@Article{info:doi/10.2196/53854,
author="Roytman, V. Maya
and Lu, Layna
and Soyemi, Elizabeth
and Leziak, Karolina
and Niznik, M. Charlotte
and Yee, M. Lynn",
title="Exploring Psychosocial Burdens of Diabetes in Pregnancy and the Feasibility of Technology-Based Support: Qualitative Study",
journal="JMIR Diabetes",
year="2025",
month="Apr",
day="21",
volume="10",
pages="e53854",
keywords="digital health",
keywords="mHealth",
keywords="pregnancy",
keywords="psychosocial",
keywords="social determinants",
keywords="technology",
keywords="diabetes",
keywords="burdens",
keywords="qualitative analysis",
keywords="mobile apps",
keywords="feasibility",
abstract="Background: Gestational diabetes mellitus and type 2 diabetes mellitus impose psychosocial burdens on pregnant individuals. As there is less evidence about the experience and management of psychosocial burdens of diabetes mellitus during pregnancy, we sought to identify these psychosocial burdens and understand how a novel smartphone app may alleviate them. The app was designed to provide supportive, educational, motivational, and logistical support content, delivered through interactive messages. Objective: The study aimed to analyze the qualitative data generated in a feasibility randomized controlled trial of a novel mobile app designed to promote self-management skills, motivate healthy behaviors, and inform low-income pregnant individuals with diabetes. Methods: Individuals receiving routine clinical care at a single, large academic medical center in Chicago, Illinois were randomized to use of the SweetMama app (n=30) or usual care (n=10) from diagnosis of diabetes until 6 weeks post partum. All individuals completed exit interviews at delivery about their experience of having diabetes during pregnancy. Interviews were guided by a semistructured interview guide and were conducted by a single interviewer extensively trained in empathic, culturally sensitive qualitative interviewing of pregnant and postpartum people. SweetMama users were also queried about their perspectives on the app. Interview data were audio-recorded and professionally transcribed. Data were analyzed by 2 researchers independently using grounded theory constant comparative techniques. Results: Of the 40 participants, the majority had gestational diabetes mellitus (n=25, 63\%), publicly funded prenatal care (n=33, 83\%), and identified as non-Hispanic Black (n=25, 63\%) or Hispanic (n=14, 35\%). Participants identified multiple psychosocial burdens, including challenges taking action, negative affectivity regarding diagnosis, diet guilt, difficulties managing other responsibilities, and reluctance to use insulin. External factors, such as taking care of children or navigating the COVID-19 pandemic, affected participant self-perception and motivation to adhere to clinical recommendations. SweetMama participants largely agreed that the use of the app helped mitigate these burdens by enhancing self-efficacy, capitalizing on external motivation, validating efforts, maintaining medical nutrition therapy, extending clinical care, and building a sense of community. Participants expressed that SweetMama supported the goals they established with their clinical team and helped them harness motivating factors for self-care. Conclusions: Psychosocial burdens of diabetes during pregnancy present challenges with diabetes self-management. Mobile health support may be an effective tool to provide motivation, behavioral cues, and access to educational and social network resources to alleviate psychosocial burdens during pregnancy. Future incorporation of machine learning and language processing models in the app may provide further personalization of recommendations and education for individuals with DM during pregnancy. Trial Registration: ClinicalTrials.gov NCT03240874; https://clinicaltrials.gov/study/NCT03240874 ",
doi="10.2196/53854",
url="https://diabetes.jmir.org/2025/1/e53854"
}


@Article{info:doi/10.2196/58095,
author="Benavent, Diego
and Iniesta-Chamorro, M. Jose
and Novella-Navarro, Marta
and P{\'e}rez-Mart{\'i}nez, Miguel
and Mart{\'i}nez-S{\'a}nchez, Nuria
and Kaffati, M{\'o}nica
and Ju{\'a}rez-Garc{\'i}a, Manuel
and Molinari-P{\'e}rez, Marina
and Gonz{\'a}lez-Torbay, Andrea
and Guti{\'e}rrez, Mariana
and L{\'o}pez-Juanes, Natalia
and Navarro-Comp{\'a}n, Victoria
and Monjo-Henry, Irene
and Rodr{\'i}guez-Rosales, Germ{\'a}n
and Bachiller, Javier
and Calvo-Aranda, Enrique
and Michelena, Xabier
and Berbel-Arcob{\'e}, Laura
and Balsa, Alejandro
and 
and G{\'o}mez, J. Enrique
and Plasencia-Rodr{\'i}guez, Chamaida",
title="Digital Health Intervention for Patient Monitoring in Immune-Mediated Inflammatory Diseases: Cocreation and Feasibility Study of the IMIDoc Platform",
journal="JMIR Hum Factors",
year="2025",
month="Apr",
day="21",
volume="12",
pages="e58095",
keywords="immune-mediated inflammatory diseases",
keywords="cocreation",
keywords="health care provider",
keywords="digital health solution",
keywords="inflammatory",
keywords="inflammatory disease",
keywords="monitoring",
keywords="care model",
keywords="patient care",
keywords="development",
keywords="app",
keywords="user centered",
keywords="patient monitoring",
keywords="decision-making",
keywords="user needs",
abstract="Background: Immune-mediated inflammatory diseases, such as rheumatoid arthritis and spondyloarthritis, pose challenges due to recurrent flares and gaps in patient monitoring. Traditional health care models often fail to capture disease progression effectively. Objective: This study aimed to describes the structured cocreation of the IMIDoc platform, an interdisciplinary initiative aimed at improving patient monitoring, education, and health care provider decision-making. Methods: IMIDoc was cocreated through an interdisciplinary team involving clinical experts, biomedical engineers, and technical developers, using user-centered design principles. The development process included the identification of unmet clinical needs, user-centered app design, implementation of medication management features, patient data recording capabilities, and educational content. A 3-month feasibility and functionality testing was performed to evaluate the usability and technical performance of the apption. Results: During the feasibility testing, 111 entries were logged for the patient mobile app, comprising 76 errors identified and corrected, 16 improvements addressing functionality, usability, and performance, and 10 evolutionary suggestions. The professional interface received 45 entries, identifying 40 errors and 5 evolutionary suggestions. Ten iterative updates significantly enhanced the user interface intuitiveness and medication reminder functionality, aligning the solution closely with clinical workflows and user needs. Conclusions: The IMIDoc platform, developed by a multidisciplinary cocreation methodology, shows potential to improve the management of immune-mediated inflammatory diseases ithrough enhanced communication and monitoring. A multicenter clinical study with 360 patients across 5 Spanish hospitals will further evaluate its impact. Trial Registration: ClinicalTrials.gov NCT06273306; https://tinyurl.com/4t6ubcsf ",
doi="10.2196/58095",
url="https://humanfactors.jmir.org/2025/1/e58095"
}


