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Journal Description

JMIR mHealth and uHealth (JMU, ISSN 2291-5222; Impact Factor 4.301) is a sister journal of JMIR, the leading eHealth journal. JMIR mHealth and uHealth is indexed in PubMed, PubMed Central, Scopus, MEDLINE and Science Citation Index Expanded (SCIE), and in June 2019 received an Impact Factor of 4.301, which ranks the journal #2 (behind JMIR) in the medical informatics category indexed by the Science Citation Index Expanded (SCIE) by Thomson Reuters/Clarivate

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

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

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

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


Recent Articles:

  • Source: Adobe Stock; Copyright: rocketclips; URL:; License: Licensed by JMIR.

    An Innovative Electronic Health Toolkit (Our Whole Lives for Chronic Pain) to Reduce Chronic Pain in Patients With Health Disparities: Open Clinical Trial


    Background: Chronic pain affects millions of Americans. Our Whole Lives, an electronic health (eHealth) toolkit for Chronic Pain (Our Whole Lives for Chronic Pain [OWLCP]), is a mind-body chronic pain management platform that teaches self-management strategies to reduce pain impact and pain medication use. Objective: The primary goal of this study was to evaluate the feasibility of OWLCP in reducing pain impact and pain-related outcomes. Methods: We conducted a pre-post clinical study (2 cohorts) to assess the feasibility of OWLCP usage among low-income patients with chronic pain. Outcome data, collected at baseline and 9 weeks, included Patient-Reported Outcomes Measurement Information System (PROMIS-29), pain self-efficacy, and pain medication use. In the statistical analysis, we used descriptive statistics, logistic regression, linear regression, and qualitative methods. Results: Among the enrolled 43 participants, the average age was 50 years, (39/43) 91% were female, (16/43) 37% were black, and (7/43) 16% were Hispanic. From baseline to follow-up, the PROMIS measures showed a reduction in depression (P=.02), pain interference (P=.003), and average pain impact score (P=.007). Pain self-efficacy increased ((P<.001), whereas opioid use had a 13% reduction (P=.03). Conclusions: The eHealth chronic pain management platform, OWLCP, is a potential tool to reduce the impact of chronic pain for low-income racially diverse populations.

  • Source: Pexels; Copyright: PhotoMIX Ltd.; URL:; License: Creative Commons Attribution (CC-BY).

    The German Version of the Mobile App Rating Scale (MARS-G): Development and Validation Study


    Background: The number of mobile health apps (MHAs), which are developed to promote healthy behaviors, prevent disease onset, manage and cure diseases, or assist with rehabilitation measures, has exploded. App store star ratings and descriptions usually provide insufficient or even false information about app quality, although they are popular among end users. A rigorous systematic approach to establish and evaluate the quality of MHAs is urgently needed. The Mobile App Rating Scale (MARS) is an assessment tool that facilitates the objective and systematic evaluation of the quality of MHAs. However, a German MARS is currently not available. Objective: The aim of this study was to translate and validate a German version of the MARS (MARS-G). Methods: The original 19-item MARS was forward and backward translated twice, and the MARS-G was created. App description items were extended, and 104 MHAs were rated twice by eight independent bilingual researchers, using the MARS-G and MARS. The internal consistency, validity, and reliability of both scales were assessed. Mokken scale analysis was used to investigate the scalability of the overall scores. Results: The retranslated scale showed excellent alignment with the original MARS. Additionally, the properties of the MARS-G were comparable to those of the original MARS. The internal consistency was good for all subscales (ie, omega ranged from 0.72 to 0.91). The correlation coefficients (r) between the dimensions of the MARS-G and MARS ranged from 0.93 to 0.98. The scalability of the MARS (H=0.50) and MARS-G (H=0.48) were good. Conclusions: The MARS-G is a reliable and valid tool for experts and stakeholders to assess the quality of health apps in German-speaking populations. The overall score is a reliable quality indicator. However, further studies are needed to assess the factorial structure of the MARS and MARS-G.

  • Source: Flickr; Copyright: Jason Cao; URL:; License: Creative Commons Attribution + ShareAlike (CC-BY-SA).

    The Effectiveness of Self-Management of Hypertension in Adults Using Mobile Health: Systematic Review and Meta-Analysis


