JMIR Publications

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  Evaluation and Research Methodology...

  Apr 15, 2024

  Tailored Prompting to Improve Adherence to Image-Based Dietary Assessment: Mixed Methods Study

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  Authors List:

  • Lachlan Lee  
  • Rosemary Hall  
  • James Stanley  
  • Jeremy Krebs  

  Abstract:

  Background: Accurately assessing an individual’s diet is vital in the management of personal nutrition and in the study of the effect of diet on health. Despite its importance, the tools available for dietary assessment remain either too imprecise, expensive, or burdensome for clinical or research use. Image-based methods offer a potential new tool to improve the reliability and accessibility of dietary assessment. Though promising, image-based methods are sensitive to adherence, as images cannot be captured from meals that have already been consumed. Adherence to image-based methods may be improved with appropriately timed prompting via text message. Objective: This study aimed to quantitatively examine the effect of prompt timing on adherence to an image-based dietary record, and qualitatively explore the participant experience of dietary assessment in order to inform the design of a novel image-based dietary assessment tool. Methods: This study used a randomised cross-over design to examine the intra-individual effect of three prompt settings on the number of images captured in a image-based dietary record. The prompt settings were control, where no prompts were sent; standard, where prompts were sent at 7:15 AM, 11:15 AM, and 5:15 PM for every participant; and tailored, where prompt timing was tailored to habitual meal times for each participant. Participants completed a text-based dietary record at baseline to determine the timing of tailored prompts. Participants were randomised to one of six study sequences, each with a unique order of the three prompt settings, with each three-day image-based dietary record separated by a wash-out period of at least seven days. The qualitative component comprised semi-structured interviews and questionnaires exploring the experience of dietary assessment. Results: Thirty seven people were recruited and 30 participants, (11 male, 19 female; mean (SD) age 30 (10.8) years), completed all image-based dietary records. Image rate increased by 0.83 images per day in the standard setting compared to control (P=.23) and increased by 1.78 images per day in the tailored setting compared to control (P=<.001). Sixty two percent of participants preferred to use the image-based dietary record versus the text-based dietary record but reported method-specific challenges with each method, particularly the inability to record via image after a meal had been consumed. Conclusions: Tailored prompting improves adherence to image-based dietary assessment. Future image-based dietary assessment tools should use tailored prompting and offer both image-based and written input options to improve record completeness.

  • JMIR Mhealth Uhealth 2024;12(1):e52074

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  Wearables and MHealth Reviews

  Apr 15, 2024

  mHealth-Based Gamification Interventions Among Men Who Have Sex With Men in the HIV Prevention and Care Continuum: Systematic Review and Meta-Analysis

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  Authors List:

  • Qianqian Luo  
  • Yue Zhang  
  • Wei Wang  
  • Tianyu Cui  
  • Tianying Li  

  Abstract:

  Background: Past few years has witnessed a burgeoning interest in applying gamification to promote desired health behaviors. However, little is known about the effectiveness of such applications in Human Immunodeficiency Virus (HIV) prevention and care continuum among men who have sex with men (MSM). Objective: To summarize and evaluate research on the effectiveness of gamification on HIV prevention and care continuum, including HIV testing promotion, condomless anal sex (CAS) reduction, uptake and adherence in pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), and antiretroviral therapy (ART). Methods: We comprehensively searched PubMed, Embase, the Cochrane Library, Web of Science, Scopus, the Journal of Medical Internet Research and its sister journals for studies published in English and Chinese from inception to January 2024. Eligible studies were included when they used gamified interventions with an active or inactive control group and assessed at least one of the following outcomes: HIV testing, CAS, uptake and adherence of PrEP, PEP, and ART. During the meta-analysis, a random-effects model was applied. Two reviewers independently assessed the quality and risk of bias of each included study. Results: The systematic review identified 26 studies, including 10 randomized controlled trials (RCTs). The results indicated that gamified digital interventions had been applied to various HIV outcomes, such as HIV testing, CAS, PrEP uptake and adherence, PEP uptake, and ART adherence. Most of the studies were conducted in the USA (19/26, 73%). The most frequently used game component was gaining points, followed by challenges. The meta-analysis showed gamification interventions could reduce the number of CAS acts at the 3-month follow-up (Two RCTs, IRR=0.62, 95%CI: 0.44-0.88). The meta-analysis also suggested an effective but non-statistically significant effect of PrEP adherence at 3-month follow up (three RCTs, RR=1.16, 95%CI: 0.96, 1.38) and 6-month follow up (Four RCTs, RR=1.28, 95%CI: 0.89, 1.84). Only one pilot RCT was designed to evaluate the effectiveness of a gamified app in promoting HIV testing and PrEP uptake. No RCT was conducted to evaluate the effect of the gamified digital intervention on PEP uptake and adherence, and ART initiation among MSM. Conclusions: Our findings suggest the short-term effect of gamified digital interventions on lowering the number of CAS in MSM. Further well-powered studies are still needed to evaluate the effect of the gamified digital intervention on HIV testing, PrEP uptake, PEP initiation and adherence, and ART initiation in MSM. Clinical Trial: PROSPERO CRD42023392193; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=392193