@Article{info:doi/10.2196/66846,
author="King, Akilah
and Omoniyi, Tayo
and Zasadzinski, Lindsay
and Gaspard, Cynthia
and Gorman, Denesha
and Saunders, Milda",
title="Interactive Computer-Adaptive Chronic Kidney Disease (I-C-CKD) Education for Hospitalized African American Patients: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2025",
month="Apr",
day="17",
volume="14",
pages="e66846",
keywords="chronic kidney disease",
keywords="computerized adaptive education",
keywords="end-stage kidney disease",
keywords="end-stage renal disease",
keywords="glomerular filtration rate",
keywords="kidney failure",
keywords="usual hospital care",
keywords="inpatient",
abstract="Background: End-stage kidney disease (ESKD) or kidney failure is a condition where the kidneys lose the ability to function. African American individuals are 4 times as likely to develop ESKD compared to White American individuals. In addition, African American patients are less likely to have an optimal dialysis start and to choose renal replacement therapy modalities that align with their goals and values. Our prior work shows that culturally tailored, in-person education improves patient outcomes. This is the foundation for our innovative intervention using an African American virtual patient educator as an option for hospitalized patients with chronic kidney disease (CKD). Objective: The Interactive Computer-Adaptive Chronic Kidney Disease (I-C-CKD) study will determine whether the computerized adaptive education and usual hospital care impact the health literacy of African American patients with kidney disease. It will also assess how patients' lifestyle and commitment to health goals are impacted by the method of health literacy education. Methods: We will screen, recruit, and enroll hospitalized patients who self-identify as African American and have advanced CKD based on their estimated glomerular filtration rate. Eligible patients who verbally consented will be randomly assigned into either the computerized adaptive education intervention group or the control group (usual hospital care). Patients in the intervention group will receive a culturally tailored, adaptive education module. To analyze pretest, posttest, and follow-up survey results on patient CKD knowledge, ESKD treatment options, and health goals, we will use a paired, 2-tailed t test with a Bonferroni adjustment for multiple comparisons. Results: Recruitment for the I-C-CKD study began on May 2, 2023. We are currently recruiting and have enrolled 96 patients who completed both pretest and posttest surveys as of December 2024. This includes 50 patients in the control group and 46 patients in the intervention group. Data analysis has not occurred. Conclusions: African American individuals often receive less patient education about self-care and treatment options for CKD. We hope this study provides a solution to increase hospitalized African American patients' knowledge of CKD and motivation for CKD self-care through computerized adaptive education, reduce disparities, and improve patient outcomes. Trial Registration: ClinicalTrials.gov NCT06364358; https://clinicaltrials.gov/study/NCT06364358 International Registered Report Identifier (IRRID): DERR1-10.2196/66846 ",
doi="10.2196/66846",
url="https://www.researchprotocols.org/2025/1/e66846"
}


@Article{info:doi/10.2196/53144,
author="Paneerselvam, Sritheran Ganesh
and Lua, Lin Pei
and Chooi, Han Wen
and Rehman, Ur Inayat
and Goh, Wen Khang
and Ming, Chiau Long",
title="Effectiveness of Mobile Apps in Improving Medication Adherence Among Chronic Kidney Disease Patients: Systematic Review",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="16",
volume="27",
pages="e53144",
keywords="mobile applications",
keywords="medication adherence",
keywords="chronic kidney disease",
keywords="health outcomes",
keywords="mobile health",
keywords="mhealth",
keywords="digital health",
keywords="kidney disease",
keywords="patient education",
keywords="medication monitoring",
keywords="e-medication",
keywords="electronic medication",
abstract="Background: Chronic kidney disease (CKD) is a serious condition affecting millions of individuals worldwide. Adherence to medication regimens among patients with CKD is often suboptimal, leading to poor health outcomes. In recent years, mobile apps have gained popularity as a promising tool to improve medication adherence and self-management in various chronic diseases. Objective: This study aimed to evaluate the effectiveness of mobile apps to improve medication adherence among patients with CKD (including end-stage and renal replacement therapy). Methods: A systematic search was conducted using Scopus, Cochrane, PubMed, and EBSCOhost to include eligible articles that studied mobile apps to improve medication adherence among patients with CKD. The quality of the selected studies was evaluated using the Newcastle?Ottawa Scale and the Cochrane risk-of-bias tool. Results: Out of 231 relevant articles, only 9 studies were selected for this systematic review. Based on Newcastle?Ottawa Scale, 7 were deemed to be of high quality, while others were of fair quality. The Cochrane risk-of-bias tool indicated a low to moderate risk of bias across the included studies. Most of the included studies had a randomized controlled design. Of the 9 selected studies, 3 papers represented medication adherence by a coefficient of 10 variability of tacrolimus, 3 papers used adherence measurement scales to calculate the score for assessing medication adherence, 2 papers represented medication adherence by self-reporting, 2 papers represented medication adherence using electronic monitoring, and 1 represented medication adherence by pill count. The mobile apps were identified as Transplant Hero (Transplant Hero LLC), Perx (Perx Health), Smartphone Medication Adherence Saves Kidneys (developed by John McGillicuddy), Adhere4U (developed by Ahram Han), My Dialysis (developed by Benyamin Saadatifar), Kidney Love (developed by National Kidney foundation), and iCKD (developed by Dr Vivek Kumar). Of these apps, 3 focused on evaluating Transplant Hero, while the remaining investigated each of the other mentioned apps individually. The apps use various strategies to promote medication adherence, including reminders, gamification, patient education, and medication monitoring. A majority, 5 out of 9 mobile apps, had a statistically significant (P<.05) effect on medication adherence. There was strong evidence for a positive effect of interventions focusing on games and reminders combined with electronic medication tray monitoring and patient education. Conclusions: Mobile apps effectively improved medication adherence in patients with CKD, but low evidence and short intervention duration warrant caution. Future research should identify ideal features, provider costs, and user-friendly, secure apps. ",
doi="10.2196/53144",
url="https://www.jmir.org/2025/1/e53144"
}


@Article{info:doi/10.2196/59275,
author="Wang, Yi
and Tyagi, Shilpa
and Ng, Liang David Wei
and Teo, Ying Valerie Hui
and Kok, David
and Foo, Dennis
and Koh, Choon-Huat Gerald",
title="Primary Technology-Enhanced Care for Hypertension Scaling Program: Trial-Based Economic Evaluation Examining Effectiveness and Cost-Effectiveness Using Real-World Data in Singapore",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="15",
volume="27",
pages="e59275",
keywords="telehealth monitoring",
keywords="hypertension",
keywords="cost-effectiveness analysis",
keywords="real-world data",
keywords="Singapore",
keywords="telehealth",
keywords="cost-effectiveness",
keywords="blood pressure monitoring",
keywords="health care",
keywords="teleconsultation",
keywords="chatbot",
keywords="regression analysis",
keywords="medical cost",
abstract="Background: Telehealth interventions are effective in hypertension management. However, the cost-effectiveness of using them for managing patients with hypertension remains inconclusive. Further research is required to understand the effectiveness and cost-effectiveness in the real-world setting. Objective: The Primary Technology-Enhanced Care for Hypertension (PTEC-HT) scaling program, a telehealth intervention for hypertension management, is currently being scaled nationwide in Singapore. The program comprises remote blood pressure (BP) monitoring at home, health care team support through teleconsultations, and in-app support with a digital chatbot. This study aimed to evaluate the program's effectiveness and cost-effectiveness. Methods: For patients under the PTEC-HT scaling program, BP readings over 6 months and 12 months, age, and gender were collected within the program. Health care use, health care cost, and patient ethnicity were extracted from the National Healthcare Group Polyclinics. For patients in the usual care group, demographic information, clinical data, health care use, and health care costs were extracted from the national claims records. Comparing the PTEC-HT scaling program with usual care, a trial-based economic evaluation using patient-level data was conducted to examine the effectiveness and cost-effectiveness over time horizons of 6 months and 12 months. The health care system's perspective was adopted. Regression analysis and exact matching were used to control for the differences between the PTEC-HT group and the usual care group. Results: For the 6-month analysis, 427 patients were included in the PTEC-HT group, and 64,679 patients were included in the usual care group. For the 12-month analysis, 338 patients were included in the PTEC-HT group, and 7324 patients were included in the usual care group. Using exact matching plus regression, in the 6-month analysis, the probability of having controlled BP was 13.5\% (95\% CI 6.3\%-20.7\%) higher for the PTEC-HT group compared to the usual care group. In the 12-month analysis, the probability of having controlled BP was 16\% (95\% CI 10.7\%-21.3\%) higher for the PTEC-HT group. Without considering the cost of the BP machine and program maintenance cost, the direct medical cost was S \$57.7 (95\% CI 54.4-61.0; a currency exchange rate of S \$1=US \$0.74 was applicable;) lower per patient for the PTEC-HT group in the 6-month analysis and S \$170.9 (95\% CI 151.9-189.9) lower per patient for the PTEC-HT group in the 12-month analysis. With the cost of the BP machine and program maintenance considered, compared to usual care, the PTEC-HT program reached breakeven at around the sixth month and saved S \$52.6 (95\% CI 33.6-71.6) per patient at the 12th month. Conclusions: Implemented in a real-world setting in Singapore, our study showed that the PTEC-HT scaling program is more effective in controlling BP status with lower cost compared to the usual care over 12 months. ",
doi="10.2196/59275",
url="https://www.jmir.org/2025/1/e59275"
}


