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Journal Description

JMIR mHealth and uHealth (JMU, ISSN 2291-5222) is a sister journal of JMIR, the leading eHealth journal. JMIR mHealth and uHealth is indexed in PubMed, PubMed Central, Scopus, and Science Citation Index Expanded (SCIE), and in June 2018 received an Impact Factor of 4.541, which ranks the journal #2 (behind JMIR) out of 25 journals in the medical informatics category indexed by the Science Citation Index Expanded (SCIE) by Thomson Reuters/Clarivate

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

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

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

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

 

Recent Articles:

  • A surgeon examining a patient's eye fundus, to assess the height of gas/fluid interface. Source: Image created by the Authors; Copyright: Zhaotian Zhang; URL: https://mhealth.jmir.org/2019/6/14592; License: Creative Commons Attribution (CC-BY).

    Development and Testing of a Mobile Phone App for Risk Estimation of Gas Volume Expansion and Intraocular Pressure Elevation in Patients With Intravitreous...

    Abstract:

    Background: Pars plana vitrectomy (PPV) with intravitreous tamponade of gas or air has been widely used for a series of vitreoretinal diseases. It is estimated that 100,000 patients per year undergo PPV globally, and half of them were subsequently tamponaded with gas or air. According to Boyle’s law (P1V1=P2V2), patients with an intravitreous remnant of gas or air will be under high risk of intraocular pressure (IOP) elevation and subsequent vision loss owing to the expanded intravitreous gas or air when traveling post operation to a place with a significantly higher altitude. We always explain to patients why postoperative travel is potentially risky. Emergency cases of elevated IOP caused by postoperative traveling would sometimes come to surgeons. However, there have been few disease education or reference tools for both the surgeons and patients to have better communication. Objective: The aim of this study was to introduce and evaluate a mobile phone app developed by surgeons (the authors) for preliminary risk estimation of volume expansion and IOP elevation in patients with intravitreous gas or air when traveling to a place of higher altitude. Methods: The app was developed on the iOS and Android operating systems. Boyle’s law (P1V1=P2V2) was the theoretical basis of the app. Intravitreous gas or air volume and altitude values were independent factors to deduce the risk report. Consecutive patients underwent vitrectomy, and those with an intravitreous remnant of gas or air were recruited. The surgeons judged the vertical height of the fluid/gas interface through the dilated pupil; the patients were instructed to judge it according to their visual field when looking straight ahead and line it out on a chart included in the app. Finally, all the patients were required to fill a Likert scale–based questionnaire with 2 main items to evaluate the participants’ user experience and attitudes toward the app. Results: A total of 50 patients were included (30 males and 20 females). All patients could independently operate the app to complete the test. The median heights of the fluid/gas interface independently judged by the surgeon and patients were 40% (range: 10%-75%) and 41% (range: 9%-78%), respectively (P=.63). The median altitude of the participants’ destinations was 150.0 m (range: 0-3490 m). The Bland-Altman analysis revealed a good agreement between the surgeons’ and patients’ judgments (bias of −0.3%), with 95% limits of agreement of −5.8% to 5.3%. Overall, the Likert scale revealed a positive attitude from the patients toward the app. Conclusions: The app is reliable for patients to have preliminary risk estimation of intravitreous gas or air volume expansion and IOP elevation if travel to a place of higher altitude is planned. The surgeons could also use it as a platform for better disease communication.

  • The Calm app (montage). Source: The Authors / iStock by Getty Images; Copyright: The Authors; URL: https://www.istockphoto.com/ca/photo/woman-hand-holding-mobile-phone-with-chroma-green-gm945398192-258217076; License: Licensed by the authors.

    Efficacy of the Mindfulness Meditation Mobile App “Calm” to Reduce Stress Among College Students: Randomized Controlled Trial

    Abstract:

