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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 self-care app for cancer patients. Source: Image created by the Authors; Copyright: Michael Mikolasek; URL:; License: Licensed by JMIR.

    Adherence to a Mindfulness and Relaxation Self-Care App for Cancer Patients: Mixed-Methods Feasibility Study


    Background: Cancer is highly prevalent worldwide and can cause high levels of distress in patients, which is often neglected in medical care. Smartphone apps are readily available and therefore seem promising to deliver distress-reducing interventions such as mindfulness and relaxation programs. Objective: This study aimed to evaluate the feasibility of a mindfulness and relaxation app for cancer patients. We looked at characteristics of participating patients in a mobile health (mHealth) study, including adherence to the app intervention, predictors for adherence, and patients’ feedback regarding the app. Methods: In this prospective observational study with a mixed-methods approach, cancer patients received a mindfulness and relaxation self-care app. Cancer patients were recruited online and through hospitals in Switzerland. We assessed self-reported measures (eg, quality of life, anxiety, depressive symptoms, openness to experience, resistance to change) at baseline, and the app gathered data on patients’ practicing time. With 8 semistructured interviews, we obtained patients’ feedback about the app and recommendations for improvements. We looked at 3 dimensions of the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework (reach, adoption, and maintenance) and analyzed data for adherence for the first 10 weeks of the app intervention. We report descriptive statistics for patient characteristics and app use. For the prediction of adherence, we used Kaplan-Meier analyses with log-rank tests and a Cox proportional hazards regression. Results: Data from 100 cancer patients (74 female) showed that 54 patients were using the app exercises continuously until week 10. In continuous app users, the median number of exercises per week dropped from 4 (interquartile range, IQR 1-7) at week 1 to a median of 2 (IQR 1-4) at week 10. Our analyses revealed 4 significant predictors for better adherence: female gender, higher openness to experience, higher resistance to change, and more depressive symptoms. Interviews revealed that the patients generally were satisfied with the app but also made suggestions on how to improve it. Conclusions: Our study indicates that a mindfulness and relaxation mHealth intervention for cancer patients is feasible with acceptable adherence and largely positive feedback from patients. Trial Registration: German Clinical Trials Register DRKS00010481; Id=trial.HTML&TRIAL_ID=DRKS00010481 (Archived by WebCite at

  • The HeadGear app. Source: Image created by the Authors; Copyright: The Authors; URL:; License: Licensed by JMIR.

    Preliminary Effectiveness of a Smartphone App to Reduce Depressive Symptoms in the Workplace: Feasibility and Acceptability Study


    Background: The workplace represents a unique setting for mental health interventions. Due to range of job-related factors, employees in male-dominated industries are at an elevated risk. However, these at-risk groups are often overlooked. HeadGear is a smartphone app–based intervention designed to reduce depressive symptoms and increase well-being in these populations. Objective: This paper presents the development and pilot testing of the app’s usability, acceptability, feasibility, and preliminary effectiveness. Methods: The development process took place from January 2016 to August 2017. Participants for prototype testing (n=21; stage 1) were recruited from industry partner organizations to assess acceptability and utility. A 5-week effectiveness and feasibility pilot study (n=84; stage 2) was then undertaken, utilizing social media recruitment. Demographic data, acceptability and utility questionnaires, depression (Patient Health Questionnaire-9), and other mental health measures were collected. Results: The majority of respondents felt HeadGear was easy to use (92%), easily understood (92%), were satisfied with the app (67%), and would recommend it to a friend (75%; stage 1). Stage 2 found that compared with baseline, depression and anxiety symptoms were significantly lower at follow-up (t30=2.53; P=.02 and t30=2.18; P=.04, respectively), days of sick leave in past month (t28=2.38; P=.02), and higher self-reported job performance (t28=−2.09; P=.046; stage 2). Over 90% of respondents claimed it helped improve their mental fitness, and user feedback was again positive. Attrition was high across the stages. Conclusions: Overall, HeadGear was well received, and preliminary findings indicate it may provide an innovative new platform for improving mental health outcomes. Unfortunately, attrition was a significant issue, and findings should be interpreted with caution. The next stage of evaluation will be a randomized controlled trial. If found to be efficacious, the app has the potential to reduce disease burden and improve health in this at-risk group.

