/47) were female. Of the participants, 32% (15/47) did not own a computer or touchscreen device. The mean SUS score was 76/100. ClereMed correctly identified 72% (5/7) of participants with functional reading difficulty, and 63% (5/8) who failed a real-life pill-sorting task, but only 21% (6/28) of participants with cognitive impairment. Participants who owned a computer or touchscreen completed ClereMed in a mean time of 26 (SD 16) seconds, compared with 52 (SD 34) seconds for those who do not own a device (P<.001). Those who had difficulty, struggled with screen glare, button activation, and the “drag and drop” function. Conclusions: ClereMed was well accepted by older participants, but it was only moderately accurate for reading ability and not for mild cognitive impairment. Future versions may be most useful as part of a larger medication assessment or as a tool to help family members and caregivers identify individuals with impaired functional reading ability. Future research is needed to improve the sensitivity for measuring cognitive impairment and on the feasibility of implementing a mobile app into pharmacy workflow.
  • Study of the Usability of Spaced Retrieval Exercise Using Mobile Devices for Alzheimer’s Disease Rehabilitation

    Abstract:

    Background: Alzheimer's disease (AD) is an irreversible brain disease that slowly destroys memory and thinking skills, and eventually the ability to carry out the simplest daily tasks. Recent studies showed that people with AD might actually benefit from physical exercises and rehabilitation processes. Studies show that rehabilitation would also add value in making the day for an individual with AD a little less foggy, frustrating, isolated, and stressful for as long as possible. Objective: The focus of our work was to explore the use of modern mobile technology to enable people with AD to improve their abilities to perform activities of daily living, and hence to promote independence and participation in social activities. Our work also aimed at reducing the burden on caregivers by increasing the AD patients’ sense of competence and ability to handle behavior problems. Methods: We developed ADcope, an integrated app that includes several modules that targeted individuals with AD, using mobile devices. We have developed two different user interfaces: text-based and graphic-based. To evaluate the usability of the app, 10 participants with early stages of AD were asked to run the two user interfaces of the spaced retrieval memory exercise using a tablet mobile device. Results: We selected 10 participants with early stages of AD (average age: 75 years; 6/10, 60% males, 4/10, 40% females). The average elapsed time per question between the text-based task (14.04 seconds) and the graphic-based task (12.89 seconds) was significantly different (P=.047). There was also a significant difference (P<.001) between the average correct answer score between the text-based task (7.60/10) and the graphic-based task (8.30/10), and between the text-based task (31.50/100) and the graphic-based task (27.20/100; P<.001). Correlation analysis for the graphic-based task showed that the average elapsed time per question and the workload score were negatively correlated (−.93, and −.79, respectively) to the participants’ performance (P<.001 and P=.006, respectively). Conclusions: We found that people with early stages of AD used mobile devices successfully without any prior experience in using such devices. Participants’ measured workload scores were low and posttask satisfaction in fulfilling the required task was conceivable. Results indicate better performance, less workload, and better response time for the graphic-based task compared with the text-based task.
  • Supporting Cancer Patients in Illness Management: Usability Evaluation of a Mobile App

    Abstract:

