JMIR Publications

JMIR mHealth and uHealth

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


Journal Description

JMIR mhealth and uhealth (mobile and ubiquitous health) (JMU, ISSN 2291-5222) is a 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:

  • Fitbit-measured steps and minutes of “fairly or very active” physical activity among postmenopausal, overweight/obese women.

    Use of the Fitbit to Measure Adherence to a Physical Activity Intervention Among Overweight or Obese, Postmenopausal Women: Self-Monitoring Trajectory...


    Background: Direct-to-consumer trackers and devices have potential to enhance theory-based physical activity interventions by offering a simple and pleasant way to help participants self-monitor their behavior. A secondary benefit of these devices is the opportunity for investigators to objectively track adherence to physical activity goals across weeks or even months, rather than relying on self-report or a small number of accelerometry wear periods. The use of consumer trackers for continuous monitoring of adherence has considerable potential to enhance physical activity research, but few studies have been published in this rapidly developing area. Objective: The objective of the study was to assess the trajectory of physical activity adherence across a 16-week self-monitoring intervention, as measured by the Fitbit tracker. Methods: Participants were 25 overweight or obese, postmenopausal women enrolled in the intervention arm of a randomized controlled physical activity intervention trial. Each participant received a 16-week technology-based intervention that used the Fitbit physical activity tracker and website. The overall study goal was 150 minutes/week of moderate to vigorous intensity physical activity (MVPA) and 10,000 steps/day; however, goals were set individually for each participant and updated at Week 4 based on progress. Adherence data were collected by the Fitbit and aggregated by Fitabase. Participants also wore an ActiGraph GT3X+ accelerometer for 7 days prior to the intervention and again during Week 16. Results: The median participant logged 10 hours or more/day of Fitbit wear on 95% of the 112 intervention days, with no significant decline in wear over the study period. Participants averaged 7540 (SD 2373) steps/day and 82 minutes/week (SD 43) of accumulated “fairly active” and “very active” minutes during the intervention. At Week 4, 80% (20/25) of women chose to maintain/increase their individual MVPA goal and 72% (18/25) of participants chose to maintain/increase their step goal. Physical activity levels were relatively stable after peaking at 3 weeks, with only small declines of 8% for steps (P=.06) and 14% for MVPA (P=.05) by 16 weeks. Conclusions: These data indicate that a sophisticated, direct-to-consumer activity tracker encouraged high levels of self-monitoring that were sustained over 16 weeks. Further study is needed to determine how to motivate additional gains in physical activity and evaluate the long-term utility of the Fitbit tracker as part of a strategy for chronic disease prevention. Trial Registration: NCT01837147; (Archived by WebCite at


    Dutch Young Adults Ratings of Behavior Change Techniques Applied in Mobile Phone Apps to Promote Physical Activity: A Cross-Sectional Survey


    Background: Interventions delivered through new device technology, including mobile phone apps, appear to be an effective method to reach young adults. Previous research indicates that self-efficacy and social support for physical activity and self-regulation behavior change techniques (BCT), such as goal setting, feedback, and self-monitoring, are important for promoting physical activity; however, little is known about evaluations by the target population of BCTs applied to physical activity apps and whether these preferences are associated with individual personality characteristics. Objective: This study aimed to explore young adults’ opinions regarding BCTs (including self-regulation techniques) applied in mobile phone physical activity apps, and to examine associations between personality characteristics and ratings of BCTs applied in physical activity apps. Methods: We conducted a cross-sectional online survey among healthy 18 to 30-year-old adults (N=179). Data on participants’ gender, age, height, weight, current education level, living situation, mobile phone use, personality traits, exercise self-efficacy, exercise self-identity, total physical activity level, and whether participants met Dutch physical activity guidelines were collected. Items for rating BCTs applied in physical activity apps were selected from a hierarchical taxonomy for BCTs, and were clustered into three BCT categories according to factor analysis: “goal setting and goal reviewing,” “feedback and self-monitoring,” and “social support and social comparison.” Results: Most participants were female (n=146), highly educated (n=169), physically active, and had high levels of self-efficacy. In general, we observed high ratings of BCTs aimed to increase “goal setting and goal reviewing” and “feedback and self-monitoring,” but not for BCTs addressing “social support and social comparison.” Only 3 (out of 16 tested) significant associations between personality characteristics and BCTs were observed: “agreeableness” was related to more positive ratings of BCTs addressing “goal setting and goal reviewing” (OR 1.61, 95% CI 1.06-2.41), “neuroticism” was related to BCTs addressing “feedback and self-monitoring” (OR 0.76, 95% CI 0.58-1.00), and “exercise self-efficacy” was related to a high rating of BCTs addressing “feedback and self-monitoring” (OR 1.06, 95% CI 1.02-1.11). No associations were observed between personality characteristics (ie, personality, exercise self-efficacy, exercise self-identity) and participants’ ratings of BCTs addressing “social support and social comparison.” Conclusions: Young Dutch physically active adults rate self-regulation techniques as most positive and techniques addressing social support as less positive among mobile phone apps that aim to promote physical activity. Such ratings of BCTs differ according to personality traits and exercise self-efficacy. Future research should focus on which behavior change techniques in app-based interventions are most effective to increase physical activity.