    Background: Effective treatment of hypertension requires careful self-management. With the ongoing development of mobile technologies and the scarcity of health care resources, mobile health (mHealth)–based self-management has become a useful treatment for hypertension, and its effectiveness has been assessed in many trials. However, there is a paucity of comprehensive summaries of the studies using both qualitative and quantitative methods. Objective: This systematic review aimed to measure the effectiveness of mHealth in improving the self-management of hypertension for adults. The outcome measures were blood pressure (BP), BP control, medication adherence, self-management behavior, and costs. Methods: A systematic search was conducted using 5 electronic databases. The snowballing method was used to scan the reference lists of relevant studies. Only peer-reviewed randomized controlled trials (RCTs) published between January 2010 and September 2019 were included. Data extraction and quality assessment were performed by 3 researchers independently, adhering to the validation guideline and checklist. Both a meta-analysis and a narrative synthesis were carried out. Results: A total of 24 studies with 8933 participants were included. Of these, 23 studies reported the clinical outcome of BP, 12 of these provided systolic blood pressure (SBP) and diastolic blood pressure (DBP) data, and 16 articles focused on change in self-management behavior and medication adherence. All 24 studies were included in the narrative synthesis. According to the meta-analysis, a greater reduction in both SBP and DBP was observed in the mHealth intervention groups compared with control groups, −3.78 mm Hg (P<.001; 95% CI −4.67 to −2.89) and −1.57 mm Hg (P<.001; 95% CI −2.28 to −0.86), respectively. Subgroup analyses showed consistent reductions in SBP and DBP across different frequencies of reminders, interactive patterns, intervention functions, and study duration subgroups. A total of 16 studies reported better medication adherence and behavioral change in the intervention groups, while 8 showed no significant change. Six studies included an economic evaluation, which drew inconsistent conclusions. However, potentially long-term financial benefits were mentioned in all economic evaluations. All studies were assessed to be at high risk of bias. Conclusions: This review found that mHealth self-management interventions were effective in BP control. The outcomes of this review showed improvements in self-management behavior and medication adherence. The most successful mHealth intervention combined the feature of tailored messages, interactive communication, and multifaceted functions. Further research with longer duration and cultural adaptation is necessary. With increasing disease burden from hypertension globally, mHealth offers a potentially effective method for self-management and control of BP. mHealth can be easily integrated into existing health care systems. Trial Registration: PROSPERO CRD42019152062;

  • Source: freepik; Copyright: freepik; URL:; License: Licensed by JMIR.

    Preliminary Effects of a Mobile Interactive Supervised Therapy Intervention on People Living With HIV: Pilot Randomized Controlled Trial


    Background: As people living with HIV infection require lifelong treatment, nonadherence to medication will reduce their chance of maintaining viral suppression and increase the risk of developing drug resistance and HIV transmission. Objective: This study aimed to evaluate the efficacy of a mobile app, Mobile Interactive Supervised Therapy (MIST), for improving adherence to oral HIV medications among HIV-infected adults in Singapore. Methods: We conducted a two-group pilot randomized controlled trial (RCT) with a process evaluation, in which 40 HIV-infected participants with once-daily medication regimes were recruited from a public tertiary hospital in Singapore and randomly assigned equally to either the intervention (receiving MIST and routine care) or control (receiving routine care only) groups. The intervention lasted for 2 months. The outcome of antiretroviral therapy (ART) adherence was measured by a 7-day recall self-report (SR), pill count (PC), an electronic medical device—Medication Event Monitoring System (MEMS)—and a mobile app—MIST (for the intervention group only). In total, 20 participants from the intervention group were interviewed at the end of the intervention to assess the acceptability of MIST. Data were collected at baseline and at 1-month and 2-month postintervention. Results: All participants had excellent medication adherence at baseline (median 100, IQR 100-100). The use of MIST did not result in a significant improvement in ART adherence when measured by the SR, PC, and MEMS, as compared with the control group at 1-month (P values >.99, .86, and .74, respectively) and 2-month (P values=.80, .84, and .82, respectively) postintervention. ART adherence also did not improve in each group over the same period. MIST was perceived to be a beneficial tool based on the process evaluation results. Conclusions: Although MIST did not enhance medication adherence to HIV treatments, mainly owing to the ceiling effect, it was perceived to be beneficial among the participants of this study. Our process evaluation provided useful data to further develop MIST for bigger and long-term mobile phone app–assisted intervention RCTs in the future. Trial Registration: NCT03794648;

  • A nurse performs the WHO handwash procedure with Myo armbands. Source: Image created by the authors; Copyright: The Authors; URL:; License: Licensed by JMIR.

    Accurate Measurement of Handwash Quality Using Sensor Armbands: Instrument Validation Study