    Background: Mobile phones and tablets currently represent a significant presence in people’s everyday lives. They enable access to different information and services independent of current place and time. Such widespread connectivity offers significant potential in different app areas including health care. Objective: Our goal was to evaluate the usability of the Connect Mobile app. The mobile app enables mobile access to the Connect system, an online system that supports cancer patients in managing health-related issues. Along with symptom management, the system promotes better patient-provider communication, collaboration, and shared decision making. The Connect Mobile app enables access to the Connect system over both mobile phones and tablets. Methods: The study consisted of usability tests of a high fidelity prototype with 7 cancer patients where the objectives were to identify existing design and functionality issues and to provide patients with a real look-and-feel of the mobile system. In addition, we conducted semistructured interviews to obtain participants’ feedback about app usefulness, identify the need for new system features and design requirements, and measure the acceptance of the mobile app and its features within everyday health management. Results: The study revealed a total of 27 design issues (13 for mobile apps and 14 for tablet apps), which were mapped to source events (ie, errors, requests for help, participants' concurrent feedback, and moderator observation). We also applied usability heuristics to identify violations of usability principles. The majority of violations were related to enabling ease of input, screen readability, and glanceability (15 issues), as well as supporting an appropriate match between systems and the real world (7 issues) and consistent mapping of system functions and interactions (4 issues). Feedback from participants also showed the cancer patients’ requirements for support systems and how these needs are influenced by different context-related factors, such as type of access terminal (eg, desktop computer, tablet, mobile phone) and phases of illness. Based on the observed results, we proposed design and functionality recommendations that can be used for the development of mobile apps for cancer patients to support their health management process. Conclusions: Understanding and addressing users’ requirements is one of the main prerequisites for developing useful and effective technology-based health interventions. The results of this study outline different user requirements related to the design of the mobile patient support app for cancer patients. The results will be used in the iterative development of the Connect Mobile app and can also inform other developers and researchers in development, integration, and evaluation of mobile health apps and services that support cancer patients in managing their health-related issues.

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  • Don’t Forget the Doctor: Key Opinion Leader Preferences on the Development of mHealth Tools for IBD Patients

    Date Submitted: Oct 28, 2014

    Open Peer Review Period: Oct 29, 2014 - Dec 24, 2014

    Background: Inflammatory Bowel Disease (IBD) encompasses a number of disorders of the gastrointestinal tract. Treatment for IBD is lifelong and complex, and the majority of IBD patients seek informati...

    Background: Inflammatory Bowel Disease (IBD) encompasses a number of disorders of the gastrointestinal tract. Treatment for IBD is lifelong and complex, and the majority of IBD patients seek information on the Internet. However, research has found existing digital resources to be of questionable quality, and that patients find content lacking. Gastroenterologists are front-line sources of information for North American IBD patients, but their opinions and preferences for digital content, design, and utility have not been investigated. Objective: The objective of this study is to systematically explore Key Opinion Leader (KOL) perceptions of, and design preferences, for mHealth tools. Methods: To critically assess these issues and elicit expert feedback, consensus was sought in a closed meeting with seven Canadian Key Opinion Leaders (KOLs) in the field of Gastroenterology. Using a qualitative approach, the meeting was audio recorded and field notes taken. To synthesize results, an anonymous questionnaire was collected at the end of the session. KOL-led discussion themes included methodological approaches to non-adherence, concordance, patient-centricity, and attributes of digital tools that would be actively supported and promoted by Gastroenterologists Results: Survey results indicated that 57% (n=4) of KOLs had experienced patients bringing digital resources to a visit, but 71% (n=5) found digital patient resources to be inaccurate or irrelevant. All KOLs agreed that digital tools were of increasing importance, and could be leveraged to aid in consultations and save time. When asked to assess digital attributes that they would be confident to refer patients to, 100% (n=7) indicated that the inclusion of evidence-based facts were of greatest importance. Patient peer support networks were deemed an asset, but only if closely monitored by experts. When asked about interventions 85% (n=6) preferred tools that addressed a mix of compliance and concordance, and 14% (n=1) supported the development of tools that focused on compliance. KOLs confirmed that they would actively refer patients and other physicians to digital resources. However, while a number of digital IBD tools exist, KOLs would be reluctant to endorse them. Conclusions: To our knowledge this is the first study that systematically explored Gastroenterologists perceptions of, and needs for, mHealth tools. Gastroenterologists appear eager to utilize digital resources that they believe benefit the physician-patient relationship but despite the trend of patient-centric tools that focus on concordance, KOLs would prefer digital tools that highlight compliance. This highlights an issue of disparity in digital health: patients may not use tools that physicians promote, and physicians may not endorse tools that patients need. Further research investigating concordance, and the gap between physician preferences and patient needs, is required

  • Scale-up considerations of an mHealth intervention to support patients with active tuberculosis

    Date Submitted: Oct 25, 2014

    Open Peer Review Period: Oct 27, 2014 - Dec 22, 2014

    Background: Tuberculosis (TB) remains a major global public health problem and mobile health (mHealth) interventions have been identified as a modality to improve TB outcomes. TextTB, an interactive t...

