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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:

  • Carrot Rewards app (montage). Source: Carrot Rewards; Copyright: Carrot Rewards; URL:; License: Licensed by JMIR.

    Evaluating the Carrot Rewards App, a Population-Level Incentive-Based Intervention Promoting Step Counts Across Two Canadian Provinces: Quasi-Experimental Study


    Background: The Carrot Rewards app was developed as part of an innovative public-private partnership to reward Canadians with loyalty points, exchangeable for retail goods, travel rewards, and groceries for engaging in healthy behaviors such as walking. Objective: This study examined whether a multicomponent intervention including goal setting, graded tasks, biofeedback, and very small incentives tied to daily step goal achievement (assessed by built-in smartphone accelerometers) could increase physical activity in two Canadian provinces, British Columbia (BC) and Newfoundland and Labrador (NL). Methods: This 12-week, quasi-experimental (single group pre-post) study included 78,882 participants; 44.39% (35,014/78,882) enrolled in the Carrot Rewards “Steps” walking program during the recruitment period (June 13–July 10, 2016). During the 2-week baseline (or “run-in”) period, we calculated participants’ mean steps per day. Thereafter, participants earned incentives in the form of loyalty points (worth Can $0.04 ) every day they reached their personalized daily step goal (ie, baseline mean+1000 steps=first daily step goal level). Participants earned additional points (Can $0.40) for meeting their step goal 10+ nonconsecutive times in a 14-day period (called a “Step Up Challenge”). Participants could earn up to Can $5.00 during the 12-week evaluation period. Upon meeting the 10-day contingency, participants could increase their daily goal by 500 steps, aiming to gradually increase the daily step number by 3000. Only participants with ≥5 valid days (days with step counts: 1000-40,000) during the baseline period were included in the analysis (n=32,229).The primary study outcome was mean steps per day (by week), analyzed using linear mixed-effects models. Results: The mean age of 32,229 participants with valid baseline data was 33.7 (SD 11.6) years; 66.11% (21,306/32,229) were female. The mean daily step count at baseline was 6511.22. Over half of users (16,336/32,229, 50.69%) were categorized as “physically inactive,” accumulating <5000 daily steps at baseline. Results from mixed-effects models revealed statistically significant increases in mean daily step counts when comparing baseline with each study week (P<.001). Compared with baseline, participants walked 115.70 more steps (95% CI 74.59 to 156.81; P<.001) at study week 12. BC and NL users classified as “high engagers” (app engagement above sample median; 15,511/32,229, 48.13%) walked 738.70 (95% CI 673.81 to 803.54; P<.001) and 346.00 (95% CI 239.26 to 452.74; P<.001) more steps, respectively. Physically inactive, high engagers (7022/32,229, 21.08%) averaged an increase of 1224.66 steps per day (95% CI 1160.69 to 1288.63; P<.001). Effect sizes were modest. Conclusions: Providing very small but immediate rewards for personalized daily step goal achievement as part of a multicomponent intervention increased daily step counts on a population scale, especially for physically inactive individuals and individuals who engaged more with the walking program. Positive effects in both BC and NL provide evidence of replicability.

  • Patient recording Activities of Daily Living using the Your Activities of Daily Living app (montage). Source: The Authors /; Copyright: The Authors; URL:; License: Creative Commons Attribution (CC-BY).

    An mHealth App for Self-Management of Chronic Lower Back Pain (Limbr): Pilot Study


