JMIR Publications

JMIR mHealth and uHealth

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

JMIR's Thomson Reuter Impact Factor of 4.636 for 2016

Journal Description

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

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

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

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

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


Recent Articles:

  • Caregiver assisting User to wear BPAS smartglasses during testing. Pictures used with user/caregiver permission. Source: The Authors; Copyright: Brain Power; URL:; License: Creative Commons Attribution (CC-BY).

    Social Communication Coaching Smartglasses: Well Tolerated in a Diverse Sample of Children and Adults With Autism


    Background: Augmented reality (AR) smartglasses are an emerging technology that is under investigation as a social communication aid for children and adults with autism spectrum disorder (ASD) and as a research tool to aid with digital phenotyping. Tolerability of this wearable technology in people with ASD is an important area for research, especially as these individuals may experience sensory, cognitive, and attentional challenges. Objective: The aim of this study was to assess the tolerability and usability of a novel smartglasses system that has been designed as a social communication aid for children and adults with autism (the Brain Power Autism System [BPAS]). BPAS runs on Google Glass Explorer Edition and other smartglasses, uses both AR and affective artificial intelligence, and helps users learn key social and emotional skills. Methods: A total of 21 children and adults with ASD across a spectrum of severity used BPAS for a coaching session. The user’s tolerability to the smartglasses, user being able to wear the smartglasses for 1 minute (initial tolerability threshold), and user being able to wear the smartglasses for the entire duration of the coaching session (whole session tolerability threshold) were determined through caregiver report. Results: Of 21 users, 19 (91%) demonstrated tolerability on all 3 measures. Caregivers reported 21 out of 21 users (100%) as tolerating the experience, while study staff found only 19 out of 21 users managed to demonstrate initial tolerability (91%). Of the 19 users who demonstrated initial tolerability, all 19 (100%) were able to use the smartglasses for the entire session (whole session tolerability threshold). Caregivers reported that 19 out of 21 users (91%) successfully used BPAS, and users surpassed caregiver expectations in 15 of 21 cases (71%). Users who could communicate reported BPAS as being comfortable (94%). Conclusions: This preliminary report suggests that BPAS is well tolerated and usable to a diverse age- and severity-range of people with ASD. This is encouraging as these devices are being developed as assistive technologies for people with ASD. Further research should focus on improving smartglasses design and exploring their efficacy in helping with social communication in children and adults with ASD.

  • Colonoscopy Preparation App (ColoprAPP). Source: Image created by the Authors; Copyright: Ben Walter; URL:; License: Creative Commons Attribution (CC-BY).

    A Smartphone App for Improvement of Colonoscopy Preparation (ColoprAPP): Development and Feasibility Study


    Background: Optimal bowel preparation is one of the major cornerstones for quality of colonoscopy. But poor bowel preparation still occurs in 10% to 25% of all patients. To optimize patient guidance, we developed a new smartphone app (ColoprAPP) for Android smartphones which guides and accompanies the patient starting 4 days before colonoscopy throughout the whole colonoscopy preparation procedure. Objective: The objective of this study was to assess the function of a newly developed smartphone app for supporting colonoscopy preparation. Methods: We carried out a prospective feasibility study including 25 patients undergoing outpatient colonoscopy at our hospital. As a control, we retrieved the data of 25 patients undergoing outpatient colonoscopy matching in age, sex, and indication for colonoscopy from our colonoscopy database. Patients were asked to download the smartphone app, ColoprAPP, in addition to being given the regular colonoscopy preparation leaflet. All colonoscopies were performed in the morning after using a split-dose preparation containing a polyethlene glycol–based purgative. The study was designed to test feasibility of the prototype, evaluate grade of bowel cleanliness (Boston bowel preparation scale [BBPS]), and assess patient satisfaction with the app. Results: The smartphone app use was feasible in all patients. BBPS count as a marker for grade of bowel preparation was significantly higher in the smartphone app–supported group (mean 8.1 [SD 0.3] vs 7.1 [SD 0.4], P=.02). Left (mean 2.8 [SD 0.1] vs 2.4 [SD 0.11], P=.02) and transverse colon (mean 2.8 [SD 0.07] vs 2.4 [SD 0.11], P<.001) revealed significantly higher BBPS counts in the smartphone app–supported group than in controls. Patient satisfaction with a smartphone app–supported colonoscopy preparation was high with an average numeric rating scale score for usefulness of 8.2 (visual analog scale 1-10). Conclusions: A novel developed smartphone app for reinforced education of bowel cleansing was feasible and led to high BBPS scores and patient satisfaction. Trial registration: NCT02512328; (Archived by WebCite at

  • Hardware setup and software UI of the reported system. Source: Image created by the Authors; Copyright: TerryDr Info Technology Co. Ltd; URL:; License: Creative Commons Attribution (CC-BY).

