@Article{info:doi/10.2196/26360, author="Jones, Chelsea and Harasym, Jessica and Miguel-Cruz, Antonio and Chisholm, Shannon and Smith-MacDonald, Lorraine and Br{\'e}mault-Phillips, Suzette", title="Neurocognitive Assessment Tools for Military Personnel With Mild Traumatic Brain Injury: Scoping Literature Review", journal="JMIR Ment Health", year="2021", month="Feb", day="22", volume="8", number="2", pages="e26360", keywords="military", keywords="rehabilitation", keywords="head injury", keywords="posttraumatic stress disorder", keywords="cognition", keywords="neurocognitive assessment tool", keywords="traumatic brain injury", keywords="assessment", keywords="brain concussion", keywords="mobile phone", abstract="Background: Mild traumatic brain injury (mTBI) occurs at a higher frequency among military personnel than among civilians. A common symptom of mTBIs is cognitive dysfunction. Health care professionals use neuropsychological assessments as part of a multidisciplinary and best practice approach for mTBI management. Such assessments support clinical diagnosis, symptom management, rehabilitation, and return-to-duty planning. Military health care organizations currently use computerized neurocognitive assessment tools (NCATs). NCATs and more traditional neuropsychological assessments present unique challenges in both clinical and military settings. Many research gaps remain regarding psychometric properties, usability, acceptance, feasibility, effectiveness, sensitivity, and utility of both types of assessments in military environments. Objective: The aims of this study were to explore evidence regarding the use of NCATs among military personnel who have sustained mTBIs; evaluate the psychometric properties of the most commonly tested NCATs for this population; and synthesize the data to explore the range and extent of NCATs among this population, clinical recommendations for use, and knowledge gaps requiring future research. Methods: Studies were identified using MEDLINE, Embase, American Psychological Association PsycINFO, CINAHL Plus with Full Text, Psych Article, Scopus, and Military \& Government Collection. Data were analyzed using descriptive analysis, thematic analysis, and the Randolph Criteria. Narrative synthesis and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews) guided the reporting of findings. The psychometric properties of NCATs were evaluated with specific criteria and summarized. Results: Of the 104 papers, 33 met the inclusion criteria for this scoping review. Thematic analysis and NCAT psychometrics were reported and summarized. Conclusions: When considering the psychometric properties of the most commonly used NCATs in military populations, these assessments have yet to demonstrate adequate validity, reliability, sensitivity, and clinical utility among military personnel with mTBIs. Additional research is needed to further validate NCATs within military populations, especially for those living outside of the United States and individuals experiencing other conditions known to adversely affect cognitive processing. Knowledge gaps remain, warranting further study of psychometric properties and the utility of baseline and normative testing for NCATs. ", doi="10.2196/26360", url="https://mental.jmir.org/2021/2/e26360", url="http://www.ncbi.nlm.nih.gov/pubmed/33616538" } @Article{info:doi/10.2196/23912, author="Queiroz, Nunes Artur Acelino Francisco Luz and Mendes, Costa Isabel Am{\'e}lia and de Godoy, Simone and Velez Lap{\~a}o, Lu{\'i}s and Dias, S{\'o}nia", title="mHealth Strategies Related to HIV Postexposure Prophylaxis Knowledge and Access: Systematic Literature Review, Technology Prospecting of Patent Databases, and Systematic Search on App Stores", journal="JMIR Mhealth Uhealth", year="2021", month="Feb", day="16", volume="9", number="2", pages="e23912", keywords="HIV", keywords="eHealth", keywords="mHealth", keywords="postexposure prophylaxis", keywords="PEP", keywords="prevention", keywords="mobile phone", abstract="Background: Globally, the number of HIV cases continue to increase, despite the development of multiple prevention strategies. New cases of HIV have been reported disproportionately more in men who have sex with men and other vulnerable populations. Issues such as internalized and structural homophobia prevent these men from accessing prevention strategies such as postexposure prophylaxis (PEP). Mobile health (mHealth) interventions are known to be one of the newest and preferred options to enhance PEP knowledge and access. Objective: The aim of this study was to identify and analyze the mobile apps addressing PEP for HIV infections. Methods: We conducted a descriptive exploratory study in 3 sequential phases: systematic literature review, patent analysis, and systematic search of app stores. For the systematic review, we followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines adapted for an integrative review in the databases of PubMed, Web of Knowledge, Scopus, Cochrane, Embase, Science Direct, Eric, Treasure, and CINAHL. The patent analysis was performed by exploring the databases of the Brazilian National Institute of Industrial Property, the United States Patent and Trademark Office, and the European Patent Office. For the systematic search, we analyzed mHealth apps related to HIV in 2 major app libraries, that is, Google Play Store and App Store. The apps were evaluated by name, characteristics, functions, and availability in iPhone operating system/Android phones. Results: We analyzed 22 studies, of which 2 were selected for the final stage. Both studies present the use of apps as mHealth strategies aimed at improving the sexual health of men who have sex with men, and they were classified as decision support systems. The search in the patent databases showed only 1 result, which was not related to the topic since it was a drug intervention. In the app libraries, 25 apps were found and analyzed, with 15 (60\%) apps available for Android systems but only 3 (12\%) addressing PEP. In general, the apps inform about HIV and HIV prevention and treatment, with the focus users being health care providers, people with HIV, or the general population, but they have only limited features available, that is, mainly text, images, and videos. The 3 apps exclusively focusing on PEP were created by researchers from Brazilian universities. Conclusions: Our review found no connection between the scientific studies, registered patents, and the available apps related to PEP; this finding indicates that these available apps do not have a theoretical or a methodological background in their creation. Thus, since the scientific knowledge on HIV is not translated into technological products, preventing the emergence of new infections, especially in the more vulnerable groups, is difficult. In the future, researchers and the community must work in synergy to create more mHealth tools aimed at PEP. ", doi="10.2196/23912", url="http://mhealth.jmir.org/2021/2/e23912/", url="http://www.ncbi.nlm.nih.gov/pubmed/33591289" } @Article{info:doi/10.2196/24080, author="Kim, Mihui and Kim, Changhwan and Kim, Eunkyo and Choi, Mona", title="Effectiveness of Mobile Health--Based Exercise Interventions for Patients with Peripheral Artery Disease: Systematic Review and Meta-Analysis", journal="JMIR Mhealth Uhealth", year="2021", month="Feb", day="15", volume="9", number="2", pages="e24080", keywords="peripheral artery disease", keywords="mobile health", keywords="exercise", keywords="adherence", keywords="meta-analysis", abstract="Background: Peripheral artery disease (PAD) affects over 236 million people worldwide, and exercise interventions are commonly used to alleviate symptoms of this condition. However, no previous systematic review has evaluated the effects of mobile health (mHealth)--based exercise interventions for patients with PAD. Objective: This study aimed to assess the effect of mHealth-based exercise interventions on walking performance, functional status, and quality of life in patients with PAD. Methods: A systematic review and meta-analysis were conducted. We searched in seven databases to identify randomized controlled trials of patients with PAD published in English up to December 4, 2020. Studies were included if patients participated in mHealth-based exercise interventions and were assessed for walking performance. We analyzed pooled effect size on walking performance, functional status, and quality of life based on the standardized mean differences between groups. Results: A total of seven studies were selected for the systematic review, and six studies were included in the meta-analysis. The duration of interventions in the included studies was 12 to 48 weeks. In the pooled analysis, when compared with the control groups, the mHealth-based exercise intervention groups were associated with significant improvements in pain-free walking (95\% CI 0.13-0.88), maximal walking (95\% CI 0.03-0.87), 6-minute walk test (6MWT) distance (95\% CI 0.59-1.24), and walking distance (95\% CI 0.02-0.49). However, benefits of the interventions on walking speed, stair-climbing ability, and quality of life were not observed. Conclusions: mHealth-based exercise interventions for patients with PAD were beneficial for improving pain-free walking, maximal walking, and 6MWT distance. We found that exercise interventions using mHealth are an important strategy for improving the exercise effectiveness and adherence rate of patients with PAD. Future studies should consider the use of various and suitable functions of mHealth that can increase the adherence rates and improve the effectiveness of exercise. ", doi="10.2196/24080", url="http://mhealth.jmir.org/2021/2/e24080/", url="http://www.ncbi.nlm.nih.gov/pubmed/33587042" } @Article{info:doi/10.2196/23477, author="Eberle, Claudia and L{\"o}hnert, Maxine and Stichling, Stefanie", title="Effectiveness of Disease-Specific mHealth Apps in Patients With Diabetes Mellitus: Scoping Review", journal="JMIR Mhealth Uhealth", year="2021", month="Feb", day="15", volume="9", number="2", pages="e23477", keywords="diabetes mellitus", keywords="mobile apps", keywords="mHealth apps", keywords="medical apps", abstract="Background: According to the World Health Organization, the worldwide prevalence of diabetes mellitus (DM) is increasing dramatically and DM comprises a large part of the global burden of disease. At the same time, the ongoing digitalization that is occurring in society today offers novel possibilities to deal with this challenge, such as the creation of mobile health (mHealth) apps. However, while a great variety of DM-specific mHealth apps exist, the evidence in terms of their clinical effectiveness is still limited. Objective: The objective of this review was to evaluate the clinical effectiveness of mHealth apps in DM management by analyzing health-related outcomes in patients diagnosed with type 1 DM (T1DM), type 2 DM (T2DM), and gestational DM. Methods: A scoping review was performed. A systematic literature search was conducted in MEDLINE (PubMed), Cochrane Library, EMBASE, CINAHL, and Web of Science Core Collection databases for studies published between January 2008 and October 2020. The studies were categorized by outcomes and type of DM. In addition, we carried out a meta-analysis to determine the impact of DM-specific mHealth apps on the management of glycated hemoglobin (HbA1c). Results: In total, 27 studies comprising 2887 patients were included. We analyzed 19 randomized controlled trials, 1 randomized crossover trial, 1 exploratory study, 1 observational study, and 5 pre-post design studies. Overall, there was a clear improvement in HbA1c values in patients diagnosed with T1DM and T2DM. In addition, positive tendencies toward improved self-care and self-efficacy as a result of mHealth app use were found. The meta-analysis revealed an effect size, compared with usual care, of a mean difference of --0.54\% (95\% CI --0.8 to --0.28) for T2DM and --0.63\% (95\% CI --0.93 to --0.32) for T1DM. Conclusions: DM-specific mHealth apps improved the glycemic control by significantly reducing HbA1c values in patients with T1DM and T2DM patients. In general, mHealth apps effectively enhanced DM management. However, further research in terms of clinical effectiveness needs to be done in greater detail. ", doi="10.2196/23477", url="http://mhealth.jmir.org/2021/2/e23477/", url="http://www.ncbi.nlm.nih.gov/pubmed/33587045" } @Article{info:doi/10.2196/26145, author="Oh, Soyeon Sarah and Kim, Kyoung-A and Kim, Minsu and Oh, Jaeuk and Chu, Hui Sang and Choi, JiYeon", title="Measurement of Digital Literacy Among Older Adults: Systematic Review", journal="J Med Internet Res", year="2021", month="Feb", day="3", volume="23", number="2", pages="e26145", keywords="healthy aging", keywords="eHealth", keywords="telehealth", keywords="mobile health", keywords="digital literacy", keywords="ehealth literacy", keywords="aging", keywords="elderly", keywords="older adults", keywords="review", keywords="literacy", abstract="Background: Numerous instruments are designed to measure digital literacy among the general population. However, few studies have assessed the use and appropriateness of these measurements for older populations. Objective: This systematic review aims to identify and critically appraise studies assessing digital literacy among older adults and to evaluate how digital literacy instruments used in existing studies address the elements of age-appropriate digital literacy using the European Commission's Digital Competence (DigComp) Framework. Methods: Electronic databases were searched for studies using validated instruments to assess digital literacy among older adults. The quality of all included studies was evaluated using the Crowe Critical Appraisal Tool (CCAT). Instruments were assessed according to their ability to incorporate the competence areas of digital literacy as defined by the DigComp Framework: (1) information and data literacy, (2) communication and collaboration, (3) digital content creation, (4) safety, and (5) problem-solving ability, or attitudes toward information and communication technology use. Results: Searches yielded 1561 studies, of which 27 studies (17 cross-sectional, 2 before and after, 2 randomized controlled trials, 1 longitudinal, and 1 mixed methods) were included in the final analysis. Studies were conducted in the United States (18/27), Germany (3/27), China (1/27), Italy (1/27), Sweden (1/27), Canada (1/27), Iran (1/27), and Bangladesh (1/27). Studies mostly defined older adults as aged ?50 years (10/27) or ?60 years (8/27). Overall, the eHealth Literacy Scale (eHEALS) was the most frequently used instrument measuring digital literacy among older adults (16/27, 59\%). Scores on the CCAT ranged from 34 (34/40, 85\%) to 40 (40/40, 100\%). Most instruments measured 1 or 2 of the DigComp Framework's elements, but the Mobile Device Proficiency Questionnaire (MDPQ) measured all 5 elements, including ``digital content creation'' and ``safety.'' Conclusions: The current digital literacy assessment instruments targeting older adults have both strengths and weaknesses, relative to their study design, administration method, and ease of use. Certain instrument modalities like the MDPQ are more generalizable and inclusive and thus, favorable for measuring the digital literacy of older adults. More studies focusing on the suitability of such instruments for older populations are warranted, especially for areas like ``digital content creation'' and ``safety'' that currently lack assessment. Evidence-based discussions regarding the implications of digitalization for the treatment of older adults and how health care professionals may benefit from this phenomenon are encouraged. ", doi="10.2196/26145", url="https://www.jmir.org/2021/2/e26145", url="http://www.ncbi.nlm.nih.gov/pubmed/33533727" } @Article{info:doi/10.2196/22601, author="He, Zihao and Wu, Hua and Yu, Fengyu and Fu, Jinmei and Sun, Shunli and Huang, Ting and Wang, Runze and Chen, Delong and Zhao, Guanggao and Quan, Minghui", title="Effects of Smartphone-Based Interventions on Physical Activity in Children and Adolescents: Systematic Review and Meta-analysis", journal="JMIR Mhealth Uhealth", year="2021", month="Feb", day="1", volume="9", number="2", pages="e22601", keywords="adolescents", keywords="children", keywords="mHealth", keywords="physical activity", keywords="smartphone", abstract="Background: About 70\% of children and adolescents worldwide do not meet the recommended level of physical activity (PA), which is closely associated with physical, psychological, and cognitive well-being. Nowadays, the use of technologies to change PA is of interest due to the need for novel, more effective intervention approaches. The previous meta-analyses have examined smartphone-based interventions and their impact on PA in adults, but evidence in children and adolescents still needs further research. Objective: This systematic review and meta-analysis aimed to determine the effectiveness of smartphone-based interventions for improving PA in children and adolescents. Methods: Five electronic databases (PubMed, Web of Science, OVID, Scopus, and the China National Knowledge Infrastructure) were searched up to June 29, 2020. Randomized controlled trials with a control group that examine the effect of smartphone interventions on PA among children and adolescents were included. Bias risks were assessed using the Cochrane collaboration tool. Meta-analysis was performed to assess the pooled effect on PA using a random effects model. Subgroup analyses were conducted to examine the potential modifying effects of different factors (eg, types of intervention, intervention duration, age, measurement, study quality). Results: A total of 9 studies were included in this review, including 4 mobile app interventions, 3 SMS text messaging interventions, and 2 app + SMS text messaging interventions. In general, the risk of bias of included studies was low. Compared with the control group, the use of smartphone intervention significantly improved PA (standardized mean difference [SMD] 0.44, 95\% CI 0.11-0.77, P=.009), especially for total PA (TPA; weighted mean difference [WMD] 32.35, 95\% CI 10.36-54.33, P=.004) and daily steps (WMD 1185, 95\% CI 303-2068, P=.008), but not for moderate-to-vigorous PA (WMD 3.91, 95\% CI --1.99 to 9.81, P=.19). High statistical heterogeneity was detected (I2=73.9\%, P<.001) for PA. Meta-regression showed that duration ($\beta$=--.08, 95\% CI --0.15 to --0.01, n=16) was a potential factor for high heterogeneity. The results of subgroup analyses indicated that app intervention (SMD 0.76, 95\% CI 0.23-1.30, P=.005), children (SMD 0.64, 95\% CI 0.10-1.18, P=.02), ``?8 weeks'' (SMD 0.76, 95\% CI 0.23-1.30, P=.005), objective measurement (SMD 0.50, 95\% CI 0.09-0.91, P=.02), and low risk of bias (SMD 0.96, 95\% CI 0.38-1.54, P=.001) can significantly improve PA. Conclusions: The evidence of meta-analysis shows that smartphone-based intervention may be a promising strategy to increase TPA and steps in children and adolescents. Currently, app intervention may be a more effective strategy among smartphone intervention technologies. To extend the promise of smartphone intervention, the future needs to design comparative trials among different smartphone technologies. Trial Registration: PROSPERO CRD42019148261; https://tinyurl.com/y5modsrd ", doi="10.2196/22601", url="https://mhealth.jmir.org/2021/2/e22601", url="http://www.ncbi.nlm.nih.gov/pubmed/33522980" } @Article{info:doi/10.2196/23409, author="Ni, Zhenni and Wang, Yiying and Qian, Yuxing", title="Privacy Policy Compliance of Chronic Disease Management Apps in China: Scale Development and Content Evaluation", journal="JMIR Mhealth Uhealth", year="2021", month="Jan", day="28", volume="9", number="1", pages="e23409", keywords="mHealth", keywords="noncommunicable diseases", keywords="content analysis", abstract="Background: With the development of mobile health (mHealth), chronic disease management apps have brought not only the possibility of reducing the burden of chronic diseases but also huge privacy risks to patients' health data. Objective: The purpose of the study was to analyze the extent to which chronic disease management apps in China comply with the Personal Information Security Specification (PI Specification). Methods: The compliance of 45 popular chronic disease management apps was evaluated from the perspective of the information life cycle. To conduct a fine-grained evaluation, a scale based on the PI Specification was developed. Finally, 6 level 1 indicators, 22 level 2 indicators, and 61 level 3 indicators were defined. Results: There were 33/45 apps (73\%) with a privacy policy, and the average score of these apps was 40.4 out of 100. Items of level 1 indicators with high scores included general characteristics (mean 51.9\% [SD 28.1\%]), information collection and use (mean 51.1\% [SD 36.7\%]), and information sharing and transfer (mean 50.3\% [SD 33.5\%]). Information storage and protection had the lowest compliance with PI Specification (mean 29.4\% [SD 32.4\%]). Few personal information (PI) controllers have stated how to handle security incidents, including security incident reporting (7/33, 21\%), security incident notification (10/33, 30\%), and commitment to bear corresponding legal responsibility for PI security incidents (1/33, 3\%). The performance of apps in the stage of information destruction (mean 31.8\% [SD 40.0\%]) was poor, and only 21\% (7/33) apps would notify third parties to promptly delete PI after individuals cancelled their accounts. Moreover, the scoring rate for rights of PI subjects is generally low (mean 31.2\% [SD 35.5\%]), especially for obtaining copies of PI (15\%) and responding to requests (25\%). Conclusions: Although most chronic disease management apps had a privacy policy, the total compliance rate of the policy content was low, especially in the stage of information storage and protection. Thus, the field has a long way to go with regard to compliance around personal privacy protection in China. ", doi="10.2196/23409", url="http://mhealth.jmir.org/2021/1/e23409/", url="http://www.ncbi.nlm.nih.gov/pubmed/33507159" } @Article{info:doi/10.2196/16282, author="Sporrel, Karlijn and Nibbeling, Nicky and Wang, Shihan and Ettema, Dick and Simons, Monique", title="Unraveling Mobile Health Exercise Interventions for Adults: Scoping Review on the Implementations and Designs of Persuasive Strategies", journal="JMIR Mhealth Uhealth", year="2021", month="Jan", day="18", volume="9", number="1", pages="e16282", keywords="mobile health", keywords="physical activity", keywords="goals", keywords="feedback", keywords="rewards", keywords="reminder systems", keywords="social support", keywords="adult", abstract="Background: It is unclear why some physical activity (PA) mobile health (mHealth) interventions successfully promote PA whereas others do not. One possible explanation is the variety in PA mHealth interventions---not only do interventions differ in the selection of persuasive strategies but also the design and implementation of persuasive strategies can vary. However, limited studies have examined the different designs and technical implementations of strategies or explored if they indeed influenced the effectiveness of the intervention. Objective: This scoping review sets out to explore the different technical implementations and design characteristics of common and likely most effective persuasive strategies, namely, goal setting, monitoring, reminders, rewards, sharing, and social comparison. Furthermore, this review aims to explore whether previous mHealth studies examined the influence of the different design characteristics and technical operationalizations of common persuasive strategies on the effectiveness of the intervention to persuade the user to engage in PA. Methods: An unsystematic snowball and gray literature search was performed to identify the literature that evaluated the persuasive strategies in experimental trials (eg, randomized controlled trial, pre-post test). Studies were included if they targeted adults, if they were (partly) delivered by a mobile system, if they reported PA outcomes, if they used an experimental trial, and when they specifically compared the effect of different designs or implementations of persuasive strategies. The study methods, implementations, and designs of persuasive strategies, and the study results were systematically extracted from the literature by the reviewers. Results: A total of 29 experimental trials were identified. We found a heterogeneity in how the strategies are being implemented and designed. Moreover, the findings indicated that the implementation and design of the strategy has an influence on the effectiveness of the PA intervention. For instance, the effectiveness of rewarding was shown to vary between types of rewards; rewarding goal achievement seems to be more effective than rewarding each step taken. Furthermore, studies comparing different ways of goal setting suggested that assigning a goal to users might appear to be more effective than letting the user set their own goal, similar to using adaptively tailored goals as opposed to static generic goals. This study further demonstrates that only a few studies have examined the influence of different technical implementations on PA behavior. Conclusions: The different implementations and designs of persuasive strategies in mHealth interventions should be critically considered when developing such interventions and before drawing conclusions on the effectiveness of the strategy as a whole. Future efforts are needed to examine which implementations and designs are most effective to improve the translation of theory-based persuasive strategies into practical delivery forms. ", doi="10.2196/16282", url="http://mhealth.jmir.org/2021/1/e16282/", url="http://www.ncbi.nlm.nih.gov/pubmed/33459598" } @Article{info:doi/10.2196/22478, author="Carrion, Carme and Robles, Noem{\'i} and Sola-Morales, Oriol and Aymerich, Marta and Ruiz Postigo, Antonio Jose", title="Mobile Health Strategies to Tackle Skin Neglected Tropical Diseases With Recommendations From Innovative Experiences: Systematic Review", journal="JMIR Mhealth Uhealth", year="2020", month="Dec", day="31", volume="8", number="12", pages="e22478", keywords="mHealth", keywords="mobile health", keywords="neglected tropical diseases", keywords="skin neglected tropical diseases", keywords="apps", keywords="SMS text messaging", keywords="low- and middle-income countries", abstract="Background: Neglected tropical diseases (NTDs) represent a diverse group of 20 communicable diseases that occur in tropical and subtropical areas in 149 countries, affecting over 1 billion people and costing developing economies billions of dollars every year. Within these diseases, those that present lesions on the skin surface are classified as skin NTDs (sNTDs). Mobile health interventions are currently being used worldwide to manage skin diseases and can be a good strategy in the epidemiological and clinical management of sNTDs. Objective: We aimed to analyze existing evidence about mobile health interventions to control and manage sNTDs in low- and middle-income countries (LMICs) and make recommendations for what should be considered in future interventions. Methods: A systematic review was conducted of the MEDLINE, Embase, and Scopus databases over 10 years up to April 30, 2020. All types of clinical studies were considered. Data were synthesized into evidence tables. Apps were selected through a comprehensive systematic search in the Google Play Store and Apple App Store conducted between March 20 and April 15, 2020. Results: From 133 potentially relevant publications, 13 studies met our criteria (9.8\%). These analyzed eight different interventions (three SMS text messaging interventions and five app interventions). Six of the 13 (46\%) studies were community-based cross-sectional studies intended to epidemiologically map a specific disease, mainly lymphatic filariasis, but also cutaneous leishmaniasis, leprosy, and NTDs, as well as sNTDs in general. Most of the studies were considered to have a high (5/13, 39\%) or moderate (4/13, 31\%) risk of bias. Fifteen apps were identified in the Google Play Store, of which three were also in the Apple App Store. Most of the apps (11/15, 73\%) were targeted at health care professionals, with only four targeted at patients. The apps focused on scabies (3/15, 20\%), lymphatic filariasis (3/15, 20\%), cutaneous leishmaniasis (1/15, 7\%), leprosy (1/15, 7\%), yaws and Buruli ulcer (1/15, 7\%), tropical diseases including more than one sNTDs (3/15, 20\%), and NTDs including sNTDs (2/15, 13\%). Only 1 (7\%) app focused on the clinical management of sNTDs. Conclusions: All mobile health interventions that were identified face technological, legal, final user, and organizational issues. There was a remarkable heterogeneity among studies, and the majority had methodological limitations that leave considerable room for improvement. Based on existing evidence, eight recommendations have been made for future interventions. ", doi="10.2196/22478", url="http://mhealth.jmir.org/2020/12/e22478/", url="http://www.ncbi.nlm.nih.gov/pubmed/33382382" } @Article{info:doi/10.2196/18513, author="Plaza Roncero, Alejandro and Marques, Gon{\c{c}}alo and Sainz-De-Abajo, Beatriz and Mart{\'i}n-Rodr{\'i}guez, Francisco and del Pozo Vegas, Carlos and Garcia-Zapirain, Begonya and de la Torre-D{\'i}ez, Isabel", title="Mobile Health Apps for Medical Emergencies: Systematic Review", journal="JMIR Mhealth Uhealth", year="2020", month="Dec", day="11", volume="8", number="12", pages="e18513", keywords="mobile health", keywords="mHealth", keywords="eHealth", keywords="Android", keywords="iOS", keywords="medical emergencies", keywords="mobile apps", abstract="Background: Mobile health apps are used to improve the quality of health care. These apps are changing the current scenario in health care, and their numbers are increasing. Objective: We wanted to perform an analysis of the current status of mobile health technologies and apps for medical emergencies. We aimed to synthesize the existing body of knowledge to provide relevant insights for this topic. Moreover, we wanted to identify common threads and gaps to support new challenging, interesting, and relevant research directions. Methods: We reviewed the main relevant papers and apps available in the literature. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was used in this review. The search criteria were adopted using systematic methods to select papers and apps. On one hand, a bibliographic review was carried out in different search databases to collect papers related to each application in the health emergency field using defined criteria. On the other hand, a review of mobile apps in two virtual storage platforms (Google Play Store and Apple App Store) was carried out. The Google Play Store and Apple App Store are related to the Android and iOS operating systems, respectively. Results: In the literature review, 28 papers in the field of medical emergency were included. These studies were collected and selected according to established criteria. Moreover, we proposed a taxonomy using six groups of applications. In total, 324 mobile apps were found, with 192 identified in the Google Play Store and 132 identified in the Apple App Store. Conclusions: We found that all apps in the Google Play Store were free, and 73 apps in the Apple App Store were paid, with the price ranging from US \$0.89 to US \$5.99. Moreover, 39\% (11/28) of the included studies were related to warning systems for emergency services and 21\% (6/28) were associated with disaster management apps. ", doi="10.2196/18513", url="http://mhealth.jmir.org/2020/12/e18513/", url="http://www.ncbi.nlm.nih.gov/pubmed/33306037" } @Article{info:doi/10.2196/18316, author="Aida, Azusa and Svensson, Thomas and Svensson, Kishi Akiko and Chung, Ung-Il and Yamauchi, Toshimasa", title="eHealth Delivery of Educational Content Using Selected Visual Methods to Improve Health Literacy on Lifestyle-Related Diseases: Literature Review", journal="JMIR Mhealth Uhealth", year="2020", month="Dec", day="9", volume="8", number="12", pages="e18316", keywords="application", keywords="educational", keywords="eHealth", keywords="health literacy", keywords="lifestyle-related disease", keywords="mHealth", keywords="review", abstract="Background: Lifestyle-related diseases, such as stroke, heart disease, and diabetes, are examples of noncommunicable diseases. Noncommunicable diseases are now the leading cause of death in the world, and their major causes are lifestyle related. The number of eHealth interventions is increasing, which is expected to improve individuals' health literacy on lifestyle-related diseases. Objective: This literature review aims to identify existing literature published in the past decade on eHealth interventions aimed at improving health literacy on lifestyle-related diseases among the general population using selected visual methods, such as educational videos, films, and movies. Methods: A systematic literature search of the PubMed database was conducted in April 2019 for papers written in English and published from April 2, 2009, through April 2, 2019. A total of 538 papers were identified and screened in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram. Finally, 23 papers were included in this review. Results: The 23 papers were characterized according to study characteristics (author and year of publication, study design and region where the study was conducted, study objective, service platform, target disease and participant age, research period, outcomes, and research method); the playback time of the educational videos, films, and movies; and the evaluation of the study's impacts on health literacy. A total of 7 studies compared results using statistical methods. Of these, 5 studies reported significant positive effects of the intervention on health literacy and health-related measures (eg, physical activity, body weight). Although most of the studies included educational content aimed at improving health literacy, only 7 studies measured health literacy. In addition, only 5 studies assessed literacy using health literacy measurement tools. Conclusions: This review found that the provision of educational content was satisfactory in most eHealth studies using selected visual methods, such as videos, films, and movies. These findings suggest that eHealth interventions influence people's health behaviors and that the need for this intervention is expected to increase. Despite the need to develop eHealth interventions, standardized measurement tools to evaluate health literacy are lacking. Further research is required to clarify acceptable health literacy measurements. ", doi="10.2196/18316", url="http://mhealth.jmir.org/2020/12/e18316/", url="http://www.ncbi.nlm.nih.gov/pubmed/33295296" } @Article{info:doi/10.2196/21576, author="Baeza-Barrag{\'a}n, Rosa Maria and Labajos Manzanares, Teresa Maria and Ruiz Vergara, Carmen and Casuso-Holgado, Jes{\'u}s Mar{\'i}a and Mart{\'i}n-Valero, Roc{\'i}o", title="The Use of Virtual Reality Technologies in the Treatment of Duchenne Muscular Dystrophy: Systematic Review", journal="JMIR Mhealth Uhealth", year="2020", month="Dec", day="8", volume="8", number="12", pages="e21576", keywords="Duchenne muscular dystrophy", keywords="virtual reality", keywords="upper limb", keywords="physical therapy", keywords="muscular dystrophy", keywords="mutation", keywords="muscle", keywords="degeneration", abstract="Background: Duchenne muscular dystrophy is a serious and progressive disease affecting one in 3500-6000 live male births. The use of new virtual reality technologies has revolutionized the world of youth rehabilitation. Objective: We performed a systematic review to study the effectiveness of the use of virtual reality systems applied in the rehabilitation of the upper limbs of individuals with Duchenne muscular dystrophy. Methods: Between June 2018 and September 2019, we carried out a series of searches in 5 scientific databases: (1) PubMed, (2) Web of Science, (3) Scopus, (4) The Cochrane Library, and (5) MEDLINE via EBSCO. Two evaluators independently conducted the searches following the PRISMA recommendations for systematic reviews for articles. Two independent evaluators collated the results. Article quality was determined using the PEDro scale. Results: A total of 7 clinical trials were included in the final review. These studies used new technologies as tools for physiotherapeutic rehabilitation of the upper limbs of patients with Duchenne muscular dystrophy. Collectively, the studies showed improvement in functionality, quality of life, and motivation with the use of virtual reality technologies in the rehabilitation of upper limbs of individuals with Duchenne muscular dystrophy. Conclusions: The treatment of neuromuscular diseases has changed in recent years, from palliative symptom management to preventive methods for capacity building. The use of virtual reality is beginning to be necessary in the treatment of progressive diseases involving movement difficulties, as it provides freedom and facilitates the improvement of results in capacity training. Given that new technologies are increasingly accessible, rehabilitation and physiotherapy programs can use these technologies more frequently, and virtual reality environments can be used to improve task performance, which is essential for people with disabilities. Ultimately, virtual reality can be a great tool for physiotherapy and can be used for Duchenne muscular dystrophy rehabilitation programs to improve patient performance during training. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42018102548; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=102548 ", doi="10.2196/21576", url="http://mhealth.jmir.org/2020/12/e21576/", url="http://www.ncbi.nlm.nih.gov/pubmed/33289679" } @Article{info:doi/10.2196/22537, author="De Miguel-Rubio, Amaranta and Rubio, Dolores M. and Alba-Rueda, Alvaro and Salazar, Alejandro and Moral-Munoz, A. Jose and Lucena-Anton, David", title="Virtual Reality Systems for Upper Limb Motor Function Recovery in Patients With Spinal Cord Injury: Systematic Review and Meta-Analysis", journal="JMIR Mhealth Uhealth", year="2020", month="Dec", day="3", volume="8", number="12", pages="e22537", keywords="virtual reality", keywords="spinal cord injuries", keywords="neurological rehabilitation", keywords="motor function", keywords="physical therapy", abstract="Background: Patients with spinal cord injury (SCI) usually present with different motor impairments, including a deterioration of upper limb motor function (ULMF), that limit their performance of activities of daily living and reduce their quality of life. Virtual reality (VR) is being used in neurological rehabilitation for the assessment and treatment of the physical impairments of this condition. Objective: A systematic review and meta-analysis was conducted to evaluate the effectiveness of VR on ULMF in patients with SCI compared with conventional physical therapy. Methods: The search was performed from October to December 2019 in Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Medline, Physiotherapy Evidence Database (PEDro), PubMed, and Cochrane Central Register of Controlled Trials. The inclusion criteria of selected studies were as follows: (1) comprised adults with SCI, (2) included an intervention with VR, (3) compared VR intervention with conventional physical therapy, (4) reported outcomes related to ULMF, and (5) was a controlled clinical trial. The Cochrane Collaboration's tool was used to evaluate the risk of bias. The RevMan 5.3 statistical software was used to obtain the meta-analysis according to the standardized mean difference (SMD) and 95\% CIs. Results: Six articles were included in this systematic review. Four of them contributed information to the meta-analysis. A total of 105 subjects were analyzed. All of the studies used semi-immersive or nonimmersive VR systems. The statistical analysis showed nonsignificant results for the Nine-Hole Peg Test (SMD --0.93, 95\% CI --1.95 to 0.09), muscle balance test (SMD --0.27, 95\% CI --0.82 to 0.27), Motricity Index (SMD 0.16, 95\% CI ?0.37 to 0.68), Jebsen-Taylor Hand Function Test (JTHFT) subtests (writing, SMD --0.10, 95\% CI --4.01 to 3.82; simulated page turning, SMD --0.99, 95\% CI --2.01 to 0.02; simulated feeding, SMD --0.64, 95\% CI --1.61 to 0.32; stacking checkers, SMD 0.99, 95\% CI --0.02 to 2.00; picking up large light objects, SMD --0.42, 95\% CI --1.37 to 0.54; and picking up large heavy objects, SMD 0.52, 95\% CI --0.44 to 1.49), range of motion of shoulder abduction/adduction (SMD --0.23, 95\% CI --1.48 to 1.03), shoulder flexion/extension (SMD 0.56, 95\% CI --1.24 to 2.36), elbow flexion (SMD --0.36, 95\% CI --1.14 to 0.42), elbow extension (SMD --0.21, 95\% CI --0.99 to 0.57), wrist extension (SMD 1.44, 95\% CI --2.19 to 5.06), and elbow supination (SMD --0.18, 95\% CI --1.80 to 1.44). Favorable results were found for the JTHFT subtest picking up small common objects (SMD --1.33, 95\% CI --2.42 to --0.24). Conclusions: The current evidence for VR interventions to improve ULMF in patients with SCI is limited. Future studies employing immersive systems to identify the key aspects that increase the clinical impact of VR interventions are needed, as well as research to prove the benefits of the use of VR in the rehabilitation of patients with SCI in the clinical setting. ", doi="10.2196/22537", url="http://mhealth.jmir.org/2020/12/e22537/", url="http://www.ncbi.nlm.nih.gov/pubmed/33270040" } @Article{info:doi/10.2196/19237, author="Robinson, Anna and Oksuz, Umay and Slight, Robert and Slight, Sarah and Husband, Andrew", title="Digital and Mobile Technologies to Promote Physical Health Behavior Change and Provide Psychological Support for Patients Undergoing Elective Surgery: Meta-Ethnography and Systematic Review", journal="JMIR Mhealth Uhealth", year="2020", month="Dec", day="1", volume="8", number="12", pages="e19237", keywords="mobile health", keywords="mHealth", keywords="healthy lifestyle", keywords="bariatric surgery", keywords="cancer", keywords="orthopedic procedures", keywords="qualitative research", keywords="systematic review", keywords="telemedicine", keywords="mobile phone", abstract="Background: Digital technology has influenced many aspects of modern living, including health care. In the context of elective surgeries, there is a strong association between preoperative physical and psychological preparedness, and improved postoperative outcomes. Health behavior changes made in the pre- and postoperative periods can be fundamental in determining the outcomes and success of elective surgeries. Understanding the potential unmet needs of patients undergoing elective surgery is central to motivating health behavior change. Integrating digital and mobile health technologies within the elective surgical pathway could be a strategy to remotely deliver this support to patients. Objective: This meta-ethnographic systematic review explores digital interventions supporting patients undergoing elective surgery with health behavior changes, specifically physical activity, weight loss, dietary intake, and psychological support. Methods: A literature search was conducted in October 2019 across 6 electronic databases (International Prospective Register of Systematic Reviews [PROSPERO]: CRD42020157813). Qualitative studies were included if they evaluated the use of digital technologies supporting behavior change in adult patients undergoing elective surgery during the pre- or postoperative period. Study quality was assessed using the Critical Appraisal Skills Programme tool. A meta-ethnographic approach was used to synthesize existing qualitative data, using the 7 phases of meta-ethnography by Noblit and Hare. Using this approach, along with reciprocal translation, enabled the development of 4 themes from the data. Results: A total of 18 studies were included covering bariatric (n=2, 11\%), cancer (n=13, 72\%), and orthopedic (n=3, 17\%) surgeries. The 4 overarching themes appear to be key in understanding and determining the effectiveness of digital and mobile interventions to support surgical patients. To successfully motivate health behavior change, technologies should provide motivation and support, enable patient engagement, facilitate peer networking, and meet individualized patient needs. Self-regulatory features such as goal setting heightened patient motivation. The personalization of difficulty levels in virtual reality--based rehabilitation was positively received. Internet-based cognitive behavioral therapy reduced depression and distress in patients undergoing cancer surgery. Peer networking provided emotional support beyond that of patient-provider relationships, improving quality of life and care satisfaction. Patients expressed the desire for digital interventions to be individually tailored according to their physical and psychological needs, before and after surgery. Conclusions: These findings have the potential to influence the future design of patient-centered digital and mobile health technologies and demonstrate a multipurpose role for digital technologies in the elective surgical pathway by motivating health behavior change and offering psychological support. Through the synthesis of patient suggestions, we highlight areas for digital technology optimization and emphasize the importance of content tailored to suit individual patients and surgical procedures. There is a significant rationale for involving patients in the cocreation of digital health technologies to enhance engagement, better support behavior change, and improve surgical outcomes. ", doi="10.2196/19237", url="https://mhealth.jmir.org/2020/12/e19237", url="http://www.ncbi.nlm.nih.gov/pubmed/33258787" } @Article{info:doi/10.2196/18774, author="de Jong, Andrea and Donelle, Lorie and Kerr, Michael", title="Nurses' Use of Personal Smartphone Technology in the Workplace: Scoping Review", journal="JMIR Mhealth Uhealth", year="2020", month="Nov", day="26", volume="8", number="11", pages="e18774", keywords="nurses", keywords="digital health", keywords="smartphone", keywords="evidence-informed practice", abstract="Background: There has been an increase in the technological infrastructures of many health care organizations to support the practice of health care providers. However, many nurses are using their personal digital devices, such as smartphones, while at work for personal and professional purposes. Despite the proliferation of smartphone use in the health care setting, there is limited research on the clinical use of these devices by nurses. It is unclear as to what extent and for what reasons nurses are using their personal smartphones to support their practice. Objective: This review aimed to understand the current breadth of research on nurses' personal smartphone use in the workplace and to identify implications for research, practice, and education. Methods: A scoping review using Arksey and O'Malley's methodological framework was conducted, and the following databases were used in the literature search: CINAHL, PubMed, ProQuest Dissertations and Theses, Embase, MEDLINE, Nursing and Allied Health Database, Scopus, Web of Science, and Cochrane Reviews. Search terms used were Nurs* AND (personal digital technology OR smartphone OR cellphone OR mobile phone OR cellular phone). Inclusion criteria included research focused on nurses' use of their own digital technologies, reported in English, and published between January 2010 and January 2020. Exclusion criteria were if the device or app was implemented for research purposes, if it was provided by the organization, if it focused on infection control, and if it was focused on nursing students or nursing education. Results: A total of 22 out of 2606 articles met the inclusion criteria. Two main themes from the thematic analyses included personal smartphone use for patient care and implications of personal smartphone use. Nurses used their smartphones to locate information about medications, procedures, diagnoses, and laboratory tests. Downloaded apps were used by nurses to locate patient care--related information. Nurses reported improved communication among health team members and used their personal devices to communicate patient information via text messaging, calling, and picture and video functions. Nurses expressed insight into personal smartphone use and challenges related to distraction, information privacy, organizational policies, and patient perception. Conclusions: Nurses view personal smartphones as an efficient method to gather patient care information and to communicate with the health care team. This review highlights knowledge gaps regarding nurses' personal device use and information safety, patient care outcomes, and communication practices. This scoping review facilitates critical reflection on patient care practices within the digital context. We infer that nurses' use of their personal devices to communicate among the health care team may demonstrate a technological ``work-around'' meant to reconcile health system demands for cost-efficiency with efforts to provide quality patient care. The current breadth of research is focused on acute care, with little research focus in other practices settings. Research initiatives are needed to explore personal device use across the continuum of health care settings. ", doi="10.2196/18774", url="https://mhealth.jmir.org/2020/11/e18774", url="http://www.ncbi.nlm.nih.gov/pubmed/33242012" } @Article{info:doi/10.2196/19391, author="Kulakli, Atik and Shubina, Ivanna", title="Scientific Publication Patterns of Mobile Technologies and Apps for Posttraumatic Stress Disorder Treatment: Bibliometric Co-Word Analysis", journal="JMIR Mhealth Uhealth", year="2020", month="Nov", day="26", volume="8", number="11", pages="e19391", keywords="posttraumatic stress disorder (PTSD)", keywords="mobile technologies", keywords="mobile apps", keywords="treatment", keywords="text analysis", keywords="co-word analysis", keywords="bibliometric", keywords="Web of Science", abstract="Background: Mobile apps are viewed as a promising opportunity to provide support for patients who have posttraumatic stress disorder (PTSD). The development of mobile technologies and apps shows similar trends in PTSD treatment. Therefore, this emerging research field has received substantial attention. Consequently, various research settings are planned for current and further studies. Objective: The aim of this study was to explore the scientific patterns of research domains related to mobile apps and other technologies for PTSD treatment in scholarly publications, and to suggest further studies for this emerging research field. Methods: We conducted a bibliometric analysis to identify publication patterns, most important keywords, trends for topicality, and text analysis, along with construction of a word cloud for papers published in the last decade (2010 to 2019). Research questions were formulated based on the relevant literature. In particular, we concentrated on highly ranked sources. Based on the proven bibliometric approach, the data were ultimately retrieved from the Web of Science Core Collection (Clarivate Analytics). Results: A total of 64 studies were found concerning the research domains. The vast majority of the papers were written in the English language (63/64, 98\%) with the remaining article (1/64, 2\%) written in French. The articles were written by 323 authors/coauthors from 11 different countries, with the United States predominating, followed by England, Canada, Italy, the Netherlands, Australia, France, Germany, Mexico, Sweden, and Vietnam. The most common publication type was peer-reviewed journal articles (48/64, 75\%), followed by reviews (8/64, 13\%), meeting abstracts (5/64, 8\%), news items (2/64, 3\%), and a proceeding (1/64, 2\%). There was a mean of 6.4 papers published per year over the study period. There was a 100\% increase in the number of publications published from 2016 to 2019 with a mean of 13.33 papers published per year during this latter period. Conclusions: Although the number of papers on mobile technologies for PTSD was quite low in the early period, there has been an overall increase in this research domain in recent years (2016-2019). Overall, these findings indicate that mobile health tools in combination with traditional treatment for mental disorders among veterans increase the efficiency of health interventions, including reducing PTSD symptoms, improving quality of life, conducting intervention evaluation, and monitoring of improvements. Mobile apps and technologies can be used as supportive tools in managing pain, anger, stress, and sleep disturbance. These findings therefore provide a useful overview of the publication trends on research domains that can inform further studies and highlight potential gaps in this field. ", doi="10.2196/19391", url="http://mhealth.jmir.org/2020/11/e19391/", url="http://www.ncbi.nlm.nih.gov/pubmed/33242019" } @Article{info:doi/10.2196/21759, author="Xu, Hongxuan and Long, Huanyu", title="The Effect of Smartphone App--Based Interventions for Patients With Hypertension: Systematic Review and Meta-Analysis", journal="JMIR Mhealth Uhealth", year="2020", month="Oct", day="19", volume="8", number="10", pages="e21759", keywords="hypertension", keywords="smartphone", keywords="blood pressure", keywords="mobile", keywords="lifestyle", keywords="adherence", keywords="smartphone app", keywords="medication adherence", abstract="Background: Hypertension is a major cause of cardiovascular disease, which is the leading cause of premature death. People with hypertension who do not comply with recommended treatment strategies have a higher risk of heart attacks and strokes, leading to hospitalization and consequently greater health care costs. The smartphone, which is now ubiquitous, offers a convenient tool to aid in the treatment of hypertension through the use of apps targeting lifestyle management, and such app-based interventions have shown promising results. In particular, recent evidence has shown the feasibility, acceptability, and success of digital interventions in changing the behavior of people with chronic conditions. Objective: The aim of this study was to systematically compile available evidence to determine the overall effect of smartphone apps on blood pressure control, medication adherence, and lifestyle changes for people with hypertension. Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement guidelines. Databases were searched to identify randomized controlled trials related to the influence of an app-based intervention in people with hypertension. Data extracted from the included studies were subjected to a meta-analysis to compare the effects of the smartphone app intervention to a control. Results: Eight studies with a total of 1657 participants fulfilled the inclusion criteria. Pooled analysis of 6 studies assessing systolic blood pressure showed a significant overall effect in favor of the smartphone intervention (weighted mean difference --2.28, 95\% CI --3.90-0.66). Pooled analysis of studies assessing medication adherence demonstrated a significant effect (P<.001) in favor of the intervention group (standard mean difference 0.38, 95\% CI 0.26-0.50) with low heterogeneity (I2=0\%). No difference between groups was demonstrated with respect to physical activity. Conclusions: A smartphone intervention leads to a reduction in blood pressure and an increase in medication adherence for people with hypertension. Future research should focus on the effect of behavior coaching apps on medication adherence, lifestyle change, and blood pressure reduction. ", doi="10.2196/21759", url="http://mhealth.jmir.org/2020/10/e21759/", url="http://www.ncbi.nlm.nih.gov/pubmed/33074161" } @Article{info:doi/10.2196/19459, author="Teadt, Sierra and Burns, C. Jade and Montgomery, M. Tiffany and Darbes, Lynae", title="African American Adolescents and Young Adults, New Media, and Sexual Health: Scoping Review", journal="JMIR Mhealth Uhealth", year="2020", month="Oct", day="5", volume="8", number="10", pages="e19459", keywords="African American", keywords="adolescent", keywords="young adult", keywords="technology", keywords="safe sex", keywords="sexually transmitted infections", keywords="sexual behavior", keywords="new media", keywords="social media", keywords="internet", abstract="Background: Rates of sexually transmitted infections and unintended pregnancies are disproportionately high among African American adolescents and young adults (AYA). New media platforms such as social networking sites, microblogs, online video sites, and mobile phone applications may be a promising approach in promoting safe sex and preventing sexually transmitted infections. Objective: The purpose of this scoping review was to address promising approaches in new media that may serve as valuable tools in health promotion, prevention, education, and intervention development aimed at African American AYA. Methods: An electronic search was conducted using Google Scholar, Scopus, Cumulative Index to Nursing and Allied Health (CINHAL), and PubMed online databases. Concept blocks and MeSH terminology were used to identify articles around African American youth and new media. Results: The search yielded 1169 articles, and 16 publications met the criteria. Studies from the review found themes in new media that included feasibility, changing attitudes, and improving knowledge related to sexual health behavior among youth of color. Conclusions: New media is a promising and feasible platform for improving the sexual health of African American AYA. Further research is suggested to better understand the benefits of new media as a sexual health promotion tool among this specific population. ", doi="10.2196/19459", url="https://mhealth.jmir.org/2020/10/e19459", url="http://www.ncbi.nlm.nih.gov/pubmed/33016890" } @Article{info:doi/10.2196/18694, author="Fuller, Daniel and Colwell, Emily and Low, Jonathan and Orychock, Kassia and Tobin, Ann Melissa and Simango, Bo and Buote, Richard and Van Heerden, Desiree and Luan, Hui and Cullen, Kimberley and Slade, Logan and Taylor, A. Nathan G.", title="Reliability and Validity of Commercially Available Wearable Devices for Measuring Steps, Energy Expenditure, and Heart Rate: Systematic Review", journal="JMIR Mhealth Uhealth", year="2020", month="Sep", day="8", volume="8", number="9", pages="e18694", keywords="commercial wearable devices", keywords="systematic review", keywords="heart rate", keywords="energy expenditure", keywords="step count", keywords="Fitbit", keywords="Apple Watch", keywords="Garmin", keywords="Polar", abstract="Background: Consumer-wearable activity trackers are small electronic devices that record fitness and health-related measures. Objective: The purpose of this systematic review was to examine the validity and reliability of commercial wearables in measuring step count, heart rate, and energy expenditure. Methods: We identified devices to be included in the review. Database searches were conducted in PubMed, Embase, and SPORTDiscus, and only articles published in the English language up to May 2019 were considered. Studies were excluded if they did not identify the device used and if they did not examine the validity or reliability of the device. Studies involving the general population and all special populations were included. We operationalized validity as criterion validity (as compared with other measures) and construct validity (degree to which the device is measuring what it claims). Reliability measures focused on intradevice and interdevice reliability. Results: We included 158 publications examining nine different commercial wearable device brands. Fitbit was by far the most studied brand. In laboratory-based settings, Fitbit, Apple Watch, and Samsung appeared to measure steps accurately. Heart rate measurement was more variable, with Apple Watch and Garmin being the most accurate and Fitbit tending toward underestimation. For energy expenditure, no brand was accurate. We also examined validity between devices within a specific brand. Conclusions: Commercial wearable devices are accurate for measuring steps and heart rate in laboratory-based settings, but this varies by the manufacturer and device type. Devices are constantly being upgraded and redesigned to new models, suggesting the need for more current reviews and research. ", doi="10.2196/18694", url="http://mhealth.jmir.org/2020/9/e18694/", url="http://www.ncbi.nlm.nih.gov/pubmed/32897239" } @Article{info:doi/10.2196/13179, author="Jansen, Ronelle and Reid, Marianne", title="Communication Technology Use by Caregivers of Adolescents With Mental Health Issues: Systematic Review", journal="JMIR Mhealth Uhealth", year="2020", month="Aug", day="19", volume="8", number="8", pages="e13179", keywords="caregiver", keywords="communication technology", keywords="adolescent", keywords="mental health issues", keywords="systematic review", keywords="self-efficacy, knowledge", keywords="parental skills", keywords="IMBP", abstract="Background: Caregivers of adolescents with mental health issues experience challenges that may result in the caregivers having a variety of unmet needs. There is a growing need to support these caregivers. Effective support to strengthen positive caregiving behavior in caregivers may address their challenges. Communication technologies offer novel opportunities to assist these caregivers and may contribute to strengthening caregiver behavior. However, little is known about the use of communication technologies among caregivers of adolescents with mental health issues. Objective: The study aimed to answer the question: ``What is the best evidence available to strengthen positive behavior of caregivers of adolescents with mental health issues using communication technology.'' Methods: A systematic review of articles published between January 2007 and August 2018 was conducted. Searches included articles of multiple study designs from EBSCO Host and Scopus platforms with prespecified eligibility criteria. Methodological quality was evaluated using the applicable Critical Appraisal Skills Programme and Joanna Briggs Institute assessment tools. Results: The search yielded 1746 articles. Altogether, 5 articles met the eligibility criteria and were included in the review for data synthesis. Data analysis and synthesis identified three thematic conclusions reflecting the types of communication technologies used, caregivers as the target population, and strengthening of positive behavior through determinants of the Integrated Model of Behavior Prediction. Conclusions: The review reported the usefulness of communication technology by caregivers. Caregivers also demonstrated improvement in self-efficacy, knowledge, parent-child communication, and parental skills reflecting positive behavior. Although the use of communication technology is expanding as a supportive intervention to address caregivers' needs, the evidence for usefulness among caregivers of adolescents with mental health issues is still scarce. More research and information related to preferred methods of communication delivery among caregivers of adolescents is still needed. ", doi="10.2196/13179", url="http://mhealth.jmir.org/2020/8/e13179/", url="http://www.ncbi.nlm.nih.gov/pubmed/32663143" } @Article{info:doi/10.2196/15779, author="Liu, Kaifeng and Xie, Zhenzhen and Or, Kalun Calvin", title="Effectiveness of Mobile App-Assisted Self-Care Interventions for Improving Patient Outcomes in Type 2 Diabetes and/or Hypertension: Systematic Review and Meta-Analysis of Randomized Controlled Trials", journal="JMIR Mhealth Uhealth", year="2020", month="Aug", day="4", volume="8", number="8", pages="e15779", keywords="mobile app", keywords="type 2 diabetes", keywords="hypertension", keywords="self-care", abstract="Background: Mobile app-assisted self-care interventions are emerging promising tools to support self-care of patients with chronic diseases such as type 2 diabetes and hypertension. The effectiveness of such interventions requires further exploration for more supporting evidence. Objective: A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted to examine the effectiveness of mobile app-assisted self-care interventions developed for type 2 diabetes and/or hypertension in improving patient outcomes. Methods: We followed the Cochrane Collaboration guidelines and searched MEDLINE, Cochrane Library, EMBASE, and CINAHL Plus for relevant studies published between January 2007 and January 2019. Primary outcomes included changes in hemoglobin A1c (HbA1c) levels, systolic blood pressure (SBP), and diastolic blood pressure (DBP). Changes in other clinical-, behavioral-, knowledge-, and psychosocial-related outcomes were included as secondary outcomes. Primary outcomes and objective secondary outcomes that were reported in at least two trials were meta-analyzed; otherwise, a narrative synthesis was used for data analysis. Results: A total of 27 trials were identified and analyzed. For primary outcomes, the use of mobile app-assisted self-care interventions was associated with significant reductions in HbA1c levels (standardized mean difference [SMD] ?0.44, 95\% CI ?0.59 to ?0.29; P<.001), SBP (SMD ?0.17, 95\% CI ?0.31 to ?0.03, P=.02), and DBP (SMD ?0.17, 95\% CI ?0.30 to ?0.03, P=.02). Subgroup analyses for primary outcomes showed that several intervention features were supportive of self-management, including blood glucose, blood pressure, and medication monitoring, communication with health care providers, automated feedback, personalized goal setting, reminders, education materials, and data visualization. In addition, 8 objective secondary outcomes were meta-analyzed, which showed that the interventions had significant lowering effects on fasting blood glucose levels and waist circumference. A total of 42 secondary outcomes were narratively synthesized, and mixed results were found. Conclusions: Mobile app-assisted self-care interventions can be effective tools for managing blood glucose and blood pressure, likely because their use facilitates remote management of health issues and data, provision of personalized self-care recommendations, patient--care provider communication, and decision making. More studies are required to further determine which combinations of intervention features are most effective in improving the control of the diseases. Moreover, evidence regarding the effects of these interventions on the behavioral, knowledge, and psychosocial outcomes of patients is still scarce, which warrants further examination. ", doi="10.2196/15779", url="http://mhealth.jmir.org/2020/8/e23600/", url="http://www.ncbi.nlm.nih.gov/pubmed/32459654" } @Article{info:doi/10.2196/14315, author="Tuvesson, Hanna and Eriks{\'e}n, Sara and Fagerstr{\"o}m, Cecilia", title="mHealth and Engagement Concerning Persons With Chronic Somatic Health Conditions: Integrative Literature Review", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="24", volume="8", number="7", pages="e14315", keywords="engagement", keywords="eHealth", keywords="mHealth", keywords="somatic disease", keywords="integrative literature review", keywords="telehealth", abstract="Background: Chronic somatic health conditions are a global public health challenge. Being engaged in one's own health management for such conditions is important, and mobile health (mHealth) solutions are often suggested as key to promoting engagement. Objective: The aim of this study was to review, critically appraise, and synthesize the available research regarding engagement through mHealth for persons with chronic somatic health conditions. Methods: An integrative literature review was conducted. The PubMed, CINAHL, and Inspec databases were used for literature searches. Quality assessment was done with the guidance of Critical Appraisal Skills Programme (CASP) checklists. We used a self-designed study protocol comprising 4 engagement aspects---cognitive, behavioral and emotional, interactional, and the usage of mHealth---as part of the synthesis and analysis. Results: A total of 44 articles met the inclusion criteria and were included in the analysis. mHealth usage was the most commonly occurring engagement aspect, behavioral and emotional aspects the second, cognitive aspects the third, and interactional aspects of engagement the least common aspect in the included articles. The results showed that there is a mix of enablers and barriers to engagement in relation to the 4 engagement aspects. The perceived meaningfulness and need for the solution and its content were important to create and maintain engagement. When perceived as meaningful, suitable, and usable, mHealth can support knowledge gain and learning, facilitate emotional and behavioral aspects such as a sense of confidence, and improve interactions and communications with health care professionals. Conclusions: mHealth solutions have the potential to support health care engagement for persons with chronic somatic conditions. More research is needed to further understand how, by which means, when, and among whom mHealth could further improve engagement for this population. ", doi="10.2196/14315", url="http://mhealth.jmir.org/2020/7/e14315/", url="http://www.ncbi.nlm.nih.gov/pubmed/32706686" } @Article{info:doi/10.2196/17039, author="Islam, Mohaimenul Md and Poly, Nasrin Tahmina and Walther, Andres Bruno and (Jack) Li, Yu-Chuan", title="Use of Mobile Phone App Interventions to Promote Weight Loss: Meta-Analysis", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="22", volume="8", number="7", pages="e17039", keywords="mobile app", keywords="mHealth", keywords="obesity", keywords="physical activity", keywords="weight gain prevention", abstract="Background: Obesity and lack of physical activity are major health risk factors for many life-threatening diseases, such as cardiovascular diseases, type 2 diabetes, and cancer. The use of mobile app interventions to promote weight loss and boost physical activity among children and adults is fascinating owing to the demand for cutting-edge and more efficient interventions. Previously published studies have examined different types of technology-based interventions and their impact on weight loss and increase in physical activity, but evidence regarding the impact of only a mobile phone app on weight loss and increase in physical activity is still lacking. Objective: The main objective of this study was to assess the efficacy of a mobile phone app intervention for reducing body weight and increasing physical activity among children and adults. Methods: PubMed, Google Scholar, Scopus, EMBASE, and the Web of Science electronic databases were searched for studies published between January 1, 2000, and April 30, 2019, without language restrictions. Two experts independently screened all the titles and abstracts to find the most appropriate studies. To be included, studies had to be either a randomized controlled trial or a case-control study that assessed a mobile phone app intervention with body weight loss and physical activity outcomes. The Cochrane Collaboration Risk of Bias tool was used to examine the risk of publication bias. Results: A total of 12 studies involving a mobile phone app intervention were included in this meta-analysis. Compared with the control group, the use of a mobile phone app was associated with significant changes in body weight (?1.07 kg, 95\% CI ?1.92 to ?0.21, P=.01) and body mass index (?0.45 kg/m2, 95\% CI ?0.78 to ?0.12, P=.008). Moreover, a nonsignificant increase in physical activity was observed (0.17, 95\% CI ?2.21 to 2.55, P=.88). Conclusions: The findings of this study demonstrate the promising and emerging efficacy of using mobile phone app interventions for weight loss. Future studies are needed to explore the long-term efficacy of mobile app interventions in larger samples. ", doi="10.2196/17039", url="https://mhealth.jmir.org/2020/7/e17039", url="http://www.ncbi.nlm.nih.gov/pubmed/32706724" } @Article{info:doi/10.2196/18255, author="Rhodes, Alexandra and Smith, D. Andrea and Chadwick, Paul and Croker, Helen and Llewellyn, H. Clare", title="Exclusively Digital Health Interventions Targeting Diet, Physical Activity, and Weight Gain in Pregnant Women: Systematic Review and Meta-Analysis", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="10", volume="8", number="7", pages="e18255", keywords="gestational weight gain", keywords="digital interventions", keywords="behavior change techniques", keywords="user engagement", keywords="smartphone", keywords="mobile phone", abstract="Background: Interventions to promote a healthy diet, physical activity, and weight management during pregnancy are increasingly embracing digital technologies. Although some interventions have combined digital with interpersonal (face-to-face or telephone) delivery, others have relied exclusively on digital delivery. Exclusively digital interventions have the advantages of greater cost-effectiveness and broader reach and as such can be a valuable resource for health care providers. Objective: This systematic review aims to focus on exclusively digital interventions to determine their effectiveness, identify behavior change techniques (BCTs), and investigate user engagement. Methods: A total of 6 databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], Excerpta Medica dataBASE [EMBASE], PsycINFO, Cumulated Index to Nursing and Allied Health Literature [CINAHL] Plus, Web of Science, and ProQuest) were searched for randomized controlled trials or pilot control trials of exclusively digital interventions to encourage healthy eating, physical activity, or appropriate weight gain during pregnancy. The outcome measures were gestational weight gain (GWG) and changes in physical activity and dietary behaviors. Study quality was assessed using the Cochrane Risk of Bias tool 2.0. Where possible, pooled effect sizes were calculated using a random effects meta-analysis. Results: In total, 11 studies met the inclusion criteria. The risk of bias was mostly high (n=5) or moderate (n=3). Of the 11 studies, 6 reported on GWG as the primary outcome, 4 of which also measured changes in physical activity and dietary behaviors, and 5 studies focused either on dietary behaviors only (n=2) or physical activity only (n=3). The meta-analyses showed no significant benefit of interventions on total GWG for either intention-to-treat data (?0.28 kg; 95\% CI ?1.43 to 0.87) or per-protocol data (?0.65 kg; 95\% CI ?1.98 to 0.67). Substantial heterogeneity in outcome measures of change in dietary behaviors and physical activity precluded further meta-analyses. BCT coding identified 7 BCTs that were common to all effective interventions. Effective interventions averaged over twice as many BCTs from the goals and planning, and feedback and monitoring domains as ineffective interventions. Data from the 6 studies reporting on user engagement indicated a positive association between high engagement with key BCTs and greater intervention effectiveness. Interventions using proactive messaging and feedback appeared to have higher levels of engagement. Conclusions: In contrast to interpersonal interventions, there is little evidence of the effectiveness of exclusively digital interventions to encourage a healthy diet, physical activity, or weight management during pregnancy. In this review, effective interventions used proactive messaging, such as reminders to engage in BCTs, feedback on progress, or tips, suggesting that interactivity may drive engagement and lead to greater effectiveness. Given the benefits of cost and reach of digital interventions, further research is needed to understand how to use advancing technologies to enhance user engagement and improve effectiveness. ", doi="10.2196/18255", url="https://mhealth.jmir.org/2020/7/e18255", url="http://www.ncbi.nlm.nih.gov/pubmed/32673251" } @Article{info:doi/10.2196/18072, author="Jacob, Christine and Sanchez-Vazquez, Antonio and Ivory, Chris", title="Understanding Clinicians' Adoption of Mobile Health Tools: A Qualitative Review of the Most Used Frameworks", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="6", volume="8", number="7", pages="e18072", keywords="telemedicine", keywords="smartphone", keywords="electronic health record", keywords="workflow", keywords="workload", keywords="workplace", keywords="public health practice", keywords="technology", keywords="perception", keywords="health education", keywords="mHealth", keywords="mobile health", keywords="telehealth", keywords="eHealth", abstract="Background: Although there is a push toward encouraging mobile health (mHealth) adoption to harness its potential, there are many challenges that sometimes go beyond