    Background: Although mobile health (mHealth) interventions can help improve outcomes among patients with chronic lower back pain (CLBP), many available mHealth apps offer content that is not evidence based. Limbr was designed to enhance self-management of CLBP by packaging self-directed rehabilitation tutorial videos, visual self-report tools, remote health coach support, and activity tracking into a suite of mobile phone apps, including Your Activities of Daily Living, an image-based tool for quantifying pain-related disability. Objective: The aim is to (1) describe patient engagement with the Limbr program, (2) describe patient-perceived utility of the Limbr program, and (3) assess the validity of the Your Activities of Daily Living module for quantifying functional status among patients with CLBP. Methods: This was a single-arm trial utilizing a convenience sample of 93 adult patients with discogenic back pain who visited a single physiatrist from January 2016 to February 2017. Eligible patients were enrolled in 3-month physical therapy program and received the Limbr mobile phone app suite for iOS or Android. The program included three daily visual self-reports to assess pain, activity level, and medication/coping mechanisms; rehabilitation video tutorials; passive activity-level measurement; and chat-based health coaching. Patient characteristics, patient engagement, and perceived utility were analyzed descriptively. Associations between participant characteristics and program interaction were analyzed using multiple linear regression. Associations between Your Activities of Daily Living and Oswestry Disability Index (ODI) assessments were examined using Pearson correlation and hierarchical linear modeling. Results: A total of 93 participants were enrolled; of these, 35 (38%) completed the program (age: mean 46, SD 16 years; female: 22/35, 63%). More than half of completers finished assessments at least every 3 days and 70% (19/27) used the rehabilitation component at least once a week. Among respondents to a Web-based feedback survey, 76% (16/21) found the daily notifications helped them remember to complete their exercises, 81% (17/21) found the system easy to use, and 62% (13/21) rated their overall experience good or excellent. Baseline Your Activities of Daily Living score was a significant predictor of baseline ODI score, with ODI increasing by 0.30 units for every 1-unit increase in Your Activities of Daily Living (P<.001). Similarly, hierarchical linear modeling analysis indicated that Your Activities of Daily Living daily assessment scores were significant predictors of ODI scores over the course of the study (P=.01). Conclusions: Engagement among participants who completed the Limbr program was high, and program utility was rated positively by most respondents. Your Activities of Daily Living was significantly associated with ODI scores, supporting the validity of this novel tool. Future studies should assess the effect of Limbr on clinical outcomes, evaluate its use among a wider patient sample, and explore strategies for reducing attrition. Trial Registration: NCT03040310; (Archived by WebCite at

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

    Text Messaging Interventions for Improvement in Physical Activity and Sedentary Behavior in Youth: Systematic Review


    Background: The use of text messages (short message service, SMS) to change physical activity and sedentary behavior in youth is of interest due to the need for novel, more effective intervention approaches. Previous reviews have examined a variety of technology-based interventions and their impact on different health behaviors, but evidence regarding the impact of just SMS on physical activity and sedentary behavior is lacking. Objective: The aim of this study was to assess the effectiveness and use of theory of SMS interventions for improving physical activity and sedentary behavior in youth. Methods: Authors systematically searched electronic databases from March to November 2017. Citations were sifted using additional reviewers, and a qualitative synthesis of eligible studies was conducted using piloted data extraction forms. To be eligible for inclusion, studies had to be of a randomized controlled or quasi-experimental design, incorporate SMS, involve adolescents between the ages of 10 and 19 years, and assess at least one physical activity or sedentary behavior outcome. Risk of bias was assessed using the Cochrane Collaboration’s Risk of Bias tool. Results: A total of 13 studies reporting 11 interventions were included in the qualitative analysis. Studies included interventions that were conducted in schools, online, or face-to-face. Studies were of high heterogeneity with regard to study duration, participant characteristics, intervention content, and outcome measures. Findings were equivocal with regard to intervention effectiveness for physical activity and sedentary behavior. Overall, 7 interventions resulted in an improvement for physical activity and 6 for sedentary behavior. All studies were judged to be of high risk of bias for at least 1 item. Conclusions: Some studies in this review showed promising results for using SMS to improve physical activity and sedentary behavior in youth. High heterogeneity of design and outcome measures precluded data pooling and conclusions as to which specific intervention elements are linked to increased effectiveness cannot be drawn. The authors propose incorporating the following elements in future studies: specific focus on desired health behavior; mixed-methods design; include long-term follow-up; include self-monitoring, goal setting, and feedback; combine SMS with a mobile app; and send 3 or more SMS text messages per week. More rigorous studies are needed to explore the relationship between intervention effectiveness and specific intervention components such as content and delivery.

  • The PARADE app collects rheumatoid arthritis symptoms from patients’ own phones (montage). Source: The Authors /; Copyright: JMIR Publications; URL:; License: Creative Commons Attribution (CC-BY).

    Using a ResearchKit Smartphone App to Collect Rheumatoid Arthritis Symptoms From Real-World Participants: Feasibility Study


