JMIR Publications

JMIR mHealth and uHealth

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

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Journal Description

JMIR mhealth and uhealth (mobile and ubiquitous health) (JMU, ISSN 2291-5222) is a spin-off journal of JMIR, the leading eHealth journal (Impact Factor 2015: 4.532). For JMIR mHealth and uHealth we are expecting the first impact factor in 2017 which will be at least 2.84. 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 is indexed in PubMed Central/PubMed, and Thomson Reuters' Science Citation Index Expanded (SCIE), and is expecting its first official impact factor in July 2017.

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: Flickr; Copyright: Jim Sneddon; URL: https://www.flickr.com/photos/37718156@N00/2399403962; License: Creative Commons Attribution (CC-BY).

    The Physical Activity Tracker Testing in Youth (P.A.T.T.Y.) Study: Content Analysis and Children’s Perceptions

    Abstract:

    Background: Activity trackers are widely used by adults and several models are now marketed for children. Objective: The aims of this study were to (1) perform a content analysis of behavioral change techniques (BCTs) used by three commercially available youth-oriented activity trackers and (2) obtain feedback describing children’s perception of these devices and the associated websites. Methods: A content analysis recorded the presence of 36 possible BCTs for the MovBand (MB), Sqord (SQ), and Zamzee (ZZ) activity trackers. In addition, 16 participants (mean age 8.6 years [SD 1.6]; 50% female [8/16]) received all three trackers and were oriented to the devices and websites. Participants were instructed to wear the trackers on 4 consecutive days and spend ≥10 min/day on each website. A cognitive interview and survey were administered when the participant returned the devices. Qualitative data analysis was used to analyze the content of the cognitive interviews. Chi-square analyses were used to determine differences in behavioral monitoring and social interaction features between websites. Results: The MB, SQ, and ZZ devices or websites included 8, 15, and 14 of the possible 36 BCTs, respectively. All of the websites had a behavioral monitoring feature (charts for tracking activity), but the percentage of participants indicating that they “liked” those features varied by website (MB: 8/16, 50%; SQ: 6/16, 38%; ZZ: 11/16, 69%). Two websites (SQ and ZZ) included an “avatar” that the user could create to represent themselves on the website. Participants reported that they “liked” creating and changing their avatar (SQ: 12/16, 75%, ZZ: 15/16, 94%), which was supported by the qualitative analyses of the cognitive interviews. Most participants (75%) indicated that they would want to wear the devices more if their friends were wearing a tracker. No significant differences were observed between SQ and ZZ devices in regards to liking or use of social support interaction features (P=.21 to .37). Conclusions: The websites contained several BCTs consistent with previously identified strategies. Children “liked” the social aspects of the websites more than the activity tracking features. Developers of commercial activity trackers for youth may benefit from considering a theoretical perspective during the website design process.

  • Clickotine® a Digital Therapeutic for Smoking Cessation (Montage). Source: Adobe Stock; Copyright: The Authors; URL: http://stock.adobe.com; License: Licensed by the authors.

    Clickotine, A Personalized Smartphone App for Smoking Cessation: Initial Evaluation

    Abstract:

    Background: Tobacco smoking is the leading cause of preventable death in the United States, and the annual economic burden attributable to smoking exceeds US $300 billion. Obstacles to smoking cessation include limited access and adherence to effective cessation interventions. Technology can help overcome these obstacles; many smartphone apps have been developed to aid smoking cessation, but few that conform to the US clinical practice guideline (USCPG) have been rigorously tested and reported in the literature. Clickotine is a novel smartphone app for smoking cessation, designed to deliver the essential features of the USCPG and engineered to engage smokers by personalizing intervention components. Objective: Our objective was to assess the engagement, efficacy, and safety of Clickotine in an initial, single-arm study. Outcomes measured were indicators of engagement with the smartphone app (number of app opens, number of interactions with the Clickotine program, and weeks active with Clickotine), cessation outcomes of 7- and 30-day self-reported abstinence from smoking, and negative health events. Methods: We recruited US residents between 18 and 65 years of age who owned an iPhone and smoked 5 or more cigarettes daily for the study via online advertising. Respondents were prescreened for eligibility by telephone and, if appropriate, directed to a Web portal to provide informed consent, confirm eligibility, and download the Clickotine app. Participants completed study assessments via the online portal at baseline and after 8 weeks. Data were collected in Amazon S3 with no manual data entry, and access to all data was maximally restrictive, logged, and auditable. Results: A total of 416 participants downloaded the app and constituted the intention-to-treat (ITT) sample. On average, participants opened the Clickotine app 100.6 times during the 8-week study (median 69), logged 214.4 interactions with the Clickotine program (median 178), and remained engaged with Clickotine for 5.3 weeks (median 5). Among the ITT sample, 45.2% (188/416) reported 7-day abstinence and 26.2% (109/416) reported 30-day abstinence from smoking after 8 weeks. Completer analysis focused on 365 (87.7%) of the 416 enrolled participants who completed the 8-week questionnaire revealed that 51.5% (188/365) of completers reported 7-day abstinence and 29.9% (109/365) reported 30-day abstinence. Few adverse events, mostly consistent with nicotine withdrawal symptoms, were reported and overall no safety signal was detected. Conclusions: In this initial single-arm trial, Clickotine users appeared to demonstrate encouraging indicators of engagement in terms of the number of app opens, number of program interactions, and continued engagement over time. Clickotine users reported encouraging quit rates while reporting few adverse events. Future research is warranted to assess Clickotine’s efficacy in a randomized controlled trial. Trial Registration: Clinicaltrials.gov NCT02656745; https://clinicaltrials.gov/ct2/show/NCT02656745 (Archived by WebCite at http://www.webcitation.org/6peTT4x60)