  • Image created by authors using an image in the public domain (

    Smartphone Apps for Schizophrenia: A Systematic Review


    Background: There is increasing interest in using mobile technologies such as smartphones for improving the care of patients with schizophrenia. However, less is known about the current clinical evidence for the feasibility and effectiveness of smartphone apps in this population. Objective: To review the published literature of smartphone apps applied for the care of patients with schizophrenia and other psychotic disorders. Methods: An electronic database search of Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, Health Technology Assessment Database, Allied and Complementary Medicine, Health and Psychosocial Instruments, PsycINFO, and Embase was conducted on May 24, 2015. All eligible studies were systematically reviewed, and proportional meta-analyses were applied to pooled data on recruitment, retention, and adherence to examine the overall feasibility of smartphone interventions for schizophrenia. Results: Our search produced 226 results from which 7 eligible articles were identified, reporting on 5 studies of smartphone apps for patients with schizophrenia. All examined feasibility, and one assessed the preliminary efficacy of a smartphone intervention for schizophrenia. Study lengths varied between 6 and 130 days. Overall retention was 92% (95% CI 82-98%). Participants consistently used the smartphone apps on more than 85% of days during the study period, averaging 3.95 interactions per person per day. Furthermore, participants responded to 71.9% of automated prompts (95% CI 65.7-77.8%). Participants reported a range of potential benefits from the various interventions, and user experience was largely positive. Conclusions: Although small, the current published literature demonstrates strong evidence for the feasibility of using smartphones to enhance the care of people with schizophrenia. High rates of engagement and satisfaction with a broad range of apps suggest the nascent potential of this mobile technology. However, there remains limited data on the efficacy of such interventions.


    Health App Use Among US Mobile Phone Owners: A National Survey


    Background: Mobile phone health apps may now seem to be ubiquitous, yet much remains unknown with regard to their usage. Information is limited with regard to important metrics, including the percentage of the population that uses health apps, reasons for adoption/nonadoption, and reasons for noncontinuance of use. Objective: The purpose of this study was to examine health app use among mobile phone owners in the United States. Methods: We conducted a cross-sectional survey of 1604 mobile phone users throughout the United States. The 36-item survey assessed sociodemographic characteristics, history of and reasons for health app use/nonuse, perceived effectiveness of health apps, reasons for stopping use, and general health status. Results: A little over half (934/1604, 58.23%) of mobile phone users had downloaded a health-related mobile app. Fitness and nutrition were the most common categories of health apps used, with most respondents using them at least daily. Common reasons for not having downloaded apps were lack of interest, cost, and concern about apps collecting their data. Individuals more likely to use health apps tended to be younger, have higher incomes, be more educated, be Latino/Hispanic, and have a body mass index (BMI) in the obese range (all P<.05). Cost was a significant concern among respondents, with a large proportion indicating that they would not pay anything for a health app. Interestingly, among those who had downloaded health apps, trust in their accuracy and data safety was quite high, and most felt that the apps had improved their health. About half of the respondents (427/934, 45.7%) had stopped using some health apps, primarily due to high data entry burden, loss of interest, and hidden costs. Conclusions: These findings suggest that while many individuals use health apps, a substantial proportion of the population does not, and that even among those who use health apps, many stop using them. These data suggest that app developers need to better address consumer concerns, such as cost and high data entry burden, and that clinical trials are necessary to test the efficacy of health apps to broaden their appeal and adoption.

  • Sample text message to promote colorectal cancer screening.