    Background: Using smartphones to enroll, obtain consent, and gather self-reported data from patients has the potential to enhance our understanding of disease burden and quantify physiological impact in the real world. It may also be possible to harness integral smartphone sensors to facilitate remote collection of clinically relevant data. Objective: We conducted the Patient Rheumatoid Arthritis Data From the Real World (PARADE) observational study using a customized ResearchKit app with a bring-your-own-device approach. Our objective was to assess the feasibility of using an entirely digital approach (social media and smartphone app) to conduct a real-world observational study of patients with rheumatoid arthritis. Methods: We conducted this observational study using a customized ResearchKit app with a bring-your-own-device approach. To recruit patients, the PARADE app, designed to guide patients through a series of tasks, was publicized via social media platforms and made available for patients in the United States to download from the Apple App Store. We collected patient-reported data, such as medical history, rheumatoid arthritis-related medications (past and present), and a range of patient-reported outcome measures. We included in the assessment a joint-pain map and a novel objective assessment of wrist range of movement, measured by the smartphone-embedded gyroscope and accelerometer. Results: Within 1 month of recruitment via social media campaigns, 399 participants self-enrolled, self-consented, and provided complete demographic data. Joint pain was the most frequently reported rheumatoid arthritis symptom to bother study participants (344/393, 87.5%). Severe patient-reported wrist pain appeared to be inversely linked with the range of wrist movement measured objectively by the app. At study entry, 292 of 399 participants (73.2%) indicated a preference for participating in a mobile app–based study. The number of participants in the study declined to 45 of 399 (11.3%) at week 12. Conclusions: Despite the declining number of participants over time, the combination of social media and smartphone app with sensor integration was a feasible and cost-effective approach for the collection of patient-reported data in rheumatoid arthritis. Integral sensors within smartphones can be harnessed to provide novel end points, and the novel wrist range of movement test warrants further clinical validation.

  • The InDEx app. Source: Image created by the Authors; Copyright: Daniel Leightley; URL:; License: Public Domain (CC0).

    A Smartphone App and Personalized Text Messaging Framework (InDEx) to Monitor and Reduce Alcohol Use in Ex-Serving Personnel: Development and Feasibility Study


    Background: Self-reported alcohol misuse remains high in armed forces personnel even after they have left service. More than 50% of ex-serving personnel meet the criteria for hazardous alcohol use; however, many fail to acknowledge that they have a problem. Previous research indicates that interventions delivered via smartphone apps are suitable in promoting self-monitoring of alcohol use, have a broad reach, and may be more cost-effective than other types of brief interventions. There is currently no such intervention specifically designed for the armed forces. Objective: This study sought to describe the development of a tailored smartphone app and personalized text messaging (short message service, SMS) framework and to test the usability and feasibility (measured and reported as user engagement) of this app in a hard-to-engage ex-serving population. Methods: App development used Agile methodology (an incremental, iterative approach used in software development) and was informed by behavior change theory, participant feedback, and focus groups. Participants were recruited between May 2017 and June 2017 from an existing United Kingdom longitudinal military health and well-being cohort study, prescreened for eligibility, and directed to download either Android or iOS versions of the ”Information about Drinking for Ex-serving personnel” (InDEx) app. Through the app, participants were asked to record alcohol consumption, complete a range of self-report measures, and set goals using implementation intentions (if-then plans). Alongside the app, participants received daily automated personalized text messages (SMS) corresponding to specific behavior change techniques with content informed by the health action process approach with the intended purpose of promoting the use of the drinks diary, suggesting alternative behaviors, and providing feedback on goals setting. Results: Invitations to take part in the study were sent to ex-serving personnel, 22.6% (31/137) of whom accepted and downloaded the app. Participants opened the InDEx app a median of 15.0 (interquartile range [IQR] 8.5-19.0) times during the 4 week period (28 days), received an average of 36.1 (SD 3.2) text messages (SMS), consumed alcohol on a median of 13.0 (IQR 11.0-15.0) days, and consumed a median of 5.6 (IQR 3.3-11.8) units per drinking day in the first week, which decreased to 4.7 (IQR 2.0-6.9) units by the last week and remained active for 4.0 (IQR 3.0-4.0) weeks. Conclusions: Personnel engaged and used the app regularly as demonstrated by the number of initializations, interactions, and time spent using InDEx. Future research is needed to evaluate the engagement with and efficacy of InDEx for the reduction of alcohol consumption and binge drinking in an armed forces population.

  • mSMART app (composite). Source: The Authors / Placeit; Copyright: Intelligent Automation, Incorporated; URL:; License: Licensed by JMIR.

    Smartphone-Based Contingency Management Intervention to Improve Pre-Exposure Prophylaxis Adherence: Pilot Trial


    Background: Pre-exposure prophylaxis (PrEP) provides a strong preventative benefit to individuals at risk for HIV. While PrEP adherence is highly correlated with its efficacy, adherence rates are variable both across and within persons. Objective: The objective of this study was to develop and pilot-test a smartphone-based intervention, known as mSMART, that targets PrEP adherence. mSMART provides contingency management in the form of monetary incentives for daily PrEP adherence based on a real-time adherence assessment using a camera-based medication event-monitoring tool as well as medication reminders, PrEP education, individualized behavioral strategies to address PrEP adherence barriers, and medication adherence feedback. Methods: This was a 4-week open-label, phase I trial in a community sample of young men who have sex with men already on PrEP (N=10). Results: Although adherence composite scores corresponding to PrEP biomarkers indicated that 90% (9/10) of the sample already had an acceptable baseline adherence in the protective range, by the end of the 4-week period, the scores improved for 30% (3/10) of the sample—adherence did not worsen for any participants. Participants reported mean PrEP adherence rates of 91% via daily entries in mSMART. At the end of the 4-week period, participants indicated acceptable ratings of satisfaction, usability, and willingness to recommend mSMART to others. There were no technical difficulties associated with smartphone compatibility, user misunderstandings about mSMART features that interfered with daily use, or study attrition. Conclusions: This study is the first to apply contingency management to PrEP adherence. Findings indicated that mSMART is feasible and acceptable. Such an adherence intervention administered via a user-friendly smartphone app can allow for widespread dissemination. Future efficacy trials are needed. Trial Registration: NCT02895893; (Accessed by Webcite at