    Development of a Whole Slide Imaging System on Smartphones and Evaluation With Frozen Section Samples


    Background: The aim was to develop scalable Whole Slide Imaging (sWSI), a WSI system based on mainstream smartphones coupled with regular optical microscopes. This ultra-low-cost solution should offer diagnostic-ready imaging quality on par with standalone scanners, supporting both oil and dry objective lenses of different magnifications, and reasonably high throughput. These performance metrics should be evaluated by expert pathologists and match those of high-end scanners. Objective: The aim was to develop scalable Whole Slide Imaging (sWSI), a whole slide imaging system based on smartphones coupled with optical microscopes. This ultra-low-cost solution should offer diagnostic-ready imaging quality on par with standalone scanners, supporting both oil and dry object lens of different magnification. All performance metrics should be evaluated by expert pathologists and match those of high-end scanners. Methods: In the sWSI design, the digitization process is split asynchronously between light-weight clients on smartphones and powerful cloud servers. The client apps automatically capture FoVs at up to 12-megapixel resolution and process them in real-time to track the operation of users, then give instant feedback of guidance. The servers first restitch each pair of FoVs, then automatically correct the unknown nonlinear distortion introduced by the lens of the smartphone on the fly, based on pair-wise stitching, before finally combining all FoVs into one gigapixel VS for each scan. These VSs can be viewed using Internet browsers anywhere. In the evaluation experiment, 100 frozen section slides from patients randomly selected among in-patients of the participating hospital were scanned by both a high-end Leica scanner and sWSI. All VSs were examined by senior pathologists whose diagnoses were compared against those made using optical microscopy as ground truth to evaluate the image quality. Results: The sWSI system is developed for both Android and iPhone smartphones and is currently being offered to the public. The image quality is reliable and throughput is approximately 1 FoV per second, yielding a 15-by-15 mm slide under 20X object lens in approximately 30-35 minutes, with little training required for the operator. The expected cost for setup is approximately US $100 and scanning each slide costs between US $1 and $10, making sWSI highly cost-effective for infrequent or low-throughput usage. In the clinical evaluation of sample-wise diagnostic reliability, average accuracy scores achieved by sWSI-scan-based diagnoses were as follows: 0.78 for breast, 0.88 for uterine corpus, 0.68 for thyroid, and 0.50 for lung samples. The respective low-sensitivity rates were 0.05, 0.05, 0.13, and 0.25 while the respective low-specificity rates were 0.18, 0.08, 0.20, and 0.25. The participating pathologists agreed that the overall quality of sWSI was generally on par with that produced by high-end scanners, and did not affect diagnosis in most cases. Pathologists confirmed that sWSI is reliable enough for standard diagnoses of most tissue categories, while it can be used for quick screening of difficult cases. Conclusions: As an ultra-low-cost alternative to whole slide scanners, diagnosis-ready VS quality and robustness for commercial usage is achieved in the sWSI solution. Operated on main-stream smartphones installed on normal optical microscopes, sWSI readily offers affordable and reliable WSI to resource-limited or infrequent clinical users.

  • Students learning with mobile Augmented Reality blended learning environment (mARble). Source: The Authors; Copyright: Urs-Vito Albrecht; URL:; License: Creative Commons Attribution (CC-BY).

    Mobile Augmented Reality as a Feature for Self-Oriented, Blended Learning in Medicine: Randomized Controlled Trial


    Background: Advantages of mobile Augmented Reality (mAR) application-based learning versus textbook-based learning were already shown in a previous study. However, it was unclear whether the augmented reality (AR) component was responsible for the success of the self-developed app or whether this was attributable to the novelty of using mobile technology for learning. Objective: The study’s aim was to test the hypothesis whether there is no difference in learning success between learners who employed the mobile AR component and those who learned without it to determine possible effects of mAR. Also, we were interested in potential emotional effects of using this technology. Methods: Forty-four medical students (male: 25, female: 19, mean age: 22.25 years, standard deviation [SD]: 3.33 years) participated in this study. Baseline emotional status was evaluated using the Profile of Mood States (POMS) questionnaire. Dermatological knowledge was ascertained using a single choice (SC) test (10 questions). The students were randomly assigned to learn 45 min with either a mobile learning method with mAR (group A) or without AR (group B). Afterwards, both groups were again asked to complete the previous questionnaires. AttrakDiff 2 questionnaires were used to evaluate the perceived usability as well as pragmatic and hedonic qualities. For capturing longer term effects, after 14 days, all participants were again asked to complete the SC questionnaire. All evaluations were anonymous, and descriptive statistics were calculated. For hypothesis testing, an unpaired signed-rank test was applied. Results: For the SC tests, there were only minor differences, with both groups gaining knowledge (average improvement group A: 3.59 [SD 1.48]; group B: 3.86 [SD 1.51]). Differences between both groups were statistically insignificant (exact Mann Whitney U, U=173.5; P=.10; r=.247). However, in the follow-up SC test after 14 days, group A had retained more knowledge (average decrease of the number of correct answers group A: 0.33 [SD 1.62]; group B: 1.14 [SD 1.30]). For both groups, descriptively, there were only small variations regarding emotional involvement, and learning experiences also differed little, with both groups rating the app similar for its stimulating effect. Conclusions: We were unable to show significant effects for mAR on the immediate learning success of the mobile learning setting. However, the similar level of stimulation being noted for both groups is inconsistent with the previous assumption of the success of mAR-based approach being solely attributable to the excitement of using mobile technology, independent of mAR; the mAR group showed some indications for a better long-term retention of knowledge. Further studies are needed to examine this aspect. Trial Registration: German Clinical Trials Register (DRKS): 00012980; navigationId=trial.HTML&TRIAL_ID=DRKS00012980 (Archived by WebCite at 6tCWoM2Jb).