    Crafting Appealing Text Messages to Encourage Colorectal Cancer Screening Test Completion: A Qualitative Study


    Background: mHealth interventions that incorporate text messages have great potential to increase receipt of preventive health services such as colorectal cancer screening. However, little is known about older adult perspectives regarding the receipt of text messages from their health care providers. Objective: To assess whether older adults would value and access text messages from their physician’s practice regarding colorectal cancer screening. Methods: We conducted four focus groups with 26 adults, aged 50 to 75 years, who had either recently completed or were overdue for colorectal cancer screening. A trained moderator followed a semistructured interview guide covering participant knowledge and attitudes regarding colorectal cancer screening, potential barriers to colorectal cancer screening, attitudes about receiving electronic communications from a doctor’s office, and reactions to sample text messages. Results: Participant responses to three primary research questions were examined: (1) facilitators and barriers to colorectal cancer screening, (2) attitudes toward receiving text messages from providers, and (3) characteristics of appealing text messages. Two themes related to facilitators of colorectal cancer screening were perceived benefits/need and family experiences and encouragement. Themes related to barriers included unpleasantness, discomfort, knowledge gaps, fear of complications, and system factors. Four themes emerged regarding receipt of text messages from health care providers: (1) comfort and familiarity with technology, (2) privacy concerns/potential for errors, (3) impact on patient-provider relationship, and (4) perceived helpfulness. Many participants expressed initial reluctance to receiving text messages but responded favorably when shown sample messages. Participants preferred messages that contained content that was important to them and were positive and reassuring, personalized, and friendly to novice texters (eg, avoided the use of texting shorthand phrases and complicated replies); they did not want messages that contain bad news or test results. They wanted the ability to choose alternative options such as email or phone calls. Conclusions: Older adults are receptive to receiving cancer screening text messages from health care providers. Sharing sample messages with patients may increase acceptance of this tool in the clinic setting. Supportive tailored text messaging reminders could enhance uptake of colorectal cancer screening by enhancing patient self-efficacy and providing cues to action to complete colonoscopy or fecal occult blood testing.

  • Screenshot of the app (image created by authors who hold the copyright).

    A Mobile Phone App for Dietary Intake Assessment in Adolescents: An Evaluation Study


    Background: There is a great need for dietary assessment methods that suit the adolescent lifestyle and give valid intake data. Objective: To develop a mobile phone app and evaluate its ability to assess energy intake (EI) and total energy expenditure (TEE) compared with objectively measured TEE. Furthermore, to investigate the impact of factors on reporting accuracy of EI, and to compare dietary intake with a Web-based method. Methods: Participants 14 to 16 years of age were recruited from year nine in schools in Gothenburg, Sweden. In total, 81 adolescents used the mobile phone app over 1 to 6 days. TEE was measured with the SenseWear Armband (SWA) during the same or proximate days. Individual factors were assessed with a questionnaire. A total of 15 participants also recorded dietary intake using a Web-based method. Results: The mobile phone app underestimated EI by 29% on a group level (P<.001) compared to TEE measured with the SWA, and there was no significant correlation between EI and TEE. Accuracy of EI relative to TEE increased with a weekend day in the record (P=.007) and lower BMI z-score (P=.001). TEE assessed with the mobile phone app was 1.19 times the value of TEE measured by the SWA on a group level (P<.001), and the correlation between the methods was .75 (P<.001). Analysis of physical activity levels (PAL) from the mobile phone app stratified by gender showed that accuracy of the mobile phone app was higher among boys. EI, nutrients, and food groups assessed with the mobile phone app and Web-based method among 15 participants were not significantly different and several were significantly correlated, but strong conclusions cannot be drawn due to the low number of participants. Conclusions: By using a mobile phone dietary assessment app, on average 71% of adolescents’ EI was captured. The accuracy of reported dietary intake was higher with lower BMI z-score and if a weekend day was included in the record. The daily question in the mobile phone app about physical activity could accurately rank the participants’ TEE.

  • By David Roseborough from Los Angeles, United States [CC BY 2.0 (], via Wikimedia Commons.