  • Source: Pixabay; Copyright: Jan Vašek; URL: https://pixabay.com/en/iphone-smartphone-oranges-home-569065/; License: Public Domain (CC0).

    Use of Fitness and Nutrition Apps: Associations With Body Mass Index, Snacking, and Drinking Habits in Adolescents

    Abstract:

    Background: Efforts to improve snacking and drinking habits are needed to promote a healthy body mass index (BMI) in adolescents. Although commercial fitness and nutrition mobile phone apps are widely used, little is known regarding their potential to improve health behaviors, especially in adolescents. In addition, evidence on the mechanisms through which such fitness and nutrition apps influence behavior is lacking. Objectives: This study assessed whether the use of commercial fitness or nutrition apps was associated with a lower BMI and healthier snacking and drinking habits in adolescents. Additionally, it explored if perceived behavioral control to eat healthy; attitudes to eat healthy for the good taste of healthy foods, for overall health or for appearance; social norm on healthy eating and social support to eat healthy mediated the associations between the frequency of use of fitness or nutrition apps and BMI, the healthy snack, and beverage ratio. Methods: Cross-sectional self-reported data on snack and beverage consumption, healthy eating determinants, and fitness and nutrition app use of adolescents (N=889; mean age 14.7 years, SD 0.8; 54.8% [481/878] boys; 18.1% [145/803] overweight) were collected in a representative sample of 20 schools in Flanders, Belgium. Height and weight were measured by the researchers. The healthy snack ratio and the healthy beverage ratio were calculated as follows: gram healthy snacks or beverages/(gram healthy snacks or beverages+gram unhealthy snacks or beverages)×100. Multilevel regression and structural equation modeling were used to analyze the proposed associations and to explore multiple mediation. Results: A total of 27.6% (245/889) of the adolescents used fitness, nutrition apps or both. Frequency of using nutrition apps was positively associated with a higher healthy beverage ratio (b=2.96 [1.11], P=.008) and a higher body mass index z-scores (zBMI; b=0.13 [0.05], P=.008. A significant interaction was found between the frequency of using nutrition and for the zBMI (b=−0.03 [0.02], P=.04) and the healthy snack ratio (b=−0.84 [0.37], P=.03). Attitude to eat healthy for appearance mediated both the fitness app use frequency-zBMI (a × b=0.02 [0.01], P=.02) and the nutrition app use frequency-zBMI (a × b=0.04 [0.01], P=.001) associations. No mediation was observed for the associations between the frequency of use of fitness or nutrition apps and the healthy snack or beverage ratio. Conclusions: Commercial fitness and nutrition apps show some association with healthier eating behaviors and BMI in adolescents. However, effective behavior change techniques should be included to affect key determinants of healthy eating.

  • Running for Diabetes. Source: Diabetes Action via Foter.com; URL: https://www.flickr.com/photos/diabetesaction/2944646241/; License: Creative Commons Attribution (CC-BY).

    Designing Patient-Centered Text Messaging Interventions for Increasing Physical Activity Among Participants With Type 2 Diabetes: Qualitative Results From...

