JMIR Publications

JMIR mHealth and uHealth

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

JMIR's Thomson Reuter Impact Factor of 4.636 for 2016

Journal Description

JMIR mHealth and uHealth (JMU, ISSN 2291-5222) is a spin-off journal of JMIR, the leading eHealth journal (Impact Factor 2016: 5.175). JMIR mHealth and uHealth is indexed in PubMed, PubMed Central, and Science Citation Index Expanded (SCIE), and in June 2017 received a stunning inaugural Impact Factor of 4.636

The journal focusses on health and biomedical applications in mobile and tablet computing, pervasive and ubiquitous computing, wearable computing and domotics.

JMIR mHealth and uHealth publishes since 2013 and was the first mhealth journal in Pubmed. It publishes even faster and has a broader scope with including papers which are more technical or more formative/developmental than what would be published in the Journal of Medical Internet Research

JMIR mHealth and uHealth features a rapid and thorough peer-review process, professional copyediting, professional production of PDF, XHTML, and XML proofs.

JMIR mHealth and uHealth adheres to the same quality standards as JMIR and all articles published here are also cross-listed in the Table of Contents of JMIR, the worlds' leading medical journal in health sciences / health services research and health informatics.


Recent Articles:

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

    The Relationship Between Individual Characteristics and Interest in Using a Mobile Phone App for HIV Self-Management: Observational Cohort Study of People...


    Background: The human immunodeficiency virus (HIV) continues to be a major health issue in the United States, and an estimated 1.2 million people in the United States are living with HIV. As part of Healthy People 2020, the Office of Disease Prevention and Health Promotion has targeted the persistent demographic and geographic disparities in HIV prevalence and management. Preliminary evidence suggests that mobile health technology (smartphone apps) may be a promising way to support HIV self-management among vulnerable populations of people living with HIV (PLWH) who lack access to appropriate health care services. Objective: This study examines the association between individual characteristics of PLWH and level of interest in using a free mobile phone app for HIV self-management. Methods: This study was conducted using cross-sectional survey data collected in the Florida Cohort Study between 2014 and 2016 (N=766). Associations between individual characteristics of PLWH and level of interest in using a free mobile phone app for HIV self-management were examined using bivariate analysis and logistic regression. Results: Overall, 85.5% (655/766) of respondents were interested in using a free mobile phone app that supports HIV self-management. Participants expressed the highest interest in app functions that facilitate communication with health care providers (568/740, 76.8%) or help to identify relevant health care services (556/745 74.6%). Age (OR 0.959, 95% CI 0.936-0.982), education (OR 1.281, 95% CI 1.027-1.598) and disability or inability to work (OR 0.296, 95% CI 0.145-0.606) were all significantly associated with being interested in using a free mobile phone app for HIV self-management. Conclusions: This study indicates that a majority of PLWH are interested in using a free mobile phone app to self-manage their condition. The findings can inform the development of mobile phone apps that support effective HIV self-management.

  • HMD integrated smartphone-based endoscope. (a) A demonstration of the smartphone-based endoscope system using the HMD. (b) Duplicated image shown in viewing optics of HMD. (c) Live endoscopic image shown in the smartphone screen. Source: Figure 5 from; Copyright: the authors; License: Creative Commons Attribution (CC-BY).

    Smartphone-Based Endoscope System for Advanced Point-of-Care Diagnostics: Feasibility Study


    Background: Endoscopic technique is often applied for the diagnosis of diseases affecting internal organs and image-guidance of surgical procedures. Although the endoscope has become an indispensable tool in the clinic, its utility has been limited to medical offices or operating rooms because of the large size of its ancillary devices. In addition, the basic design and imaging capability of the system have remained relatively unchanged for decades. Objective: The objective of this study was to develop a smartphone-based endoscope system capable of advanced endoscopic functionalities in a compact size and at an affordable cost and to demonstrate its feasibility of point-of-care through human subject imaging. Methods: We developed and designed to set up a smartphone-based endoscope system, incorporating a portable light source, relay-lens, custom adapter, and homebuilt Android app. We attached three different types of existing rigid or flexible endoscopic probes to our system and captured the endoscopic images using the homebuilt app. Both smartphone-based endoscope system and commercialized clinical endoscope system were utilized to compare the imaging quality and performance. Connecting the head-mounted display (HMD) wirelessly, the smartphone-based endoscope system could superimpose an endoscopic image to real-world view. Results: A total of 15 volunteers who were accepted into our study were captured using our smartphone-based endoscope system, as well as the commercialized clinical endoscope system. It was found that the imaging performance of our device had acceptable quality compared with that of the conventional endoscope system in the clinical setting. In addition, images captured from the HMD used in the smartphone-based endoscope system improved eye-hand coordination between the manipulating site and the smartphone screen, which in turn reduced spatial disorientation. Conclusions: The performance of our endoscope system was evaluated against a commercial system in routine otolaryngology examinations. We also demonstrated and evaluated the feasibility of conducting endoscopic procedures through a custom HMD.