    Views of Women and Health Professionals on mHealth Lifestyle Interventions in Pregnancy: A Qualitative Investigation


    Background: Evidence suggests that women are failing to meet guidelines for nutrition, physical activity, and weight gain during pregnancy. Interventions to promote a healthy lifestyle in pregnancy demonstrate mixed results and many are time and resource intensive. mHealth-delivered interventions offer an opportunity to provide trusted source information in a timely and cost-effective manner. Studies regarding women’s and health professionals’ views of mHealth in antenatal care are limited. Objective: This study aimed to explore women’s and health professionals’ views regarding mHealth information sources and interventions to assist women to eat well, be physically active, and gain healthy amounts of weight in pregnancy. Methods: A descriptive qualitative research approach employed focus groups and in-depth interviews with 15 pregnant or postpartum women and 12 in-depth interviews with health professionals including two from each category: obstetricians, general practitioners, midwives, dietitians, physiotherapists, and community pharmacists. All interviews were transcribed verbatim and thematically analyzed. Results: Women uniformly embraced the concept of mHealth information sources and interventions in antenatal care and saw them as central to information acquisition and ideally incorporated into future antenatal care processes. Health professionals exhibited varied views perceiving mHealth as an inevitable, often parallel, service rather than one integrated into the care model. Four key themes emerged: engagement, risk perception, responsibility, and functionality. Women saw their ability to access mHealth elements as a way to self-manage or control information acquisition that was unavailable in traditional care models and information sources. The emergence of technology was perceived by some health professionals to have shifted control of information from trusted sources, such as health professionals and health organizations, to nontrusted sources. Some health professionals were concerned about the medicolegal risks of mHealth (incorrect or harmful information and privacy concerns), while others acknowledged that mHealth was feasible if inherent risks were addressed. Across both groups, there was uncertainty as to who should be responsible for ensuring high-quality mHealth. The absence of a key pregnancy or women’s advocacy group, lack of health funds for technologies, and the perceived inability of maternity hospitals to embrace technology were seen to be key barriers to provision. Women consistently identified the functionality of mHealth as adding value to antenatal care models. For some health professionals, lack of familiarity with and fear of mHealth limited their engagement with and comprehension of the capacity of new technologies to support antenatal care. Conclusions: Women exhibited positive views regarding mHealth for the promotion of a healthy lifestyle in antenatal care. Conversely, health professionals expressed a much wider variation in attitudes and were more able to identify potential risks and barriers to development and implementation. This study contributes to the understanding of the opportunities and challenges in developing mHealth lifestyle interventions in antenatal care.

  • Screenshot of electronic Dietary Intake Assessment (eDIA).

(Created by authors).

    Electronic Dietary Intake Assessment (e-DIA): Comparison of a Mobile Phone Digital Entry App for Dietary Data Collection With 24-Hour Dietary Recalls


    Background: The electronic Dietary Intake Assessment (e-DIA), a digital entry food record mobile phone app, was developed to measure energy and nutrient intake prospectively. This can be used in monitoring population intakes or intervention studies in young adults. Objective: The objective was to assess the relative validity of e-DIA as a dietary assessment tool for energy and nutrient intakes using the 24-hour dietary recall as a reference method. Methods: University students aged 19 to 24 years recorded their food and drink intake on the e-DIA for five days consecutively and completed 24-hour dietary recalls on three random days during this 5-day study period. Mean differences in energy, macro-, and micronutrient intakes were evaluated between the methods using paired t tests or Wilcoxon signed-rank tests, and correlation coefficients were calculated on unadjusted, energy-adjusted, and deattenuated values. Bland-Altman plots and cross-classification into quartiles were used to assess agreement between the two methods. Results: Eighty participants completed the study (38% male). No significant differences were found between the two methods for mean intakes of energy or nutrients. Deattenuated correlation coefficients ranged from 0.55 to 0.79 (mean 0.68). Bland-Altman plots showed wide limits of agreement between the methods but without obvious bias. Cross-classification into same or adjacent quartiles ranged from 75% to 93% (mean 85%). Conclusions: The e-DIA shows potential as a dietary intake assessment tool at a group level with good ranking agreement for energy and all nutrients.

  • Mobile phones in research (The image is from and is released under the creative commons CCO and is free for commercial use without requiring attribution).

