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Journal Description

JMIR mHealth and uHealth (JMU, ISSN 2291-5222; Impact Factor 4.301) is a sister journal of JMIR, the leading eHealth journal. JMIR mHealth and uHealth is indexed in PubMed, PubMed Central, Scopus, and Science Citation Index Expanded (SCIE), and in June 2019 received an Impact Factor of 4.301, which ranks the journal #2 (behind JMIR) 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: The Authors / Placeit; Copyright: JMIR Publications; URL: https://mhealth.jmir.org/2019/7/e12587; License: Creative Commons Attribution (CC-BY).
    mHealth for Rehabilitation

    Jul 11, 2019

    Exploring the Impact of a Mobile Health Solution for Postpartum Pelvic Floor Muscle Training: Pilot Randomized Controlled Feasibility Study

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    Abstract:

    Background: The postpartum period is a vulnerable time for the pelvic floor. Early implementation of pelvic floor muscle exercises, appropriately termed as pelvic floor muscle training (PFMT), in the postpartum period has been advocated because of its established effectiveness. The popularity of mobile health (mHealth) devices highlights their perceived utility. The effectiveness of various mHealth technologies with claims to support pelvic floor health and fitness is yet to be substantiated through systematic inquiry. Objective: The aim of this study was to determine the acceptability, feasibility, and potential effect on outcomes of an mHealth device purposed to facilitate pelvic floor muscle training among postpartum women. Methods: A 16-week mixed methods pilot study was conducted to evaluate outcomes and determine aspects of acceptability and feasibility of an mHealth device. All participants received standardized examination of their pelvic floor muscles and associated instruction on the correct performance of PFMT. Those randomized to the iBall intervention received instructions on its use. Schedules for utilization of the iBall and PFMT were not prescribed, but all participants were informed of the standard established recommendation of PFMT, which includes 3 sets of 10 exercises, 3 to 4 times a week, for the duration of the intervention period. Quantitative data included the measurement of pelvic floor muscle parameters (strength, endurance, and coordination) following the PERFECT assessment scheme: Incontinence Impact Questionnaire scores and the Urogenital Distress Inventory (UDI-6) scores. Aspects of acceptability and feasibility were collected through one-to-one interviews. Interview transcripts were analyzed using Thorne’s interpretive description approach. Results: A total of 23 women with a mean age of 32.2 years were randomized to an intervention group (n=13) or a control group (n=10). Both groups improved on all measures. The only statistically significant change was the UDI-6 score within both groups at 16 weeks compared with baseline. There was no statistically significant difference between the intervention group and control group on any outcomes. Most participants using the iBall (n=10, 77%) indicated value in the concept of the mHealth solution. Technical difficulties (n=10, 77%), a cumbersome initiation process (n=8, 61%), and discomfort from the device (n=8, 61%) were reasons impeding intervention acceptability. Most participants (n=17, 74%) indicated that the initial assessment and training was more useful than the mHealth solution, a tenet that was echoed by all control group participants. Conclusions: Our pilot study demonstrated the potential for mHealth solution–enhanced PFMT in the early postpartum period. Usability issues in hardware and software hindered feasibility and acceptance by the participants. Our findings can inform the redesign of mHealth solutions that may be of value if acceptability and feasibility issues can be overcome. Trial Registration: ClinicalTrials.gov NCT02865954; https://clinicaltrials.gov/ct2/show/NCT02865954

  • Sensing at-risk population. Source: Image created by the Authors; Copyright: The Authors; URL: https://mhealth.jmir.org/2019/7/e14090; License: Creative Commons Attribution (CC-BY).
    Wearable Devices and Sensors

    Jul 10, 2019

    A Combination of Indoor Localization and Wearable Sensor–Based Physical Activity Recognition to Assess Older Patients Undergoing Subacute Rehabilitation:...

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    Abstract:

    Background: Health care, in recent years, has made great leaps in integrating wireless technology into traditional models of care. The availability of ubiquitous devices such as wearable sensors has enabled researchers to collect voluminous datasets and harness them in a wide range of health care topics. One of the goals of using on-body wearable sensors has been to study and analyze human activity and functional patterns, thereby predicting harmful outcomes such as falls. It can also be used to track precise individual movements to form personalized behavioral patterns, to standardize the concept of frailty, well-being/independence, etc. Most wearable devices such as activity trackers and smartwatches are equipped with low-cost embedded sensors that can provide users with health statistics. In addition to wearable devices, Bluetooth low-energy sensors known as BLE beacons have gained traction among researchers in ambient intelligence domain. The low cost and durability of newer versions have made BLE beacons feasible gadgets to yield indoor localization data, an adjunct feature in human activity recognition. In the studies by Moatamed et al and the patent application by Ramezani et al, we introduced a generic framework (Sensing At-Risk Population) that draws on the classification of human movements using a 3-axial accelerometer and extracting indoor localization using BLE beacons, in concert. Objective: The study aimed to examine the ability of combination of physical activity and indoor location features, extracted at baseline, on a cohort of 154 rehabilitation-dwelling patients to discriminate between subacute care patients who are re-admitted to the hospital versus the patients who are able to stay in a community setting. Methods: We analyzed physical activity sensor features to assess activity time and intensity. We also analyzed activities with regard to indoor localization. Chi-square and Kruskal-Wallis tests were used to compare demographic variables and sensor feature variables in outcome groups. Random forests were used to build predictive models based on the most significant features. Results: Standing time percentage (P<.001, d=1.51), laying down time percentage (P<.001, d=1.35), resident room energy intensity (P<.001, d=1.25), resident bed energy intensity (P<.001, d=1.23), and energy percentage of active state (P=.001, d=1.24) are the 5 most statistically significant features in distinguishing outcome groups at baseline. The energy intensity of the resident room (P<.001, d=1.25) was achieved by capturing indoor localization information. Random forests revealed that the energy intensity of the resident room, as a standalone attribute, is the most sensitive parameter in the identification of outcome groups (area under the curve=0.84). Conclusions: This study demonstrates that a combination of indoor localization and physical activity tracking produces a series of features at baseline, a subset of which can better distinguish between at-risk patients that can gain independence versus the patients that are rehospitalized.