@Article{info:doi/10.2196/66335,
author="Po{\ss}-Doering, Regina
and Brinkm{\"o}ller, Sabrina
and Balzer, Alexandra
and Wurmbach, Sophie Viktoria
and Paul, Cinara
and Stolz, Regina
and Zugaj, Richard Marco
and Tesarz, Jonas
and Wensing, Michel
and Stra{\ss}ner, Cornelia",
title="Resource-Oriented Case Management to Implement Recommendations for Patients With Chronic Pain and Frequent Use of Analgesics in General Practices (Project RELIEF): Protocol for a Single-Arm Exploratory Feasibility Study",
journal="JMIR Res Protoc",
year="2025",
month="Apr",
day="15",
volume="14",
pages="e66335",
keywords="chronic noncancer pain",
keywords="case management",
keywords="primary care",
keywords="general practice resource-oriented",
keywords="chronic pain",
keywords="analgesics",
keywords="pharmacological treatment",
keywords="pain medications",
keywords="holistic approach",
keywords="feasibility",
keywords="single-arm",
keywords="exploratory",
keywords="pilot study",
keywords="screening",
keywords="questionnaire",
keywords="survey",
keywords="protocol",
abstract="Background: Chronic noncancer pain (CNCP) is a frequent reason for counseling in general practice. Current German guidelines emphasize its biopsychosocial etiology and the importance of self-care and nonpharmacological treatment strategies such as education, physical and social activity, and psychological approaches. Comprehensive assessments are necessary to individualize treatment maximally and monitor appropriate use of pain medication. General practitioners face many challenges in implementing holistic pain management, which considers biological, psychological, and social aspects. In project RELIEF (resource-oriented case management to implement recommendations for patients with chronic pain and frequent use of analgesics in general practices), a case management program was developed to facilitate implementation of guideline recommendations on pain management regarding medical assessment and monitoring, patient and practice team education, promotion of self-care strategies, and rational pharmacotherapy. Objective: We evaluated the feasibility of the intervention and study procedures before applying them in a larger cluster randomized controlled trial. Our secondary objective is to estimate potential effects of the complex intervention. Methods: A single-arm trial with general practices and patients with CNCP and analgesics use will be conducted, accompanied by a mixed methods process evaluation. The intervention comprises 5 components, including software-supported medical pain history, 3 scheduled structured appointments, e-learning on CNCP for general practitioners and medical assistants, educational material for patients, toolbox with information on (regional) resources for patients and practice teams. Participating practices will be located in the federal state of Baden-W{\"u}rttemberg, Germany, and will recruit eligible patients (adults with CNCP for more than 3 months, with at least moderate pain-related disability, permanent or on-demand use of analgesics or co-analgesics in the previous 4 weeks, and practice team assessed ability to participate actively in the trial). A questionnaire given to the first 150 adult patients entering the practice in February 2025 will help screen eligible patients. The primary objective will be measured by a set of predefined indicators. The key secondary outcome is pain-related disability measured by the Pain Disability Index German version. All participants will be asked to participate in the process evaluation. Outcome evaluation data will be gathered by paper-based and digitally provided questionnaires to be completed by participants. Process evaluation data will be gathered in surveys and a qualitative study. Descriptive analyses will be performed. Results: Recruitment occurred between October and December 2024. Targeted sample size was 6 practices and 50 patients. The intervention period will be February-June 2025. It is expected that eligible patients will benefit from the intervention and that improved medication management and intensified use of nonpharmacological treatment strategies will reduce pain-related disabilities and other patient-reported outcomes. Conclusions: This study will provide valuable information regarding feasibility and potential effects before testing the intervention in a confirmatory cluster randomized controlled trial. Trial Registration: German Clinical Trials Register DRKS00034831; https://www.drks.de/search/de/trial/DRKS00034831 International Registered Report Identifier (IRRID): PRR1-10.2196/66335 ",
doi="10.2196/66335",
url="https://www.researchprotocols.org/2025/1/e66335"
}


@Article{info:doi/10.2196/72037,
author="Pessoa, Cheila",
title="Enhancing Self-Management Support Apps for Spinal Cord Injury: The Missing Role of Caregivers",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Apr",
day="14",
volume="13",
pages="e72037",
keywords="mobile phone",
keywords="mHealth",
keywords="eHealth",
keywords="telemedicine",
keywords="telehealth",
keywords="spinal cord injury",
keywords="self-management",
keywords="internet-based intervention",
keywords="World Wide Web",
keywords="systematic review",
keywords="caregiver",
doi="10.2196/72037",
url="https://mhealth.jmir.org/2025/1/e72037"
}