    Abstract:

    Background: Type 2 diabetes mellitus (T2DM) is a disease affecting approximately 29.1 million people in the United States, and an additional 86 million adults have prediabetes. Diabetes self-management education, a complex health intervention composed of 7 behaviors, is effective at improving self-care behaviors and glycemic control. Studies have employed text messages for education, reminders, and motivational messaging that can serve as “cues to action,” aiming to improve glucose monitoring, self-care behaviors, appointment attendance, and medication adherence. Objectives: The Text to Move (TTM) study was a 6-month 2-parallel group randomized controlled trial of individuals with T2DM to increase physical activity, measured by a pedometer. The intervention arm received text messages twice daily for 6 months that were tailored to the participant’s stage of behavior change as defined by the transtheoretical model of behavior change. Methods: We assessed participants’ attitudes regarding their experience with text messaging, focusing on perceived barriers and facilitators, through two focus groups and telephone interviews. All interviews were audiorecorded, transcribed verbatim, coded, and analyzed using a grounded theory approach. Results: The response rate was 67% (31/46 participants). The average age was 51.4 years and 61% (19/31 participants) were male. The majority of individuals were English speakers and married, had completed at least 12th grade and approximately half of the participants were employed full-time. Overall, participants were satisfied with the TTM program and recalled the text messages as educational, informational, and motivational. Program involvement increased the sense of connection with their health care center. The wearing of pedometers and daily step count information served as motivational reminders and created a sense of accountability through the sentinel effect. However, there was frustration concerning the automation of the text message program, including the repetitiveness, predictability of text time delivery, and lack of customization and interactivity of text message content. Participants recommended personalization of texting frequency as well as more contact time with personnel for a stronger sense of support, including greater surveillance and feedback based on their own results and comparison to other participants. Conclusions: Participants in a theory-based text messaging intervention identified key facilitators and barriers to program efficacy that should be incorporated into future texting interventions to optimize participant satisfaction and outcomes. Trial Registration: Clinicaltrials.gov NCT01569243; http://clinicaltrials.gov/ct2/show/NCT01569243 (Archived by Webcite at http://www.webcitation.org/6pfH6yXag)

  • TOC image. Source: Image created by the authors; Copyright: The Authors; URL: http; License: Public Domain (CC0).

    Development of a Culturally Tailored Text Message Maternal Health Program: TextMATCH

    Abstract:

    Background: Mobile phones are increasingly being used to deliver health information and health services globally. Mobile health (mHealth) interventions may be well-suited for minority groups with greater barriers to accessing traditional health services. However, little has been written about the process of culturally adapting interventions for multiple ethnic and cultural minorities within a population. Objective: This study describes the process of developing a culturally tailored text message-based maternal health program (TextMATCH: Text for MATernal and Child Health) for Māori, Pacific, Asian, and South Asian families living in New Zealand. We report on engagement and acceptability of the TextMATCH program. Methods: Program data was examined to describe engagement with the program 18 months after implementation. Telephone interviews were conducted with a sample of participants who consented to provide feedback on acceptability and relevance of the program. Results: A total of 1404 participants enrolled in TextMATCH over 18 months, with 18.52% (260) actively opting out at some point (after 0 to 17 months of messages). It was found that 356 (70.9%) of the 502 eligible participants actively switched from the initial pregnancy program to the baby program after delivery. Phone interviews were conducted with 29 participants including 6 who had withdrawn (duration of program from 3 to 16 months). Only 2 participants reported that the program was not useful, with the remainder rating the usefulness of messages positively (average 4.24 out of 5). All participants stated that the messages were relevant, culturally appropriate, and easy to understand. Most were happy with the specific advice and the language options provided. Conclusions: We have demonstrated the importance of an intensive approach to the development of a culturally adapted and tailored mHealth program for multiple different cultural minority groups within our population.

  • DREAM-GLOBAL BP. Source: The authors; Copyright: Photo credit: Sheldon Tobe; URL: http://mhealth.jmir.org/2017/4/e47/; License: Creative Commons Attribution (CC-BY).

    A Framework for the Study of Complex mHealth Interventions in Diverse Cultural Settings

    Abstract:

    Background: To facilitate decision-making capacity between options of care under real-life service conditions, clinical trials must be pragmatic to evaluate mobile health (mHealth) interventions under the variable conditions of health care settings with a wide range of participants. The mHealth interventions require changes in the behavior of patients and providers, creating considerable complexity and ambiguity related to causal chains. Process evaluations of the implementation are necessary to shed light on the range of unanticipated effects an intervention may have, what the active ingredients in everyday practice are, how they exert their effect, and how these may vary among recipients or between sites. Objective: Building on the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile HEalth Applications and onLine TeleHealth) statement and participatory evaluation theory, we present a framework for the process evaluations for mHealth interventions in multiple cultural settings. We also describe the application of this evaluation framework to the implementation of DREAM-GLOBAL (Diagnosing hypertension—Engaging Action and Management in Getting Lower BP in Indigenous and LMIC [low- and middle-income countries]), a pragmatic randomized controlled trial (RCT), and mHealth intervention designed to improve hypertension management in low-resource environments. We describe the evaluation questions and the data collection processes developed by us. Methods: Our literature review revealed that there is a significant knowledge gap related to the development of a process evaluation framework for mHealth interventions. We used community-based participatory research (CBPR) methods and formative research data to develop a process evaluation framework nested within a pragmatic RCT. Results: Four human organizational levels of participants impacted by the mHealth intervention were identified that included patients, providers, community and organizations actors, and health systems and settings. These four levels represent evaluation domains and became the core focus of the evaluation. In addition, primary implementation themes to explore in each of the domains were identified as follows: (1) the major active components of the intervention, (2) technology of the intervention, (3) cultural congruence, (4) task shifting, and (5) unintended consequences. Using the four organizational domains and their interaction with primary implementation themes, we developed detailed evaluation research questions and identified the data or information sources to best answer our questions. Conclusions: Using DREAM-GLOBAL to illustrate our approach, we succeeded in developing an uncomplicated process evaluation framework for mHealth interventions that provide key information to stakeholders, which can optimize implementation of a pragmatic trial as well as inform scale up. The human organizational level domains used to focus the primary implementation themes in the DREAM-GLOBAL process evaluation framework are sufficiently supported in our research, and the literature and can serve as a valuable tool for other mHealth process evaluations. Trial Registration: ClinicalTrials.gov NCT02111226; https://clinicaltrials.gov/ct2/show/NCT02111226 (Archived by WebCite at http://www.webcitation.org/6oxfHXege)