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

    Effectiveness of SmartMoms, a Novel eHealth Intervention for Management of Gestational Weight Gain: Randomized Controlled Pilot Trial


    Background: Two-thirds of pregnant women exceed gestational weight gain (GWG) recommendations. Because excess GWG is associated with adverse outcomes for mother and child, development of scalable and cost-effective approaches to deliver intensive lifestyle programs during pregnancy is urgent. Objective: The aim of this study was to decrease the proportion of women who exceed the Institute of Medicine (IOM) 2009 GWG guidelines. Methods: In a parallel-arm randomized controlled trial, 54 pregnant women (age 18-40 years) who were overweight (n=25) or obese (n=29) were enrolled to test whether an intensive lifestyle intervention (called SmartMoms) decreased the proportion of women with excess GWG, defined as exceeding the 2009 IOM guidelines, compared to no intervention (usual care group). The SmartMoms intervention was delivered through mobile phone (remote group) or in a traditional in-person, clinic-based setting (in-person group), and included a personalized dietary intake prescription, self-monitoring weight against a personalized weight graph, activity tracking with a pedometer, receipt of health information, and continuous personalized feedback from counselors. Results: A significantly smaller proportion of women exceeded the IOM 2009 GWG guidelines in the SmartMoms intervention groups (in-person: 56%, 10/18; remote: 58%, 11/19) compared to usual care (85%, 11/13; P=.02). The remote intervention was a lower cost to participants (mean US $97, SD $6 vs mean US $347, SD $40 per participant; P<.001) and clinics (US $215 vs US $419 per participant) and with increased intervention adherence (76.5% vs 60.8%; P=.049). Conclusions: An intensive lifestyle intervention for GWG can be effectively delivered via a mobile phone, which is both cost-effective and scalable. Trial Registration: NCT01610752; (Archived by WebCite at

  • ORION smartphone app. Source: Image created by the Authors; Copyright: The Authors / Osaka Prefectural Government, NTT DATA KANSAI corporation; URL:; License: Creative Commons Attribution + NoDerivatives (CC-BY-ND).

    Improvements in Patient Acceptance by Hospitals Following the Introduction of a Smartphone App for the Emergency Medical Service System: A Population-Based...


    Background: Recently, the number of ambulance dispatches has been increasing in Japan, and it is therefore difficult for hospitals to accept emergency patients smoothly and appropriately because of the limited hospital capacity. To facilitate the process of requesting patient transport and hospital acceptance, an emergency information system using information technology (IT) has been built and introduced in various communities. However, its effectiveness has not been thoroughly revealed. We introduced a smartphone app system in 2013 that enables emergency medical service (EMS) personnel to share information among themselves regarding on-scene ambulances and the hospital situation. Objective: The aim of this study was to assess the effects of introducing this smartphone app on the EMS system in Osaka City, Japan. Methods: This retrospective study analyzed the population-based ambulance records of Osaka Municipal Fire Department. The study period was 6 years, from January 1, 2010 to December 31, 2015. We enrolled emergency patients for whom on-scene EMS personnel conducted hospital selection. The main endpoint was the difficulty experienced in gaining hospital acceptance at the scene. The definition of difficulty was making ≥5 phone calls by EMS personnel at the scene to hospitals until a decision to transport was determined. The smartphone app was introduced in January 2013, and we compared the patients treated from 2010 to 2012 (control group) with those treated from 2013 to 2015 (smartphone app group) using an interrupted time-series analysis to assess the effects of introducing this smartphone app. Results: A total of 600,526 emergency patients for whom EMS personnel selected hospitals were eligible for our analysis. There were 300,131 emergency patients in the control group (50.00%, 300,313/600,526) from 2010 to 2012 and 300,395 emergency patients in the smartphone app group (50.00%, 300,395/600,526) from 2013 to 2015. The rate of difficulty in hospital acceptance was 14.19% (42,585/300,131) in the control group and 10.93% (32,819/300,395) in the smartphone app group. No change over time in the number of difficulties in hospital acceptance was found before the introduction of the smartphone app (regression coefficient: −2.43, 95% CI −5.49 to 0.64), but after its introduction, the number of difficulties in hospital acceptance gradually decreased by month (regression coefficient: −11.61, 95% CI −14.57 to −8.65). Conclusions: Sharing information between an ambulance and a hospital by using the smartphone app at the scene was associated with decreased difficulty in obtaining hospital acceptance. Our app and findings may be worth considering in other areas of the world where emergency medical information systems with IT are needed.