@Article{info:doi/10.2196/60758,
author="Caballero Mateos, Irene
and Morales Portillo, Crist{\'o}bal
and Lainez L{\'o}pez, Mar{\'i}a
and Vilches-Arenas, {\'A}ngel",
title="Efficacy of a Digital Educational Intervention for Patients With Type 2 Diabetes Mellitus: Multicenter, Randomized, Prospective, 6-Month Follow-Up Study",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="10",
volume="27",
pages="e60758",
keywords="body composition",
keywords="type 2 diabetes mellitus",
keywords="digital",
keywords="metabolic control",
keywords="social networks",
keywords="satisfaction",
keywords="telemedicine",
abstract="Background: Adherence to therapies and metabolic control among patients with type 2 diabetes mellitus (T2DM) remain challenging. The use of new technologies, such as telemedicine, digitalized systems, and social networks, could improve self-management and disease control. Objective: We evaluated the efficacy of a digital educational intervention for patients with T2DM, expressed as changes in glycated hemoglobin (HbA1c) and body composition and evaluation of the response using validated questionnaires of satisfaction with health care professionals (Instrument for Evaluation of the Experience of Chronic Patients), Diabetes Knowledge Scale (ECODI), and adherence to treatment over 6 months of follow-up (Morisky, Green, Levine Medication Assessment Questionnaire). Methods: This multicenter, randomized, prospective study included adults with T2DM with poor metabolic control who started treatment with glucagon-like peptide-1 receptor agonists. Patients were randomized to digital intervention or usual care. The intervention group received education through social networks and digital tools in a structured program of healthy lifestyle changes. This was provided by a ``Digital Coach'' for weekly and on-demand advice and individualized support. Baseline and follow-up demographic, clinical parameter, adherence, and quality of life data were collected. Results: We included 85 patients (control: n=41; intervention: n=44). Both groups were matched regarding demographics, physical examination, insulin, and biochemical parameters. We observed a reduction in body weight (intervention: --8.7, SD 6.1 kg vs control: --4.9, SD 5.0 kg; t83=--3.13; P=.002), BMI (intervention: --3.0, SD 2.1 kg/m2 vs control: --1.8, SD 1.8 kg/m2; t83=--2.82; P=.006), and fast mass in both groups but greater in the intervention group. There were greater reductions in fasting plasma glucose (intervention: 122.6, SD 81.5 mg/dL vs control: 70.5, SD 72.9 mg/dL; t83=3.10; P=.004) and HbA1c (intervention: 3.7\%, SD 1.9\% vs control: 2.6\%, SD 2.1\%; t83=2.54; P=.006) in the intervention group. Although there was no significant change in the Spanish version of the Diabetes Quality of Life Questionnaire (EsDQOL) satisfaction score in the control group after 6 months of follow-up (0.7, SD 19.8), there was a marked reduction in EsDQOL satisfaction score in the intervention group (--13.7, SD 23.1; t83=--3.08; P=.02). According to the ECODI scale, knowledge about diabetes increased more in the intervention group (intervention: 0.3, SD 1.8 vs control: 1.5, SD 1.5; t83=--3.33; P=.001). Although the medication adherence score worsened in the control group after 6 months, it significantly improved with the intervention (control: --8\% vs intervention: 13.8\%; $\chi$21=0.35; P=.01). Patients' health care experiences improved with the intervention but not with the control. Conclusions: The digital educational intervention was effective at improving glycemic control, body composition, adherence, and patient satisfaction compared with usual care in patients with T2DM. The implementation of digital tools and social media could highly improve the multidisciplinary approach to the management of this population. Trial Registration: ClinicalTrials.gov NCT06850129; https://clinicaltrials.gov/study/NCT06850129 ",
doi="10.2196/60758",
url="https://www.jmir.org/2025/1/e60758"
}


@Article{info:doi/10.2196/65721,
author="Wiesm{\"u}ller, Fabian
and Prenner, Andreas
and Ziegl, Andreas
and El-Moazen, Gihan
and Modre-Osprian, Robert
and Baumgartner, Martin
and Brodmann, Marianne
and Seinost, Gerald
and Silbernagel, G{\"u}nther
and Schreier, G{\"u}nter
and Hayn, Dieter",
title="Support of Home-Based Structured Walking Training and Prediction of the 6-Minute Walk Test Distance in Patients With Peripheral Arterial Disease Based on Telehealth Data: Prospective Cohort Study",
journal="JMIR Form Res",
year="2025",
month="Apr",
day="10",
volume="9",
pages="e65721",
keywords="mHealth",
keywords="telehealth",
keywords="peripheral arterial disease",
keywords="home-based structured walking training",
keywords="trend estimation",
keywords="predictive modeling",
keywords="continuous data",
keywords="walking",
keywords="walking training",
keywords="prediction",
keywords="prediction model",
keywords="cardiovascular disease",
keywords="stroke",
keywords="heart failure",
keywords="physical fitness",
keywords="telehealth system",
abstract="Background: Telehealth has been effective in managing cardiovascular diseases like stroke and heart failure and has shown promising results in managing patients with peripheral arterial disease. However, more work is needed to fully understand the effect of telehealth-based predictive modeling on the physical fitness of patients with peripheral arterial disease. Objective: For this work, data from the Keep Pace study were analyzed in depth to gain insights on temporal developments of patients' conditions and to develop models to predict the patients' total walking distance at the study end. This could help to determine patients who are likely to benefit from the telehealth program and to continuously provide estimations to the patients as a motivating factor. Methods: This work analyzes continuous patient-reported telehealth data, in combination with in-clinic data from 19 Fontaine stage II patients with peripheral arterial disease who underwent a 12-week telehealth-based walking program. This analysis granted insights into the increase of the total walking distance of the 6-minute walk tests (6MWT) as a measure for physical fitness, the steady decrease in the patients' pain, and the positive correlation between well-being and the total walking distance measured by the 6MWT. Results: This work analyzed trends of and correlations between continuous patient-generated data. Findings of this study include a significant decrease of the patients' pain sensation over time (P=.006), a low but highly significant correlation between pain sensation and steps taken on the same day (r=?0.11; P<.001) and the walking distance of the independently performed 6MWTs (r=?0.39; P<.001). Despite the reported pain, adherence to the 6MWT measurement protocol was high (85.53\%). Additionally, patients significantly improved their timed-up-and-go test times during the study (P=.002). Predicting the total walking distance at the study end measured by the 6MWT worked well at study baseline (root mean squared error of 30 meters; 7.04\% of the mean total walking distance at the study end of 425 meters) and continuously improved by adding further telehealth data. Future work should validate these findings in a larger cohort and in a prospective setting based on a clinical outcome. Conclusions: We conclude that the prototypical trend estimation has great potential for an integration in the telehealth system to be used in future work to provide tailored patient-specific advice based on these predictions. Continuous data from the telehealth system grant a deeper insight and a better understanding of the patients' status concerning well-being and level of pain as well as their current physical fitness level and the progress toward reaching set goals. Trial Registration: ClinicalTrials.gov Identifier: NCT05619835; https://tinyurl.com/mrxt7y9u ",
doi="10.2196/65721",
url="https://formative.jmir.org/2025/1/e65721"
}


@Article{info:doi/10.2196/59579,
author="Li, Yang
and Yang, Yue
and Liu, Xiaoqin
and Zhang, Xinting
and Li, Fei",
title="Effectiveness of Telemedicine-Delivered Carbohydrate-Counting Interventions in Patients With Type 1 Diabetes: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="10",
volume="27",
pages="e59579",
keywords="type 1 diabetes",
keywords="hemoglobin A1c",
keywords="telemedicine",
keywords="carbohydrate counting",
keywords="review",
abstract="Background: Type 1 diabetes mellitus (T1DM) significantly affects patients' quality of life and can be life-threatening, necessitating improved monitoring strategies. Telemedicine, which leverages telecommunications technologies to deliver health care services and expertise, has the potential to enhance T1DM management. However, its effectiveness remains to be fully established. Objective: This study aims to evaluate the effectiveness of various telemedicine-based carbohydrate-counting (CC) interventions in patients with T1DM. Methods: This systematic review and meta-analysis searched 5 databases---PubMed, Web of Science, CINAHL, Embase, and Cochrane---as well as reference lists of retrieved articles on September 26, 2024, for randomized controlled trials (RCTs) assessing the effectiveness of telemedicine-based CC interventions in reducing glycated hemoglobin A1c (HbA1c) levels in patients with T1DM. Results: From 3612 citations, we identified 18 eligible RCTs (n=1627) from 14 regions for inclusion in the meta-analysis. Participants in the telemedicine intervention group experienced a 0.35\% reduction in HbA1c levels (95\% CI --0.54 to --0.16) compared with the control group. A total of 13 studies used smartphone apps, 4 used connected and wearable glucometers, and 3 delivered the intervention through web-based systems. Significant reductions in HbA1c were observed across smartphone apps (--0.36\%, 95\% CI --0.63\% to --0.09\%), connected and wearable glucometers (--0.35\%, 95\% CI --0.56\% to --0.14\%), and web-based systems (--0.36\%, 95\% CI --0.71\% to --0.02\%). Considerable heterogeneity was noted (I2=81\%, P<.001). Telemedicine-based CC interventions also increased time in range by 9.59\% (95\% CI 6.50\%-12.67\%). However, evidence regarding treatment satisfaction, total daily insulin dose, and hypoglycemia remains inconclusive. Subgroup analysis showed that telemedicine platform variety did not significantly contribute to heterogeneity, while meta-regression indicated that the impact on HbA1c was most pronounced in trials conducted in Asia. Conclusions: Compared with usual care, telemedicine-delivered CC interventions improved HbA1c and time in range but did not significantly impact other clinically relevant outcomes in patients with T1DM. High-quality, large-scale RCTs are needed to draw definitive conclusions. These findings provide health care professionals with updated evidence on the role of telemedicine in glycemic control for patients with T1DM. Trial Registration: PROSPERO CRD42024523025; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024523025 ",
doi="10.2196/59579",
url="https://www.jmir.org/2025/1/e59579",
url="http://www.ncbi.nlm.nih.gov/pubmed/39965802"
}