    Background: Tuberculosis (TB) remains a major global public health problem and mobile health (mHealth) interventions have been identified as a modality to improve TB outcomes. TextTB, an interactive texting-based intervention to promote adherence with TB medication was piloted in Argentina with results supporting trialing at a larger scale. Objective: The objective of this research was to inform scale-up by better understanding issues encountered during piloting. Methods: A descriptive qualitative design guided by a sociotechnical framework was used. The setting was a clinic within a public pulmonary-specialized hospital in Argentina. Data were collected through workflow observation (n=115 days), text messages (n=2286), review of the study log, and stakeholder input. Emerging issues were categorized as organizational, human/social, technical, or sociotechnical considerations. Results: Issues encountered included: workflow issues (e.g., human, training, security), technical challenges (e.g., data errors, platform shortcomings), and message delivery issues (e.g., unintentional sending of multiple messages, auto-confirmation problems). Non-intervention related issues included variable mobile network coverage, electrical/internet outages, and medication shortages. Conclusions: Intervention challenges were largely manageable during piloting, but when evaluating for scale-up, issues to be addressed were identified with potential solutions outlined here. These findings may help others considering implementing an mHealth intervention to mitigate these challenges. Although some of the issues may be context dependent, electrical/internet outages and limited resources are not unique issues to our setting. Release of new software versions does not necessarily result in solutions for certain issues, particularly when specific features are removed therefore other software options will need to be considered for scale-up. Improved automation of some features will be necessary, however retention of the intervention capability to be interactive, user-friendly, and patient-focused will be key. Continued collaboration with stakeholders will be required to conduct further research and to understand how such an mHealth intervention can be effectively integrated into larger health systems.

  • SMSaúde: Design, development and implementation of a remote/mobile patient management system to improve retention in care for HIV/AIDS and tuberculosis patients

    Date Submitted: Sep 10, 2014

    Open Peer Review Period: Sep 11, 2014 - Nov 6, 2014

    Background: The wide spread and low cost of mobile phones and convenience of Short Message Service (SMS) suggest potential suitability for use with alternative strategies for supporting retention in c...

    Background: The wide spread and low cost of mobile phones and convenience of Short Message Service (SMS) suggest potential suitability for use with alternative strategies for supporting retention in care and adherence to the treatment of various chronic diseases such as HIV and Tuberculosis (TB). Despite the growing body of literature reporting positive outcomes of SMS based communication with patients, there is yet very little research about the integration of communication technologies and electronic medical records (EMR) or electronic patient tracking system (EPTS). Objective: To design, develop and implement an integrated mobile phone text messaging system used to follow up patients with HIV and TB in treatment in Mozambique. Methods: Following the design science research methodology we developed a web-based system that provides support to patients. A case study involving three healthcare sites in Mozambique was a basis for discussing design issues for this kind of system. We used brainstorming technique to solicit usability requirements, focus group meetings to discuss and define system architecture, and prototyping to test in real environment and improve the system. Results: We found seven sets of system requirements that need to be addressed for success: functionalities of the system, data collection, telecommunication costs, privacy and data security, text message content, connectivity, and system scalability. A text messaging system was designed and implemented in three health facilities. These sites feed data into a central data repository, which can be used for analysis of operations and decision support. Based on the treatment schedule, the system automatically sends SMS appointment reminders, medication reminders, as well as motivation and educational messages to patients enrolled in antiretroviral treatment and TB. Conclusions: We successfully defined the requirements, designed and implemented a mobile phone text messaging system to support HIV and TB. Implementation of this system could improve patients’ self-management skills and strengthen communication between patients and health care providers.