  • Graphic of a mobile phone to illustrate sleep apps. Source: The Authors; Copyright: Julie W. McMahon, Senior Campus Designer, University of Illinois-Urbana Champaign; License: Licensed by the authors.

    Mobile Phone Interventions for Sleep Disorders and Sleep Quality: Systematic Review


    Background: Although mobile health technologies have been developed for interventions to improve sleep disorders and sleep quality, evidence of their effectiveness remains limited. Objective: A systematic literature review was performed to determine the effectiveness of mobile technology interventions for improving sleep disorders and sleep quality. Methods: Four electronic databases (EBSCOhost, PubMed/Medline, Scopus, and Web of Science) were searched for articles on mobile technology and sleep interventions published between January 1983 and December 2016. Studies were eligible for inclusion if they met the following criteria: (1) written in English, (2) adequate details on study design, (3) focus on sleep intervention research, (4) sleep index measurement outcome provided, and (5) publication in peer-reviewed journals. Results: An initial sample of 2679 English-language papers were retrieved from five electronic databases. After screening and review, 16 eligible studies were evaluated to examine the impact of mobile phone interventions on sleep disorders and sleep quality. These included one case study, three pre-post studies, and 12 randomized controlled trials. The studies were categorized as (1) conventional mobile phone support and (2) utilizing mobile phone apps. Based on the results of sleep outcome measurements, 88% (14/16) studies showed that mobile phone interventions have the capability to attenuate sleep disorders and to enhance sleep quality, regardless of intervention type. In addition, mobile phone intervention methods (either alternatively or as an auxiliary) provide better sleep solutions in comparison with other recognized treatments (eg, cognitive behavioral therapy for insomnia). Conclusions: We found evidence to support the use of mobile phone interventions to address sleep disorders and to improve sleep quality. Our findings suggest that mobile phone technologies can be effective for future sleep intervention research.

  • Consent from researchers app screen (montage). Source: ThemPower, Sage Bionetworks /; Copyright: JMIR Publications; URL:; License: Creative Commons Attribution (CC-BY).

    Consent Processes for Mobile App Mediated Research: Systematic Review


    Background: Since the launch of ResearchKit on the iOS platform in March 2015 and ResearchStack on the Android platform in June 2016, many academic and commercial institutions around the world have adapted these frameworks to develop mobile app-based research studies. These studies cover a wide variety of subject areas including melanoma, cardiomyopathy, and autism. Additionally, these app-based studies target a variety of participant populations, including children and pregnant women. Objective: The aim of this review was to document the variety of self-administered remote informed consent processes used in app-based research studies available between May and September 2016. Remote consent is defined as any consenting process with zero in-person steps, when a participant is able to join a study without ever seeing a member of the research team. This type of review has not been previously conducted. The research community would benefit from a rigorous interrogation of the types of consent taken as part of the seismic shift to entirely mobile meditated research studies. Methods: This review examines both the process of information giving and specific content shared, with special attention to data privacy, aggregation, and sharing. Results: Consistency across some elements of the app-based consent processes was found; for example, informing participants about how data will be curated from the phone. Variations in other elements were identified; for example, where specific information is shared and the level of detail disclosed. Additionally, several novel elements present in eConsent not typically seen in traditional consent for research were highlighted. Conclusions: This review advocates the importance of participant informedness in a novel and largely unregulated research setting.

  • Beat-to-beat analysis from R-R intervals (RRI) and peak-to-peak intervals (PPI). Source: Figure 3 from; Copyright: the authors; License: Creative Commons Attribution (CC-BY).

    Clinical Validation of Heart Rate Apps: Mixed-Methods Evaluation Study


    Background: Photoplethysmography (PPG) is a proven way to measure heart rate (HR). This technology is already available in smartphones, which allows measuring HR only by using the smartphone. Given the widespread availability of smartphones, this creates a scalable way to enable mobile HR monitoring. An essential precondition is that these technologies are as reliable and accurate as the current clinical (gold) standards. At this moment, there is no consensus on a gold standard method for the validation of HR apps. This results in different validation processes that do not always reflect the veracious outcome of comparison. Objective: The aim of this paper was to investigate and describe the necessary elements in validating and comparing HR apps versus standard technology. Methods: The FibriCheck (Qompium) app was used in two separate prospective nonrandomized studies. In the first study, the HR of the FibriCheck app was consecutively compared with 2 different Food and Drug Administration (FDA)-cleared HR devices: the Nonin oximeter and the AliveCor Mobile ECG. In the second study, a next step in validation was performed by comparing the beat-to-beat intervals of the FibriCheck app to a synchronized ECG recording. Results: In the first study, the HR (BPM, beats per minute) of 88 random subjects consecutively measured with the 3 devices showed a correlation coefficient of .834 between FibriCheck and Nonin, .88 between FibriCheck and AliveCor, and .897 between Nonin and AliveCor. A single way analysis of variance (ANOVA; P=.61 was executed to test the hypothesis that there were no significant differences between the HRs as measured by the 3 devices. In the second study, 20,298 (ms) R-R intervals (RRI)–peak-to-peak intervals (PPI) from 229 subjects were analyzed. This resulted in a positive correlation (rs=.993, root mean square deviation [RMSE]=23.04 ms, and normalized root mean square error [NRMSE]=0.012) between the PPI from FibriCheck and the RRI from the wearable ECG. There was no significant difference (P=.92) between these intervals. Conclusions: Our findings suggest that the most suitable method for the validation of an HR app is a simultaneous measurement of the HR by the smartphone app and an ECG system, compared on the basis of beat-to-beat analysis. This approach could lead to more correct assessments of the accuracy of HR apps.