@Article{info:doi/10.2196/68936,
author="Fundoiano-Hershcovitz, Yifat
and Lee, Felix
and Stanger, Catherine
and Breuer Asher, Inbar
and Horwitz, L. David
and Manejwala, Omar
and Liska, Jan
and Kerr, David",
title="Digital Health Intervention on Awareness of Vaccination Against Influenza Among Adults With Diabetes: Pragmatic Randomized Follow-Up Study",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="10",
volume="27",
pages="e68936",
keywords="digital health",
keywords="diabetes management",
keywords="influenza vaccination",
keywords="flu vaccination awareness",
keywords="mobile health",
abstract="Background: Diabetes mellitus significantly increases the risk of severe complications from influenza, necessitating targeted vaccination efforts. Despite vaccination being the most effective preventive measure, coverage remains below the World Health Organization's targets, partly due to limited awareness among patients. This study evaluated a digital health intervention aimed at improving influenza vaccination rates among adults with diabetes. Objective: This study aimed to demonstrate the effectiveness of digital health platforms in increasing vaccination rates among people with diabetes and to emphasize the impact of tailored messaging frequency on patient engagement and health behavior change. We hypothesized that digital tools providing empirical evidence of increased health risk awareness can effectively drive preventive actions. Methods: The study leveraged the Dario (Dario Health Corp) digital health platform to retrospectively analyze data from 64,904 users with diabetes assigned by the platform into three groups: (1) Group A received previously studied monthly flu nudge messages; (2) Group B received an adapted intervention with 2-3 monthly messages; (3) Group C served as the control with no intervention. Surveys were conducted at baseline, 3 months, and 6 months to assess vaccination status, awareness of influenza risks, and recollection of educational content. Statistical analyses, including logistic regression, chi-square tests, and t tests, were used to evaluate differences between groups. Results: Out of 64,904 users, 8431 completed the surveys. Vaccination rates were 71.0\% in group A, 71.9\% in group B, and 70.5\% in group C. Group B showed significantly higher awareness of influenza risks compared with the control group odds ratio (OR; OR 1.35, 95\% CI 1.12-1.63; P=.001), while group A did not (OR 1.10, 95\% CI 0.92-1.32; P=.27). Recollection of educational content was also higher in groups A (OR 1.29, 95\% CI 1.07-1.56; P=.008) and B (OR 1.92, 95\% CI 1.59-2.33; P<.001) compared with the control. In addition, a significant correlation between awareness and vaccination rates was found only in group B ($\chi$2(df=1)=6.12, P=.01). Conclusions: The adapted digital intervention (group B) effectively increased awareness of influenza risks and recollection of educational content, which correlated with the higher trend in vaccination rates. This study demonstrates the potential of digital health tools to enhance influenza vaccination among people with diabetes by improving risk awareness and education. Further research should focus on optimizing these interventions to achieve significant improvements in vaccination uptake and overall public health outcomes. Trial Registration: ClinicalTrials.gov NCT06840236; https://clinicaltrials.gov/study/NCT06840236 ",
doi="10.2196/68936",
url="https://www.jmir.org/2025/1/e68936",
url="http://www.ncbi.nlm.nih.gov/pubmed/40209214"
}


@Article{info:doi/10.2196/60703,
author="Seng, Benjamin Jun Jie
and Nyanavoli, Hosea
and Decruz, Moses Glenn
and Kwan, Heng Yu
and Low, Leng Lian",
title="Health Coaching and Its Impact in the Remote Management of Patients With Type 2 Diabetes Mellitus: Scoping Review of the Literature",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="9",
volume="27",
pages="e60703",
keywords="diabetes mellitus",
keywords="type 2",
keywords="remote consultation",
keywords="telenursing",
keywords="education",
keywords="health coaching",
keywords="scoping review",
keywords="telemonitoring",
keywords="PRISMA",
abstract="Background: Health coaching refers to the practice of health education and promotion to drive goal-directed behavioral changes and improve an individual's well-being. Remote patient monitoring systems, which employ health coaching interventions, have been gaining interest and may aid in the management of patients with type 2 diabetes mellitus (T2DM). Objective: This scoping review aims to summarize the impact of health coaching in the remote monitoring of patients with T2DM. Methods: A scoping review was performed in MEDLINE, Embase, CINAHL, PsychInfo, and Web of Science up to September 2024 and was reported using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. The initial abstract screening, full-text review, and data extraction were performed by 2 independent reviewers. Studies that evaluated the impact of health coaching on the remote management of patients with T2DM were included. Outcomes evaluated were grouped into clinical, humanistic, psychiatric, behavioral, knowledge, and economic domains. A narrative review was performed for the impact of health coaching on the remote management of patients with T2DM. Results: Among 168,888 citations identified, 104 studies were included. Majority of the studies were conducted in North America (56/104, 53.8\%) and Asia (30/104, 28.8\%). Approximately half of the studies (48/104, 46.2\%) were conducted in primary health care settings, and one-third of the studies (37/104, 35.6\%) employed nurses as health coaches. Phone consultations were the most common modality of remote monitoring (45/104, 43.3\%). The follow-up duration of most studies (64/104, 61.5\%) was less than 1 year. Regarding clinical outcomes, majority of the studies (68/92, 73\%) showed improvements in diabetes-related parameters, but there was no improvement in blood pressure (21/32, 66\%) or hyperlipidemia control (19/32, 59\%). For humanistic outcomes, health coaching was associated with higher satisfaction with diabetes-related care (10/11, 91\%), but there was no improvement in quality of life (12/20, 60\%). Regarding psychiatric outcomes, there was no association with improvement in depressive (8/14, 57\%) or anxiety symptoms (4/5, 80\%). For behavioral outcomes, most studies (12/19, 63\%) showed improvement in diabetes-related self-efficacy. For knowledge outcomes, evidence was mixed, with half of the studies (5/9, 56\%) showing improvement in diabetes-related knowledge. For economic outcomes, majority of the studies (8/11, 73\%) did not show a reduction in health care use. Conclusions: Health coaching was associated with improved diabetes control and self-management among patients with T2DM on remote monitoring. Its role appears limited in improving health care use, lipid parameters, and quality of life; however, this may have been confounded by the short duration of follow-up in the studies. More studies are required to identify the optimal modality and duration of digital health coaching for patients with T2DM. ",
doi="10.2196/60703",
url="https://www.jmir.org/2025/1/e60703",
url="http://www.ncbi.nlm.nih.gov/pubmed/40202791"
}


