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 spin-off journal of JMIR, the leading eHealth journal (Impact Factor 2016: 5.175). 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: Pixabay; Copyright: StockSnap; URL:; License: Public Domain (CC0).

    Commercially Available Smartphone Apps to Support Postoperative Pain Self-Management: Scoping Review


    Background: Recently, the use of smartphones to deliver health-related content has experienced rapid growth, with more than 165,000 mobile health (mHealth) apps currently available in the digital marketplace. With 3 out of 4 Canadians currently owning a smartphone, mHealth apps offer opportunities to deliver accessible health-related knowledge and support. Many individuals experience pain after surgery, which can negatively impact their health-related quality of life, including sleep, emotional, and social functioning. Smartphone apps that provide remote real-time monitoring and symptom management have the potential to improve self-management skills in patients experiencing postoperative pain. Increased confidence and practice of self-management skills could contribute to decreased postoperative pain and reduce risk of developing persistent pain. Published reviews of general pain self-management apps demonstrate a lack of evidence-based content, theoretical grounding, and health care professional involvement. However, no review to date has focused on the app marketplace specific for individuals with postoperative pain. Objective: The aim of this study was to characterize and critically appraise the content and functionality of commercially available postoperative pain self-management apps. Methods: An electronic search and extraction was conducted between December 2016 and March 2017 of the official Canadian app stores for the three major smartphone operating systems (iPhone operating system [iOS], Android, and Windows). Stores were searched separately using predetermined search terms. Two authors screened apps based on information provided in the public app description. Metadata from all included apps were abstracted into a standard spreadsheet. Two authors verified the data with reference to the apps and downloaded apps themselves. The content and functionality of each app as it pertained to postoperative pain self-management was rated. Results: A total of 10 apps met the inclusion criteria. All included apps were designed exclusively for the Android platform. Education was the most common self-management feature offered (8/10, 80%), with none of the apps offering features related to goal setting or social support. Overall, no single app was comprehensive in terms of pain self-management content. Five (50%) apps reported the involvement of a health care provider in their development. However, not a single app involved end users in their development, and none of the apps underwent scientific evaluation. Additionally, none of the apps were designed for use in pediatric patients. Conclusions: Currently available postoperative pain apps for patients lack evidence-based content, goal setting, and social support functions. There is a need to develop and test comprehensive theory-based apps to support patients with pain self-management care following surgery.

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

    Designing a Self-Management App for Young People With Type 1 Diabetes: Methodological Challenges, Experiences, and Recommendations


    Background: Young people with type 1 diabetes often struggle to self-manage their disease. Mobile health (mHealth) apps show promise in supporting self-management of chronic conditions such as type 1 diabetes. Many health care providers become involved in app development. Unfortunately, limited information is available to guide their selection of appropriate methods, techniques, and tools for a participatory design (PD) project in health care. Objective: The aim of our study was to develop an mHealth app to support young people in self-managing type 1 diabetes. This paper presents our methodological recommendations based on experiences and reflections from a 2-year research study. Methods: A mixed methods design was used to identify user needs before designing the app and testing it in a randomized controlled trial. App design was based on qualitative, explorative, interventional, and experimental activities within an overall iterative PD approach. Several techniques and tools were used, including workshops, a mail panel, think-aloud tests, and a feasibility study. Results: The final mHealth solution was “Young with Diabetes” (YWD). The iterative PD approach supported researchers and designers in understanding the needs of end users (ie, young people, parents, and health care providers) and their assessment of YWD, as well as how to improve app usability and feasibility. It is critical to include all end user groups during all phases of a PD project and to establish a multidisciplinary team to provide the wide range of expertise required to build a usable and useful mHealth app. Conclusions: Future research is needed to develop and evaluate more efficient PD techniques. Health care providers need guidance on what tools and techniques to choose for which subgroups of users and guidance on how to introduce an app to colleagues to successfully implement an mHealth app in health care organizations. These steps are important for anyone who wants to design an mHealth app for any illness.

  • Source: The Authors; Copyright: Alexander Gorny; URL:; License: Creative Commons Attribution (CC-BY).