  • Usability testing of the mHealth intervention, MyPEEPS Mobile. Source: Image created by the Authors; Copyright: Hwayoung Cho; URL:; License: Licensed by JMIR.

    A Mobile Health Intervention for HIV Prevention Among Racially and Ethnically Diverse Young Men: Usability Evaluation


    Background: Mobile health (mHealth) apps have the potential to be a useful mode of delivering HIV prevention information, particularly for young men (13-24 years) who account for 21% of new HIV diagnoses in the United States. We translated an existing evidence-based, face-to-face HIV prevention curriculum into a portable platform and developed a mobile Web app: MyPEEPS Mobile. Objective: The purpose of this study was to assess the usability of MyPEEPS Mobile from both expert and end user perspectives. Methods: We conducted a heuristic evaluation with five experts in informatics to identify violations of usability principles and end user usability testing with 20 young men aged 15 to 18 years in New York, NY, Birmingham, AL, and Chicago, IL to identify potential obstacles to their use of the app. Results: Mean scores of the overall severity of the identified heuristic violations rated by experts ranged from 0.4 and 2.6 (0=no usability problem to 4=usability catastrophe). Overall, our end users successfully completed the tasks associated with use case scenarios and provided comments/recommendations on improving usability of MyPEEPS Mobile. The mean of the overall Post-Study System Usability Questionnaire scores rated by the end users was 1.63 (SD 0.65), reflecting strong user acceptance of the app. Conclusions: The comments made by experts and end users will be used to refine MyPEEPS Mobile prior to a pilot study assessing the acceptability of the app across diverse sexual minority young men in their everyday lives.

  • The MyFood app (montage). Source: The Authors /; Copyright: JMIR Publications; URL:; License: Creative Commons Attribution (CC-BY).

    A Dietary Assessment App for Hospitalized Patients at Nutritional Risk: Development and Evaluation of the MyFood App


    Background: Disease-related malnutrition is a common challenge among hospitalized patients. There seems to be a lack of an effective system to follow-up nutritional monitoring and treatment of patients at nutritional risk after risk assessment. We identify a need for a more standardized system to prevent and treat disease-related malnutrition. Objective: We aimed to develop a dietary assessment app for tablets for use in a hospital setting and to evaluate the app’s ability to measure individual intake of energy, protein, liquid, and food and beverage items among hospitalized patients for two days. We also aimed to measure patients’ experiences using the app. Methods: We have developed the MyFood app, which consists of three modules: 1) collection of information about the patient, 2) dietary assessment function, and 3) evaluation of recorded intake compared to individual needs. We used observations from digital photography of the meals, combined with partial weighing of the meal components, as a reference method to evaluate the app’s dietary assessment system for two days. Differences in the intake estimations of energy, protein, liquid, and food and beverage items between MyFood and the photograph method were analyzed on both group and individual level. Results: Thirty-two patients hospitalized at Oslo University Hospital were included in the study. The data collection period ran from March to May 2017. About half of the patients had ≥90% agreement between MyFood and the photograph method for energy, protein, and liquid intake on both recording days. Dinner was the meal with the lowest percent agreement between methods. MyFood overestimated patients’ intake of bread and cereals and underestimated fruit consumption. Agreement between methods increased from day 1 to day 2 for bread and cereals, spreads, egg, yogurt, soup, hot dishes, and desserts. Ninety percent of participants reported that MyFood was easy to use, and 97% found the app easy to navigate. Conclusions: We developed the MyFood app as a tool to monitor dietary intake among hospitalized patients at nutritional risk. The recorded intake of energy, protein, and liquid using MyFood showed good agreement with the photograph method for the majority of participants. The app’s ability to estimate intake within food groups was good, except for bread and cereals which were overestimated and fruits which were underestimated. The app was well accepted among study participants and has the potential to be a dietary assessment tool for use among patients in clinical practice.