    Background: Hand hygiene is a crucial and cost-effective method to prevent health care–associated infections, and in 2009, the World Health Organization (WHO) issued guidelines to encourage and standardize hand hygiene procedures. However, a common challenge in health care settings is low adherence, leading to low handwashing quality. Recent advances in machine learning and wearable sensing have made it possible to accurately measure handwashing quality for the purposes of training, feedback, or accreditation. Objective: We measured the accuracy of a sensor armband (Myo armband) in detecting the steps and duration of the WHO procedures for handwashing and handrubbing. Methods: We recruited 20 participants (10 females; mean age 26.5 years, SD 3.3). In a semistructured environment, we collected armband data (acceleration, gyroscope, orientation, and surface electromyography data) and video data from each participant during 15 handrub and 15 handwash sessions. We evaluated the detection accuracy for different armband placements, sensor configurations, user-dependent vs user-independent models, and the use of bootstrapping. Results: Using a single armband, the accuracy was 96% (SD 0.01) for the user-dependent model and 82% (SD 0.08) for the user-independent model. This increased when using two armbands to 97% (SD 0.01) and 91% (SD 0.04), respectively. Performance increased when the armband was placed on the forearm (user dependent: 97%, SD 0.01; and user independent: 91%, SD 0.04) and decreased when placed on the arm (user dependent: 96%, SD 0.01; and user independent: 80%, SD 0.06). In terms of bootstrapping, user-dependent models can achieve more than 80% accuracy after six training sessions and 90% with 16 sessions. Finally, we found that the combination of accelerometer and gyroscope minimizes power consumption and cost while maximizing performance. Conclusions: A sensor armband can be used to measure hand hygiene quality relatively accurately, in terms of both handwashing and handrubbing. The performance is acceptable using a single armband worn in the upper arm but can substantially improve by placing the armband on the forearm or by using two armbands. Trial Registration:

  • Man using a mobile phone to help wound dressing in the home environment. Source: Image created by the Authors; Copyright: The Authors; URL:; License: Creative Commons Attribution (CC-BY).

    Wound Care Knowledge, Attitudes, and Practices and Mobile Health Technology Use in the Home Environment: Cross-Sectional Survey of Social Network Users


    Background: Injury causing wounds is a frequent event. Inadequate or inappropriate treatment of injuries can threaten individual health. However, little is known about wound care knowledge, attitudes, and practices and mobile health (mHealth) use in the home environment in Taiwan. Objective: This study aimed to evaluate wound care knowledge, attitudes, and practices and mHealth technology use among social network users. Methods: A cross-sectional survey on social media platforms was conducted on adults aged 20 years and older. Data were collected from social network users in the home environment. Results: A total of 361 participants were enrolled. The mHealth technology use of participants was positively correlated with wound care knowledge (r=.132, P=.01), attitudes (r=.239, P<.001), and practices (r=.132, P=.01). Participants did not have adequate knowledge (correct rate 69.1%) and were unfamiliar with the guidelines of proper wound care (correct rate 74.5%). Most participants had positive attitudes toward wound care and mHealth technology use. A total of 95.6% (345/361) of participants perceived that the use of mHealth technology can improve wound care outcomes, and 93.9% (339/361) perceived that wound care products should be optimized to be used with a mobile device. However, 93.6% (338/361) of participants had no experience using mHealth technology for wound care. Conclusions: Our study shows the potential of mHealth technology to enhance wound care knowledge among social network users. Thus, government agencies and medical institutions in Taiwan should provide easy-to-use information products that enhance wound care knowledge, promote adequate behavior toward wound care, and prevent unpredictable or undesirable outcomes.

  • Source: Image created by the authors; Copyright: The Authors; URL:; License: Public Domain (CC0).

    Importance of Photography Education to Improve Image Quality for Accurate Remote Diagnoses in Dental Trauma Patients: Observational Study


    Background: High-quality photos are critical for the remote diagnosis of dental trauma and thus are beneficial to the prognosis. The quality of the images obtained using a cell phone depends on the level of dental and photography knowledge of the person who is taking the photos. Objective: This study aimed to determine the efficacy of photography education in improving images used for the remote diagnosis of dental trauma. Methods: The subjects comprised 30 laypeople and 30 dentists who were randomly assigned to 15 subgroups with 2 subjects in each. Each subject was asked to take photos of their own anterior teeth and those of their partner on the assumption that an accident occurred using both an iPhone 4s and iPhone 6. Education about how to take an appropriate photo of the anterior teeth for teleconsultation purposes was then provided, after which photos were taken again. Photos were assessed by a dentist for their usefulness in diagnosis. Results: This study analyzed 965 photos: 441 taken by laypeople and 524 taken by dentists. Photos taken after providing education had significantly higher scores for all assessment items than those taken before education (P<.05). The scores were also significantly higher for photos taken using the rear camera than those taken using the front camera (P<.02). The iPhone 6 did not have overwhelming advantages. The photos taken by dentists had significantly higher scores than those taken by laypeople for most of the evaluated items. Conclusions: Both laypeople and dentists might find photography education useful for when they are taking photos to be used in teleconsultations. The type of cell phone does not significantly affect the usefulness of such photos.

  • IT Intervention in Charging Inpatients Medical Materials. Source: Min-Chi,Liao; Copyright: The Authors; URL:; License: Licensed by the authors.

    Performance Evaluation of an Information Technology Intervention Regarding Charging for Inpatient Medical Materials at a Regional Teaching Hospital in...