  • Source: iStock by Getty Images; Copyright: DragonImages; URL: https://www.istockphoto.com/fr/photo/m%C3%A9decin-et-le-patient-%C3%A0-laide-de-lapplication-mobile-gm693635052-128109079; License: Licensed by the authors.
    Usability and user perceptions of...

    Jul 10, 2019

    Patients’ Perceptions of mHealth Apps: Meta-Ethnographic Review of Qualitative Studies

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    Background: Mobile phones and tablets are being increasingly integrated into the daily lives of many people worldwide. Mobile health (mHealth) apps have promising possibilities for optimizing health systems, improving care and health, and reducing health disparities. However, health care apps often seem to be underused after being downloaded. Objective: The aim of this paper is to reach a better understanding of people’s perceptions, beliefs, and experience of mHealth apps as well as to determine how highly they appreciate these tools. Methods: A systematic review was carried out on qualitative studies published in English, on patients’ perception of mHealth apps between January 2013 and June 2018. Data extracted from these articles were synthesized using a meta-ethnographic approach and an interpretative method. Results: A total of 356 articles were selected for screening, and 43 of them met the inclusion criteria. Most of the articles included populations inhabiting developed countries and were published during the last 2 years, and most of the apps on which they focused were designed to help patients with chronic diseases. In this review, we present the strengths and weaknesses of using mHealth apps from the patients’ point of view. The strengths can be categorized into two main aspects: engaging patients in their own health care and increasing patient empowerment. The weaknesses pointed out by the participants focus on four main topics: trustworthiness, appropriateness, personalization, and accessibility of these tools. Conclusions: Although many of the patients included in the studies reviewed considered mHealth apps as a useful complementary tool, some major problems arise in their optimal use, including the need for more closely tailored designs, the cost of these apps, the validity of the information delivered, and security and privacy issues. Many of these issues could be resolved with more support from health providers. In addition, it would be worth developing standards to ensure that these apps provide patients accurate evidence-based information.

  • Source: The Authors / Pexels; Copyright: The Authors / rawpixel.com; URL: https://mhealth.jmir.org/2019/7/e14602; License: Licensed by the authors.
    mHealth for Wellness, Behavior Change...

    Jul 9, 2019

    A Pilot Randomized Controlled Trial of a Web-Based Growth Mindset Intervention to Enhance the Effectiveness of a Smartphone App for Smoking Cessation

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    Background: Although smartphone apps have shown promise for smoking cessation, there is a need to enhance their low engagement rates. This study evaluated the application of the growth mindset theory, which has demonstrated the potential to improve persistence in behavior change in other domains, as a means to improve engagement and cessation. Objective: This study aimed to explore the feasibility, utility, and efficacy of a Web-based growth mindset intervention for addiction when used alongside a smoking cessation app. Methods: Daily smokers (N=398) were all recruited on the Web and randomly assigned to receive either a cessation app alone or the app plus a Web-delivered growth mindset intervention. The primary outcome was engagement, that is, the number of log-ins to the smoking cessation app. The secondary outcome was 30-day point prevalence abstinence at 2-month follow-up collected through a Web-based survey. Results: The 2-month outcome data retention rate was 91.5% (364/398). In addition, 77.9% (310/398) of the participants in the experimental arm viewed at least 1 page of their growth mindset intervention, and 21.1% (84/398) of the group viewed all the growth mindset intervention. The intention-to-treat analysis did not show statistically significant differences between the experimental and comparison arms on log-ins to the app (19.46 vs 21.61; P=.38). The experimental arm had cessation rates, which trended higher than the comparison arm (17% vs 13%; P=.10). The modified intent-to-treat analysis, including only participants who used their assigned intervention at least once (n=115 in experimental group and n=151 in the control group), showed that the experimental arm had a similar number of log-ins (32.31 vs 28.48; P=.55) but significantly higher cessation rates (21% vs 13%; P=.03) than the comparison arm. Conclusions: A growth mindset intervention for addiction did not increase engagement rates, although it may increase cessation rates when used alongside a smartphone app for smoking cessation. Future research is required to refine the intervention and assess efficacy with long-term follow-up to evaluate the efficacy of the mindset intervention. Trial Registration: ClinicalTrials.gov NCT03174730; https://clinicaltrials.gov/ct2/show/NCT03174730

  • The Diabetesdagboka mobile app with a connected smartwatch. Source: Czech Technical University in Prague; Copyright: Czech Technical University in Prague; URL: https://mhealth.jmir.org/2019/7/e11527; License: Licensed by JMIR.
    mHealth for Symptom and Disease...