  • Checking PiezoRx step counts. Source: Image created by the Authors; Copyright: The Authors; URL:; License: Creative Commons Attribution (CC-BY).

    Medical-Grade Physical Activity Monitoring for Measuring Step Count and Moderate-to-Vigorous Physical Activity: Validity and Reliability Study


    Background: The use of physical activity (PA) monitors is commonly associated with an increase in habitual PA level in healthy and clinical populations. The PiezoRx is a medical-grade PA monitor that uses adjustable step rate thresholds to estimate moderate-to-vigorous physical activity (MVPA) and is a valid indicator of free-living PA in adults. Laboratory validation of step count derived MVPA in adults is needed to justify the use of these monitors in clinical practice to track individuals’ progress toward meeting PA guidelines that are based on MVPA, not steps. Objective: The objective of our study was to assess the validity and interinstrument reliability of the PiezoRx to derive step count and MVPA in a laboratory setting compared with criterion measures and other frequently used PA monitors in a diverse sample of adults. Methods: The adult participants (n=43; 39.4 years, SD 15.2) wore an Omron HJ-320 pedometer, an ActiGraph GT3X accelerometer, and four PiezoRx monitors during a progressive treadmill protocol conducted for 6 minutes at speeds of 2.4, 3.2, 4.0, 5.6, 6.4, and 7.2 km/hour, respectively. The four PiezoRx monitors were set at different MVPA step rate thresholds (MPA in steps/minute/VPA in steps/minute) 100/120, 110/130, height adjusted, and height+fitness adjusted. Results: The PiezoRx was more correlated (intraclass correlation, ICC=.97; P<.001) to manual step counting than the ActiGraph (ICC=.72; P<.001) and Omron (ICC=.62; P<.001). The PiezoRxs absolute percent error in measuring steps was 2.2% (ActiGraph=15.9%; Omron=15.0%). Compared with indirect calorimetry, the height-adjusted PiezoRx and ActiGraph were accurate measures of the time spent in MVPA (both ICC=.76; P<.001). Conclusions: The PiezoRx PA monitor appears to be a valid and reliable measure of step count and MVPA in this diverse sample of adults. The device’s ability to measure MVPA may be improved when anthropometric differences are considered, performing at par or better than a research grade accelerometer.

  • Source: Flickr; Copyright: screenpunk; URL:; License: Creative Commons Attribution + Noncommercial (CC-BY-NC).

    Development and Feasibility Testing of an mHealth (Text Message and WeChat) Intervention to Improve the Medication Adherence and Quality of Life of People...


    Background: Most people living with HIV (PLWH) reside in middle- and low-income countries with limited access to health services. Thus, cost-effective interventions that can reach a large number of PLWH are urgently needed. Objective: The objective of our study was to assess the feasibility and acceptability of an mHealth intervention among PLWH in China. Methods: Based on previous formative research, we designed an mHealth intervention program that included sending weekly reminders to participants via text messages (short message service, SMS) and articles on HIV self-management three times a week via a popular social media app WeChat. A total of 62 PLWH recruited from an HIV outpatient clinic were randomly assigned to intervention or control group. The intervention lasted for 3 months, and all participants were assessed for their medication adherence, presence of depression, quality of life (QoL), and CD4 (cluster of differentiation 4) counts. Upon completing the intervention, we interviewed 31 participants to further assess the feasibility and acceptability of the study. Results: At baseline, the intervention and control groups did not differ in terms of demographic characteristics or any of the major outcome measures. About 85% (53/62) of the participants completed the intervention, and they provided valuable feedback on the design and content of the intervention. Participants preferred WeChat as the platform for receiving information and interactive communication for ease of access. Furthermore, they made specific recommendations about building trust, interactive features, and personalized feedback. In the follow-up assessment, the intervention and control groups did not differ in terms of major outcome measures. Conclusions: This pilot study represents one of the first efforts to develop a text messaging (SMS)- and WeChat-based intervention that focused on improving the medication adherence and QoL of PLWH in China. Our data indicates that an mHealth intervention is feasible and acceptable to this population. The data collected through this pilot study will inform the future designs and implementations of mHealth interventions in this vulnerable population. We recommend more innovative mHealth interventions with rigorous designs for the PLWH in middle- and low-income countries. Trial Registration: Chinese Clinical Trial Registry ChiCTR1800017987; (Archived by WebCite at Registered Report Ientifier: RR1-10.2196

  • Picture of eating detection sensor. Source: Image created by the authors; Copyright: CSEM SA—Swiss Center for Electronics & Microtechnology; URL:; License: Creative Commons Attribution (CC-BY).