the technology to involve other elements such as social, cultural, and organizational factors. Objective: This review aimed to explore which frameworks are used the most, to understand clinicians' adoption of mHealth as well as to identify potential shortcomings in these frameworks. Highlighting these gaps and the main factors that were not specifically covered in the most frequently used frameworks will assist future researchers to include all relevant key factors. Methods: This review was an in-depth subanalysis of a larger systematic review that included research papers published between 2008 and 2018 and focused on the social, organizational, and technical factors impacting clinicians' adoption of mHealth. The initial systematic review included 171 studies, of which 50 studies used a theoretical framework. These 50 studies are the subject of this qualitative review, reflecting further on the frameworks used and how these can help future researchers design studies that investigate the topic of mHealth adoption more robustly. Results: The most commonly used frameworks were different forms of extensions of the Technology Acceptance Model (TAM; 17/50, 34\%), the diffusion of innovation theory (DOI; 8/50, 16\%), and different forms of extensions of the unified theory of acceptance and use of technology (6/50, 12\%). Some studies used a combination of the TAM and DOI frameworks (3/50, 6\%), whereas others used the consolidated framework for implementation research (3/50, 6\%) and sociotechnical systems (STS) theory (2/50, 4\%). The factors cited by more than 20\% of the studies were usefulness, output quality, ease of use, technical support, data privacy, self-efficacy, attitude, organizational inner setting, training, leadership engagement, workload, and workflow fit. Most factors could be linked to one framework or another, but there was no single framework that could adequately cover all relevant and specific factors without some expansion. Conclusions: Health care technologies are generally more complex than tools that address individual user needs as they usually support patients with comorbidities who are typically treated by multidisciplinary teams who might even work in different health care organizations. This special nature of how the health care sector operates and its highly regulated nature, the usual budget deficits, and the interdependence between health care organizations necessitate some crucial expansions to existing theoretical frameworks usually used when studying adoption. We propose a shift toward theoretical frameworks that take into account implementation challenges that factor in the complexity of the sociotechnical structure of health care organizations and the interplay between the technical, social, and organizational aspects. Our consolidated framework offers recommendations on which factors to include when investigating clinicians' adoption of mHealth, taking into account all three aspects. ", doi="10.2196/18072", url="https://mhealth.jmir.org/2020/7/e18072", url="http://www.ncbi.nlm.nih.gov/pubmed/32442132" } @Article{info:doi/10.2196/16695, author="Indraratna, Praveen and Tardo, Daniel and Yu, Jennifer and Delbaere, Kim and Brodie, Matthew and Lovell, Nigel and Ooi, Sze-Yuan", title="Mobile Phone Technologies in the Management of Ischemic Heart Disease, Heart Failure, and Hypertension: Systematic Review and Meta-Analysis", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="6", volume="8", number="7", pages="e16695", keywords="mobile phone", keywords="text messaging", keywords="telemedicine", keywords="myocardial ischemia", keywords="heart failure", keywords="hypertension", abstract="Background: Cardiovascular disease (CVD) remains the leading cause of death worldwide. Mobile phones have become ubiquitous in most developed societies. Smartphone apps, telemonitoring, and clinician-driven SMS allow for novel opportunities and methods in managing chronic CVD, such as ischemic heart disease, heart failure, and hypertension, and in the conduct and support of cardiac rehabilitation. Objective: A systematic review was conducted using seven electronic databases, identifying all relevant randomized control trials (RCTs) featuring a mobile phone intervention (MPI) used in the management of chronic CVD. Outcomes assessed included mortality, hospitalizations, blood pressure (BP), and BMI. Methods: Electronic data searches were performed using seven databases from January 2000 to June 2019. Relevant articles were reviewed and analyzed. Meta-analysis was performed using standard techniques. The odds ratio (OR) was used as a summary statistic for dichotomous variables. A random effect model was used. Results: A total of 26 RCTs including 6713 patients were identified and are described in this review, and 12 RCTs were included in the meta-analysis. In patients with heart failure, MPIs were associated with a significantly lower rate of hospitalizations (244/792, 30.8\% vs 287/803, 35.7\%; n=1595; OR 0.77, 95\% CI 0.62 to 0.97; P=.03; I2=0\%). In patients with hypertension, patients exposed to MPIs had a significantly lower systolic BP (mean difference 4.3 mm Hg; 95\% CI ?7.8 to ?0.78 mm Hg; n=2023; P=.02). Conclusions: The available data suggest that MPIs may have a role as a valuable adjunct in the management of chronic CVD. ", doi="10.2196/16695", url="https://mhealth.jmir.org/2020/7/e16695", url="http://www.ncbi.nlm.nih.gov/pubmed/32628615" } @Article{info:doi/10.2196/18868, author="Benjumea, Jaime and Ropero, Jorge and Rivera-Romero, Octavio and Dorronzoro-Zubiete, Enrique and Carrasco, Alejandro", title="Privacy Assessment in Mobile Health Apps: Scoping Review", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="2", volume="8", number="7", pages="e18868", keywords="privacy", keywords="mHealth", keywords="apps", keywords="privacy assessment", keywords="data privacy", keywords="review", keywords="security", keywords="mobile phone", abstract="Background: Privacy has always been a concern, especially in the health domain. The proliferation of mobile health (mHealth) apps has led to a large amount of sensitive data being generated. Some authors have performed privacy assessments of mHealth apps. They have evaluated diverse privacy components; however, different authors have used different criteria for their assessments. Objective: This scoping review aims to understand how privacy is assessed for mHealth apps, focusing on the components, scales, criteria, and scoring methods used. A simple taxonomy to categorize the privacy assessments of mHealth apps based on component evaluation is also proposed. Methods: We followed the methodology defined by Arksey and O'Malley to conduct a scoping review. Included studies were categorized based on the privacy component, which was assessed using the proposed taxonomy. Results: The database searches retrieved a total of 710 citations---24 of them met the defined selection criteria, and data were extracted from them. Even though the inclusion criteria considered articles published since 2009, all the studies that were ultimately included were published from 2014 onward. Although 12 papers out of 24 (50\%) analyzed only privacy, 8 (33\%) analyzed both privacy and security. Moreover, 4 papers (17\%) analyzed full apps, with privacy being just part of the assessment. The evaluation criteria used by authors were heterogeneous and were based on their experience, the literature, and/or existing legal frameworks. Regarding the set of items used for the assessments, each article defined a different one. Items included app permissions, analysis of the destination, analysis of the content of communications, study of the privacy policy, use of remote storage, and existence of a password to access the app, among many others. Most of the included studies provided a scoring method that enables the comparison of privacy among apps. Conclusions: The privacy assessment of mHealth apps is a complex task, as the criteria used by different authors for their evaluations are very heterogeneous. Although some studies about privacy assessment have been conducted, a very large set of items to evaluate privacy has been used up until now. In-app information and privacy policies are primarily utilized by the scientific community to extract privacy information from mHealth apps. The creation of a scale based on more objective criteria is a desirable step forward for privacy assessment in the future. ", doi="10.2196/18868", url="https://mhealth.jmir.org/2020/7/e18868", url="http://www.ncbi.nlm.nih.gov/pubmed/32459640" } @Article{info:doi/10.2196/15942, author="Lo, Brian and Shi, Jenny and Hollenberg, Elisa and Abi-Jaoud{\'e}, Alexxa and Johnson, Andrew and Wiljer, David", title="Surveying the Role of Analytics in Evaluating Digital Mental Health Interventions for Transition-Aged Youth: Scoping Review", journal="JMIR Ment Health", year="2020", month="Jun", day="25", volume="7", number="6", pages="e15942", keywords="user engagement", keywords="mobile apps", keywords="mHealth", keywords="telemedicine", keywords="mental health", keywords="adolescent", keywords="data analytics", abstract="Background: Consumer-facing digital health interventions provide a promising avenue to bridge gaps in mental health care delivery. To evaluate these interventions, understanding how the target population uses a solution is critical to the overall validity and reliability of the evaluation. As a result, usage data (analytics) can provide a proxy for evaluating the engagement of a solution. However, there is paucity of guidance on how usage data or analytics should be used to assess and evaluate digital mental health interventions. Objective: This review aimed to examine how usage data are collected and analyzed in evaluations of mental health mobile apps for transition-aged youth (15-29 years). Methods: A scoping review was conducted using the Arksey and O'Malley framework. A systematic search was conducted on 5 journal databases using keywords related to usage and engagement, mental health apps, and evaluation. A total of 1784 papers from 2008 to 2019 were identified and screened to ensure that they included analytics and evaluated a mental health app for transition-aged youth. After full-text screening, 49 papers were included in the analysis. Results: Of the 49 papers included in the analysis, 40 unique digital mental health innovations were evaluated, and about 80\% (39/49) of the papers were published over the past 6 years. About 80\% involved a randomized controlled trial and evaluated apps with information delivery features. There were heterogeneous findings in the concept that analytics was ascribed to, with the top 3 being engagement, adherence, and acceptability. There was also a significant spread in the number of metrics collected by each study, with 35\% (17/49) of the papers collecting only 1 metric and 29\% (14/49) collecting 4 or more analytic metrics. The number of modules completed, the session duration, and the number of log ins were the most common usage metrics collected. Conclusions: This review of current literature identified significant variability and heterogeneity in using analytics to evaluate digital mental health interventions for transition-aged youth. The large proportion of publications from the last 6 years suggests that user analytics is increasingly being integrated into the evaluation of these apps. Numerous gaps related to selecting appropriate and relevant metrics and defining successful or high levels of engagement have been identified for future exploration. Although long-term use or adoption is an important precursor to realizing the expected benefits of an app, few studies have examined this issue. Researchers would benefit from clarification and guidance on how to measure and analyze app usage in terms of evaluating digital mental health interventions for transition-aged youth. Given the established role of adoption in the success of health information technologies, understanding how to abstract and analyze user adoption for consumer digital mental health apps is also an emerging priority. ", doi="10.2196/15942", url="https://mental.jmir.org/2020/6/e15942", url="http://www.ncbi.nlm.nih.gov/pubmed/32348261" } @Article{info:doi/10.2196/16214, author="Tully, Louise and Burls, Amanda and Sorensen, Jan and El-Moslemany, Riyad and O'Malley, Grace", title="Mobile Health for Pediatric Weight Management: Systematic Scoping Review", journal="JMIR Mhealth Uhealth", year="2020", month="Jun", day="3", volume="8", number="6", pages="e16214", keywords="childhood obesity", keywords="behavior change", keywords="weight management", keywords="mHealth", keywords="eHealth", keywords="connected health", keywords="lifestyle medicine", keywords="digital health", abstract="Background: The prevalence and consequences of obesity among children and adolescents remain a leading global public health concern, and evidence-based, multidisciplinary lifestyle interventions are the cornerstone of treatment. Mobile electronic devices are widely used across socioeconomic categories and may provide a means of extending the reach and efficiency of health care interventions. Objective: We aimed to synthesize the evidence regarding mobile health (mHealth) for the treatment of childhood overweight and obesity to map the breadth and nature of the literature in this field and describe the characteristics of published studies. Methods: We conducted a systematic scoping review in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews, by searching nine academic databases in addition to gray literature for studies describing acceptability, usability, feasibility, effectiveness, adherence, or cost-effectiveness of interventions assessing mHealth for childhood obesity treatment. We also hand searched the reference lists of relevant articles. Studies aimed at the prevention of overweight or obesity were excluded, as were studies in which mHealth was not the primary mode of treatment delivery for at least one study arm or was not independently assessed. A random portion of all abstracts and full texts was double screened by a second reviewer to ensure consistency. Data were charted according to study characteristics, including design, participants, intervention content, behavior change theory (BCT) underpinning the study, mode of delivery, and outcomes measured. Results: We identified 42 eligible studies assessing acceptability (n=7), usability (n=2), feasibility or pilot studies (n=15), treatment effect (n=17), and fidelity (n=1). Change in BMI z-scores or percentiles was most commonly measured, among a variety of dietary, physical activity, psychological, and usability or acceptability measures. SMS, mobile apps, and wearable devices made up the majority of mobile interventions, and 69\% (29/42) of the studies specified a BCT used. Conclusions: Pediatric weight management using mHealth is an emerging field, with most work to date aimed at developing and piloting such interventions. Few large trials are published, and these are heterogeneous in nature and rarely reported according to the Consolidated Standards of Reporting Trials for eHealth guidelines. There is an evidence gap in the cost-effectiveness analyses of such studies. ", doi="10.2196/16214", url="https://mhealth.jmir.org/2020/6/e16214", url="http://www.ncbi.nlm.nih.gov/pubmed/32490849" } @Article{info:doi/10.2196/15111, author="Hussain, Tasmeen and Smith, Patricia and Yee, M. Lynn", title="Mobile Phone--Based Behavioral Interventions in Pregnancy to Promote Maternal and Fetal Health in High-Income Countries: Systematic Review", journal="JMIR Mhealth Uhealth", year="2020", month="May", day="28", volume="8", number="5", pages="e15111", keywords="mHealth", keywords="mobile health", keywords="pregnancy", keywords="smartphone", keywords="text messaging", keywords="mobile applications", keywords="software", keywords="chronic disease", keywords="health behavior", abstract="Background: Chronic diseases have recently had an increasing effect on maternal-fetal health, especially in high-income countries. However, there remains a lack of discussion regarding health management with technological approaches, including mobile health (mHealth) interventions. Objective: This study aimed to systematically evaluate mHealth interventions used in pregnancy in high-income countries and their effects on maternal health behaviors and maternal-fetal health outcomes. Methods: This systematic review identified studies published between January 1, 2000, and November 30, 2018, in MEDLINE via PubMed, Cochrane Library, EMBASE, CINAHL, PsycINFO, Web of Science, and gray literature. Studies were eligible for inclusion if they included only pregnant women in high-income countries and evaluated stand-alone mobile phone interventions intended to promote healthy maternal beliefs, behaviors, and/or maternal-fetal health outcomes. Two researchers independently reviewed and categorized aspects of full-text articles, including source, study design, intervention and control, duration, participant age, attrition rate, main outcomes, and risk of bias. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and the study was registered in PROSPERO before initiation. Results: Of the 2225 records examined, 28 studies were included and categorized into 4 themes: (1) gestational weight gain, obesity and physical activity (n=9); (2) smoking cessation (n=9); (3) influenza vaccination (n=2); and (4) general prenatal health, preventive strategies, and miscellaneous topics (n=8). Reported sample sizes ranged from 16 to 5243 with a median of 91. Most studies were performed in the United States (18/28, 64\%) and were randomized controlled trials (21/28, 75\%). All participants in the included studies were pregnant at the time of study initiation. Overall, 14\% (4/28) of studies showed association between intervention use and improved health outcomes; all 4 studies focused on healthy gestational weight. Among those, 3 studies showed intervention use was associated with less overall gestational weight gain. These 3 studies involved interventions with text messaging or an app in combination with another communication strategy (Facebook or email). Regarding smoking cessation, influenza vaccination, and miscellaneous topics, there was some evidence of positive effects on health behaviors and beliefs, but very limited correlation with improved health outcomes. Data and interventions were heterogeneous, precluding a meta-analysis. Conclusions: In high-income countries, utilization of mobile phone--based health behavior interventions in pregnancy demonstrates some correlation with positive beliefs, behaviors, and health outcomes. More effective interventions are multimodal in terms of features and tend to focus on healthy gestational weight gain. ", doi="10.2196/15111", url="https://mhealth.jmir.org/2020/5/e15111", url="http://www.ncbi.nlm.nih.gov/pubmed/32463373" } @Article{info:doi/10.2196/18092, author="Khundaqji, Hamzeh and Hing, Wayne and Furness, James and Climstein, Mike", title="Smart Shirts for Monitoring Physiological Parameters: Scoping Review", journal="JMIR Mhealth Uhealth", year="2020", month="May", day="27", volume="8", number="5", pages="e18092", keywords="wearable electronic devices", keywords="biomedical technology", keywords="telemedicine", keywords="fitness trackers", keywords="sports", keywords="exercise", keywords="physiology", keywords="clinical decision making", keywords="vital signs", abstract="Background: The recent trends of technological innovation and widescale digitization as potential solutions to challenges in health care, sports, and emergency service operations have led to the conception of smart textile technology. In health care, these smart textile systems present the potential to aid preventative medicine and early diagnosis through continuous, noninvasive tracking of physical and mental health while promoting proactive involvement of patients in their medical management. In areas such as sports and emergency response, the potential to provide comprehensive and simultaneous physiological insights across multiple body systems is promising. However, it is currently unclear what type of evidence exists surrounding the use of smart textiles for the monitoring of physiological outcome measures across different settings. Objective: This scoping review aimed to systematically survey the existing body of scientific literature surrounding smart textiles in their most prevalent form, the smart shirt, for monitoring physiological outcome measures. Methods: A total of 5 electronic bibliographic databases were systematically searched (Ovid Medical Literature Analysis and Retrieval System Online, Excerpta Medica database, Scopus, Cumulative Index to Nursing and Allied Health Literature, and SPORTDiscus). Publications from the inception of the database to June 24, 2019 were reviewed. Nonindexed literature relevant to this review was also systematically searched. The results were then collated, summarized, and reported. Results: Following the removal of duplicates, 7871 citations were identified. On the basis of title and abstract screening, 7632 citations were excluded, whereas 239 were retrieved and assessed for eligibility. Of these, 101 citations were included in the final analysis. Included studies were categorized into four themes: (1) prototype design, (2) validation, (3) observational, and (4) reviews. Among the 101 analyzed studies, prototype design was the most prevalent theme (50/101, 49.5\%), followed by validation (29/101, 28.7\%), observational studies (21/101, 20.8\%), and reviews (1/101, 0.1\%). Presented prototype designs ranged from those capable of monitoring one physiological metric to those capable of monitoring several simultaneously. In 29 validation studies, 16 distinct smart shirts were validated against reference technology under various conditions and work rates, including rest, submaximal exercise, and maximal exercise. The identified observational studies used smart shirts in clinical, healthy, and occupational populations for aims such as early diagnosis and stress detection. One scoping review was identified, investigating the use of smart shirts for electrocardiograph signal monitoring in cardiac patients. Conclusions: Although smart shirts have been found to be valid and reliable in the monitoring of specific physiological metrics, results were variable for others, demonstrating the need for further systematic validation. Analysis of the results has also demonstrated gaps in knowledge, such as a considerable lag of validation and observational studies in comparison with prototype design and limited investigation using smart shirts in pediatric, elite sports, and emergency service populations. ", doi="10.2196/18092", url="http://mhealth.jmir.org/2020/5/e18092/", url="http://www.ncbi.nlm.nih.gov/pubmed/32348279" } @Article{info:doi/10.2196/15400, author="Wang, Youfa and Min, Jungwon and Khuri, Jacob and Xue, Hong and Xie, Bo and A Kaminsky, Leonard and J Cheskin, Lawrence", title="Effectiveness of Mobile Health Interventions on Diabetes and Obesity Treatment and Management: Systematic Review of Systematic Reviews", journal="JMIR Mhealth Uhealth", year="2020", month="Apr", day="28", volume="8", number="4", pages="e15400", keywords="diabetes mellitus", keywords="obesity", keywords="overweight", keywords="mHealth", keywords="mobile app", keywords="telemedicine", abstract="Background: Diabetes and obesity have become epidemics and costly chronic diseases. The impact of mobile health (mHealth) interventions on diabetes and obesity management is promising; however, studies showed varied results in the efficacy of mHealth interventions. Objective: This review aimed to evaluate the effectiveness of mHealth interventions for diabetes and obesity treatment and management on the basis of evidence reported in reviews and meta-analyses and to provide recommendations for future interventions and research. Methods: We systematically searched the PubMed, IEEE Xplore Digital Library, and Cochrane databases for systematic reviews published between January 1, 2005, and October 1, 2019. We analyzed 17 reviews, which assessed 55,604 original intervention studies, that met the inclusion criteria. Of those, 6 reviews were included in our meta-analysis. Results: The reviews primarily focused on the use of mobile apps and text messaging and the self-monitoring and management function of mHealth programs in patients with diabetes and obesity. All reviews examined changes in biomarkers, and some reviews assessed treatment adherence (n=7) and health behaviors (n=9). Although the effectiveness of mHealth interventions varied widely by study, all reviews concluded that mHealth was a feasible option and had the potential for improving patient health when compared with standard care, especially for glycemic control (?0.3\% to ?0.5\% greater reduction in hemoglobin A1c) and weight reduction (?1.0 kg to ?2.4 kg body weight). Overall, the existing 6 meta-analysis studies showed pooled favorable effects of these mHealth interventions (?0.79, 95\% CI ?1.17 to ?0.42; I2=90.5). Conclusions: mHealth interventions are promising, but there is limited evidence about their effectiveness in glycemic control and weight reduction. Future research to develop evidence-based mHealth strategies should use valid measures and rigorous study designs. To enhance the effectiveness of mHealth interventions, future studies are warranted for the optimal formats and the frequency of contacting patients, better tailoring of messages, and enhancing usability, which places a greater emphasis on maintaining effectiveness over time. ", doi="10.2196/15400", url="http://mhealth.jmir.org/2020/4/e15400/", url="http://www.ncbi.nlm.nih.gov/pubmed/32343253" } @Article{info:doi/10.2196/16085, author="Baker, Jess and Kohlhoff, Jane and Onobrakpor, Se-Inyenede and Woolfenden, Sue and Smith, Rebecca and Knebel, Constanze and Eapen, Valsamma", title="The Acceptability and Effectiveness of Web-Based Developmental Surveillance Programs: Rapid Review", journal="JMIR Mhealth Uhealth", year="2020", month="Apr", day="23", volume="8", number="4", pages="e16085", keywords="public health surveillance", keywords="mass screening", keywords="developmental disabilities", keywords="neurodevelopmental disorders", keywords="review literature as topic", keywords="health care disparities", abstract="Background: Web-based developmental surveillance programs may be an innovative solution to improving the early detection of childhood developmental difficulties, especially within disadvantaged populations. Objective: This review aimed to identify the acceptability and effectiveness of web-based developmental surveillance programs for children aged 0 to 6 years. Methods: A total of 6 databases and gray literature were searched using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses--informed protocol. Data extraction included variables related to health equity. Results: In total, 20 studies were identified. Most papers implemented web-based versions of the Modified Checklist for Autism in Toddlers, Revised with Follow-Up screener for autism spectrum disorder or Parent Evaluation of Developmental Status screeners for broad developmental delay. Caregivers and practitioners indicated a preference for web-based screeners, primarily for user-friendliness, improved follow-up accuracy, time, and training efficiencies. Conclusions: Although evidence is limited as to the necessity of web- versus face-to-face--based developmental screening, there are clear efficiencies in its use. Trial Registration: PROSPERO CRD42019127894; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=127894 ", doi="10.2196/16085", url="http://mhealth.jmir.org/2020/4/e16085/", url="http://www.ncbi.nlm.nih.gov/pubmed/32324149" } @Article{info:doi/10.2196/16055, author="Romare, Charlotte and Sk{\"a}r, Lisa", title="Smart Glasses for Caring Situations in Complex Care Environments: Scoping Review", journal="JMIR Mhealth Uhealth", year="2020", month="Apr", day="20", volume="8", number="4", pages="e16055", keywords="anesthesia department", keywords="critical care", keywords="intensive care units", keywords="scoping review", keywords="smart glasses", abstract="Background: Anesthesia departments and intensive care units represent two advanced, high-tech, and complex care environments. Health care in those environments involves different types of technology to provide safe, high-quality care. Smart glasses have previously been used in different health care settings and have been suggested to assist health care professionals in numerous areas. However, smart glasses in the complex contexts of anesthesia care and intensive care are new and innovative. An overview of existing research related to these contexts is needed before implementing smart glasses into complex care environments. Objective: The aim of this study was to highlight potential benefits and limitations with health care professionals' use of smart glasses in situations occurring in complex care environments. Methods: A scoping review with six steps was conducted to fulfill the objective. Database searches were conducted in PubMed and Scopus; original articles about health care professionals' use of smart glasses in complex care environments and/or situations occurring in those environments were included. The searches yielded a total of 20 articles that were included in the review. Results: Three categories were created during the qualitative content analysis: (1) smart glasses as a versatile tool that offers opportunities and challenges, (2) smart glasses entail positive and negative impacts on health care professionals, and (3) smart glasses' quality of use provides facilities and leaves room for improvement. Smart glasses were found to be both a helpful tool and a hindrance in caring situations that might occur in complex care environments. This review provides an increased understanding about different situations where smart glasses might be used by health care professionals in clinical practice in anesthesia care and intensive care; however, research about smart glasses in clinical complex care environments is limited. Conclusions: Thoughtful implementation and improved hardware are needed to meet health care professionals' needs. New technology brings challenges; more research is required to elucidate how smart glasses affect patient safety, health care professionals, and quality of care in complex care environments. ", doi="10.2196/16055", url="http://mhealth.jmir.org/2020/4/e16055/", url="http://www.ncbi.nlm.nih.gov/pubmed/32310144" } @Article{info:doi/10.2196/15446, author="Cheikh-Moussa, Kamila and Mira, Joaquin Jose and Orozco-Beltran, Domingo", title="Improving Engagement Among Patients With Chronic Cardiometabolic Conditions Using mHealth: Critical Review of Reviews", journal="JMIR Mhealth Uhealth", year="2020", month="Apr", day="8", volume="8", number="4", pages="e15446", keywords="mHealth", keywords="patients", keywords="telemedicine", keywords="engagement", keywords="chronic disease", keywords="cardiovascular disease", keywords="diabetes", keywords="obesity", abstract="Background: The burden imposed by cardiometabolic diseases remains a principal health care system concern. Integration of mobile health (mHealth) interventions is helpful for telemonitoring of these patients, which enables patients to be more active and take part in their treatment, while being more conscious and gaining more control over the outcomes. However, little is known about the degree to which users engage, and the extent to which this interaction matches the usage pattern for which mHealth interventions were designed. Objective: The aim of this study was to describe the characteristics and results of studies on mHealth solutions that measured the effects of interventions with patient engagement in the context of chronic cardiometabolic diseases. Methods: A critical review of systematic reviews was conducted to recover data on interventions focused on the engagement of patients with chronic cardiometabolic diseases using mHealth technologies. Articles (from January 1, 2010) were searched in the Medlars Online International Literature Medline (Medline/Pubmed), Embase, Cochrane Library, PsycINFO, and Scielo databases. Only studies that quantified a measure of engagement by patients with cardiometabolic disease were included for analysis. The Critical Appraisal Skills Programme (CASP) was used to determine included studies considering the quality of the data provided. The Scottish Intercollegiate Guidelines Network (SIGN) checklist was used to assess the quality of the evidence according to the methodology used in the studies reviewed. Engagement was defined as the level of patient implication or participation in self-care interventions. Engagement measures included number of logs to the website or platform, frequency of usage, number of messages exchanged, and number of tasks completed. Results: Initially, 638 papers were retrieved after applying the inclusion and exclusion criteria. Finally, only three systematic reviews measuring engagement were included in the analysis. No reviews applying a meta-analysis approach were found. The three review articles described the results of 10 clinical trials and feasibility studies that quantified engagement and met the inclusion criteria assessed through CASP. The sample size varied between 6 and 270 individuals, who were predominantly men. Cardiac disease was the principal target in the comparison of traditional and mHealth interventions for engagement improvement. The level of patient engagement with mHealth technologies varied between 50\% and 97\%, and technologies incorporating smartphones with a reminder function resulted in the highest level of engagement. Conclusions: mHealth interventions are an effective solution for improving engagement of patients with chronic cardiometabolic diseases. However, there is a need for advanced analysis and higher-quality studies focused on long-term engagement with specific interventions. The use of smartphones with a single app that includes a reminder function appears to result in better improvement in active participation, leading to higher engagement among patients with cardiometabolic diseases. ", doi="10.2196/15446", url="https://mhealth.jmir.org/2020/4/e15446", url="http://www.ncbi.nlm.nih.gov/pubmed/32267239" } @Article{info:doi/10.2196/15549, author="Yang, Yang and Chen, Helen and Qazi, Hammad and Morita, P. Plinio", title="Intervention and Evaluation of Mobile Health Technologies in Management of Patients Undergoing Chronic Dialysis: Scoping Review", journal="JMIR Mhealth Uhealth", year="2020", month="Apr", day="3", volume="8", number="4", pages="e15549", keywords="mobile health", keywords="renal dialysis", keywords="health technology assessment", keywords="patient outcome assessment", abstract="Background: Studies have shown the effectiveness and user acceptance of mobile health (mHealth) technologies in managing patients with chronic kidney disease (CKD). However, incorporating mHealth technology into the standard care of patients with CKD still faces many challenges. To our knowledge, there are no reviews on mHealth interventions and their assessments concerning the management of patients undergoing dialysis. Objective: This study provided a scoping review on existing apps and interventions of mHealth technologies in adult patients undergoing chronic dialysis and identified the gaps in patient outcome assessment of mHealth technologies in the literature. Methods: We systematically searched PubMed (MEDLINE), Scopus, and the Cumulative Index to Nursing and Allied Health Literature databases, as well as gray literature sources. Two keywords, ``mHealth'' and ``dialysis,'' were combined to address the main concepts of the objectives. Inclusion criteria were as follows: (1) mHealth interventions, which are on a smartphone, tablet, or web-based portals that are accessible through mobile devices; and (2) adult patients (age ?18 years) on chronic dialysis. Only English papers published from January 2008 to October 2018 were included. Studies with mHealth apps for other chronic conditions, based on e-consultation or videoconferencing, non-English publications, and review papers were excluded. Results: Of the 1054 papers identified, 22 met the inclusion and exclusion criteria. Most studies (n=20) were randomized controlled trials and cohort studies. These studies were carried out in 7 countries. The main purposes of these mHealth interventions were as follows: nutrition or dietary self-monitoring (n=7), remote biometric monitoring (n=7), web-based portal (n=4), self-monitoring of in-session dialysis-specific information (n=3), and self-monitoring of lifestyle or behavioral change (n=1). The outcomes of the 22 included studies were organized into five categories: (1) patient satisfaction and acceptance, (2) clinical effectiveness, (3) economic assessment, (4) health-related quality of life, and (5) impact on lifestyle or behavioral change. The mHealth interventions showed neutral to positive results in chronic dialysis patient management, reporting no to significant improvement of dialysis-specific measurements and some components of the overall quality of life assessment. Evaluation of these mHealth interventions consistently demonstrated evidence in patients' satisfaction, high level of user acceptance, and reduced use of health resources and cost savings to health care services. However, there is a lack of studies evaluating safety, organizational, sociocultural, ethical, and legal aspects of mHealth technologies. Furthermore, a comprehensive cost-effectiveness and cost-benefit analysis of adopting mHealth technologies was not found in the literature. Conclusions: The gaps identified in this study will inform the creation of health policies and organizational support for mHealth implementation in patients undergoing dialysis. The findings of this review will inform the development of a comprehensive service model that utilizes mHealth technologies for home monitoring and self-management of patients undergoing chronic dialysis. ", doi="10.2196/15549", url="https://mhealth.jmir.org/2020/4/e15549", url="http://www.ncbi.nlm.nih.gov/pubmed/32242823" } @Article{info:doi/10.2196/14897, author="Miralles, Ignacio and Granell, Carlos and D{\'i}az-Sanahuja, Laura and Van Woensel, William and Bret{\'o}n-L{\'o}pez, Juana and Mira, Adriana and Castilla, Diana and Casteleyn, Sven", title="Smartphone Apps for the Treatment of Mental Disorders: Systematic Review", journal="JMIR Mhealth Uhealth", year="2020", month="Apr", day="2", volume="8", number="4", pages="e14897", keywords="mental health", keywords="mental disorders", keywords="treatment", keywords="intervention", keywords="mHealth", keywords="smartphone", keywords="mobile phone", keywords="mobile apps", keywords="systematic review", abstract="Background: Smartphone apps are an increasingly popular means for delivering psychological interventions to patients suffering from a mental disorder. In line with this popularity, there is a need to analyze and summarize the state of the art, both from a psychological and technical perspective. Objective: This study aimed to systematically review the literature on the use of smartphones for psychological interventions. Our systematic review has the following objectives: (1) analyze the coverage of mental disorders in research articles per year; (2) study the types of assessment in research articles per mental disorder per year; (3) map the use of advanced technical features, such as sensors, and novel software features, such as personalization and social media, per mental disorder; (4) provide an overview of smartphone apps per mental disorder; and (5) provide an overview of the key characteristics of empirical assessments with rigorous designs (ie, randomized controlled trials [RCTs]). Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews were followed. We performed searches in Scopus, Web of Science, American Psychological Association PsycNET, and Medical Literature Analysis and Retrieval System Online, covering a period of 6 years (2013-2018). We included papers that described the use of smartphone apps to deliver psychological interventions for known mental disorders. We formed multidisciplinary teams, comprising experts in psychology and computer science, to select and classify articles based on psychological and technical features. Results: We found 158 articles that met the inclusion criteria. We observed an increasing interest in smartphone-based interventions over time. Most research targeted disorders with high prevalence, that is, depressive (31/158,19.6\%) and anxiety disorders (18/158, 11.4\%). Of the total, 72.7\% (115/158) of the papers focused on six mental disorders: depression, anxiety, trauma and stressor-related, substance-related and addiction, schizophrenia spectrum, and other psychotic disorders, or a combination of disorders. More than half of known mental disorders were not or very scarcely (<3\%) represented. An increasing number of studies were dedicated to assessing clinical effects, but RCTs were still a minority (25/158, 15.8\%). From a technical viewpoint, interventions were leveraging the improved modalities (screen and sound) and interactivity of smartphones but only sparingly leveraged their truly novel capabilities, such as sensors, alternative delivery paradigms, and analytical methods. Conclusions: There is a need for designing interventions for the full breadth of mental disorders, rather than primarily focusing on most prevalent disorders. We further contend that an increasingly systematic focus, that is, involving RCTs, is needed to improve the robustness and trustworthiness of assessments. Regarding technical aspects, we argue that further exploration and innovative use of the novel capabilities of smartphones are needed to fully realize their potential for the treatment of mental health disorders. ", doi="10.2196/14897", url="https://mhealth.jmir.org/2020/4/e14897", url="http://www.ncbi.nlm.nih.gov/pubmed/32238332" } @Article{info:doi/10.2196/17776, author="Li, Ran and Liang, Ning and Bu, Fanlong and Hesketh, Therese", title="The Effectiveness of Self-Management of Hypertension in Adults Using Mobile Health: Systematic Review and Meta-Analysis", journal="JMIR Mhealth Uhealth", year="2020", month="Mar", day="27", volume="8", number="3", pages="e17776", keywords="hypertension", keywords="self-management", keywords="mHealth", keywords="medication adherence", keywords="mobile phone", keywords="health behavior", abstract="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; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=152062 ", doi="10.2196/17776", url="http://mhealth.jmir.org/2020/3/e17776/", url="http://www.ncbi.nlm.nih.gov/pubmed/32217503" } @Article{info:doi/10.2196/17046, author="Milne-Ives, Madison and Lam, Ching and De Cock, Caroline and Van Velthoven, Helena Michelle and Meinert, Edward", title="Mobile Apps for Health Behavior Change in Physical Activity, Diet, Drug and Alcohol Use, and Mental Health: Systematic Review", journal="JMIR Mhealth Uhealth", year="2020", month="Mar", day="18", volume="8", number="3", pages="e17046", keywords="telemedicine", keywords="evidence-based medicine", keywords="mobile health", keywords="digital health", keywords="mobile applications", keywords="app", keywords="cell phone", keywords="smartphone", keywords="mobile phone", keywords="health behavior", keywords="intervention", keywords="behavior change", keywords="systematic review", abstract="Background: With a growing focus on patient interaction with health management, mobile apps are increasingly used to deliver behavioral health interventions. The large variation in these mobile health apps---their target patient group, health behavior, and behavioral change strategies---has resulted in a large but incohesive body of literature. Objective: This systematic review aimed to assess the effectiveness of mobile apps in improving health behaviors and outcomes and to examine the inclusion and effectiveness of behavior change techniques (BCTs) in mobile health apps. Methods: PubMed, EMBASE, CINAHL, and Web of Science were systematically searched for articles published between 2014 and 2019 that evaluated mobile apps for health behavior change. Two authors independently screened and selected studies according to the eligibility criteria. Data were extracted and the risk of bias was assessed by one reviewer and validated by a second reviewer. Results: A total of 52 randomized controlled trials met the inclusion criteria and were included in the analysis---37 studies focused on physical activity, diet, or a combination of both, 11 on drug and alcohol use, and 4 on mental health. Participant perceptions were generally positive---only one app was rated as less helpful and satisfactory than the control---and the studies that measured engagement and usability found relatively high study completion rates (mean 83\%; n=18, N=39) and ease-of-use ratings (3 significantly better than control, 9/15 rated >70\%). However, there was little evidence of changed behavior or health outcomes. Conclusions: There was no strong evidence in support of the effectiveness of mobile apps in improving health behaviors or outcomes because few studies found significant differences between the app and control groups. Further research is needed to identify the BCTs that are most effective at promoting behavior change. Improved reporting is necessary to accurately evaluate the mobile health app effectiveness and risk of bias. ", doi="10.2196/17046", url="http://mhealth.jmir.org/2020/3/e17046/", url="http://www.ncbi.nlm.nih.gov/pubmed/32186518" } @Article{info:doi/10.2196/16060, author="Portz, D. Jennifer and Elsbernd, Kira and Plys, Evan and Ford, Lynett Kelsey and Zhang, Xuhong and Gore, Odette M. and Moore, L. Susan and Zhou, Shuo and Bull, Sheana", title="Elements of Social Convoy Theory in Mobile Health for Palliative Care: Scoping Review", journal="JMIR Mhealth Uhealth", year="2020", month="Jan", day="6", volume="8", number="1", pages="e16060", keywords="mHealth", keywords="palliative care", keywords="caregivers", keywords="mobile apps", abstract="Background: Mobile health (mHealth) provides a unique modality for improving access to and awareness of palliative care among patients, families, and caregivers from diverse backgrounds. Some mHealth palliative care apps exist, both commercially available and established by academic researchers. However, the elements of family support and family caregiving tools offered by these early apps is unknown. Objective: The objective of this scoping review was to use social convoy theory to describe the inclusion and functionality of family, social relationships, and caregivers in palliative care mobile apps. Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review guidelines, a systematic search of palliative care mHealth included (1) research-based mobile apps identified from academic searches published between January 1, 2010, and March 31, 2019 and (2) commercially available apps for app stores in April 2019. Two reviewers independently assessed abstracts, app titles, and descriptions against the inclusion and exclusion criteria. Abstracted data covered app name, research team or developer, palliative care element, target audience, and features for family support and caregiving functionality as defined by social convoy theory. Results: Overall, 10 articles describing 9 individual research-based apps and 22 commercially available apps were identified. Commercially available apps were most commonly designed for both patients and social convoys, whereas the majority of research apps were designed for patient use only. Conclusions: Results suggest there is an emerging presence of apps for patients and social convoys receiving palliative care; however, there are many needs for developers and researchers to address in the future. Although palliative care mHealth is a growing field, additional research is needed for apps that embrace a team approach to information sharing, target family- and caregiver-specific issues, promote access to palliative care, and are comprehensive of palliative needs. ", doi="10.2196/16060", url="https://mhealth.jmir.org/2020/1/e16060", url="http://www.ncbi.nlm.nih.gov/pubmed/31904581" } @Article{info:doi/10.2196/13311, author="Taj, Fawad and Klein, A. Michel C. and van Halteren, Aart", title="Digital Health Behavior Change Technology: Bibliometric and Scoping Review of Two Decades of Research", journal="JMIR Mhealth Uhealth", year="2019", month="Dec", day="13", volume="7", number="12", pages="e13311", keywords="persuasive technology", keywords="digital health behavior", keywords="behavior change systems", keywords="behavior change support systems", keywords="bibliometric analysis", keywords="scoping review", abstract="Background: Research on digital technology to change health behavior has increased enormously in recent decades. Due to the interdisciplinary nature of this topic, knowledge and technologies from different research areas are required. Up to now, it is not clear how the knowledge from those fields is combined in actual applications. A comprehensive analysis that systematically maps and explores the use of knowledge within this emerging interdisciplinary field is required. Objective: This study aims to provide an overview of the research area around the design and development of digital technologies for health behavior change and to explore trends and patterns. Methods: A bibliometric analysis is used to provide an overview of the field, and a scoping review is presented to identify the trends and possible gaps. The study is based on the publications related to persuasive technologies and health behavior change in the last 18 years, as indexed by the Web of Science and Scopus (317 and 314 articles, respectively). In the first part, regional and time-based publishing trends; research fields and keyword co-occurrence networks; influential journals; and collaboration network between influential authors, countries, and institutions are examined. In the second part, the behavioral domains, technological means and theoretical foundations are investigated via a scoping review. Results: The literature reviewed shows a clear and emerging trend after 2001 in technology-based behavior change, which grew exponentially after the introduction of the smartphone around 2009. Authors from the United States, Europe, and Australia have the highest number of publications in the field. The three most active research areas are computer science, public and occupational health, and psychology. The keyword ``mhealth'' was the dominant term and predominantly used together with the term ``physical activity'' and ``ehealth''. A total of three strong clusters of coauthors have been found. Nearly half of the total reported papers were published in three journals. The United States, the United Kingdom, and the Netherlands have the highest degree of author collaboration and a strong institutional network. Mobile phones were most often used as a technology platform, regardless of the targeted behavioral domain. Physical activity and healthy eating were the most frequently targeted behavioral domains. Most articles did not report about the behavior change techniques that were applied. Among the reported behavior change techniques, goal setting and self-management were the most frequently reported. Conclusions: Closer cooperation and interaction between behavioral sciences and technological areas is needed, so that theoretical knowledge and new technological advancements are better connected in actual applications. Eventually, this could result in a larger societal impact, an increase of the effectiveness of digital technologies for health behavioral change, and more insight in the relationship between behavioral change strategies and persuasive technologies' effectiveness. ", doi="10.2196/13311", url="https://mhealth.jmir.org/2019/12/e13311", url="http://www.ncbi.nlm.nih.gov/pubmed/31833836" } @Article{info:doi/10.2196/15122, author="Koo, Mi Bon and Vizer, M. Lisa", title="Examining Mobile Technologies to Support Older Adults With Dementia Through the Lens of Personhood and Human Needs: Scoping Review", journal="JMIR Mhealth Uhealth", year="2019", month="Nov", day="11", volume="7", number="11", pages="e15122", keywords="dementia", keywords="Alzheimer disease", keywords="mobile health", keywords="consumer health informatics", keywords="personhood", keywords="systematic review", keywords="smartphone", keywords="mobile phone", keywords="tablet computers", abstract="Background: With the world's rapidly growing older adult population, there is an increase in the number of people living with dementia. This growth leads to a strain on their caregivers and our health care system and to an increased attention on mitigating strain by using mobile technology to sustain the independence of people with dementia. However, less attention is given to whether these technologies meet the stated and unstated needs of people with dementia. Objective: The aim of this study was to provide an overview of the current research on mobile technologies for people with dementia, considering the current research through the lens of personhood and human needs, and to identify any gaps that represent research opportunities. Methods: We performed a systematic search in Medical Literature Analysis and Retrieval System Online (MEDLINE), Web of Science, PsycINFO, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Excerpta Medica dataBASE (EMBASE), and the Cochrane Central Register of Controlled Trials (CENTRAL) in October 2018. We screened 5560 articles and identified 24 that met our inclusion and exclusion criteria. We then performed thematic analysis to organize the articles by the types of support mobile technologies provide and mapped those types of support to human needs to identify the gaps in support. Results: Articles described research on mobile technologies that support people with dementia to (1) perform daily activities, (2) maintain social interaction, (3) aid memory, (4) engage in leisure activities, (5) track location, and (6) monitor health. At least one type of support mapped to each human need, with most supporting lower-level needs such as physiological and safety needs. Little attention seems to be paid to personhood. Conclusions: Mobile technologies that support daily activities, relationships, memory, leisure activities, health, and safety can partially compensate for decreased function owing to dementia, but the human needs of people with dementia are often not adequately considered. Most technologies support basic physiological and safety needs, whereas many pay little attention to higher-level needs such as self-esteem and agency. Important research opportunities include using person-centered methods to develop technology to meet higher-level needs and to preserve personhood by incorporating human and psychological needs of people with dementia along with ethical considerations. ", doi="10.2196/15122", url="https://mhealth.jmir.org/2019/11/e15122", url="http://www.ncbi.nlm.nih.gov/pubmed/31710305" } @Article{info:doi/10.2196/12612, author="Puigdomenech Puig, Elisa and Robles, Noem{\'i} and Saig{\'i}-Rubi{\'o}, Francesc and Zamora, Alberto and Moharra, Montse and Paluzie, Guillermo and Balfeg{\'o}, Mariona and Cuatrecasas Cambra, Guillem and Garcia-Lorda, Pilar and Carrion, Carme", title="Assessment of the Efficacy, Safety, and Effectiveness of Weight Control and Obesity Management Mobile Health Interventions: Systematic Review", journal="JMIR Mhealth Uhealth", year="2019", month="Oct", day="25", volume="7", number="10", pages="e12612", keywords="mHealth", keywords="obesity", keywords="overweight", keywords="systematic review", keywords="technology assessment", abstract="Background: The use of apps to tackle overweight and obesity by tracking physical and dietary patterns and providing recommendations and motivation strategies to achieve personalized goals has increased over recent years. However, evidence of the efficacy, effectiveness, and safety of these apps is severely lacking. Objective: The aim of this study was to identify efficacy, safety, and effectiveness criteria used to assess weight control, overweight, and obesity management in mobile health (mHealth) interventions through a systematic review. Methods: PubMed, PsycINFO, Scopus, UK Trial Database, ClinicalTrials.gov, and the Cochrane Library were surveyed up to May 2018. All types of clinical studies were considered. A total of 2 independent reviewers assessed quality using Scottish Intercollegiate Guidelines Network (SIGN) criteria. Ratings were used to provide an overall score for each study (low, moderate, or high). Data were synthesized in evidence tables. Results: From 233 potentially relevant publications, only 28 studies were included. Of these, 13 (46\%) were randomized control trials, 11 were single-arm studies (39\%), 3 were nonrandomized controlled trials (11\%), and 1 study was a cluster randomized trial (4\%). The studies were classified as low (15), high (7), and moderate (6) quality according to SIGN criteria. All studies focused on efficacy, with only 1 trial mentioning safety and another 1 effectiveness. In 11 studies, the apps were used as stand-alone interventions, the others were multicomponent studies that included other tools for support such as sensors or websites. The main management tool included in the apps was feedback messaging (24), followed by goal-setting mechanisms (20) and self-monitoring (19). The majority of studies took weight or body mass index loss as the main outcome (22) followed by changes in physical activity (14) and diet (12). Regarding outputs, usability, adherence, and engagement (17) were the most reported, followed by satisfaction (7) and acceptability (4). Conclusions: There is a remarkable heterogeneity among these studies and the majority have methodological limitations that leave considerable room for improvement. Further research is required to identify all relevant criteria for assessing the efficacy of mHealth interventions in the management of overweight and obesity. Trial Registration: PROSPERO CRD42017056761; https://tinyurl.com/y2zhxtjx ", doi="10.2196/12612", url="http://mhealth.jmir.org/2019/10/e12612/", url="http://www.ncbi.nlm.nih.gov/pubmed/31654566" } @Article{info:doi/10.2196/14404, author="Wang, Ziqi and Zhu, Yaxin and Cui, Liyuan and Qu, Bo", title="Electronic Health Interventions to Improve Adherence to Antiretroviral Therapy in People Living With HIV: Systematic Review and Meta-Analysis", journal="JMIR Mhealth Uhealth", year="2019", month="Oct", day="16", volume="7", number="10", pages="e14404", keywords="HIV", keywords="highly active antiretroviral therapy", keywords="medication adherence", keywords="eHealth", abstract="Background: Electronic health (eHealth) is increasingly used for self-management and service delivery of HIV-related diseases. With the publication of studies increasingly focusing on antiretroviral therapy (ART) adherence, this makes it possible to quantitatively and systematically assess the effectiveness and feasibility of eHealth interventions. Objective: The purpose of this review was to explore the effectiveness of eHealth interventions on improving ART adherence in people living with HIV. The effects of different intervention characteristics, participant characteristics, and study characteristics were also assessed. Methods: We systematically searched MEDLINE (via PubMed), EMBASE, the Cochrane Central Register of Controlled Trials, and 3 conference abstract databases using search terms related to HIV, ART, adherence, and eHealth interventions. We independently screened the studies, extracted the data, and assessed the study quality and then compared the information in pairs. Articles published in English that used randomized controlled trials to assess eHealth interventions to improve ART adherence of people living with HIV were identified. We extracted the data including study characteristics, participant characteristics, intervention characteristics, and outcome measures. The Cochrane risk-of-bias tool was used to assess the risk of bias and study overall quality. Odds ratios, Cohen d, and their 95\% CIs were estimated using random-effects models. We also performed multiple subgroup analyses and sensitivity analyses to define any sources of heterogeneity. Results: Among 3941 articles identified, a total of 19 studies (including 21 trials) met the inclusion criteria. We found 8 trials from high-income countries and 13 trials from low- and middle-income countries. Furthermore, at baseline, the health status of participants in 14 trials was healthy. Of the trials included, 7 of 21 used personality content, 12 of 21 used a 2-way communication strategy, and 7 of 21 used medical content. In the pooled analysis of 3937 participants (mean age: 35 years; 47.16\%, 1857/3937 females), eHealth interventions significantly improved the ART adherence of people living with HIV (pooled Cohen d=0.25; 95\% CI 0.05 to 0.46; P=.01). The interventions were also correlated with improved biochemical outcomes reported by 11 trials (pooled Cohen d=0.25; 95\% CI 0.11 to 0.38; P<.001). The effect was sensitive to sample size (Q=5.56; P=.02) and study duration (Q=8.89; P=.003), but it could not be explained by other moderators. The primary meta-analysis result was stable in the 3 sensitivity analyses. Conclusions: Some of the eHealth interventions may be used as an effective method to increase the ART adherence of people living with HIV. Considering that most of the trials included a small sample size and were conducted for a short duration, these results should be interpreted with caution. Future studies need to determine the features of eHealth interventions to better improve ART adherence along with long-term effectiveness of interventions, effectiveness of real-time adherence monitoring, enhancement of study design, and influences on biochemical outcomes. ", doi="10.2196/14404", url="https://mhealth.jmir.org/2019/10/e14404", url="http://www.ncbi.nlm.nih.gov/pubmed/31621641" } @Article{info:doi/10.2196/14877, author="Hobson, R. Georgina and Caffery, J. Liam and Neuhaus, Maike and Langbecker, H. Danette", title="Mobile Health for First Nations Populations: Systematic Review", journal="JMIR Mhealth Uhealth", year="2019", month="Oct", day="7", volume="7", number="10", pages="e14877", keywords="mHealth", keywords="mobile health", keywords="indigenous", keywords="First Nations", keywords="aboriginal", keywords="humans", keywords="systematic review", abstract="Background: The ubiquitous presence and functionality of mobile devices offers the potential for mobile health (mHealth) to create equitable health opportunities. While mHealth is used among First Nations populations to respond to health challenges, the characteristics, uptake, and effectiveness of these interventions are unclear. Objective: This review aimed to identify the characteristics of mHealth interventions (eg, study locations, health topic, and modality) evaluated with First Nations populations and to summarize the outcomes reported for intervention use, user perspectives including cultural responsiveness, and clinical effectiveness. In addition, the review sought to identify the presence of First Nations expertise in the design and evaluation of mHealth interventions with First Nations populations. Methods: The methods of this systematic review were detailed in a registered protocol with the International Prospective Register of Systematic Reviews (PROSPERO, CRD42019123276). Systematic searches of peer-reviewed, scientific papers were conducted across 7 databases in October 2018. Eligible studies had a primary focus on mHealth interventions with experimental or quasi-experimental design to respond to a health challenge with First Nations people from Canada, Australia, New Zealand, and the United States. Two authors independently screened records for eligibility and assessed risk of bias using the Joanna Briggs Institute checklists. Data were synthesized narratively owing to the mix of study designs, interventions, and outcomes. The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Results: Searches yielded 1053 unique records, after review and screening, 13 studies (5 randomized controlled trials and 8 quasi-experimental designs) were included in the final analysis. Studies were conducted in Australia (n=9), the United States (n=2), and New Zealand (n=2). The most common health challenge addressed was mental health and suicide (n=5). Intervention modalities included text messaging (n=5), apps (n=4), multimedia messaging (n=1), tablet software (n=1), or a combination of short messaging service (SMS) and apps (n=1). Results showed mixed engagement with the intervention (n=3); favorable user perspectives, including acceptability and cultural appropriateness (n=6); and mixed outcomes for clinical effectiveness (n=10). A diverse range of risks of bias were identified, the most common of which included a lack of clarity about allocation and blinding protocols and group treatment for randomized controlled trials and a lack of control group and single outcome measures for quasi-experimental designs. First Nations expertise informed all mHealth studies, through authorship (n=8), affiliation with First Nations bodies (n=3), participatory study design (n=5), First Nations reference groups (n=5), or a combination of these. Conclusions: mHealth modalities, including SMS and apps, appear favorable for delivery of health interventions with First Nations populations, particularly in the area of mental health and suicide prevention. Importantly, First Nations expertise was strongly embedded within the studies, augmenting favorable use and user engagement. However, evidence of efficacy is limited. ", doi="10.2196/14877", url="https://mhealth.jmir.org/2019/10/e14877", url="http://www.ncbi.nlm.nih.gov/pubmed/31593537" } @Article{info:doi/10.2196/14275, author="Wali, Sahr and Hussain-Shamsy, Neesha and Ross, Heather and Cafazzo, Joseph", title="Investigating the Use of Mobile Health Interventions in Vulnerable Populations for Cardiovascular Disease Management: Scoping Review", journal="JMIR Mhealth Uhealth", year="2019", month="Oct", day="7", volume="7", number="10", pages="e14275", keywords="mobile health", keywords="health services", keywords="indigenous", keywords="low- and middle-income countries", keywords="cardiovascular disease", keywords="self-care", abstract="Background: Cardiovascular disease (CVD) has grown to become one of the leading causes of mortality worldwide. The advancements of CVD-related treatments have led to a decline in CVD prevalence among individuals in high-income countries (HICs). However, these improvements do not reflect the state of individuals in low- and middle-income countries (LMICs) and vulnerable subgroup populations in HICs, such as the Indigenous. To help minimize the health disparities in these populations, technology-based interventions have been offered as a potential solution, but there is concern regarding if they will be effective, or even needed, as these tools have been designed for use in HICs. Objective: The objective of this study was to explore how mobile health (mHealth) interventions currently assist individuals in Indigenous communities and LMICs with CVD management. Methods: A scoping review guided by the methods outlined by Arksey and O'Malley was conducted. A comprehensive search was completed by 2 reviewers in 5 electronic databases using keywords related to mobile health, cardiovascular disease, self-care, Indigenous communities, and LMICs. Studies were screened over 2 rounds and critically reviewed using a descriptive-analytical narrative method. Descriptive data were categorized into thematic groups reflecting the major findings related to the study objective. Results: We identified a total of 11 original articles and 11 review papers that met the criteria for this scoping review. The majority of the studies included a telemonitoring- and text messaging (short message service, SMS)--related feature associated with the intervention. The use of SMS was the most common approach to effectively promote disease management among individuals in both LMICs and Indigenous communities. However, customizing for cultural considerations within the design of the intervention was highlighted as a pivotal component to encourage CVD management. Specifically, individuals emphasized that the inclusion of collaborative partnerships with community members would strengthen the effectiveness of the intervention by ensuring it was designed with the appropriate context. Conclusions: Technology-based interventions used within Indigenous communities and LMICs have shown their potential to assist individuals with managing their condition. Although the literature available regarding this topic is limited, this review outlines key components to promote the effective use of these tools in the context of these vulnerable populations. ", doi="10.2196/14275", url="https://mhealth.jmir.org/2019/10/e14275", url="http://www.ncbi.nlm.nih.gov/pubmed/31593547" } @Article{info:doi/10.2196/13245, author="Cruz, Marques Fl{\'a}via Oliveira Almeida and Vilela, Alencar Ricardo and Ferreira, Barros Elaine and Melo, Santos Nilce and Reis, Dos Paula Elaine Diniz", title="Evidence on the Use of Mobile Apps During the Treatment of Breast Cancer: Systematic Review", journal="JMIR Mhealth Uhealth", year="2019", month="Aug", day="27", volume="7", number="8", pages="e13245", keywords="mobile applications", keywords="health education", keywords="nursing care", keywords="review", keywords="educational technology", keywords="breast neoplasms", abstract="Background: Cancer is a major cause of morbidity, disability, and mortality worldwide, and breast cancer is the most common cause of death in women. Different modalities of cancer treatment can have adverse effects that reduce the quality of life of patients and lead to treatment interruptions, if not managed properly. The use of mobile technologies has brought innovative possibilities for improving health care. Mobile apps can help individuals manage their own health and well-being and may also promote healthy lifestyles and information access. Objective: The aim of this study was to identify available evidence on the use of mobile apps to provide information and facilitate communication regarding self-care management related to the adverse effects of toxicities owing to breast cancer therapy. Methods: This systematic review includes studies which were identified using a search strategy adapted for each electronic database: CINAHL, Cochrane Library, LILACS, LIVIVO, PubMed, SCOPUS, and Web of Science. In addition, a gray literature search was performed using Google Scholar. All the electronic database searches were conducted on April 17, 2019. Two investigators independently reviewed the titles and abstracts of the studies identified and then read the full text of all selected papers. The quality of the included studies was analyzed by the Cochrane Collaboration Risk of Bias Tool and the Methodological Index for Non-Randomized Studies. Results: A total of 9 studies which met the eligibility criteria---3 randomized clinical trials and 6 nonrandomized studies published in English from 2010 to 2018---were considered for this systematic review; 396 patients with breast cancer, as well as 40 experts in the medical and nursing fields, and 3 software engineers were included. Conclusions: The evidence from the studies included in this systematic review is currently limited but suggests that mobile apps for women with breast cancer might be an acceptable information source that can improve patient well-being; they can also be used to report symptoms and adverse treatment-related effects and promote self-care. There is a need to test more evidence-based apps in future randomized clinical trials. ", doi="10.2196/13245", url="http://mhealth.jmir.org/2019/8/e13245/", url="http://www.ncbi.nlm.nih.gov/pubmed/31456578" } @Article{info:doi/10.2196/12649, author="Trifan, Alina and Oliveira, Maryse and Oliveira, Lu{\'i}s Jos{\'e}", title="Passive Sensing of Health Outcomes Through Smartphones: Systematic Review of Current Solutions and Possible Limitations", journal="JMIR Mhealth Uhealth", year="2019", month="Aug", day="23", volume="7", number="8", pages="e12649", keywords="smartphone", keywords="mobile phone", keywords="mhealth", keywords="digital health", keywords="digital medicine", keywords="digital phenotyping", keywords="health care", keywords="self-management", keywords="systematic review", abstract="Background: Technological advancements, together with the decrease in both price and size of a large variety of sensors, has expanded the role and capabilities of regular mobile phones, turning them into powerful yet ubiquitous monitoring systems. At present, smartphones have the potential to continuously collect information about the users, monitor their activities and behaviors in real time, and provide them with feedback and recommendations. Objective: This systematic review aimed to identify recent scientific studies that explored the passive use of smartphones for generating health- and well-being--related outcomes. In addition, it explores users' engagement and possible challenges in using such self-monitoring systems. Methods: A systematic review was conducted, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, to identify recent publications that explore the use of smartphones as ubiquitous health monitoring systems. We ran reproducible search queries on PubMed, IEEE Xplore, ACM Digital Library, and Scopus online databases and aimed to find answers to the following questions: (1) What is the study focus of the selected papers? (2) What smartphone sensing technologies and data are used to gather health-related input? (3) How are the developed systems validated? and (4) What are the limitations and challenges when using such sensing systems? Results: Our bibliographic research returned 7404 unique publications. Of these, 118 met the predefined inclusion criteria, which considered publication dates from 2014 onward, English language, and relevance for the topic of this review. The selected papers highlight that smartphones are already being used in multiple health-related scenarios. Of those, physical activity (29.6\%; 35/118) and mental health (27.9; 33/118) are 2 of the most studied applications. Accelerometers (57.7\%; 67/118) and global positioning systems (GPS; 40.6\%; 48/118) are 2 of the most used sensors in smartphones for collecting data from which the health status or well-being of its users can be inferred. Conclusions: One relevant outcome of this systematic review is that although smartphones present many advantages for the passive monitoring of users' health and well-being, there is a lack of correlation between smartphone-generated outcomes and clinical knowledge. Moreover, user engagement and motivation are not always modeled as prerequisites, which directly affects user adherence and full validation of such systems. ", doi="10.2196/12649", url="http://mhealth.jmir.org/2019/8/e12649/", url="http://www.ncbi.nlm.nih.gov/pubmed/31444874" } @Article{info:doi/10.2196/13309, author="Sandberg, J. Charlotte E. and Knight, R. Stephen and Qureshi, Uzair Ahmad and Pathak, Samir", title="Using Telemedicine to Diagnose Surgical Site Infections in Low- and Middle-Income Countries: Systematic Review", journal="JMIR Mhealth Uhealth", year="2019", month="Aug", day="19", volume="7", number="8", pages="e13309", keywords="surgical site infection", keywords="wound infection", keywords="developing country", keywords="low- and middle-income countries", keywords="telemedicine", keywords="postoperative", keywords="follow-up", abstract="Background: A high burden of preventable morbidity and mortality due to surgical site infections (SSIs) occurs in low- and middle-income countries (LMICs), and most of these SSIs occur following discharge. There is a high loss to follow-up due to a wide geographical spread of patients, and cost of travel can result in delayed and missed diagnoses. Objective: This review analyzes the literature surrounding the use of telemedicine and assesses the feasibility of using mobile phone technology to both diagnose SSIs remotely in LMICs and to overcome social barriers. Methods: A literature search was performed using Medline, Embase, CINAHL, PubMed, Web of Science, the Cochrane Central Register of Controlled Trials and Google Scholar. Included were English language papers reporting the use of telemedicine for detecting SSIs in comparison to the current practice of direct clinical diagnosis. Papers were excluded if infections were not due to surgical wounds, or if SSIs were not validated with in-person diagnosis. The primary outcome of this review was to review