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Journal Description

JMIR mHealth and uHealth (JMU, ISSN 2291-5222; Impact Factor 4.31) is a sister journal of JMIR, the leading eHealth journal. JMIR mHealth and uHealth is indexed in PubMed, PubMed Central, Scopus, MEDLINE and Science Citation Index Expanded (SCIE), and in June 2020 received an Impact Factor of 4.31, ranking the journal Q1 in the medical informatics category indexed by the Science Citation Index Expanded (SCIE) by Thomson Reuters/Clarivate

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

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

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

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

 

Recent Articles:

  • Source: Burst; Copyright: Matthew Henry; URL: https://burst.shopify.com/photos/using-smartphone-with-city-in-the-background?q=using+smart+phone; License: Licensed by JMIR.

    The Effect of Smartphone App–Based Interventions for Patients With Hypertension: Systematic Review and Meta-Analysis

    Abstract:

    Background: Hypertension is a major cause of cardiovascular disease, which is the leading cause of premature death. People with hypertension who do not comply with recommended treatment strategies have a higher risk of heart attacks and strokes, leading to hospitalization and consequently greater health care costs. The smartphone, which is now ubiquitous, offers a convenient tool to aid in the treatment of hypertension through the use of apps targeting lifestyle management, and such app-based interventions have shown promising results. In particular, recent evidence has shown the feasibility, acceptability, and success of digital interventions in changing the behavior of people with chronic conditions. Objective: The aim of this study was to systematically compile available evidence to determine the overall effect of smartphone apps on blood pressure control, medication adherence, and lifestyle changes for people with hypertension. Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement guidelines. Databases were searched to identify randomized controlled trials related to the influence of an app-based intervention in people with hypertension. Data extracted from the included studies were subjected to a meta-analysis to compare the effects of the smartphone app intervention to a control. Results: Eight studies with a total of 1657 participants fulfilled the inclusion criteria. Pooled analysis of 6 studies assessing systolic blood pressure showed a significant overall effect in favor of the smartphone intervention (weighted mean difference –2.28, 95% CI –3.90-0.66). Pooled analysis of studies assessing medication adherence demonstrated a significant effect (P<.001) in favor of the intervention group (standard mean difference 0.38, 95% CI 0.26-0.50) with low heterogeneity (I2=0%). No difference between groups was demonstrated with respect to physical activity. Conclusions: A smartphone intervention leads to a reduction in blood pressure and an increase in medication adherence for people with hypertension. Future research should focus on the effect of behavior coaching apps on medication adherence, lifestyle change, and blood pressure reduction.

  • Source: Pexels; Copyright: Andrea Piacquadio; URL: https://www.pexels.com/de-de/foto/gesund-mann-paar-liebe-3763872/; License: Licensed by JMIR.

    Archetypes of Gamification: Analysis of mHealth Apps

    Abstract:

    Background: Nowadays, numerous health-related mobile apps implement gamification in an attempt to draw on the motivational potential of video games and thereby increase user engagement or foster certain health behaviors. However, research on effective gamification is still in its infancy and researchers increasingly recognize methodological shortcomings of existing studies. What we actually know about the phenomenon today stems from fragmented pieces of knowledge, and a variety of different perspectives. Existing research primarily draws on conceptual knowledge that is gained from research prototypes, and isolated from industry best practices. We still lack knowledge on how gamification has been successfully designed and implemented within the industry and whether certain gamification approaches have shown to be particularly suitable for certain health behaviors. Objective: We address this lack of knowledge concerning best practices in the design and implementation of gamification for health-related mobile apps by identifying archetypes of gamification approaches that have emerged in pertinent health-related mobile apps and analyzing to what extent those gamification approaches are influenced by the underlying desired health-related outcomes. Methods: A 3-step research approach is employed. As a first step, a database of 143 pertinent gamified health-related mobile apps from the Apple App Store and Google Play Store is set up. Second, the gamification approach of each app within the database is classified based on an established taxonomy for gamification in health-related apps. Finally, a 2-step cluster analysis is conducted in order to identify archetypes of the most dominant gamification approaches in pertinent gamified health-related mobile apps. Results: Eight archetypes of gamification emerged from the analysis of health-related mobile apps: (1) competition and collaboration, (2) pursuing self-set goals without rewards, (3) episodical compliance tracking, (4) inherent gamification for external goals, (5) internal rewards for self-set goals, (6) continuous assistance through positive reinforcement, (7) positive and negative reinforcement without rewards, and (8) progressive gamification for health professionals. The results indicate a close relationship between the identified archetypes and the actual health behavior that is being targeted. Conclusions: By unveiling salient best practices and discussing their relationship to targeted health behaviors, this study contributes to a more profound understanding of gamification in mobile health. The results can serve as a foundation for future research that advances the knowledge on how gamification may positively influence health behavior change and guide practitioners in the design and development of highly motivating and effective health-related mobile health apps.