  • Copyright: Created by Annett Salzwedel (author); URL: http://mhealth.jmir.org/2017/4/e51/; License: Creative Commons Attribution (CC-BY).

    User Interest in Digital Health Technologies to Encourage Physical Activity: Results of a Survey in Students and Staff of a German University

    Abstract:

    Background: Although the benefits for health of physical activity (PA) are well documented, the majority of the population is unable to implement present recommendations into daily routine. Mobile health (mHealth) apps could help increase the level of PA. However, this is contingent on the interest of potential users. Objective: The aim of this study was the explorative, nuanced determination of the interest in mHealth apps with respect to PA among students and staff of a university. Methods: We conducted a Web-based survey from June to July 2015 in which students and employees from the University of Potsdam were asked about their activity level, interest in mHealth fitness apps, chronic diseases, and sociodemographic parameters. Results: A total of 1217 students (67.30%, 819/1217; female; 26.0 years [SD 4.9]) and 485 employees (67.5%, 327/485; female; 42.7 years [SD 11.7]) participated in the survey. The recommendation for PA (3 times per week) was not met by 70.1% (340/485) of employees and 52.67% (641/1217) of students. Within these groups, 53.2% (341/641 students) and 44.2% (150/340 employees)—independent of age, sex, body mass index (BMI), and level of education or professional qualification—indicated an interest in mHealth fitness apps. Conclusions: Even in a younger, highly educated population, the majority of respondents reported an insufficient level of PA. About half of them indicated their interest in training support. This suggests that the use of personalized mobile fitness apps may become increasingly significant for a positive change of lifestyle.

  • Multiple medications can be consolidated on medication adherence apps. Copyright: Waltin Zomaya; URL: http://mhealth.jmir.org/2017/4/e45/; License: Creative Commons Attribution (CC-BY).

    Assessing the Medication Adherence App Marketplace From the Health Professional and Consumer Vantage Points

    Abstract:

    Background: Nonadherence produces considerable health consequences and economic burden to patients and payers. One approach to improve medication nonadherence that has gained interest in recent years is the use of smartphone adherence apps. The development of smartphone adherence apps has increased rapidly since 2012; however, literature evaluating the clinical app and effectiveness of smartphone adherence apps to improve medication adherence is generally lacking. Objective: The aims of this study were to (1) provide an updated evaluation and comparison of medication adherence apps in the marketplace by assessing the features, functionality, and health literacy (HL) of the highest-ranking adherence apps and (2) indirectly measure the validity of our rating methodology by determining the relationship between our app evaluations and Web-based consumer ratings. Methods: Two independent reviewers assessed the features and functionality using a 4-domain rating tool of all adherence apps identified based on developer claims. The same reviewers downloaded and tested the 100 highest-ranking apps including an additional domain for assessment of HL. Pearson product correlations were estimated between the consumer ratings and our domain and total scores. Results: A total of 824 adherence apps were identified; of these, 645 unique apps were evaluated after applying exclusion criteria. The median initial score based on descriptions was 14 (max of 68; range 0-60). As a result, 100 of the highest-scoring unique apps underwent user testing. The median overall user-tested score was 31.5 (max of 73; range 0-60). The majority of the user tested the adherence apps that underwent user testing reported a consumer rating score in their respective online marketplace. The mean consumer rating was 3.93 (SD 0.84). The total user-tested score was positively correlated with consumer ratings (r=.1969, P=.04). Conclusions: More adherence apps are available in the Web-based marketplace, and the quality of these apps varies considerably. Consumer ratings are positively but weakly correlated with user-testing scores suggesting that our rating tool has some validity but that consumers and clinicians may assess adherence app quality differently.