the feasibility of telemedicine for remote SSI detection. Results: A total of 404 articles were screened and three studies were identified that reported on 2082 patients across three countries. All studies assessed the accuracy of remote diagnosis of SSIs using predetermined telephone questionnaires. In total, 44 SSIs were accurately detected using telemedicine and an additional 14 were picked up on clinical follow-up. Conclusions: The use of telemedicine has shown to be a feasible method in remote diagnosis of SSIs. Telemedicine is a useful adjunct for clinical practice in LMICs to decrease loss to postsurgical follow-up. ", doi="10.2196/13309", url="http://mhealth.jmir.org/2019/8/e13309/", url="http://www.ncbi.nlm.nih.gov/pubmed/31429414" } @Article{info:doi/10.2196/14655, author="Hansen, B. William and Scheier, M. Lawrence", title="Specialized Smartphone Intervention Apps: Review of 2014 to 2018 NIH Funded Grants", journal="JMIR Mhealth Uhealth", year="2019", month="Jul", day="29", volume="7", number="7", pages="e14655", keywords="smartphone", keywords="intervention", keywords="funded grants", keywords="mobile phone", abstract="Background: The widespread adoption of smartphones provides researchers with expanded opportunities for developing, testing and implementing interventions. National Institutes of Health (NIH) funds competitive, investigator-initiated grant applications. Funded grants represent the state of the science and therefore are expected to anticipate the progression of research in the near future. Objective: The objective of this paper is to provide an analysis of the kinds of smartphone-based intervention apps funded in NIH research grants during the five-year period between 2014 and 2018. Methods: We queried NIH Reporter to identify candidate funded grants that addressed mHealth and the use of smartphones. From 1524 potential grants, we identified 397 that met the requisites of including an intervention app. Each grant's abstract was analyzed to understand the focus of intervention. The year of funding, type of activity (eg, R01, R34, and so on) and funding were noted. Results: We identified 13 categories of strategies employed in funded smartphone intervention apps. Most grants included either one (35.0\%) or two (39.0\%) intervention approaches. These included artificial intelligence (57 apps), bionic adaptation (33 apps), cognitive and behavioral therapies (68 apps), contingency management (24 apps), education and information (85 apps), enhanced motivation (50 apps), facilitating, reminding and referring (60 apps), gaming and gamification (52 apps), mindfulness training (18 apps), monitoring and feedback (192 apps), norm setting (7 apps), skills training (85 apps) and social support and social networking (59 apps). The most frequently observed grant types included Small Business Innovation Research (SBIR) and Small Business Technology Transfer (STTR) grants (40.8\%) and Research Project?Grants (R01s) (26.2\%). The number of grants funded increased through the five-year period from 60 in 2014 to 112 in 2018. Conclusions: Smartphone intervention apps are increasingly competitive for NIH funding. They reflect a wide diversity of approaches that have significant potential for use in applied settings. ", doi="10.2196/14655", url="http://mhealth.jmir.org/2019/7/e14655/", url="http://www.ncbi.nlm.nih.gov/pubmed/31359866" } @Article{info:doi/10.2196/12042, author="Low, Kee Jac and Manias, Elizabeth", title="Use of Technology-Based Tools to Support Adolescents and Young Adults With Chronic Disease: Systematic Review and Meta-Analysis", journal="JMIR Mhealth Uhealth", year="2019", month="Jul", day="18", volume="7", number="7", pages="e12042", keywords="young adult", keywords="adolescent", keywords="self-management", keywords="transition to adult care", keywords="disease management", keywords="systematic review", abstract="Background: With the large amount of material that is readily available on the internet, there are endless opportunities for electronic health--literate patients to obtain and learn new information. Although novel, a Web- or mobile-based program can be a powerful way to engage adolescents and young adults (AYAs). The ongoing engagement of AYAs with chronic disease is vital not only to empower them but also to ensure a smooth transition from pediatric to adult health care. Objective: This study aimed to evaluate the current evidence on Web- or mobile-based interventions designed for AYAs. Methods: This review was registered with PROSPERO: CRD42018096487. A systematic search of MEDLINE Complete, EMBASE, and CINAHL Complete was conducted on April 10, 2019, for studies that examined the perspectives of transition-age patients about technology-based interventions, the process involved in intervention development, or the evaluation of intervention efficacy. For each study, the comprehensiveness of reporting was appraised. The Downs and Black checklist was used for intervention efficacy trials, the Standards for Reporting Qualitative Research checklist was used for qualitative work, and a 16-item tool developed by Tong et al was used for questionnaire research. Results: The search uncovered 29 relevant studies, which included qualitative studies (n=14), intervention efficacy studies (n=7), questionnaire studies (n=4), mixed qualitative and questionnaire studies (n=2), and a mixed qualitative and pilot randomized controlled trial study (n=1). The reporting comprehensiveness score of questionnaires was rated considerably lower (n=6, 13\%-57\% [2/16-8/14]) than the scores of intervention efficacy trials (n=8, 48\%-85\% [13/27-23/27]) and qualitative research (n=17, 40\%-93\% [8.5/21-19.5/21]). AYAs were receptive to obtaining information via a website or mobile app. An intervention was more likely to be perceived as useful by AYAs when there was a concerted effort to involve AYAs and subject matter experts in the process of intervention design, as opposed to relying solely on the AYAs or the experts alone. The preferred medium of intervention delivery varied greatly for AYAs, ranging from static text to audiovisual materials. However, AYAs considered being concise was the most important aspect. Across different conditions, AYAs were interested in receiving information on diverse topics, such as anxiety and stress management, dealing with insurance, and having social relationships. Patients also requested for disease-specific information, such as weather forecasts and pollen levels for patients with asthma and information related to the pretransplant period for organ transplant recipients. Meta-analyses showed no significant group differences across time on quality of life, self-efficacy, and self-management. Conclusions: Owing to the lack of intervention efficacy trials, no conclusion can be drawn if an intervention delivered via a mobile app is better than that delivered via a website. However, through this systematic review, it is confirmed that AYAs were receptive to receiving medical information electronically. ", doi="10.2196/12042", url="http://mhealth.jmir.org/2019/7/e12042/", url="http://www.ncbi.nlm.nih.gov/pubmed/31322129" } @Article{info:doi/10.2196/13817, author="Vo, VanAnh and Auroy, Lola and Sarradon-Eck, Aline", title="Patients' Perceptions of mHealth Apps: Meta-Ethnographic Review of Qualitative Studies", journal="JMIR Mhealth Uhealth", year="2019", month="Jul", day="10", volume="7", number="7", pages="e13817", keywords="mHealth", keywords="apps", keywords="mobile apps", keywords="qualitative studies", keywords="systematic review", keywords="mobile phone", abstract="Background: Mobile phones and tablets are being increasingly integrated into the daily lives of many people worldwide. Mobile health (mHealth) apps have promising possibilities for optimizing health systems, improving care and health, and reducing health disparities. However, health care apps often seem to be underused after being downloaded. Objective: The aim of this paper is to reach a better understanding of people's perceptions, beliefs, and experience of mHealth apps as well as to determine how highly they appreciate these tools. Methods: A systematic review was carried out on qualitative studies published in English, on patients' perception of mHealth apps between January 2013 and June 2018. Data extracted from these articles were synthesized using a meta-ethnographic approach and an interpretative method. Results: A total of 356 articles were selected for screening, and 43 of them met the inclusion criteria. Most of the articles included populations inhabiting developed countries and were published during the last 2 years, and most of the apps on which they focused were designed to help patients with chronic diseases. In this review, we present the strengths and weaknesses of using mHealth apps from the patients' point of view. The strengths can be categorized into two main aspects: engaging patients in their own health care and increasing patient empowerment. The weaknesses pointed out by the participants focus on four main topics: trustworthiness, appropriateness, personalization, and accessibility of these tools. Conclusions: Although many of the patients included in the studies reviewed considered mHealth apps as a useful complementary tool, some major problems arise in their optimal use, including the need for more closely tailored designs, the cost of these apps, the validity of the information delivered, and security and privacy issues. Many of these issues could be resolved with more support from health providers. In addition, it would be worth developing standards to ensure that these apps provide patients accurate evidence-based information. ", doi="10.2196/13817", url="http://mhealth.jmir.org/2019/7/e13817/", url="http://www.ncbi.nlm.nih.gov/pubmed/31293246" } @Article{info:doi/10.2196/11926, author="McKay, H. Fiona and Wright, Annemarie and Shill, Jane and Stephens, Hugh and Uccellini, Mary", title="Using Health and Well-Being Apps for Behavior Change: A Systematic Search and Rating of Apps", journal="JMIR Mhealth Uhealth", year="2019", month="Jul", day="04", volume="7", number="7", pages="e11926", keywords="smartphone", keywords="mobile apps", keywords="health promotion", keywords="health behavior", keywords="rating", abstract="Background: Smartphones have allowed for the development and use of apps. There is now a proliferation of mobile health interventions for physical activity, healthy eating, smoking and alcohol cessation or reduction, and improved mental well-being. However, the strength or potential of these apps to lead to behavior change remains uncertain. Objective: The aim of this study was to review a large sample of healthy lifestyle apps at a single point in time (June to July 2018) to determine their potential for promoting health-related behavior change with a view to sharing this information with the public. In addition, the study sought to test a wide range of apps using a new scale, the App Behavior Change Scale (ABACUS). Methods: Apps focusing on 5 major modifiable lifestyle behaviors were identified using a priori key search terms across the Australian Apple iTunes and Google Play stores. Lifestyle behavior categories were selected for their impact on health and included smoking, alcohol use, physical activity, nutrition, and mental well-being. Apps were included if they had an average user rating between 3 and 5, if they were updated in the last 18 months, if the description of the app included 2 of 4 behavior change features, and if they were in English. The selected behavior change apps were rated in 2 ways using previously developed rating scales: the Mobile App Rating Scale (MARS) for functionality and the ABACUS for potential to encourage behavior change. Results: The initial search identified 212,352 apps. After applying the filtering criteria, 5018 apps remained. Of these, 344 were classified as behavior change apps and were reviewed and rated. Apps were given an average MARS score of 2.93 out of 5 (SD 0.58, range 1.42-4.16), indicating low-to-moderate functionality. Scores for the ABACUS ranged from 1 to 17, out of 21, with an average score of 7.8 (SD 2.8), indicating a low-to-moderate number of behavior change techniques included in apps. The ability of an app to encourage practice or rehearsal, in addition to daily activities, was the most commonly identified feature across all apps (310/344, 90.1\%), whereas the second most common feature was the ability of the user to easily self-monitor behavior (289/344, 84.0\%). Conclusions: The wide variety of apps included in this 2018 study and the limited number of behavior change techniques found in many apps suggest an opportunity for improvement in app design that will promote sustained and significant lifestyle behavior change and, therefore, better health. The use of the 2 scales for the review and rating of the apps was successful and provided a method that could be replicated and tested in other behavior change areas. ", doi="10.2196/11926", url="https://mhealth.jmir.org/2019/7/e11926/", url="http://www.ncbi.nlm.nih.gov/pubmed/31274112" } @Article{info:doi/10.2196/13641, author="Giebel, Denk Godwin and Gissel, Christian", title="Accuracy of mHealth Devices for Atrial Fibrillation Screening: Systematic Review", journal="JMIR Mhealth Uhealth", year="2019", month="Jun", day="16", volume="7", number="6", pages="e13641", keywords="mHealth", keywords="atrial fibrillation", keywords="wearable", keywords="app", abstract="Background: Mobile health (mHealth) devices can be used for the diagnosis of atrial fibrillation. Early diagnosis allows better treatment and prevention of secondary diseases like stroke. Although there are many different mHealth devices to screen for atrial fibrillation, their accuracy varies due to different technological approaches. Objective: We aimed to systematically review available studies that assessed the accuracy of mHealth devices in screening for atrial fibrillation. The goal of this review was to provide a comprehensive overview of available technologies, specific characteristics, and accuracy of all relevant studies. Methods: PubMed and Web of Science databases were searched from January 2014 until January 2019. Our systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses. We restricted the search by year of publication, language, noninvasive methods, and focus on diagnosis of atrial fibrillation. Articles not including information about the accuracy of devices were excluded. Results: We found 467 relevant studies. After removing duplicates and excluding ineligible records, 22 studies were included. The accuracy of mHealth devices varied among different technologies, their application settings, and study populations. We described and summarized the eligible studies. Conclusions: Our systematic review identifies different technologies for screening for atrial fibrillation with mHealth devices. A specific technology's suitability depends on the underlying form of atrial fibrillation to be diagnosed. With the suitable use of mHealth, early diagnosis and treatment of atrial fibrillation are possible. Successful application of mHealth technologies could contribute to significantly reducing the cost of illness of atrial fibrillation. ", doi="10.2196/13641", url="http://mhealth.jmir.org/2019/6/e13641/", url="http://www.ncbi.nlm.nih.gov/pubmed/31199337" } @Article{info:doi/10.2196/10879, author="Falck, Leandra and Zoller, Marco and Rosemann, Thomas and Mart{\'i}nez-Gonz{\'a}lez, Anani Nahara and Chmiel, Corinne", title="Toward Standardized Monitoring of Patients With Chronic Diseases in Primary Care Using Electronic Medical Records: Systematic Review", journal="JMIR Med Inform", year="2019", month="May", day="24", volume="7", number="2", pages="e10879", keywords="monitoring of chronic diseases", keywords="indicators", keywords="primary care", keywords="systematic review", keywords="electronic medical record", keywords="diabetes mellitus type 2", keywords="arterial hypertension", keywords="asthma", keywords="osteoarthritis", keywords="chronic heart failure", abstract="Background: Long-term care for patients with chronic diseases poses a huge challenge in primary care. In particular, there is a deficit regarding monitoring and structured follow-up. Appropriate electronic medical records (EMRs) could help improving this but, so far, there are no evidence-based specifications concerning the indicators that should be monitored at regular intervals. Objective: The aim was to identify and collect a set of evidence-based indicators that could be used for monitoring chronic conditions at regular intervals in primary care using EMRs. Methods: We searched MEDLINE (Ovid), Embase (Elsevier), the Cochrane Library (Wiley), the reference lists of included studies and relevant reviews, and the content of clinical guidelines. We included primary studies and guidelines reporting about indicators that allow for the assessment of care and help monitor the status and process of disease for five chronic conditions, including type 2 diabetes mellitus, asthma, arterial hypertension, chronic heart failure, and osteoarthritis. Results: The use of the term ``monitoring'' in terms of disease management and long-term care for patients with chronic diseases is not widely used in the literature. Nevertheless, we identified a substantial number of disease-specific indicators that can be used for routine monitoring of chronic diseases in primary care by means of EMRs. Conclusions: To our knowledge, this is the first systematic review summarizing the existing scientific evidence on the standardized long-term monitoring of chronic diseases using EMRs. In a second step, our extensive set of indicators will serve as a generic template for evaluating their usability by means of an adapted Delphi procedure. In a third step, the indicators will be summarized into a user-friendly EMR layout. ", doi="10.2196/10879", url="http://medinform.jmir.org/2019/2/e10879/", url="http://www.ncbi.nlm.nih.gov/pubmed/31127717" } @Article{info:doi/10.2196/11967, author="Romanzini, Possamai Catiana Leila and Romanzini, Marcelo and Batista, Biagi Mariana and Barbosa, Lopes Cynthia Correa and Shigaki, Blasquez Gabriela and Dunton, Genevieve and Mason, Tyler and Ronque, Vaz Enio Ricardo", title="Methodology Used in Ecological Momentary Assessment Studies About Sedentary Behavior in Children, Adolescents, and Adults: Systematic Review Using the Checklist for Reporting Ecological Momentary Assessment Studies", journal="J Med Internet Res", year="2019", month="May", day="15", volume="21", number="5", pages="e11967", keywords="physical activity", keywords="accelerometry", keywords="health behavior", abstract="Background: The use of ecological momentary assessment (EMA) to measure sedentary behavior (SB) in children, adolescents, and adults can increase the understanding of the role of the context of SB in health outcomes. Objective: The aim of this study was to systematically review literature to describe EMA methodology used in studies on SB in youth and adults, verify how many studies adhere to the Methods aspect of the Checklist for Reporting EMA Studies (CREMAS), and detail measures used to assess SB and this associated context. Methods: A systematic literature review was conducted in the PubMed, Scopus, Web of Science, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and SPORTDiscus databases, covering the entire period of existence of the databases until January 2018. Results: This review presented information about the characteristics and methodology used in 21 articles that utilized EMA to measure SB in youth and adults. There were more studies conducted among youth compared with adults, and studies of youth included more waves and more participants (n=696) than studies with adults (n=97). Most studies (85.7\%) adhered to the Methods aspect of the CREMAS. The main criteria used to measure SB in EMA were self-report (81\%) with only 19\% measuring SB using objective methods (eg, accelerometer). The main equipment to collect objective SB was the ActiGraph, and the cutoff point to define SB was <100 counts/min. Studies most commonly used a 15-min window to compare EMA and accelerometer data. Conclusions: The majority of studies in this review met minimum CREMAS criteria for studies conducted with EMA. Most studies measured SB with EMA self-report (n=17; 81.0\%), and a few studies also used objective methods (n=4; 19\%). The standardization of the 15-min window criteria to compare EMA and accelerometer data would lead to a comparison between these and new studies. New studies using EMA with mobile phones should be conducted as they can be considered an attractive method for capturing information about the specific context of SB activities of young people and adults in real time or very close to it. ", doi="10.2196/11967", url="https://www.jmir.org/2019/5/e11967/", url="http://www.ncbi.nlm.nih.gov/pubmed/31094349" } @Article{info:doi/10.2196/mhealth.8298, author="B{\"o}hm, Birgit and Karwiese, D. Svenja and B{\"o}hm, Harald and Oberhoffer, Renate", title="Effects of Mobile Health Including Wearable Activity Trackers to Increase Physical Activity Outcomes Among Healthy Children and Adolescents: Systematic Review", journal="JMIR Mhealth Uhealth", year="2019", month="Apr", day="30", volume="7", number="4", pages="e8298", keywords="children", keywords="adolescent", keywords="mHealth", keywords="fitness tracker", keywords="physical activity", keywords="physical fitness", abstract="Background: Children and adolescents do not meet the current recommendations on physical activity (PA), and as such, the health-related benefits of regular PA are not achieved. Nowadays, technology-based programs represent an appealing and promising option for children and adolescents to promote PA. Objective: The aim of this review was to systematically evaluate the effects of mobile health (mHealth) and wearable activity trackers on PA-related outcomes in this target group. Methods: Electronic databases such as the Cochrane Central Register of Controlled Trials, PubMed, Scopus, SPORTDiscus, and Web of Science were searched to retrieve English language articles published in peer-reviewed journals from January 2012 to June 2018. Those included were articles that contained descriptions of interventions designed to increase PA among children (aged 6 to 12 years) only, or adolescents (aged 13 to 18 years) only, or articles that include both populations, and also, articles that measured at least 1 PA-related cognitive, psychosocial, or behavioral outcome. The interventions had to be based on mHealth tools (mobile phones, smartphones, tablets, or mobile apps) or wearable activity trackers. Randomized controlled trials (RCTs) and non-RCTs, cohort studies, before-and-after studies, and cross-sectional studies were considered, but only controlled studies with a PA comparison between groups were assessed for methodological quality. Results: In total, 857 articles were identified. Finally, 7 studies (5 with tools of mHealth and 2 with wearable activity trackers) met the inclusion criteria. All studies with tools of mHealth used an RCT design, and 3 were of high methodological quality. Intervention delivery ranged from 4 weeks to 12 months, whereby mainly smartphone apps were used as a tool. Intervention delivery in studies with wearable activity trackers covered a period from 22 sessions during school recess and 8 weeks. Trackers were used as an intervention and evaluation tool. No evidence was found for the effect of mHealth tools, respectively wearable activity trackers, on PA-related outcomes. Conclusions: Given the small number of studies, poor compliance with accelerometers as a measuring instrument for PA, risk of bias, missing RCTs in relation to wearable activity trackers, and the heterogeneity of intervention programs, caution is warranted regarding the comparability of the studies and their effects. There is a clear need for future studies to develop PA interventions grounded on intervention mapping with a high methodological study design for specific target groups to achieve meaningful evidence. ", doi="10.2196/mhealth.8298", url="http://mhealth.jmir.org/2019/4/e8298/", url="http://www.ncbi.nlm.nih.gov/pubmed/31038460" } @Article{info:doi/10.2196/10967, author="Eckert, Martin and Volmerg, S. Julia and Friedrich, M. Christoph", title="Augmented Reality in Medicine: Systematic and Bibliographic Review", journal="JMIR Mhealth Uhealth", year="2019", month="Apr", day="26", volume="7", number="4", pages="e10967", keywords="mixed/augmented reality", keywords="medicine", keywords="mobile computing", keywords="systematic review", keywords="mobile phone", abstract="Background: Augmented reality (AR) is a technology that integrates digital information into the user's real-world environment. It offers a new approach for treatments and education in medicine. AR aids in surgery planning and patient treatment and helps explain complex medical situations to patients and their relatives. Objective: This systematic and bibliographic review offers an overview of the development of apps in AR with a medical use case from March 2012 to June 2017. This work can aid as a guide to the literature and categorizes the publications in the field of AR research. Methods: From March 2012 to June 2017, a total of 1309 publications from PubMed and Scopus databases were manually analyzed and categorized based on a predefined taxonomy. Of the total, 340 duplicates were removed and 631 publications were excluded due to incorrect classification or unavailable technical data. The remaining 338 publications were original research studies on AR. An assessment of the maturity of the projects was conducted on these publications by using the technology readiness level. To provide a comprehensive process of inclusion and exclusion, the authors adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Results: The results showed an increasing trend in the number of publications on AR in medicine. There were no relevant clinical trials on the effect of AR in medicine. Domains that used display technologies seemed to be researched more than other medical fields. The technology readiness level showed that AR technology is following a rough bell curve from levels 4 to 7. Current AR technology is more often applied to treatment scenarios than training scenarios. Conclusions: This work discusses the applicability and future development of augmented- and mixed-reality technologies such as wearable computers and AR devices. It offers an overview of current technology and a base for researchers interested in developing AR apps in medicine. The field of AR is well researched, and there is a positive trend in its application, but its use is still in the early stages in the field of medicine and it is not widely adopted in clinical practice. Clinical studies proving the effectiveness of applied AR technologies are still lacking. ", doi="10.2196/10967", url="http://mhealth.jmir.org/2019/4/e10967/", url="http://www.ncbi.nlm.nih.gov/pubmed/31025950" } @Article{info:doi/10.2196/13250, author="Ali, H. Shahmir and Luo, Rong and Li, Yuan and Liu, Xiangjun and Tang, Chengyao and Zhang, Puhong", title="Application of Mobile Health Technologies Aimed at Salt Reduction: Systematic Review", journal="JMIR Mhealth Uhealth", year="2019", month="Apr", day="17", volume="7", number="4", pages="e13250", keywords="mobile health", keywords="sodium", keywords="diet", keywords="cardiovascular diseases", keywords="systematic review", abstract="Background: High salt consumption has contributed to the rise of noncommunicable diseases around the world. The application of mobile health (mHealth) technologies has witnessed rapid growth in recent years. However, evidence to support mHealth interventions to confront the challenge of salt reduction has not yet been critically reviewed. Objective: The aim of this study was to identify, characterize, and evaluate mHealth interventions aimed at salt reduction across the world. Methods: A systematic search of studies in English or Chinese language published from January 1, 1992 to July 31, 2017 was conducted using 4 English databases (PubMed, MEDLINE, Global Health, and Cochrane) and 3 Chinese databases (Wanfang, China Science and Technology Journal, and China National Knowledge of Infrastructure). All studies directly using mobile technologies in health care with a primary or secondary objective of reducing dietary salt consumption were included. Results: A total of 1609 articles were found using the search strategy, with 11 full articles (8 English and 3 Chinese) being included for data extraction, including 11 interventional studies. Overall, few high-quality interventions were identified. Most interventions were limited by small study population sample sizes, lack of control groups, and short follow-up times, all of which were obstacles in generating long-term scalable approaches. Most interventions employed short message service as a platform for mHealth interventions, whereas some innovative mHealth technologies were also explored. Most interventions had a primary focus of improving awareness of dietary salt consumption. The outcome variables used to measure intervention effectiveness included 24-hour urinary sodium excretion, spot urine sampling, dietary records, and indirect behavior or knowledge indicators targeting salt consumption. Although most interventions displayed positive outcome results, none of them provided reliable evidence to evaluate the effectiveness of salt reduction. Conclusions: Salt reduction in mHealth initiatives remains relatively unexplored; however, studies that did intervene on salt-reduction show the potential of mHealth as an effective intervention method. We provide 3 recommendations for future mHealth interventions in salt reduction---(1) increased use of new, innovative, and interactive mHealth technologies; (2) development of mHealth interventions with primary prevention measures and goals of salt reduction; and (3) large-scale, rigorously designed, and object-targeted clinical trials of mHealth interventions with appropriate quantitative outcome variables, in particular 24-hour urine sodium. ", doi="10.2196/13250", url="http://mhealth.jmir.org/2019/4/e13250/", url="http://www.ncbi.nlm.nih.gov/pubmed/30994467" } @Article{info:doi/10.2196/11244, author="Yang, Qinghua and Van Stee, K. Stephanie", title="The Comparative Effectiveness of Mobile Phone Interventions in Improving Health Outcomes: Meta-Analytic Review", journal="JMIR Mhealth Uhealth", year="2019", month="Apr", day="03", volume="7", number="4", pages="e11244", keywords="meta-analysis", keywords="mobile phones", keywords="mHealth", keywords="intervention study", abstract="Background: As mobile technology continues expanding, researchers have been using mobile phones to conduct health interventions (mobile health---mHealth---interventions). The multiple features of mobile phones offer great opportunities to disseminate large-scale, cost-efficient, and tailored messages to participants. However, the interventions to date have shown mixed results, with a large variance of effect sizes (Cohen d=?0.62 to 1.65). Objective: The study aimed to generate cumulative knowledge that informs mHealth intervention research. The aims were twofold: (1) to calculate an overall effect magnitude for mHealth interventions compared with alternative interventions or conditions, and (2) to analyze potential moderators of mHealth interventions' comparative efficacy. Methods: Comprehensive searches of the Communication \& Mass Media Complete, PsycINFO, Web of Knowledge, Academic Search Premier, PubMed and MEDLINE databases were conducted to identify potentially eligible studies in peer-reviewed journals, conference proceedings, and dissertations and theses. Search queries were formulated using a combination of search terms: ``intervention'' (Title or Abstract) AND ``health'' (Title or Abstract) AND ``*phone*'' OR ``black-berr*'' (OR mHealth OR ``application*'' OR app* OR mobile OR cellular OR ``short messag*'' OR palm* OR iPhone* OR MP3* OR MP4* OR iPod*) (Title or Abstract). Cohen d was computed as the basic unit of analysis, and the variance-weighted analysis was implemented to compute the overall effect size under a random-effects model. Analysis of variance--like and meta-regression models were conducted to analyze categorical and continuous moderators, respectively. Results: The search resulted in 3424 potential studies, the abstracts (and full text, as necessary) of which were reviewed for relevance. Studies were screened in multiple stages using explicit inclusion and exclusion criteria, and citations were evaluated for inclusion of qualified studies. A total of 64 studies were included in the current meta-analysis. Results showed that mHealth interventions are relatively more effective than comparison interventions or conditions, with a small but significant overall weighted effect size (Cohen d=0.31). In addition, the effects of interventions are moderated by theoretical paradigm, 3 engagement types (ie, changing personal environment, reinforcement tracking, social presentation), mobile use type, intervention channel, and length of follow-up. Conclusions: To the best of our knowledge, this is the most comprehensive meta-analysis to date that examined the overall effectiveness of mHealth interventions across health topics and is the first study that statistically tested moderators. Our findings not only shed light on intervention design using mobile phones, but also provide new directions for research in health communication and promotion using new media. Future research scholarship is needed to examine the effectiveness of mHealth interventions across various health issues, especially those that have not yet been investigated (eg, substance use, sexual health), engaging participants using social features on mobile phones, and designing tailored mHealth interventions for diverse subpopulations to maximize effects. ", doi="10.2196/11244", url="https://mhealth.jmir.org/2019/4/e11244/", url="http://www.ncbi.nlm.nih.gov/pubmed/30942695" } @Article{info:doi/10.2196/11215, author="Yang, Sook Yong and Ryu, Wook Gi and Choi, Mona", title="Methodological Strategies for Ecological Momentary Assessment to Evaluate Mood and Stress in Adult Patients Using Mobile Phones: Systematic Review", journal="JMIR Mhealth Uhealth", year="2019", month="Apr", day="01", volume="7", number="4", pages="e11215", keywords="review", keywords="experience sampling method", keywords="ecological momentary assessment", keywords="mobile apps", keywords="mood", keywords="stress", abstract="Background: Ecological momentary assessment (EMA) has utility for measuring psychological properties in daily life. EMA has also allowed researchers to collect data on diverse experiences and symptoms from various subjects. Objective: The aim of this study was to review methodological strategies and useful related information for EMA using mobile phones to capture changes of mood and stress in adult patients seeking health care. Methods: We searched PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, the Cochrane Library, PsycINFO, and Web of Science. This review included studies published in peer-reviewed journals in English between January 2008 and November 2017 that used basic- or advanced-feature mobile phones to measure momentary mood or stress in adult patients seeking health care in outpatient departments. We excluded studies of smoking and substance addictions and studies of mental disorder patients who had been diagnosed by physicians. Results: We reviewed 12 selected articles that used EMA via mobile phones to measure momentary mood and stress and other related variables from various patients with chronic fatigue syndrome, breast cancer, migraine, HIV, tinnitus, temporomandibular disorder, end-stage kidney disease, and traumatic brain injury. Most of the selected studies (11/12, 92\%) used signal contingency and in 8 of the 12 studies (67\%) alarms were sent at random or semirandom intervals to prompt the momentary measurement. Out of 12 studies, 7 (58\%) used specific apps directly installed on mobile phones, 3 (25\%) used mobile phones to link to Web-based survey programs, and 2 (17\%) used an interactive voice-response system. Conclusions: This study provides researchers with useful information regarding methodological details for utilizing EMA to measure mood and stress in adult patients. This review shows that EMA methods could be effective and reasonable for measuring momentary mood and stress, given that basic- and advanced-feature mobile phones are ubiquitous, familiar, and easy to approach. Therefore, researchers could adopt and utilize EMA methods using mobile phones to measure psychological health outcomes, such as mood and stress, in adult patients. ", doi="10.2196/11215", url="https://mhealth.jmir.org/2019/4/e11215/", url="http://www.ncbi.nlm.nih.gov/pubmed/30932866" } @Article{info:doi/10.2196/12191, author="Ricci-Cabello, Ignacio and Bobrow, Kirsten and Islam, Shariful Sheikh Mohammed and Chow, K. Clara and Maddison, Ralph and Whittaker, Robyn and Farmer, J. Andrew", title="Examining Development Processes for Text Messaging Interventions to Prevent Cardiovascular Disease: Systematic Literature Review", journal="JMIR Mhealth Uhealth", year="2019", month="Mar", day="29", volume="7", number="3", pages="e12191", keywords="systematic review", keywords="cardiovascular disease", keywords="telemedicine", keywords="text messaging", keywords="methods", abstract="Background: Interventions delivered by mobile phones have the potential to prevent cardiovascular disease (CVD) by supporting behavior change toward healthier lifestyles and treatment adherence. To allow replication and adaptation of these interventions across settings, it is important to fully understand how they have been developed. However, the development processes of these interventions have not previously been systematically examined. Objective: This study aimed to systematically describe and compare the development process of text messaging interventions identified in the Text2PreventCVD systematic review. Methods: We extracted data about the development process of the 9 interventions identified in the Text2PreventCVD systematic review. Data extraction, which was guided by frameworks for the development of complex interventions, considered the following development stages: intervention planning, design, development, and