    The SPLENDID Eating Detection Sensor: Development and Feasibility Study


    Background: The available methods for monitoring food intake—which for a great part rely on self-report—often provide biased and incomplete data. Currently, no good technological solutions are available. Hence, the SPLENDID eating detection sensor (an ear-worn device with an air microphone and a photoplethysmogram [PPG] sensor) was developed to enable complete and objective measurements of eating events. The technical performance of this device has been described before. To date, literature is lacking a description of how such a device is perceived and experienced by potential users. Objective: The objective of our study was to explore how potential users perceive and experience the SPLENDID eating detection sensor. Methods: Potential users evaluated the eating detection sensor at different stages of its development: (1) At the start, 12 health professionals (eg, dieticians, personal trainers) were interviewed and a focus group was held with 5 potential end users to find out their thoughts on the concept of the eating detection sensor. (2) Then, preliminary prototypes of the eating detection sensor were tested in a laboratory setting where 23 young adults reported their experiences. (3) Next, the first wearable version of the eating detection sensor was tested in a semicontrolled study where 22 young, overweight adults used the sensor on 2 separate days (from lunch till dinner) and reported their experiences. (4) The final version of the sensor was tested in a 4-week feasibility study by 20 young, overweight adults who reported their experiences. Results: Throughout all the development stages, most individuals were enthusiastic about the eating detection sensor. However, it was stressed multiple times that it was critical that the device be discreet and comfortable to wear for a longer period. In the final study, the eating detection sensor received an average grade of 3.7 for wearer comfort on a scale of 1 to 10. Moreover, experienced discomfort was the main reason for wearing the eating detection sensor <2 hours a day. The participants reported having used the eating detection sensor on 19/28 instructed days on average. Conclusions: The SPLENDID eating detection sensor, which uses an air microphone and a PPG sensor, is a promising new device that can facilitate the collection of reliable food intake data, as shown by its technical potential. Potential users are enthusiastic, but to be successful wearer comfort and discreetness of the device need to be improved.

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

    Mobile Apps for Oral Health Promotion: Content Review and Heuristic Usability Analysis


    Background: There has been an increase in consumer-facing mobile health (mHealth) apps in recent years. Prior reviews have characterized the availability, usability, or quality of popular mHealth apps targeting a range of health behaviors, but none has examined apps that promote better oral health care. Oral disease affects billions of people worldwide and mobile phone use is on the rise, so the market for well-designed and effective oral health apps is substantial. Objective: We examined the content and usability of popular oral health promotion apps to better understand the current state of these self-help interventions and inform the need and opportunity for future app development. Methods: Between February and March 2018, we identified oral health-focused apps that were designed for Android or iOS, available in English, and targeted adult consumers (as opposed to children or dental health professionals). The sample was limited to the most popular and highly rated apps on each platform. For each app reviewed, we assessed its basic descriptive characteristics (eg, platform, cost), evidence of a theoretical basis or empirical validation, key program functionality, and the extent to which the app addressed diet and tobacco and alcohol use as risk factors for oral disease. We characterized the framing (ie, gain vs loss) of all persuasive messaging and conducted a heuristic analysis to assess each app’s usability as a persuasive health technology. Results: Thirty-three apps were eligible for review based on the selection criteria. Two-thirds (22/33, 67%) were geared toward the general public as opposed to dental clinic patients, insurance plan members, or owners of specific electric toothbrushes. Most (31/33, 94%) were free to download, and a majority (19/33, 58%) were sponsored by software developers as opposed to oral health experts. None offered any theoretical basis for the content or had been empirically validated. Common program features included tools for tracking or reminding one to brush their teeth and assistance scheduling dental appointments. Nineteen apps (58%) included educational or persuasive content intended to influence oral health behavior. Only 32% (6/19) of these included a larger proportion of gain-framed than loss-framed messaging. Most of the apps did not mention diet, alcohol or tobacco—important risk factors for oral disease. Overall, the apps performed poorly on standard usability heuristics recommended for persuasive health technologies. Conclusions: The quality of the reviewed apps was generally poor. Important opportunities exist to develop oral health promotion apps that have theoretically grounded content, are empirically validated, and adhere to good design principles for persuasive health technologies.

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    Date Submitted: Sep 14, 2018

    Open Peer Review Period: Sep 19, 2018 - Nov 14, 2018

    Introduction: Mobile augmented reality (MAR) applications offer support for emergency responders in rural areas. We describe the lessons learned from the development process of AR MAPPER, a MAR app th...

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  • A Framework for Mobile Health, Smartphone/Device and App Competencies for Psychiatry and Medicine

    Date Submitted: Sep 16, 2018

    Open Peer Review Period: Sep 17, 2018 - Nov 13, 2018

    Background: Technology use is ubiquitous in the digital age, especially in the X, Millennial/Y and Z generations. To ensure quality care, clinicians need skills, knowledge and attitudes that can be me...