  • Source: Image created by the authors; Copyright: Titus J Brinker; URL:; License: Creative Commons Attribution (CC-BY).

    Photoaging Mobile Apps as a Novel Opportunity for Melanoma Prevention: Pilot Study


    Background: Around 90% of melanomas are caused by ultraviolet (UV) exposure and are therefore eminently preventable. Unhealthy tanning behavior is mostly initiated in early adolescence, often with the belief that it increases attractiveness; the problems related to skin atrophy and malignant melanoma are too far in the future to fathom. Photoaging desktop programs, in which an image is altered to predict future appearance, have been successful in positively influencing behavior in adiposity or tobacco prevention settings. Objective: To develop and test a photoaging app designed for melanoma prevention. Methods: We harnessed the widespread availability of mobile phones and adolescents’ interest in appearance to develop a free mobile app called Sunface. This app has the user take a self-portrait (ie, a selfie), and then photoages the image based on Fitzpatrick skin type and individual UV protection behavior. Afterward, the app explains the visual results and aims at increasing self-competence on skin cancer prevention by providing guideline recommendations on sun protection and the ABCDE rule for melanoma self-detection. The underlying aging algorithms are based on publications showing UV-induced skin damage by outdoor as well as indoor tanning. To get a first impression on how well the app would be received in a young target group, we included a total sample of 25 students in our cross-sectional pilot study with a median age of 22 (range 19-25) years of both sexes (11/25, 44% female; 14/25, 56% male) attending the University of Essen in Germany. Results: The majority of enrolled students stated that they would download the app (22/25, 88%), that the intervention had the potential to motivate them to use sun protection (23/25, 92%) and that they thought such an app could change their perceptions that tanning makes you attractive (19/25, 76%). Only a minority of students disagreed or fully disagreed that they would download such an app (2/25, 8%) or that such an app could change their perceptions on tanning and attractiveness (4/25, 16%). Conclusions: Based on previous studies and the initial study results presented here, it is reasonable to speculate that the app may induce behavioral change in the target population. Further work is required to implement and examine the effectiveness of app-based photoaging interventions within risk groups from various cultural backgrounds.

  • Source: Wikimedia Commons; Copyright: Davidstankiewicz; URL:; License: Creative Commons Attribution + ShareAlike (CC-BY-SA).

    Tamper-Resistant Mobile Health Using Blockchain Technology


    Background: Digital health technologies, including telemedicine, mobile health (mHealth), and remote monitoring, are playing a greater role in medical practice. Safe and accurate management of medical information leads to the advancement of digital health, which in turn results in a number of beneficial effects. Furthermore, mHealth can help lower costs by facilitating the delivery of care and connecting people to their health care providers. Mobile apps help empower patients and health care providers to proactively address medical conditions through near real-time monitoring and treatment, regardless of the location of the patient or the health care provider. Additionally, mHealth data are stored in servers, and consequently, data management that prevents all forms of manipulation is crucial for both medical practice and clinical trials. Objective: The aim of this study was to develop and evaluate a tamper-resistant mHealth system using blockchain technology, which enables trusted and auditable computing using a decentralized network. Methods: We developed an mHealth system for cognitive behavioral therapy for insomnia using a smartphone app. The volunteer data collected with the app were stored in JavaScript Object Notation format and sent to the blockchain network. Thereafter, we evaluated the tamper resistance of the data against the inconsistencies caused by artificial faults. Results: Electronic medical records collected using smartphones were successfully sent to a private Hyperledger Fabric blockchain network. We verified the data update process under conditions where all the validating peers were running normally. The mHealth data were successfully updated under network faults. We further ensured that any electronic health record registered to the blockchain network was resistant to tampering and revision. The mHealth data update was compatible with tamper resistance in the blockchain network. Conclusions: Blockchain serves as a tamperproof system for mHealth. Combining mHealth with blockchain technology may provide a novel solution that enables both accessibility and data transparency without a third party such as a contract research organization.

  • Patient participation with the smartphone application. Source: Image created by the authors; Copyright: The authors; URL:; License: Creative Commons Attribution (CC-BY).