pretesting. Following data extraction, we invited the developers of the interventions to contribute to our study by reviewing the accuracy of the extracted data and providing additional data not reported in the available publications. Results: A comprehensive description of the development process was available for 5 interventions. Multiple methodologies were used for the development of each intervention. Intervention planning involved gathering information from stakeholder consultations, literature reviews, examination of relevant theory, and preliminary qualitative research. Intervention design involved the use of behavior change theories and behavior change techniques. Intervention development involved (1) generating message content based on clinical guidelines and expert opinions; (2) conducting literature reviews and primary qualitative research to inform decisions about message frequency, timing, and level of tailoring; and (3) gathering end-user feedback concerning message readability, intervention acceptability, and perceived utility. Intervention pretesting involved pilot studies with samples of 10 to 30 participants receiving messages for a period ranging from 1 to 4 weeks. Conclusions: The development process of the text messaging interventions examined was complex and comprehensive, involving multiple studies to guide decisions about the scope, content, and structure of the interventions. Additional research is needed to establish whether effective messaging systems can be adapted from work already done or whether this level of development is needed for application in other conditions and settings. ", doi="10.2196/12191", url="http://mhealth.jmir.org/2019/3/e12191/", url="http://www.ncbi.nlm.nih.gov/pubmed/30924790" } @Article{info:doi/10.2196/10855, author="Vergani, Laura and Marton, Giulia and Pizzoli, Maria Silvia Francesca and Monzani, Dario and Mazzocco, Ketti and Pravettoni, Gabriella", title="Training Cognitive Functions Using Mobile Apps in Breast Cancer Patients: Systematic Review", journal="JMIR Mhealth Uhealth", year="2019", month="Mar", day="19", volume="7", number="3", pages="e10855", keywords="cognitive impairment", keywords="breast cancer", keywords="cognitive training", keywords="intervention", keywords="mobile-based interventions", abstract="Background: Breast cancer is an invalidating disease and its treatment can bring serious side effects that have a physical and psychological impact. Specifically, cancer treatment generally has a strong impact on cognitive function. In recent years, new technologies and eHealth have had a growing influence on health care and innovative mobile apps can be useful tools to deliver cognitive exercise in the patient's home. Objective: This systematic review gives an overview of the state-of-the-art mobile apps aimed at training cognitive functions to better understand whether these apps could be useful tools to counteract cognitive impairment in breast cancer patients. Methods: We searched in a systematic way all the full-text articles from the PubMed and Embase databases. Results: We found eleven studies using mobile apps to deliver cognitive training. They included a total of 819 participants. App and study characteristics are presented and discussed, including cognitive domains trained (attention, problem solving, memory, cognitive control, executive function, visuospatial function, and language). None of the apps were specifically developed for breast cancer patients. They were generally developed for a specific clinical population. Only 2 apps deal with more than 1 cognitive domain, and only 3 studies focus on the efficacy of the app training intervention. Conclusions: These results highlight the lack of empirical evidence on the efficacy of currently available apps to train cognitive function. Cognitive domains are not well defined across studies. It is noteworthy that no apps are specifically developed for cancer patients, and their applicability to breast cancer should not be taken for granted. Future studies should test the feasibility, usability, and effectiveness of available cognitive training apps in women with breast cancer. Due to the complexity and multidimensionality of cognitive difficulties in this cancer population, it may be useful to design, develop, and implement an ad hoc app targeting cognitive impairment in breast cancer patients. ", doi="10.2196/10855", url="https://mhealth.jmir.org/2019/3/e10855/", url="http://www.ncbi.nlm.nih.gov/pubmed/30888326" } @Article{info:doi/10.2196/12385, author="Lee, Seohyun and Lee, Youngji and Lee, Sangmi and Islam, Shariful Sheikh Mohammed and Kim, Sun-Young", title="Toward Developing a Standardized Core Set of Outcome Measures in Mobile Health Interventions for Tuberculosis Management: Systematic Review", journal="JMIR Mhealth Uhealth", year="2019", month="Feb", day="19", volume="7", number="2", pages="e12385", keywords="mHealth", keywords="tuberculosis", keywords="outcome measures", keywords="evidence synthesis", keywords="low-and middle-income countries", abstract="Background: Tuberculosis (TB) management can be challenging in low- and middle-income countries (LMICs) not only because of its high burden but also the prolonged treatment period involving multiple drugs. With rapid development in mobile technology, mobile health (mHealth) interventions or using a mobile device for TB management has gained popularity. Despite the potential usefulness of mHealth interventions for TB, few studies have quantitatively synthesized evidence on its effectiveness, presumably because of variability in outcome measures reported in the literature. Objective: The aim of this systematic review was to evaluate the outcome measures reported in TB mHealth literature in LMICs. Methods: MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews were searched to identify mHealth intervention studies for TB (published up to May 2018) that reported any type of outcome measures. The extracted information included the study setting, types of mHealth technology used, target population, study design, and categories of outcome measures. Outcomes were classified into 13 categories including treatment outcome, adherence, process measure, perception, technical outcome, and so on. The qualitative synthesis of evidence focused on the categories of outcome measures reported by the type of mHealth interventions. Results: A total of 27 studies were included for the qualitative synthesis of evidence. The study designs varied widely, ranging from randomized controlled trials to economic evaluations. A total of 12 studies adopted short message service (SMS), whereas 5 studies used SMS in combination with additional technologies or mobile apps. The study populations were also diverse, including patients with TB, patients with TB/HIV, health care workers, and general patients attending a clinic. There was a wide range of variations in the definition of outcome measures across the studies. Among the diverse categories of outcome measures, treatment outcomes have been reported in 14 studies, but only 6 of them measured the outcome according to the standard TB treatment definitions by the World Health Organization. Conclusions: This critical evaluation of outcomes reported in mHealth studies for TB management suggests that substantial variability exists in reporting outcome measures. To overcome the challenges in evidence synthesis for mHealth interventions, this study can provide insights into the development of a core set of outcome measures by intervention type and study design. ", doi="10.2196/12385", url="http://mhealth.jmir.org/2019/2/e12385/", url="http://www.ncbi.nlm.nih.gov/pubmed/30777847" } @Article{info:doi/10.2196/11606, author="Li, Christien Ka Hou and White, Anne Francesca and Tipoe, Timothy and Liu, Tong and Wong, CS Martin and Jesuthasan, Aaron and Baranchuk, Adrian and Tse, Gary and Yan, P. Bryan", title="The Current State of Mobile Phone Apps for Monitoring Heart Rate, Heart Rate Variability, and Atrial Fibrillation: Narrative Review", journal="JMIR Mhealth Uhealth", year="2019", month="Feb", day="15", volume="7", number="2", pages="e11606", keywords="mobile phone apps", keywords="atrial fibrillation", keywords="heart rate", keywords="arrhythmia", keywords="photoplethysmography", keywords="electrocardiography", keywords="mobile health", abstract="Background: Mobile phone apps capable of monitoring arrhythmias and heart rate (HR) are increasingly used for screening, diagnosis, and monitoring of HR and rhythm disorders such as atrial fibrillation (AF). These apps involve either the use of (1) photoplethysmographic recording or (2) a handheld external electrocardiographic recording device attached to the mobile phone or wristband. Objective: This review seeks to explore the current state of mobile phone apps in cardiac rhythmology while highlighting shortcomings for further research. Methods: We conducted a narrative review of the use of mobile phone devices by searching PubMed and EMBASE from their inception to October 2018. Potentially relevant papers were then compared against a checklist for relevance and reviewed independently for inclusion, with focus on 4 allocated topics of (1) mobile phone monitoring, (2) AF, (3) HR, and (4) HR variability (HRV). Results: The findings of this narrative review suggest that there is a role for mobile phone apps in the diagnosis, monitoring, and screening for arrhythmias and HR. Photoplethysmography and handheld electrocardiograph recorders are the 2 main techniques adopted in monitoring HR, HRV, and AF. Conclusions: A number of studies have demonstrated high accuracy of a number of different mobile devices for the detection of AF. However, further studies are warranted to validate their use for large scale AF screening. ", doi="10.2196/11606", url="http://mhealth.jmir.org/2019/2/e11606/", url="http://www.ncbi.nlm.nih.gov/pubmed/30767904" } @Article{info:doi/10.2196/13080, author="Devan, Hemakumar and Farmery, Devin and Peebles, Lucy and Grainger, Rebecca", title="Evaluation of Self-Management Support Functions in Apps for People With Persistent Pain: Systematic Review", journal="JMIR Mhealth Uhealth", year="2019", month="Feb", day="12", volume="7", number="2", pages="e13080", keywords="smartphone", keywords="chronic pain", keywords="culture", keywords="mHealth", keywords="self-management", keywords="technology", abstract="Background: Smartphone apps are a potential mechanism for development of self-management skills in people with persistent pain. However, the inclusion of best-practice content items in available pain management apps fostering core self-management skills for self-management support is not known. Objective: The aim of the study was to evaluate the contents of smartphone apps providing information on pain management strategies for people with persistent pain facilitating self-management support and to appraise the app quality. Methods: A systematic search was performed in the New Zealand App Store and Google Play Store. Apps were included if they were designed for people with persistent pain, provided information on pain self-management strategies, and were available in English. App contents were evaluated using an a priori 14-item self-management support (SMS-14) checklist. App quality was assessed using the 23-item Mobile Apps Rating Scale. Results: Of the 939 apps screened, 19 apps met the inclusion criteria. Meditation and guided relaxation were the most frequently included self-management strategies. Overall, the included apps met a median of 4 (range 1-8) of the SMS-14 checklist. A total of 3 apps (Curable, PainScale-Pain Diary and Coach, and SuperBetter) met the largest number of items (8 out of 14) to foster self-management of pain. Self-monitoring of symptoms (n=11) and self-tailoring of strategies (n=9) were frequently featured functions, whereas a few apps had features facilitating social support and enabling communicating with clinicians. No apps provided information tailored to the cultural needs of the user. The app quality mean scores using Mobile Apps Rating Scale ranged from 2.7 to 4.5 (out of 5.0). Although use of 2 apps (Headspace and SuperBetter) has been shown to improve health outcomes, none of the included apps have been evaluated in people with persistent pain. Conclusions: Of the 3 apps (Curable, PainScale-Pain Diary and Coach, and SuperBetter) that met the largest number of items to support skills in self-management of pain, 2 apps (PainScale-Pain Diary and Coach and SuperBetter) were free, suggesting the potential for using apps as a scalable, wide-reaching intervention to complement face-to-face care. However, none provided culturally tailored information. Although 2 apps (Headspace and SuperBetter) were validated to show improved health outcomes, none were tested in people with persistent pain. Both users and clinicians should be aware of such limitations and make informed choices in using or recommending apps as a self-management tool. For better integration of apps in clinical practice, concerted efforts are required among app developers, clinicians, and people with persistent pain in developing apps and evaluating for clinical efficacy. ", doi="10.2196/13080", url="http://mhealth.jmir.org/2019/2/e13080/", url="http://www.ncbi.nlm.nih.gov/pubmed/30747715" } @Article{info:doi/10.2196/12281, author="Kiss, Nicole and Baguley, James Brenton and Ball, Kylie and Daly, M. Robin and Fraser, F. Steve and Granger, L. Catherine and Ugalde, Anna", title="Technology-Supported Self-Guided Nutrition and Physical Activity Interventions for Adults With Cancer: Systematic Review", journal="JMIR Mhealth Uhealth", year="2019", month="Feb", day="12", volume="7", number="2", pages="e12281", keywords="cancer", keywords="diet", keywords="exercise", keywords="nutrition", keywords="physical activity", keywords="self-guided interventions", keywords="technology", abstract="Background: Nutrition and physical activity interventions are important components of cancer care. With an increasing demand for services, there is a need to consider flexible, easily accessible, and tailored models of care while maintaining optimal outcomes. Objective: This systematic review describes and appraises the efficacy of technology-supported self-guided nutrition and physical activity interventions for people with cancer. Methods: A systematic search of multiple databases from 1973 to July 2018 was conducted for randomized and nonrandomized trials investigating technology-supported self-guided nutrition and physical activity interventions. Risk of bias was assessed using the Cochrane Risk of Bias tool. Outcomes included behavioural, health-related, clinical, health service, or financial measures. Results: Sixteen randomized controlled trials representing 2684 participants were included. Most studies were web-based interventions (n=9) and had a 12-week follow-up duration (n=8). Seven studies assessed dietary behaviour, of which two reported a significant benefit on diet quality or fruit and vegetable intake. Fifteen studies measured physical activity behaviour, of which eight studies reported a significant improvement in muscle strength and moderate-to-vigorous physical activity. Four of the nine studies assessing the health-related quality of life (HRQoL) reported a significant improvement in global HRQoL or a domain subscale. A significant improvement in fatigue was found in four of six studies. Interpretation of findings was influenced by inadequate reporting of intervention description and compliance. Conclusions: This review identified short-term benefits of technology-supported self-guided interventions on the physical activity level and fatigue and some benefit on dietary behaviour and HRQoL in people with cancer. However, current literature demonstrates a lack of evidence for long-term benefit. Trial Registration: PROSPERO CRD42017080346; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=80346 ", doi="10.2196/12281", url="http://mhealth.jmir.org/2019/2/e12281/", url="http://www.ncbi.nlm.nih.gov/pubmed/30747720" } @Article{info:doi/10.2196/11847, author="Lee, M. Alexandra and Chavez, Sarah and Bian, Jiang and Thompson, A. Lindsay and Gurka, J. Matthew and Williamson, G. Victoria and Modave, Fran{\c{c}}ois", title="Efficacy and Effectiveness of Mobile Health Technologies for Facilitating Physical Activity in Adolescents: Scoping Review", journal="JMIR Mhealth Uhealth", year="2019", month="Feb", day="12", volume="7", number="2", pages="e11847", keywords="review", keywords="mobile health", keywords="adolescent", keywords="exercise", abstract="Background: Increasing physical activity (PA) levels in adolescents aged 12 to 18 years is associated with prevention of unhealthy weight gain and improvement in cardiovascular fitness. The widespread availability of mobile health (mHealth) and wearable devices offers self-monitoring and motivational features for increasing PA levels and improving adherence to exercise programs. Objective: The aim of this scoping review was to identify the efficacy or effectiveness of mHealth intervention strategies for facilitating PA among adolescents aged 12 to 18 years. Methods: We conducted a systematic search for peer-reviewed studies published between 2008 and 2018 in the following electronic databases: PubMed, Google Scholar, PsychINFO, or SportDiscus. The search terms used included mHealth or ``mobile health'' or apps, ``physical activity'' or exercise, children or adolescents or teens or ``young adults'' or kids, and efficacy or effectiveness. Articles published outside of the date range (July 2008 to October 2018) and non-English articles were removed before abstract review. Three reviewers assessed all abstracts against the inclusion and exclusion criteria. Any uncertainties or differences in opinion were discussed as a group. The inclusion criteria were that the studies should (1) have an mHealth component, (2) target participants aged between 12 and 18 years, (3) have results on efficacy or effectiveness, and (4) assess PA-related outcomes. Reviews, abstracts only, protocols without results, and short message service text messaging--only interventions were excluded. We also extracted potentially relevant papers from reviews. At least 2 reviewers examined all full articles for fit with the criteria and extracted data for analysis. Data extracted from selected studies included study population, study type, components of PA intervention, and PA outcome results. Results: Overall, 126 articles were initially identified. Reviewers pulled 18 additional articles from excluded review papers. Only 18 articles were passed onto full review, and 16 were kept for analysis. The included studies differed in the sizes of the study populations (11-607 participants), locations of the study sites (7 countries), study setting, and study design. Overall, 5 mHealth intervention categories were identified: website, website+wearable, app, wearable+app, and website+wearable+app. The most common measures reported were subjective weekly PA (4/13) and objective daily moderate-to-vigorous PA (5/13) of the 19 different PA outcomes assessed. Furthermore, 5 of 13 studies with a control or comparison group showed a significant improvement in PA outcomes between the intervention group and the control or comparison group. Of those 5 studies, 3 permitted isolation of mHealth intervention components in the analysis. Conclusions: PA outcomes for adolescents improved over time through mHealth intervention use; however, the lack of consistency in chosen PA outcome measures, paucity of significant outcomes via between-group analyses, and the various study designs that prevent separating the effects of intervention components calls into question their true effect. ", doi="10.2196/11847", url="http://mhealth.jmir.org/2019/2/e11847/", url="http://www.ncbi.nlm.nih.gov/pubmed/30747716" } @Article{info:doi/10.2196/11836, author="Chan, Ling Ko and Chen, Mengtong", title="Effects of Social Media and Mobile Health Apps on Pregnancy Care: Meta-Analysis", journal="JMIR Mhealth Uhealth", year="2019", month="Jan", day="30", volume="7", number="1", pages="e11836", keywords="mHealth", keywords="social media", keywords="pregnancy", keywords="postpartum", keywords="maternal health", abstract="Background: The use of social media and mobile health (mHealth) apps has been increasing in pregnancy care. However, the effectiveness of these interventions is still unclear. Objectives: We conducted a meta-analysis to examine the effectiveness of these interventions with regard to different health outcomes in pregnant and postpartum women and investigate the characteristics and components of interventions that may affect program effectiveness. Method: We performed a comprehensive literature search of major electronic databases and reference sections of related reviews and eligible studies. A random effects model was used to calculate the effect size. Results: Fifteen randomized controlled trial studies published in and before June 2018 that met the inclusion criteria were included in the meta-analysis. The interventions were effective in promoting maternal physical health including weight management, gestational diabetes mellitus control, and asthma control with a moderate to large effect size (d=0.72). Large effect sizes were also found for improving maternal mental health (d=0.84) and knowledge about pregnancy (d=0.80). Weight control interventions using wearable devices were more effective. Conclusion: Social media and mHealth apps have the potential to be widely used in improving maternal well-being. More large-scale clinical trials focusing on different health outcomes are suggested for future studies. ", doi="10.2196/11836", url="https://mhealth.jmir.org/2019/1/e11836/", url="http://www.ncbi.nlm.nih.gov/pubmed/30698533" } @Article{info:doi/10.2196/10899, author="Song, Ting and Qian, Siyu and Yu, Ping", title="Mobile Health Interventions for Self-Control of Unhealthy Alcohol Use: Systematic Review", journal="JMIR Mhealth Uhealth", year="2019", month="Jan", day="29", volume="7", number="1", pages="e10899", keywords="systematic review", keywords="alcohol drinking", keywords="self-control", keywords="mobile health", keywords="mHealth", keywords="treatment outcome", abstract="Background: Unhealthy alcohol use (UAU) is one of the major causes of preventable morbidity, mortality, and associated behavioral risks worldwide. Although mobile health (mHealth) interventions can provide consumers with an effective means for self-control of UAU in a timely, ubiquitous, and cost-effective manner, to date, there is a lack of understanding about different health outcomes brought by such interventions. The core components of these interventions are also unclear. Objective: This study aimed to systematically review and synthesize the research evidence about the efficacy of mHealth interventions on various health outcomes for consumer self-control of UAU and to identify the core components to achieve these outcomes. Methods: We systematically searched 7 electronic interdisciplinary databases: Scopus, PubMed, PubMed Central, CINAHL Plus with full text, MEDLINE with full text, PsycINFO, and PsycARTICLES. Search terms and Medical Subject Headings ``mHealth,'' ``text message,'' ``SMS,'' ``App,'' ``IVR,'' ``self-control,'' ``self-regulation,'' ``alcohol*,'' and ``intervention'' were used individually or in combination to identify peer-reviewed publications in English from 2008 to 2017. We screened titles and abstracts and assessed full-text papers as per inclusion and exclusion criteria. Data were extracted from the included papers according to the Consolidated Standards of Reporting Trials-EHEALTH checklist (V 1.6.1) by 2 authors independently. Data quality was assessed by the Mixed Methods Appraisal Tool. Data synthesis and analyses were conducted following the procedures for qualitative content analysis. Statistical testing was also conducted to test differences among groups of studies. Results: In total, 19 studies were included in the review. Of these 19 studies, 12 (63\%) mHealth interventions brought significant positive outcomes in improving participants' health as measured by behavioral (n=11), physiological (n=1), and cognitive indicators (n=1). No significant health outcome was reported in 6 studies (6/19, 32\%). Surprisingly, a significant negative outcome was reported for the male participants in the intervention arm in 1 study (1/19, 5\%), but no change was found for the female participants. In total, 5 core components reported in the mHealth interventions for consumer self-control of UAU were context, theoretical base, delivery mode, content, and implementation procedure. However, sound evidence is yet to be generated about the role of each component for mHealth success. The health outcomes were similar regardless of types of UAU, deployment setting, with or without nonmobile cointervention, and with or without theory. Conclusions: Most studies reported mHealth interventions for self-control of UAU appeared to be improving behavior, especially the ones delivered by short message service and interactive voice response systems. Further studies are needed to gather sound evidence about the effects of mHealth interventions on improving physiological and cognitive outcomes as well as the optimal design of these interventions, their implementation, and effects in supporting self-control of UAU. ", doi="10.2196/10899", url="http://mhealth.jmir.org/2019/1/e10899/", url="http://www.ncbi.nlm.nih.gov/pubmed/30694200" } @Article{info:doi/10.2196/11942, author="Sezgin, Emre and Lin, Simon", title="Technology-Based Interventions, Assessments, and Solutions for Safe Driving Training for Adolescents: Rapid Review", journal="JMIR Mhealth Uhealth", year="2019", month="Jan", day="24", volume="7", number="1", pages="e11942", keywords="adolescent health", keywords="assessment", keywords="driving safety", keywords="teen driving", keywords="technology-based intervention", abstract="Background: Safe driving training for adolescents aims to prevent injury and promote their well-being. In that regard, information and communication technologies have been used to understand adolescent driving behavior and develop interventions. Objective: The purpose of this review is to explore and discuss existing approaches to technology-based driving interventions, driving assessments, and solutions in the literature. Methods: We searched the Web of Science and PubMed databases following a review protocol to collect relevant peer-reviewed journal articles. Inclusion criteria were (1) being published in the English language, (2) being published in a peer-reviewed journal, (3) testing the driving behavior of teens with technology-based intervention methods, and (4) being published between January 2000 and March 2018. We appraised the articles by reading their abstracts to select studies matching the inclusion criteria and reading the full text of articles for final refinement. Results: Initial keyword searches on technology-based solutions resulted in 828 publications that we refined further by title screening (n=131) and abstract evaluation against inclusion criteria (n=29). Finally, we selected 16 articles that met the inclusion criteria and examined them regarding the use of technology-based interventions, assessments, and solutions. Use of built-in tracking devices and installation of black box devices were widely used methods for capturing driving events. Smartphones were increasingly adapted for data collection, and use of gamification for intervention design was an emerging concept. Visual and audio feedback also were used for intervention. Conclusions: Our findings suggest that social influence is effective in technology-based interventions; parental involvement for promoting safe driving behavior is highly effective. However, the use of smartphones and gamification needs more study regarding their implementation and sustainability. Further developments in technology for predicting teen behavior and programs for behavioral change are needed. ", doi="10.2196/11942", url="http://mhealth.jmir.org/2019/1/e11942/", url="http://www.ncbi.nlm.nih.gov/pubmed/30679149" } @Article{info:doi/10.2196/11312, author="Kankanhalli, Atreyi and Shin, Jieun and Oh, Hyelim", title="Mobile-Based Interventions for Dietary Behavior Change and Health Outcomes: Scoping Review", journal="JMIR Mhealth Uhealth", year="2019", month="Jan", day="21", volume="7", number="1", pages="e11312", keywords="mHealth", keywords="mobile-based intervention", keywords="dietary behavior", keywords="food intake", keywords="behavior change", keywords="health outcomes", abstract="Background: Mobile apps are being widely used for delivering health interventions, with their ubiquitous access and sensing capabilities. One such use is the delivery of interventions for healthy eating behavior. Objective: The aim of this study was to provide a comprehensive view of the literature on the use of mobile interventions for eating behavior change. We synthesized the studies with such interventions and mapped out their input methods, interventions, and outcomes. Methods: We conducted a scoping literature search in PubMed/MEDLINE, Association for Computing Machinery Digital Library, and PsycINFO databases to identify relevant papers published between January 2013 and April 2018. We also hand-searched relevant themes of journals in the Journal of Medical Internet Research and registered protocols. Studies were included if they provided and assessed mobile-based interventions for dietary behavior changes and/or health outcomes. Results: The search resulted in 30 studies that we classified by 3 main aspects: input methods, mobile-based interventions, and dietary behavior changes and health outcomes. First, regarding input methods, 5 studies allowed photo/voice/video inputs of diet information, whereas text input methods were used in the remaining studies. Other than diet information, the content of the input data in the mobile apps included user's demographics, medication, health behaviors, and goals. Second, we identified 6 categories of intervention contents, that is, self-monitoring, feedback, gamification, goal reviews, social support, and educational information. Although all 30 studies included self-monitoring as a key component of their intervention, personalized feedback was a component in 18 studies, gamification was used in 10 studies, goal reviews in 5 studies, social support in 3 studies, and educational information in 2 studies. Finally, we found that 13 studies directly examined the effects of interventions on health outcomes and 12 studies examined the effects on dietary behavior changes, whereas only 5 studies observed the effects both on dietary behavior changes and health outcomes. Regarding the type of studies, although two-thirds of the included studies conducted diverse forms of randomized control trials, the other 10 studies used field studies, surveys, protocols, qualitative interviews, propensity score matching method, and test and reference method. Conclusions: This scoping review identified and classified studies on mobile-based interventions for dietary behavior change as per the input methods, nature of intervention, and outcomes examined. Our findings indicated that dietary behavior changes, although playing a mediating role in improving health outcomes, have not been adequately examined in the literature. Dietary behavior change as a mechanism for the relationship between mobile-based intervention and health outcomes needs to be further investigated. Our review provides guidance for future research in this promising mobile health area. ", doi="10.2196/11312", url="http://mhealth.jmir.org/2019/1/e11312/", url="http://www.ncbi.nlm.nih.gov/pubmed/30664461" } @Article{info:doi/10.2196/11941, author="Pham, Quynh and Graham, Gary and Carrion, Carme and Morita, P. Plinio and Seto, Emily and Stinson, N. Jennifer and Cafazzo, A. Joseph", title="A Library of Analytic Indicators to Evaluate Effective Engagement with Consumer mHealth Apps for Chronic Conditions: Scoping Review", journal="JMIR Mhealth Uhealth", year="2019", month="Jan", day="18", volume="7", number="1", pages="e11941", keywords="analytics", keywords="effective engagement", keywords="engagement", keywords="adherence", keywords="log data", keywords="mobile health", keywords="mobile applications", keywords="chronic disease", keywords="scoping review", abstract="Background: There is mixed evidence to support current ambitions for mobile health (mHealth) apps to improve chronic health and well-being. One proposed explanation for this variable effect is that users do not engage with apps as intended. The application of analytics, defined as the use of data to generate new insights, is an emerging approach to study and interpret engagement with mHealth interventions. Objective: This study aimed to consolidate how analytic indicators of engagement have previously been applied across clinical and technological contexts, to inform how they might be optimally applied in future evaluations. Methods: We conducted a scoping review to catalog the range of analytic indicators being used in evaluations of consumer mHealth apps for chronic conditions. We categorized studies according to app structure and application of engagement data and calculated descriptive data for each category. Chi-square and Fisher exact tests of independence were applied to calculate differences between coded variables. Results: A total of 41 studies met our inclusion criteria. The average mHealth evaluation included for review was a two-group pretest-posttest randomized controlled trial of a hybrid-structured app for mental health self-management, had 103 participants, lasted 5 months, did not provide access to health care provider services, measured 3 analytic indicators of engagement, segmented users based on engagement data, applied engagement data for descriptive analyses, and did not report on attrition. Across the reviewed studies, engagement was measured using the following 7 analytic indicators: the number of measures recorded (76\%, 31/41), the frequency of interactions logged (73\%, 30/41), the number of features accessed (49\%, 20/41), the number of log-ins or sessions logged (46\%, 19/41), the number of modules or lessons started or completed (29\%, 12/41), time spent engaging with the app (27\%, 11/41), and the number or content of pages accessed (17\%, 7/41). Engagement with unstructured apps was mostly measured by the number of features accessed (8/10, P=.04), and engagement with hybrid apps was mostly measured by the number of measures recorded (21/24, P=.03). A total of 24 studies presented, described, or summarized the data generated from applying analytic indicators to measure engagement. The remaining 17 studies used or planned to use these data to infer a relationship between engagement patterns and intended outcomes. Conclusions: Although researchers measured on average 3 indicators in a single study, the majority reported findings descriptively and did not further investigate how engagement with an app contributed to its impact on health and well-being. Researchers are gaining nuanced insights into engagement but are not yet characterizing effective engagement for improved outcomes. Raising the standard of mHealth app efficacy through measuring analytic indicators of engagement may enable greater confidence in the causal impact of apps on improved chronic health and well-being. ", doi="10.2196/11941", url="http://mhealth.jmir.org/2019/1/e11941/", url="http://www.ncbi.nlm.nih.gov/pubmed/30664463" } @Article{info:doi/10.2196/11098, author="Ghanvatkar, Suparna and Kankanhalli, Atreyi and Rajan, Vaibhav", title="User Models for Personalized Physical Activity Interventions: Scoping Review", journal="JMIR Mhealth Uhealth", year="2019", month="Jan", day="16", volume="7", number="1", pages="e11098", keywords="review", keywords="exercise", keywords="physical fitness", keywords="automation", keywords="mobile apps", keywords="web browser", keywords="health communication", keywords="health promotion", abstract="Background: Fitness devices have spurred the development of apps that aim to motivate users, through interventions, to increase their physical activity (PA). Personalization in the interventions is essential as the target users are diverse with respect to their activity levels, requirements, preferences, and behavior. Objective: This review aimed to (1) identify different kinds of personalization in interventions for promoting PA among any type of user group, (2) identify user models used for providing personalization, and (3) identify gaps in the current literature and suggest future research directions. Methods: A scoping review was undertaken by searching the databases PsycINFO, PubMed, Scopus, and Web of Science. The main inclusion criteria were (1) studies that aimed to promote PA; (2) studies that had personalization, with the intention of promoting PA through technology-based interventions; and (3) studies that described user models for personalization. Results: The literature search resulted in 49 eligible studies. Of these, 67\% (33/49) studies focused solely on increasing PA, whereas the remaining studies had other objectives, such as maintaining healthy lifestyle (8 studies), weight loss management (6 studies), and rehabilitation (2 studies). The reviewed studies provide personalization in 6 categories: goal recommendation, activity recommendation, fitness partner recommendation, educational content, motivational content, and intervention timing. With respect to the mode of generation, interventions were found to be semiautomated or automatic. Of these, the automatic interventions were either knowledge-based or data-driven or both. User models in the studies were constructed with parameters from 5 categories: PA profile, demographics, medical data, behavior change technique (BCT) parameters, and contextual information. Only 27 of the eligible studies evaluated the interventions for improvement in PA, and 16 of these concluded that the interventions to increase PA are more effective when they are personalized. Conclusions: This review investigates personalization in the form of recommendations or feedback for increasing PA. On the basis of the review and gaps identified, research directions for improving the efficacy of personalized interventions are proposed. First, data-driven prediction techniques can facilitate effective personalization. Second, use of BCTs in automated