  • Source: freepik; Copyright: user18526052; URL: https://www.freepik.com/free-photo/dark-haired-lady-wearing-casual-t-shirt-medical-protective-mask-working-front-lap-top-screen-looks-concentrated-student-female-doing-online-university-task-education_8761054.htm#page=1&query=person%20using%20mask%20compu; License: Licensed by JMIR.

    Solving Community SARS-CoV-2 Testing With Telehealth: Development and Implementation for Screening, Evaluation and Testing

    Abstract:

    Background: Telehealth has emerged as a crucial component of the SARS-CoV-2 pandemic emergency response. Simply stated, telehealth is a tool to provide health care from a distance. Jefferson Health has leveraged its acute care telehealth platform to screen, order testing, and manage patients with COVID-19–related concerns. Objective: This study aims to describe the expansion and results of using a telehealth program to increase access to care while minimizing additional potential exposures during the early period of the COVID-19 pandemic. Methods: Screening algorithms for patients with SARS-CoV-2–related complaints were created, and 150 new clinicians were trained within 72 hours to address increased patient demand. Simultaneously, Jefferson Health created mobile testing sites throughout eastern Pennsylvania and the southern New Jersey region. Visit volume, the number of SARS-CoV-2 tests ordered, and the number of positive tests were evaluated, and the volume was compared with preceding time periods. Results: From March 8, 2020, to April 11, 2020, 4663 patients were screened using telehealth, representing a surge in visit volume. There were 1521 patients sent to mobile testing sites, and they received a telephone call from a centralized call center for results. Of the patients who were tested, nearly 20% (n=301) had a positive result. Conclusions: Our model demonstrates how using telehealth for a referral to central testing sites can increase access to community-based care, decrease clinician exposure, and minimize the demand for personal protective equipment. The scaling of this innovation may allow health care systems to focus on preparing for and delivering hospital-based care needs.

  • Source: freepik; Copyright: freepik; URL: https://www.freepik.com/free-photo/doctor-using-his-phone_5480778.htm#page=1&query=physicians%20using%20phone&position=43; License: Licensed by JMIR.

    eHealth Literacy of German Physicians in the Pre–COVID-19 Era: Questionnaire Study

    Abstract:

    Background: Digitalization is a disruptive technology that changes the way we deliver diagnostic procedures and treatments in medicine. Different stakeholders have varying interests in and expectations of the digitalization of modern medicine. Many recent digital advances in the medical field, such as the implementation of electronic health records, telemedical services, and mobile health apps, are increasingly used by medical professionals and patients. During the current pandemic outbreak of a novel coronavirus-caused respiratory disease (COVID-19), many modern information and communication technologies (ICT) have been used to overcome the physical barriers and limitations caused by government-issued curfews and workforce shortages. Therefore, the COVID-19 pandemic has led to a surge in the usage of modern ICT in medicine. At the same time, the eHealth literacy of physicians working with these technologies has probably not improved since our study. Objective: This paper describes a representative cohort of German physicians before the COVID-19 pandemic and their eHealth literacy and attitude towards modern ICT. Methods: A structured, self-developed questionnaire about user behavior and attitudes towards eHealth applications was administered to a representative cohort of 93 German physicians. Results: Of the 93 German physicians who participated in the study, 97% (90/93) use a mobile phone. Medical apps are used by 42% (39/93). Half of the surveyed physicians (47/93, 50%) use their private mobile phones for official purposes on a daily basis. Telemedicine is part of the daily routine for more than one-third (31/93, 33%) of all participants. More than 80% (76/93, 82%) of the trial participants state that their knowledge regarding the legal aspects and data safety of medical apps and cloud computing is insufficient. Conclusions: Modern ICT is frequently used and mostly welcomed by German physicians. However, there is a tremendous lack of eHealth literacy and knowledge about the safe and secure implementation of these technologies in routine clinical practice.