    Background: The process of manually recording the consumption of medical materials can be time consuming and prone to omission owing to its detailed and complicated nature. Implementing an information system will better improve work performance. Objective: The Information System Success Model was adopted as the theoretical foundation. The opinions of nursing staff were collected to verify the impact of the system intervention on their work performance. Methods: This cross-sectional study was conducted at a regional teaching hospital. Nursing staff were invited to participate in the field survey. A total of 296 questionnaires were collected, and of these, 284 (95.9%) were valid and returned. Results: The key findings showed that two critical factors (“subjective norm” and “system quality”) had significant positive effects (both P<.001) on user satisfaction (R2=0.709). The path of “service quality” to “user satisfaction” showed marginal significance (P=.08) under the 92% CI. Finally, the explanatory power of the model reached 68.9%. Conclusions: Support from the top management, appointment of a nurse supervisor as the change agent, recruitment of seed members to establish a pioneer team, and promotion of the system through the influence of opinion leaders in small groups were critical success factors needed for implementing the system in the case hospital. The target system was proven to be able to improve work performance, and the time saved could be further used for patient care, thereby increasing the value of nursing work. The positive experiences gained from this study could lay the foundation for the further promotion of the new system, and this is for future studies to replicate. The example of the successful experience of the case hospital could also serve as a reference for other hospitals in developing countries like Taiwan with regard to the promotion of nursing informatization.

  • Source: Adobe Stock; Copyright: voltan; URL:; License: Licensed by the authors.

    Volumetric Food Quantification Using Computer Vision on a Depth-Sensing Smartphone: Preclinical Study


    Background: Quantification of dietary intake is key to the prevention and management of numerous metabolic disorders. Conventional approaches are challenging, laborious, and lack accuracy. The recent advent of depth-sensing smartphones in conjunction with computer vision could facilitate reliable quantification of food intake. Objective: The objective of this study was to evaluate the accuracy of a novel smartphone app combining depth-sensing hardware with computer vision to quantify meal macronutrient content using volumetry. Methods: The app ran on a smartphone with a built-in depth sensor applying structured light (iPhone X). The app estimated weight, macronutrient (carbohydrate, protein, fat), and energy content of 48 randomly chosen meals (breakfasts, cooked meals, snacks) encompassing 128 food items. The reference weight was generated by weighing individual food items using a precision scale. The study endpoints were (1) error of estimated meal weight, (2) error of estimated meal macronutrient content and energy content, (3) segmentation performance, and (4) processing time. Results: In both absolute and relative terms, the mean (SD) absolute errors of the app’s estimates were 35.1 g (42.8 g; relative absolute error: 14.0% [12.2%]) for weight; 5.5 g (5.1 g; relative absolute error: 14.8% [10.9%]) for carbohydrate content; 1.3 g (1.7 g; relative absolute error: 12.3% [12.8%]) for fat content; 2.4 g (5.6 g; relative absolute error: 13.0% [13.8%]) for protein content; and 41.2 kcal (42.5 kcal; relative absolute error: 12.7% [10.8%]) for energy content. Although estimation accuracy was not affected by the viewing angle, the type of meal mattered, with slightly worse performance for cooked meals than for breakfasts and snacks. Segmentation adjustment was required for 7 of the 128 items. Mean (SD) processing time across all meals was 22.9 seconds (8.6 seconds). Conclusions: This study evaluated the accuracy of a novel smartphone app with an integrated depth-sensing camera and found highly accurate volume estimation across a broad range of food items. In addition, the system demonstrated high segmentation performance and low processing time, highlighting its usability.

  • Woman using a mobile phone in Bondo, Kenya. Source: Paul J. Brown; Copyright: Paul J. Brown; URL:; License: Licensed by the authors.

    The Utility of SMS to Report Male Partner HIV Self-testing Outcomes Among Women Seeking Reproductive Health Services in Kenya: Cohort Study