    Mobile Phones in Research and Treatment: Ethical Guidelines and Future Directions


    Mobile phones and other remote monitoring devices, collectively referred to as "mHealth," promise to transform the treatment of a range of conditions, including movement disorders, such as Parkinson’s disease. In this viewpoint paper, we use Parkinson’s disease as an example, although most considerations discussed below are valid for a wide variety of conditions. The ability to easily collect vast arrays of personal data over long periods will give clinicians and researchers unique insights into disease treatment and progression. These capabilities also pose new ethical challenges that health care professionals will need to manage if this promise is to be realized with minimal risk of harm. These challenges include privacy protection when anonymity is not always possible, minimization of third-party uses of mHealth data, informing patients of complex risks when obtaining consent, managing data in ways that maximize benefit while minimizing the potential for disclosure to third parties, careful communication of clinically relevant information gleaned via mHealth technologies, and rigorous evaluation and regulation of mHealth products before widespread use. Given the complex array of symptoms and differences in comfort and literacy with technology, it is likely that these solutions will need to be individualized. It is therefore critical that developers of mHealth apps engage with patients throughout the development process to ensure that the technology meets their needs. These challenges will be best met through early and ongoing engagement with patients and other relevant stakeholders.

  • BodyWear sensor (image taken by the property of the authors).

    Basal Temperature Measurement Using a Multi-Sensor Armband in Australian Young Women: A Comparative Observational Study


    Background: The menstrual cycle is a key marker of health in women of reproductive age. Monitoring ovulation is useful in health studies involving young women. The upward shift in basal body temperature, which occurs shortly after ovulation and continues until the next menses, is a potentially useful marker of ovulation, which has been exploited in clinical and research settings. Objective: We investigated the utility of BodyMedia SenseWear (BMSW) in monitoring ovulation in young women by analyzing the correlation and agreement of basal temperatures measured using BMSW and a digital oral thermometer. Methods: Kappa statistics were used to determine the agreement in ovulation detection between the two devices, for each participant, under each form of analysis. Participants also completed an online questionnaire assessing the acceptability of both devices. Results: We recruited 16 participants with 15 of them providing analyzable data (11 OCP non-users, 4 OCP users). Weak to moderate correlations were observed between thermometer and BMSW temperature measurements averaged over 5 different time intervals. However, no agreement between methods was observed using Bland-Altman plots. There was a significant difference in the range of temperatures that each device recorded (thermometer: 35.3-37.2°C, BMSW: 29.7-36.7°C) with BMSW temperatures significantly lower than thermometer temperatures: mean 34.6°C (SD 1.2) versus 36.4°C (SD 0.3) respectively, P<.001. Poor agreement was observed between devices under quantitative analysis of ovulation while fair agreement was observed under visual analysis. Under both quantitative and visual analysis, there was 0% agreement for evidence of ovulation. Conclusions: This study demonstrated the importance of evaluating biomeasures collected using mobile monitoring devices by comparison with standard methods. It revealed a relatively poor correlation between BMSW and oral thermometer temperature readings and suggested that BMSW is unlikely to detect an upward shift in basal body temperature. Participant behavior suggested poor compliance in the use of BMSW for basal temperature measurement and that the basal body temperature method may not be suitable for use in unselected samples of young women. There is a need for research tools for monitoring ovulation that are simple, self-administered, and inexpensive, yet appealing to young women.

  • This image is from the public domain (google/

    Evaluation of Social Media Utilization by Latino Adolescents: Implications for Mobile Health Interventions


    Background: Trends in social media use, including sending/receiving short message service (SMS) and social networking, are constantly changing, yet little is known about adolescent’s utilization and behaviors. This longitudinal study examines social media utilization among Latino youths, and differences by sex and acculturation. Objectives: The purpose of this study was to examine Latino adolescents’ social media utilization and behavior over a 16-month period, and to assess whether changes in use differed by sex and acculturation. Methods: This study included 555 Latino youths aged 13-19 who completed baseline and 16-month follow-up surveys. Prevalence of social media utilization and frequency, by sex and acculturation categories, was examined using generalized estimating equations. Results: Women are more likely to use SMS, but men are significantly more likely to SMS a girl/boyfriend (P=.03). The use of Internet by men and women to research health information increased over time. Facebook use declined over time (P<.001), whereas use of YouTube (P=.03) and Instagram (P<.001) increased, especially among women and more US acculturated youths. Conclusion: Social media is ubiquitous in Latino adolescents’ lives and may be a powerful mode for public health intervention delivery.

  • Screenshot of app providing an example of a fact about iron.