  • JMIR Mhealth Uhealth 2024;12(1):e49509

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  mHealth for Symptom and Disease...

  Apr 11, 2024

  The Impact of mHealth-Based Continuous Care on Disease Knowledge, Treatment Compliance, and Serum Uric Acid Levels in Chinese Patients With Gout: Randomized...

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  Authors List:

  • Ying Wang  
  • Yanling Chen  
  • Yuqing Song  
  • Hong Chen  
  • Xin Guo  
  • Ling Ma  
  • Huan Liu  

  Abstract:

  Background: In patients with gout, suboptimal management refers to a lack of disease knowledge, low treatment compliance, and inadequate control of serum uric acid levels. Several studies have shown that continuous care is recommended for disease management in patients with gout. However, in China, the continuous care model commonly used for gout patients requires significant labor and time costs, and its efficiency and coverage remain low, and mHealth seems to address these issues. Objective: This study aimed to explore the impact of mHealth-based continuous care on improving gout knowledge and treatment compliance and reducing serum uric acid levels. Methods: This study was a single-center, single-blind, and parallel-group randomized controlled trial. Participants were recruited at the West China Hospital of Sichuan University in Chengdu, China, between February 2021 and July 2021 and were randomly assigned to the intervention and control groups. The intervention group received continuous care via the mHealth app, including establishing a health file, a 24-stage gout-related knowledge share, and interactive support. The control group received routine continuous care, including face-to-face health education, paper health education material consistent with the content of the intervention group, and telephone consultations initiated by the patient. The follow-up period was conducted at 6 months. Participants’ gout knowledge levels and treatment compliance were measured at baseline and in the 12th and 24th weeks, and participants’ serum uric acid levels were measured at baseline and in the 24th week. The intention-to-treat principle and a generalized estimating equation model were used to test the effect of the intervention. Results: 258 potential participants underwent eligibility assessments, and 120 were recruited and randomized into the intervention group (N = 60) and the control group (N = 60). 93 completed the 24-week study. The two groups had no significant differences in sociodemographic or clinical characteristics. The baseline measurements were comparable (P＞.05). Compared with the control group, the intervention group exhibited a significant improvement in gout knowledge levels over time (β=0.617, 95%CI .104-1.129; P=.02 ＆β=1.300, 95%CI .669-1.931; P<.001 in the 12th and 24th weeks, respectively). There was no significant difference in treatment adherence between the two groups in the 12th week (β=1.667, 95%CI -3.283-6.617; P=.51), while a statistical difference was observed in the 24th week (β=6.287, 95%CI 1.357-11.216; P=.01). In the 24th week, serum uric acid levels in both the intervention and control groups were below baseline in the 24th week, but there was no significant difference in SUA changes between the two groups (P = .43). Conclusions: Continuous care based on the mHealth app improves knowledge levels and treatment compliance among patients with gout. We suggest incorporating this intervention modality into standard continuous care for patients with gout. Clinical Trial: Chinese Clinical Trials Registry ChiCTR2100042712; https://www.chictr.org.cn/showproj.html?proj=121002

  • JMIR Mhealth Uhealth 2024;12(1):e47012

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  Wearables and MHealth Reviews

  Apr 11, 2024

  Users' Acceptability and Perceived Efficacy of mHealth for Opioid Use Disorder: Scoping Review

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  Authors List:

  • Lynnette Nathalie Lyzwinski  
  • Mohamed Elgendi  
  • Carlo Menon  

  Abstract:

  Background: The opioid crisis continues to pose significant challenges to global public health, necessitating the development of novel interventions to support individuals in managing their substance use and preventing overdose-related deaths. Mobile health (mHealth), as a promising platform for addressing opioid use disorder, requires a comprehensive understanding of user perspectives to minimize barriers to care and optimize the benefits of mHealth interventions. Objective: This study aims to synthesize qualitative insights into opioid users’ acceptability and perceived efficacy of mHealth and wearable technologies for opioid use disorder. Methods: A scoping review of PubMed (MEDLINE) and Google Scholar databases was conducted to identify research on opioid user perspectives concerning mHealth-assisted interventions, including wearable sensors, SMS text messaging, and app-based technology. Results: Overall, users demonstrate a high willingness to engage with mHealth interventions to prevent overdose-related deaths and manage opioid use. Users perceive mHealth as an opportunity to access care and desire the involvement of trusted health care professionals in these technologies. User comfort with wearing opioid sensors emerged as a significant factor. Personally tailored content, social support, and encouragement are preferred by users. Privacy concerns and limited access to technology pose barriers to care. Conclusions: To maximize benefits and minimize risks for users, it is crucial to implement robust privacy measures, provide comprehensive user training, integrate behavior change techniques, offer professional and peer support, deliver tailored messages, incorporate behavior change theories, assess readiness for change, design stigma-reducing apps, use visual elements, and conduct user-focused research for effective opioid management in mHealth interventions. mHealth demonstrates considerable potential as a tool for addressing opioid use disorder and preventing overdose-related deaths, given the high acceptability and perceived benefits reported by users.

  • JMIR Mhealth Uhealth 2024;12(1):e49751

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  mHealth in the Developing...

  Apr 9, 2024

  Effectiveness and Implementation of a Text Messaging mHealth Intervention to Prevent Childhood Obesity in Mexico in the COVID-19 Context: Mixed Methods Study

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  Authors List:

  • Ana Lilia Lozada-Tequeanes  
  • Florence L Théodore  
  • Edith Kim-Herrera  
  • Armando García-Guerra  
  • Amado D Quezada-Sánchez  
  • Rocio Alvarado-Casas  
  • Anabelle Bonvecchio  

  Abstract:

  Background: Promoting physical activity (PA) and healthy feeding (HF) is crucial to address the alarming increase in obesity rates in developing countries. Leveraging mobile phones for behavior change communication to encourage infant PA and promote HF is particularly significant within the Mexican context. Objective: This study aims to explore the effectiveness and feasibility of mHealth interventions aimed at promoting PA and HF among primary caregivers (PCs) of Mexican children under the age of 5 years. Additionally, the study aims to disseminate insights gained from intervention implementation amidst the COVID-19 pandemic and assess the potential of behavior change mHealth interventions on a broader population scale. Methods: NUTRES, an mHealth intervention, underwent an effectiveness-implementation hybrid trial. Over 36 weeks, participants in the intervention group (IG), totaling 230 individuals, received approximately 108 SMS text messages tailored to their children’s age. These messages covered topics such as PA and HF and emphasized the significance of proper child nutrition amidst the COVID-19 pandemic. NUTRES participants were recruited from both urban and rural health units across 2 states in Mexico. Given the COVID-19 context, both baseline and follow-up surveys were conducted via mobile or fixed telephone. The evaluation of effectiveness and implementation used a mixed methods approach. Qualitative analysis delved into participants’ experiences with NUTRES and various implementation indicators, including acceptance, relevance, and coverage. Grounded theory was used for coding and analysis. Furthermore, difference-in-differences regression models were used to discern disparities between groups (comparison group [CG] versus IG) concerning knowledge and practices pertaining to infant PA and HF. Results: Of the total 494 PCs enrolled in NUTRES, 334 persisted until the end of the study, accounting for 67.6% (334/494) participation across both groups. A majority of PCs (43/141, 30.5%, always; and 97/141, 68.8%, sometimes) used the SMS text message information. Satisfaction and acceptability toward NUTRES were notably high, reaching 98% (96/98), with respondents expressing that NUTRES was “good,” “useful,” and “helpful” for enhancing child nutrition. Significant differences after the intervention were observed in PA knowledge, with social interaction favored (CG: 8/135, 5.9% vs IG: 20/137, 14.6%; P=.048), as well as in HF practice knowledge. Notably, sweetened beverage consumption, associated with the development of chronic diseases, showed divergence (CG: 92/157, 58.6% vs IG: 110/145, 75.9%; P=.003). In the difference-in-differences model, a notable increase of 0.03 in knowledge regarding the benefits of PA was observed (CG: mean 0.13, SD 0.10 vs IG: mean 0.16, SD 0.11; P=.02). PCs expressed feeling accompanied and supported, particularly amidst the disruption of routine health care services during the COVID-19 pandemic. Conclusions: While NUTRES exhibited a restricted impact on targeted knowledge and behaviors, the SMS text messages functioned effectively as both a reminder and a source of new knowledge for PCs of Mexican children under 5 years of age. The key lessons learned were as follows: mHealth intervention strategies can effectively maintain communication with individuals during emergencies, such as the COVID-19 pandemic; methodological and implementation barriers can constrain the effectiveness of mHealth interventions; and using mixed methods approaches ensures the complementary nature of results. The findings contribute valuable evidence regarding the opportunities and constraints associated with using mobile phones to enhance knowledge and practices concerning PA and HF among PCs of children under 5 years old. Trial Registration: ClinicalTrials.gov NCT04250896; https://clinicaltrials.gov/ct2/show/NCT04250896