  • Smarter Pregnancy, an mHealth platform to improve nutrition and lifestyle during the periconception period. Source: Peercode /; Copyright: JMIR Publications; URL:; License: Creative Commons Attribution (CC-BY).

    Opportunities of mHealth in Preconception Care: Preferences and Experiences of Patients and Health Care Providers and Other Involved Professionals


    Background: The importance of the preconception period and preconception care (PCC) are broadly acknowledged and the potential benefits regarding health promotion have been studied extensively. PCC provides the opportunity to identify, prevent, and treat modifiable and nonmodifiable risk factors to optimize the health of couples trying to become pregnant. The prevalence of modifiable and nonmodifiable risk factors in these couples is high, but the uptake of PCC remains low. Objective: The aim of this study is to identify the preferences and experiences of women and men (patients) trying to become pregnant and of health care providers and other involved professionals regarding mobile health (mHealth), in particular the coaching platform Smarter Pregnancy, and its potential role in PCC. Methods: Patients who participated in the Smarter Pregnancy randomized controlled trial (RCT) and health care providers and professionals also involved in PCC were invited to participate in a qualitative study. The barriers, benefits, and opportunities of big data collection by mHealth were discussed in focus group sessions, prompted with statements regarding PCC. Results: We composed five focus groups, consisting of 27 patients in total (23 women and 4 men), who participated in the RCT, and nine health care providers and other professionals. Of the patients, 67% (18/27) were familiar with the concept of PCC, but only 15% (4/27) received any form of PCC. A majority of 56% (combined percentages of statements 1 [n=18], 2 [n=11], and 3 [n=16]) of the patients believed in the benefit of receiving PCC, and all agreed that men should be involved in PCC as well. Patients did not have a problem using anonymized data obtained from mHealth tools for scientific purposes. Patients and health care providers and other professionals both acknowledged the lack of awareness regarding the importance of PCC and stated that mHealth provides several opportunities to support clinical PCC. Conclusions: Our findings substantiate previous studies addressing the low uptake of PCC due to unawareness or lack of perception of its relevance by couples who are trying to become pregnant. The positive judgment and experiences with mHealth, in particular Smarter Pregnancy, will stimulate future research and further development of effective and cost-effective personalized mHealth apps for patients, health care providers, and other professionals as an add-on to clinical PCC.

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

    Quantifying Human Movement Using the Movn Smartphone App: Validation and Field Study


    Background: The use of embedded smartphone sensors offers opportunities to measure physical activity (PA) and human movement. Big data—which includes billions of digital traces—offers scientists a new lens to examine PA in fine-grained detail and allows us to track people’s geocoded movement patterns to determine their interaction with the environment. Objective: The objective of this study was to examine the validity of the Movn smartphone app (Moving Analytics) for collecting PA and human movement data. Methods: The criterion and convergent validity of the Movn smartphone app for estimating energy expenditure (EE) were assessed in both laboratory and free-living settings, compared with indirect calorimetry (criterion reference) and a stand-alone accelerometer that is commonly used in PA research (GT1m, ActiGraph Corp, convergent reference). A supporting cross-validation study assessed the consistency of activity data when collected across different smartphone devices. Global positioning system (GPS) and accelerometer data were integrated with geographical information software to demonstrate the feasibility of geospatial analysis of human movement. Results: A total of 21 participants contributed to linear regression analysis to estimate EE from Movn activity counts (standard error of estimation [SEE]=1.94 kcal/min). The equation was cross-validated in an independent sample (N=42, SEE=1.10 kcal/min). During laboratory-based treadmill exercise, EE from Movn was comparable to calorimetry (bias=0.36 [−0.07 to 0.78] kcal/min, t82=1.66, P=.10) but overestimated as compared with the ActiGraph accelerometer (bias=0.93 [0.58-1.29] kcal/min, t89=5.27, P<.001). The absolute magnitude of criterion biases increased as a function of locomotive speed (F1,4=7.54, P<.001) but was relatively consistent for the convergent comparison (F1,4=1.26, P<.29). Furthermore, 95% limits of agreement were consistent for criterion and convergent biases, and EE from Movn was strongly correlated with both reference measures (criterion r=.91, convergent r=.92, both P<.001). Movn overestimated EE during free-living activities (bias=1.00 [0.98-1.02] kcal/min, t6123=101.49, P<.001), and biases were larger during high-intensity activities (F3,6120=1550.51, P<.001). In addition, 95% limits of agreement for convergent biases were heterogeneous across free-living activity intensity levels, but Movn and ActiGraph measures were strongly correlated (r=.87, P<.001). Integration of GPS and accelerometer data within a geographic information system (GIS) enabled creation of individual temporospatial maps. Conclusions: The Movn smartphone app can provide valid passive measurement of EE and can enrich these data with contextualizing temporospatial information. Although enhanced understanding of geographic and temporal variation in human movement patterns could inform intervention development, it also presents challenges for data processing and analytics.