    Background: College students experience high levels of stress. Mindfulness meditation delivered via a mobile app may be an appealing, efficacious way to reduce stress in college students. Objective: We aimed to test the initial efficacy and sustained effects of an 8-week mindfulness meditation mobile app—Calm—compared to a wait-list control on stress, mindfulness, and self-compassion in college students with elevated stress. We also explored the intervention’s effect on health behaviors (ie, sleep disturbance, alcohol consumption [binge drinking], physical activity, and healthy eating [fruit and vegetable consumption]) and the feasibility and acceptability of the app. Methods: This study was a randomized, wait-list, control trial with assessments at baseline, postintervention (8 weeks), and at follow-up (12 weeks). Participants were eligible if they were current full-time undergraduate students and (1) at least 18 years of age, (2) scored ≥14 points on the Perceived Stress Scale, (3) owned a smartphone, (4) were willing to download the Calm app, (5) were willing to be randomized, and (7) were able to read and understand English. Participants were asked to meditate using Calm at least 10 minutes per day. A P value ≤.05 was considered statistically significant. Results: A total of 88 participants were included in the analysis. The mean age (SD) was 20.41 (2.31) years for the intervention group and 21.85 (6.3) years for the control group. There were significant differences in all outcomes (stress, mindfulness, and self-compassion) between the intervention and control groups after adjustment for covariates postintervention (all P<.04). These effects persisted at follow-up (all P<.03), except for the nonreacting subscale of mindfulness (P=.08). There was a significant interaction between group and time factors in perceived stress (P=.002), mindfulness (P<.001), and self-compassion (P<.001). Bonferroni posthoc tests showed significant within-group mean differences for perceived stress in the intervention group (P<.001), while there were no significant within-group mean differences in the control group (all P>.19). Similar results were found for mindfulness and self-compassion. Effect sizes ranged from moderate (0.59) to large (1.24) across all outcomes. A significant group×time interaction in models of sleep disturbance was found, but no significant effects were found for other health behaviors. The majority of students in the intervention group reported that Calm was helpful to reduce stress and stated they would use Calm in the future. The majority were satisfied using Calm and likely to recommend it to other college students. The intervention group participated in meditation for an average of 38 minutes/week during the intervention and 20 minutes/week during follow-up. Conclusions: Calm is an effective modality to deliver mindfulness meditation in order to reduce stress and improve mindfulness and self-compassion in stressed college students. Our findings provide important information that can be applied to the design of future studies or mental health resources in university programs. Trial Registration: ClinicalTrials.gov NCT03891810; https://clinicaltrials.gov/ct2/show/NCT03891810

  • BENECA mHealth. Source: Image created by the Authors; Copyright: The Authors; URL: http://mhealth.jmir.org/2019/6/e14136/; License: Creative Commons Attribution (CC-BY).

    A Mobile System to Improve Quality of Life Via Energy Balance in Breast Cancer Survivors (BENECA mHealth): Prospective Test-Retest Quasiexperimental...

    Abstract:

    Background: Energy balance is defined as the difference between energy expenditure and energy intake. The current state of knowledge supports the need to better integrate mechanistic approaches through effective studies of energy balance in the cancer population because of an observed significant lack of adherence to healthy lifestyle recommendations. To stimulate changes in breast cancer survivors’ lifestyles based on energy balance, our group developed the BENECA (Energy Balance on Cancer) mHealth app. BENECA has been previously validated as a reliable energy balance monitoring system. Objective: Based on our previous results, the goal of this study was to investigate the feasibility of BENECA mHealth in an ecological clinical setting with breast cancer survivors, by studying (1) its feasibility and (2) pretest-posttest differences with regard to breast cancer survivor lifestyles, quality of life (QoL), and physical activity (PA) motivation. Methods: Eighty breast cancer survivors diagnosed with stage I to IIIA and with a body mass index over 25 kg/m2 were enrolled in this prospective test-retest quasi-experimental study. Patients used BENECA mHealth for 8 weeks and were assessed at baseline and the postintervention period. Feasibility main outcomes included percentage of adoption, usage, and attrition; user app quality perception measured with the Mobile App Rating Scale (MARS); satisfaction with the Net Promoter Score (NPS); and barriers and facilitators of its use. Clinical main outcomes included measuring QoL with the European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30 (EORT QLQ-C30), PA assessment with accelerometry, PA motivation measure with a Spanish self-efficacy scale for physical activity (EAF), and body composition with dual-energy x-ray absorptiometry. Statistical tests (using paired-sample t tests) and Kaplan-Meier survival curves were analyzed. Results: BENECA was considered feasible by the breast cancer survivors in terms of use (76%, 58/76), adoption (69%, 80/116), and satisfaction (positive NPS). The app quality score did not make it one of the best-rated apps (mean 3.71, SD 0.47 points out of 5). BENECA mHealth improved the QoL of participants (global health mean difference [MD] 12.83, 95% CI 8.95-16.71, P<.001), and EAF score (global MD 36.99, 95% CI 25.52-48.46, P<.001), daily moderate-to-vigorous PA (MD 7.38, 95% CI 0.39-14.37, P=.04), and reduced body weight (MD −1.42, 95% CI −1.97 to −0.87, P<.001). Conclusions: BENECA mHealth can be considered feasible in a real clinical context to promote behavioral changes in the lifestyles of breast cancer survivors, but it needs to be enhanced to improve user satisfaction with use and functionality. This study highlights the importance of the use of mobile apps based on energy balance and how the QoL of breast cancer survivors can be improved via monitoring.

  • Source: Freepik; Copyright: nensuria; URL: https://www.freepik.com/free-photo/lady-addict-white-breaks-lovely_1108610.htm; License: Licensed by JMIR.