  • Student texting. Source: Francisco Osorio via flickr; URL: https://goo.gl/s8CgHd; License: Creative Commons Attribution (CC-BY).

    Texting and Mobile Phone App Interventions for Improving Adherence to Preventive Behavior in Adolescents: A Systematic Review

    Abstract:

    Background: Many preventable behaviors contribute to adolescent mortality and morbidity. Non-adherence to preventive measures represents a challenge and has been associated with worse health outcomes in this population. The widespread use of electronic communication technologies by adolescents, particularly the use of text messaging (short message service, SMS) and mobile phones, presents new opportunities to intervene on risk and preventive risk behavior, but little is known about their efficacy. Objective: This study aimed to systematically evaluate evidence for the efficacy of text messaging and mobile phone app interventions to improve adherence to preventive behavior among adolescents and describe intervention approaches to inform intervention development. Methods: This review covers literature published between 1995 and 2015. Searches included PubMed, Embase, CENTRAL, PsycINFO, CINAHL, INSPEC, Web of Science, Google Scholar, and additional databases. The search strategy sought articles on text messaging and mobile phone apps combined with adherence or compliance, and adolescents and youth. An additional hand search of related themes in the Journal of Medical Internet Research was also conducted. Two reviewers independently screened titles and abstracts, assessed full-text articles, and extracted data from articles that met inclusion criteria. Included studies reflect original research—experimental or preexperimental designs with text messaging or mobile phone app interventions—targeting adherence to preventive behavior among adolescents (12-24 years old). The preferred reporting items of systematic reviews and meta-analyses (PRISMA) guidelines were followed for reporting results, and findings were critically appraised against the Oxford Centre for Evidence-based Medicine criteria. Results: Of 1454 records, 19 met inclusion criteria, including text messaging (n=15) and mobile phone apps (n=4). Studies targeted clinic attendance, contraceptive use, oral health, physical activity and weight management, sun protection, human papillomavirus (HPV) vaccination, smoking cessation, and sexual health. Most studies were performed in the United States (47%, 9/19), included younger adolescents (63%, 12/19), and had sample size <100 (63%, 12/19). Although most studies were randomized controlled trials (RCTs; 58%, 11/19), only 5 followed an intent-to-treat analysis. Only 6 of 19 studies (32%) incorporated a theoretical framework in their design. Most studies reported good feasibility with high acceptability and satisfaction. About half of the included studies (42%, 8/19) demonstrated significant improvement in preventive behavior with moderate standardized mean differences. As early efforts in this field to establish feasibility and initial efficacy, most studies were low to moderate in quality. Studies varied in sample size and methods of preventive behavior adherence or outcome assessment, which prohibited performing a meta-analysis. Conclusions: Despite the promising feasibility and acceptability of text messaging and mobile phone apps in improving preventive behavior among adolescents, overall findings were modest in terms of efficacy. Further research evaluating the efficacy, effectiveness, and cost-effectiveness of these intervention approaches in promoting preventive behavior among adolescents is needed.

  • Montage: Girl using the MyT1D app. Source: Holtz/PlaceIt; Copyright: The Authors; URL: http://mhealth.jmir.org/2017/4/e53/; License: Creative Commons Attribution (CC-BY).

    Developing a Patient-Centered mHealth App: A Tool for Adolescents With Type 1 Diabetes and Their Parents

    Abstract:

    Background: Type 1 diabetes (T1D) afflicts approximately 154,000 people under 20 years of age. Three-quarters of adolescents are not achieving glycosylated hemoglobin (HbA1c) targets, which leads to negative health outcomes. Mobile health (mHealth), the use of technology in health, has been used successfully to improve health in many chronic conditions, including diabetes. Objective: The purpose of this study was to use patient-centered research methods to inform and improve the design and functionality of our T1D app, MyT1DHero, and to provide insight for others who are designing a health app for adolescents and parents. Methods: This study included data from focus groups with participants recruited from the Juvenile Diabetes Research Foundation (JDRF) southeast Michigan’s family network. All data collected during the sessions were audio-recorded, transcribed, and coded. Results: Four key themes were identified: (1) diabetes is unpredictable, (2) negative and frustrated communication, (3) motivations to use an app, and (4) feedback specific to our app. Conclusions: A patient-centered approach was used to assist in the development of an app for adolescents with T1D. Participants were satisfied with overall app design; customization, interactivity, and tangible rewards were identified as being necessary for continued use. Participants believed the app would help improve the communication between parents and adolescents. Many apps developed in the health context have not used a patient-centered design method or have seen vast improvements in health. This paper offers suggestions to others seeking to develop apps for adolescents and their parents.