    Mobile Phone App Aimed at Improving Iron Intake and Bioavailability in Premenopausal Women: A Qualitative Evaluation


    Background: Low iron intake can lead to iron deficiency, which can result in impaired health and iron-deficiency anemia. A mobile phone app, combining successful dietary strategies to increase bioavailable iron with strategies for behavior change, such as goal setting, monitoring, feedback, and resources for knowledge acquisition, was developed with the aim to increase bioavailable iron intake in premenopausal women. Objective: To evaluate the content, usability, and acceptability of a mobile phone app designed to improve intake of bioavailable dietary iron. Methods: Women aged 18-50 years with an Android mobile phone were invited to participate. Over a 2-week period women were asked to interact with the app. Following this period, semistructured focus groups with participants were conducted. Focus groups were audio recorded and analyzed via an inductive open-coding method using the qualitative analysis software NVivo 10. Themes were identified and frequency of code occurrence was calculated. Results: Four focus groups (n=26) were conducted (age range 19-36 years, mean 24.7, SD 5.2). Two themes about the app’s functionality were identified (frequency of occurrence in brackets): interface and design (134) and usability (86). Four themes about the app’s components were identified: goal tracker (121), facts (78), photo diary (40), and games (46). A number of suggestions to improve the interface and design of the app were provided and will inform the ongoing development of the app. Conclusions: This research indicates that participants are interested in iron and their health and are willing to use an app utilizing behavior change strategies to increase intake of bioavailable iron. The inclusion of information about the link between diet and health, monitoring and tracking of the achievement of dietary goals, and weekly reviews of goals were also seen as valuable components of the app and should be considered in mobile health apps aimed at adult women.

Citing this Article

Right click to copy or hit: ctrl+c (cmd+c on mac)

Latest Submissions Open for Peer-Review:

View All Open Peer Review Articles
  • Recognition Of Common Gait Patterns Using I-Pod Touch Tri-Axial Accelerometer Data: Preliminary Results

    Date Submitted: Nov 28, 2015

    Open Peer Review Period: Nov 28, 2015 - Jan 23, 2016

    It has been shown that a wireless tri-axial accelerometer in an I-Pod Touch device is capable of quantifying gait parameters with great consistency and accuracy. However, its use by a clinician in cli...

    It has been shown that a wireless tri-axial accelerometer in an I-Pod Touch device is capable of quantifying gait parameters with great consistency and accuracy. However, its use by a clinician in clinical practice is limited due to difficulties in interpreting and understanding the temporal and spatial component of the waveforms generated. We describe a new method for data displaying common gait patterns seen in the clinic. Summarised gait data was represented as a circular pattern for easy recognition. 36 subjects with 9 each for four gait patterns respectively (normal gait, antalgic gait, short limb gait and waddling gait) were presented to 6 trained orthopaedic observers who successfully differentiated the patterns into features groups with distinctive patterns. The results of our preliminary study showed promise in detecting characteristic features for waveforms of each type of gait, easily differentiated from another.

  • Smartphone Applications for Preventing Cancer through Educational and Behavioral Interventions: State of the Art and Remaining Challenges

    Date Submitted: Nov 20, 2015

    Open Peer Review Period: Nov 20, 2015 - Jan 15, 2016

    Background: Rapid developments in technology have encouraged the use of smartphones in smoking cessation; promoting healthy diet, nutrition, and physical activity; sun safety; and cancer screening. A...

    Background: Rapid developments in technology have encouraged the use of smartphones in smoking cessation; promoting healthy diet, nutrition, and physical activity; sun safety; and cancer screening. Although many applications (apps) relating to the prevention of cancer and other chronic diseases are available from major smartphone platforms, relatively few have been tested in research studies to determine their effectiveness. Objective: In this review, we discuss smartphone apps for smoking cessation, healthy diet and nutrition, physical activity, weight management, cancer screening, and sun safety, and issues related to the development and testing of new apps.In addition to summarizing randomized controlled trials of smartphone apps that may contribute to cancer prevention and control, we discuss key methodologic issues and outstanding challenges. Methods: Bibliographic searches were conducted in PubMed and CINAHL with relevant search terms to identify articles published in English through October 2015. Results: In randomized controlled trials, smartphone apps have been shown to be effective in promoting better dietary compliance for lower calorie, low fat, and high fiber foods, higher physical activity levels, and weight loss. The use of smartphone apps for smoking cessation has been shown to be feasible and effective in a handful of randomized controlled trials. Smartphone apps are a potentially useful behavioral intervention for encouraging adherence with guidelines for routine cancer screening and sun safety, although more research is needed. There is currently a lack of research-tested apps for promoting breast or colorectal cancer screening or for helping people to avoid carcinogenic exposures in work and home environments. Conclusions: Future studies should utilize randomized controlled trial research designs, larger sample sizes, and longer study periods to better establish the cancer prevention and control capabilities of smartphones. In developing new and refined apps for cancer prevention and control, both health literacy and e-Health literacy should be taken into account. There is a need for culturally appropriate, tailored health messages to increase knowledge and awareness of health behaviors such as smoking cessation, cancer screening, healthy eating, and sun safety. Smartphone apps are likely to be a useful and low-cost intervention for improving diet and nutrition, encouraging physical activity, addressing