    Background: Use of SMS for data collection is expanding, but coverage, bias, and logistical constraints are poorly described. Objective: The aim of this study is to assess the use of SMS to capture clinical outcomes that occur at home and identify potential biases in reporting compared to in-person ascertainment. Methods: In the PrEP Implementation in Young Women and Adolescents program, which integrated pre-exposure prophylaxis (PrEP) into antenatal care, postnatal care, and family planning facilities in Kisumu County, Kenya, HIV-negative women 14 years of age or older were offered oral HIV self-tests (HIVSTs) to take home to male partners. Women that brought a phone with a Safaricom SIM to the clinic were offered registration in an automated SMS system (mSurvey) to collect information on HIVST outcomes. Women were asked if they offered the test to their male partners, and asked about the test process and results. HIVST outcomes were collected via SMS (sent 2.5 weeks later), in-person (if women returned for a follow-up scheduled 1 month later), or using both methods (if women initiated PrEP, they also had scheduled follow-up visits). The SMS prompted women to reply at no charge. HIVST outcomes were compared between women with scheduled follow-up visits and those without (follow-up visits were only scheduled for women who initiated PrEP). HIVST outcomes were also compared between women reporting via SMS and in-person. Results: Among 2123 women offered HIVSTs and mSurvey registration, 486 (23.89%) accepted HIVSTs, of whom 359 (73.87%) were eligible for mSurvey. Additionally, 76/170 (44.7%) women with scheduled follow-up visits and 146/189 (77.3%) without scheduled follow-up visits registered in mSurvey. Among the 76 women with scheduled follow-ups, 62 (82%) had HIVST outcomes collected: 19 (31%) in-person, 20 (32%) by SMS, and 23 (37%) using both methods. Among the 146 women without scheduled visits, 87 (59.6%) had HIVST outcomes collected: 3 (3%) in-person, 82 (94%) by SMS, and 2 (2%) using both methods. SMS increased the collection of HIVST outcomes substantially for women with scheduled follow-up visits (1.48-fold), and captured 82 additional reports from women without scheduled follow-up visits. Among 222 women with reported HIVST outcomes, frequencies of offering partners the HIVST (85/95, 89% in-person vs 96/102, 94% SMS; P=.31), partners using the HIVST (83/85, 98% vs 92/96, 96%; P=.50), women using HIVST with partners (82/83, 99% vs 91/92, 99%; P=.94), and seeing partner’s HIVST results (82/83, 99% vs 89/92, 97%; P=.56) were similar between women reporting in-person only versus by SMS only. However, frequency of reports of experiencing harm or negative reactions from partners was more commonly reported in the SMS group (17/102, 16.7% vs 2/85, 2%; P=.003). Barriers to the SMS system registration included not having a Safaricom SIM or a functioning phone. Conclusions: Our results suggest that the use of SMS substantially improves completeness of outcome data, does not bias reporting of nonsensitive information, and may increase reporting of sensitive information.  

  • Source: Adobe Stock; Copyright: maryviolet / Adobe; URL:; License: Licensed by JMIR.

    Using Mobile Health Tools to Engage Rural Underserved Individuals in a Diabetes Education Program in South Texas: Feasibility Study


    Background: Access to diabetes education and resources for diabetes self-management is limited in rural communities, despite higher rates of diabetes in rural populations compared with urban populations. Technology and mobile health (mHealth) interventions can reduce barriers and improve access to diabetes education in rural communities. Screening, Brief Intervention, and Referral to Treatment (SBIRT) and financial incentives can be used with mHealth interventions to increase the uptake of diabetes education; however, studies have not examined their combined use for diabetes self-management in rural settings. Objective: This two-phase Stage 1 feasibility study aimed to use a mixed methods design to examine the feasibility and acceptability of an mHealth diabetes education program combining SBIRT and financial incentives to engage rural individuals. Methods: In Phase 1, we aimed to develop, adapt, and refine the intervention protocol. In Phase 2, a 3-month quasi-experimental study was conducted with individuals from 2 rural communities in South Texas. Study participants were individuals who attended free diabetes screening events in their community. Those with low or medium risk received health education material, whereas those with high risk or those with a previous diagnosis of diabetes participated in motivational interviewing and enrolled in the 6-week mHealth Diabetes Self-Management Education Program under either an unconditional or aversion incentive contract. The participants returned for a 3-month follow-up. Feasibility and acceptability of the intervention were determined by the rate of participant recruitment and retention, the fidelity of program delivery and compliance, and the participant’s satisfaction with the intervention program. Results: Of the 98 screened rural community members in South Texas, 72 individuals met the study eligibility and 62 individuals agreed to enroll in the study. The sample was predominately female and Hispanic, with an average age of 52.6 years. The feedback from study participants indicated high levels of satisfaction with the mHealth diabetes education program. In the poststudy survey, the participants reported high levels of confidence to continue lifestyle modifications, that is, weight loss, physical activity, and diet. The retention rate was 50% at the 3-month follow-up. Participation in the intervention was high at the beginning and dissipated in the later weeks regardless of the incentive contract type. Positive changes were observed in weight (mean -2.64, SD 6.01; P<.05) and glycemic control index (-.30; P<.05) in all participants from baseline to follow-up. Conclusions: The finding showed strong feasibility and acceptability of study recruitment and enrollment. The participants’ participation and retention were reasonable given the unforeseen events that impacted the study communities during the study period. Combining mHealth with SBIRT has the potential to reach individuals with need to participate in diabetes education in rural communities.

  • Source: Freepik; Copyright: katemangostar; URL:; License: Licensed by JMIR.