@Article{info:doi/10.2196/72466,
author="Plavoukou, Theodora
and Iosifidis, Michail
and Papagiannis, Georgios
and Stasinopoulos, Dimitrios
and Georgoudis, Georgios",
title="The Effectiveness of Telerehabilitation in Managing Pain, Strength, and Balance in Adult Patients With Knee Osteoarthritis: Systematic Review",
journal="JMIR Rehabil Assist Technol",
year="2025",
month="Apr",
day="8",
volume="12",
pages="e72466",
keywords="telerehabilitation",
keywords="knee osteoarthritis",
keywords="pain management",
keywords="remote physiotherapy",
keywords="digital health",
keywords="remote therapy",
keywords="physiotherapy",
keywords="strength",
keywords="balance",
keywords="functional mobility",
keywords="rehabilitation technology",
abstract="Background: Knee osteoarthritis (KOA) is a chronic, degenerative joint disease characterized by pain, stiffness, and functional impairment, significantly affecting mobility and quality of life. Traditional rehabilitation, mainly through in-person physiotherapy, is widely recommended for KOA management. However, access to these services is often limited due to geographic, financial, and mobility constraints. Telerehabilitation has emerged as an alternative, providing remote rehabilitation through digital platforms. Despite its increasing adoption, its effectiveness in improving key functional parameters such as pain, strength, and balance remains uncertain. While previous studies have focused primarily on pain relief and overall functional improvement, a broader assessment of its impact on mobility and fall prevention is needed. Objective: This systematic review examines the effectiveness of telerehabilitation in improving pain, strength, and balance in adults with KOA compared with traditional rehabilitation or no intervention. In addition, it evaluates the impact of different telerehabilitation models, such as therapist-guided versus self-managed programs, and explores the feasibility of integrating telerehabilitation as an alternative in KOA management. Methods: A systematic search of 4 databases (PubMed, PEDro, Cochrane, and Scopus) was conducted to identify randomized controlled trials (RCTs) published from May 2004 to May 2024. Inclusion criteria consisted of adults with KOA, evaluation of telerehabilitation either as a stand-alone intervention or in comparison to traditional rehabilitation or no intervention, and measurement of at least one primary outcome (pain, strength, or balance). A total of 2 independent reviewers assessed the risk of bias using validated tools. Due to variations in intervention programs and assessment methods, a narrative synthesis was performed instead of a meta-analysis. The review followed established guidelines, and data extraction was conducted using appropriate software. Results: A total of 6 RCTs (N=581 participants) met the inclusion criteria. The results indicate that telerehabilitation effectively reduces pain and improves strength and balance, although the extent of benefits varies. Some studies reported similar pain reductions between telerehabilitation and traditional rehabilitation, while others highlighted greater functional improvements in telerehabilitation groups. Therapist-guided telerehabilitation was associated with higher adherence rates and better functional outcomes compared with self-managed programs. The risk of bias assessment showed that most studies were of moderate to good quality, though common issues included selection bias, performance bias, and participant attrition. Conclusions: Telerehabilitation is a promising alternative for KOA management, especially for individuals facing barriers to in-person therapy. It is effective in reducing pain and improving strength and balance, though its success depends on patient engagement, intervention delivery, and rehabilitation protocols. Therapist-guided programs yield better outcomes than self-managed approaches. Further research is needed to standardize intervention protocols, integrate emerging technologies, and evaluate cost-effectiveness to guide clinical practice and health care policies. Trial Registration: PROSPERO CRD42024564141; https://tinyurl.com/25ykvy7d ",
doi="10.2196/72466",
url="https://rehab.jmir.org/2025/1/e72466",
url="http://www.ncbi.nlm.nih.gov/pubmed/40198917"
}


@Article{info:doi/10.2196/68179,
author="Rades, Dirk
and K{\"u}ter, Jan-Dirk
and von Staden, Michael
and Al-Salool, Ahmed
and Janssen, Stefan
and Timke, Carmen
and Duma, Nona Marciana
and Bartscht, Tobias
and Vesterg{\aa}rd Madsen, Christine
and Kristiansen, Charlotte
and Cremers, Florian",
title="A Reminder App to Optimize Bladder Filling During Radiotherapy for Patients With  Prostate Cancer (REFILL-PAC): Protocol for a Prospective Trial",
journal="JMIR Res Protoc",
year="2025",
month="Apr",
day="8",
volume="14",
pages="e68179",
keywords="prostate cancer",
keywords="external beam radiation therapy",
keywords="radiation toxicity",
keywords="bladder filling",
keywords="mobile app",
abstract="Background: Many patients with nonmetastatic prostate cancer receive radiotherapy, which may be associated with acute cystitis, particularly if the volume of the urinary bladder is small. Three studies showed bladder volumes <200 ml or <180 ml to be associated with increased urinary toxicity. Therefore, it is important to maintain bladder volumes greater than 200 ml during as many radiation fractions as possible. Several studies investigated drinking protocols, where patients were asked to drink a certain amount of water prior to radiotherapy sessions. This may require considerable discipline from the patients, who are predominantly older adults. Adherence to a drinking protocol may be facilitated by a mobile app that reminds patients to drink water prior to each radiation session. This study investigates the effect of such an app on bladder filling status in patients with prostate cancer undergoing external beam radiotherapy (EBRT) alone. Objective: The primary goal of this study is to evaluate the impact of an app that reminds patients irradiated for prostate cancer to drink 300 ml of water prior to each radiotherapy session on the number of fractions with bladder volumes <200 ml during the radiotherapy course. Methods: This ongoing phase 2 aims to recruit 28 patients treated with EBRT alone for nonmetastatic prostate cancer. Radiotherapy will be administered using normo-fractionation, with doses ranging from 70 to 80 Gy in 35 to 40 fractions of 2 Gy, preferably with volumetric-modulated arc therapy (VMAT). Treatment volumes include the prostate with or without the seminal vesicles. Results: Recruitment for this trial will start in March 2025 and is planned to be completed in October 2026. The study is scheduled to conclude in December 2026. Conclusions: This trial is the first to evaluate the impact of a reminder app on the number of radiotherapy fractions with bladder volumes <200 ml in patients undergoing irradiation for localized prostate cancer. Trial Registration: Clinicaltrials.gov NCT06653751; https://clinicaltrials.gov/show/NCT06653751 International Registered Report Identifier (IRRID): PRR1-10.2196/68179 ",
doi="10.2196/68179",
url="https://www.researchprotocols.org/2025/1/e68179"
}