    Mindfulness-Based Smoking Cessation Enhanced With Mobile Technology (iQuit Mindfully): Pilot Randomized Controlled Trial

    Abstract:

    Background: Mindfulness training shows promise for improving smoking cessation and lapse recovery, and between-session mobile health messages could enhance treatment engagement and effectiveness. Personalized, in-the-moment text messaging support could be particularly useful for low-income smokers with fewer smoking cessation resources. Objective: This pilot study examined the feasibility of a text messaging program (iQuit Mindfully) as an adjunct to in-person Mindfulness-Based Addiction Treatment (MBAT) for smoking cessation. Methods: A total of 71 participants were randomly assigned to MBAT (n=33) or iQuit Mindfully (n=38; MBAT + between-session text messages); of these, 70% (50/71) were African American, and 61% (43/71) had an annual household income of US $30,000 or less. All participants received 8 weekly therapist-led group counseling sessions, nicotine patches, and self-help materials. Outcomes were feasibility (attrition, engagement, and participants’ ratings), participants’ feedback regarding the text messaging intervention, and smoking cessation (assessed in person). Results: Strong retention was achieved (76% [54/71] at the end of treatment, and 89% [63/71] at 1-month follow-up). In the iQuit Mindfully group, engagement was high (88% [29/33] indicated reading all or most texts, and 89% [34/38] engaged in interactive texting), and participants provided positive ratings (on a 1-10 scale, average rating for recommending the program to others was 8.4 [SD 2.5]). Participants indicated benefiting from the texts (eg, appreciating encouraging reminders, coping strategies, and social support) and suggested improvements (eg, more personalization). Overall, biochemically confirmed smoking cessation rates were 22% (12/55) at the end of treatment and 19% (12/62) at 1-month follow-up, with no differences between conditions. Living below the poverty level predicted worse cessation outcomes at 1-month follow-up among participants receiving in-person only treatment (P=.03) but not among those receiving iQuit Mindfully. Conclusions: Text messaging appears to be a feasible and acceptable modality for supporting mindfulness-based smoking cessation treatment. The availability of 24/7 text messaging might be particularly helpful for low-income smokers who have access to fewer cessation resources and experience significant day-to-day barriers to quitting. Trial Registration: ClinicalTrials.gov NCT03029819; https://clinicaltrials.gov/ct2/show/NCT03029819

  • Source: Image created by the Authors; Copyright: The Authors; URL: http://mhealth.jmir.org/2019/6/e12190/; License: Creative Commons Attribution (CC-BY).

    Consumer Wearable Deployments in Actigraphy Research: Evaluation of an Observational Study

    Abstract:

    Background: Consumer wearables can provide a practical and accessible method of data collection in actigraphy research. However, as this area continues to grow, it is becoming increasingly important for researchers to be aware of the many challenges facing the capture of quality data using consumer wearables. Objective: This study aimed to (1) present the challenges encountered by a research team in actigraphy data collection using a consumer wearable and (2) present considerations for researchers to apply in the pursuit of robust data using this approach. Methods: The Nokia Go was deployed to 33 elite Gaelic footballers from a single team for a planned period of 14 weeks. A bring-your-own-device model was employed for this study where the Health Mate app was downloaded on participants’ personal mobile phones and connected to the Nokia Go via Bluetooth. Retrospective evaluation of the researcher and participant experience was conducted through transactional data such as study logs and email correspondence. The participant experience of the data collection process was further explored through the design of a 34-question survey utilizing aspects of the Technology Acceptance Model. Results: Researcher challenges included device disconnection, logistics and monitoring, and rectifying of technical issues. Participant challenges included device syncing, loss of the device, and wear issues, particularly during contact sport. Following disconnection issues, the data collection period was defined as 87 days for which there were 18 remaining participants. Average wear time was 79 out of 87 days (90%) and 20.8 hours per day. The participant survey found mainly positive results regarding device comfort, perceived ease of use, and perceived usefulness. Conclusions: Although this study did not encounter some of the common published barriers to wearable data collection, our experience was impacted by technical issues such as disconnection and syncing challenges, practical considerations such as loss of the device, issues with personal mobile phones in the bring-your-own-device model, and the logistics and resources required to ensure a smooth data collection with an active cohort. Recommendations for achieving high-quality data are made for readers to consider in the deployment of consumer wearables in research.

  • Source: Image created by the Authors; Copyright: The Authors; URL: http://mhealth.jmir.org/2019/6/e13987/; License: Creative Commons Attribution (CC-BY).

    Using the Extended Parallel Process Model to Examine the Nature and Impact of Breast Cancer Prevention Information on Mobile-Based Social Media: Content...

    Abstract:

    Background: With the rise of mobile technology, an increasing number of people use mobile-based social media to access health information. Many scholars have explored the nature of health information on social media; however, the impact of such information on people was understudied. Objective: This study aimed to examine the nature and impact of health information on mobile-based social media. Specifically, we investigated how the levels of threat and efficacy of breast cancer prevention information affect individuals’ engagement with the information, such as readings and likes. Methods: Breast cancer prevention articles posted on a Chinese mobile-based social media platform (ie, WeChat Subscription Account [WeChat SA]) from January 1 to December 31, 2017, were extracted using the Python Web Crawler. We used content analysis and analysis of covariance to analyze our data. Results: The results revealed that the vast majority of titles and main bodies of the articles involved one of the extended parallel process model components: threat or efficacy. Conclusions: Breast cancer prevention information on WeChat SA was well designed. Both threat and efficacy significantly affected the number of readings, whereas only efficacy had a significant effect on the number of likes. Moreover, breast cancer prevention information that contained both high levels of threat and efficacy gained the largest number of readings and likes.