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  • Development process of text messaging interventions for the prevention and management of cardiovascular disease included in the Text2Prevent cardiovascular disease systematic review

    Date Submitted: Sep 13, 2018

    Open Peer Review Period: Sep 17, 2018 - Nov 13, 2018

    Background: Interventions delivered by mobile phones or other digital devices have the potential to improve outcomes and prevention for people with cardiovascular disease (CVD) by supporting behaviour...

    Background: Interventions delivered by mobile phones or other digital devices have the potential to improve outcomes and prevention for people with cardiovascular disease (CVD) by supporting behaviour change towards healthier lifestyle and successful treatment adherence. To allow replication and adaptation of these interventions across settings it is important to fully understand how they have been developed. However, the differing development processes have not been systematically compared. Objective: To systematically describe and compare the development process for text messaging interventions targeting the prevention and management of cardiovascular disease collaborating in the Text2Prevent CVD study group. Methods: We gathered data from the nine trials identified in the Text2PreventCVD meta-analysis describing the intervention development process. Data extraction was guided by frameworks for the development of complex interventions that included the following development stages: intervention planning, design, development, and pretesting. Following systematic data extraction from available publications, we invited authors to contribute by reviewing extracted data and providing additional details not reported in publications. Results: A comprehensive description of the intervention development process was available for five trials. A variety of methodologies were reported for the development of each intervention. Intervention planning involved gathering information from stakeholder consultations, literature reviews, examination of relevant theory, and preliminary qualitative research. Intervention design involved the theories of behaviour change (in some cases to select or develop intervention techniques, or to tailor intervention techniques to recipients), and the use of multiple behaviour change techniques. Intervention development involved i) generating messages content based on clinical guidelines and expert opinions, ii) conducting literature reviews and primary qualitative research to inform decisions about other intervention characteristics (message frequency, timing, directionality, or level of tailoring), and iii) gathering end of user feedback (through structured questionnaires, semi-structured interviews, or focus groups) to examine message readability, intervention acceptability and perceived utility. Intervention pre-testing involved pilot studies with a purposive or convenience sample of 10 to 30 participants receiving messages for a period of one to four weeks. Conclusions: The development process of the text messaging interventions for the prevention and management of CVD identified in this review was complex and comprehensive, requiring numerous studies to obtain evidence to inform decisions about the scope, content, and structure of the interventions. Additional research is needed to examine the potential association between development methods and intervention success, as well as trying to identify "active ingredients" in the development methods. Further work is also needed to establish whether effective messaging systems can be adapted from work already done, or whether this level of development is needed for application in other conditions and settings.

  • Effect of a Tablet-Based Self-Monitoring Tool on the Usage of an Incentive Spirometer by Surgical Patients

    Date Submitted: Sep 13, 2018

    Open Peer Review Period: Sep 17, 2018 - Sep 26, 2018

    Background: An incentive spirometer (IS) plays a key role in the prevention of post-operative complications, and the appropriate use of an IS is especially well-known for the prevention of respiratory...

    Background: An incentive spirometer (IS) plays a key role in the prevention of post-operative complications, and the appropriate use of an IS is especially well-known for the prevention of respiratory complications. However, IS utilization depends on the patient’s engagement, and information and communication technology (ICT) can help in this area. Objective: This study’s aim was to determine the effect of mobile ICT on the usage of an IS [Go-breath] app by post-operative patients after general anesthesia. Methods: Our study recruited a total of 42 patients from April to May 2018 who used the Go-breath app at a single tertiary hospital in South Korea. The patients were randomly classified into either a test or control group. The main function of the Go-breath app was to allow for self-reporting and frequency monitoring of IS use, deep breathing, and active coughing in real-time. The Go-breath app was identical for both the test and control groups, except for the presence of the alarm function. The test group heard an alarm every 60 minutes from 9 am to 9 pm for two days. For the test group only, a dashboard was established in the nurse’s station through which a nurse could rapidly assess the performance of multiple patients. Results: The incentive spirometer index (ISI) in the test group was 20.2 points higher than that in the control group (113.5 points in the test group and 93.2 points in the control group, p=.22). The system usability scale generally showed the same score in the two groups. We observed that the performance rates of IS count, active coughing, and deep breathing were also higher in the test group, but with no statistically significant difference between the groups. For the usefulness “yes or no” question, over 90.0% of patients answered “yes” and wanted more functional options and information. Conclusions: The use of the Go-breath app resulted in considerable differences between the test group and control group, but with no statistically significant differences. Clinical Trial: US National Institutes of Health Clinical Trials Registry : NCT03569332 institutional review board of the study site number : 2018-02-135

  • A smartphone app with optical imaging for self-management of hand rheumatoid arthritis: Pilot study

    Date Submitted: Sep 16, 2018

    Open Peer Review Period: Sep 17, 2018 - Sep 26, 2018

    Background: When individuals are active self-managers of their own health patient outcomes are improved and the burden to the healthcare system is reduced. There is a need for technology that facilita...