@Article{info:doi/10.2196/59632,
author="Hwang, Misun
and Zheng, Yaguang
and Cho, Youmin
and Jiang, Yun",
title="AI Applications for Chronic Condition Self-Management: Scoping Review",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="8",
volume="27",
pages="e59632",
keywords="artificial intelligence",
keywords="chronic disease",
keywords="self-management",
keywords="generative AI",
keywords="emotional self-management",
abstract="Background: Artificial intelligence (AI) has potential in promoting and supporting self-management in patients with chronic conditions. However, the development and application of current AI technologies to meet patients' needs and improve their performance in chronic condition self-management tasks remain poorly understood. It is crucial to gather comprehensive information to guide the development and selection of effective AI solutions tailored for self-management in patients with chronic conditions. Objective: This scoping review aimed to provide a comprehensive overview of AI applications for chronic condition self-management based on 3 essential self-management tasks, medical, behavioral, and emotional self-management, and to identify the current developmental stages and knowledge gaps of AI applications for chronic condition self-management. Methods: A literature review was conducted for studies published in English between January 2011 and October 2024. In total, 4 databases, including PubMed, Web of Science, CINAHL, and PsycINFO, were searched using combined terms related to self-management and AI. The inclusion criteria included studies focused on the adult population with any type of chronic condition and AI technologies supporting self-management. This review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Results: Of the 1873 articles retrieved from the search, 66 (3.5\%) were eligible and included in this review. The most studied chronic condition was diabetes (20/66, 30\%). Regarding self-management tasks, most studies aimed to support medical (45/66, 68\%) or behavioral self-management (27/66, 41\%), and fewer studies focused on emotional self-management (14/66, 21\%). Conversational AI (21/66, 32\%) and multiple machine learning algorithms (16/66, 24\%) were the most used AI technologies. However, most AI technologies remained in the algorithm development (25/66, 38\%) or early feasibility testing stages (25/66, 38\%). Conclusions: A variety of AI technologies have been developed and applied in chronic condition self-management, primarily for medication, symptoms, and lifestyle self-management. Fewer AI technologies were developed for emotional self-management tasks, and most AIs remained in the early developmental stages. More research is needed to generate evidence for integrating AI into chronic condition self-management to obtain optimal health outcomes. ",
doi="10.2196/59632",
url="https://www.jmir.org/2025/1/e59632"
}


@Article{info:doi/10.2196/65629,
author="Lim, De Ming
and Connie, Tee
and Goh, Ong Michael Kah
and Saedon, `Izzati Nor",
title="Model-Based Feature Extraction and Classification for Parkinson Disease Screening Using Gait Analysis: Development and Validation Study",
journal="JMIR Aging",
year="2025",
month="Apr",
day="8",
volume="8",
pages="e65629",
keywords="model-based features",
keywords="gait analysis",
keywords="Parkinson disease",
keywords="computer vision",
keywords="support vector machine",
abstract="Background: Parkinson disease (PD) is a progressive neurodegenerative disorder that affects motor coordination, leading to gait abnormalities. Early detection of PD is crucial for effective management and treatment. Traditional diagnostic methods often require invasive procedures or are performed when the disease has significantly progressed. Therefore, there is a need for noninvasive techniques that can identify early motor symptoms, particularly those related to gait. Objective: The study aimed to develop a noninvasive approach for the early detection of PD by analyzing model-based gait features. The primary focus is on identifying subtle gait abnormalities associated with PD using kinematic characteristics. Methods: Data were collected through controlled video recordings of participants performing the timed up and go (TUG) assessment, with particular emphasis on the turning phase. The kinematic features analyzed include shoulder distance, step length, stride length, knee and hip angles, leg and arm symmetry, and trunk angles. These features were processed using advanced filtering techniques and analyzed through machine learning methods to distinguish between normal and PD-affected gait patterns. Results: The analysis of kinematic features during the turning phase of the TUG assessment revealed that individuals with PD exhibited subtle gait abnormalities, such as freezing of gait, reduced step length, and asymmetrical movements. The model-based features proved effective in differentiating between normal and PD-affected gait, demonstrating the potential of this approach in early detection. Conclusions: This study presents a promising noninvasive method for the early detection of PD by analyzing specific gait features during the turning phase of the TUG assessment. The findings suggest that this approach could serve as a sensitive and accurate tool for diagnosing and monitoring PD, potentially leading to earlier intervention and improved patient outcomes. ",
doi="10.2196/65629",
url="https://aging.jmir.org/2025/1/e65629"
}


@Article{info:doi/10.2196/67108,
author="Lin, Chen Yu
and Hagen, Ryan
and Powers, D. Benjamin
and Dineen, P. Sean
and Milano, Jeanine
and Hume, Emma
and Sprow, Olivia
and Diaz-Carraway, Sophia
and Permuth, B. Jennifer
and Deneve, Jeremiah
and Alishahi Tabriz, Amir
and Turner, Kea",
title="Digital Health Intervention to Reduce Malnutrition Among Individuals With Gastrointestinal Cancer Receiving Cytoreductive Surgery Combined With Hyperthermic Intraperitoneal Chemotherapy: Feasibility, Acceptability, and Usability Trial",
journal="JMIR Cancer",
year="2025",
month="Apr",
day="7",
volume="11",
pages="e67108",
keywords="gastrointestinal cancer",
keywords="peritoneal disease",
keywords="cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy",
keywords="digital health intervention",
keywords="nutrition",
keywords="feasibility",
abstract="Background: Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) can improve survival outcomes for individuals with gastrointestinal (GI) cancer and peritoneal disease (PD). Individuals with GI cancer and PD receiving CRS-HIPEC are at increased risk for malnutrition. Despite the increased risk for malnutrition, there has been limited study of nutritional interventions for individuals receiving CRS-HIPEC. Objective: We aimed to test the feasibility, acceptability, and usability of Support Through Remote Observation and Nutrition Guidance (STRONG), a multilevel digital health intervention to improve nutritional management among individuals with GI cancer and PD receiving CRS-HIPEC. We also assessed patient-reported outcomes, including malnutrition risk, health-related quality of life, and weight-related measures. Methods: STRONG is a 12-week digital intervention in which participants received biweekly nutritional counseling with a dietitian, logged food intake using a Fitbit tracker, and reported nutrition-related outcomes. Dietitians received access to a web-based dashboard and remotely monitored patients' reported food intake and nutrition-impact symptoms. Implementation outcomes were assessed against prespecified benchmarks consistent with benchmarks used in prior studies. Changes in patient-reported outcomes at baseline and follow-up were assessed using linear and ordered logistic regressions. Results: Participants (N=10) had a median age of 57.5 (IQR 54-69) years. Feasibility benchmarks were achieved for recruitment (10/17, 59\% vs benchmark: 50\%), study assessment completion (9/10, 90\% vs benchmark: 60\%), dietitian appointment attendance (7/10, 70\% vs benchmark: 60\%), daily food intake logging adherence (6/10, 60\% vs benchmark: 60\%), and participant retention (10/10, 100\% vs benchmark: 60\%). Most participants rated the intervention as acceptable (8/10, 80\% vs benchmark: 70\%) and reported a high level of usability for dietitian services (10/10, 100\%). The benchmark usability for the Fitbit tracker to log food intake was not met. Compared to baseline, participants saw on average a 6.0 point reduction in malnutrition risk score (P=.01), a 20.5 point improvement in general health-related quality of life score (P=.002), and a 5.6 percentage point increase in 1-month weight change (P=.04) at the end of the study. Conclusions: The STRONG intervention demonstrated to be feasible, acceptable, and usable among individuals with GI cancer and PD receiving CRS-HIPEC. A fully powered randomized controlled trial is needed to test the effectiveness of STRONG for reducing malnutrition and improving patient outcomes. Trial Registration: ClinicalTrials.gov NCT05649969; https://clinicaltrials.gov/study/NCT05649969 ",
doi="10.2196/67108",
url="https://cancer.jmir.org/2025/1/e67108"
}