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

    What Drives Young Vietnamese to Use Mobile Health Innovations? Implications for Health Communication and Behavioral Interventions


    Background: Mobile phone use in Vietnam has become increasingly popular in recent years, with youth (people aged 15-24 years) being one of the groups with the heaviest use. Health-related apps on mobile phones (mobile health [mHealth] apps) appear to be a feasible approach for disease and health management, especially for self-management. However, there has been a scarcity of research on mobile phone usage for health care among youth and adolescents. Objective: This study aims to identify the patterns of usage of mobile phone apps and the preferences for functionalities of mobile phone-based health-related apps among Vietnamese youth. Methods: An online cross-sectional study was conducted in Vietnam in August to October 2015. Web-based respondent-driven sampling technique was adopted to recruit participants. The online questionnaire was developed and distributed using Google Forms. Chi square and Mann-Whitney tests were used to investigate the difference in attitude and preference for mobile phone apps between the two genders. Results: Among 356 youths (age from 15 to 25 years) sampled, low prevalence was found of using mHealth apps such as beauty counseling (6.5%, 23/356), nutrition counseling (7.9%, 28/356), disease prevention (9.8%, 35/356), and disease treatment (7.6%, 27/356). The majority of users found the app(s) they used to be useful (72.7%, 48/356) and reported satisfaction with these apps (61.9%, 39/356). No significant differences were found between the genders in their perception of the usefulness of apps and their satisfaction with mobile health apps. Most of the participants (68.2%, 238/356) preferred apps which are conceptualized and designed to run on a mobile phone compared to Web-based apps, and 50% (176/356) preferred visual materials. Approximately 53.9% (188/356) reported that it was integral for the mobile phone apps to have a sharing/social network functionality. Participants with a higher perceived stress score and EuroQol-5 Dimensions (EQ-5D) index were significantly less likely to use mHealth apps. Conclusions: This study found a low proportion using mHealth-related mobile phone apps, but a high level of receptiveness and satisfaction among Vietnamese youth. Acceptance level and preferences toward mHealth apps as well as specifically preferred functionalities discovered in this study are essential not only in conceptualizing and developing appropriate mobile phone interventions targeting youth and adolescents, but also in the application of technically advanced solutions in disease prevention and health management.

  • Pregnant women waiting for antenatal care in the maternity department of the Maternal and Child Health Hospital of Hunan Province. Source: The Authors; Copyright: The Authors; URL:; License: Licensed by JMIR.

    The Association Between the Use of Antenatal Care Smartphone Apps in Pregnant Women and Antenatal Depression: Cross-Sectional Study


    Background: Antenatal care smartphone apps are increasingly used by pregnant women, but studies on their use and impact are scarce. Objective: This study investigates the use of antenatal care apps in pregnant women and explores the association between the use of these apps and antenatal depression. Methods: This study used a convenient sample of pregnant women recruited from Hunan Provincial Maternal and Child Health Hospital in November 2015. The participants were surveyed for their demographic characteristics, use of antenatal care apps, and antenatal depression. Factors that influenced antenatal pregnancy were analyzed using logistic regression. Results: Of the 1304 pregnant women, 71.31% (930/1304) used antenatal care apps. Higher usage of apps was associated with urban residency, nonmigrant status, first pregnancy, planned pregnancy, having no previous children, and opportunity to communicate with peer pregnant women. The cutoff score of the Edinburgh Postnatal Depression Scale was 10, and 46.11% (601/1304) of the pregnant women had depression. Logistic regression showed that depression was associated with the availability of disease-screening functions in the apps (odds ratio (OR) 1.78, 95% CI 1.03-3.06) and spending 30 minutes or more using the app (OR 2.05, 95% CI 1.19-3.52). Using apps with social media features was a protective factor for antenatal depression (OR 0.33, 95% CI 0.12-0.89). Conclusions: The prevalence of the use of prenatal care apps in pregnant women is high. The functions and time spent on these apps are associated with the incidence of antenatal depression.

  • Source:; Copyright: bruce mars; URL:; License: Public Domain (CC0).

    To Prompt or Not to Prompt? A Microrandomized Trial of Time-Varying Push Notifications to Increase Proximal Engagement With a Mobile Health App


    Background: Mobile health (mHealth) apps provide an opportunity for easy, just-in-time access to health promotion and self-management support. However, poor user engagement with these apps remains a significant unresolved challenge. Objective: This study aimed to assess the effect of sending versus not sending a push notification containing a contextually tailored health message on proximal engagement, measured here as self-monitoring via the app. Secondary aims were to examine whether this effect varies by the number of weeks enrolled in the program or by weekday versus weekend. An exploratory aim was to describe how the effect on proximal engagement differs between weekday versus weekend by the time of day. Methods: The study analyzes the causal effects of push notifications on proximal engagement in 1255 users of a commercial workplace well-being intervention app over 89 days. The app employs a microrandomized trial (MRT) design to send push notifications. At 1 of 6 times per day (8:30 am, 12:30 pm, 5:30 pm, 6:30 pm, 7:30 pm, and 8:30 pm; selected randomly), available users were randomized with equal probability to be sent or not sent a push notification containing a tailored health message. The primary outcome of interest was whether the user self-monitored behaviors and feelings at some time during the next 24 hours via the app. A generalization of log-linear regression analysis, adapted for use with data arising from an MRT, was used to examine the effect of sending a push notification versus not sending a push notification on the probability of engagement over the next 24 hours. Results: Users were estimated to be 3.9% more likely to engage with the app in the next 24 hours when a tailored health message was sent versus when it was not sent (risk ratio 1.039; 95% CI 1.01 to 1.08; P<.05). The effect of sending the message attenuated over the course of the study, but this effect was not statistically significant (P=.84). The effect of sending the message was greater on weekends than on weekdays, but the difference between these effects was not statistically significant (P=.18). When sent a tailored health message on weekends, the users were 8.7% more likely to engage with the app (95% CI 1.01 to 1.17), whereas on weekdays, the users were 2.5% more likely to engage with the app (95% CI 0.98 to 1.07). The effect of sending a tailored health message was greatest at 12:30 pm on weekends, when the users were 11.8% more likely to engage (90% CI 1.02 to 1.13). Conclusions: Sending a push notification containing a tailored health message was associated with greater engagement in an mHealth app. Results suggested that users are more likely to engage with the app within 24 hours when push notifications are sent at mid-day on weekends.