    Jul 9, 2019

    Customizing the Types of Technologies Used by Patients With Type 1 Diabetes Mellitus for Diabetes Treatment: Case Series on Patient Experience

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    Background: Despite the fact there are many wearable and mobile medical devices that enable patients to better self-manage their diabetes, not many patients are aware of all the options they have. In addition, there are those who are not fully satisfied with the devices they use, and those who often do not use them effectively. Objective: The study aimed to propose possible changes to the combination of devices used by 6 specific patients for diabetes self-management. We assessed the suitability of selected technical devices for diabetes control. Methods: Data of 6 patients (3 men and 3 women) with type 1 diabetes mellitus, who had been using the Diani telemedicine system for at least 3 months, were analyzed. The suitability of selected technical devices for diabetes control was ascertained using the data obtained via the Diani telemedicine system, as well as the patients’ subjective feelings and statements, their everyday life habits, and self-management of diabetes. Informed consent was signed and obtained from each of the patients included. Results: Each of the presented case studies describes how a given patient handled the system and its specific components based on his or her lifestyle, level of education, habits related to diabetes management, personality type, and other factors. At the conclusion of each case study, the best composition of devices for patients with similar personal descriptions was suggested. Conclusions: We believe this study can provide relevant guidance on how to help particular patients choose the technology that is best suited for their needs, based on the specific patient information we are able to obtain from them. Furthermore, clinicians or educators should be aware of available technologies a given patient can choose from. In addition, there is a substantial need for proper patient education in order for them to effectively use devices for diabetes self-management.

  • Source: Image created by the Authors; Copyright: The Authors; URL: https://mhealth.jmir.org/2019/6/e12445; License: Creative Commons Attribution (CC-BY).
    mHealth for Wellness, Behavior Change...

    Jul 8, 2019

    Physical Activity Behavior Change Driven by Engagement With an Incentive-Based App: Evaluating the Impact of Sweatcoin

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    Background: Physical inactivity, now the fourth leading cause of death, is a primary element of noncommunicable diseases. Despite a great number of attempts, there is still a lack of effective approaches that can motivate sedentary populations to increase their levels of physical activity over a sustained period. Incentives for exercise can provide an immediate reward for increasing activity levels, but because of limited funding to provide rewards, previous programs using this approach have only shown short-term changes in behavior. Sweatcoin (Sweatco Ltd, UK) is an app-based platform that converts physical movement into virtual currency. The currency can be exchanged for goods and services on their marketplace, providing a continuous incentive to be active. This study investigates the physical activity behavior change observed in Sweatcoin users over a 6-month period of app usage. Objective: The aim of this study was to investigate the change in physical activity (measured using daily step count) of a sample of Sweatcoin users, the longevity of the change, and whether this change can be predicted by demographic and other lifestyle variables. Methods: Activity data from a sample of 5892 Sweatcoin users were used to analyze daily step count. Activity change was measured in terms of the percentage change in average daily step count for each month after registration, relative to that in the 3 months before using the app. Users were grouped according to having no or negative, moderate, or high activity change. A subset of users completed a questionnaire that allowed differences between groups in terms of activity and demographic status to be investigated using regression analyses. Results: Daily step count increased by 19% on average over the 6 months following registration (P<.001). Of the questionnaire respondents, 728 were valid responses. A multinomial logistic regression identified the key drivers of moderate and high activity behavior change relative to no or negative change based on the defined groupings. There was a clear impact of seasonality, with those registering for the app in winter (odds ratio [OR] 4.67; P=.001) and spring (OR 5.05; P=.001) being more likely to show high positive activity behavior change than those registering in summer. More striking were the results identifying those classified as overweight (measured through body mass index [BMI]; OR 1.83; P=.02) and less active (based on a self-reported scale of physical activity; OR 0.88; P=.048), being most likely to show high levels of physical activity change following registration with the app. Conclusions: The results highlight that an incentives-based app can induce significant physical activity behavior change, sustained over a 6-month period. Importantly, the results suggest that those typically lacking motivation to exercise (sedentary and high BMI) are most likely to be incentivized to increase their activity levels.

  • A woman using the mobile PHR app on her Android phone at home (montage). Source: The Authors / Placeit; Copyright: The Authors; URL: https://mhealth.jmir.org/2019/7/e13194; License: Creative Commons Attribution (CC-BY).
    mHealth for Wellness, Behavior Change...

    Jul 5, 2019

    Applying a User-Centered Approach to Building a Mobile Personal Health Record App: Development and Usability Study

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    Background: A personal health record (PHR) system encourages patients to engage with their own health care by giving them the ability to manage and keep track of their own health data. Of the numerous PHR systems available in the market, many are Web-based patient portals and a few are mobile apps. They have mainly been created by hospitals and electronic health record (EHR) vendors. One major limitation of these hospital-created PHR systems is that patients can only view specific health data extracted from their EHR. Patients do not have the freedom to add important personal health data they collect in their daily lives into their PHR. Therefore, there is an information gap between clinical visits. Objective: The aim of this study was to develop and evaluate a new mobile PHR app that can be easily used to manage various types of personal health data to fill the information gap. Methods: A user-centered approach was used to guide the development and evaluation of the new mobile PHR app. There were three steps in this study: needs assessment, app design and development, and conducting a usability study. First, a large-scale questionnaire study was conducted with the general population to gain an understanding of their needs and expectations with regard to a mobile PHR app. A mobile PHR app for personal medical data tracking and management was then created based on the results of the questionnaire study. End users were actively involved in all stages of the app development. Finally, a usability study was performed with participants to evaluate the usability of the mobile PHR app, which involved asking participants to finish a set of tasks and to respond to a usability questionnaire. Results: In the questionnaire study for needs assessment, there were 609 participants in total. The answers from these participants revealed that they wanted to manage various types of personal health data in a mobile PHR app. Participants also reported some features they desired to have in the app. On the basis of the needs assessment findings, a new mobile PHR app (PittPHR) was created with 6 major modules: health records, history, trackers, contacts, appointments, and resources. This app allows users to customize the trackers according to their needs. In the usability study, there were 15 participants. The usability study participants expressed satisfaction with the app and provided comments and suggestions for further development. Conclusions: This new mobile PHR app provides options for users to manage a wide range of personal health data conveniently in one place. The app fills the information gap between clinical visits. The study results indicated that this new mobile PHR app meets the need of users and that users welcome this app.