    Background: When individuals are active self-managers of their own health patient outcomes are improved and the burden to the healthcare system is reduced. There is a need for technology that facilitates self-management of rheumatoid arthritis (RA) that can reduce the number of patient visits, promptly identify treatment needs, and reduce the costs associated with poor RA management. A smartphone application named LiveWith™ Arthritis has been developed that allows patients with RA to use their smartphone to regularly collect self-management data and to take objective measurements of the impact of RA on their finger joints using optical imaging technology. Objective: The objectives of this pilot study were to 1) gather preliminary data as to whether a smartphone application with hand optical imaging capabilities improves self-management behaviors (self-efficacy in managing symptoms and patient activation), 2) determine if app use shows promise in improving health outcomes (pain, HAQ-II), and 3) determine barriers to use of the smartphone application in adults with RA. Methods: This pilot study used a mixed-method design. The quantitative portion was a traditional two-group experimental design, and the qualitative portion was a follow up telephone interview for intervention participants who did not complete the study. Measures of self management included the PROMIS self efficacy in managing symptoms (P-SEMS) and Patient Activation Measure (PAM). Health outcomes included pain by Visual Analog Scale and disability by Health Assessment Questionnaire II (HAQ-II). Results: The final sample consisted of 21 intervention participants and 15 controls. There was a statistically significant improvement in self-efficacy in managing symptoms (P-SEMS) and promising trends for improvement in PAM, HAQ-II and pain scores for participants who used the app. Of the intervention participants who did not complete the study, n=12 completed the qualitative interview on barriers to use. Qualitative content analysis revealed three themes for barriers to using the app including 1)frustration with technology, 2) RA made the app difficult to use, and 3) I already have a self-management system that works for me. Conclusions: The LiveWith™ Arthritis app shows promise for improving self-management behaviors and health outcomes in adults with RA. Future study with a larger sample size is required to confirm findings. Initial app experience is important for adoption and continual use of the app. Individuals with significant disability to the hand would benefit from voice activated app features. Participants who already have a system of managing their RA may not feel compelled to switch methods, even when a novel optical imagining feature is available.

  • Vital Challenges for Health and Wellness Mobile Applications – A case study in Asia Pacific

    Date Submitted: Sep 10, 2018

    Open Peer Review Period: Sep 15, 2018 - Nov 10, 2018

    Background: By 2019, there will be an estimated 4.68-billion mobile phone users globally. Along with this comes an unprecedented proliferation in mobile Apps, a plug and play product positioned to imp...

    Background: By 2019, there will be an estimated 4.68-billion mobile phone users globally. Along with this comes an unprecedented proliferation in mobile Apps, a plug and play product positioned to improve lives in innumerable ways. Within this landscape, medical Apps will see a 41% compounded annual growth rate (CAGR) between 2015-2020, but paradoxically, prevailing evidence indicates declining downloads of such Apps and decreasing “stickiness” with the intended end users. Objective: As usability is a prerequisite for success of health and wellness mobile Apps, this paper aims to provide insights and suggestions for improving the mHealth App usability experience, by exploring the degree of alignment between mHealth Insiders and consumers. Methods: A need gap was identified in past mHealth research approaches, where few mixed-methods studies have been performed. A customized mixed-research data synchronization was used to align (i) categorical data from qualitative mHealth insider interviews and (ii) numerical data from a quantitative consumer survey, in order to identify common usability themes and areas of divergence. Results: Of the five usability attributes described in Nielsen’s model, Satisfaction ranked as the top attribute for both mHealth Insiders and consumers. Satisfaction refers to user-likability, comfort and pleasure. Also, five out of nine mHealth Insiders’ top concerns are similar to consumers. On the other hand, consumers did not grade themes such as intuitiveness – deemed vital by mHealth Insiders – as important. Other concerns by the consumers include in-App charging and advertisements. Conclusions: Strengthening the connectivity between suppliers and users (through the designed research tool) will contribute to increased uptake of mHealth Apps. This study supports and has also contributed to the existing pool of mixed-research studies. In addition, this work has generated several ideas (e.g. sustainable business model Apps) and initiated new avenues of inquiry (e.g. dominant category players to lead future development) for future validation. Clinical Trial: No Clinical Trial