  • Source: The Authors / Placeit; Copyright: JMIR Publications; URL: http://mhealth.jmir.org/2019/6/e12645/; License: Creative Commons Attribution (CC-BY).

    Mobile Health Management Platform–Based Pulmonary Rehabilitation for Patients With Non–Small Cell Lung Cancer: Prospective Clinical Trial

    Abstract:

    Background: Lung cancer patients experience various symptoms during treatment. Although pulmonary rehabilitation is an effective way to improve these symptoms, a medical environment of limited availability makes it difficult to provide seamless and adequate rehabilitation for lung cancer patients. Objective: This study aimed to investigate the effects of a personalized pulmonary rehabilitation program using real-time mobile patient health data for patients with non–small cell lung cancer. Methods: We conducted a prospective clinical trial in 64 patients with non–small cell lung cancer aged between 20 and 80 years at a large tertiary hospital in Seoul, South Korea. A 12-week personalized pulmonary rehabilitation program, called efil breath, was administered to determine the effectiveness of the newly developed rehabilitation app. Participants were randomly allocated to the fixed exercise or fixed-interactive exercise group (which received the personalized program). We measured changes in 6-minute walk distance (6MWD) and dyspnea (modified Medical Research Council [mMRC] score) at 6 weeks; and quality of life and service satisfaction at 12 weeks. We used the paired t test to analyze the variables. Results: Patients used the newly developed mobile health pulmonary rehabilitation app and a real-time patient monitoring website. In all participants, significant changes were observed in 6MWD at 12 weeks from a mean of 433.43m (SD 65.60) to 471.25m (SD 75.69; P=.001), and mMRC from a mean score of 0.94 (0.66) to 0.61 (SD 0.82; P=.02). The intervention significantly improved their quality of life (EuroQol-visual analog scale [EQ-VAS]) compared with baseline (mean score 76.05, SD 12.37 vs 82.09, SD 13.67, respectively; P=.002). Conclusions: A personalized mobile health–based pulmonary rehabilitation app for recording and monitoring real-time health data of patients with non–small cell lung cancer can supplement traditional health care center–based rehabilitation programs. This technology can encourage improvement of physical activity, dyspnea, and quality of life.

  • Source: The Authors / Placeit; Copyright: JMIR Publications; URL: http://mhealth.jmir.org/2019/6/e13964/; License: Creative Commons Attribution (CC-BY).

    Utilization of Hospital Room Hospitality Features on Patient-Controlled Tablet Computers: Cohort Study

    Abstract:

    Background: Patient portals tethered to electronic health records can improve patient experience, activation, and outcomes. However, adoption of inpatient portals has been challenging. One way to potentially increase inpatient portal usage is to integrate it with a room control (RC) app on a common tablet computer. Objective: The aim of this study was to perform a retrospective analysis of patient usage of an RC app provided on tablet computers in patient rooms of our new inpatient tower. Methods: We identified all patients who were admitted for >24 hours to our new inpatient tower over a 90-day period from September 1 to November 30, 2017. After excluding newborn patients from our analysis, we then identified patients who used the RC app at least one time during their admission. We linked these data to patient demographics (including age, sex, and race) and admitting service. We then performed univariable and multivariable logistic regression to assess patterns of RC app usage. Results: A total of 3411 patients were admitted over the course of the study period; 2242/3411 (65.73%) used the RC app during their hospitalization. Compared with white patients, other/mixed/unknown race and Asian, Hawaiian, Pacific Islander, American Indian race were significantly associated with increased use of the RC app in a multivariable analysis. Increasing age was significantly associated with increased usage of the RC app. Usage of the RC app also varied by admitting services. Compared with general medicine, bone marrow transplant and general surgery patients had increased usage of the RC app. Conversely, critical care, medical specialties, neurology, surgical subspecialties, and obstetrics/gynecology were all associated with decreased usage of the RC app. Conclusions: Our study shows that one-third of patients are not using the RC app for critical room functions. Future initiatives to increase RC usage should take these populations into consideration. Contrary to common belief, older patients may use tablet-enabled RCs just as often, if not more often, than younger patients. Certain admitting services, such as neurology and surgical subspecialties, may have had lower usage rates owing to accessibility issues. Our study allows hospitals to tailor support for specific patient populations to increase RC app usage.

  • Source: The Authors / Unsplash; Copyright: The Authors; URL: https://mhealth.jmir.org/2019/6/e13501; License: Creative Commons Attribution (CC-BY).

    An Electronic Teaching Module for Improving Knowledge of Self-Management of Vaso-Occlusive Pain Crises in Patients With Sickle Cell Disease: Pilot...