  • Source: Image created by the Authors; Copyright: The Authors; URL: https://mhealth.jmir.org/2019/7/e11926; License: Creative Commons Attribution (CC-BY).
    mHealth for Wellness, Behavior Change...

    Jul 4, 2019

    Using Health and Well-Being Apps for Behavior Change: A Systematic Search and Rating of Apps

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    Background: Smartphones have allowed for the development and use of apps. There is now a proliferation of mobile health interventions for physical activity, healthy eating, smoking and alcohol cessation or reduction, and improved mental well-being. However, the strength or potential of these apps to lead to behavior change remains uncertain. Objective: The aim of this study was to review a large sample of healthy lifestyle apps at a single point in time (June to July 2018) to determine their potential for promoting health-related behavior change with a view to sharing this information with the public. In addition, the study sought to test a wide range of apps using a new scale, the App Behavior Change Scale (ABACUS). Methods: Apps focusing on 5 major modifiable lifestyle behaviors were identified using a priori key search terms across the Australian Apple iTunes and Google Play stores. Lifestyle behavior categories were selected for their impact on health and included smoking, alcohol use, physical activity, nutrition, and mental well-being. Apps were included if they had an average user rating between 3 and 5, if they were updated in the last 18 months, if the description of the app included 2 of 4 behavior change features, and if they were in English. The selected behavior change apps were rated in 2 ways using previously developed rating scales: the Mobile App Rating Scale (MARS) for functionality and the ABACUS for potential to encourage behavior change. Results: The initial search identified 212,352 apps. After applying the filtering criteria, 5018 apps remained. Of these, 344 were classified as behavior change apps and were reviewed and rated. Apps were given an average MARS score of 2.93 out of 5 (SD 0.58, range 1.42-4.16), indicating low-to-moderate functionality. Scores for the ABACUS ranged from 1 to 17, out of 21, with an average score of 7.8 (SD 2.8), indicating a low-to-moderate number of behavior change techniques included in apps. The ability of an app to encourage practice or rehearsal, in addition to daily activities, was the most commonly identified feature across all apps (310/344, 90.1%), whereas the second most common feature was the ability of the user to easily self-monitor behavior (289/344, 84.0%). Conclusions: The wide variety of apps included in this 2018 study and the limited number of behavior change techniques found in many apps suggest an opportunity for improvement in app design that will promote sustained and significant lifestyle behavior change and, therefore, better health. The use of the 2 scales for the review and rating of the apps was successful and provided a method that could be replicated and tested in other behavior change areas.

  • The Smiling Instead of Smoking app (montage). Source: The Authors / Placeit; Copyright: JMIR Publications; URL: https://mhealth.jmir.org/2019/7/e13436; License: Creative Commons Attribution (CC-BY).
    mHealth for Wellness, Behavior Change...

    Jul 3, 2019

    Leveraging Positive Psychology to Support Smoking Cessation in Nondaily Smokers Using a Smartphone App: Feasibility and Acceptability Study

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    Background: Nondaily smoking is an increasingly prevalent smoking pattern that poses substantial health risks. Objective: We tested the feasibility of using a smartphone app with positive psychology exercises to support smoking cessation in nondaily smokers. Methods: In this prospective, single-group pilot study, nondaily smokers (n=30) used version 1 of the Smiling Instead of Smoking (SiS) app for 3 weeks while undergoing a quit attempt. The app assigned daily happiness exercises, provided smoking cessation tools, and made smoking cessation information available. Participants answered surveys at baseline and 2, 6, 12, and 24 weeks after their chosen quit day and participated in structured user feedback sessions 2 weeks after their chosen quit day. Results: App usage during the prescribed 3 weeks of use was high, with an average 84% (25.2/30) of participants using the app on any given day. App use was largely driven by completing happiness exercises (73%, 22/30) of participants per day), which participants continued to complete even after the end of the prescribed period. At the end of prescribed use, 90% (27/30) of participants reported that the app had helped them during their quit attempt, primarily by reminding them to stay on track (83%, 25/30) and boosting their confidence to quit (80%, 24/30) and belief that quitting was worthwhile (80%, 24/30). Happiness exercises were rated more favorably than user-initiated smoking cessation tools, and 80% (24/30) of participants proactively expressed in interviews that they liked them. App functionality to engage social support was not well received. Functionality to deal with risky times was rated useful but was rarely used. Within-person changes from baseline to the end of prescribed use were observed for several theorized mechanisms of behavior change, all in the expected direction: confidence increased (on a 0-100 scale, internal cues: b=16.7, 95% CI 7.2 to 26.3, P=.001; external cues: b=15.8, 95% CI 5.4 to 26.1, P=.004), urge to smoke decreased (on a 1-7 scale, b=−0.8, 95% CI −1.3 to −0.3, P=.002), and perceptions of smoking became less positive (on a 1-5 scale, psychoactive benefits: b=−0.5, 95% CI −0.9 to −0.2, P=.006; pleasure: b=−0.4, 95% CI −0.7 to −0.01, P=.03; on a 0-100 scale, importance of pros of smoking: b=−11.3, 95% CI −18.9 to −3.8, P=.004). Self-reported abstinence rates were 40% (12/30) and 53% (16/30) of participants 2 and 24 weeks post quit, respectively, with 30% (9/30) biochemically validated as abstinent 2 weeks post quit. Conclusions: A smartphone app using happiness exercises to aid smoking cessation was well received by nondaily smokers. Given the high nonadherence and dropout rates for technology-delivered interventions reported in the literature, the high engagement with positive psychology exercises is noteworthy. Observed within-person changes and abstinence rates are promising and warrant further development of this app.