  • Source: Image created by the Authors; Copyright: The Authors; URL: http://mhealth.jmir.org/2020/10/e22080/; License: Creative Commons Attribution (CC-BY).

    Implementation of a Home-Based mHealth App Intervention Program With Human Mediation for Swallowing Tongue Pressure Strengthening Exercises in Older Adults:...

    Abstract:

    Background: Tongue pressure is an effective index of swallowing function, and it decreases with aging and disease progression. Previous research has shown beneficial effects of swallowing exercises combined with myofunctional tongue-strengthening therapy on tongue function. Tongue exercises delivered through mobile health (mHealth) technologies have the potential to advance health care in the digital age to be more efficient for people with limited resources, especially older adults. Objective: The purpose of this study is to explore the immediate and long-term maintenance effects of an 8-week home-based mHealth app intervention with biweekly (ie, every 2 weeks) human mediation aimed at improving the swallowing tongue pressure in older adults. Methods: We developed an mHealth app intervention that was used for 8 weeks (3 times/day, 5 days/week, for a total of 120 sessions) by 11 community-dwelling older adults (10 women; mean age 75.7 years) who complained of swallowing difficulties. The app included a swallowing monitoring and intervention protocol with 3 therapy maneuvers: effortful prolonged swallowing, effortful pitch glide, and effortful tongue rotation. The 8-week intervention was mediated by biweekly face-to-face meetings to monitor each participant’s progress and ability to implement the training sessions according to the given protocol. Preintervention and postintervention isometric and swallowing tongue pressures were measured using the Iowa Oral Performance Instrument. We also investigated the maintenance effects of the intervention on swallowing tongue pressure at 12 weeks postintervention. Results: Of the 11 participants, 8 adhered to the home-based 8-week app therapy program with the optimal intervention dosage. At the main trial end point (ie, 8 weeks) of the intervention program, the participants demonstrated a significant increase in swallowing tongue pressure (median 17.5 kPa before the intervention and 26.5 kPa after the intervention; P=.046). However, long-term maintenance effects of the training program on swallowing tongue pressure at 12 weeks postintervention were not observed. Conclusions: Swallowing tongue pressure is known to be closely related to dysphagia symptoms. This is the first study to demonstrate the effectiveness of the combined methods of effortful prolonged swallowing, effortful pitch glide, and effortful tongue rotation using mobile app training accompanied by biweekly human mediation in improving swallowing tongue pressure in older adults. The mHealth app is a promising platform that can be used to deliver effective and convenient therapeutic service to vulnerable older adults. To investigate the therapeutic efficacy with a larger sample size and observe the long-term effects of the intervention program, further studies are warranted.

  • e-OncoSalud app. Source: Image created by the Authors; Copyright: The Authors; URL: http://mhealth.jmir.org/2020/10/e20480/; License: Creative Commons Attribution (CC-BY).

    Effect of a Mobile App for the Pharmacotherapeutic Follow-Up of Patients With Cancer on Their Health Outcomes: Quasi-Experimental Study

    Abstract:

    Background: Oral antineoplastic agents (OAAs) have revolutionized cancer management. However, they have been reported with adverse side effects and drug-drug interactions. Moreover, patient adherence to OAA treatment is critical. Mobile apps can enable remote and real-time pharmacotherapeutic monitoring of patients, while also promoting patient autonomy in their health care. Objective: The primary objective was to analyze the effect of using a mobile app for the follow-up of patients with oncohematological malignancies undergoing treatment with OAAs on their health outcomes. The secondary objectives were to analyze the role of the app in communication with health care professionals and patient satisfaction with the app. Methods: We performed a comparative, quasi-experimental study based on a prepost intervention with 101 patients (control group, n=51, traditional pharmacotherapeutic follow-up vs intervention group, n=50, follow-up through e-OncoSalud, a custom-designed app that promotes follow-up at home and the safety of patients receiving OAAs). The effect of this app on drug safety, adherence to treatment, and quality of life was evaluated. Results: With regard to drug safety, 73% (37/51) of the patients in the control group and 70% (35/50) of the patients in the intervention group (P=.01) presented with drug-related problems. The probability of detecting an insufficiently treated health problem in the intervention group was significantly higher than that in the control group (P=.04). The proportion of patients who presented with side effects in the intervention group was significantly lower than that in the control group (P>.99). In the control group, 49% (25/51) of the patients consumed some health resources during the first 6 months of treatment compared with 36% (18/50) of the patients in the intervention group (P=.76). Adherence to treatment was 97.6% (SD 7.9) in the intervention group, which was significantly higher than that in the control group (92.9% [SD 10.0]; P=.02). The EuroQol-5D in the intervention group yielded a mean (SD) index of 0.875 (0.156), which was significantly higher than that in the control group (0.741 [0.177]; P<.001). Approximately 60% (29/50) of the patients used the messaging module to communicate with pharmacists. The most frequent types of messages were acknowledgments (77/283, 27.2%), doubts about contraindications and interactions with OAAs (70/283, 24.7%), and consultations for adverse reactions to treatment (39/283, 13.8%). The satisfaction with the app survey conducted in the intervention group yielded an overall mean (SD) score of 9.1 (0.4) out of 10. Conclusions: Use of e-OncoSalud for the real-time follow-up of patients receiving OAAs facilitated the optimization of some health outcomes. The intervention group had significantly higher health-related quality of life and adherence to treatment than the control group. Further, the probability of the intervention group presenting with side effects was significantly lower than that of the control group.

  • Source: Prizzmable/ the Authors; Copyright: Prizzmable; URL: https://mhealth.jmir.org/2020/10/e17881; License: Licensed by the authors.

    Light-Induced Fluorescence-Based Device and Hybrid Mobile App for Oral Hygiene Management at Home: Development and Usability Study

    Abstract:

    Background: Dental diseases can be prevented through the management of dental plaques. Dental plaque can be identified using the light-induced fluorescence (LIF) technique that emits light at 405 nm. The LIF technique is more convenient than the commercial technique using a disclosing agent, but the result may vary for each individual as it still requires visual identification. Objective: The objective of this study is to introduce and validate a deep learning–based oral hygiene monitoring system that makes it easy to identify dental plaques at home. Methods: We developed a LIF-based system consisting of a device that can visually identify dental plaques and a mobile app that displays the location and area of dental plaques on oral images. The mobile app is programmed to automatically determine the location and distribution of dental plaques using a deep learning–based algorithm and present the results to the user as time series data. The mobile app is also built with convergence of naive and web applications so that the algorithm is executed on a cloud server to efficiently distribute computing resources. Results: The location and distribution of users’ dental plaques could be identified via the hand-held LIF device or mobile app. The color correction filter in the device was developed using a color mixing technique. The mobile app was built as a hybrid app combining the functionalities of a native application and a web application. Through the scrollable WebView on the mobile app, changes in the time series of dental plaque could be confirmed. The algorithm for dental plaque detection was implemented to run on Amazon Web Services for object detection by single shot multibox detector and instance segmentation by Mask region-based convolutional neural network. Conclusions: This paper shows that the system can be used as a home oral care product for timely identification and management of dental plaques. In the future, it is expected that these products will significantly reduce the social costs associated with dental diseases.

  • Source: Unsplash; Copyright: Quentin Dr; URL: https://unsplash.com/photos/gvm_Kmm3-9o; License: Licensed by JMIR.

    Event-Level Association Between Daily Alcohol Use and Same-Day Nonadherence to Antiretroviral Therapy Among Young Men Who Have Sex With Men and Trans Women...