  • JMIR Mhealth Uhealth 2024;12(1):e55509

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  Wearables and MHealth Reviews

  Apr 8, 2024

  Effects of Telemedicine on Informal Caregivers of Patients in Palliative Care: Systematic Review and Meta-Analysis

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  Authors List:

  • Xiaoyu Yang  
  • Xueting Li  
  • Shanshan Jiang  
  • Xinying Yu  

  Abstract:

  Background: Telemedicine technology is a rapidly developing field that demonstrates immense potential in improving medical services. In palliative care, informal caregivers assume the primary responsibility in patient care and often face challenges such as increased physical and mental stress, and declining health. In such cases, telemedicine interventions can provide support and improve their health outcomes. However, research findings regarding the use of telemedicine among informal caregivers are controversial, and its efficacy remains unclear. Objective: This study aimed to evaluate the impacts of telemedicine on managing the burden, anxiety, depression, and quality of life of informal caregivers of palliative care. Methods: A systematic literature search was conducted using the PubMed, Embase, Web of Science, CENTRAL, PsycINFO, CINAHL Plus with Full Text, CBM, CNKI, WanFang, and VIP databases to identify relevant randomized controlled trials (RCTs)published from inception to March 2023. Two authors independently screened the studies and extracted relevant information. The methodological quality of the included studies was assessed using the Cochrane risk of bias tool. Intervention effects were estimated and sensitivity analysis was conducted using Review Manager 5.4, while 95% prediction intervals (PI) were calculated using R (version 4.3.2) and RStudio. Results: Nine RCTs were included in this study. The meta-analysis indicated that telemedicine has reduced the caregiving burden (SMD −0.49; 95% CI −0.72 to −0.27; P<.001; PI −0.86 to −0.13) and anxiety (SMD −0.23; 95% CI −0.40 to −0.06; P=.009; PI −0.98 to 0.39) of informal caregivers; however, it did not affect depression (SMD −0.21; 95% CI -0.47 to 0.05; P=.11; PI −0.94 to 0.51) or quality of life (SMD 0.35; 95% CI −0.20 to 0.89; P=.21; PI −2.15 to 2.85). Conclusions: While telemedicine can alleviate the caregiving burden and anxiety of informal caregivers, it does not significantly reduce depression or improve their quality of life. Further high-quality, large-sample studies are needed to validate the effects of telemedicine. Furthermore, personalized intervention programs based on theoretical foundations are required to support caregivers. Clinical Trial: PROSPERO CRD42023415688; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=415688

  • JMIR Mhealth Uhealth 2024;12(1):e54244

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  Text-messaging (SMS, WeChat...

  Apr 5, 2024

  Development of a Health Behavioral Digital Intervention for Patients With Hypertension Based on an Intelligent Health Promotion System and WeChat: Randomized...