    A Mobile Health Intervention for Mental Health Promotion Among University Students: Randomized Controlled Trial


    Background: High positive mental health, including the ability to cope with the normal stresses of life, work productively, and be able to contribute to one’s community, has been associated with various health outcomes. The role of positive mental health is therefore increasingly recognized in national mental health promotion programs and policies. Mobile health (mHealth) interventions could be a cost-effective way to disseminate positive psychological interventions to the general population. Objective: The aim of this study was to estimate the effect of a fully automated mHealth intervention on positive mental health, and anxiety and depression symptomology among Swedish university students using a randomized controlled trial design. Methods: A 2-arm, single-blind (researchers), parallel-groups randomized controlled trial with an mHealth positive psychology program intervention group and a relevant online mental health information control group was employed to estimate the effect of the novel intervention. Participants were recruited using digital advertising through student health care centers in Sweden. Inclusion criteria were (1) university students, (2) able to read and understand Swedish, (3) and have access to a mobile phone. Exclusion criteria were high positive mental health, as assessed by the Mental Health Continuum Short Form (MHC-SF), or high depression and anxiety symptomology, as assessed by the Hospital Anxiety Depression Scale (HADS). The primary outcome was positive mental health (MHC-SF), and the secondary outcomes were depression and anxiety symptomatology (HADS). The subscales of MHC-SF were also analyzed as exploratory outcomes. Outcomes were measured 3 months after randomization through questionnaires completed on the participants’ mobile phones. Results: A total of 654 participants (median age 25 years), including 510 (78.0%) identifying as female, were randomized to either the intervention (n=348) or control group (n=306). At follow-up, positive mental health was significantly higher in the intervention group compared with the control group (incidence rate ratio [IRR]=1.067, 95% CI 1.024-1.112, P=.002). For both depression and anxiety symptomatology, the intervention group showed significantly lower scores at follow-up compared with the control group (depression: IRR=0.820, 95% CI 0.714-0.942, P=.005; anxiety: IRR=0.899, 95% CI 0.840-0.962, P=.002). Follow-up rates were lower than expected (58.3% for primary outcomes and 52.3% for secondary outcomes); however, attrition analyses did not identify any systematic attrition with respect to baseline variables. Conclusions: The mHealth intervention was estimated to be superior to usual care in increasing positive mental health among university students. A protective effect of the intervention was also found on depressive and anxiety symptoms. These findings demonstrate the feasibility of using an automated mobile phone format to enhance positive mental health, which offers promise for the use of mHealth solutions in public mental health promotion. Trial Registration: International Standard Randomized Controlled Trial Registry ISRCTN54748632;

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  • Recommendations for a mobile health research platform from a developer's perspective: Survey Study

    Date Submitted: Mar 18, 2020

    Open Peer Review Period: Mar 18, 2020 - May 13, 2020

    Background: The use of mobile phone apps and connected wearable devices offers a great opportunity for health research. In order make healthcare data accessible across organisations, physicians and pa...

    Background: The use of mobile phone apps and connected wearable devices offers a great opportunity for health research. In order make healthcare data accessible across organisations, physicians and patients, recent platforms like Apple HealthKit, Google Fit or Samsung Health allow to securely store and share health data among smartphone apps with the consent of the user. These mobile health records can be combined with software platforms, like ResearchKit and ResearchStack to simplify the development of research apps by providing ready-made common use cases while being compliant to regulations in data protection and health research. Even though a plethora of such platforms exist, none of them can be considered as a widely established tool yet. Objective: To provide recommendations for new platforms through the analysis of the limitations posed by existing platforms and by identifying common needs and established practices in mHealth development. Methods: We first analyse the state of the art of mobile-health development in research settings, including existing tools and frameworks to support it. To complement the scant literature, we disseminated a survey among mobile-health researchers and developers to understand best practices, what type of tools are used and which would be desirable. Results: Related to current practices and unmet needs in mHealth development we identify the following themes: a) costs and resources, b) usability and context awareness, c) middleware and software architectures, d) multi-platform support, e) mobile connectivity, f) reliability and testing, g) data protection and regulatory compliance and h) interoperability. In relation to existing platforms we identified these common shortcomings: 1) poor regulatory compliance, 2) lack of documentation, 3) low maturity, 4) poor usability (from the developer’s perspective) and intuitiveness. Our survey received 28 very varied responses, which identify a core of concerns shared for most of the reported projects and not entirely met by the current offer of development platforms. Based on these results, we provide recommendations for future mobile-health platforms, particularly focusing on multi-operating system support, integration with existing health records, regulatory compliance, involvement of stakeholders, modularity, extensibility and overall quality of the code base. Conclusions: Our recommendations intend to guide the development of a platform to be used as a common tool for future research in mobile-health.

  • Engagement, acceptability, usability and preliminary efficacy of a self-monitoring mHealth intervention to reduce sedentary behavior in older adults: a mixed-methods study

    Date Submitted: Mar 11, 2020

    Open Peer Review Period: Mar 10, 2020 - May 5, 2020

    Background: Although healthy aging can be stimulated by the reduction of sedentary behavior, few interventions are available for older adults. Previous studies suggest that self-monitoring might be a...