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

    A Mobile Technology Intervention With Ultraviolet Radiation Dosimeters and Smartphone Apps for Skin Cancer Prevention in Young Adults: Randomized Controlled...


    Background: Skin cancer is the most prevalent and most preventable cancer in Australia. Despite Australia’s long-running public health campaigns, young Australian adults continue to report high levels of ultraviolet radiation (UVR) exposure and frequent sunburns. Young people are now increasingly turning away from traditional media, such as newspapers and TV, favoring Web-based streaming, which is challenging the health care sector to develop new ways to reach this group with targeted, personalized health promotion messages. Advances in technology have enabled delivery of time- and context-relevant health interventions. Objective: The primary aim of this randomized controlled trial was to test the effect of UVR feedback from a smartphone app or a UVR dosimeter feedback device on sun protection habits, sun exposure behaviors, sunburn, and physical activity levels in young adults. Methods: Young adults aged 18-35 years (n=124) were recruited from Queensland, Australia, between September 2015 and April 2016, via social or traditional media campaigns and outreach activities in the local community. Participants were randomized into 3 groups for a 4-week intervention: (1) no intervention control group; (2) UVR monitor group, who were asked to wear a UVR dosimeter feedback device set to their skin type; and (3) a SunSmart app group, who were asked to download and use the SunSmart phone app. Data were self-assessed through Web-based surveys at baseline and 1 week and 3 months postintervention. Results: Complete data were available for 86.2% (107/124) of participants (control group, n=36; UVR monitor group, n=36; and SunSmart app group, n=35). Intervention uptake in the UVR monitor group was high, with 94% (34/36) of participants using the device all or some of the time when outdoors. All SunSmart app group participants downloaded the app on their smartphone. There was no significant difference in the change in the sun protection habits (SPH) index (main outcome measure) across the 3 groups. However, compared with the control group, a significantly greater proportion of the participants in the UVR monitor group reduced their time unprotected and exposed to UVR on weekends during the intervention compared with the baseline (odds ratio [OR]: 2.706, 95% CI 1.047-6.992, P=.04). This significant effect was sustained with greater reductions observed up to 3 months postintervention (OR: 3.130, 95% CI 1.196-8.190, P=.02). There were no significant differences between the groups in weekday sun exposure, sunscreen use, sunburn, suntan, or physical activity. Conclusions: Using technology such as apps and personal UVR monitoring devices may improve some sun exposure behaviors among young adults, but as the SPH index did not increase in this study, further research is required to achieve consistent uptake of sun protection in young people. Trial Registration: The Australian and New Zealand Clinical Trials register ACTRN12615001296527; (Archived by WebCite at

  • Fitness tracker use to increase physical activity. Source: Pixabay; Copyright: StockSnap; URL:; License: Public Domain (CC0).

    Feasibility of Using a Commercial Fitness Tracker as an Adjunct to Family-Based Weight Management Treatment: Pilot Randomized Trial


    Background: Fitness trackers can engage users through automated self-monitoring of physical activity. Studies evaluating the utility of fitness trackers are limited among adolescents, who are often difficult to engage in weight management treatment and are heavy technology users. Objective: We conducted a pilot randomized trial to describe the impact of providing adolescents and caregivers with fitness trackers as an adjunct to treatment in a tertiary care weight management clinic on adolescent fitness tracker satisfaction, fitness tracker utilization patterns, and physical activity levels. Methods: Adolescents were randomized to 1 of 2 groups (adolescent or dyad) at their initial weight management clinic visit. Adolescents received a fitness tracker and counseling around activity data in addition to standard treatment. A caregiver of adolescents in the dyad group also received a fitness tracker. Satisfaction with the fitness tracker, fitness tracker utilization patterns, and physical activity patterns were evaluated over 3 months. Results: A total of 88 adolescents were enrolled, with 69% (61/88) being female, 36% (32/88) black, 23% (20/88) Hispanic, and 63% (55/88) with severe obesity. Most adolescents reported that the fitness tracker was helping them meet their healthy lifestyle goals (69%) and be more motivated to achieve a healthy weight (66%). Despite this, 68% discontinued use of the fitness tracker by the end of the study. There were no significant differences between the adolescent and the dyad group in outcomes, but adolescents in the dyad group were 12.2 times more likely to discontinue using their fitness tracker if their caregiver also discontinued use of their fitness tracker (95% CI 2.4-61.6). Compared with adolescents who discontinued use of the fitness tracker during the study, adolescents who continued to use the fitness tracker recorded a higher number of daily steps in months 2 and 3 of the study (mean 5760 vs 4148 in month 2, P=.005, and mean 5942 vs 3487 in month 3, P=.002). Conclusions: Despite high levels of satisfaction with the fitness trackers, fitness tracker discontinuation rates were high, especially among adolescents whose caregivers also discontinued use of their fitness tracker. More studies are needed to determine how to sustain the use of fitness trackers among adolescents with obesity and engage caregivers in adolescent weight management interventions.