    Abstract:

    Background: Young trans women (TW) and men who have sex with men (MSM) are disproportionately impacted by HIV. Optimizing adherence to antiretroviral therapy (ART) is one mechanism by which public health experts aim to achieve favorable HIV health outcomes while reducing disease transmission. However, alcohol use is prevalent among young TW and MSM and threatens optimal adherence. In addition, the daily variations in alcohol use and ART adherence and their association with each other are poorly understood, warranting more appropriate methodological approaches, such as analysis of ecological momentary assessment (EMA) data. Objective: The aim of this analysis is to characterize the association between daily alcohol use and same-day ART nonadherence captured by an EMA study of young MSM and TW living with HIV in San Francisco. Methods: Young MSM and TW enrolled in the Health eNav digital HIV care navigation intervention were included in the analytic sample (N=113). Data on alcohol and ART use were collected by daily EMA surveys administered via text messaging and were analyzed over 30 days of follow-up. A multivariable mixed-effects logistic regression model adjusting for baseline sociodemographic characteristics was specified to investigate whether daily alcohol use was associated with same-day ART nonuse. Results: Daily alcohol use was associated with higher same-day ART nonuse. On average, participants drank alcohol on 15.20 (SD 8.93) days and used ART on 15.19 (SD 10.16) days out of 30 days. Daily alcohol use was associated with 1.89 (95% CI 1.14-3.15) times the adjusted odds of same-day ART nonuse for each participant. Conclusions: Results are consistent with other analyses of daily alcohol and ART use and underscore the importance of individually targeted interventions that are sensitive to each participant’s dynamic risk environment. Trial Registration:

  • Detecting COVID-19 outbreak using WeChat. Source: Image created by the authors; Copyright: The authors; URL: https://mhealth.jmir.org/2020/10/e19589; License: Creative Commons Attribution (CC-BY).

    Using WeChat, a Chinese Social Media App, for Early Detection of the COVID-19 Outbreak in December 2019: Retrospective Study

    Abstract:

    Background: A novel coronavirus, SARS-CoV-2, was identified in December 2019, when the first cases were reported in Wuhan, China. The once-localized outbreak has since been declared a pandemic. As of April 24, 2020, there have been 2.7 million confirmed cases and nearly 200,000 deaths. Early warning systems using new technologies should be established to prevent or mitigate such events in the future. Objective: This study aimed to explore the possibility of detecting the SARS-CoV-2 outbreak in 2019 using social media. Methods: WeChat Index is a data service that shows how frequently a specific keyword appears in posts, subscriptions, and search over the last 90 days on WeChat, the most popular Chinese social media app. We plotted daily WeChat Index results for keywords related to SARS-CoV-2 from November 17, 2019, to February 14, 2020. Results: WeChat Index hits for “Feidian” (which means severe acute respiratory syndrome in Chinese) stayed at low levels until 16 days ahead of the local authority’s outbreak announcement on December 31, 2019, when the index increased significantly. The WeChat Index values persisted at relatively high levels from December 15 to 29, 2019, and rose rapidly on December 30, 2019, the day before the announcement. The WeChat Index hits also spiked for the keywords “SARS,” “coronavirus,” “novel coronavirus,” “shortness of breath,” “dyspnea,” and “diarrhea,” but these terms were not as meaningful for the early detection of the outbreak as the term “Feidian”. Conclusions: By using retrospective infoveillance data from the WeChat Index, the SARS-CoV-2 outbreak in December 2019 could have been detected about two weeks before the outbreak announcement. WeChat may offer a new approach for the early detection of disease outbreaks.

  • Source: Unsplash; Copyright: Robin Worrall; URL: https://unsplash.com/photos/FPt10LXK0cg; License: Licensed by JMIR.

    Exploring the Effects of a Brief Biofeedback Breathing Session Delivered Through the BioBase App in Facilitating Employee Stress Recovery: Randomized...