    Abstract:

    Background: For patients with sickle cell disease (SCD), effective management of vaso-occlusive crises (VOCs) is integral to provision of care, as nearly all affected individuals will suffer from VOCs in their lifetime. A recent systematic review of technological interventions to improve self-management in the care of SCD concluded that electronic health has the potential to improve the care of individuals with SCD. Objective: The aim of this study was to assess the value of an electronic teaching module (ETM) provided by Emmi Solutions for educating adult SCD patients on VOC self-management and treatment options for SCD. Methods: A pretest assessed adults with SCD for baseline knowledge with regard to self-management of VOCs. Participants then watched the 35-min ETM and completed a posttest and survey on the ETM. Results: A total of 20 adults enrolled. Their knowledge scores improved (pretest median 66.5% and posttest median 85%; P<.001). In total, 18 participants (18/20, 90%) agreed that they “learned a lot” or “learned something” from the ETM. The most common topic about which they reported learning was hydroxyurea. A total of 12 participants (12/20, 60%) agreed with the statement that they “would recommend the module to a friend or family member with sickle cell disease.” Conclusions: The ETM is associated with an increase in knowledge in patients with SCD. Limitations of the study include small sample size, no assessment of knowledge before premodule questionnaire completion, and no longitudinal follow-up. Identifying patients with SCD who demonstrate affinity for self-education via an ETM may further enhance utility of this tool to educate and empower patients.

  • Source: Image created by the Authors; Copyright: The Authors; URL: http://mhealth.jmir.org/2019/6/e13084/; License: Licensed by JMIR.

    Validity Evaluation of the Fitbit Charge2 and the Garmin vivosmart HR+ in Free-Living Environments in an Older Adult Cohort

    Abstract:

    Background: Few studies have investigated the validity of mainstream wrist-based activity trackers in healthy older adults in real life, as opposed to laboratory settings. Objective: This study explored the performance of two wrist-worn trackers (Fitbit Charge 2 and Garmin vivosmart HR+) in estimating steps, energy expenditure, moderate-to-vigorous physical activity (MVPA) levels, and sleep parameters (total sleep time [TST] and wake after sleep onset [WASO]) against gold-standard technologies in a cohort of healthy older adults in a free-living environment. Methods: Overall, 20 participants (>65 years) took part in the study. The devices were worn by the participants for 24 hours, and the results were compared against validated technology (ActiGraph and New-Lifestyles NL-2000i). Mean error, mean percentage error (MPE), mean absolute percentage error (MAPE), intraclass correlation (ICC), and Bland-Altman plots were computed for all the parameters considered. Results: For step counting, all trackers were highly correlated with one another (ICCs>0.89). Although the Fitbit tended to overcount steps (MPE=12.36%), the Garmin and ActiGraph undercounted (MPE 9.36% and 11.53%, respectively). The Garmin had poor ICC values when energy expenditure was compared against the criterion. The Fitbit had moderate-to-good ICCs in comparison to the other activity trackers, and showed the best results (MAPE=12.25%), although it underestimated calories burned. For MVPA levels estimation, the wristband trackers were highly correlated (ICC=0.96); however, they were moderately correlated against the criterion and they overestimated MVPA activity minutes. For the sleep parameters, the ICCs were poor for all cases, except when comparing the Fitbit with the criterion, which showed moderate agreement. The TST was slightly overestimated with the Fitbit, although it provided good results with an average MAPE equal to 10.13%. Conversely, WASO estimation was poorer and was overestimated by the Fitbit but underestimated by the Garmin. Again, the Fitbit was the most accurate, with an average MAPE of 49.7%. Conclusions: The tested well-known devices could be adopted to estimate steps, energy expenditure, and sleep duration with an acceptable level of accuracy in the population of interest, although clinicians should be cautious in considering other parameters for clinical and research purposes.

  • Source: Freepik; Copyright: nensuria; URL: https://www.freepik.com/free-photo/portrait-young-woman-using-they-smartwatch-after-running_1139967.htm; License: Licensed by JMIR.

    Feedback on Physical Activity Through a Wearable Device Connected to a Mobile Phone App in Patients With Metabolic Syndrome: Pilot Study

    Abstract:

    Background: Little is known of the effect of wearable devices on metabolic impairments in clinical settings. We hypothesized that a wearable device that can monitor and provide feedback on physical activity may help resolve metabolic syndrome. Objective: This study aimed to examine the objective effects of the use of these devices on metabolic syndrome resolution. Methods: Patients diagnosed with metabolic syndrome were recruited. Participants were prescribed regular walking using a wearable device (Coffee WALKIE +Dv.3, GC Healthcare CI, Korea) on their wrist for 12 weeks. Participants received self-feedback on the amount of their exercise through an app on their mobile phone. The information on physical activities of the participants was uploaded automatically to a website. Thus, a trained nurse could provide individuals with feedback regarding the physical activity via telephone consultation on alternate weeks. Blood pressure (BP), body composition, fasting plasma glucose, and lipid profiles were recorded. The primary outcome was metabolic syndrome resolution. The secondary outcome was an improvement in the components of metabolic impairment. Results: Of the 53 participants recruited, 20 participants with a median age of 46 (range 36-50) years completed the trial. There was no significant difference in the amount of calorie expenditure at weeks 4, 8, and 12. After 12 weeks, metabolic syndrome was resolved in 9 of 20 participants (45%), and the mean number of metabolic impairment components per person decreased from 3.4 to 2.9. Particularly, the mean systolic and diastolic BP decreased from mean 136.6 (SD 18.5) mm Hg to mean 127.4 (SD 19.5) mm Hg and from mean 84.0 (SD 8.1) mm Hg to mean 77.4 (SD 14.4) mm Hg (both P=.02), respectively. Conclusions: This study found that a 12-week intervention via feedback, based on a wearable physical activity monitor, helped metabolic syndrome patients to be more engaged in regular walking and it improved impaired metabolic components, especially in BP. However, some practical challenges regarding patients’ adherence and sustained engagement were observed.

  • Source: Image created by the Authors; Copyright: The Authors; URL: http://mhealth.jmir.org/2019/6/e12631/; License: Creative Commons Attribution (CC-BY).

    Understanding the Use of Smartphone Apps for Health Information Among Pregnant Chinese Women: Mixed Methods Study

    Abstract:

    Background: Hospital-based health promotion resources to assist pregnant women in adopting a healthy lifestyle and optimizing gestational weight gain are important, but with limited effects. Increasingly, women are using mobile apps to access health information during the antenatal period. Objective: The aims of the study were to investigate app-usage by Chinese women during pregnancy and to gain a better understanding of their views and attitudes toward apps containing health information. Methods: A mixed methods study design was applied. Study participants were recruited from 2 maternity hospitals in Shanghai, China, between March and July 2018. A self-administered Web-based survey was conducted with 535 pregnant Chinese women on their sources of health information and reasons for using apps during pregnancy. A total of 4 semistructured focus groups were also conducted with the pregnant women (n=28). Results: The use of pregnancy-related apps and the internet was common among the respondents. Almost half of the women had used pregnancy-related apps. Specifically, the use of apps for health information declined as pregnancy progressed from 70% (35/50) in the first trimester to 41.3% (143/346) in the third trimester. The main reason for using an app was to monitor fetal development (436/535, 81.5%), followed by learning about nutrition and recording diet in pregnancy (140/535, 26.2%). The women found that the apps were useful and convenient and can support lifestyle modifications during pregnancy. However, some apps also contained misinformation or incorrect information that could cause anxiety as reported by the participants. Many women expressed the need for developing an app containing evidence-based, well-informed, and tailored health information to support them during pregnancy. Conclusions: The study suggests that apps were widely used by many Chinese women during pregnancy to monitor fetal development, to obtain diet and physical activity information, and to track their body changes. The women highly appreciated the evidence-based information, expert opinions, and tailored advice available on apps. Smartphone apps have the potential to deliver health information for pregnant women.

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  • A pedometer guided physical activity intervention in obese pregnant women: a randomized feasibility study (The Fit MUM study)

    Date Submitted: Jun 20, 2019

    Open Peer Review Period: Jun 24, 2019 - Aug 19, 2019

    Background: Obesity in pregnancy is a growing problem worldwide, with excessive gestational weight gain (GWG) occurring in the majority of pregnancies. This significantly increases risks to mother and...

    Background: Obesity in pregnancy is a growing problem worldwide, with excessive gestational weight gain (GWG) occurring in the majority of pregnancies. This significantly increases risks to mother and child. A major contributor to both pre-pregnancy obesity and excessive GWG is physical inactivity, however past interventions targeting maternal weight gain and activity levels during the antenatal period have been ineffective in women who are already overweight. Pedometer-guided activity may offer a novel solution to increasing activity levels in this population. Objective: Our aim in this initial feasibility randomized controlled trial was to test a pedometer-based intervention to increase activity and reduce excessive GWG in thirty pregnant women. Methods: Thirty pregnant women with obesity were supplied with a Fitbit Zip® pedometer, and randomized to one of three groups; Control: pedometer-only; App: pedometer-synched to patients’ personal smartphones, with self-monitoring of activity; App-coach: addition of a health-coach delivered behavioral change program. Feasibility outcomes included participant compliance with wearing pedometers, data synching, and data integrity; activity outcomes (step counts, active minutes) were analysed using linear mixed models and generalised estimating equations. Results: Twenty-seven participants completed the study; mean BMI in all groups was ≥ 35 kg/m2. Recruitment and retention rate were feasible, as was activity data synching to participants’ smartphones, although mean (SD) percentage of missing data days were 23.4% (20.6%), 39.5% (32.4%), and 21.1% (16.0%) in control, App group and App-coach group patients respectively. Estimated mean baseline activity levels were 14.5 active minutes/day and 5455 steps/day, with no significant differences found in activity levels between groups. Conclusions: Activity data synching with a personal smartphone is feasible in a cohort of pregnant women with obesity. A future definitive study seeking to reduce GWG and improve activity in this population must focus on improving compliance with activity data recording, and behavioural interventions delivered. Clinical Trial: Australian and New Zealand Clinical Trials Registry ACTRN12617000038392.