    Fitbit Charge HR Wireless Heart Rate Monitor: Validation Study Conducted Under Free-Living Conditions


    Background: Many modern smart watches and activity trackers feature an optical sensor that estimates the wearer’s heart rate. Recent studies have evaluated the performance of these consumer devices in the laboratory. Objective: The objective of our study was to examine the accuracy and sensitivity of a common wrist-worn tracker device in measuring heart rates and detecting 1-min bouts of moderate to vigorous physical activity (MVPA) under free-living conditions. Methods: Ten healthy volunteers were recruited from a large university in Singapore to participate in a limited field test, followed by a month of continuous data collection. During the field test, each participant would wear one Fitbit Charge HR activity tracker and one Polar H6 heart rate monitor. Fitbit measures were accessed at 1-min intervals, while Polar readings were available for 10-s intervals. We derived intraclass correlation coefficients (ICCs) for individual participants comparing heart rate estimates. We applied Centers for Disease Control and Prevention heart rate zone cut-offs to ascertain the sensitivity and specificity of Fitbit in identifying 1-min epochs falling into MVPA heart rate zone. Results: We collected paired heart rate data for 2509 1-min epochs in 10 individuals under free-living conditions of 3 to 6 hours. The overall ICC comparing 1-min Fitbit measures with average 10-s Polar H6 measures for the same epoch was .83 (95% CI .63-.91). On average, the Fitbit tracker underestimated heart rate measures by −5.96 bpm (standard error, SE=0.18). At the low intensity heart rate zone, the underestimate was smaller at −4.22 bpm (SE=0.15). This underestimate grew to −16.2 bpm (SE=0.74) in the MVPA heart rate zone. Fitbit devices detected 52.9% (192/363) of MVPA heart rate zone epochs correctly. Positive and negative predictive values were 86.1% (192/223) and 92.52% (2115/2286), respectively. During subsequent 1 month of continuous data collection (270 person-days), only 3.9% of 1-min epochs could be categorized as MVPA according to heart rate zones. This measure was affected by decreasing wear time and adherence over the period of follow-up. Conclusions: Under free-living conditions, Fitbit trackers are affected by significant systematic errors. Improvements in tracker accuracy and sensitivity when measuring MVPA are required before they can be considered for use in the context of exercise prescription to promote better health.

  • A physician examining a patient using Google Glass. Source: Internet Medicine Digital Healthcare; Copyright: Internet Medicine Digital Healthcare; URL:; License: Fair use/fair dealings.

    Using Google Glass in Nonsurgical Medical Settings: Systematic Review


    Background: Wearable technologies provide users hands-free access to computer functions and are becoming increasingly popular on both the consumer market and in various industries. The medical industry has pioneered research and implementation of head-mounted wearable devices, such as Google Glass. Most of this research has focused on surgical interventions; however, other medical fields have begun to explore the potential of this technology to support both patients and clinicians. Objective: Our aim was to systematically evaluate the feasibility, usability, and acceptability of using Google Glass in nonsurgical medical settings and to determine the benefits, limitations, and future directions of its application. Methods: This review covers literature published between January 2013 and May 2017. Searches included PubMed MEDLINE, Embase, INSPEC (Ebsco), Cochrane Central Register of Controlled Trials (CENTRAL), IEEE Explore, Web of Science, Scopus, and Compendex. The search strategy sought all articles on Google Glass. Two reviewers independently screened titles and abstracts, assessed full-text articles, and extracted data from articles that met all predefined criteria. Any disagreements were resolved by discussion or consultation by the senior author. Included studies were original research articles that evaluated the feasibility, usability, or acceptability of Google Glass in nonsurgical medical settings. The preferred reporting results of systematic reviews and meta-analyses (PRISMA) guidelines were followed for reporting of results. Results: Of the 852 records examined, 51 met all predefined criteria, including patient-centered (n=21) and clinician-centered studies (n=30). Patient-centered studies explored the utility of Google Glass in supporting patients with motor impairments (n=8), visual impairments (n=5), developmental and psychiatric disorders (n=2), weight management concerns (n=3), allergies (n=1), or other health concerns (n=2). Clinician-centered studies explored the utility of Google Glass in student training (n=9), disaster relief (n=4), diagnostics (n=2), nursing (n=1), autopsy and postmortem examination (n=1), wound care (n=1), behavioral sciences (n=1), and various medical subspecialties, including, cardiology (n=3), radiology (n=3), neurology (n=1), anesthesiology (n=1), pulmonology (n=1), toxicology (n=1), and dermatology (n=1). Most of the studies were conducted in the United States (40/51, 78%), did not report specific age information for participants (38/51, 75%), had sample size <30 participants (29/51, 57%), and were pilot or feasibility studies (31/51, 61%). Most patient-centered studies (19/21, 90%) demonstrated feasibility with high satisfaction and acceptability among participants, despite a few technical challenges with the device. A number of clinician-centered studies (11/30, 37%) reported low to moderate satisfaction among participants, with the most promising results being in the area of student training. Studies varied in sample size, approach for implementation of Google Glass, and outcomes assessment. Conclusions: The use of Google Glass in nonsurgical medical settings varied. More promising results regarding the feasibility, usability, and acceptability of using Google Glass were seen in patient-centered studies and student training settings. Further research evaluating the efficacy and cost-effectiveness of Google Glass as an intervention to improve important clinical outcomes is warranted.