  • An AI-embedded mobile app for neck and back pain self management. Source: The Authors / Placeit; Copyright: JMIR Publications; URL:; License: Creative Commons Attribution (CC-BY).

    The Perceived Benefits of an Artificial Intelligence–Embedded Mobile App Implementing Evidence-Based Guidelines for the Self-Management of Chronic Neck and...


    Background: Chronic musculoskeletal neck and back pain are disabling conditions among adults. Use of technology has been suggested as an alternative way to increase adherence to exercise therapy, which may improve clinical outcomes. Objective: The aim was to investigate the self-perceived benefits of an artificial intelligence (AI)–embedded mobile app to self-manage chronic neck and back pain. Methods: A total of 161 participants responded to the invitation. The evaluation questionnaire included 14 questions that were intended to explore if using the AI rehabilitation system may (1) increase time spent on therapeutic exercise, (2) affect pain level (assessed by the 0-10 Numerical Pain Rating Scale), and (3) reduce the need for other interventions. Results: An increase in time spent on therapeutic exercise per day was observed. The median Numerical Pain Rating Scale scores were 6 (interquartile range [IQR] 5-8) before and 4 (IQR 3-6) after using the AI-embedded mobile app (95% CI 1.18-1.81). A 3-point reduction was reported by the participants who used the AI-embedded mobile app for more than 6 months. Reduction in the usage of other interventions while using the AI-embedded mobile app was also reported. Conclusions: This study demonstrated the positive self-perceived beneficiary effect of using the AI-embedded mobile app to provide a personalized therapeutic exercise program. The positive results suggest that it at least warrants further study to investigate the physiological effect of the AI-embedded mobile app and how it compares with routine clinical care.

  • A representative sample conversation (demonstration) with Wysa AI Chat-bot on a smartphone device for mental well-being. Source: Wysa Ltd; Copyright: Wysa Ltd; URL:; License: Licensed by JMIR.

    An Empathy-Driven, Conversational Artificial Intelligence Agent (Wysa) for Digital Mental Well-Being: Real-World Data Evaluation Mixed-Methods Study


    Background: A World Health Organization 2017 report stated that major depression affects almost 5% of the human population. Major depression is associated with impaired psychosocial functioning and reduced quality of life. Challenges such as shortage of mental health personnel, long waiting times, perceived stigma, and lower government spends pose barriers to the alleviation of mental health problems. Face-to-face psychotherapy alone provides only point-in-time support and cannot scale quickly enough to address this growing global public health challenge. Artificial intelligence (AI)-enabled, empathetic, and evidence-driven conversational mobile app technologies could play an active role in filling this gap by increasing adoption and enabling reach. Although such a technology can help manage these barriers, they should never replace time with a health care professional for more severe mental health problems. However, app technologies could act as a supplementary or intermediate support system. Mobile mental well-being apps need to uphold privacy and foster both short- and long-term positive outcomes. Objective: This study aimed to present a preliminary real-world data evaluation of the effectiveness and engagement levels of an AI-enabled, empathetic, text-based conversational mobile mental well-being app, Wysa, on users with self-reported symptoms of depression. Methods: In the study, a group of anonymous global users were observed who voluntarily installed the Wysa app, engaged in text-based messaging, and self-reported symptoms of depression using the Patient Health Questionnaire-9. On the basis of the extent of app usage on and between 2 consecutive screening time points, 2 distinct groups of users (high users and low users) emerged. The study used mixed-methods approach to evaluate the impact and engagement levels among these users. The quantitative analysis measured the app impact by comparing the average improvement in symptoms of depression between high and low users. The qualitative analysis measured the app engagement and experience by analyzing in-app user feedback and evaluated the performance of a machine learning classifier to detect user objections during conversations. Results: The average mood improvement (ie, difference in pre- and post-self-reported depression scores) between the groups (ie, high vs low users; n=108 and n=21, respectively) revealed that the high users group had significantly higher average improvement (mean 5.84 [SD 6.66]) compared with the low users group (mean 3.52 [SD 6.15]); Mann-Whitney P=.03 and with a moderate effect size of 0.63. Moreover, 67.7% of user-provided feedback responses found the app experience helpful and encouraging. Conclusions: The real-world data evaluation findings on the effectiveness and engagement levels of Wysa app on users with self-reported symptoms of depression show promise. However, further work is required to validate these initial findings in much larger samples and across longer periods.