  • Care4Today (montage). Source: The Authors / Placeit; Copyright: The Authors; URL: https://mhealth.jmir.org/2019/7/e12900; License: Creative Commons Attribution (CC-BY).
    mHealth for Treatment Adherence

    Jul 3, 2019

    Attitudes, Beliefs, and Willingness Toward the Use of mHealth Tools for Medication Adherence in the Florida mHealth Adherence Project for People Living With...

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    Abstract:

    Background: Antiretroviral (ART) adherence among people living with HIV (PLWH) continues to be a challenge despite advances in HIV prevention and treatment. Mobile health (mHealth) interventions are increasingly deployed as tools for ART adherence. However, little is known about the uptake and attitudes toward commercially available, biprogrammatic mobile apps (ie, designed for both smartphone and short message service [SMS] messaging) among demographically diverse PLWH. Objectives: The Florida mHealth Adherence Project for PLWH (FL-mAPP) is an innovative pilot study that aimed to determine the acceptability of a commercially available, biprogrammatic mHealth intervention platform to ensure medication adherence and gauge the current attitudes of PLWH toward current and future mHealth apps. Methods: A predeveloped, commercially available, biprogrammatic mHealth platform (Care4Today Mobile Health Manager, Johnson & Johnson, New Brunswick, NJ) was deployed, with self-reported ART adherence recorded in the app and paper survey at both short term (30-day) or long-term (90-day) follow-ups. Consented participants completed baseline surveys on sociodemographics and attitudes, beliefs, and willingness toward the use of mHealth interventions for HIV care using a 5-point Likert scale. Chi-square tests and multivariate logistic regression analyses identified correlations with successful uptake of the mHealth platform. Results: Among 132 PLWH, 66% (n=87) initially agreed to use the mHealth platform, of which 54% (n=47) successfully connected to the platform. Of the 87 agreeing to use the mHealth platform, we found an approximate 2:1 ratio of persons agreeing to try the smartphone app (n=59) versus the SMS text messages (n=28). Factors correlating with mHealth uptake were above high school level education (adjusted odds ratio 2.65; P=.05), confidence that a clinical staff member would assist with mHealth app use (adjusted odds ratio 2.92, P=.048), belief that PLWH would use such an mHealth app (adjusted odds ratio 2.89; P=.02), and ownership of a smartphone in contrast to a “flip-phone” model (adjusted odds ratio 2.80; P=.05). Of the sample, 70.2% (n=92) reported daily interest in receiving medication adherence reminders via an app (80.4% users versus 64.7% nonusers), although not significantly different among the user groups (P=.06). In addition, 34.8% (n=16) of mHealth users reported a theoretical “daily” interest and 68.2% (n=58) of non-mHealth users reported no interest in using an mHealth app for potentially tracking alcohol or drug intake (P=.002). Conclusions: This commercially available, biprogrammatic mHealth platform showed feasibility and efficacy for enhanced ART and medication adherence within public health clinics and successfully included older age groups. Successful use of the platform among demographically diverse PLWH is important for HIV implementation science and promising for uptake on a larger scale.

  • Self-examination of nevi using smartphone apps. Source: The Authors; Copyright: Theresa Steeb; URL: http://mhealth.jmir.org/2019/7/e13844/; License: Creative Commons Attribution (CC-BY).
    mHealth for Patient Education

    Jul 2, 2019

    Patient Attitudes and Their Awareness Towards Skin Cancer–Related Apps: Cross-Sectional Survey

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    Background: In the emerging era of digitalization and electronic health, skin cancer–related apps represent useful tools to support dermatologic consultation and examination. Yet, little is known about how patients perceive the value of such apps. Objective: The aim of this study was to investigate patient attitudes and their awareness toward skin cancer–related apps. Methods: A cross-sectional study including 200 patients from the oncological outpatient unit was conducted at the University Hospital (LMU Munich, Germany) between September and December 2018. Patients were asked to complete a self-administered questionnaire on the popularity and usefulness of health-related and skin cancer–related apps. A descriptive analysis was performed with the expression of categorical variables as frequencies and percentages. For continuous variables, the median and range were indicated. Contingency tables and chi-square tests were performed to investigate associations between sociodemographic data and selected items of the questionnaire. Results: A total of 98.9% (195/197) of patients had never used skin cancer–related apps or could not remember. In 49.7% (93/187) of cases, patients were unsure about the usefulness of skin cancer apps, whereas 42.6% (78/183) thought that skin cancer apps could supplement or support the professional skin examination performed by a physician. However, 47.9% (90/188) were interested in acquiring more information by their dermatologists about skin cancer apps. Young age (P=.002), male gender (P=.02), a previous history of melanoma (P=.004), and higher educational level (P=.002) were significantly associated with a positive attitude. Nevertheless, 55.9% (105/188) preferred a printed patient brochure on skin cancer to downloading and using an app. Conclusions: The experience and knowledge of skin cancer–related apps was surprisingly low in this population, although there was a high general interest in more information about such apps. Printed patient brochures were the preferred information source.