  • TreC-LifeStyle App for Nutrition Education. Source: Image created by the authors; Copyright: The Authors; URL: https://www.youtube.com/watch?v=LJ6T3172P3g; License: Licensed by the authors.

    Design of a Mobile App for Nutrition Education (TreC-LifeStyle) and Formative Evaluation With Families of Overweight Children

    Abstract:

    Background: Nutrition and diet apps represent today a popular area of mobile health (mHealth), offering the possibility of delivering behavior change (BC) interventions for healthy eating and weight management in a scalable and cost-effective way. However, if commercial apps for pediatric weight management fail to retain users because of a lack of theoretical background and evidence-based content, mHealth apps that are more evidence-based are found less engaging and popular among consumers. Approaching the apps development process from a multidisciplinary and user-centered design (UCD) perspective is likely to help overcome these limitations, raising the chances for an easier adoption and integration of nutrition education apps within primary care interventions. Objective: The aim of this study was to describe the design and development of the TreC-LifeStyle nutrition education app and the results of a formative evaluation with families. Methods: The design of the nutrition education intervention was based on a multidisciplinary UCD approach, involving a team of BC experts, working with 2 nutritionists and 3 pediatricians from a primary care center. The app content was derived from evidence-based knowledge founded on the Food Pyramid and Mediterranean Diet guidelines used by pediatricians in primary care. A formative evaluation of the TreC-LifeStyle app involved 6 families of overweight children (aged 7-12 years) self-reporting daily food intake of children for 6 weeks and providing feedback on the user experience with the mHealth intervention. Analysis of the app’s usage patterns during the intervention and of participants’ feedback informed the refinement of the app design and a tuning of the nutrition education strategies to improve user engagement and compliance with the intervention. Results: Design sessions with the contribution of pediatricians and nutritionists helped define the nutrition education app and intervention, providing an effective human and virtual coaching approach to raise parents’ awareness about children’s eating behavior and lifestyle. The 6 families participating in the pilot study found the app usable and showed high compliance with the intervention over the 6 weeks, but analysis of their interaction and feedback showed the need for improving some of the app features related to the BC techniques “monitoring of the behavior” and “information provision.” Conclusions: The UCD and formative evaluation of TreC-LifeStyle show that nutrition education apps are feasible and acceptable solutions to support health promotion interventions in primary care.

  • Source: Stocksy; Copyright: Joselito Briones; URL: https://www.stocksy.com/188078; License: Licensed by the authors.

    Technology Use and Preferences for Mobile Phone–Based HIV Prevention and Treatment Among Black Young Men Who Have Sex With Men: Exploratory Research

    Abstract:

    Background: Black young men who have sex with men (BYMSM) experience higher human immunodeficiency virus (HIV) incidence than their white and Latino counterparts. Objective: The aim of our study was to understand BYMSM’s preferences for mobile phone–based HIV prevention and treatment in order to inform culturally tailored interventions to reduce the spread of HIV and improve HIV treatment outcomes in this population. Methods: Qualitative focus groups (N=6) with BYMSM aged 18-29 years (N=41; 46%, 19/41 HIV-positive) were conducted to elucidate their preferences for the design and delivery of mobile phone–based HIV prevention and treatment interventions. A modified grounded theory approach to data analysis was undertaken using ATLAS.ti textual analysis software. Results: Participants preferred holistic health interventions that did not focus exclusively on HIV prevention and treatment. Issues of privacy and confidentiality were paramount. Participants preferred functionality that enables discreet connections to culturally competent health educators and treatment providers who can address the range of health and psychosocial concerns faced by BYMSM. Conclusions: Mobile phone–based HIV prevention has the potential to increase engagement with HIV prevention and treatment resources among BYMSM. For these approaches to be successful, researchers must include BYMSM in the design and creation of these interventions.

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  • Does using plain language and adding communication technology to an existing health related questionnaire help to generate accurate information?

    Date Submitted: Apr 28, 2017

    Open Peer Review Period: Apr 29, 2017 - Jun 24, 2017

    Background: Low educated patients are disadvantaged in using questionnaires within the health care setting, because most health related questionnaires are not taking educational background of patients...