    Patients’ Perspective on Participation in Care With or Without the Support of a Smartphone App During Radiotherapy for Prostate Cancer: Qualitative Study


    Background: Patients with prostate cancer are often cared for as outpatients during radiotherapy, which can be an aggravating circumstance for patient participation. There is a need to evaluate whether an interactive smartphone app could enable participation in care, specifically during treatment for prostate cancer. The interactive app (Interaktor) used in this study is developed in codesign with patients and health care professionals; it includes daily reports of symptoms, a risk assessment model, evidence-based self-care advice, along with the provision of immediate access to clinicians. Objective: The aim of this study was to explore how patients with prostate cancer perceived their participation with or without the support of the smartphone app during radiotherapy. Methods: A total of 28 prostate cancer patients receiving adjuvant radiotherapy were interviewed about their perceived participation in their own care. All the patients interviewed in this study participated in an intervention study where the control group received standard care that comprised having access to a contact nurse to turn to with any concerns during their treatment. In addition to standard care, the patients in the intervention group received the app downloaded in a smartphone. The patients’ age ranged between 57 and 77 years; 17 patients used the smartphone app. The interviews were analyzed with directed qualitative content analysis. Results: The four dimensions of patient participation, which include mutual participation, fight for participation, requirement for participation, and participation in getting basic needs satisfied, were confirmed as valid perspectives in the interviews with the patients with prostate cancer, irrespective of whether they used the smartphone app. However, the patients who had used the smartphone app described it as a facilitating factor, especially for mutual participation. Conclusions: Using innovative ways to communicate with patients, such as an interactive app for symptom management with contact with health care in real time, can successfully help achieve increased patient participation in care.

  • Source: The Authors; Copyright: PulseOn Oy; URL:; License: Fair use/fair dealings.

    Estimating Heart Rate, Energy Expenditure, and Physical Performance With a Wrist Photoplethysmographic Device During Running


    Background: Wearable sensors enable long-term monitoring of health and wellbeing indicators. An objective evaluation of sensors’ accuracy is important, especially for their use in health care. Objective: The aim of this study was to use a wrist-worn optical heart rate (OHR) device to estimate heart rate (HR), energy expenditure (EE), and maximal oxygen intake capacity (VO2Max) during running and to evaluate the accuracy of the estimated parameters (HR, EE, and VO2Max) against golden reference methods. Methods: A total of 24 healthy volunteers, of whom 11 were female, with a mean age of 36.2 years (SD 8.2 years) participated in a submaximal self-paced outdoor running test and maximal voluntary exercise test in a sports laboratory. OHR was monitored with a PulseOn wrist-worn photoplethysmographic device and the running speed with a phone GPS sensor. A physiological model based on HR, running speed, and personal characteristics (age, gender, weight, and height) was used to estimate EE during the maximal voluntary exercise test and VO2Max during the submaximal outdoor running test. ECG-based HR and respiratory gas analysis based estimates were used as golden references. Results: OHR was able to measure HR during running with a 1.9% mean absolute percentage error (MAPE). VO2Max estimated during the submaximal outdoor running test was closely similar to the sports laboratory estimate (MAPE 5.2%). The energy expenditure estimate (n=23) was quite accurate when HR was above the aerobic threshold (MAPE 6.7%), but MAPE increased to 16.5% during a lighter intensity of exercise. Conclusions: The results suggest that wrist-worn OHR may accurately estimate HR during running up to maximal HR. When combined with physiological modeling, wrist-worn OHR may be used for an estimation of EE, especially during higher intensity running, and VO2Max, even during submaximal self-paced outdoor recreational running.

  • The Fitbit Charge HR devices used in the study. Source: Image created by the authors; Copyright: The authors; License: Creative Commons Attribution + Noncommercial + NoDerivatives (CC-BY-NC-ND).

    Exploring the Association Between Self-Reported Asthma Impact and Fitbit-Derived Sleep Quality and Physical Activity Measures in Adolescents


    Background: Smart wearables such as the Fitbit wristband provide the opportunity to monitor patients more comprehensively, to track patients in a fashion that more closely follows the contours of their lives, and to derive a more complete dataset that enables precision medicine. However, the utility and efficacy of using wearable devices to monitor adolescent patients’ asthma outcomes have not been established. Objective: The objective of this study was to explore the association between self‑reported sleep data, Fitbit sleep and physical activity data, and pediatric asthma impact (PAI). Methods: We conducted an 8‑week pilot study with 22 adolescent asthma patients to collect: (1) weekly or biweekly patient‑reported data using the Patient-Reported Outcomes Measurement Information System (PROMIS) measures of PAI, sleep disturbance (SD), and sleep‑related impairment (SRI) and (2) real-time Fitbit (ie, Fitbit Charge HR) data on physical activity (F-AM) and sleep quality (F‑SQ). To explore the relationship among the self-reported and Fitbit measures, we computed weekly Pearson correlations among these variables of interest. Results: We have shown that the Fitbit-derived sleep quality F-SQ measure has a moderate correlation with the PROMIS SD score (average r=−.31, P=.01) and a weak but significant correlation with the PROMIS PAI score (average r=−.18, P=.02). The Fitbit physical activity measure has a negligible correlation with PAI (average r=.04, P=.62). Conclusions: Our findings support the potential of using wrist-worn devices to continuously monitor two important factors—physical activity and sleep—associated with patients’ asthma outcomes and to develop a personalized asthma management platform.