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

    Client-Focused Security Assessment of mHealth Apps and Recommended Practices to Prevent or Mitigate Transport Security Issues


    Background: Mobile health (mHealth) apps show a growing importance for patients and health care professionals. Apps in this category are diverse. Some display important information (ie, drug interactions), whereas others help patients to keep track of their health. However, insufficient transport security can lead to confidentiality issues for patients and medical professionals, as well as safety issues regarding data integrity. mHealth apps should therefore deploy intensified vigilance to protect their data and integrity. This paper analyzes the state of security in mHealth apps. Objective: The objectives of this study were as follows: (1) identification of relevant transport issues in mHealth apps, (2) development of a platform for test purposes, and (3) recommendation of practices to mitigate them. Methods: Security characteristics relevant to the transport security of mHealth apps were assessed, presented, and discussed. These characteristics were used in the development of a prototypical platform facilitating streamlined tests of apps. For the tests, six lists of the 10 most downloaded free apps from three countries and two stores were selected. As some apps were part of these top 10 lists in more than one country, 53 unique apps were tested. Results: Out of the 53 apps tested from three European App Stores for Android and iOS, 21/53 (40%) showed critical results. All 21 apps failed to guarantee the integrity of data displayed. A total of 18 apps leaked private data or were observable in a way that compromised confidentiality between apps and their servers; 17 apps used unprotected connections; and two apps failed to validate certificates correctly. None of the apps tested utilized certificate pinning. Many apps employed analytics or ad providers, undermining user privacy. Conclusions: The tests show that many mHealth apps do not apply sufficient transport security measures. The most common security issue was the use of any kind of unprotected connection. Some apps used secure connections only for selected tasks, leaving all other traffic vulnerable.

  • Health facility staff learning to use the patient-controlled health record. Source: Image created by the Authors; Copyright: Gilbert Burnham; URL:; License: Creative Commons Attribution (CC-BY).

    Guidelines and mHealth to Improve Quality of Hypertension and Type 2 Diabetes Care for Vulnerable Populations in Lebanon: Longitudinal Cohort Study


    Background: Given the protracted nature of the crisis in Syria, the large noncommunicable disease (NCD) caseload of Syrian refugees and host Lebanese, and the high costs of providing NCD care, the implications for Lebanon’s health system are vast. Objective: The aim of this study was to evaluate the effectiveness of treatment guidelines and a mobile health (mHealth) app on quality of care and health outcomes in primary care settings in Lebanon. Methods: A longitudinal cohort study was implemented from January 2015 to August 2016 to evaluate the effectiveness of treatment guidelines and an mHealth app on quality of care and health outcomes for Syrian and Lebanese patients in Lebanese primary health care (PHC) facilities. Results: Compared with baseline record extraction, recording of blood pressure (BP) readings (−11.4%, P<.001) and blood sugar measurements (−6.9%, P=.03) significantly decreased following the implementation of treatment guidelines. Recording of BP readings also decreased after the mHealth phase as compared with baseline (−8.4%, P=.001); however, recording of body mass index (BMI) reporting increased at the end of the mHealth phase from baseline (8.1%, P<.001) and the guidelines phase (7.7%, P<.001). There were a great proportion of patients for whom blood sugar, BP, weight, height, and BMI were recorded using the tablet compared with in paper records; however, only differences in BMI were statistically significant (31.6% higher in app data as compared with paper records; P<.001). Data extracted from the mHealth app showed that a higher proportion of providers offered lifestyle counseling compared with the counseling reported in patients’ paper records (health diet counseling; 77.3% in app data vs 8.8% in paper records, P<.001 and physical activity counseling and 59.7% in app vs 7.1% in paper records, P<.001). There were statistically significant increases in all four measures of patient-provider interaction across study phases. Provider inquiry of medical history increased by 16.6% from baseline following guideline implementation and by 28.2% from baseline to mHealth implementation (P<.001). From baseline, patient report of provider inquiry regarding medication complications increased in the guidelines and mHealth phases by 12.9% and 59.6%, respectively, (P<.001). The proportion of patients reporting that providers asked other questions relevant to their illness increased from baseline through guidelines implementation by 27.8% and to mHealth implementation by 66.3% (P<.001). Follow-up scheduling increased from baseline to the guidelines phase by 20.6% and the mHealth phase by 39.8% (P<.001). Conclusions: Results from this study of an mHealth app in 10 PHC facilities in Lebanon indicate that the app has potential to improve adherence to guidelines and quality of care. Further studies are necessary to determine the effects of patient-controlled health record apps on provider adherence to treatment guidelines, as well as patients’ long-term medication and treatment adherence and disease control.