    Background: Although healthy aging can be stimulated by the reduction of sedentary behavior, few interventions are available for older adults. Previous studies suggest that self-monitoring might be a promising behavior change technique to reduce older adults’ sedentary behavior. However, little is known about older adults’ experiences with a self-monitoring based intervention aimed at the reduction of sedentary behavior. Objective: The aim of the current study is to evaluate engagement, acceptability, usability and preliminary efficacy of a self-monitoring mHealth intervention developed to reduce older adults’ sedentary behavior. Methods: A mixed-methods study was performed among 28 community-dwelling older adults. The three-week intervention consisted of general sedentary behavior information, and visual and tactile feedback on participants’ sedentary behavior. Semi-structured interviews were conducted to explore engagement with, and acceptability and usability of the intervention. Sedentary time, standing time, and number of steps were measured using the thigh-worn activPAL accelerometer before and after the intervention. System usage data of the app were recorded. Quantitative data were analyzed using descriptive statistics and paired samples T-tests; while qualitative data were thematically analyzed and presented using pen profiles. Results: Participants mainly reported positive feelings regarding the intervention, such as motivating, surprising, and interesting. They commonly reported that the intervention changed their thinking (i.e. they became more aware of their sedentary behavior), but not their behavior. There were mixed opinions on the kind of feedback (i.e. tactile vs visual) that they preferred. The intervention was considered easy to use, and the design was described as clear. Some problems were noticed regarding attaching and wearing the self-monitoring device. System usage data showed that the median frequency of consulting the application widely differed among participants, ranging from 0 to 20 times a day. Sitting and standing time were very similar at pre and post measurements (P = 0.91 and P = 0.76 respectively) and there was a small improvement in steps of around 400 per day (P = 0.50). Conclusions: Although the intervention was well perceived by the majority of older adults, no reductions in sedentary time were found. Possible explanations for the lack of reductions might be the short intervention duration, or the fact that only bringing the habitual sedentary behavior into conscious awareness might not be sufficient to achieve behavior change. Clinical Trial:; Identification Number: NCT04003324;

  • Smartphone Application-supported validation of three automatic devices for the self-measurement of blood pressure according to the European Society of Hypertension International Protocol revision 2010: the Omron HEM-7120, Yuwell YE680A, and Cofoe KF-65B

    Date Submitted: Mar 8, 2020

    Open Peer Review Period: Mar 8, 2020 - May 3, 2020

    Background: Electronic sphygmomanometer is widely used in the households, medical institutions, and can be applied to the measurement of blood pressure and pulse at the same time. Currently, there are...

    Background: Electronic sphygmomanometer is widely used in the households, medical institutions, and can be applied to the measurement of blood pressure and pulse at the same time. Currently, there are few studies on accuracy comparison among different sphygmomanometers, and strict standardized verification is needed to ensure the comparability of blood pressure data. Objective: The aim of the present study was to validate the Omron HEM-7120, Yuwell YE680A, and Cofoe KF-65B for monitoring upper arm blood pressure (BP) according to the European Society of Hypertension International Protocol revision 2010 (ESH-IP revision 2010). Methods: Three trained medical doctors validated the performance of these devices by comparing the data obtained from the devices with those of a standard mercury sphygmomanometer. Results: We included 33 participants for each experiment; and the mean age of the participants was 50.0±11.2(Omron HEM-7120 experiment), 49.5±13.7(Yuwell YE680A experiment), and 48.8±15.0 years (Cofoe KF-65B experiment) in the respective studies. The absolute differences between the devices and the mercury readings within 5, 10, and 15 mmHg were as follows: HEM-7120, 73/99, 94/99 and 96/99, respectively, for systolic BP and 73/99, 91/99, 96/99, respectively, for diastolic BP; Yuwell YE680A, 50/99, 79/99 and 91/99, respectively, for systolic BP and 67/99, 87/99, 95/99, respectively, for diastolic BP; and Cofoe KF-65B, 53/99, 79/99 and 91/99, respectively, for systolic BP and 65/99, 89/99, 96/99, respectively, for diastolic BP. The findings also indicated that the devices’ systolic blood pressure readings were higher than mercury (1.3 mmHg, 1.0 mmHg and 4.1 mmHg higher for the Omron, Yuwell and Cofoe devices, respectively), while diastolic readings were lower than mercury (2.0 mmHg, 1.1 mmHg and 3.3 mmHg lower, respectively). Conclusions: The Omron HEM-7120 passed the requirements of the ESH-IP 2010 revision, while the Yuwell YE680A and Cofoe KF-65B failed.

  • Mobile phone applications for food allergies and/or intolerances: A systematic search and quality assessment of the identified applications in Apps Stores.

    Date Submitted: Feb 21, 2020

    Open Peer Review Period: Feb 20, 2020 - Apr 16, 2020

    Background: Food allergies and intolerances, as adverse reactions to the ingestion, contact or inhalation of a specific food, derivate or additive, are increasing worldwide, whereas mobile phone appli...