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

    Development and Testing of an Intelligent Pain Management System (IPMS) on Mobile Phones Through a Randomized Trial Among Chinese Cancer Patients: A New...


    Background: Cancer has become increasingly prevalent in China over the past few decades. Among the factors that determine the quality of life of cancer patients, pain has commonly been recognized as a most critical one; it could also lead to the ineffective treatment of the cancer. Driven by the need for better pain management for cancer patients, our research team developed a mobile-based Intelligent Pain Management System (IPMS). Objective: Our objective was to design, develop, and test the IPMS to facilitate real-time pain recording and timely intervention among cancer patients with pain. The system’s usability, feasibility, compliance, and satisfaction were also assessed. Methods: A sample of 46 patients with cancer pain symptoms were recruited at the Oncology Center of Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Chongming Branch (hereinafter referred to as “the Oncology Center”). In a pretest, participants completed a pain management knowledge questionnaire and were evaluated using the baseline cancer pain assessment and Karnofsky Performance Status (KPS) evaluation. The participants were then randomly assigned into two groups (the trial group and the control group). After a 14-day trial period, another round of cancer pain assessment, KPS evaluation and pain management knowledge assessment were repeated. In the trial group, the data were fully automatically collected by the IPMS. In the control group, the data were collected using conventional methods, such as phone interviews or door-to-door visits by physicians. The participants were also asked to complete a satisfaction questionnaire on the use of the IPMS. Results: All participants successfully completed the trial. First, the feasibility of IPMS by observing the number of daily pain assessments recorded among patients was assessed. Second, the users’ satisfaction, effectiveness of pain management, and changes in the quality of their lives were evaluated. All the participants gave high satisfaction score after they used IMPS. Both groups reported similar pain scores and KPS scores at the baseline. At the end of the trial, the mean pain score of the trial group was significantly lower than of the control group (P<.001). The ending KPS score of the trial group was significantly higher than of the control group (P<.001). The improvement of pain management knowledge score in the trial group was more pronounced than that in the control group (P<.001). Conclusions: This study provided preliminary data to support the potentials of using IPMS in cancer pain communication between patients and doctors and to provide real-time supportive intervention on a convenient basis at a low cost. Overall, the IPMS can serve as a reliable and effective approach to control cancer pain and improve quality of life for patients with cancer pain. Trial Registration: NCT02765269; (Archived by WebCite at

  • Young man with prototype of goal-setting module for iMHere (montage). Source: The Authors /; Copyright: JMIR Publications; URL:; License: Creative Commons Attribution (CC-BY).

    Design of Mobile Health Tools to Promote Goal Achievement in Self-Management Tasks


    Background: Goal-setting within rehabilitation is a common practice ultimately geared toward helping patients make functional progress. Objective: The purposes of this study were to (1) qualitatively analyze data from a wellness program for patients with spina bifida (SB) and spinal cord injury (SCI) in order to generate software requirements for a goal-setting module to support their complex goal-setting routines, (2) design a prototype of a goal-setting module within an existing mobile health (mHealth) system, and (3) identify what educational content might be necessary to integrate into the system. Methods: A total of 750 goals were analyzed from patients with SB and SCI enrolled in a wellness program. These goals were qualitatively analyzed in order to operationalize a set of software requirements for an mHealth goal-setting module and identify important educational content. Results: Those of male sex (P=.02) and with SCI diagnosis (P<.001) were more likely to achieve goals than females or those with SB. Temporality (P<.001) and type (P<.001) of goal were associated with likelihood that the goal would be achieved. Nearly all (210/213; 98.6%) of the fact-finding goals were achieved. There was no significant difference in achievement based on goal theme. Checklists, data tracking, and fact-finding tools were identified as three functionalities that could support goal-setting and achievement in an mHealth system. Based on the qualitative analysis, a list of software requirements for a goal-setting module was generated, and a prototype was developed. Targets for educational content were also generated. Conclusions: Innovative mHealth tools can be developed to support commonly set goals by individuals with disabilities.