  • NutCracker app (montage). Source: Image created by the Authors; Copyright: The Authors; URL:; License: Creative Commons Attribution + Noncommercial (CC-BY-NC).

    Providing a Smart Healthy Diet for the Low-Income Population: Qualitative Study on the Usage and Perception of a Designed Cooking App


    Background: Health behaviors among low-income groups have become a major issue in the context of increasing social inequalities. The low-income population is less likely to be receptive to nutritional recommendations, but providing cooking advice could be more effective. In this domain, taking advantage of digital devices can be a bonus with its own challenges. Objective: The aim of this study was to develop and deploy NutCracker, a social network–based cooking app for low-income population, including cooking tips and nutritional advices, aiming at creating small online communities. We further determined the usefulness, perceptions, barriers, and motivators to use NutCracker. Methods: The smartphone app, designed jointly with beneficiaries of the social emergency services, was implemented in a disadvantaged neighborhood of Magny, (Paris region, France). Once the app became available, 28 subjects, living in the neighborhood, tested the app for a 6-month period. Logs to the app and usages were collected by the software. In total, 12 in-depth, semistructured interviews were conducted among the users and the social workers to analyze their uses and perceptions of the app relative to their interest in cooking, cooking skills, socioeconomic constraints, and social integration. These interviews were compared with 21 supplementary interviews conducted among low-income individuals in the general population. Results: NutCracker was developed as a social network–based app, and it includes cooking tips, nutritional advice, and Web-based quizzes. We identified barriers to uses (especially technical barriers, lack of knowledge in the field of new technologies and written comprehension, and search for real contacts) and motivators (in particular, good social integration, previous use of social networks, and help of children as intermediaries). Cooking skills were both a barrier and a lever. Conclusions: Targeting the low-income groups through a cooking app to promote healthier behaviors offers many advantages but has not been fully explored. However, the barriers in low-income milieu remain high, especially among the less socially integrated strata. Lessons from this intervention allow us to identify barriers and possible levers to improve nutrition promotion and awareness in deprived areas, especially in the time of social crisis.

  • Application of real-time comprehensive dashboard for the emergency department. Source: Image created by the Authors; Copyright: The Authors; URL:; License: Creative Commons Attribution + Noncommercial + ShareAlike (CC-BY-NC-SA).

    A Real-Time Autonomous Dashboard for the Emergency Department: 5-Year Case Study


    Background: The task of monitoring and managing the entire emergency department (ED) is becoming more important due to increasing pressure on the ED. Recently, dashboards have received the spotlight as health information technology to support these tasks. Objective: This study aimed to describe the development of a real-time autonomous dashboard for the ED and to evaluate perspectives of clinical staff on its usability. Methods: We developed a dashboard based on three principles—“anytime, anywhere, at a glance;” “minimal interruption to workflow;” and “protect patient privacy”—and 3 design features—“geographical layout,” “patient-level alert,” and “real-time summary data.” Items to evaluate the dashboard were selected based on the throughput factor of the conceptual model of ED crowding. Moreover, ED physicians and nurses were surveyed using the system usability scale (SUS) and situation awareness index as well as a questionnaire we created on the basis of the construct of the Situation Awareness Rating Technique. Results: The first version of the ED dashboard was successfully launched in 2013, and it has undergone 3 major revisions since then because of geographical changes in ED and modifications to improve usability. A total of 52 ED staff members participated in the survey. The average SUS score of the dashboard was 67.6 points, which indicates “OK-to-Good” usability. The participants also reported that the dashboard provided efficient “concentration support” (4.15 points), “complexity representation” (4.02 points), “variability representation” (3.96 points), “information quality” (3.94 points), and “familiarity” (3.94 points). However, the “division of attention” was rated at 2.25 points. Conclusions: We developed a real-time autonomous ED dashboard and successfully used it for 5 years with good evaluation from users.

  • Feature of "Talking Pole". Source: The Authors; Copyright: The Authors; URL:; License: Licensed by JMIR.