  • Source: The Authors / Placeit; Copyright: JMIR Publications; URL: https://mhealth.jmir.org/2019/7/e12952; License: Creative Commons Attribution (CC-BY).
    mHealth in a Clinical Setting

    Jul 2, 2019

    “Seeing Pain Differently”: A Qualitative Investigation Into the Differences and Similarities of Pain and Rheumatology Specialists’ Interpretation of...

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    Background: In contrast to the use of traditional unidimensional paper-based scales, a mobile health (mHealth) assessment of pain in children and young people (CYP) with juvenile idiopathic arthritis (JIA) enables comprehensive and complex multidimensional pain data to be captured remotely by individuals. However, how professionals use multidimensional pain data to interpret and synthesize pain reports gathered using mHealth tools is not yet known. Objective: The aim of this study was to explore the salience and prioritization of different mHealth pain features as interpreted by key stakeholders involved in research and management of pain in CYP with JIA. Methods: Pain and rheumatology specialists were purposively recruited via professional organizations. Face-to-face focus groups were conducted for each specialist group. Participants were asked to rank order 9 static vignette scenarios created from real patient mHealth multidimensional pain data. These data had been collected by a researcher in a separate study using My Pain Tracker, a valid and acceptable mHealth iPad pain communication tool that collects information about intensity, severity, location, emotion, and pictorial pain qualities. In the focus groups, specialists discussed their decision-making processes behind each rank order in the focus groups. The total group rank ordering of vignette scenarios was calculated. Qualitative data from discussions were analyzed using latent thematic analysis. Results: A total of 9 pain specialists took part in 1 focus group and 10 rheumatology specialists in another. In pain specialists, the consensus for the highest pain experience (44%) was poorer than their ranking of the lowest pain experiences (55%). Conversely, in rheumatology specialists, the consensus for the highest pain experience (70%) was stronger than their ranking of the lowest pain experience (50%). Pain intensity was a high priority for pain specialists, but rheumatology specialists gave high priority to intensity and severity taken together. Pain spread was highly prioritized, with the number of pain locations (particular areas or joints) being a high priority for both groups; radiating pain was a high priority for pain specialists only. Pain emotion was challenging for both groups and was only perceived to be a high priority when specialists had additional confirmatory evidence (such as information about pain interference or clinical observations) to validate the pain emotion report. Pain qualities such as particular word descriptors, use of the color red, and fire symbols were seen to be high priority by both groups in interpretation of CYP pain reports. Conclusions: Pain interpretation is complex. Findings from this study of specialists’ decision-making processes indicate which aspects of pain are prioritized and weighted more heavily than others by those interpreting mHealth data. Findings are useful for developing electronic graphical summaries which assist specialists in interpreting patient-reported mHealth pain data more efficiently in clinical and research settings.

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  • How IT identity affects individuals’ personal health devices (PHDs) use behaviors: An empirical study

    Date Submitted: Jul 12, 2019

    Open Peer Review Period: Jul 15, 2019 - Sep 9, 2019

    Background: Nowadays, interactions with IT are inevitable parts of individuals’ relationships with the world. In recent years, the use of smart devices and wearables as means to monitor and control...

    Background: Nowadays, interactions with IT are inevitable parts of individuals’ relationships with the world. In recent years, the use of smart devices and wearables as means to monitor and control health status has grown significantly. According to identity theories at the individual level, prior studies proposed an IT identity construct which is treated as a new form of identity. IT identity is the degree to which use of an IT is considered as an integral part of a person’s sense of self. Objective: The main objective of this study is to investigate the possible effects of IT identity on use of personal health devices (PHDs) by individuals. Thus, to understand how various factors impact enactment of IT identity and how IT identity influence individuals’ use behaviors, we drew on identity theories and the notion of IT identity to develop a theoretical model. Methods: To empirically test the model, we administered an online survey to individuals who used a PHD in order to achieve a health-related goal (such as monitoring health conditions). The dataset (including 504 samples) was analyzed within a Structural Equation Modeling framework. Results: The results confirm that IT identity is a multidimensional construct with three reflective dimensions. This study exhibits that the identity verification process (i.e., IT characterizes through IT experience) foster IT identity in relation to PHDs, which in turn, encourages individuals to engage in resultant behaviors such as feature use and enhanced use. The findings also reveal that perceived health status plays a moderating role in the relationship between IT identity and positive use behaviors. Moreover, the results highlight the effects of situational factors (IT design, IT dynamism, and privacy policy) on the use behaviors. Conclusions: The findings of this study provide contributions to research and practice. This study can contribute to our current understandings of IT identity by developing and empirically testing a research model which explain antecedents and consequences of IT identity in the context of PHDs. Results imply that IT identity significantly helps individuals express their self-concepts in interactions with smart devices used in healthcare.

  • Feasibility & Acceptability of a Smartphone Attention Bias Application for Individuals with Addictive Disorders

    Date Submitted: Jul 11, 2019

    Open Peer Review Period: Jul 15, 2019 - Sep 9, 2019

    Abstract Background Conventional psychologies therapies are unable to address automatic biases that result in individuals relapsing into their substance use disorder. Advances in experimental psycho...