  • Source:; Copyright: patrisyu; URL:; License: Licensed by the authors.

    Improving Adherence to Web-Based and Mobile Technologies for People With Psychosis: Systematic Review of New Potential Predictors of Adherence


    Background: Despite the boom in new technologically based interventions for people with psychosis, recent studies suggest medium to low rates of adherence to these types of interventions. The benefits will be limited if only a minority of service users adhere and engage; if specific predictors of adherence can be identified then technologies can be adapted to increase the service user benefits. Objective: The study aimed to present a systematic review of rates of adherence, dropout, and approaches to analyzing adherence to newly developed mobile and Web-based interventions for people with psychosis. Specific predictors of adherence were also explored. Methods: Using keywords (Internet or online or Web-based or website or mobile) AND (bipolar disorder or manic depression or manic depressive illness or manic-depressive psychosis or psychosis or schizophr* or psychotic), the following databases were searched: OVID including MedLine, EMBASE and PsychInfo, Pubmed and Web of Science. The objectives and inclusion criteria for suitable studies were defined following PICOS (population: people with psychosis; intervention: mobile or Internet-based technology; comparison group: no comparison group specified; outcomes: measures of adherence; study design: randomized controlled trials (RCT), feasibility studies, and observational studies) criteria. In addition to measurement and analysis of adherence, two theoretically proposed predictors of adherence were examined: (1) level of support from a clinician or researcher throughout the study, and (2) level of service user involvement in the app or intervention development. We provide a narrative synthesis of the findings and followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines for reporting systematic reviews. Results: Of the 20 studies that reported a measure of adherence and a rate of dropout, 5 of these conducted statistical analyses to determine predictors of dropout, 6 analyzed the effects of specific adherence predictors (eg, symptom severity or type of technological interface) on the effects of the intervention, 4 administered poststudy feedback questionnaires to assess continued use of the intervention, and 2 studies evaluated the effects of different types of interventions on adherence. Overall, the percentage of participants adhering to interventions ranged from 28-100% with a mean of 83%. Adherence was greater in studies with higher levels of social support and service user involvement in the development of the intervention. Studies of shorter duration also had higher rates of adherence. Conclusions: Adherence to mobile and Web-based interventions was robust across most studies. Although 2 studies found specific predictors of nonadherence (male gender and younger age), most did not specifically analyze predictors. The duration of the study may be an important predictor of adherence. Future studies should consider reporting a universal measure of adherence and aim to conduct complex analyses on predictors of adherence such as level of social presence and service user involvement.

  • Woman using Health Buddies App (montage). Source: The Authors /; Copyright: JMIR Publications; URL:; License: Creative Commons Attribution (CC-BY).

    The Health Buddies App as a Novel Tool to Improve Adherence and Knowledge in Atrial Fibrillation Patients: A Pilot Study


    Background: Atrial fibrillation (AF) constitutes an important risk for stroke, especially in an ageing population. A new app (Health Buddies) was developed as a tool to improve adherence to non-vitamin K antagonist oral anticoagulants (NOACs) in an elderly AF population by providing a virtual contract with their grandchildren, spelling out daily challenges for both. Objective: The aim of this pilot study was to assess the feasibility and usability of the Health Buddies app in AF patients. Methods: Two workshops were conducted to steer app development and to test a first prototype. The feasibility of the finalized app was investigated by assessing the number of eligible AF patients (based on current prescription of NOACs, the presence of grandchildren between 5 and 15 years old, availability of a mobile phone, computer, or tablet), and the proportion of those who were willing to participate. Participants had to use the app for 3 months. The motivation of the patients to use the app was assessed based on the number of logins to the app. Their perception of its usefulness was examined by specific questionnaires. Additionally, the effects on knowledge level about AF and its treatment, and adherence to NOAC intake were investigated. Results: Out of 830 screened AF patients, 410 were taking NOACs and 114 were eligible for inclusion. However, only 3.7% (15/410) of the total NOAC population or 13.2% of the eligible patients (15/114) were willing to participate. The main reasons for not participating were no interest to participate in general or in the concept in particular (29/99, 29%), not feeling comfortable using technology (22/99, 22%), no interest by the grandchildren or their parents (20/99, 20%), or too busy a lifestyle (12/99, 12%). App use significantly decreased towards the end of the study period in both patients (P=.009) and grandchildren (P<.001). NOAC adherence showed a taking adherence and regimen adherence of 88.6% (SD 15.4) and 81.8% (SD 18.7), respectively. Knowledge level increased from 64.6% (SD 14.7) to 70.4% (SD 10.4) after 3 months (P=.09). The app scored positively on clarity, novelty, stimulation, and attractiveness as measured with the user experience questionnaire. Patients evaluated the educational aspect of this app as a capital gain. Conclusions: Only a small proportion of the current AF population seems eligible for the innovative Health Buddies app in its current form. Although the app was positively rated by its users, a large subset of patients was not willing to participate in this study or to use the app. Efforts have to be made to expand the target group in the future.