    Experience of Emergency Department Patients With Using the Talking Pole Device: Prospective Interventional Descriptive Study


    Background: Patient engagement is important. However, it can be difficult in emergency departments (EDs). Objective: The aim of this study was to evaluate the satisfaction of ED patients using a patient-friendly health information technology (HIT) device, the “Talking Pole,” and to assess the factors relevant to their satisfaction. Methods: This study was conducted in May 2017 at the ED of a tertiary hospital. The “Talking Pole” is a smartphone-based device attached to a intravenous infusion pole with sensors. It is capable of sensing patient movement and fluid dynamics. In addition, it provides clinical information from electronic medical records to patients and serves as a wireless communication tool between patients and nurses. Patients and caregivers who entered the observation room of the ED were selected for the study. The “Talking Pole” devices were provided to all participants, regardless of their need for an intravenous pole upon admittance to the ED. After 2 hours, each participant was given an 18-item questionnaire created for this research, measured on a 5-point Likert scale, regarding their satisfaction with “Talking Pole.” Results: Among 52 participants recruited, 54% (28/52) were patients and the remaining were caregivers. In total, 38% (20/52) were male participants; the average age was 54.6 (SD 12.9) years, and 63% (33/52) of the participants were oncology patients and their caregivers. The overall satisfaction rate was 4.17 (SD 0.79 ) points. Spearman correlation coefficient showed a strong association of “overall satisfaction” with “comparison to the previous visit” (ρ=.73 ), “perceived benefit” (ρ=.73), “information satisfaction” (ρ=.70), and “efficiency” (ρ=.70). Conclusions: In this study, we introduced a patient-friendly HIT device, the “Talking Pole.” Its architecture focused on enhancing information delivery, which is regarded as a bottleneck toward achieving patient engagement in EDs. Patient and caregiver satisfaction with the “Talking Pole” was positive in the ED environment. In particular, correlation coefficient results improved our understanding about patients’ satisfaction, HIT devices, and services used in the ED.

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  • A Promising Food-Coaching Intervention Program to Obtain Optimal Gestational Weight Gain in Pregnant Overweight and Obese Women: A Pilot Randomized Control Trial of A Smartphone App

    Date Submitted: Dec 3, 2018

    Open Peer Review Period: Dec 7, 2018 - Feb 1, 2019

    Background: Traditional dietary recommendations to obtain optimal gestational weight gain (GWG) is ineffective. Objective: In this pilot, we aimed to study the feasibility of a novel food coaching sma...

    Background: Traditional dietary recommendations to obtain optimal gestational weight gain (GWG) is ineffective. Objective: In this pilot, we aimed to study the feasibility of a novel food coaching smartphone app in controlling GWG and macronutrients intake, among overweight and obese pregnant women. Methods: We designed a randomized controlled trial (RCT) and recruited 30 overweight and obese pregnant women (1:1 ratio) during 18-20 weeks of gestation and followed them up in 4 and 8 weeks, respectively. Both groups received standard pregnancy dietary orientation at recruitment, while intervention group received an 8-week’s real-time food coaching via a smartphone app. This food coaching smartphone app (Glycoleap, Holmusk, Singapore) aimed to improve care and outcomes for people with diabetes. Pregnant women using this app were able to upload food images (e.g., a picture of a meal, a drink, or a dessert) and received real-time and detailed food coaching comments and guidance provided by professional dietitians during the day (8am-8pm). We collected detailed characteristics during recruitment and examined anthropometry at all visits. We compared mean differences of 8-week’s GWG and macronutrients intake between two groups. Results: Upon study completion, 3 subjects dropped out from intervention while 1 gave birth prematurely from control group. The acceptance of smartphone app is 90%. More achieved optimal GWG per week in intervention group (7/12, 58.3%) than in control group (5/14, 35.7%). Food coaching smartphone app seemed to help in reducing GWG and cholesterol intake. Conclusions: Our findings showed that food coaching smartphone app is feasible and also more favorable in weight gain control and cholesterol intake control among overweight and obese pregnant women. Although our results were not significant (perhaps attributed to the small sample size), it provided a proof-of-concept on the feasibility of applying such technology in future RCTs with a larger sample size, an earlier intervention onset, and a longer follow-up for overweight and obese pregnant women. Clinical Trial: Null.

  • Challenges to ‘gold-standard’ evaluations of digital health interventions for young people: Research and implementation lessons from the ARMADILLO randomized controlled trial in Kenya

    Date Submitted: Dec 3, 2018

    Open Peer Review Period: Dec 7, 2018 - Feb 1, 2019

    Background: Evidence on the efficacy of sexual and reproductive health (SRH) communication interventions for youth (aged 15-24), especially from low- and middle-income countries, is lacking. Therefore...