  • Spatial span test (montage). Source: The Authors / Dribbble; Copyright: Amir Hamdi; URL:; License: Creative Commons Attribution (CC-BY).

    Validation of a Smartphone-Based Approach to In Situ Cognitive Fatigue Assessment


    Background: Acquired Brain Injuries (ABIs) can result in multiple detrimental cognitive effects, such as reduced memory capability, concentration, and planning. These effects can lead to cognitive fatigue, which can exacerbate the symptoms of ABIs and hinder management and recovery. Assessing cognitive fatigue is difficult due to the largely subjective nature of the condition and existing assessment approaches. Traditional methods of assessment use self-assessment questionnaires delivered in a medical setting, but recent work has attempted to employ more objective cognitive tests as a way of evaluating cognitive fatigue. However, these tests are still predominantly delivered within a medical environment, limiting their utility and efficacy. Objective: The aim of this research was to investigate how cognitive fatigue can be accurately assessed in situ, during the quotidian activities of life. It was hypothesized that this assessment could be achieved through the use of mobile assistive technology to assess working memory, sustained attention, information processing speed, reaction time, and cognitive throughput. Methods: The study used a bespoke smartphone app to track daily cognitive performance, in order to assess potential levels of cognitive fatigue. Twenty-one participants with no prior reported brain injuries took place in a two-week study, resulting in 81 individual testing instances being collected. The smartphone app delivered three cognitive tests on a daily basis: (1) Spatial Span to measure visuospatial working memory; (2) Psychomotor Vigilance Task (PVT) to measure sustained attention, information processing speed, and reaction time; and (3) a Mental Arithmetic Test to measure cognitive throughput. A smartphone-optimized version of the Mental Fatigue Scale (MFS) self-assessment questionnaire was used as a baseline to assess the validity of the three cognitive tests, as the questionnaire has already been validated in multiple peer-reviewed studies. Results: The most highly correlated results were from the PVT, which showed a positive correlation with those from the prevalidated MFS, measuring 0.342 (P<.008). Scores from the cognitive tests were entered into a regression model and showed that only reaction time in the PVT was a significant predictor of fatigue (P=.016, F=2.682, 95% CI 9.0-84.2). Higher scores on the MFS were related to increases in reaction time during our mobile variant of the PVT. Conclusions: The results show that the PVT mobile cognitive test developed for this study could be used as a valid and reliable method for measuring cognitive fatigue in situ. This test would remove the subjectivity associated with established self-assessment approaches and the need for assessments to be performed in a medical setting. Based on our findings, future work could explore delivering a small set of tests with increased duration to further improve measurement reliability. Moreover, as the smartphone assessment tool can be used as part of everyday life, additional sources of data relating to physiological, psychological, and environmental context could be included within the analysis to improve the nature and precision of the assessment process.

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  • Results of a systematic review of concepts and designs of 58 different mobile applications for the management of the West African Ebola outbreak 2014/15

    Date Submitted: Sep 21, 2017

    Open Peer Review Period: Sep 23, 2017 - Nov 18, 2017

    Background: The use of mobile phone information technology in the health sector has received much attention especially during the Ebola Virus Disease (EVD) outbreak in 2014 until 2015. Mobile health (...

    Background: The use of mobile phone information technology in the health sector has received much attention especially during the Ebola Virus Disease (EVD) outbreak in 2014 until 2015. Mobile health (mHealth) promises to allow a major improvement, but there is a lack of an overview of what kinds of tools were available and used based on the functionalities they offer. Objective: We, therefore, conducted a systematic review of mHealth tools in the context of the recent EVD outbreak to support further mHealth developments for infectious disease control. Methods: We conducted a systematic review using the PRISMA systematic review methodology on mobile health tools developed in the context of the 2014-2015 Ebola-Virus-Disease (EVD) outbreak to identify the most promising approaches used. Using a 4-eye approach, we searched for publications in any language from 01.01.2014 until 31.12.2015 in MEDLINE and Google Scholar. Using the search strategy: ("outbreak" OR "epidemic") AND ("mobile phone" OR "smartphone" OR “smart phone” OR "mobile phone" OR "tablet" OR "mHealth") AND ("Ebola" OR "EVD” OR "VHF" OR "Ebola Virus Disease" OR "viral hemorrhagic fever"). We used a standardized form to extract information on the tools’ functionalities. Results: The automatic search generated 965 publications, of which 77 (8 %) reported on 58 different tools. Three tools offered functionalities for EVD case notification, case management and contact tracing and two adhered to the integrated disease surveillance and reporting system (IDSR). Conclusions: Among a large number of tools for EVD outbreak management in 2014 and 2015, only three appeared to contain the key functionalities for outbreak management and may be most promising for further development. We recommend focusing attention on the further development of those tools that contain comprehensive portfolios of outbreak management functionalities and reference to established standards in disease surveillance Clinical Trial: null