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  Authors List:

  • Ting Sun  
  • Xuejie Xu  
  • Zenghui Ding  
  • Hui Xie  
  • Linlin Ma  
  • Jing Zhang  
  • Yuxin Xia  
  • Guoli Zhang  
  • Zuchang Ma  

  Abstract:

  Background: The effectiveness of timely medication, physical activity (PA), a healthy diet, and blood pressure (BP) monitoring for promoting health outcomes and behavioral changes among patients with hypertension is supported by a substantial amount of literature, with “adherence” playing a pivotal role. Nevertheless, there is a lack of consistent evidence regarding whether digital interventions can improve adherence to healthy behaviors among individuals with hypertension. Objective: The aim was to develop a health behavioral digital intervention for hypertensive patients (HBDIHP) based on an intelligent health promotion system and WeChat following the behavior change wheel (BCW) theory and digital micro-intervention care (DMIC) model and assess its efficacy in controlling BP and improving healthy behavior adherence. Methods: A 2-arm, randomized trial design was used. We randomly assigned 68 individuals aged >60 years with hypertension in a 1:1 ratio to either the control or experimental group. The digital intervention was established through the following steps: (1) developing digital health education materials focused on adherence to exercise prescriptions, Dietary Approaches to Stop Hypertension (DASH), prescribed medication, and monitoring of BP; (2) using the BCW theory to select behavior change techniques; (3) constructing the intervention's logic following the guidelines of the DMIC model; (4) creating an intervention manual including the aforementioned elements. Prior to the experiment, participants underwent physical examinations at the community health service center's intelligent health cabin and received intelligent personalized health recommendations. The experimental group underwent a 12-week behavior intervention via WeChat, while the control group received routine health education and a self-management manual. The primary outcomes included BP and adherence indicators. Data analysis was performed using SPSS, with independent sample t tests, chi-square tests, paired t tests, and McNemar tests. A P value <.05 was considered statistically significant. Results: The final analysis included 54 participants with a mean age of 67.24 (SD 4.19) years (n=23 experimental group, n=31 control group). The experimental group had improvements in systolic BP (–7.36 mm Hg, P=.002), exercise time (856.35 metabolic equivalent [MET]-min/week, P<.001), medication adherence (0.56, P=.001), BP monitoring frequency (P=.02), and learning performance (3.23, P<.001). Both groups experienced weight reduction (experimental: 1.2 kg, P=.002; control: 1.11 kg, P=.009) after the intervention. The diet types and quantities for both groups (P<.001) as well as the subendocardial viability ratio (0.16, P=.01) showed significant improvement. However, there were no statistically significant changes in other health outcomes. Conclusions: The observations suggest our program may have enhanced specific health outcomes and adherence to health behaviors in older adults with hypertension. However, a longer-term, larger-scale trial is necessary to validate the effectiveness. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200062643; https://www.chictr.org.cn/showprojEN.html?proj=172782

  • JMIR Mhealth Uhealth 2024;12(1):e53006

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  Wearables and MHealth Reviews

  Apr 5, 2024

  Attributes, Methods, and Frameworks Used to Evaluate Wearables and Their Companion mHealth Apps: Scoping Review

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  Authors List:

  • Preetha Moorthy  
  • Lina Weinert  
  • Christina Schüttler  
  • Laura Svensson  
  • Brita Sedlmayr  
  • Julia Müller  
  • Till Nagel  

  Abstract:

  Background: Wearable devices, mobile technologies, and their combination have been accepted into clinical use to better assess the physical fitness and quality of life of patients and as preventive measures. Usability is pivotal for overcoming constraints and gaining users’ acceptance of technology such as wearables and their companion mobile health (mHealth) apps. However, owing to limitations in design and evaluation, interactive wearables and mHealth apps have often been restricted from their full potential. Objective: This study aims to identify studies that have incorporated wearable devices and determine their frequency of use in conjunction with mHealth apps or their combination. Specifically, this study aims to understand the attributes and evaluation techniques used to evaluate usability in the health care domain for these technologies and their combinations. Methods: We conducted an extensive search across 4 electronic databases, spanning the last 30 years up to December 2021. Studies including the keywords “wearable devices,” “mobile apps,” “mHealth apps,” “physiological data,” “usability,” “user experience,” and “user evaluation” were considered for inclusion. A team of 5 reviewers screened the collected publications and charted the features based on the research questions. Subsequently, we categorized these characteristics following existing usability and wearable taxonomies. We applied a methodological framework for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. Results: A total of 382 reports were identified from the search strategy, and 68 articles were included. Most of the studies (57/68, 84%) involved the simultaneous use of wearables and connected mobile apps. Wrist-worn commercial consumer devices such as wristbands were the most prevalent, accounting for 66% (45/68) of the wearables identified in our review. Approximately half of the data from the medical domain (32/68, 47%) focused on studies involving participants with chronic illnesses or disorders. Overall, 29 usability attributes were identified, and 5 attributes were frequently used for evaluation: satisfaction (34/68, 50%), ease of use (27/68, 40%), user experience (16/68, 24%), perceived usefulness (18/68, 26%), and effectiveness (15/68, 22%). Only 10% (7/68) of the studies used a user- or human-centered design paradigm for usability evaluation. Conclusions: Our scoping review identified the types and categories of wearable devices and mHealth apps, their frequency of use in studies, and their implementation in the medical context. In addition, we examined the usability evaluation of these technologies: methods, attributes, and frameworks. Within the array of available wearables and mHealth apps, health care providers encounter the challenge of selecting devices and companion apps that are effective, user-friendly, and compatible with user interactions. The current gap in usability and user experience in health care research limits our understanding of the strengths and limitations of wearable technologies and their companion apps. Additional research is necessary to overcome these limitations.