  • Using data mining techniques to analyze patterns of usage in Manage My Pain. Source: Image created by the authors; Copyright: The authors; URL:; License: Creative Commons Attribution (CC-BY).

    Patterns of User Engagement With the Mobile App, Manage My Pain: Results of a Data Mining Investigation


    Background: Pain is one of the most prevalent health-related concerns and is among the top 3 most common reasons for seeking medical help. Scientific publications of data collected from pain tracking and monitoring apps are important to help consumers and healthcare professionals select the right app for their use. Objective: The main objectives of this paper were to (1) discover user engagement patterns of the pain management app, Manage My Pain, using data mining methods; and (2) identify the association between several attributes characterizing individual users and their levels of engagement. Methods: User engagement was defined by 2 key features of the app: longevity (number of days between the first and last pain record) and number of records. Users were divided into 5 user engagement clusters employing the k-means clustering algorithm. Each cluster was characterized by 6 attributes: gender, age, number of pain conditions, number of medications, pain severity, and opioid use. Z tests and chi-square tests were used for analyzing categorical attributes. Effects of gender and cluster on numerical attributes were analyzed using 2-way analysis of variances (ANOVAs) followed up by pairwise comparisons using Tukey honest significant difference (HSD). Results: The clustering process produced 5 clusters representing different levels of user engagement. The proportion of males and females was significantly different in 4 of the 5 clusters (all P ≤.03). The proportion of males was higher than females in users with relatively high longevity. Mean ages of users in 2 clusters with high longevity were higher than users from other 3 clusters (all P <.001). Overall, males were significantly older than females (P <.001). Across clusters, females reported more pain conditions than males (all P <.001). Users from highly engaged clusters reported taking more medication than less engaged users (all P <.001). Females reported taking a greater number of medications than males (P =.04). In 4 of 5 clusters, the percentage of males taking an opioid was significantly greater (all P ≤.05) than that of females. The proportion of males with mild pain was significantly higher than that of females in 3 clusters (all P ≤.008). Conclusions: Although most users of the app reported being female, male users were more likely to be highly engaged in the app. Users in the most engaged clusters self-reported a higher number of pain conditions, a higher number of current medications, and a higher incidence of opioid usage. The high engagement by males in these clusters does not appear to be driven by pain severity which may, in part, be the case for females. Use of a mobile pain app may be relatively more attractive to highly-engaged males than highly-engaged females, and to those with relatively more complex chronic pain problems.

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  • Mobile health approaches in the management of skin cancer: Lessons from integrative mapping of evidence-based research

    Date Submitted: Jul 26, 2017

    Open Peer Review Period: Jul 26, 2017 - Sep 20, 2017

    Background: mHealth, which encompasses mobile health technologies and interventions, is rapidly evolving in various medical specialties, and its impact is evident in oncology. Mobile technologies are...

    Background: mHealth, which encompasses mobile health technologies and interventions, is rapidly evolving in various medical specialties, and its impact is evident in oncology. Mobile technologies are perceived as effective in prevention and as feasible for managing skin cancer, but the diagnostic accuracy of these tools remains in doubt. These drawbacks in the application of mHealth to teledermatology call for intensified research to strengthen its role in dermatology. Objective: The purpose of this review was to describe current trends in research addressing the integration of mHealth into the management of skin cancer by examining evaluations of mHealth and its contributions across the cancer care continuum. Methods: A systematic review framework was applied to the search using the three electronic databases, PubMed, Web of Science, and Embase. We extensively reviewed appropriate studies regarding skin cancer and mobile technology published between 2000 and present. Studies were included if they discussed the role and impact of mobile technology in the management and evaluation of skin cancer. 33 studies were selected for analysis adhering to inclusion and exclusion criteria. Results: Of the 33 studies, 15 studies (45%) assessed the diagnostic accuracy of mobile technology in detecting skin cancer and ten studies (30%) examined the feasibility and acceptability of mobile technology. The remaining studies (24%) concerned skin cancer prevention, early diagnosis, reduced treatment, and follow-up care through mHealth interventions. Not all phases of skin cancer involve mHealth, and not all have been addressed by research. While the focus of current research was skewed toward prevention and diagnosis phases, the treatment and follow-up phases were the least addressed in the literature. Conclusions: The present review extends knowledge not only on the contributions but also on the integration of mHealth technologies in different phases of skin cancer care. To optimize the effectiveness of mHealth in dermatology, larger numbers of robust, evidence-based studies on teledermatology implementations, evenly distributed across the care continuum, should be conducted so that research can be expanded to systematic reviews.