  • An mHealth Platform for Supporting Clinical Data Integration in Augmentative and Alternative Communication Service Delivery

    Date Submitted: Sep 20, 2017

    Open Peer Review Period: Sep 23, 2017 - Nov 18, 2017

    Background: The recent trend of increasing healthcare costs in the United States is likely not sustainable. To make healthcare more economically sustainable, attention must be directed towards improvi...

    Background: The recent trend of increasing healthcare costs in the United States is likely not sustainable. To make healthcare more economically sustainable, attention must be directed towards improving the quality while simultaneously reducing the cost of healthcare. One of the recommended approaches to providing better care at a lower cost is to build high quality data collection and reporting systems, which support healthcare professionals in making optimal clinical decisions based on solid, extensive evidence. Objective: This project sought to develop an integrated mHealth Augmentative and Alternative Communication (AAC) platform consisting of an AAC mobile app and a web-based clinician portal for supporting evidence-based clinical service delivery. Methods: A questionnaire and an interview study were used to collect clinicians’ ideas regarding what constitutes their desired “clinically relevant” data. In response, a web portal was designed by combining mobile and web technologies with AAC intervention to create an integrated platform for supporting data collection, integration, and reporting. Finally, a usability study was conducted with healthcare professionals. Results: A web-based portal was created and integrated with a tablet-based AAC mobile app and data analysis procedures. In the usability study, all participants agreed that the integrated platform provides the ability to collect comprehensive clinical evidence, automatically analyze collected data in real time, and generate clinically relevant performance measures through an easily accessible web portal. Conclusions: The integrated platform offers a better approach for clinical data reporting and analytics. Additionally, the platform streamlines the workflow of AAC clinical service delivery.

  • Prevalence, demographic correlates, and perceived impacts of use of mobile health applications: a cross-sectional questionnaire study​​

    Date Submitted: Sep 21, 2017

    Open Peer Review Period: Sep 23, 2017 - Nov 18, 2017

    Background: The advent of mobile applications (apps) has changed the way people obtain health information and services and advance their understanding of and management strategies for their health. Al...

    Background: The advent of mobile applications (apps) has changed the way people obtain health information and services and advance their understanding of and management strategies for their health. Although many health apps are available, little is known about the prevalence of their use for various health purposes, whether the use is associated with demographic characteristics, and the impacts of the use on health knowledge and management. Objective: This study aimed to examine the prevalence and demographic correlates of use of health apps and the perceived impacts on health knowledge and management. Methods: A cross-sectional questionnaire survey of a random sample of 633 adults living in the community was conducted. Results: A total of 612 (96.7%) participants reported using mobile devices. Of them, 235 (38.4%) reported using multiple types of health apps. The most prevalent health app type was about healthy living information, 32.2%, followed by vital measurement or recording, 13.0%, health and medical reminders, 10.4%, recovery and rehabilitation information, 6.9%, assistance in diagnosis, 4.6%, emergency services, 2.6%, telehealth, 1.8%, and others, 3.1%. Multivariate logistic regression analysis found that those using health apps were more likely to be women and have a higher self-rated social class. Participants with education/culture/academic occupations, that worked in disciplinary forces, and with “others” occupations (e.g., health care, sports, media, social work, etc.) tended to agree that using health apps could increase their health knowledge or improve the effectiveness of health management. Conclusions: We found that the most prevalent types of health apps were ‘healthy living information apps’, ‘vital measurement and record apps’, and ‘health and medical reminders apps’. Results of the study showed that different demographic characteristics including gender, self-rated social class, education level, and occupation may be related to health app use. Since participants’ responses were diverse and they did not gather on a common idea, there were existing uncertainties in ‘whether using health apps could increase personal health knowledge and improve the effectiveness of personal health management’.

  • Response to Letter 'Digital blind-spots: the role of symptom severity and user experience in digital intervention adherence'

    Date Submitted: Sep 8, 2017

    Open Peer Review Period: Sep 20, 2017 - Nov 15, 2017

    Background: In their letter the authors state that a) our claim that there is little effect of symptom severity on drop-out was not clearly supported and b) our discussion of service user involvement...