  • “I now know I’m the boss”: Development of mobile phone-based sexual and reproductive health intervention for female sex workers in Kenya

    Date Submitted: Jun 19, 2019

    Open Peer Review Period: Jun 24, 2019 - Aug 19, 2019

    Background: Female sex workers (FSWs) have high rates of both unintended pregnancy and HIV, but few health promotion interventions address their contraceptive needs or other sexual and reproductive he...

    Background: Female sex workers (FSWs) have high rates of both unintended pregnancy and HIV, but few health promotion interventions address their contraceptive needs or other sexual and reproductive health and rights (SRHR) concerns. A broader approach integrates contraceptive promotion with HIV and STI prevention and management, alcohol awareness, gender-based violence and rights, and healthcare utilization. The WHISPER mobile phone intervention uses a participatory development approach and behaviour change theory to address these high-priority concerns of FSWs in Mombasa, Kenya. Objective: This paper aims to describe the development and content of the WHISPER intervention, its theoretical framework and key content domains, and; explore workshop participants’ responses to the proposed intervention, particularly with regards to message content and behavior change constructs. Methods: The research team worked closely with FSWs in two phases of intervention development. First, we drafted content based on review of the literature and behavior change theories. Second, we conducted six workshops with 42 FSWs to test and refine message content, and 12 interviews to assess the technical performance of the intervention. Workshop data were thematically analyzed using a mixed deductive and inductive approach. Results: The intervention framework specified six SRHR domains that were viewed as highly relevant by FSWs. Reactions to content in these domains revealed that social cognitive strategies to improve knowledge, outcome expectations, skills, and self-efficacy resonated well with workshop participants. Participants found the messages empowering to themselves and their communities, and most said they would share the messages with others. The final intervention was a 12-month SMS program consisting of informational and motivational messages, role model stories portraying behavior change among FSWs, and on-demand contraceptive information. Conclusions: Our results highlight the need for health promotion interventions that incorporate both HIV/STI prevention and management and broader components of SRHR. Using a theory-based, participatory approach, we developed a digital health intervention that reflects the complex reality of FSWs’ lives and provides a feasible approach for addressing their SRHR concerns and needs. FSW may benefit from health promotion interventions that provide relevant, actionable, and engaging content to support behaviour change.

  • Towards ecological sleep monitoring : a systematic review of clinical applications of mHealth wearable based sleep monitoring.

    Date Submitted: Jun 20, 2019

    Open Peer Review Period: Jun 24, 2019 - Aug 19, 2019

    Background: Sleep disorders are a major public health issue. Nearly one in two people will experience sleep disturbances during lifetime with a potential harmful impact on well-being, physical and men...

    Background: Sleep disorders are a major public health issue. Nearly one in two people will experience sleep disturbances during lifetime with a potential harmful impact on well-being, physical and mental health. Objective: To better understand the clinical applications of wearables-based sleep monitoring, we conducted a review of the literature, including feasibility studies and clinical trials on this topic. Methods: We searched PubMed, PsycINFO, ScienceDirect, the Cochrane Library, Scopus, and Web of Science up to June 2019. We created the list of keywords based on two domains: wearables and sleep. The primary selection criterion was the reporting of clinical trials using wearable devices for sleep recording in adults. Results: The initial research collected 645 articles. 18 articles meeting the inclusion criteria were included in the final analysis. Out of the selected articles, tree categories appeared. We identified feasibility studies, population comparison studies and studies comparing mHealth wearables to ploysmnography identifying sleep stages. Conclusions: This review showed that wearables are acceptable but poorly reliable sleep monitoring. However, mHealth wearable devices appear as promising tools for ecological monitoring. Clinical Trial: to be registered soon

  • Mobile phone apps’ support for people with mild dementia: A systematic review

    Date Submitted: Jun 17, 2019

    Open Peer Review Period: Jun 20, 2019 - Aug 15, 2019

    Background: Dementia is a general term for various disorders characterized by memory impairment and loss of at least one cognitive domain. People with dementia are faced with different difficulties in...

    Background: Dementia is a general term for various disorders characterized by memory impairment and loss of at least one cognitive domain. People with dementia are faced with different difficulties in their daily life activities (DLA). With the use of modern technologies, such as mobile phone apps – often called health apps, their difficulties can be alleviated. Objective: The aim of this paper was to systematically search, analyze and synthetize mobile phone apps designed to support people with mild dementia in daily life activities in two apps bases: Apple App Store and Google Play Store. Methods: A search was conducted in May 2019 following PRISMA recommendations. Results were analyzed and displayed as tables and graphs. Results were synthetized using thematic analysis which was conducted from 14 components, based on human needs for categorized nursing activities. Mobile phone apps were assessed for quality using the System Usability Scale. Results: A total of 15 mobile phone apps were identified applying inclusion and exclusion criteria. Five major themes were identified with thematic analysis: multi-component DLA, communication and feelings, recreation, eating and drinking, and movement. Most of the apps (73%) of the apps were not mentioned in scientific literature. Conclusions: There are many mobile phone apps available in mobile phone markets for the support for people with mild dementia; yet only a few of them are focused on challenges in daily life activities. Most of the available apps were not evaluated nor assessed for quality.