  • Text-Message Self-Regulation Support to Reduce Alcohol Consumption among Non-Treatment-Seeking Young Adults

    Date Submitted: Jul 22, 2017

    Open Peer Review Period: Jul 24, 2017 - Sep 18, 2017

    Background: Stand-alone text message-based interventions can reduce heavy drinking episodes among non-treatment seeking young adults, but may not be optimized. Self-regulation support could enhance ef...

    Background: Stand-alone text message-based interventions can reduce heavy drinking episodes among non-treatment seeking young adults, but may not be optimized. Self-regulation support could enhance effectiveness by assisting goal setting and striving, but it remains unknown how to best integrate into text-message interventions. Objective: To evaluate engagement with a text message intervention (TRAC2) focused on reducing weekend alcohol consumption incorporating drinking-limit goal-commitment ecological momentary assessments (EMA) tailored to past 2-week alcohol consumption, intra-weekend goal reminders, self-efficacy EMA with support tailored to goal confidence, and max weekend alcohol consumption EMA with drinking limit goal feedback. Methods: We enrolled 38 non-treatment seeking young adults who screened positive for hazardous drinking in an urban emergency department. Following a 2-week text message assessment-only run-in, participants were given the opportunity to enroll in 4-week intervention blocks. We examined patterns of EMA responses and voluntary re-enrollment. We then examined how goal commitment and goal self-efficacy related to event-level alcohol consumption. Finally, we examined the association of length of TRAC2 exposure with alcohol-related outcomes from baseline to 3-months follow-up. Results: Among a diverse sample of young adults (56% female, 54% black race, 32% college enrolled), response rates to EMA queries were, on average, 82.3% for the first 4-week intervention block, 75.3% for the second 4-week block, and 72.8% for the third 4-week block. There were high rates of event-level drinking limit goal commitment (94%) and goal success (89%). The percentage of subjects being prompted to commit to a drinking limit goal above the binge threshold was 51.7% on week 1 and decreased to 0% by week 4. Low situational confidence was associated with lower goal success. There were reductions in alcohol consumption from baseline to 3-months but reductions were not different by length of intervention exposure. Conclusions: Preliminary evidence suggests that non-treatment seeking young adults will engage with a text message intervention incorporating self-regulation support features, resulting in high rates of weekend drinking limit goal commitment and goal success. Clinical Trial: n/a

  • The Effect of Using Mobile Phone on Medical Students’ Mental Focus in Respond to Knowledge Questions

    Date Submitted: Jul 18, 2017

    Open Peer Review Period: Jul 18, 2017 - Sep 12, 2017

    Background: BACKGROUND: Today, using the mobile phone has grown widely. This massive growth captures the attention of researchers on biological effects of mobile phone. Evidences have shown that exces...

    Background: BACKGROUND: Today, using the mobile phone has grown widely. This massive growth captures the attention of researchers on biological effects of mobile phone. Evidences have shown that excessive use of mobile phone has negative impact on physical and psychological health of mobile phone users. Objective: Aims: to evaluate the effect of using mobile phones on the students’ mental focus when they answer to general scientific questions, simultaneously in Ahvaz, Iran. Methods: METHOD: In this analytical study, a group of 60 students in the field of Health Information Technology (HIT) were participated. Participants were evaluated in order to verify the same level of information homogeneity and the ability of using a mobile phone. Therefore, the students were asked at the first step to respond to general information questions showed in computer monitor. Then, a message including 6-9 words by mobile phone was typed by the subjects while the typing time was registered. Next, they were asked to send a message while answering the questions showed on the monitor screen of the computers, simultaneously. Next, the difference between response accuracy to questions of graphical test in two phases was analyzed. Results: RESULTS: The results showed that the average scores of correct response to graphic test, as typing a text on the mobile phone, was (26.8000) and the average scores of correct respond to graphics test without typing a text on mobile phone was (30.2000). Moreover, the average scores when typing a text on mobile phone was (74.40) while the average scores for typing a text on mobile phone and responding to graphics test, simultaneously was (194.12). Conclusions: Conclusion: The results showed that using the mobile phone has a negative impact on the selected students’ performance to respond simultaneously to the general scientific questions.