    Background: In their letter the authors state that a) our claim that there is little effect of symptom severity on drop-out was not clearly supported and b) our discussion of service user involvement does not include ‘User Experience/User Interface (UXUI)’. We respond to each of these comments. Objective: NA Methods: NA Results: NA Conclusions: NA

  • Developing sustainable and impactful mobile phone HIV testing interventions for Spanish-speaking men who have sex with men in the United States (US): Lessons learned from informative interviews

    Date Submitted: Sep 18, 2017

    Open Peer Review Period: Sep 20, 2017 - Nov 15, 2017

    Background: While many gay, bisexual, and other men who have sex with men (MSM) test for HIV at least once in their lifetime, opportunities to improve regular HIV testing, particularly among Hispanic/...

    Background: While many gay, bisexual, and other men who have sex with men (MSM) test for HIV at least once in their lifetime, opportunities to improve regular HIV testing, particularly among Hispanic/Latino MSM, are needed. Many mHealth interventions in development and that include HIV testing have primarily focused on English-speaking white, Black and MSM of other races. To date, no studies have assessed app use, attitudes and motivations for downloading and sustaining use of mobile apps, and preferences with respect to HIV prevention among Spanish-speaking, Hispanic MSM in the U.S. Objective: The primary objectives of this study were to answer the following questions: 1) What features and functions of smartphone apps do Hispanic, Spanish-speaking MSM believe are associated with downloading apps to their smartphones?; 2) What features and functions of smartphone apps are most likely to influence men’s sustained use of apps over time?; and 3) What features and functions do the men prefer in a smartphone app aimed to promote regular testing for HIV? Methods: Interviews (n=15) were conducted with a racially diverse group of sexually active, HIV-negative, Spanish-speaking, Hispanic MSM (Mean age of 32; 40% tested for HIV 6 months ago) in Miami, Florida. Interviews were digitally recorded, transcribed verbatim, translated back to English, and de-identified for analysis. A constant comparison method (i.e., grounded theory coding) was employed to examine and re-examine the themes that emerged from the interviews. Results: Personal interest was the primary reason associated with whether men downloaded an app. Keeping personal information secure, cost, influence by peers and posted reviews, ease of use, and functionality affected whether they downloaded and used the app over time. Men also reported that entertainment value and frequency of updates influenced whether they kept and continued to use an app over time. There were four reasons why participants chose to delete an app: dislike, lack of use, cost, and lack of memory/space. Participants’ also shared their preferences for an app to encourage regular HIV testing by providing feedback on test reminders, tailored testing interval recommendations, HIV test locator, and monitoring of personal sexual behaviors. Conclusions: The features and functions of mobile apps that Spanish-speaking MSM in this study believed were associated with downloading and/or sustained engagement of an app generally reflected the priorities mentioned in an earlier study with English-speaking MSM. However, unlike the earlier study, Spanish-speaking MSM prioritized personal interest in a mobile app and de-emphasized the efficiency of an app to make their lives easier in their decision to download an app to their mobile device. As such, tailoring mobile apps to the language and needs of Spanish-speaking MSM is critical to help appeal to their willingness to download a mobile app. Despite the growing number of HIV prevention apps in development, few are specifically tailored to Spanish-speaking MSM, representing an important gap that should be addressed in future research.

  • Design of an mHealth tool for self-management and care engagement of cardiovascular disease patients: enhancing user experience through user study

    Date Submitted: Sep 20, 2017

    Open Peer Review Period: Sep 20, 2017 - Sep 29, 2017

    Background: As patient communication, engagement, personal health data tracking, and up-to-date information became more efficient through mobile health (mHealth), cardiovascular diseases (CVD) and oth...

    Background: As patient communication, engagement, personal health data tracking, and up-to-date information became more efficient through mobile health (mHealth), cardiovascular diseases (CVD) and other diseases that require behavioral improvements in daily life are now capable of being managed and prevented more effectively. However, in order to increase patient engagement through mHealth, it is important for the initial design to consider functionality and usability factors and accurately assess user demands during the developmental process so that the application (app) can be used continuously. Objective: This study designed a user-friendly, personalized mHealth service for patients with CVD based on user research to help enhance communication between patients and doctors. Methods: In order to drive the mobile functions and services that are needed to manage diseases in CVD patients, user research was conducted on CVD patients and doctors at a tertiary general hospital. Interviews and a survey were conducted on patients (35 subjects) and a focus group interview was conducted on doctors (5 subjects). A mock-up mobile app was developed based on the user survey results, and a usability test was conducted (8 subjects) to find the factors that need to be considered in order to improve usability. Results: The majority of patients showed a positive response in terms of their interest or intent to use an app for managing CVD. Communication with doctors, self-risk assessment, exercise, tailored education, blood pressure (BP) management, health status recording, and other related functions had a score of 4.0 or higher on a 5-point Likert scale, showing that these functions were useful to patients. The medical staff requested a function that offers a comprehensive view of the patient’s daily health status by linking a regular health examination service with the hospital’s electronic medical records system. The results of the mock-up usability test showed that the ease of inputting and visualizing BP and other health conditions was required. Conclusions: Insights derived from a user study for developing an mHealth tool for CVD management, such as self-assessment and a communication channel, would be helpful to improve patient engagement in care.