  • Assistant for detection of clinical depressive frames developed on mobile platforms

    Date Submitted: Nov 15, 2015

    Open Peer Review Period: Nov 16, 2015 - Jan 11, 2016

    Background: Depression is a condition capable of significantly effecting a person’s behavior or perception of his/her environment and the 14th leading cause of death in Mexico. HoD Detector is a low...

    Background: Depression is a condition capable of significantly effecting a person’s behavior or perception of his/her environment and the 14th leading cause of death in Mexico. HoD Detector is a low-cost, easy to use application that aids in the diagnosis of a depressive disorder and motivates the user to seek professional help. Objective: The purpose of this study was to describe HoD Detector and evaluate the accuracy and usability of this application (with university students) for future enhancements of the system. Methods: The development of this application involved basic algorithms and the use of a database in order to successfully make a diagnosis and store the results of each user for further reference. Results: The application is capable of giving a proper diagnosis with the time interval of 2-5 minutes. There were little to no complaints in regards to the usability of the application. Conclusions: HoD Detector has the potential to become an extremely useful tool to diagnose depression and motivate users to seek professional help not only in Mexico, but on an international scale.

  • The electronic Patient Reported Outcome (ePRO) Tool: Testing usability and feasibility of a mobile app for patients with complex chronic disease and disability in primary care settings.

    Date Submitted: Nov 9, 2015

    Open Peer Review Period: Nov 9, 2015 - Jan 4, 2016

    Background: People experiencing complex chronic disease and disability (CCDD) face some of the greatest challenges of any patient population. Primary care providers find it difficult to manage these p...

    Background: People experiencing complex chronic disease and disability (CCDD) face some of the greatest challenges of any patient population. Primary care providers find it difficult to manage these patients’ multiple discordant conditions and symptoms and their often complex social challenges. The electronic Patient Reported Outcome (ePRO) tool is designed to overcome some of these challenges through supporting goal-oriented primary care delivery. Using the tool, patients and providers collaboratively develop health care goals on a portal linked to a mobile device to help patients track progress between visits. Objective: This study tested the usability and feasibility of adopting the ePRO tool into a single inter-disciplinary primary health care practice in Toronto, Canada. We used the Fit between Individuals, Task and Technology (FITT) framework to guide our assessment and explore whether the ePRO tool is, 1) feasible for adoption in inter-disciplinary primary health care practices and, 2) usable from both the patient and provider perspective. This usability pilot is part of a broader user-centred design development strategy. Methods: We conducted a 4-week pilot study in which patients and providers used the ePRO tool to develop health related goals which patients then monitored using a mobile device. Patients and providers collaboratively set goals using the system during an initial visit, and had at least one follow-up visit at the end of the pilot to discuss progress. Focus groups and interviews were conducted with patients and providers to capture usability and feasibility measures. Data from the ePRO system was extracted to provide information regarding tool use. Results: Six providers and eleven patients participated in the study; three patients dropped out mainly due to health issues. The tool was used heavily by patients; 8 individuals completed 210 monitoring protocols, equal to over 1300 questions. Providers and patients accessed the portal an average of 10 and 1.5 times respectively. Users found the system easy to use, some patients reporting that the tool helped in their ability to self-manage, catalyzed a sense of responsibility over their care, and improved patient-centred care delivery. Some providers found that the tool helped focus conversations on goal-setting. However, the tool did not fit well with provider workflows, monitoring questions were not adequately tailored to individual patient needs, and daily reporting became tedious and time consuming for patients. Conclusions: While our study suggests relatively low usability and feasibility of the ePRO tool, we are encouraged by the early impact on patient outcomes and generally positive responses from both user groups regarding the potential of the tool to improve care for patients with CCDD. As is consistent with our user-centred design development approach, we have modified the tool based on user feedback and are now testing the re-developed tool through an exploratory trial.