  • Participants of the hackathon working their way to produce a mHealth application. Source: KKU mHealth Hackathon; Copyright: Khon Kaen University; URL:; License: Creative Commons Attribution (CC-BY).

    Tackling Regional Public Health Issues Using Mobile Health Technology: Event Report of an mHealth Hackathon in Thailand


    Hackathons are intense, short, collaborative events focusing on solving real world problems through interdisciplinary teams. This is a report of the mHealth hackathon hosted by Khon Kaen University in collaboration with MIT Sana and faculty members from Harvard Medical School with the aim to improve health care delivery in the Northeast region of Thailand. Key health challenges, such as improving population health literacy, tracking disease trajectory and outcomes among rural communities, and supporting the workflow of overburdened frontline providers, were addressed using mHealth. Many modifications from the usual format of hackathon were made to tailor the event to the local context and culture, such as the process of recruiting participants and how teams were matched and formed. These modifications serve as good learning points for hosting future hackathons. There are also many lessons learned about how to achieve a fruitful collaboration despite cultural barriers, how to best provide mentorship to the participants, how to instill in the participants a sense of mission, and how to match the participants in a fair and efficient manner. This event showcases how interdisciplinary collaboration can produce results that are unattainable by any discipline alone and demonstrates that innovations are the fruits of collective wisdom of people from different fields of expertise who work together toward the same goals.

  • Bugs and Buttons app (montage). Source: Little Bit Studio, LLC /; Copyright: JMIR Publications; URL:; License: Creative Commons Attribution (CC-BY).

    ADHD: Is There an App for That? A Suitability Assessment of Apps for the Parents of Children and Young People With ADHD


    Background: Attention-deficit hyperactivity disorder (ADHD) is a highly comorbid disorder that can impact significantly on the individual and their family. ADHD is managed via pharmacological and nonpharmacological interventions. Parents also gain support from parent support groups, which may include chat rooms, as well as face-to-face meetings. With the growth of technology use over recent years, parents have access to more resources that ever before. A number of mobile apps have been developed to help parents manage ADHD in their children and young people. Unfortunately many of these apps are not evidence-based, and little is known of their suitability for the parents or whether they are helpful in ADHD management. Objective: The aim of this study was to explore the (1) parents’ views of the suitability of the top ten listed apps for parents of children and young people with ADHD and (2) the views of clinicians that work with them on the suitability and value of the apps. Methods: The top 10 listed apps specifically targeted toward the parents of children and young people with ADHD were identified via the Google Play (n=5) and iTunes store (n=5). Interviews were then undertaken with 7 parents of children or young people with ADHD and 6 clinicians who specialize in working with this population to explore their opinions of the 10 apps identified and what they believe the key components are for apps to be suitable and valuable for this population. Results: Four themes emerged from clinician and parent interviews: (1) the importance of relating to the app, (2) apps that address ADHD-related difficulties, (3) how the apps can affect family relationships, and (4) apps as an educational tool. Two additional themes emerged from the clinician interviews alone: monitoring ADHD symptoms and that apps should be practical. Parents also identified an additional theme: the importance of the technology. Overall, the characteristics of the current top 10 listed apps did not appear to match well to the views of our sample. Conclusions: Findings suggest that these apps may not fully meet the complex needs of this parent population. Further research is required to explore the value of apps with this population and how they can be tailored to their very specific needs.