    Abstract Background Conventional psychologies therapies are unable to address automatic biases that result in individuals relapsing into their substance use disorder. Advances in experimental psychology has led to a better understanding of attention and approach biases, and methods to modify these biases. Several studies have demonstrated the effectiveness of bias modification amongst clinical cohorts. The advances in Mobile-health technologies has enabled these interventions to be delivered remotely. To date, there remains a lack of studies examining bias modification in a substance-using, non-Western sample. Objective This study was designed to determine the feasibility of an attention bias modification smartphone application for the reduction of attention biases amongst treatment-seeking individuals. The secondary aim is to determine the acceptability of the intervention. Methods A feasibility study was conducted amongst inpatients, who were in their rehabilitation phase, at the National Addictions Management Service (NAMS). Participants were to complete a set of baseline questionnaires, and on each that they are in the study, undertake an attention bias assessment and modification task, whilst completing a visual analogue scale to assess for their craving. Feasibility was determined by the acceptance rate of participation and participants’ adherence to the interventions. Acceptability was assessed by a perception questionnaire. Descriptive Statistical Analyses was performed using SPSS Version 22. A thematic analysis approach was used in the qualitative synthesis of users’ perceptions. Results Of the 40 participants invited to participate in the feasibility study, 10 declined, giving an acceptance rate of 75%. Of the recruited participants, 6 participants were diagnosed with alcohol dependence, 17 with opioid dependence, 2 with cannabis dependence and 5 with stimulant dependence. 11 participants out of the 30 participants failed to complete all the planned interventions. 22 out of the 30 participants (73%) completed the perspective questionnaires, of which 100% rated the application to be extremely and very easy, 77% extremely or very interactive, 54% extremely or very motivated and 33% reported there being a change in their confidence levels. Conclusions Our results highlight that it is feasible to recruit participants to undertake attention bias modification interventions and participants generally accept a mobile version of such an intervention. Nevertheless, our acceptability data highlights that there could be improvements in the existing application, and a participatory design approach might be helpful in future conceptualization .

  • Cognitive-motor interference in people with Multiple Sclerosis: design, development and testing of CMI-APP for dual task assessment and training.

    Date Submitted: Jul 9, 2019

    Open Peer Review Period: Jul 12, 2019 - Sep 6, 2019

    Background: The interest towards dual-task training (DTT) is increased due to the ascertainment that the traditional interventions may not prepare patients to adequately face the challenges of most ac...

    Background: The interest towards dual-task training (DTT) is increased due to the ascertainment that the traditional interventions may not prepare patients to adequately face the challenges of most activities of daily living. These do usually involve cognitive and motor tasks at the same time with often a decline in performance. Cognitive-motor interference (CMI) has been investigated in different neurological populations, but few evidences are present for people with Multiple Sclerosis (PwMS). To date, the use of computerized tools is mandatory to allow the application of more standardized assessment and rehabilitation intervention protocols, and easier implementation of multi-center and multi-language studies. Objective: Here, we describe the design and development of CMI-APP, an adaptive and interactive technology tablet-based application. Moreover, we present the preliminary results of a multi-center pilot study on PwMS performed in several European centers to evaluate feasibility and adherence to a rehabilitation program based on CMI-APP. Methods: CMI-APP includes user-friendly interfaces for personal data input and management, for assessment of CMI and for DTT. A dedicated team developed CMI-APP for any Android tablet above API level 14 (version 4.0), using C# as programming language and Unity and Visual Studio as development tools. Three cognitive assessment tests for working memory, information processing speed, sustained attention and four motor assessment tests for walking at different difficulty level were implemented in CMI-APP. Dual cognitive-motor tasks were given by the combination of single cognitive and motor tasks. CMI-APP implements exercises for DTT for twelve different cognitive functions, namely: sustained attention, text comprehension, verbal fluency, auditory discrimination, visual discrimination, working memory, information processing speed, auditory memory, visual memory, verbal analog reasoning, visual analog reasoning, visual spatial planning, which can be performed during walking or stepping on the spot. Fifteen PwMS were recruited (mean age: 52.6±8.6 years; mean disease duration 9.4±8.4 years; Expanded Disability Status Scale: 3.6±1.1) and requested to perform a DTT of 20 sessions. Adherence to the rehabilitation program was evaluated with the percentage of performed sessions, perceived exertion during the training with the Borg 15-point Ratings of Perceived Exertion Scale (RPE) and subjective experience towards the training with the Intrinsic Motivation Inventory (IMI). Results: Adherence was 91%. DTT was perceived as ‘’a little bit heavy’’ (mean RPE: 12.6±1.9). IMI revealed participants enjoyed the training, felt it valuable and to some extent important to them, without feelings of pressure. They felt competent although they did not always feel they could choose the exercises probably because the therapist chose them and many exercises had few difficulty levels. Conclusions: CMI-APP is a tool safe, highly usable, motivating and well-accepted by PwMS for DTT. This is fundamental in preparation of future large-sample studies examining CMI and the effectiveness of a DTT intervention with CMI-APP on PwMS.

  • Development of the Living Labs for Mobile App-based Health(LLm Health) Program for Korean-Chinese Women Workers in South Korea: A Mixed Methods Study

    Date Submitted: Jul 5, 2019

    Open Peer Review Period: Jul 9, 2019 - Sep 3, 2019

    Background: Korean-Chinese (KC) women make up the largest group of female migrants in South Korea. To prevent and manage chronic diseases in middle-aged KC women working full-time, it is necessary to...