  • Proposed Taxonomy of Telemedicine

    Date Submitted: Jul 15, 2017

    Open Peer Review Period: Jul 16, 2017 - Sep 10, 2017

    Background: In the past 20 years, the use of telemedicine has increased, with telemedicine programs being conducted through the Internet and ISDN technologies. Objective: To validate a proposed taxono...

    Background: In the past 20 years, the use of telemedicine has increased, with telemedicine programs being conducted through the Internet and ISDN technologies. Objective: To validate a proposed taxonomy using keywords from a random sample Methods: I used three facets to search the Scopus database for telemedicine and drew a random sample from the results. I analyzed author and index keywords from the 327 random sample articles, along with taking into account the long literature review I conducted for my dissertation Toward a Discourse Community for Telemedicine: A Domain Analytic View of Published Scholarship to create my own taxonomy of telemedicine and to validate the three taxonomies of Tulu, Chatterjee and Maheshwari (2007), Bashshur, Shannon, Krupinski, Grigsby (2011), and Nepal, Li, Jang-Jaccard, and Alem (2014). Results: Results: The keywords collected from the random sample fit into the Proposed Taxonomy categories and so validated the Proposed Taxonomy. Conclusions: As is evident from the ontology rendered from the keywords found in the author and index keywords, telemedicine touches on several areas. Central to telemedicine are diagnosis and treatment of disease, including specific disease and specific telemedicine used.

  • Creating a Predictive Model for employee turnover utilizing behavioral risk factors extracted from an employer-based Happiness app

    Date Submitted: Jul 13, 2017

    Open Peer Review Period: Jul 14, 2017 - Sep 8, 2017

    Background: In the past, significant research has been directed towards predicting churn of customers, particularly in the telecoms industry. However, few works have addressed the equally important qu...

    Background: In the past, significant research has been directed towards predicting churn of customers, particularly in the telecoms industry. However, few works have addressed the equally important question of employee turnover in companies and none have been able to create a predictive model to manage retention Objective: To identify turnover risk factors of employees. Methods: Using a smartphone Happiness application that tracks Happiness, we applied search-engine like classification methods (such as Google page ranking algorithm) to rank employees by risk of turnover. We set a risk cut-off to cluster employees in two groups: the ones that turn over and the ones that stay in the company. Then we used the top discriminant traits of each group to identify risk factors. The data source is the employee interaction with a mobile app that is used to track happiness. Sample size: 4k employees. Time length: 2 years. Participating companies: 34. Results: We developed a turnover prediction model that identifies employees that turnover with Sensitivity 34% and Specificity 99.4%. Predictive value of the positive test is 80%. Predictive value of the negative test= 96%. Test set contained 116 churns, test set sample size 1944 employees. Risk factors related to app usage are identified. Conclusions: The top three risk factors related to employee churn are low number of likes received in the anonymous company forum (low employee comment likeability), infrequent company posts (disengaged company), lower happiness than the company average (low relative happiness). Other factors such as absolute individual happiness, or likes given to other's anonymous post (positivity and engagement of the employee) was not found to be correlated with turnover. Clinical Trial: Does not apply

  • Identifying Asbestos-Containing Materials in Homes: Design and Development of the ACM Check Mobile Phone App

    Date Submitted: Jul 12, 2017

    Open Peer Review Period: Jul 13, 2017 - Sep 7, 2017

    Background: Asbestos-containing materials (ACM) can still be found in many homes in Australia and other countries. ACMs present a health risk when they are damaged or disturbed, such as during do-it-y...

    Background: Asbestos-containing materials (ACM) can still be found in many homes in Australia and other countries. ACMs present a health risk when they are damaged or disturbed, such as during do-it-yourself home renovations. However, there remains a lack of knowledge and awareness amongst community members about asbestos identification and its safe management in residential settings. Objective: To describe the process of developing a mobile phone application (“app”), ACM Check, that incorporates a questionnaire designed to identify and assess asbestos-containing materials located in residential settings. Methods: A multidisciplinary team was involved in the formative development and creation of the mobile phone app. The formative development process included 6 steps: defining the scope of the app; comprehensive desktop review; drafting and revising the content, questionnaire, conditional branching rules and scoring algorithms; expert input; manual pre-testing of the questionnaire; and formulation of a final content document to be provided to the software development company. ACM Check was then constructed on the iOS platform for use in a validation study prior to being updated, replicated on Android, and released to the public. Results: The ACM Check app identifies potential ACMs, prioritises the materials based on their condition and likelihood of disturbance, and generates a summary report for each house assessed. Conclusions: ACM Check is an initiative to raise community members’ awareness of asbestos in the residential environment and also serves as a data collection tool for epidemiological research. It can potentially be modified for implementation in other countries or used as the basis for the assessment of other occupational or environmental hazards.