    Background: Evidence on the efficacy of sexual and reproductive health (SRH) communication interventions for youth (aged 15-24), especially from low- and middle-income countries, is lacking. Therefore, the World Health Organization initiated the Adolescent/Youth Reproductive Mobile Access and Delivery Initiative for Love and Life outcomes (ARMADILLO) Study. The ARMADILLO intervention is a free, menu-based, on-demand SMS (text message) platform providing youth-validated SRH information. A randomized controlled trial assessing the effect of the ARMADILLO intervention on SRH-related outcomes was implemented in Kwale County, Kenya. Objective: This article describes implementation challenges related to the RCT. These issues, observed during enrolment and early in the intervention period, have implications for digital health researchers and program implementers. Methods: This was an open, three-armed, randomized controlled trial. Following completion of a baseline survey, participants were randomized into: the ARMADILLO intervention (Arm 1); a once-a-week contact SMS (Arm 2); or usual care (Arm 3, no intervention). The intervention period lasted seven weeks, after which data collectors administered an endline survey. Two methodological decisions had significant implications for the overall success of the trial’s implementation. As a result, some participants became ‘stuck’ in their progression through the study. The team took a series of measures (reminder SMS, phone calls and eventually correcting the system) so that all participants eventually flowed into the intervention period. Results: Three weeks after recruitment began, 660 participants had been randomized; however, 103 (47%) participants in Arm 1 and 140 (69%) in Arm 2 were ‘stuck’ at the language menu. Later, the research team called 231 of these non-engaging participants, and successfully reached 136 to learn reasons for non-engagement. Thirty-two phone numbers were found to be linked with participants who were in violation of the study’s eligibility criteria about phone ownership. Among eligible participants, 30 participants indicated that they had assumed the introductory message was a scam or spam. Twenty-seven participants were confused by some aspect of the system. Eleven were apathetic about engaging. Twenty-four non-engagers experienced some sort of technical issue. All participants eventually started their seven-week study period. Conclusions: The ARMADILLO Study’s implementation challenges provide several lessons related to both researching and implementing client-side digital health interventions. Research lessons: 1) have meticulous phone data collection protocols to reduce wrong numbers; 2) train participants on the digital intervention in efficacy assessments, even if it is modelled after existing services; and 3) Client-side digital health interventions have analog discontinuation challenges: factor these into sample size calculations. Implementation lessons: 1) ‘phone ownership’ is a fluid concept; 2) digital health campaigns need to establish a credible presence in a ‘noisy’ digital space; and 3) interest in a service can be sporadic and/or fleeting. Clinical Trial: This trial was retrospectively registered with the ISRCTN Registry and assigned registration number ISRCTN85156148 on 29 May 2018.

  • Evaluating the Quality of Mobile Apps Used by Occupational Therapists Using the uMARS App Quality Rating Tool

    Date Submitted: Dec 3, 2018

    Open Peer Review Period: Dec 7, 2018 - Feb 1, 2019

    Background: The continuous development of mobile applications, or “apps”, has led to many healthcare professionals using them in clinical settings; however, little research is available to guide o...

    Background: The continuous development of mobile applications, or “apps”, has led to many healthcare professionals using them in clinical settings; however, little research is available to guide occupational therapists (OTs) in choosing quality apps for use in their respective clinical settings. Objective: The purpose of this study was to evaluate the quality of the most frequently noted mobile apps used by OTs. Methods: A previous study surveying OTs’ use of apps in therapy compiled a list of apps frequently noted. Twenty-five of these apps were evaluated individually by two trained researchers using the uMARS, a simple, multidimensional analysis tool that can be easily used to evaluate the quality of apps. Results: The top 10 apps had a total quality score of 4.3, or higher, out of 5 based on the mean scores of engagement, functionality, and aesthetics. Apps scored highest in functionality and lowest in engagement. Apps noted most frequently were not always high-quality apps; apps noted least frequently were not always low-quality apps. Conclusions: Determining the effectiveness of using apps in clinical settings must be built upon a foundation of the implementation of high-quality apps. Mobile apps should not be incorporated into clinical settings solely based on frequency of use. The uMARS should be considered as a useful tool for OTs, and other professionals, to determine app quality.

  • Co-designing and testing the acceptability of a virtual agent to support self-management for individuals living with physical and mental comorbidities

    Date Submitted: Nov 29, 2018

    Open Peer Review Period: Dec 5, 2018 - Jan 30, 2019

    Background: Individuals living with long-term physical health conditions frequently experience co-occurring mental health problems. This comorbidity has a significant impact on individual’s levels o...

    Background: Individuals living with long-term physical health conditions frequently experience co-occurring mental health problems. This comorbidity has a significant impact on individual’s levels of emotional distress, health outcomes and associated healthcare utilization. As healthcare services struggle to meet demand and care increasingly moves to the community, digital tools are being promoted to support patients to self-manage their health. One such technology is the autonomous virtual agent. Objective: To co-design the content, functionality and interface modalities of an autonomous virtual agent to support self-management for patients with an exemplar long-term condition (Chronic Pulmonary Obstructive Disease, COPD), and then to assess the acceptability and system content. Methods: We conducted two co-design workshops and a proof-of-concept implementation of an autonomous virtual agent with natural language processing capabilities. This implementation formed the basis for video-based scenario testing of acceptability with adults with a diagnosis of COPD and health professionals involved in their care. Results: Adults (n = 6) with a diagnosis of COPD and health professionals (n = 5) specified four priority self-management scenarios for which they would like to receive support: at time of diagnosis (information provision); during acute exacerbations (crisis support); during periods of low mood (emotional support); and for general self-management (motivation). Based on the scenario testing, 12 additional adults with COPD felt the system was both acceptable and engaging, particularly with respect to internet of things capabilities. They felt the system would be particularly useful for individuals living alone. Conclusions: Patients did not explicitly separate out mental and physical health needs, although the content they developed for Avachat had a clear psychological approach. Supported self-management delivered via an autonomous virtual agent was acceptable to the participants. A co-design process has allowed the research team to identify key design principles, content and functionality to underpin an autonomous agent for delivering self-management support to older adults living with COPD and potentially other long term conditions.