    Background: Korean-Chinese (KC) women make up the largest group of female migrants in South Korea. To prevent and manage chronic diseases in middle-aged KC women working full-time, it is necessary to develop health promotion programs that utilize an online platform, because such a platform would allow individuals to participate in health promotion interventions at their convenience. Objective: To develop a living lab for mobile-based health (LLm Health) program focused on improving the physical activity and cultural adaptation of KC women workers. Methods: We used a mixed methods design. Living lab principles were factored into the LLm Health program, including the use of multiple methods, user engagement, multi-stakeholder participants, real-life setting, and co-creation. The program was developed using the four steps of the intervention mapping method: needs assessment, setting of objectives, identification of intervention strategies, and intervention design. Needs assessment was conducted through a literature review, focus group interviews with a total of 16 middle-aged KC women and online survey related to health promotion of migrant workers to 38 stakeholders, such as national institution. Korean-Chinese middle aged women participated in the early stages of program development and provided the idea of developing programs and mobile apps to enhance physical activity and acculturation. The mobile app developed in the program was validated with the help of 12 KC women and four experts including three nursing professors and a professor of physical education. They were asked to rate each item based on content, interface design, and technology on the four-point scale using 23-item Smartphone App Evaluation Tool for Healthcare. Results: The LLm Health program comprised a 24-week walking program using Fitbit devices, the mobile app, and social-cognitive interventions. The mobile app contained six components: a step counter, an exercise timer, an online chat function, health information, level of cardiovascular risk, and health status. The cultural aspects and lifestyles of KC women were adapted to the entire process of program development. The content validity of the mobile app was found to be as .90 and .96 according to the 12 KC women and four experts, respectively. Conclusions: The mobile app was found to be valid and acceptable for KC women. The living lab approach was useful strategy for developing a culturally adaptive LLm Health program for KC women workers as leading active participation of KC women in the overall research process including needs assessment, program composition and pre-evaluation.

  • SedVis: Supporting Sedentary Behavior Change by Visualizing Personal Mobility Patterns and Action Planning on Smartphone

    Date Submitted: Jul 4, 2019

    Open Peer Review Period: Jul 8, 2019 - Sep 2, 2019

    Background: Prolonged sedentary behavior is related to a number of risk factors for chronic diseases. Given the high prevalence of sedentary behavior in daily life, light-weight solutions for behavior...

    Background: Prolonged sedentary behavior is related to a number of risk factors for chronic diseases. Given the high prevalence of sedentary behavior in daily life, light-weight solutions for behavior change are needed to avoid detrimental health effects. Objective: Based on behavioral theories, the mobile app SedVis was developed. The app provides personal mobility pattern visualization and action planning. We aimed to study the effect of the mobility visualization on users’ action planning and change in sedentary behavior, as well as engagement with the visualization and user experience of the app. Methods: We conducted a three-week pilot study with 16 participants who had the motivation to reduce their sedentary behavior. A mixed study design was adopted: after the one-week baseline period with no access to the functions in the app, only the intervention group (N=8) was given the access to the visualizations, while both the control group (N=8) and the intervention group were asked to make action plans every day during the two-week intervention period. Results: We analyze the data using both traditional null-hypothesis significance testing and Bayesian statistics. The results showed that the visualizations in SedVis had no statistically significant effect on the participants’ action planning. The intervention involving the visualizations and action planning in SedVis had a positive effect on reducing participants’ sedentary hours with weak evidence, while the control condition did not decrease sedentary time. We also found that the more frequently the users checked the app, the more they reduced the sedentary behavior. The visualizations in the app also led to higher user-perceived novelty. No participants complained about the interruption, while some participants commented that making action plans every day was boring. Conclusions: Using a smartphone app to collect mobility data and provide feedback in real time using visualizations is a promising method to induce changes in sedentary behavior and might be more effective than action planning alone.

  • Importance of Education to Enhance Image Quality for Accurate Diagnosis in Dental Trauma Patients: Observational Study

    Date Submitted: Jul 3, 2019

    Open Peer Review Period: Jul 8, 2019 - Sep 2, 2019

    Background: Properly taken photos is a critical factor for the remote diagnosis of dental trauma and thus benefit its prognosis. The quality of the images collected by a cell phone depends on the leve...

    Background: Properly taken photos is a critical factor for the remote diagnosis of dental trauma and thus benefit its prognosis. The quality of the images collected by a cell phone depends on the level of dental knowledge of the person who is taking the photos. Objective: This study was to investigate the efficacy of education in the enhancement of transmitted images for remote diagnosis of dental trauma. Methods: The subjects included 30 laypeople and 30 dentists. They were randomly assigned into 15 subgroups with two in each. Everyone was asked to take photos of anterior teeth of himself/herself and his/her partner’s assumed an accident occurred, by using both iPhone 4s and iPhone 6. Education about how to take a proper photo of anterior teeth for teleconsultation was then performed. Photos were taken again. An assessment was carried out by a dentist base on the quality of photos for diagnosis. Results: Finally, 965 photos were collected, from which 441 photos were taken by laypeople while 524 photos were taken by dentists. The photos taken after education had significantly higher scores than those taken before education in all items (P<.05). The photos taken by rear camera had significantly higher scores than that taken by the front camera by him/herself (P<.02). iPhone 6 did not have overwhelming advantages. The photos taken by dentists had significantly higher scores than that taken by laypeople in most of the evaluated items. Conclusions: Education might be useful in taking qualified photos for teleconsultation in both laypeople and dentists. The type of cellphone does not significantly affect the qualities of photos.

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