  • Source: Pixabay; Copyright: Vidmir Raic; URL:; License: Public Domain (CC0).

    Desire to Be Underweight: Exploratory Study on a Weight Loss App Community and User Perceptions of the Impact on Disordered Eating Behaviors


    Background: Mobile health (mHealth) apps for weight loss (weight loss apps) can be useful diet and exercise tools for individuals in need of losing weight. Most studies view weight loss app users as these types of individuals, but not all users have the same needs. In fact, users with disordered eating behaviors who desire to be underweight are also utilizing weight loss apps; however, few studies give a sense of the prevalence of these users in weight loss app communities and their perceptions of weight loss apps in relation to disordered eating behaviors. Objective: The aim of this study was to provide an analysis of users’ body mass indices (BMIs) in a weight loss app community and examples of how users with underweight BMI goals perceive the impact of the app on disordered eating behaviors. Methods: We focused on two aspects of a weight loss app (DropPounds): profile data and forum posts, and we moved from a broader picture of the community to a narrower focus on users’ perceptions. We analyzed profile data to better understand the goal BMIs of all users, highlighting the prevalence of users with underweight BMI goals. Then we explored how users with a desire to be underweight discussed the weight loss app’s impact on disordered eating behaviors. Results: We found three main results: (1) no user (regardless of start BMI) starts with a weight gain goal, and most users want to lose weight; (2) 6.78% (1261/18,601) of the community want to be underweight, and most identify as female; (3) users with underweight BMI goals tend to view the app as positive, especially for reducing bingeing; however, some acknowledge its role in exacerbating disordered eating behaviors. Conclusions: These findings are important for our understanding of the different types of users who utilize weight loss apps, the perceptions of weight loss apps related to disordered eating, and how weight loss apps may impact users with a desire to be underweight. Whereas these users had underweight goals, they often view the app as helpful in reducing disordered eating behaviors, which led to additional questions. Therefore, future research is needed.

  • Experimental setup for capturing falls data and detecting falls. Source: Image created by the Authors; Copyright: The Authors; URL:; License: Creative Commons Attribution (CC-BY).

    Fall Detection in Individuals With Lower Limb Amputations Using Mobile Phones: Machine Learning Enhances Robustness for Real-World Applications


    Background: Automatically detecting falls with mobile phones provides an opportunity for rapid response to injuries and better knowledge of what precipitated the fall and its consequences. This is beneficial for populations that are prone to falling, such as people with lower limb amputations. Prior studies have focused on fall detection in able-bodied individuals using data from a laboratory setting. Such approaches may provide a limited ability to detect falls in amputees and in real-world scenarios. Objective: The aim was to develop a classifier that uses data from able-bodied individuals to detect falls in individuals with a lower limb amputation, while they freely carry the mobile phone in different locations and during free-living. Methods: We obtained 861 simulated indoor and outdoor falls from 10 young control (non-amputee) individuals and 6 individuals with a lower limb amputation. In addition, we recorded a broad database of activities of daily living, including data from three participants’ free-living routines. Sensor readings (accelerometer and gyroscope) from a mobile phone were recorded as participants freely carried it in three common locations—on the waist, in a pocket, and in the hand. A set of 40 features were computed from the sensors data and four classifiers were trained and combined through stacking to detect falls. We compared the performance of two population-specific models, trained and tested on either able-bodied or amputee participants, with that of a model trained on able-bodied participants and tested on amputees. A simple threshold-based classifier was used to benchmark our machine-learning classifier. Results: The accuracy of fall detection in amputees for a model trained on control individuals (sensitivity: mean 0.989, 1.96*standard error of the mean [SEM] 0.017; specificity: mean 0.968, SEM 0.025) was not statistically different (P=.69) from that of a model trained on the amputee population (sensitivity: mean 0.984, SEM 0.016; specificity: mean 0.965, SEM 0.022). Detection of falls in control individuals yielded similar results (sensitivity: mean 0.979, SEM 0.022; specificity: mean 0.991, SEM 0.012). A mean 2.2 (SD 1.7) false alarms per day were obtained when evaluating the model (vs mean 122.1, SD 166.1 based on thresholds) on data recorded as participants carried the phone during their daily routine for two or more days. Machine-learning classifiers outperformed the threshold-based one (P<.001). Conclusions: A mobile phone-based fall detection model can use data from non-amputee individuals to detect falls in individuals walking with a prosthesis. We successfully detected falls when the mobile phone was carried across multiple locations and without a predetermined orientation. Furthermore, the number of false alarms yielded by the model over a longer period of time was reasonably low. This moves the application of mobile phone-based fall detection systems closer to a real-world use case scenario.