  • Text Message Intervention to Reduce Heavy Episodic Alcohol Consumption among Young Adults: Focus Group Findings

    Date Submitted: Nov 6, 2015

    Open Peer Review Period: Nov 7, 2015 - Jan 2, 2016

    Background: Recent trial results show that an automated and interactive text message intervention (TRAC) is effective in reducing alcohol consumption among non-treatment seeking young adults, but may...

    Background: Recent trial results show that an automated and interactive text message intervention (TRAC) is effective in reducing alcohol consumption among non-treatment seeking young adults, but may not be optimized. Objective: To assess attitudes and opinions of young adults regarding the TRAC intervention in an effort to inform future intervention design. Methods: We conducted five focus groups with 18 young adults, aged 18-25 years, who had been randomized to 12-weeks of the TRAC intervention and who completed the final follow-up (9-month) assessment as part of a clinical trial. A trained moderator followed a semi-structured interview guide covering acceptability and usefulness of the TRAC intervention, specifically probing user reactions to: drinking assessments, goal-setting prompts, and feedback messages. Participants were also asked their opinions about possible additions to the intervention, including intra-drinking support messaging and a web-based tracking dashboard. Focus groups were audio-recorded, transcribed, and analyzed, including identification of emergent themes. Results: We identified four emergent themes regarding the TRAC intervention: (1) ease of use, (2) comfort & confidentiality (3) increased awareness of drinking behavior, and (4) accountability for drinking behavior. Participant’s comments supported the existing features of the TRAC intervention including pre-weekend drinking plan and post-weekend drinking assessments, goal setting prompts and feedback messages. Participants suggested increasing personalization, adding minimally disruptive intra-drinking support messaging and a web-based dashboard to display progress and share and compare progress with peers. Conclusions: Young adults perceived the TRAC intervention as an acceptable and useful way to help them reduce heavy episodic drinking.Findings suggest that user adoption and intervention adherence depends on its ease of use and conversational nature. Findings also suggest that effectiveness depends on an intervention’s ability to help individuals become more aware of their drinking and accountable for their drinking choices, which occurs through accretion of experiences with the intervention over time. Successful programs should balance repetition with novelty and directive with receptive feedback as well as attempt to personalize materials based on user-specific features and provide additional support through online adjuncts.

  • Development and testing of an automated four days SMS guidance as an aid for improving colonoscopy preparation

    Date Submitted: Oct 26, 2015

    Open Peer Review Period: Nov 4, 2015 - Dec 30, 2015

    Background: In gastroenterology a sufficient colon cleansing improves adenoma detection rate and prevents the need for preterm repeat colonoscopies due to invalid preparation. It has been shown that p...

    Background: In gastroenterology a sufficient colon cleansing improves adenoma detection rate and prevents the need for preterm repeat colonoscopies due to invalid preparation. It has been shown that patient education is of major importance for improvement of colon cleansing. Objective: Aim of this study was to assess the function of a automated short-message-service supported colonoscopy preparation starting four days before colonoscopy appointment. Methods: After analysis of percentage of patients using a mobile phone for relevance, a web based, automated SMS-system was developed. Following a single center feasibility study at a tertiary care center was performed. Patients scheduled for out-patient colonoscopy were asked for participation. Patients enrolled in the study group received automated information about dietary recommendation and bowel cleansing during colonoscopy preparation. Data of out-patient colonoscopies with regular preparation procedure were used as matched pairs and served as control. Primary endpoint was feasibility of SMS in colonoscopy preparation assessed as stable function of the system. Secondary endpoints were quality of bowel preparation according to the Boston-bowel-preparation-score (BBPS) and patient satisfaction with SMS provided information assessed by a questionnaire. Results: SMS service was successful in 19 of 20 patients. Colonoscopy was feasible in all patients of the study group. Mean (±SEM) total Boston Bowel preparation score was higher in the SMS group than in the control group (7.3 ± 0.3 vs. 6.4 ± 0.2). Patient satisfaction regarding SMS based information was high. Conclusions: Using Short-Message-Service for colonoscopy preparation with a four days guidance including dietary recommendation is a new approach to improve colonoscopy preparation. Quality of colonoscopy preparation was higher and patients were highly satisfied with the system during colonoscopy preparation.