interventions, and in combination with PA guidelines, are yet to be explored, and preliminary studies in this direction are promising. Third, systems with automated interventions also need to be suitably adapted to serve specific needs of patients with clinical conditions. Fourth, previous user models focus on single metric evaluations of PA instead of a potentially more effective, holistic, and multidimensional view. Fifth, with the widespread adoption of activity monitoring devices and mobile phones, personalized and dynamic user models can be created using available user data, including users' social profile. Finally, the long-term effects of such interventions as well as the technology medium used for the interventions need to be evaluated rigorously. ", doi="10.2196/11098", url="http://mhealth.jmir.org/2019/1/e11098/", url="http://www.ncbi.nlm.nih.gov/pubmed/30664474" } @Article{info:doi/10.2196/11724, author="Skrabal Ross, Xiomara and Gunn, M. Kate and Patterson, Pandora and Olver, Ian", title="Mobile-Based Oral Chemotherapy Adherence--Enhancing Interventions: Scoping Review", journal="JMIR Mhealth Uhealth", year="2018", month="Dec", day="21", volume="6", number="12", pages="e11724", keywords="medication adherence", keywords="antineoplastic agents", keywords="neoplasms", keywords="cell phone", keywords="text messaging", keywords="mobile apps", keywords="review", keywords="mHealth", abstract="Background: Adherence to oral chemotherapy is crucial to maximize treatment outcomes and avoid health complications in cancer patients. Mobile phones are widely available worldwide, and evidence that this technology can be successfully employed to increase medication adherence for the treatment of other chronic diseases (eg, diabetes) is well established. However, the extent to which there is evidence that mobile phone--based interventions improve adherence to oral chemotherapy is unknown. Objective: This scoping review aims to explore what is known about mobile phone--delivered interventions designed to enhance adherence to oral chemotherapy, to examine the reported findings on the utility of these interventions in increasing oral chemotherapy adherence, and to identify opportunities for development of future interventions. Methods: This study followed Arksey and O'Malley's scoping review methodological framework. Results: The review search yielded 5 studies reporting on 4 interventions with adults (aged >18 years) diagnosed with diverse cancer types. All interventions were considered acceptable, useful, and feasible. The following themes were evident: text messages and mobile apps were the main methods of delivering these interventions, the 2 most commonly employed oral chemotherapy adherence--enhancing strategies were management and reporting of drug-related symptoms and reminders to take medication, the importance of stakeholders' engagement in intervention design, and the overall positive perceptions of delivery features. Areas for future research identified by this review include the need for further studies to evaluate the impact of mobile phone--delivered interventions on adherence to oral chemotherapy as well as the relevance for future studies to incorporate design frameworks and economic evaluations and to explore the moderator effect of high anxiety, poor baseline adherence, and longer time taking prescribed drug on adherence to oral chemotherapy. Conclusions: Despite the increasing body of evidence on the use of mobile phones to deliver medication adherence--enhancing interventions in chronic diseases, literature on the oral chemotherapy context is lacking. This review showed that existing interventions are highly acceptable and useful to cancer patients. The engagement of stakeholders as well as the use of a design framework are important elements in the development of mobile phone--delivered interventions that can be translated into oncology settings. ", doi="10.2196/11724", url="http://mhealth.jmir.org/2018/12/e11724/", url="http://www.ncbi.nlm.nih.gov/pubmed/30578182" } @Article{info:doi/10.2196/10026, author="Richards, Rebecca and Kinnersley, Paul and Brain, Kate and McCutchan, Grace and Staffurth, John and Wood, Fiona", title="Use of Mobile Devices to Help Cancer Patients Meet Their Information Needs in Non-Inpatient Settings: Systematic Review", journal="JMIR Mhealth Uhealth", year="2018", month="Dec", day="14", volume="6", number="12", pages="e10026", keywords="cell phone", keywords="smartphone", keywords="computers, handheld", keywords="cancer", keywords="neoplasms", keywords="patients", keywords="information dissemination", keywords="consumer health information", abstract="Background: The shift from inpatient to outpatient cancer care means that patients are now required to manage their condition at home, away from regular supervision by clinicians. Subsequently, research has consistently reported that many patients with cancer have unmet information needs during their illness. Mobile devices, such as mobile phones and tablet computers, provide an opportunity to deliver information to patients remotely. To date, no systematic reviews have evaluated how mobile devices have been used specifically to help patients meet to their information needs. Objective: A systematic review was conducted to identify studies that describe the use of mobile interventions to enable patients with cancer meet their cancer-related information needs in non-inpatient settings, and to describe the effects and feasibility of these interventions. Methods: MEDLINE, Embase, and PsycINFO databases were searched up until January 2017. Search terms related to ``mobile devices,'' ``information needs,'' and ``cancer'' were used. There were no restrictions on study type in order to be as inclusive as possible. Study participants were patients with cancer undergoing treatment. Interventions had to be delivered by a mobile or handheld device, attempt to meet patients' cancer-related information needs, and be for use in non-inpatient settings. Critical Appraisal Skills Programme checklists were used to assess the methodological quality of included studies. A narrative synthesis was performed and findings were organized by common themes found across studies. Results: The initial search yielded 1020 results. We included 23 articles describing 20 studies. Interventions aimed to improve the monitoring and management of treatment-related symptoms (17/20, 85\%), directly increase patients' knowledge related to their condition (2/20, 10\%), and improve communication of symptoms to clinicians in consultations (1/20, 5\%). Studies focused on adult (17/20; age range 24-87 years) and adolescent (3/20; age range 8-18 years) patients. Sample sizes ranged from 4-125, with 13 studies having 25 participants or fewer. Most studies were conducted in the United Kingdom (12/20, 52\%) or United States (7/20, 30\%). Of the 23 articles included, 12 were of medium quality, 9 of poor quality, and 2 of good quality. Overall, interventions were reported to be acceptable and perceived as useful and easy to use. Few technical problems were encountered. Adherence was generally consistent and high (periods ranged from 5 days to 6 months). However, there was considerable variation in use of intervention components within and between studies. Reported benefits of the interventions included improved symptom management, patient empowerment, and improved clinician-patient communication, although mixed findings were reported for patients' health-related quality of life and anxiety. Conclusions: The current review highlighted that mobile interventions for patients with cancer are only meeting treatment or symptom-related information needs. There were no interventions designed to meet patients' full range of cancer-related information needs, from information on psychological support to how to manage finances during cancer, and the long-term effects of treatment. More comprehensive interventions are required for patients to meet their information needs when managing their condition in non-inpatient settings. Controlled evaluations are needed to further determine the effectiveness of these types of intervention. ", doi="10.2196/10026", url="https://mhealth.jmir.org/2018/12/e10026/", url="http://www.ncbi.nlm.nih.gov/pubmed/30552082" } @Article{info:doi/10.2196/mhealth.9119, author="Hughson, Patricia Jo-anne and Daly, Oliver J. and Woodward-Kron, Robyn and Hajek, John and Story, David", title="The Rise of Pregnancy Apps and the Implications for Culturally and Linguistically Diverse Women: Narrative Review", journal="JMIR Mhealth Uhealth", year="2018", month="Nov", day="16", volume="6", number="11", pages="e189", keywords="culture", keywords="emigrants and immigrants", keywords="health communication", keywords="information-seeking behavior", keywords="literacy", keywords="maternal health", keywords="mHealth", keywords="mobile phone", keywords="pregnancy", keywords="self-care", keywords="vulnerable populations", abstract="Background: Pregnancy apps are a booming global industry, with most pregnant women in high-income countries now using them. From the perspective of health care and health information provision, this is both encouraging and unsettling; the demand indicates a clear direction for the development of future resources, but it also underscores the importance of processes ensuring access, reliability, and quality control. Objective: This review provides an overview of current literature on pregnancy apps and aims at describing (1) the ways in which apps are used by women, in general, and by those of a culturally and linguistically diverse (CALD) background; (2) the utility and quality of information provided; and (3) areas where more research, development, and oversight are needed. Methods: We chose a narrative review methodology for the study and performed a structured literature search including studies published between 2012 and 2017. Searches were performed using MEDLINE, EMBASE, and CINAHL databases. Studies were identified for inclusion using two separate search criteria and strategies: (1) studies on pregnancy apps and pregnant women's use of these apps and (2) studies on CALD pregnant women and their use of technology for accessing information on and services for pregnancy. Overall, we selected 38 studies. Results: We found that pregnancy apps were principally used to access pregnancy health and fetal development information. Data storage capability, Web-based features or personalized tools, and social media features were also popular app features sought by women. Lower rates of the pregnancy app uptake were indicated among lower-income and non-English-speaking women. Preliminary evidence indicates that a combination of technological, health literacy, and language issues may result in lower uptake of pregnancy apps by these groups; however, further investigation is required. A marked limitation of the health app industry is lack of regulation in a commercially dominated field, making it difficult for users to assess the reliability of the information being presented. Health professionals and users alike indicate that given the choice, they would prefer using pregnancy apps that are relevant to their local health care context and come from a trusted source. Evidence indicates a need for greater health professional and institutional engagement in the app development, as well as awareness of and guidance for women's use of these resources. Conclusions: This is the first review of pregnancy app use, types of information provided, and features preferred by pregnant women in general and by those of a CALD background in particular. It indicates the demand for access to accurate information that is relevant to users, their community, and their associated health services. Given the popularity of pregnancy apps, such apps have enormous potential to be used for the provision of accurate, evidence-based health information. ", doi="10.2196/mhealth.9119", url="https://mhealth.jmir.org/2018/11/e189/", url="http://www.ncbi.nlm.nih.gov/pubmed/30446483" } @Article{info:doi/10.2196/10076, author="Eckerstorfer, V. Lisa and Tanzer, K. Norbert and Vogrincic-Haselbacher, Claudia and Kedia, Gayannee and Brohmer, Hilmar and Dinslaken, Isabelle and Corcoran, Katja", title="Key Elements of mHealth Interventions to Successfully Increase Physical Activity: Meta-Regression", journal="JMIR Mhealth Uhealth", year="2018", month="Nov", day="12", volume="6", number="11", pages="e10076", keywords="exercise", keywords="physical activity", keywords="mHealth", keywords="behavior change", keywords="meta-analysis", keywords="meta-regression", abstract="Background: Mobile technology gives researchers unimagined opportunities to design new interventions to increase physical activity. Unfortunately, it is still unclear which elements are useful to initiate and maintain behavior change. Objective: In this meta-analysis, we investigated randomized controlled trials of physical activity interventions that were delivered via mobile phone. We analyzed which elements contributed to intervention success. Methods: After searching four databases and science networks for eligible studies, we entered 50 studies with N=5997 participants into a random-effects meta-analysis, controlling for baseline group differences. We also calculated meta-regressions with the most frequently used behavior change techniques (behavioral goals, general information, self-monitoring, information on where and when, and instructions on how to) as moderators. Results: We found a small overall effect of the Hedges g=0.29, (95\% CI 0.20 to 0.37) which reduced to g=0.22 after correcting for publication bias. In the moderator analyses, behavioral goals and self-monitoring each led to more intervention success. Interventions that used neither behavioral goals nor self-monitoring had a negligible effect of g=0.01, whereas utilizing either technique increased effectiveness by $\Delta$g=0.31, but combining them did not provide additional benefits ($\Delta$g=0.36). Conclusions: Overall, mHealth interventions to increase physical activity have a small to moderate effect. However, including behavioral goals or self-monitoring can lead to greater intervention success. More research is needed to look at more behavior change techniques and their interactions. Reporting interventions in trial registrations and articles need to be structured and thorough to gain accurate insights. This can be achieved by basing the design or reporting of interventions on taxonomies of behavior change. ", doi="10.2196/10076", url="https://mhealth.jmir.org/2018/11/e10076/", url="http://www.ncbi.nlm.nih.gov/pubmed/30425028" } @Article{info:doi/10.2196/publichealth.9015, author="Tom-Aba, Daniel and Nguku, Mboya Patrick and Arinze, Chukwujekwu Chinedu and Krause, Gerard", title="Assessing the Concepts and Designs of 58 Mobile Apps for the Management of the 2014-2015 West Africa Ebola Outbreak: Systematic Review", journal="JMIR Public Health Surveill", year="2018", month="Oct", day="29", volume="4", number="4", pages="e68", keywords="case management", keywords="contact tracing", keywords="Ebola virus disease", keywords="eHealth", keywords="mHealth", keywords="systematic review", keywords="West Africa", abstract="Background: The use of mobile phone information technology (IT) in the health sector has received much attention especially during the 2014-2015 Ebola virus disease (EVD) outbreak. mHealth can be attributed to a major improvement in EVD control, but there lacks an overview of what kinds of tools were available and used based on the functionalities they offer. Objective: We aimed to conduct a systematic review of mHealth tools in the context of the recent EVD outbreak to identify the most promising approaches and guide further mHealth developments for infectious disease control. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched for all reports on mHealth tools developed in the context of the 2014-2015 EVD outbreak published between January 1, 2014 and December 31, 2015 on Google Scholar, MEDLINE, CAB Abstracts (Global Health), POPLINE, and Web of Science in any language 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'') AND (``2014'' OR ``2015''). The relevant publications were selected by 2 independent reviewers who applied a standardized data extraction form on the tools' functionalities. Results: We identified 1220 publications through the search strategy, of which 6.31\% (77/1220) were original publications reporting on 58 specific mHealth tools in the context of the EVD outbreak. Of these, 62\% (34/55) offered functionalities for surveillance, 22\% (10/45) for case management, 18\% (7/38) for contact tracing, and 6\% (3/51) for laboratory data management. Only 3 tools, namely Community Care, Sense Ebola Followup, and Surveillance and Outbreak Response Management and Analysis System supported all four of these functionalities. Conclusions: Among the 58 identified tools related to EVD management in 2014 and 2015, only 3 appeared to contain all 4 key functionalities relevant for the response to EVD outbreaks and may be most promising for further development. ", doi="10.2196/publichealth.9015", url="http://publichealth.jmir.org/2018/4/e68/", url="http://www.ncbi.nlm.nih.gov/pubmed/30373727" } @Article{info:doi/10.2196/11231, author="Thurnheer, E. Simon and Gravestock, Isaac and Pichierri, Giuseppe and Steurer, Johann and Burgstaller, M. Jakob", title="Benefits of Mobile Apps in Pain Management: Systematic Review", journal="JMIR Mhealth Uhealth", year="2018", month="Oct", day="22", volume="6", number="10", pages="e11231", keywords="mobile application", keywords="pain", keywords="pain management", keywords="smartphone", keywords="cell phone", keywords="telemedicine", keywords="review", abstract="Background: Pain is a common condition with a significant physical, psychosocial, and economic impact. Due to enormous progress in mobile device technology as well as the increase in smartphone ownership in the general population, mobile apps can be used to monitor patients with pain and support them in pain management. Objective: The aim of this review was to assess the efficacy of smartphone or computer tablet apps in the management of patients with pain. Methods: In December 2017, a literature search was performed in the following databases: MEDLINE, EMBASE, CINAHL, Cochrane, and PsycINFO. In addition, a bibliography search was conducted. We included studies with at least 20 participants per arm that evaluated the effects of apps on smartphones or computer tablets on improvement in pain. Results: A total of 15 studies with 1962 patients met the inclusion criteria. Of these, 4 studies examined the effect of mobile apps on pain management in an in-clinic setting and 11 in an out-clinic setting. The majority of the original studies reported beneficial effects of the use of a pain app. Severity of pain decreased in most studies where patients were using an app compared with patients not using an app. Other outcomes, such as worst pain or quality of life showed improvements in patients using an app. Due to heterogeneity between the original studies---patient characteristics, app content, and study setting---a synthesis of the results by statistical methods was not performed. Conclusions: Apps for pain management may be beneficial for patients, particularly in an out-clinic setting. Studies have shown that pain apps are workable and well liked by patients and health care professionals. There is no doubt that in the near future, mobile technologies will develop further. Medicine could profit from this development as indicated by our results, but there is a need for more scientific inputs. It is desirable to know which elements of apps or additional devices and tools may improve usability and help patients in pain management. ", doi="10.2196/11231", url="http://mhealth.jmir.org/2018/10/e11231/", url="http://www.ncbi.nlm.nih.gov/pubmed/30348633" } @Article{info:doi/10.2196/10799, author="Ludwig, Kim and Arthur, Rosie and Sculthorpe, Nicholas and Fountain, Hollie and Buchan, S. Duncan", title="Text Messaging Interventions for Improvement in Physical Activity and Sedentary Behavior in Youth: Systematic Review", journal="JMIR Mhealth Uhealth", year="2018", month="Sep", day="17", volume="6", number="9", pages="e10799", keywords="review", keywords="exercise", keywords="sedentary lifestyle", keywords="text messaging", keywords="cell phone", keywords="telemedicine", keywords="adolescent", abstract="Background: The use of text messages (short message service, SMS) to change physical activity and sedentary behavior in youth is of interest due to the need for novel, more effective intervention approaches. Previous reviews have examined a variety of technology-based interventions and their impact on different health behaviors, but evidence regarding the impact of just SMS on physical activity and sedentary behavior is lacking. Objective: The aim of this study was to assess the effectiveness and use of theory of SMS interventions for improving physical activity and sedentary behavior in youth. Methods: Authors systematically searched electronic databases from March to November 2017. Citations were sifted using additional reviewers, and a qualitative synthesis of eligible studies was conducted using piloted data extraction forms. To be eligible for inclusion, studies had to be of a randomized controlled or quasi-experimental design, incorporate SMS, involve adolescents between the ages of 10 and 19 years, and assess at least one physical activity or sedentary behavior outcome. Risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool. Results: A total of 13 studies reporting 11 interventions were included in the qualitative analysis. Studies included interventions that were conducted in schools, online, or face-to-face. Studies were of high heterogeneity with regard to study duration, participant characteristics, intervention content, and outcome measures. Findings were equivocal with regard to intervention effectiveness for physical activity and sedentary behavior. Overall, 7 interventions resulted in an improvement for physical activity and 6 for sedentary behavior. All studies were judged to be of high risk of bias for at least 1 item. Conclusions: Some studies in this review showed promising results for using SMS to improve physical activity and sedentary behavior in youth. High heterogeneity of design and outcome measures precluded data pooling and conclusions as to which specific intervention elements are linked to increased effectiveness cannot be drawn. The authors propose incorporating the following elements in future studies: specific focus on desired health behavior; mixed-methods design; include long-term follow-up; include self-monitoring, goal setting, and feedback; combine SMS with a mobile app; and send 3 or more SMS text messages per week. More rigorous studies are needed to explore the relationship between intervention effectiveness and specific intervention components such as content and delivery. ", doi="10.2196/10799", url="http://mhealth.jmir.org/2018/9/e10799/", url="http://www.ncbi.nlm.nih.gov/pubmed/30224335" } @Article{info:doi/10.2196/mhealth.8554, author="Choi, Jihye and Cho, Youngtae and Woo, Hyekyung", title="mHealth Approaches in Managing Skin Cancer: Systematic Review of Evidence-Based Research Using Integrative Mapping", journal="JMIR Mhealth Uhealth", year="2018", month="Aug", day="02", volume="6", number="8", pages="e164", keywords="skin cancer", keywords="mHealth", keywords="e-Health", keywords="mobile technology", keywords="teledermatology", keywords="melanoma", abstract="Background: mHealth, which encompasses mobile health technologies and interventions, is rapidly evolving in various medical specialties, and its impact is evident in oncology. In particular, mHealth has established itself as a prominent part of dermatology for cancer screening. Intensified research to seek its use and effectiveness in each phase of the skin cancer continuum is needed in this fast-growing field of teledermatology. Objective: The purpose of this review was to describe current trends in research addressing the integration of mHealth and its contributions across the skin cancer continuum. Methods: A systematic review framework was applied to the search using three electronic databases: PubMed, Web of Science, and Embase. We extensively reviewed appropriate studies regarding skin cancer and mobile technology published between 2007 and 2017. Studies of the role and impact of mobile technology in the prevention and management of skin cancer were included. We selected 18 studies adhering to the inclusion and exclusion criteria for analysis. Results: Of the 18 studies, 5 (28\%) evaluated prevention interventions, 6 (33\%) assessed diagnostic accuracy, and 7 (39\%) pertained to feasibility in the context of mHealth approaches for skin cancer care. These studies portray the potential of mobile teledermatology in the prevention and management of skin cancer. However, not all phases of skin cancer involve mHealth, and not all have been addressed by research. Conclusions: This review extends our knowledge not only on the contributions of mHealth technologies, but also on their integration in different phases of skin cancer care. To optimize the effectiveness of mHealth in dermatology, larger numbers of robust, evidence-based studies on teledermatology implementations, distributed evenly across the care continuum, should be conducted so that research can be expanded to systematic reviews. ", doi="10.2196/mhealth.8554", url="http://mhealth.jmir.org/2018/8/e164/", url="http://www.ncbi.nlm.nih.gov/pubmed/30072362" } @Article{info:doi/10.2196/10115, author="Adu, D. Mary and Malabu, H. Usman and Callander, J. Emily and Malau-Aduli, EO Aduli and Malau-Aduli, S. Bunmi", title="Considerations for the Development of Mobile Phone Apps to Support Diabetes Self-Management: Systematic Review", journal="JMIR Mhealth Uhealth", year="2018", month="Jun", day="21", volume="6", number="6", pages="e10115", keywords="mobile phone apps", keywords="diabetes melitus", keywords="self-management", keywords="developmental consideration", keywords="systematic review", abstract="Background: There is increased research interest in the use of mobile phone apps to support diabetes management. However, there are divergent views on what constitute the minimum standards for inclusion in the development of mobile phone apps. Mobile phone apps require an evidence-based approach to development which will consequently impact on their effectiveness. Therefore, comprehensive information on developmental considerations could help designers and researchers to develop innovative and effective patient-centered self-management mobile phone apps for diabetes patients. Objective: This systematic review examined the developmental considerations adopted in trials that engaged mobile phone applications for diabetes self-management. Methods: A comprehensive search strategy was implemented across 5 electronic databases; Medline, Scopus, Social Science Citation Index, the Cochrane Central Register of Controlled Trials and Cumulative Index of Nursing and Allied Health Literature (CINALHL) and supplemented by reference list from identified studies. Study quality was evaluated using the Joanna Briggs Critical appraisal checklist for trials. Information on developmental factors (health behavioral theory, functionality, pilot testing, user and clinical expert involvements, data privacy and app security) were assessed across experimental studies using a template developed for the review. Results: A total of 11 studies (10 randomized controlled trials and 1 quasi-experimental trial) that fitted the inclusion criteria were identified. All the included studies had the functionality of self-monitoring of blood glucose. However, only some of them included functions for data analytics (7/11, 63.6\%), education (6/11, 54.5\%) and reminder (6/11, 54.5\%). There were 5/11(45.5\%) studies with significantly improved glycosylated hemoglobin in the intervention groups where educational functionality was present in the apps used in the 5 trials. Only 1 (1/11, 9.1\%) study considered health behavioral theory and user involvement, while 2 (2/11, 18.1\%) other studies reported the involvement of clinical experts in the development of their apps. There were 4 (4/11, 36.4\%) studies which referred to data security and privacy considerations during their app development while 7 (7/12, 63.6\%) studies provided information on pilot testing of apps before use in the full trial. Overall, none of the studies provided information on all developmental factors assessed in the review. Conclusions: There is a lack of elaborate and detailed information in the literature regarding the factors considered in the development of apps used as interventions for diabetes self-management. Documentation and inclusion of such vital information will foster a transparent and shared decision-making process that will ultimately lead to the development of practical and user-friendly self-management apps that can enhance the quality of life for diabetes patients. ", doi="10.2196/10115", url="http://mhealth.jmir.org/2018/6/e10115/", url="http://www.ncbi.nlm.nih.gov/pubmed/29929949" } @Article{info:doi/10.2196/mhealth.9671, author="Rivera-Romero, Octavio and Olmo, Alberto and Mu{\~n}oz, Roc{\'i}o and Stiefel, Pablo and Miranda, Luisa Mar{\'i}a and Beltr{\'a}n, M. Luis", title="Mobile Health Solutions for Hypertensive Disorders in Pregnancy: Scoping Literature Review", journal="JMIR Mhealth Uhealth", year="2018", month="May", day="30", volume="6", number="5", pages="e130", keywords="pregnancy", keywords="hypertension", keywords="pre-eclampsia", keywords="blood pressure", keywords="telemedicine", abstract="Background: Hypertensive disorders are the most common complications during pregnancy, occurring in 5\% to 11\% of pregnancies; gestational hypertension and preeclampsia are the leading causes of perinatal and maternal morbidity and mortality, especially in low- and middle-income countries (LMIC) where maternal and perinatal mortality ratios are still high. Pregnant women with hypertensive disorders could greatly benefit from mobile health (mHealth) solutions as a novel way to identify and control early symptoms, as shown in an increasing number of publications in the field. Such digital health solutions may overcome access limiting factors and the lack of skilled medical professionals and finances commonly presented in resource-poor environments. Objective: The aim of this study was to conduct a literature review of mHealth solutions used as support in hypertensive disorders during pregnancy, with the objective to identify the most relevant protocols and prototypes that could influence and improve current clinical practice. Methods: A methodological review following a scoping methodology was conducted. Manuscripts published in research journals reporting technical information of mHealth solutions for hypertensive disorders in pregnancy were included, categorizing articles in different groups: Diagnosis and Monitoring, mHealth Decision Support System, Education, and Health Promotion, and seven research questions were posed to study the manuscripts. Results: The search in electronic research databases yielded 327 articles. After removing duplicates, 230 articles were selected for screening. Finally, 11 articles met the inclusion criteria, and data were extracted from them. Very positive results in the improvement of maternal health and acceptability of solutions were found, although most of the studies involved a small number of participants, and none were complete clinical studies. Accordingly, none of the reported prototypes were integrated in the different health care systems. Only 4 studies used sensors for physiological measurements, and only 2 used blood pressure sensors despite the importance of this physiological parameter in the control of hypertension. The reported mHealth solutions have great potential to improve clinical practice in areas lacking skilled medical professionals or with a low health care budget, of special relevance in LMIC, although again, no extensive clinical validation has been carried out in these environments. Conclusions: mHealth solutions hold enormous potential to support hypertensive disorders during pregnancy and improve current clinical practice. Although very positive results have been reported in terms of usability and the improvement of maternal health, rigorous complete clinical trials are still necessary to support integration in health care systems. There is a clear need for simple mHealth solutions specifically developed for resource-poor environments that meet the United Nations Sustainable Development Goal (SDG); of enormous interest in LMIC. ", doi="10.2196/mhealth.9671", url="http://mhealth.jmir.org/2018/5/e130/" } @Article{info:doi/10.2196/mhealth.8639, author="Lam, A. Jeffrey and Dang, Thuy Linh and Phan, Tran Ngoc and Trinh, Thi Hue and Vu, Cong Nguyen and Nguyen, Kieu Cuong", title="Mobile Health Initiatives in Vietnam: Scoping Study", journal="JMIR Mhealth Uhealth", year="2018", month="Apr", day="24", volume="6", number="4", pages="e106", keywords="mHealth", keywords="eHealth", keywords="mobile health", keywords="telemedicine", keywords="Vietnam", keywords="scoping review", abstract="Background: Mobile health (mHealth) offers a promising solution to the multitude of challenges the Vietnamese health system faces, but there is a scarcity of published information on mHealth in Vietnam. Objective: The objectives of this scoping study were (1) to summarize the extent, range, and nature of mHealth initiatives in Vietnam and (2) to examine the opportunities and threats of mHealth utilization in the Vietnamese context. Methods: This scoping study systematically identified and extracted relevant information from 20 past and current mHealth initiatives in Vietnam. The study includes multimodal information sources, including published literature, gray literature (ie, government reports and unpublished literature), conference presentations, Web-based documents, and key informant interviews. Results: We extracted information from 27 records from the electronic search and conducted 14 key informant interviews, allowing us to identify 20 mHealth initiatives in Vietnam. Most of the initiatives were primarily funded by external donors (n=15), while other initiatives were government funded (n=1) or self-funded (n=4). A majority of the initiatives targeted vulnerable and hard-to-reach populations (n=11), aimed to prevent the occurrence of disease (n=12), and used text messaging (short message service, SMS) as part of their intervention (n=14). The study revealed that Vietnamese mHealth implementation has been challenged by factors including features unique to the Vietnamese language (n=4) and sociocultural factors (n=3). Conclusions: The largest threats to the popularity of mHealth initiatives are the absence of government policy, lack of government interest, heavy dependence on foreign funding, and lack of technological infrastructure. Finally, while current mHealth initiatives have already demonstrated promising opportunities for alternative models of funding, such as social entrepreneurship or private business models, sustainable mHealth initiatives outside of those funded by external donors have not yet been undertaken. ", doi="10.2196/mhealth.8639", url="http://mhealth.jmir.org/2018/4/e106/", url="http://www.ncbi.nlm.nih.gov/pubmed/29691214" } @Article{info:doi/10.2196/jmir.8342, author="Elaheebocus, Ally Sheik Mohammad Roushdat and Weal, Mark and Morrison, Leanne and Yardley, Lucy", title="Peer-Based Social Media Features in Behavior Change Interventions: Systematic Review", journal="J Med Internet Res", year="2018", month="Feb", day="22", volume="20", number="2", pages="e20", keywords="systematic review", keywords="social media", keywords="behavior control", keywords="health behavior", keywords="behavioral medicine", keywords="eHealth", abstract="Background: Incorporating social media features into digital behavior change interventions (DBCIs) has the potential to contribute positively to their success. However, the lack of clear design principles to describe and guide the use of these features in behavioral interventions limits cross-study comparisons of their uses and effects. Objective: The aim of this study was to provide a systematic review of DBCIs targeting modifiable behavioral risk factors that have included social media features as part of their intervention infrastructure. A taxonomy of social media features is presented to inform the development, description, and evaluation of behavioral interventions. Methods: Search terms were used in 8 databases to identify DBCIs that incorporated social media features and targeted tobacco smoking, diet and nutrition, physical activities, or alcohol consumption. The screening and review process was performed by 2 independent researchers. Results: A total of 5264 articles were screened, and 143 articles describing a total of 134 studies were retained for full review. The majority of studies (70\%) reported positive outcomes, followed by 28\% finding no effects with regard to their respective objectives and hypothesis, and 2\% of the studies found that their interventions had negative outcomes. Few studies reported on the association between the inclusion of social media features and intervention effect. A taxonomy of social media features used in behavioral interventions has been presented with 36 social media features organized under 7 high-level categories. The taxonomy has been used to guide the analysis of this review. Conclusions: Although social media features are commonly included in DBCIs, there is an acute lack of information with respect to their effect on outcomes and a lack of clear guidance to inform the selection process based on the features' suitability for the different behaviors. The proposed taxonomy along with the set of recommendations included in this review will support future research aimed at isolating and reporting the effects of social media features on DBCIs, cross-study comparisons, and evaluations. ", doi="10.2196/jmir.8342", url="http://www.jmir.org/2018/2/e20/", url="http://www.ncbi.nlm.nih.gov/pubmed/29472174" } @Article{info:doi/10.2196/mhealth.8873, author="Marcolino, Soriano Milena and Oliveira, Queiroz Jo{\~a}o Antonio and D'Agostino, Marcelo and Ribeiro, Luiz Antonio and