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

    Willingness to Use Mobile Phone Apps for HIV Prevention Among Men Who Have Sex with Men in London: Web-Based Survey


    Background: Many men who have sex with men (MSM) use apps to connect with and meet other MSM. Given that these apps are often used to arrange sexual encounters, it is possible that apps may be suitable venues for messages and initiatives related to HIV prevention such as those to increase HIV testing rates among this population. Objective: The purpose of this study was to assess willingness to use a new app for reminders of when to be tested for HIV infection among a sample of MSM in London who use apps to arrange sexual encounters. Methods: Broadcast advertisements targeted users of a popular social-networking app for MSM in London. Advertisements directed users to a Web-based survey of sexual behaviors and sexual health needs. Willingness to use apps for reminders of when to be tested for HIV was assessed. In addition, participants responded to items assessing recent sexual behaviors, substance use, and demographic characteristics. Exploratory analyses were undertaken to examine differences in willingness to use an app by demographic and behavioral characteristics. Results: Broadcast advertisements yielded a sample of 169 HIV-negative MSM. Overall, two-thirds (108/169, 63.9%) reported willingness to use an app to remind them when to be tested for HIV. There were no significant differences in willingness to use these apps based on demographic characteristics, but MSM who reported recent binge drinking and recent club drug use more frequently reported willingness to use this app compared to their nonusing counterparts. Conclusions: MSM in this sample are willing to use a new app for HIV testing reminders. Given the high levels of willingness to use them, these types of apps should be developed, evaluated, and made available for this population.

  • Suicide prevention app (montage). Source: ISD Innovations, Inc /; Copyright: JMIR Publications; URL:; License: Creative Commons Attribution (CC-BY).

    Mobile Apps for Suicide Prevention: Review of Virtual Stores and Literature


    Background: The best manner to prevent suicide is to recognize suicidal signs and signals, and know how to respond to them. Objective: We aim to study the existing mobile apps for suicide prevention in the literature and the most commonly used virtual stores. Methods: Two reviews were carried out. The first was done by searching the most commonly used commercial app stores, which are iTunes and Google Play. The second was a review of mobile health (mHealth) apps in published articles within the last 10 years in the following 7 scientific databases: Science Direct, Medline, PsycINFO, Embase, The Cochrane Library, IEEE Xplore, and Google Scholar. Results: A total of 124 apps related to suicide were found in the cited virtual stores but only 20 apps were specifically designed for suicide prevention. All apps were free and most were designed for Android. Furthermore, 6 relevant papers were found in the indicated scientific databases; in these studies, some real experiences with physicians, caregivers, and families were described. The importance of these people in suicide prevention was indicated. Conclusions: The number of apps regarding suicide prevention is small, and there was little information available from literature searches, indicating that technology-based suicide prevention remains understudied. Many of the apps provided no interactive features. It is important to verify the accuracy of the results of different apps that are available on iOS and Android. The confidence generated by these apps can benefit end users, either by improving their health monitoring or simply to verify their body condition.

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    Date Submitted: Oct 20, 2017

    Open Peer Review Period: Oct 22, 2017 - Dec 17, 2017

    Background: Healthcare involves the maintenance or improvement of health via diagnosis, treatment, and prevention of disease, illness, injury, or other physical and mental impairments. During the past...