    Background: Food allergies and intolerances, as adverse reactions to the ingestion, contact or inhalation of a specific food, derivate or additive, are increasing worldwide, whereas mobile phone applications (Apps) are emerging as a promising tool in the management of food allergies and/or intolerances. Objective: The aim of this review is to systemically search and integrate the information of Apps present in Apple App Store (iOS) and Google Play Store (Android) about food allergies and/or intolerances, and to evaluate their quality through the Mobile App Rating Scale (MARS) tool. Methods: Apps were searched through specific keywords translated in English, Spanish and Italian language (“food allergy”, “food intolerance” and “allergens”). Inclusion criteria were: ≥ 3/5 minimum users’ star rating as a tool to evaluate Apps’ quality; ≥ 1000 reviews as an indicator of reliability; and last update up to 2017. Eligible Apps were evaluated and searched on PubMed to check if already present in scientific articles. Apps’ features were distinguished into input and output ones, depending on whether the contents were inserted by users or automatically generated. The included Apps were divided according to their function (“food products”, “restaurants” and “meal planners” Apps) and evaluated through the MARS tool comprising: 1) App classification category, collecting general and technical information; 2) App quality category, divided into “objective” (including four sections: engagement, functionality, aesthetics, and information) and “subjective” quality; and 3) App specific section, as optional section to evaluate the perceived impact of the App. Only App quality category and App specific section were rated for the quality assessment. For each section, mean±standard deviations (SD), statistical significance between-sections and between Apps’ function were evaluated. Results: Fourteen Apps were included: n=12 related to food allergies and intolerances, detecting from 2 to 15 food allergens; and n=2 related to gluten intolerance only. From the MARS quality assessment: a) objective quality scored 3.8±0.4 points (mean± SD of 5 maximum points); b) subjective quality scored 3.5±0.6 points; and c) App specific section scored 3.6±0.7 points. Therefore, Apps resulted in overall acceptable quality, considering ratings ≥ of 3points. From a between-sections comparison, engagement obtained lower scores than functionality, aesthetics and information sections. However, comparing Apps by function, “meal planners” Apps presented higher scores for the engagement section (4.1±0.4 points), than “food products” (3.0±0.6) and “restaurants” Apps (3.2±0.3 points) (P<.05). Conclusions: The present review integrates information of 14 Apps to help consumers to avoid food allergies and/or intolerances, providing suggestions for future Apps. Specifically, the analysed Apps have acceptable quality despite the MARS engagement section should be further improved in “food products” and “restaurants” function Apps. Additionally, for Apps recommendation, their effectiveness in detecting food allergens should be tested in scientific trials.

  • Validity of the Wrist-wearable Activity Devices for Estimating Physical Activity in Adolescents: A Comparative Study

    Date Submitted: Feb 19, 2020

    Open Peer Review Period: Feb 19, 2020 - Apr 15, 2020

    Background: The rapid advancements in science and technology of wrist-wearable activity devices offer considerable potential for clinical applications. Self-monitoring of one’s physical activity (PA...

    Background: The rapid advancements in science and technology of wrist-wearable activity devices offer considerable potential for clinical applications. Self-monitoring of one’s physical activity (PA) with activity devices is helpful to improve the PA levels of adolescents. However, knowing the accuracy of activity devices in adolescents is necessary to identify current levels of PA and to assess the effectiveness of intervention programs designed to increase PA. Objective: The study aimed to determine the validity of the eleven commercially available wrist-wearable activity devices for monitoring total steps and total 24-h total energy expenditure (TEE) in healthy adolescents under simulated free-living conditions. Methods: Nineteen (10 male and 9 female) participants aged 14-18 years performed a 24-hour activity cycle in a Metabolic Chamber. Each participant simultaneously wore eleven commercially wrist-wearable activity devices [XiaoMi Band2 (XiaoMi), Huawei B2 (Huawei), Bong2s, Amazfit, Fitbit Flex (Fitbit), Jawbone Up3 (Jawbone), Misfit Shine2 (Misfit), Golife Care-X (Golife), Withings Pulse O2 (Withings), Garmin Vivofit (Garmin) and Polar Loop (Polar)] and one research-based triaxial accelerometer (ActiGraph GT3X+). Criterion measures were total EE from the Metabolic Chamber (mcTEE) and total steps from the ActiGraph GT3X+ (AGsteps). Results: Pearson’s correlation coefficients (r) for 24-h TEE ranged from 0.78 (Misfit, Amazfit) to 0.96 (Polar) and for steps ranged from 0.20 (Golife) to 0.57 (Garmin). Mean Absolute Percent Error (MAPE) for TEE ranged from 5.7% (XiaoMi) to 26.4% (Amazfit) and for steps ranged from14.2% (Bong2s) to 27.6% (Polar). TEE estimates from the XiaoMi, Jawbone, Garmin and Bong2s were equivalent with mcTEE. Total steps from Bong2s was equivalent with AGsteps. Conclusions: Overall, the Bong2s had the best accuracy for estimating TEE and total steps under simulated free-living conditions. Further research is needed to examine the validity of these devices in different types of physical activities under real-world conditions.