  • JMIR Mhealth Uhealth 2024;12(1):e52179

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  mHealth for Wellness, Behavior Change...

  Apr 1, 2024

  The Association of Macronutrient Consumption and BMI to Exhaled Carbon Dioxide in Lumen Users: Retrospective Real-World Study

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  Authors List:

  • Shlomo Yeshurun  
  • Tomer Cramer  
  • Daniel Souroujon  
  • Merav Mor  

  Abstract:

  Background: Metabolic flexibility is the ability of the body to rapidly switch between fuel sources based on their accessibility and metabolic requirements. High metabolic flexibility is associated with improved health outcomes and a reduced risk of several metabolic disorders. Metabolic flexibility can be improved through lifestyle changes, such as increasing physical activity and eating a balanced macronutrient diet. Lumen is a small handheld device that measures metabolic fuel usage through exhaled carbon dioxide (CO₂), which allows individuals to monitor their metabolic flexibility and make lifestyle changes to enhance it. Objective: This retrospective study aims to examine the postprandial CO₂ response to meals logged by Lumen users and its relationship with macronutrient intake and BMI. Methods: We analyzed deidentified data from 2607 Lumen users who logged their meals and measured their exhaled CO₂ before and after those meals between May 1, 2023, and October 18, 2023. A linear mixed model was fitted to test the association between macronutrient consumption, BMI, age, and gender to the postprandial CO₂ response, followed by a 2-way ANOVA. Results: The model demonstrated significant associations (P<.001) between CO₂ response after meals and both BMI and carbohydrate intake (BMI: β=–0.112, 95% CI –0.156 to –0.069; carbohydrates: β=0.046, 95% CI 0.034-0.058). In addition, a 2-way ANOVA revealed that higher carbohydrate intake resulted in a higher CO₂ response compared to low carbohydrate intake (F_2,2569=24.23; P<.001), and users with high BMI showed modest responses to meals compared with low BMI (F_2,2569=5.88; P=.003). Conclusions: In this study, we show that Lumen’s CO₂ response is influenced both by macronutrient consumption and BMI. The results of this study highlight a distinct pattern of reduced metabolic flexibility in users with obesity, indicating the value of Lumen for assessing postprandial metabolic flexibility.

  • JMIR Mhealth Uhealth 2024;12(1):e56083

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  mHealth in a Clinical Setting

  Mar 29, 2024

  The Effectiveness of a Cell Phone eHealth App in Changing Knowledge, Stigmatizing Attitudes, and Intention to Seek Help Associated With Obsessive-Compulsive...

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  Authors List:

  • Antonio Chaves  
  • Sandra Arnáez  
  • Gemma García-Soriano  

  Abstract:

  Background: Obsessive-compulsive disorder (OCD) is a disabling disorder associated with high interference in people’s lives. However, patients with OCD either do not seek help or delay seeking help. Research suggests that this could be explained by poor mental health literacy about the disorder and the associated stigma. Objective: This study aims to evaluate the feasibility, acceptability, and preliminary effectiveness of a mental health mobile app, esTOCma, developed to improve knowledge about OCD and its treatment, increase help-seeking intention, and reduce stigmatizing attitudes and social distance associated with OCD. Methods: We used preintervention, postintervention, and 3-month follow-up assessments in this single-arm pilot intervention. Overall, 90 participants were recruited from the community using the snowball sampling method. We used esTOCma to defeat the “stigma monster” over the course of 10 missions. The participants completed the sociodemographic information and Obsessive-Compulsive Inventory–Revised at preassessment and an acceptability questionnaire at postassessment. All other measures were completed at the preassessment, postassessment, and 3-month follow-up (ie, the Spanish Mental Illness Stigma Attribution Questionnaire–27, the General Help-Seeking Questionnaire, the Social Distance Scale, and the Mental Health Literacy Questionnaire). Results: Of the 90 participants from the community that were assessed for eligibility, 86% (n=78) were allocated to intervention. Of these 78 participants, 79% (n=62) completed the game and answered the postintervention assessment (completer group). Overall, 69% (43/62) of the participants also completed the 3-month follow-up assessment. The participants completing the study were older (P=.003) and had a higher baseline knowledge of OCD (P=.05). The participants took an average of 13.64 (SD 10.50) days to complete the intervention, including the pre- and postassessments. The participants spent an average of 4.56 (SD 3.33) days completing the 10 missions included in the app. Each mission took a mean of between 2 (SD 3.01) and 9.35 (SD 3.06) minutes. The app was rated as useful or very useful by the vast majority of participants 90% (56/62). Moreover, 90% (56/62) of the participants reported that they had learned or learned a lot, and 98% (61/62) of the participants reported that they would recommend the app to a friend. Repeated measures ANOVA (43/62, 69%) showed that after the intervention participants showed an increased knowledge of mental health and intention to seek help as well as fewer stigmatizing attitudes and less social distance. Conclusions: Preliminary data show that esTOCma is a feasible and acceptable app, and after completing its 10 missions, there is an increase in the understanding of OCD and help-seeking intention along with a decrease in the social stigma and social distance associated with OCD that lasts for at least 3 months. The results support the potential of technology-based interventions to increase the intention to seek help and reduce the stigma associated with OCD. A larger, community-controlled study is also recommended.

  • JMIR Mhealth Uhealth 2024;12(1):e48027

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  mHealth for Symptom and Disease...

  Mar 28, 2024

  Mining User Reviews From Hypertension Management Mobile Health Apps to Explore Factors Influencing User Satisfaction and Their Asymmetry: Comparative Study

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  Authors List:

  • Yunfan He  
  • Wei Zhu  
  • Tong Wang  
  • Han Chen  
  • Junyi Xin  
  • Yongcheng Liu  
  • Jianbo Lei  
  • Jun Liang  

  Abstract:

  Background: Hypertension significantly impacts the well-being and health of individuals globally. Hypertension management apps (HMAs) have been shown to assist patients in controlling blood pressure (BP), with their efficacy validated in clinical trials. However, the utilization of HMAs continues to be suboptimal. Presently, there is a dearth of real-world research based on big data and exploratory mining that compares Chinese and American HMAs. Objective: This study aims to systematically gather HMAs and their user reviews from both China and the United States. Subsequently, using data mining techniques, the study aims to compare the user experience, satisfaction levels, influencing factors, and asymmetry between Chinese and American users of HMAs. In addition, the study seeks to assess the disparities in satisfaction and its determinants while delving into the asymmetry of these factors. Methods: The study sourced HMAs and user reviews from 10 prominent Chinese and American app stores globally. Using the latent Dirichlet allocation (LDA) topic model, the research identified various topics within user reviews. Subsequently, the Tobit model was used to investigate the impact and distinctions of each topic on user satisfaction. The Wald test was applied to analyze differences in effects across various factors. Results: We examined a total of 261 HMAs along with their associated user reviews, amounting to 116,686 reviews in total. In terms of quantity and overall satisfaction levels, Chinese HMAs (n=91) and corresponding reviews (n=16,561) were notably fewer compared with their American counterparts (n=220 HMAs and n=100,125 reviews). The overall satisfaction rate among HMA users was 75.22% (87,773/116,686), with Chinese HMAs demonstrating a higher satisfaction rate (13,866/16,561, 83.73%) compared with that for American HMAs (73,907/100,125, 73.81%). Chinese users primarily focus on reliability (2165/16,561, 13.07%) and measurement accuracy (2091/16,561, 12.63%) when considering HMAs, whereas American users prioritize BP tracking (17,285/100,125, 17.26%) and data synchronization (12,837/100,125, 12.82%). Seven factors (easy to use: P<.001; measurement accuracy: P<.001; compatibility: P<.001; cost: P<.001; heart rate detection function: P=.02; blood pressure tracking function: P<.001; and interface design: P=.01) significantly influenced the positive deviation (PD) of Chinese HMA user satisfaction, while 8 factors (easy to use: P<.001; reliability: P<.001; measurement accuracy: P<.001; compatibility: P<.001; cost: P<.001; interface design: P<.001; real-time: P<.001; and data privacy: P=.001) affected the negative deviation (ND). Notably, BP tracking had the greatest effect on PD (β=.354, P<.001), while cost had the most significant impact on ND (β=3.703, P<.001). All 12 factors (easy to use: P<.001; blood pressure tracking function: P<.001; data synchronization: P<.001; blood pressure management effect: P<.001; heart rate detection function: P<.001; data sharing: P<.001; reliability: P<.001; compatibility: P<.001; interface design: P<.001; advertisement distribution: P<.001; measurement accuracy: P<.001; and cost: P<.001) significantly influenced the PD and ND of American HMA user satisfaction. Notably, BP tracking had the greatest effect on PD (β=0.312, P<.001), while data synchronization had the most significant impact on ND (β=2.662, P<.001). In addition, the influencing factors of PD and ND in user satisfaction of HMA in China and the United States are different. Conclusions: User satisfaction factors varied significantly between different countries, showing considerable asymmetry. For Chinese HMA users, ease of use and interface design emerged as motivational factors, while factors such as cost, measurement accuracy, and compatibility primarily contributed to user dissatisfaction. For American HMA users, motivational factors were ease of use, BP tracking, BP management effect, interface design, measurement accuracy, and cost. Moreover, users expect features such as data sharing, synchronization, software reliability, compatibility, heart rate detection, and nonintrusive advertisement distribution. Tailored experience plans should be devised for different user groups in various countries to address these diverse preferences and requirements.

  • JMIR Mhealth Uhealth 2024;12(1):e55199

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  Wearables and MHealth Reviews

  Mar 27, 2024

  Accuracy of Fitbit Charge 4, Garmin Vivosmart 4, and WHOOP Versus Polysomnography: Systematic Review

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  Authors List:

  • An-Marie Schyvens  
  • Nina Catharina Van Oost  
  • Jean-Marie Aerts  
  • Federica Masci  
  • Brent Peters  
  • An Neven  
  • Hélène Dirix  
  • Geert Wets  
  • Veerle Ross  
  • Johan Verbraecken  

  Abstract:

  Background: It has been shown that consumer wrist worn wearables are able to monitor sleep parameters and thus could be used as an alternative for polysomnography. Following this, wearables gained immense popularity over the past few years. However, their accuracy has been a major concern for years. Objective: The objective of this review paper is to appraise the performance of three recent-generation wearable devices (Fitbit Charge 4, Garmin Vivosmart 4 and WHOOP) in determining sleep parameters and sleep stages. Methods: A comprehensive database search was done via Pubmed, Google Scholar and Web of Science using relevant keywords such as ‘validity’, ‘accuracy’, ‘assessment’, ‘performance’, ‘polysomnography’ in combination with ‘whoop’, ‘fitbit charge 4’, and/or ‘garmin vivosmart 4’. Results: The results of this review suggest that WHOOP presents the least amount of disagreement relative to polysomnography (PSG) and/or Sleep Profiler for Total Sleep Time (TST), Light Sleep (LS) and Deep Sleep (DS), but showed the largest amount of disagreement for REM sleep. The Fitbit Charge 4 and Garmin Vivosmart 4 both showed moderate accuracy in assessing sleep stages and TST compared to PSG. Only Fitbit Charge 4 showed the least amount of disagreement for REM sleep relative to PSG. In addition, the Fitbit Charge 4 showed higher sensitivities for LS, DS and REM sleep compared to the Garmin Vivosmart 4 and WHOOP. Conclusions: The findings of this review indicate that the devices with higher relative agreement and sensitivities for multi-state sleep, i.e., Fitbit Charge 4 and WHOOP, seem appropriate to derive suitable estimates of sleep parameters. However, the analyses regarding the multi-state categorisation of sleep indicate that all devices can benefit from further improvement for the assessment of specific sleep stages.

  • JMIR Mhealth Uhealth 2024;12(1):e52192

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