    Background: Healthcare involves the maintenance or improvement of health via diagnosis, treatment, and prevention of disease, illness, injury, or other physical and mental impairments. During the past decade, there has been a proliferation of research on health information technology (HIT), which shows that HIT is essential for improving the quality of mobile healthcare and management. Objective: The smart-healthcare industry is a growing market that uses new technologies for the mobile healthcare and management field. The provision of more precise service solutions will allow smart healthcare and management strategies to be deployed in the healthcare industry. Methods: Thus, this study gives theoretical and practical insights into an ontology-based cloud computing approach in the mobile healthcare and management context. Results: Depending on the characteristics of the variable content, these data formats are defined as category data variable and numerical data variable (Table 1). These health evaluation factors also have a threshold value for each factor in Table 2, which determines the health status. Conclusions: This increases the understanding of the creation of value using a cloud computing business model and opens new paths for the development of a business case for healthcare providers.

  • Usability and acceptability of a wearable activity tracker in young adolescents

    Date Submitted: Oct 17, 2017

    Open Peer Review Period: Oct 18, 2017 - Dec 13, 2017

    Background: Wearable activity trackers have the potential to be integrated into physical activity interventions, yet little is known about how adolescents use these devices or perceive their acceptabi...

    Background: Wearable activity trackers have the potential to be integrated into physical activity interventions, yet little is known about how adolescents use these devices or perceive their acceptability. Objective: The aim of this study was to examine the acceptability and usability of a wearable activity tracker among adolescents. A secondary aim was to determine adolescents’ awareness and use of the different functions and features in the wearable activity tracker and accompanying app. Methods: Sixty adolescents (aged 13-14 years) in Year 8 from three secondary schools in Melbourne, Australia, were provided with a wrist-worn Fitbit Flex and accompanying app and asked to use it for six weeks. Demographic data (age, sex) were collected via an online survey completed during week 1 of the study. At the conclusion of the 6-week period, all adolescents participated in focus groups that explored their perceptions of the acceptability and usability of the Fitbit Flex, accompanying app, and online Fitbit profile. Qualitative data were analysed using pen profiles, which were constructed from verbatim transcripts. Results: Adolescents typically found the Fitbit Flex easy to use for activity tracking, though greater difficulties were reported for monitoring sleep. The Fitbit Flex was perceived to be useful for tracking daily activity, and adolescents used a range of features and functions available through the device and the app. Barriers to use included the comfort/design of the Fitbit Flex, a lack of specific feedback about activity levels, and the inability to wear the wearable activity tracker for water-based sports. Conclusions: Adolescents reported that the Fitbit Flex was easy to use, and that it was a useful tool for tracking daily activity. A number of functions and features were used, including the devices visual display to track and self-monitor activity, goal-setting in the app, and undertaking challenges against friends. However, several barriers to use were identified, which may impact on sustained use over time. Overall, wearable activity trackers have potential to be integrated into physical activity interventions, but both the functionality and wearability of the monitor should be considered.

  • New-Onset Diabetes Educator to Educate Children and their Caregivers about Diabetes at the Time of Diagnosis: a Pragmatic Trial

    Date Submitted: Oct 17, 2017

    Open Peer Review Period: Oct 18, 2017 - Dec 13, 2017

    Background: Background Diabetes self-management education (DSME) is essential at the time of diagnosis. We developed the New Onset Diabetes Educator (NODE), an animation-based educational web applicat...

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  • The Iranian Red Crescent Society’s Educational Mobile Application: A Tool for Improving Students’ Awareness of First Aids

    Date Submitted: Oct 16, 2017

    Open Peer Review Period: Oct 17, 2017 - Dec 12, 2017

    Background: The first aid educational mobile application (Khadem) developed by the Iranian Red Crescent Society provides the most important and simplest trainings of first aid in crisis situations for...

    Background: The first aid educational mobile application (Khadem) developed by the Iranian Red Crescent Society provides the most important and simplest trainings of first aid in crisis situations for people. Objective: Therefore, the present study was aimed to investigate the impact of this mobile application on improving high school students’ awareness of first aid. Methods: In this quasi-experimental study (before and after using the mobile application), 51 students studying at high schools in Ahvaz, were selected as the sample using simple random sampling method. Firstly and before the intervention, their awareness and mastery of the first aid was measured by a test. Then the mobile software was offered to them, and one month later, they were asked to sit another test. The scores obtained before and after intervention were measured. Descriptive and inferential statistics were used for data analysis using SPSS V.22 Results: Overall, the students' awareness of first aids was very low. In the intervention group, the average score of the students’ awareness significantly increased after intervention (offering mobile application) (P <0.01). According to Spearman, Kruskal-Wallis and Mann-Whitney tests analysis, age, gender, and school grade have no impact on the average scores obtained before and after intervention. (P <0.05). Conclusions: Due to the various advantages and capabilities of smartphones and their popularity among students, they can provide a good opportunity to teach the students vital subjects such as first aid, although this technology is yet to be officially included in the curriculum. Clinical Trial: Students, Educational Mobile App, First Aid, Red Crescent.