    Background: Low educated patients are disadvantaged in using questionnaires within the health care setting, because most health related questionnaires are not taking educational background of patients into account. The ‘Dutch Talking Touch Screen Questionnaire’ (DTTSQ) was developed in an attempt to meet the needs of low educated patients by using plain language and adding communication technology to an existing paper-based questionnaire. For physical therapists to use the DTTSQ as part of their intake procedure it needs to generate accurate information from all of their patients, independent from educational level. Objective: The aim of this study was to get a first impression of the information that is generated by the DTTSQ. To achieve this goal, response processes of physical therapy patients with diverse levels of education were analyzed. Methods: The qualitative Three Step Test Interview method was used to collect observational data on actual response behavior of twenty-four physical therapy patients with diverse levels of education. The interviews included both think-a-loud and retrospective probing techniques. Results: Twenty of the twenty-four respondents encountered one or more problems during their response process. Almost three quarters of all problems were generated by two of the total of eight questions. No problems were experienced with comprehension of text or wording. No educational group in this research population stood out from the rest in the sort or amount of problems that arose. In spite of the fact that twenty respondents did not respond to each question in the way that was intended by its developers, all respondents recognized themselves in the outcomes of the questionnaire. Conclusions: The results of this study show that the DTTSQ, except for two questions, was reasonably successful in generating the information that it was meant to generate. On the basis of the results of this study developers are recommended to pre-test both the effects of formulation of text and the design of the user-interface on the response processes of the target population during the development of digital(ized) health related questionnaires.

  • Acceptability of Electronic Brief Intervention and Text Messaging for Marijuana Use During Pregnancy

    Date Submitted: Apr 26, 2017

    Open Peer Review Period: Apr 26, 2017 - Jun 21, 2017

    Background: Marijuana is the most widely used illicit substance during pregnancy. Technology-delivered brief interventions and text messaging have shown promise in general and pregnant samples, but ha...

    Background: Marijuana is the most widely used illicit substance during pregnancy. Technology-delivered brief interventions and text messaging have shown promise in general and pregnant samples, but have not yet been applied to marijuana use in pregnancy. Objective: To evaluate, among pregnant women and prenatal care providers, the acceptability of an electronic brief intervention and text messaging plan for marijuana use in pregnancy. Methods: Participants included patients (n= 10) and medical staff (n = 12) from an urban prenatal clinic. Patient-participants were recruited directly during a prenatal care visit. Those who were eligible reviewed the interventions individually and provided quantitative and qualitative feedback regarding software acceptability and helpfulness during a one on one interview with research staff. Provider-participants took part in focus groups in which the intervention materials were reviewed and discussed. Qualitative and focus group feedback was transcribed, coded manually, and classified by category and theme. Results: Patient-participants provided high ratings for satisfaction, with mean ratings for respectfulness, interest, ease of use, and helpfulness ranging between 4.4 and 4.7 on a 1-5 Likert scale. Five of ten participants reported that they preferred working with the program versus their doctor and 9 of 10 said the intervention made them more likely to reduce their marijuana use. Provider-participants received the program favorably, stating the information presented was both relevant and important for their patient population. Conclusions: These findings support the acceptability of electronic brief intervention and text messaging for marijuana use during pregnancy. This, combined with their ease of use and low barrier to initiation, suggests that further evaluation is justified. Clinical Trial: NC702191605

  • Design and Pilot Testing of an Interactive Mobile Health Application to Improve Self-Care in Heart Failure

    Date Submitted: Apr 10, 2017

    Open Peer Review Period: Apr 11, 2017 - Jun 6, 2017

    Background: The sophistication of today's mobile health and the increasing adoption of smartphones to address the rising incidence of chronic diseases. Chronic heart failure (CHF) is a progressive ch...

    Background: The sophistication of today's mobile health and the increasing adoption of smartphones to address the rising incidence of chronic diseases. Chronic heart failure (CHF) is a progressive chronic disease affecting 5.7 million Americans and over 15 million globally. Patients with CHF are required to engage in complex self-care behaviors. While people with CHF are living longer, they often have poor health-related quality of life and experience severe and frequent symptoms that limit several aspects of their lives. Smartphone applications have created new and interactive ways of communication between patients and healthcare providers and a venue to enhance adherence to self-care management. Objective: The purpose of this study was to test the feasibility and potential efficacy of a novel mobile application (HeartMapp) in improving self-care behaviors and quality of life of patients with CHF. Methods: This was a single-blind, pilot randomized controlled trial. Participants were enrolled in the hospital prior to discharge and followed at home. The intervention group had HeartMapp (n=9), while the control group (n=9) had CHF education downloaded in their mobile phones. Both groups were followed at 30-days at home. Results: A total of 72% (n=13) participants completed the study, mean age 534.02 years, 56% were females, 61% lived alone, 33% African Americans, and 83% used mobile phone to get health information. Results are promising with a trend that participants in the HeartMapp group had significant mean score change on self-care management (8.7 vs 2.3; t=3.38; p=0.006), self-care confidence (6.7 vs 1.8; t=2.53; p=0.28) and CHF knowledge (3 vs -.66; t=2.37; p=0.037). Depression improved among both groups, more so on the control group (-1.14 vs -5.17; t= 1.97; p=0.074). Quality of life declined among both groups more so on the control group (2.14 vs 9.0; t= -1.43; p=.18). Conclusions: Patients who received the HeartMapp intervention demonstrated clinically meaningful improvements in HF self-care management, self-care confidence, and CHF knowledge, supporting the use of mobile application such as HeartMapp for improving CHF outcomes. The trend demonstrated among the small sample of CHF patients warrants further exploration. Clinical Trial: Pilot study. Not registered

  • Examining Health App Use among U.S. Smartphone Users with Chronic Disease

    Date Submitted: Apr 6, 2017

    Open Peer Review Period: Apr 6, 2017 - Jun 1, 2017

    Background: Mobile apps hold promise for serving as a lifestyle intervention in public health to promote wellness and attenuate chronic conditions, yet little is known about how individuals with chron...