  • Text Message Support for Weight Loss in Patients with Prediabetes: A Pragmatic Trial

    Date Submitted: Nov 28, 2018

    Open Peer Review Period: Dec 5, 2018 - Jan 30, 2019

    Background: To reach all 84.1 million US adults estimated to have prediabetes, lower-cost and less-burdensome alternatives to the National Diabetes Prevention Program (NDPP) appear needed. In a previo...

    Background: To reach all 84.1 million US adults estimated to have prediabetes, lower-cost and less-burdensome alternatives to the National Diabetes Prevention Program (NDPP) appear needed. In a previous randomized controlled trial (RCT), we demonstrated efficacy of a 12-month text message support program called SMS4PreDM in individuals with prediabetes. Objective: Upon dissemination of SMS4PreDM in a safety net healthcare system, we evaluated implementation and effectiveness in a pragmatic study Methods: English- and Spanish-speaking patients with diabetes risks (e.g. A1c 5.7-6.4) were referred by their providers and offered NDPP classes and/or SMS4PreDM. This analysis focuses on the impact of SMS4PreDM on weight loss among 285 SMS4PreDM-only participants who began the yearlong intervention between October 2015 and April 2017, as compared to a usual-care control group of 1233 patients with diabetes risks who were identified from electronic health record (EHR) data during the same time period but not referred. Weight outcomes included mean time-related weight change and realization of either ≥3% weight loss or gain. Mixed linear models adjusted for age, gender, race, ethnicity, preferred language, and baseline weight. A secondary analysis stratified by language. We also assessed implementation factors, including retention and cost. Results: The intervention group realized time-related mean weight loss of 1.3 pounds (SE = 0.74), while the control group realized mean weight gain of 0.25 pounds (SE=0.59, p-value=0.004). Spanish-speaking SMS4PreDM participants (n=130) realized time-related mean weight loss of 1.11 pounds (SE = 1.22) compared with weight gain of 0.96 pounds (SE = 1.14) in Spanish-speaking controls (n=382, p-value <.0001). English-speaking intervention participants (n=155) did not achieve more time-related mean weight change (-0.89 pounds; SE = 0.93) than English-speaking controls (n=828; 0.31 pounds gained; SE=0.62, p-value = 0.143). While the intervention group overall did not reach the ≥3% weight loss goal more than control participants 19.0%(95% CI 14.8 – 23.9) vs 21.6%(95% CI 19.3 – 24.0), p-value=0.33, more controls gained ≥3% weight compared with intervention participants 27.3% (95% CI 24.9 – 29.9) vs 20.0% (95% CI 16.8 – 25.1) p-value=.011. SMS4PreDM delivery costs were $100.92 per participant. Conclusions: Results suggest that SMS4PreDM may not be sufficiently effective to serve as a population health strategy. Clinical Trial: This was a pragmatic investigation of a previous published RCT and not registered as a clinical trial

  • Development of a smart phone application for the provision of personalised food-based information in an eating-out situation

    Date Submitted: Nov 28, 2018

    Open Peer Review Period: Dec 5, 2018 - Jan 30, 2019

    Background: Background: Increasing pressure from governments, public health bodies and consumers is driving a need for increased food-based information provision in eating-out situations. Meals eaten...

    Background: Background: Increasing pressure from governments, public health bodies and consumers is driving a need for increased food-based information provision in eating-out situations. Meals eaten out of the home are known to be less healthy than meals eaten at home, and consumers can complain of poor information on the health impact and allergen content of meals eaten out. Objective: Objective: To describe the development and early assessment of a smart phone application (app) that allows personalised accurate food-based information provision while considering individual characteristics (allergies, diet type and preferences), to enable informed consumer choice when eating out. Methods: Methods: Requirements for the app were first elicited through consideration of current legislative and scientific literature, refined and validated through consultation with potential end-users, and prioritised by potential stakeholders using the MoSCoW method. An app was then designed and developed to address these requirements using an agile approach. The developed app was finally evaluated at eight public engagement events using the System Usability Scale (SUS) questionnaire and qualitative feedback. Results: Results: Consideration of the literature and consultation with consumers revealed a need for information provision for consumers in the eating out situation, plus the ability to limit the information provided to that which was personally relevant or interesting. The app was designed to provide information to consumers on the dishes available in a workplace canteen and to allow consumers the freedom to personalise the app and choose the information that they received. Evaluation using the SUS questionnaire revealed positive responses to the app from a range of potential users, and qualitative comments demonstrated broad interest in its use. Conclusions: Conclusions: This work details the successful development and early assessment of a novel smart phone app designed to provide food-based information in an eating out situation, in a personalised manner.