    Abstract:

    Background: Recovery from stress is a predictive factor for cardiovascular health, and heart rate variability (HRV) is suggested to be an index of how well people physiologically recover from stress. Biofeedback and mindfulness interventions that include guided breathing have been shown to be effective in increasing HRV and facilitating stress recovery. Objective: This study aims to assess the effectiveness of a brief app-based breathing intervention (BioBase) in enhancing physiological recovery among employees who were induced to cognitive and emotional stress. Methods: In total, we recruited 75 full-time employees. Interbeat (RR) intervals were recorded continuously for 5 min at baseline and during cognitive and emotional stress induction. The session ended with a 5-min recovery period during which participants were randomly allocated into 3 conditions: app-based breathing (BioBase), mindfulness body scan, or control. Subjective tension was assessed at the end of each period. Results: Subjective tension significantly increased following stress induction. HRV significantly decreased following the stress period. In the recovery phase, the root mean square of successive RR interval differences (P=.002), the percentage of successive RR intervals that differed by >50 ms (P=.008), and high frequency (P=.01) were significantly higher in the BioBase breathing condition than in the mindfulness body scan and the control groups. Conclusions: Biofeedback breathing interventions digitally delivered through a commercially available app can be effective in facilitating stress recovery among employees. These findings contribute to the mobile health literature on the beneficial effects of brief app-based breathing interventions on employees’ cardiovascular health.

  • Source: freepik; Copyright: Nature photo created by rawpixel.com; URL: https://www.freepik.com/free-photo/senior-runner-using-fitness-tracker_2757031.htm#page=1&query=fitness%20tracker&position=29; License: Licensed by JMIR.

    Fitness-Tracker Assisted Frailty-Assessment Before Transcatheter Aortic Valve Implantation: Proof-of-Concept Study

    Abstract:

    Background: While transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic valve stenosis, wearable health-monitoring devices are gradually transforming digital patient care. Objective: The aim of this study was to develop a simple, efficient, and economical method for preprocedural frailty assessment based on parameters measured by a wearable health-monitoring device. Methods: In this prospective study, we analyzed data of 50 consecutive patients with mean (SD) age of 77.5 (5.1) years and a median (IQR) European system for cardiac operative risk evaluation (EuroSCORE) II of 3.3 (4.1) undergoing either transfemoral or transapical TAVR between 2017 and 2018. Every patient was fitted with a wrist-worn health-monitoring device (Garmin Vivosmart 3) for 1 week prior to the procedure. Twenty different parameters were measured, and threshold levels for the 3 most predictive categories (ie, step count, heart rate, and preprocedural stress) were calculated. Patients were assigned 1 point per category for exceeding the cut-off value and were then classified into 4 stages (no, borderline, moderate, and severe frailty). Furthermore, the FItness-tracker assisted Frailty-Assessment Score (FIFA score) was compared with the scores of the preprocedural gait speed category derived from the 6-minute walk test (GSC-6MWT) and the Edmonton Frail Scale classification (EFS-C). The primary study endpoint was hospital mortality. Results: The overall preprocedural stress level (P=.02), minutes of high stress per day (P=.02), minutes of rest per day (P=.045), and daily heart rate maximum (P=.048) as single parameters were the strongest predictors of hospital mortality. When comparing the different frailty scores, the FIFA score demonstrated the greatest predictive power for hospital mortality (FIFA area under the curve [AUC] 0.844, CI 0.656-1.000; P=.048; GSC-6MWT AUC 0.671, CI 0.487-0.855; P=.42; EFS-C AUC 0.636, CI 0.254-1.000; P=.44). Conclusions: This proof-of-concept study demonstrates the strong predictive performance of the FIFA score compared to that of the conventional frailty assessments.

  • ASHAs using ImTeCHO to provide services and maintain record at doorstep. Source: Image created by the authors; Copyright: The Authors; URL: http://mhealth.jmir.org/2020/9/e17066/; License: Creative Commons Attribution (CC-BY).

    Costing and Cost-Effectiveness of a Mobile Health Intervention (ImTeCHO) in Improving Infant Mortality in Tribal Areas of Gujarat, India: Cluster Randomized...