Alkmim, Moreira Maria Beatriz and Novillo-Ortiz, David", title="The Impact of mHealth Interventions: Systematic Review of Systematic Reviews", journal="JMIR Mhealth Uhealth", year="2018", month="Jan", day="17", volume="6", number="1", pages="e23", keywords="telemedicine", keywords="medical informatics", keywords="mobile phones", abstract="Background: Mobile phone usage has been rapidly increasing worldwide. mHealth could efficiently deliver high-quality health care, but the evidence supporting its current effectiveness is still mixed. Objective: We performed a systematic review of systematic reviews to assess the impact or effectiveness of mobile health (mHealth) interventions in different health conditions and in the processes of health care service delivery. Methods: We used a common search strategy of five major scientific databases, restricting the search by publication date, language, and parameters in methodology and content. Methodological quality was evaluated using the Measurement Tool to Assess Systematic Reviews (AMSTAR) checklist. Results: The searches resulted in a total of 10,689 articles. Of these, 23 systematic reviews (371 studies; more than 79,665 patients) were included. Seventeen reviews included studies performed in low- and middle-income countries. The studies used diverse mHealth interventions, most frequently text messaging (short message service, SMS) applied to different purposes (reminder, alert, education, motivation, prevention). Ten reviews were rated as low quality (AMSTAR score 0-4), seven were rated as moderate quality (AMSTAR score 5-8), and six were categorized as high quality (AMSTAR score 9-11). A beneficial impact of mHealth was observed in chronic disease management, showing improvement in symptoms and peak flow variability in asthma patients, reducing hospitalizations and improving forced expiratory volume in 1 second; improving chronic pulmonary diseases symptoms; improving heart failure symptoms, reducing deaths and hospitalization; improving glycemic control in diabetes patients; improving blood pressure in hypertensive patients; and reducing weight in overweight and obese patients. Studies also showed a positive impact of SMS reminders in improving attendance rates, with a similar impact to phone call reminders at reduced cost, and improved adherence to tuberculosis and human immunodeficiency virus therapy in some scenarios, with evidence of decrease of viral load. Conclusions: Although mHealth is growing in popularity, the evidence for efficacy is still limited. In general, the methodological quality of the studies included in the systematic reviews is low. For some fields, its impact is not evident, the results are mixed, or no long-term studies exist. Exceptions include the moderate quality evidence of improvement in asthma patients, attendance rates, and increased smoking abstinence rates. Most studies were performed in high-income countries, implying that mHealth is still at an early stage of development in low-income countries. ", doi="10.2196/mhealth.8873", url="http://mhealth.jmir.org/2018/1/e23/", url="http://www.ncbi.nlm.nih.gov/pubmed/29343463" } @Article{info:doi/10.2196/mhealth.8998, author="Chen, Huan and Chai, Yanling and Dong, Le and Niu, Wenyi and Zhang, Puhong", title="Effectiveness and Appropriateness of mHealth Interventions for Maternal and Child Health: Systematic Review", journal="JMIR Mhealth Uhealth", year="2018", month="Jan", day="09", volume="6", number="1", pages="e7", keywords="telemedicine", keywords="maternal health", keywords="child health", abstract="Background: The application of mobile health (mHealth) technology in reproductive, maternal, newborn, and child health (RMNCH) is increasing worldwide. However, best practice and the most effective mHealth interventions have not been reviewed systematically. Objective: A systematic review and meta-analysis of studies of mHealth interventions for RMNCH around the world were conducted to investigate their characteristics as well as the features and effectiveness of mHealth interventions. Methods: Studies of mHealth interventions for RMNCH between January 2011 and December 2016 were retrieved from 6 databases (PubMed, EMBASE, Global Health, China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals, and Wanfang Data Knowledge Service Medium). Comparable studies were included in a random-effects meta-analysis for both exclusive breastfeeding (EBF) and antenatal checks (ANC). Descriptive analyses were conducted for mHealth studies with a range of study designs. Results: Analyses of 245 studies were included, including 51 randomized controlled trials (RCTs). Results showed that there are increasing numbers of studies on mHealth interventions for RMNCH. Although 2 meta-analysis, one with 2 RCTs on EBF (odds ratio [OR] 2.03, 95\% CI 1.34-3.08, I2=25\%) and the other with 3 RCTs on ANC (OR 1.43, 95\% CI 1.13-1.79, I2=78\%), showed that mHealth interventions are more effective than usual care, almost half (43\%) of RCTs showed negative or unclear results on mHealth interventions. Functions described in mHealth interventions were diverse, and the health stages covered were broad. However, single function or single stage appeared to be dominant among mHealth interventions compared with multiple functions or stages. Conclusions: More rigorous evaluations are needed to draw consistent conclusions and to analyze mHealth products with multiple functions, especially those popular in the app markets. ", doi="10.2196/mhealth.8998", url="http://mhealth.jmir.org/2018/1/e7/", url="http://www.ncbi.nlm.nih.gov/pubmed/29317380" } @Article{info:doi/10.2196/mhealth.8671, author="Dougherty, Bryn and Badawy, M. Sherif", title="Using Google Glass in Nonsurgical Medical Settings: Systematic Review", journal="JMIR Mhealth Uhealth", year="2017", month="Oct", day="19", volume="5", number="10", pages="e159", keywords="Google Glass", keywords="wearable", keywords="wearable device", keywords="head-mounted wearable device", keywords="non-surgical setting", keywords="non-surgical condition", keywords="medical setting", keywords="medical condition", abstract="Background: Wearable technologies provide users hands-free access to computer functions and are becoming increasingly popular on both the consumer market and in various industries. The medical industry has pioneered research and implementation of head-mounted wearable devices, such as Google Glass. Most of this research has focused on surgical interventions; however, other medical fields have begun to explore the potential of this technology to support both patients and clinicians. Objective: Our aim was to systematically evaluate the feasibility, usability, and acceptability of using Google Glass in nonsurgical medical settings and to determine the benefits, limitations, and future directions of its application. Methods: This review covers literature published between January 2013 and May 2017. Searches included PubMed MEDLINE, Embase, INSPEC (Ebsco), Cochrane Central Register of Controlled Trials (CENTRAL), IEEE Explore, Web of Science, Scopus, and Compendex. The search strategy sought all articles on Google Glass. Two reviewers independently screened titles and abstracts, assessed full-text articles, and extracted data from articles that met all predefined criteria. Any disagreements were resolved by discussion or consultation by the senior author. Included studies were original research articles that evaluated the feasibility, usability, or acceptability of Google Glass in nonsurgical medical settings. The preferred reporting results of systematic reviews and meta-analyses (PRISMA) guidelines were followed for reporting of results. Results: Of the 852 records examined, 51 met all predefined criteria, including patient-centered (n=21) and clinician-centered studies (n=30). Patient-centered studies explored the utility of Google Glass in supporting patients with motor impairments (n=8), visual impairments (n=5), developmental and psychiatric disorders (n=2), weight management concerns (n=3), allergies (n=1), or other health concerns (n=2). Clinician-centered studies explored the utility of Google Glass in student training (n=9), disaster relief (n=4), diagnostics (n=2), nursing (n=1), autopsy and postmortem examination (n=1), wound care (n=1), behavioral sciences (n=1), and various medical subspecialties, including, cardiology (n=3), radiology (n=3), neurology (n=1), anesthesiology (n=1), pulmonology (n=1), toxicology (n=1), and dermatology (n=1). Most of the studies were conducted in the United States (40/51, 78\%), did not report specific age information for participants (38/51, 75\%), had sample size <30 participants (29/51, 57\%), and were pilot or feasibility studies (31/51, 61\%). Most patient-centered studies (19/21, 90\%) demonstrated feasibility with high satisfaction and acceptability among participants, despite a few technical challenges with the device. A number of clinician-centered studies (11/30, 37\%) reported low to moderate satisfaction among participants, with the most promising results being in the area of student training. Studies varied in sample size, approach for implementation of Google Glass, and outcomes assessment. Conclusions: The use of Google Glass in nonsurgical medical settings varied. More promising results regarding the feasibility, usability, and acceptability of using Google Glass were seen in patient-centered studies and student training settings. Further research evaluating the efficacy and cost-effectiveness of Google Glass as an intervention to improve important clinical outcomes is warranted. ", doi="10.2196/mhealth.8671", url="http://mhealth.jmir.org/2017/10/e159/", url="http://www.ncbi.nlm.nih.gov/pubmed/29051136" } @Article{info:doi/10.2196/mhealth.7014, author="Moore, Sarah and Tass{\'e}, Anne-Marie and Thorogood, Adrian and Winship, Ingrid and Zawati, Ma'n and Doerr, Megan", title="Consent Processes for Mobile App Mediated Research: Systematic Review", journal="JMIR Mhealth Uhealth", year="2017", month="Aug", day="30", volume="5", number="8", pages="e126", keywords="mHealth, informed consent, smartphone, cell phone, mobile applications, privacy, research ethics", abstract="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. ", doi="10.2196/mhealth.7014", url="http://mhealth.jmir.org/2017/8/e126/", url="http://www.ncbi.nlm.nih.gov/pubmed/28855147" } @Article{info:doi/10.2196/mhealth.7088, author="Killikelly, Clare and He, Zhimin and Reeder, Clare and Wykes, Til", title="Improving Adherence to Web-Based and Mobile Technologies for People With Psychosis: Systematic Review of New Potential Predictors of Adherence", journal="JMIR Mhealth Uhealth", year="2017", month="Jul", day="20", volume="5", number="7", pages="e94", keywords="patient compliance", keywords="schizophrenia spectrum and other psychotic disorders", keywords="mobile phone", keywords="mHealth", abstract="Background: Despite the boom in new technologically based interventions for people with psychosis, recent studies suggest medium to low rates of adherence to these types of interventions. The benefits will be limited if only a minority of service users adhere and engage; if specific predictors of adherence can be identified then technologies can be adapted to increase the service user benefits. Objective: The study aimed to present a systematic review of rates of adherence, dropout, and approaches to analyzing adherence to newly developed mobile and Web-based interventions for people with psychosis. Specific predictors of adherence were also explored. Methods: Using keywords (Internet or online or Web-based or website or mobile) AND (bipolar disorder or manic depression or manic depressive illness or manic-depressive psychosis or psychosis or schizophr* or psychotic), the following databases were searched: OVID including MedLine, EMBASE and PsychInfo, Pubmed and Web of Science. The objectives and inclusion criteria for suitable studies were defined following PICOS (population: people with psychosis; intervention: mobile or Internet-based technology; comparison group: no comparison group specified; outcomes: measures of adherence; study design: randomized controlled trials (RCT), feasibility studies, and observational studies) criteria. In addition to measurement and analysis of adherence, two theoretically proposed predictors of adherence were examined: (1) level of support from a clinician or researcher throughout the study, and (2) level of service user involvement in the app or intervention development. We provide a narrative synthesis of the findings and followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines for reporting systematic reviews. Results: Of the 20 studies that reported a measure of adherence and a rate of dropout, 5 of these conducted statistical analyses to determine predictors of dropout, 6 analyzed the effects of specific adherence predictors (eg, symptom severity or type of technological interface) on the effects of the intervention, 4 administered poststudy feedback questionnaires to assess continued use of the intervention, and 2 studies evaluated the effects of different types of interventions on adherence. Overall, the percentage of participants adhering to interventions ranged from 28-100\% with a mean of 83\%. Adherence was greater in studies with higher levels of social support and service user involvement in the development of the intervention. Studies of shorter duration also had higher rates of adherence. Conclusions: Adherence to mobile and Web-based interventions was robust across most studies. Although 2 studies found specific predictors of nonadherence (male gender and younger age), most did not specifically analyze predictors. The duration of the study may be an important predictor of adherence. Future studies should consider reporting a universal measure of adherence and aim to conduct complex analyses on predictors of adherence such as level of social presence and service user involvement. ", doi="10.2196/mhealth.7088", url="http://mhealth.jmir.org/2017/7/e94/", url="http://www.ncbi.nlm.nih.gov/pubmed/28729235" } @Article{info:doi/10.2196/mhealth.7141, author="Kim, YB Ben and Lee, Joon", title="Smart Devices for Older Adults Managing Chronic Disease: A Scoping Review", journal="JMIR Mhealth Uhealth", year="2017", month="May", day="23", volume="5", number="5", pages="e69", keywords="mobile health", keywords="mHealth", keywords="smartphone", keywords="mobile phone", keywords="tablet", keywords="older adults", keywords="seniors", keywords="chronic disease", keywords="chronic disease management", keywords="scoping review", abstract="Background: The emergence of smartphones and tablets featuring vastly advancing functionalities (eg, sensors, computing power, interactivity) has transformed the way mHealth interventions support chronic disease management for older adults. Baby boomers have begun to widely adopt smart devices and have expressed their desire to incorporate technologies into their chronic care. Although smart devices are actively used in research, little is known about the extent, characteristics, and range of smart device-based interventions. Objective: We conducted a scoping review to (1) understand the nature, extent, and range of smart device-based research activities, (2) identify the limitations of the current research and knowledge gap, and (3) recommend future research directions. Methods: We used the Arksey and O'Malley framework to conduct a scoping review. We identified relevant studies from MEDLINE, Embase, CINAHL, and Web of Science databases using search terms related to mobile health, chronic disease, and older adults. Selected studies used smart devices, sampled older adults, and were published in 2010 or after. The exclusion criteria were sole reliance on text messaging (short message service, SMS) or interactive voice response, validation of an electronic version of a questionnaire, postoperative monitoring, and evaluation of usability. We reviewed references. We charted quantitative data and analyzed qualitative studies using thematic synthesis. To collate and summarize the data, we used the chronic care model. Results: A total of 51 articles met the eligibility criteria. Research activity increased steeply in 2014 (17/51, 33\%) and preexperimental design predominated (16/50, 32\%). Diabetes (16/46, 35\%) and heart failure management (9/46, 20\%) were most frequently studied. We identified diversity and heterogeneity in the collection of biometrics and patient-reported outcome measures within and between chronic diseases. Across studies, we found 8 self-management supporting strategies and 4 distinct communication channels for supporting the decision-making process. In particular, self-monitoring (38/40, 95\%), automated feedback (15/40, 38\%), and patient education (13/40, 38\%) were commonly used as self-management support strategies. Of the 23 studies that implemented decision support strategies, clinical decision making was delegated to patients in 10 studies (43\%). The impact on patient outcomes was consistent with studies that used cellular phones. Patients with heart failure and asthma reported improved quality of life. Qualitative analysis yielded 2 themes of facilitating technology adoption for older adults and 3 themes of barriers. Conclusions: Limitations of current research included a lack of gerontological focus, dominance of preexperimental design, narrow research scope, inadequate support for participants, and insufficient evidence for clinical outcome. Recommendations for future research include generating evidence for smart device-based programs, using patient-generated data for advanced data mining techniques, validating patient decision support systems, and expanding mHealth practice through innovative technologies. ", doi="10.2196/mhealth.7141", url="http://mhealth.jmir.org/2017/5/e69/", url="http://www.ncbi.nlm.nih.gov/pubmed/28536089" } @Article{info:doi/10.2196/jmir.7428, author="Gibson, G. Dustin and Pereira, Amanda and Farrenkopf, A. Brooke and Labrique, B. Alain and Pariyo, W. George and Hyder, A. Adnan", title="Mobile Phone Surveys for Collecting Population-Level Estimates in Low- and Middle-Income Countries: A Literature Review", journal="J Med Internet Res", year="2017", month="May", day="05", volume="19", number="5", pages="e139", keywords="survey methodology", keywords="cellular phone", keywords="interactive voice response", keywords="short messages service", keywords="computer-assisted telephone interview", keywords="mobile phone surveys", abstract="Background: National and subnational level surveys are important for monitoring disease burden, prioritizing resource allocation, and evaluating public health policies. As mobile phone access and ownership become more common globally, mobile phone surveys (MPSs) offer an opportunity to supplement traditional public health household surveys. Objective: The objective of this study was to systematically review the current landscape of MPSs to collect population-level estimates in low- and middle-income countries (LMICs). Methods: Primary and gray literature from 7 online databases were systematically searched for studies that deployed MPSs to collect population-level estimates. Titles and abstracts were screened on primary inclusion and exclusion criteria by two research assistants. Articles that met primary screening requirements were read in full and screened for secondary eligibility criteria. Articles included in review were grouped into the following three categories by their survey modality: (1) interactive voice response (IVR), (2) short message service (SMS), and (3) human operator or computer-assisted telephone interviews (CATI). Data were abstracted by two research assistants. The conduct and reporting of the review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: A total of 6625 articles were identified through the literature review. Overall, 11 articles were identified that contained 19 MPS (CATI, IVR, or SMS) surveys to collect population-level estimates across a range of topics. MPSs were used in Latin America (n=8), the Middle East (n=1), South Asia (n=2), and sub-Saharan Africa (n=8). Nine articles presented results for 10 CATI surveys (10/19, 53\%). Two articles discussed the findings of 6 IVR surveys (6/19, 32\%). Three SMS surveys were identified from 2 articles (3/19, 16\%). Approximately 63\% (12/19) of MPS were delivered to mobile phone numbers collected from previously administered household surveys. The majority of MPS (11/19, 58\%) were panel surveys where a cohort of participants, who often were provided a mobile phone upon a face-to-face enrollment, were surveyed multiple times. Conclusions: Very few reports of population-level MPS were identified. Of the MPS that were identified, the majority of surveys were conducted using CATI. Due to the limited number of identified IVR and SMS surveys, the relative advantages and disadvantages among the three survey modalities cannot be adequately assessed. The majority of MPS were sent to mobile phone numbers that were collected from a previously administered household survey. There is limited evidence on whether a random digit dialing (RDD) approach or a simple random sample of mobile network provided list of numbers can produce a population representative survey. ", doi="10.2196/jmir.7428", url="http://www.jmir.org/2017/5/e139/", url="http://www.ncbi.nlm.nih.gov/pubmed/28476725" } @Article{info:doi/10.2196/mhealth.6309, author="Bonoto, Cezar Br{\'a}ulio and de Ara{\'u}jo, Eloisa V{\^a}nia and God{\'o}i, Piassi Isabella and de Lemos, Pires L{\'i}via Lovato and Godman, Brian and Bennie, Marion and Diniz, Mauricio Leonardo and Junior, Guerra Augusto Afonso", title="Efficacy of Mobile Apps to Support the Care of Patients With Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials", journal="JMIR Mhealth Uhealth", year="2017", month="Mar", day="01", volume="5", number="3", pages="e4", keywords="diabetes mellitus", keywords="self-care", keywords="mobile applications", keywords="telemedicine", abstract="Background: Diabetes Mellitus (DM) is a chronic disease that is considered a global public health problem. Education and self-monitoring by diabetic patients help to optimize and make possible a satisfactory metabolic control enabling improved management and reduced morbidity and mortality. The global growth in the use of mobile phones makes them a powerful platform to help provide tailored health, delivered conveniently to patients through health apps. Objective: The aim of our study was to evaluate the efficacy of mobile apps through a systematic review and meta-analysis to assist DM patients in treatment. Methods: We conducted searches in the electronic databases MEDLINE (Pubmed), Cochrane Register of Controlled Trials (CENTRAL), and LILACS (Latin American and Caribbean Health Sciences Literature), including manual search in references of publications that included systematic reviews, specialized journals, and gray literature. We considered eligible randomized controlled trials (RCTs) conducted after 2008 with participants of all ages, patients with DM, and users of apps to help manage the disease. The meta-analysis of glycated hemoglobin (HbA1c) was performed in Review Manager software version 5.3. Results: The literature search identified 1236 publications. Of these, 13 studies were included that evaluated 1263 patients. In 6 RCTs, there were a statistical significant reduction (P<.05) of HbA1c at the end of studies in the intervention group. The HbA1c data were evaluated by meta-analysis with the following results (mean difference, MD ?0.44; CI: ?0.59 to ?0.29; P<.001; I{\texttwosuperior}=32\%).The evaluation favored the treatment in patients who used apps without significant heterogeneity. Conclusions: The use of apps by diabetic patients could help improve the control of HbA1c. In addition, the apps seem to strengthen the perception of self-care by contributing better information and health education to patients. Patients also become more self-confident to deal with their diabetes, mainly by reducing their fear of not knowing how to deal with potential hypoglycemic episodes that may occur. ", doi="10.2196/mhealth.6309", url="http://mhealth.jmir.org/2017/3/e4/", url="http://www.ncbi.nlm.nih.gov/pubmed/28249834" } @Article{info:doi/10.2196/mhealth.5720, author="Pham, Quynh and Wiljer, David and Cafazzo, A. Joseph", title="Beyond the Randomized Controlled Trial: A Review of Alternatives in mHealth Clinical Trial Methods", journal="JMIR Mhealth Uhealth", year="2016", month="Sep", day="09", volume="4", number="3", pages="e107", keywords="mobile health", keywords="mobile applications", keywords="smartphones", keywords="medical informatics", keywords="research design", keywords="clinical trials", abstract="Background: Randomized controlled trials (RCTs) have long been considered the primary research study design capable of eliciting causal relationships between health interventions and consequent outcomes. However, with a prolonged duration from recruitment to publication, high-cost trial implementation, and a rigid trial protocol, RCTs are perceived as an impractical evaluation methodology for most mHealth apps. Objective: Given the recent development of alternative evaluation methodologies and tools to automate mHealth research, we sought to determine the breadth of these methods and the extent that they were being used in clinical trials. Methods: We conducted a review of the ClinicalTrials.gov registry to identify and examine current clinical trials involving mHealth apps and retrieved relevant trials registered between November 2014 and November 2015. Results: Of the 137 trials identified, 71 were found to meet inclusion criteria. The majority used a randomized controlled trial design (80\%, 57/71). Study designs included 36 two-group pretest-posttest control group comparisons (51\%, 36/71), 16 posttest-only control group comparisons (23\%, 16/71), 7 one-group pretest-posttest designs (10\%, 7/71), 2 one-shot case study designs (3\%, 2/71), and 2 static-group comparisons (3\%, 2/71). A total of 17 trials included a qualitative component to their methodology (24\%, 17/71). Complete trial data collection required 20 months on average to complete (mean 21, SD 12). For trials with a total duration of 2 years or more (31\%, 22/71), the average time from recruitment to complete data collection (mean 35 months, SD 10) was 2 years longer than the average time required to collect primary data (mean 11, SD 8). Trials had a moderate sample size of 112 participants. Two trials were conducted online (3\%, 2/71) and 7 trials collected data continuously (10\%, 7/68). Onsite study implementation was heavily favored (97\%, 69/71). Trials with four data collection points had a longer study duration than trials with two data collection points: F4,56=3.2, P=.021, $\eta$2=0.18. Single-blinded trials had a longer data collection period compared to open trials: F2,58=3.8, P=.028, $\eta$2=0.12. Academic sponsorship was the most common form of trial funding (73\%, 52/71). Trials with academic sponsorship had a longer study duration compared to industry sponsorship: F2,61=3.7, P=.030, $\eta$2=0.11. Combined, data collection frequency, study masking, sample size, and study sponsorship accounted for 32.6\% of the variance in study duration: F4,55=6.6, P<.01, adjusted r2=.33. Only 7 trials had been completed at the time this retrospective review was conducted (10\%, 7/71). Conclusions: mHealth evaluation methodology has not deviated from common methods, despite the need for more relevant and timely evaluations. There is a need for clinical evaluation to keep pace with the level of innovation of mHealth if it is to have meaningful impact in informing payers, providers, policy makers, and patients. ", doi="10.2196/mhealth.5720", url="http://mhealth.jmir.org/2016/3/e107/", url="http://www.ncbi.nlm.nih.gov/pubmed/27613084" } @Article{info:doi/10.2196/mhealth.5127, author="Matthew-Maich, Nancy and Harris, Lauren and Ploeg, Jenny and Markle-Reid, Maureen and Valaitis, Ruta and Ibrahim, Sarah and Gafni, Amiram and Isaacs, Sandra", title="Designing, Implementing, and Evaluating Mobile Health Technologies for Managing Chronic Conditions in Older Adults: A Scoping Review", journal="JMIR mHealth uHealth", year="2016", month="Jun", day="09", volume="4", number="2", pages="e29", keywords="Telemedicine", keywords="Mobile health", keywords="Health Plan Implementations", keywords="Evaluation Studies as Topic", keywords="Design", keywords="mHealth Innovations", keywords="Frail Elderly", keywords="Older Adults", keywords="Multiple Chronic Conditions", keywords="Home Care Services", keywords="Scoping Review", keywords="Communication", keywords="Information Communication Technologies", abstract="Background: The current landscape of a rapidly aging population accompanied by multiple chronic conditions presents numerous challenges to optimally support the complex needs of this group. Mobile health (mHealth) technologies have shown promise in supporting older persons to manage chronic conditions; however, there remains a dearth of evidence-informed guidance to develop such innovations. Objectives: The purpose of this study was to conduct a scoping review of current practices and recommendations for designing, implementing, and evaluating mHealth technologies to support the management of chronic conditions in community-dwelling older adults. Methods: A 5-stage scoping review methodology was used to map the relevant literature published between January 2005 and March 2015 as follows: (1) identified the research question, (2) identified relevant studies, (3) selected relevant studies for review, (4) charted data from selected literature, and (5) summarized and reported results. Electronic searches were conducted in 5 databases. In addition, hand searches of reference lists and a key journal were completed. Inclusion criteria were research and nonresearch papers focused on mHealth technologies designed for use by community-living older adults with at least one chronic condition, or health care providers or informal caregivers providing care in the home and community setting. Two reviewers independently identified articles for review and extracted data. Results: We identified 42 articles that met the inclusion criteria. Of these, described innovations focused on older adults with specific chronic conditions (n=17), chronic conditions in general (n=6), or older adults in general or those receiving homecare services (n=18). Most of the mHealth solutions described were designed for use by both patients and health care providers or health care providers only. Thematic categories identified included the following: (1) practices and considerations when designing mHealth technologies; (2) factors that support/hinder feasibility, acceptability, and usability of mHealth technologies; and (3) approaches or methods for evaluating mHealth technologies. Conclusions: There is limited yet increasing use of mHealth technologies in home health care for older adults. A user-centered, collaborative, interdisciplinary approach to enhance feasibility, acceptability, and usability of mHealth innovations is imperative. Creating teams with the required pools of expertise and insight regarding needs is critical. The cyclical, iterative process of developing mHealth innovations needs to be viewed as a whole with supportive theoretical frameworks. Many barriers to implementation and sustainability have limited the number of successful, evidence-based mHealth solutions beyond the pilot or feasibility stage. The science of implementation of mHealth technologies in home-based care for older adults and self-management of chronic conditions are important areas for further research. Additionally, changing needs as cohorts and technologies advance are important considerations. Lessons learned from the data and important implications for practice, policy, and research are discussed to inform the future development of innovations. ", doi="10.2196/mhealth.5127", url="http://mhealth.jmir.org/2016/2/e29/", url="http://www.ncbi.nlm.nih.gov/pubmed/27282195" } @Article{info:doi/10.2196/mhealth.3216, author="Nhavoto, Ant{\'o}nio Jos{\'e} and Gr{\"o}nlund, {\AA}ke", title="Mobile Technologies and Geographic Information Systems to Improve Health Care Systems: A Literature Review", journal="JMIR mHealth uHealth", year="2014", month="May", day="08", volume="2", number="2", pages="e21", keywords="health care", keywords="eHealth", keywords="mobile technology", keywords="mobile phone", keywords="SMS", keywords="text messaging", keywords="geographic information system", keywords="GIS", abstract="Background: A growing body of research has employed mobile technologies and geographic information systems (GIS) for enhancing health care and health information systems, but there is yet a lack of studies of how these two types of systems are integrated together into the information infrastructure of an organization so as to provide a basis for data analysis and decision support. Integration of data and technical systems across the organization is necessary for efficient large-scale implementation. Objective: The aim of this paper is to identify how mobile technologies and GIS applications have been used, independently as well as in combination, for improving health care. Methods: The electronic databases PubMed, BioMed Central, Wiley Online Library, Scopus, Science Direct, and Web of Science were searched to retrieve English language articles published in international academic journals after 2005. Only articles addressing the use of mobile or GIS technologies and that met a prespecified keyword strategy were selected for review. Results: A total of 271 articles were selected, among which 220 concerned mobile technologies and 51 GIS. Most articles concern developed countries (198/271, 73.1\%), and in particular the United States (81/271, 29.9\%), United Kingdom (31/271, 11.4\%), and Canada (14/271, 5.2\%). Applications of mobile technologies can be categorized by six themes: treatment and disease management, data collection and disease surveillance, health support systems, health promotion and disease prevention, communication between patients and health care providers or among providers, and medical education. GIS applications can be categorized by four themes: disease surveillance, health support systems, health promotion and disease prevention, and communication to or between health care providers. Mobile applications typically focus on using text messaging (short message service, SMS) for communication between patients and health care providers, most prominently reminders and advice to patients. These applications generally have modest benefits and may be appropriate for implementation. Integration of health data using GIS technology also exhibit modest benefits such as improved understanding of the interplay of psychological, social, environmental, area-level, and sociodemographic influences on physical activity. The studies evaluated showed promising results in helping patients treating different illnesses and managing their condition effectively. However, most studies use small sample sizes and short intervention periods, which means limited clinical or statistical significance. Conclusions: A vast majority of the papers report positive results, including retention rate, benefits for patients, and economic gains for the health care provider. However, implementation issues are little discussed, which means the reasons for the scarcity of large-scale implementations, which might be expected given the overwhelmingly positive results, are yet unclear. There is also little combination between GIS and mobile technologies. In order for health care processes to be effective they must integrate different kinds of existing technologies and data. Further research and development is necessary to provide integration and better understand implementation issues. ", doi="10.2196/mhealth.3216", url="http://mhealth.jmir.org/2014/2/e21/", url="http://www.ncbi.nlm.nih.gov/pubmed/25099368" } @Article{info:doi/10.2196/mhealth.2688, author="Goel, Sonu and Bhatnagar, Nidhi and Sharma, Deepak and Singh, Amarjeet", title="Bridging the Human Resource Gap in Primary Health Care Delivery Systems of Developing Countries With mHealth: Narrative Literature Review", journal="JMIR Mhealth Uhealth", year="2013", month="Dec", day="03", volume="1", number="2", pages="e25", keywords="mHealth", keywords="human resource", keywords="health", keywords="developing countries", keywords="projects", abstract="Background: Mobile health (mHealth) has the potential to solve human resource issues in the health care sector. mHealth is of particular interest in developing countries, where widespread mobile networks and access to devices are connecting people like never before. Objective: The aim of this paper was to review published and unpublished literature, field projects, and pilot studies on mHealth usage in overcoming shortage of human health resources in developing countries. Methods: A narrative literature review was undertaken using an iterative approach in extracting literature focused on mHealth and human health resources of low-income countries, especially India. The present review has undertaken comprehensive coverage of the work on related field projects that have been either published, accepted for publication, or pilot tested. Results: This review presented the use of mHealth across various dimensions of primary health care, including data collection, disease surveillance, health education, supervision, monitoring, and feedback. Field studies of fast, error-free data collection and transmission using mHealth were also documented. New apps for supervision, monitoring, and utilization of innovative health education tools were documented in the current review. Practical limitations of mHealth and challenges set forth in developing countries included issues of data security, cost constraints, health provider privacy, and technical barriers. Conclusions: In the present review, we have documented a few mHealth projects that contribute to the proficient use of human resources. These projects pave the path for the efficient utilization of mHealth, offering solutions to emerging human resource challenges and simultaneously revamping the health care delivery in resource-limited settings. ", doi="10.2196/mhealth.2688", url="http://mhealth.jmir.org/2013/2/e25/", url="http://www.ncbi.nlm.nih.gov/pubmed/25099436" }