  • Diet and fitness apps in daily life in France: diversity of uses and digital inequalities

    Date Submitted: Oct 16, 2017

    Open Peer Review Period: Oct 16, 2017 - Oct 24, 2017

    Background: Digital devices are driving economic and social transformations, but assessing the uses, perceptions, and impact of these new technologies on diet and physical activity remains a major soc...

    Background: Digital devices are driving economic and social transformations, but assessing the uses, perceptions, and impact of these new technologies on diet and physical activity remains a major societal challenge. Objective: We aimed to determine under which social, economic, and cultural conditions individuals in France were more likely to be actively invested in the use of self-tracking diet and fitness applications as new ways of self-governance. Methods: Existing users of three diet and fitness self-tracking applications (Weight Watchers®, MyFitnessPal, and “sport” apps) were recruited from three regions of France. In-depth semi-directive interviews were conducted with each participant using open-ended questions to gain qualitative information about their use of diet and fitness apps. Results: We interviewed 79 individuals (Weight Watchers®, n=37; MyFitnessPal, n=20; sport apps, n=22). Quantitative analysis revealed three clusters of interviewees who differed by (1) social background and curative goal linked to use under constraint versus preventive goal linked to chosen use; and (2) intensity of their self-quantification efforts and participation in social networks. Interviewees used the applications for a diversity of uses including measurement, tracking, quantification, and participation in digital communities. A “digital divide” was revealed, comprising a major social gap. Social conditions for appropriation of self-tracking devices included socio-demographic factors, life course stages, and crosscutting factors of heterogeneity. Conclusions: Individuals from affluent or intermediate social milieus were most likely to use the applications and to participate in the associated on-line social networks. These interviewees also demonstrated a preventative approach to a healthy lifestyle. Individuals from lower milieus are more reluctant to digital devices in the field of diet / physical activity, and to the self-quantification process. The results of the study have major implications for public health.

  • Translation and validation of the Nomophobia Questionnaire (NMP-Q) in the Italian language: insights from factor analysis

    Date Submitted: Oct 15, 2017

    Open Peer Review Period: Oct 15, 2017 - Oct 24, 2017

    Background: Nomophobia, which is a portmanteau word for no mobile phone phobia, a fear of feeling disconnected, is considered to be a modern situational phobia. Objective: No psychometric scales in It...

    Background: Nomophobia, which is a portmanteau word for no mobile phone phobia, a fear of feeling disconnected, is considered to be a modern situational phobia. Objective: No psychometric scales in Italian are available for investigating nomophobia. We therefore planned a translation and validation study of the Nomophobia Questionnaire (NMP-Q) developed by Yildirim and Correia. Methods: The NMP-Q was translated from English into Italian using a backwards and forwards procedure. In order to explore the underlying factor structure of the translated questionnaire, exploratory factor analysis (EFA) was carried out. A principal component analysis (PCA) approach with varimax rotation was performed. Multivariate regression analyses were computed to shed light on the psychological predictors of nomophobia. Results: 403 subjects volunteered to take part in the study. They were aged 27.91±8.63 years and comprised 160 males (39.7%) and 243 females (60.3%). 45 subjects normally spent less than 1 hour on their mobile (11.2%), 94 between 1 and 2 hours (23.3%), 69 between 2 and 3 hours (17.1%), 58 between 3 and 4 hours (14.4%), 48 between 4 and 5 hours (11.9%), 29 between 5 and 7 hours (7.2%), 36 between 7 and 9 hours (8.9%) and 24 more than 10 hours (6.0%). The eigenvalues and scree plot supported a 3-factorial nature of the translated questionnaire. The NMP-Q showed an overall Cronbach’s alpha coefficient of 0.95 (0.94, 0.89 and 0.88 for the three factors). The first factor explained 23.32% of the variance, while the second and third explained 23.91% and 18.67% respectively. The total NMP-Q score correlated with the number of hours spent on the mobile. Conclusions: The Italian version of the NMP-Q proved to be reliable.