    Background: Mobile apps hold promise for serving as a lifestyle intervention in public health to promote wellness and attenuate chronic conditions, yet little is known about how individuals with chronic illness use or perceive mobile apps. Objective: The current study explores behaviors and perceptions about mobile phone based applications (apps) for health among individuals with CMC, and examines if behaviors and beliefs are different between individuals with and without CMCs. Methods: Data were collected from a national cross-sectional survey of 1,604 smartphone users in the U.S. assessing mobile health use, beliefs and preferences. The current study examined responses by CMC (no CMC, one CMC, and with two or more CMCs). Responses were summarized using descriptive statistics and the relationship between comorbidity and health app download was examined via regression. Results: Participants reported using health-related apps frequently (“two or more times daily” was reported by 29% of individuals without CMC, whereas 16% to 28% of individuals with CMC reported health app use “two or more times daily”). Reasons for downloading health apps varied, but “track activity/exercise” was among the most common reasons for download in all groups (46% among individuals without CMC, between 27% and 39% for individuals with CMC. Logistic regression revealed individuals with at least one CMC were less likely than individuals without CMC to download health apps (OR=0.46, 95%C[0.37-0.59],p<.001). Individuals with hypertension (OR=0.44, 95%CI[0.35-0.56],p<.001) and high cholesterol (OR=0.52, 95%CI[0.41-0.67),p<.001) were less likely than individuals without these conditions to report health app download. Finally, individuals with comorbidity were less likely than individuals without comorbidity to report health app download (OR=0.54, 95%CI[0.44-0.68],p<.001). Conclusions: Results from this study suggest that those who may benefit from health apps (individuals with CMC and/or comorbidity) were less likely to report download and use compared to individuals without these conditions. Results of this study identify beliefs and behaviors by CMC, and thus may be useful for designers and developers to create tailored programs for specific CMC needs.

  • Using Mobile Health Services for the Dissemination of Sexually Transmissible Infection Information to Women in Bangladesh: Health Care Provider Perspectives

    Date Submitted: Apr 2, 2017

    Open Peer Review Period: Apr 6, 2017 - Jun 1, 2017

    Background: As many as one-third of all pregnancies in Bangladesh are unplanned, and although 61% of married women in Bangladesh use contraceptive methods, the prevalence of contraceptive use is lower...

    Background: As many as one-third of all pregnancies in Bangladesh are unplanned, and although 61% of married women in Bangladesh use contraceptive methods, the prevalence of contraceptive use is lower in rural areas than in urban areas. As the data on Sexually Transmissible Infections (STI) cases are hardly reported in Bangladesh, the awareness level and knowledge of the correct ways to avoid HIV/AIDS among the general public in Bangladesh are quite low. Mobile health (mHealth) services present a strong platform for increasing the access to STI services for women at risk for contracting various reproductive tract infections. We sought to investigate the knowledge, attitudes and practices of mHealth STI clients from the formal sexual and reproductive healthcare providers’ perspectives. Objective: To explore the perceptions of mobile health care service providers to understand the usage of mobile health services for STI health information dissemination. Methods: 22 interviews were conducted with formal health care providers in a private mobile health service delivery organization. Interview data was coded and qualitatively analyzed for themes using standard qualitative research practices. Results: Our findings suggest that using the mobile network service system, majority of the women population were more responsive and interested in such services. There had been more number of STI clients than for other reproductive health services. There was a sudden sense of trust working amongst the women clients as they mostly preferred to share their health complications with the female medical graduates more. The consultation expense and timeliness and accessibility of the service also played a major role in availing the mHealth service. Conclusions: We report low utilization yet high acceptability of mHealth services among women clients in Bangladesh. This study found some similarities with other studies in terms of service accessibility, health literacy and service utilization, while there had been some unique findings about the women clients who are now mobile users and have been taking independent decisions in availing STI services in more patriarchal societal community settings. Service expansion is needed as it may help increase the dissemination of information about STI and other reproductive health complications, and connecting women with formal providers, more referral services, increased diagnosis appointments thorugh the application of mHealth. While in-person visits remain necessary for adequate treatment.

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