    Abstract:

    Background: During 2013, a mobile health (mHealth) program, Innovative Mobile Technology for Community Health Operation (ImTeCHO), was launched in predominantly tribal and rural communities of Gujarat, India. ImTeCHO was developed as a job aid for Accredited Social Health Activists (ASHAs) and staff of primary health centers to increase coverage of maternal, neonatal, and child health care. Objective: In this study, we assessed the incremental cost per life-years saved as a result of the ImTeCHO intervention as compared to routine maternal, neonatal, and child health care programs. Methods: A two-arm, parallel, stratified cluster randomized trial with 11 clusters (primary health centers) randomly allocated to the intervention (280 ASHAs, n=2,34,134) and control (281 ASHAs, n=2,42,809) arms was initiated in 2015 in a predominantly tribal and rural community of Gujarat. A system of surveillance assessed all live births and infant deaths in the intervention and control areas. All costs, including those required during the start-up and implementation phases, were estimated from a program perspective. Incremental cost-effectiveness ratios were estimated by dividing the incremental cost of the intervention with the number of deaths averted to estimate the cost per infant death averted. This was further analyzed to estimate the cost per life-years saved for the purpose of comparability. Sensitivity analysis was undertaken to account for parameter uncertainties. Results: Out of a total of 5754 live births (3014 in the intervention arm, 2740 in the control arm) reported in the study area, per protocol analysis showed that the implementation of ImTeCHO resulted in saving 11 infant deaths per 1000 live births in the study area at an annual incremental cost of US $163,841, which is equivalent to US $54,360 per 1000 live births. Overall, ImTeCHO is a cost-effective intervention from a program perspective at an incremental cost of US $74 per life-years saved or US $5057 per death averted. In a realistic environment with district scale-up, the program is expected to become even more cost-effective. Conclusions: Overall, the findings of our study strongly suggest that the mHealth intervention as part of the ImTeCHO program is cost-effective and should be considered for replication elsewhere in India. Trial Registration: Clinical Trials Registry of India CTRI/2015/06/005847; http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=11820&EncHid=&modid=&compid=%27,%2711820det%27

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  • The POWER app: design and usability testing of a mobile app for the collection of patient-reported outcome data in type A haemophilia

    Date Submitted: Oct 16, 2020

    Open Peer Review Period: Oct 16, 2020 - Dec 11, 2020

    Background: Mobile technologies can offer a high potential solution to increase the rigorousness and reliability of data collected within clinical studies. However, the development process of mHealth...

    Background: Mobile technologies can offer a high potential solution to increase the rigorousness and reliability of data collected within clinical studies. However, the development process of mHealth apps is often inadequate and not sufficiently participatory, affecting the potential to meet intended purposes. Objective: The aim of this study was to design and validate a mHealth app for physical activities and electronic patient-reported outcomes (ePRO) collection in the POWER observational study currently enrolling patients with haemophilia A. Methods: We adopted a user-design process grounded in design science engaging several stakeholders in the development and usability testing of this mobile application, measured through the mHealth app usability questionnaire (MAUQ). During an initial need-assessment focus group we elicited the specific design requirements of the end-users. We then conducted 2 Exploratory Focus Groups to seek additional inputs for improvement and 2 Confirmatory Focus Groups to validate the proposed artifact and test its usability in the field. Results: Findings from thematic analysis of the need-assessment FG revealed a demand for sense making, simplification of app functionalities, maximized integration, and minimized feeling of external control. Participants involved in the later stages of the design refinement contributed to improve the design further by refining the app layout and adding aspects such as a chatbot function and a visual feedback on the number of hours the wearable device has been worn, to make sure the minimum is reached and observed data are actually registered. The end-users rated the app highly during the quantitative assessment, with an average MAUQ score of 5.32 (range 4.44-6.23) and 6.20 (5.72-6.88) out of seven in the two iterative usability testing cycles. Conclusions: The results of the usability test indicated high and growing satisfaction with the app. The adoption of a thorough user-centered design process can maximize the likelihood of sustained retention of the POWER mHealth app and make it fit for data collection of relevant outcomes in the observational study. Findings from our work support the use of different types of focus groups in the design process of a mHealth app. Continuous use of this tool and the actual level of engagement will be properly evaluated during the on-going study.

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