  • Are modern activity trackers useful for monitoring exercise behavior in chronic cardiac patients: a validation study.

    Date Submitted: Jun 15, 2019

    Open Peer Review Period: Jun 18, 2019 - Aug 13, 2019

    Background: Improving physical activity (PA) is a core component of secondary prevention and cardiac (tele)rehabilitation. Commercially available activity trackers are frequently used to monitor and p...

    Background: Improving physical activity (PA) is a core component of secondary prevention and cardiac (tele)rehabilitation. Commercially available activity trackers are frequently used to monitor and promote PA in cardiac patients. However studies on the validity of these devices in cardiac patients are scarce. As cardiac patients are being advised and treated based on PA parameters measured by these devices, it is highly important to evaluate the accuracy of these parameters in this specific population. Objective: The aim of this study was to determine the accuracy and responsiveness of two wrist-worn activity trackers, Fitbit Charge 2 (FC2) and Mio Slice (MS), for the assessment of energy expenditure (EE) in cardiac patients. Methods: EE assessed by the activity trackers was compared with indirect calorimetry (Oxycon Mobile, (OM)) during a laboratory activity protocol. Two groups were assessed: patients with stable coronary artery disease (CAD) with preserved left ventricular ejection fraction (LVEF) and patients with heart failure with reduced ejection fraction (HFrEF). Results: 38 patients were included: 19 with CAD and 19 with HFrEF (LVEF 31.8±7.6 %). The CAD group showed no significant difference in total EE between FC2 and OM (47.5±112 kcal, p=.09), in contrast to a significant difference between MS and OM (88±108 kcal, p=.003). The HFrEF group showed significant differences in EE between FC2 and OM (38±57 kcal, p=.01), as well as between MS and OM (106±167 kcal, p=.02). Agreement of the activity trackers was low in both groups (CAD: ICC FC2=0.10, ICC MS=0.12; HFrEF: ICC FC2=0.42, ICC MS=0.11). The responsiveness of FC2 was poor, while MS was able to detect changes in cycling intensity only. Conclusions: Both activity trackers demonstrated low accuracy in estimating EE in cardiac patients, but importantly, also showed poor performance to detect within-patient changes in exercise intensity. These findings show that these commercially available activity trackers should not be used for interventions to improve exercise behavior in patients with CAD and HFrEF and highlight the need for population-specific devices and algorithms. Clinical Trial: ClinicalTrials.gov, NCT03951740

  • Content and Feature Preferences for a Physical Activity App for Adults with Physical Disabilities: Focus Group Findings

    Date Submitted: Jun 13, 2019

    Open Peer Review Period: Jun 17, 2019 - Aug 12, 2019

    Background: Hundreds of thousands of mobile phone applications intended to improve health and fitness are available for download across platforms and operating systems; however few have been designed...

    Background: Hundreds of thousands of mobile phone applications intended to improve health and fitness are available for download across platforms and operating systems; however few have been designed with people with disabilities (PwD) in mind, ignoring a large population that may benefit from an effective tool to increase physical activity. Objective: This study represents the first phase in the development process of a fitness tracking app for PwD interested in nontraditional sport. The aim of this research was to explore user preferences for content, appearance, and operational features of a proposed physical activity app for PwD to inform the design of a mobile phone app for increasing physical activity. Methods: Four focus groups were conducted with 15 adults with physical disabilities who currently participate in non-traditional, non-Paralympic sport. Data collected from the focus group sessions centered on content, functionality, and appearance of apps currently used by participants as well as preferences for a future app. All sessions were audio recorded and transcribed verbatim. Thematic analysis of the data was undertaken. Results: Participants (mean age 35.7, SD 9.2, years) were mostly white (13/15, 87%), and all were currently participating in CrossFit and at least one other sport. Five main themes were identified. Themes included preferences for (1) workout-specific features that were tailored or searchable by disability, (2) user experience that was intuitive and accessible, (3) profile personalization options, (4) gamification features that allowed for competition with self and other users, and (5) social features that allowed increased interaction among users. Participants expressed a primary interest in having a fitness app that was designed for PwD such that the features present in other fitness tracking apps were relevant to them and their community of adaptive athletes. Conclusions: The results showed that features related to user experience, social engagement, and gamification are considered important to PwD. Features highlighted by participants as most desired, from a consumer perspective, were in line with research identifying attributes of quality apps that use behavior change techniques to influence positive physical activity behavior change. Such insights should inform the development of any fitness app designed to integrate users with disabilities as a primary user base.

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