@Article{info:doi/10.2196/65668,
author="Han, Seunghoon
and Song, Jihong
and Han, Sungpil
and Choi, Suein
and Lim, Jonghyuk
and Oh, Yeob Byeong
and Shin, Dongoh",
title="Participant Adherence in Repeated-Dose Clinical Studies Using Video-Based Observation: Retrospective Data Analysis",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Apr",
day="7",
volume="13",
pages="e65668",
keywords="adherence",
keywords="mobile health",
keywords="self-administration",
keywords="repeated-dose clinical trials",
keywords="video-based monitoring",
keywords="mobile phone",
abstract="Background: Maintaining accurate medication records in clinical trials is essential to ensure data validity. Traditional methods such as direct observation, self-reporting, and pill counts have shown limitations that make them inaccurate or impractical. Video-based monitoring systems, available as commercial or proprietary mobile applications for smartphones and tablets, offer a promising solution to these traditional limitations. In Korea, a system applicable to the clinical trial context has been developed and used. Objective: This study aimed to evaluate the usefulness of an asynchronous video-based self-administration of the investigational medicinal product (SAI) monitoring system (VSMS) in ensuring accurate dosing and validating participant adherence to planned dosing times in repeated-dose clinical trials. Methods: A retrospective analysis was conducted using data from 17,619 SAI events in repeated-dose clinical trials using the VSMS between February 2020 and March 2023. The SAI events were classified into four categories: (1) Verified on-time dosing, (2) Verified deviated dosing, (3) Unverified dosing, and (4) Missed dosing. Analysis methods included calculating the success rate for verified SAI events and analyzing trends in difference between planned and actual dosing times (PADEV) over the dosing period and by push notification type. The mean PADEV for each subsequent dosing period was compared with the initial period using either a paired t test or a Wilcoxon signed-rank test to assess any differences. Results: A comprehensive analysis of 17,619 scheduled SAI events across 14 cohorts demonstrated a high success rate of 97\% (17,151/17,619), with only 3\% (468/17,619) unsuccessful due to issues like unclear video recordings or technical difficulties. Of the successful events, 99\% (16,975/17,151) were verified as on-time dosing, confirming that the dosing occurred within the designated SAI time window with appropriate recorded behavior. In addition, over 90\% (367/407) of participants consistently reported dosing videos on all analyzed SAI days, with most days showing over 90\% objective dosing data, underscoring the system's effectiveness in supporting accurate SAI. There were cohort differences in the tendency to dose earlier or later, but no associated cohort characteristics were identified. The initial SAI behaviors were generally sustained during the whole period of participation, with only 16\% (13/79) of study days showing significant shifts in actual dosing times. Earlier deviations in SAI times were observed when only dosing notifications were used, compared with using reminders together or no notifications. Conclusions: VSMS has proven to be an effective tool for obtaining dosing information with accuracy comparable to direct observation, even in remote settings. The use of various alarm features and appropriate intervention by the investigator or observer was identified as a way to minimize adherence deterioration. It is expected that the usage and usefulness of VSMS will be continuously improved through the accumulation of experience in various medical fields. ",
doi="10.2196/65668",
url="https://mhealth.jmir.org/2025/1/e65668"
}


@Article{info:doi/10.2196/64742,
author="Chen, Yuyin
and Zhang, Yuanyuan
and Long, Xiuhong
and Tu, Huiqiong
and Chen, Jibing",
title="Effectiveness of Virtual Reality--Complemented Pulmonary Rehabilitation on Lung Function, Exercise Capacity, Dyspnea, and Health Status in Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="7",
volume="27",
pages="e64742",
keywords="virtual reality",
keywords="video games",
keywords="exergaming",
keywords="pulmonary rehabilitation",
keywords="chronic obstructive pulmonary disease",
keywords="lung function",
keywords="exercise capacity",
keywords="dyspnea",
keywords="health status",
keywords="randomized controlled trial",
keywords="systematic review",
keywords="meta-analysis",
abstract="Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition characterized by persistent airflow obstruction. Pulmonary rehabilitation (PR) is a cornerstone of COPD management but remains underutilized due to barriers such as low motivation and accessibility issues. Virtual reality (VR)--complemented PR offers a novel approach to overcoming these barriers by enhancing patient engagement and rehabilitation outcomes. Objective: This review aims to evaluate the effect of VR-complemented PR compared with comparators on lung function, exercise capacity, dyspnea, health status, and oxygenation in patients with COPD. Additionally, the study aimed to identify which comparator type (active exercise vs nonactive exercise control group) and intervention duration would result in the greatest improvements in rehabilitation outcomes. The study also assessed patient-reported experience measures, including acceptability and engagement. Methods: A comprehensive search of 11 international and Chinese databases identified randomized controlled trials (RCTs) published up to November 2024. Data were analyzed using RevMan 5.4, with pooled effect sizes reported as mean differences (MDs) and 95\% CIs. Results: A total of 16 RCTs involving 1052 participants were included. VR-complemented PR significantly improved lung function (forced expiratory volume in 1 second [FEV1] [L], MD 0.25, P<.001; FEV1/forced vital capacity [FVC], MD 6.12, P<.001; FVC, MD 0.28, P<.001) compared with comparators. Exercise capacity, assessed by the 6MWD, significantly improved (MD 23.49, P<.001) compared with comparators; however, it did not reach the minimally clinically important difference of 26 m, indicating limited clinical significance despite statistical significance. VR-complemented PR also significantly reduced dyspnea measured by the modified British Medical Research Council scale (MD --0.28, P<.001), improved health status measured by the COPD Assessment Test (MD --2.95, P<.001), and enhanced oxygenation status measured by SpO2 (MD 1.35, P=.04) compared with comparators. Subgroup analyses revealed that VR-complemented PR had a significantly greater effect on FEV1 (L) (MD 0.32, P=.005) and 6MWD (MD 40.93, P<.001) compared with the nonactive exercise control group. Additionally, VR-complemented PR showed a greater improvement in FEV1/FVC (MD 6.15, P<.001) compared with the active exercise control group. Intervention duration influenced outcomes, with 5-12-week programs showing the greatest improvement in 6MWD (MD 38.96, P<.001). VR-complemented PR was well-accepted, with higher adherence and engagement rates than comparators. Conclusions: VR-complemented PR significantly improves lung function, exercise capacity, dyspnea, health status, and oxygenation in patients with COPD compared with comparators, while enhancing adherence and engagement. Subgroup analyses showed greater effects on FEV1 (L) and 6MWD compared with the nonactive exercise control group, and a larger improvement in FEV1/FVC compared with the active exercise control group. Interventions (5-12 weeks) yielded the most significant benefits in exercise capacity. These findings highlight VR as a promising adjunct to traditional PR, with future research focusing on long-term outcomes and standardized protocols. ",
doi="10.2196/64742",
url="https://www.jmir.org/2025/1/e64742"
}


@Article{info:doi/10.2196/65782,
author="Chauhan, Kumari Gauri
and Vavken, Patrick
and Jacob, Christine",
title="Mobile Apps and Wearable Devices for Cardiovascular Health: Narrative Review",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Apr",
day="4",
volume="13",
pages="e65782",
keywords="eHealth",
keywords="mobile health",
keywords="mHealth",
keywords="digital health",
keywords="technology assessment",
keywords="technology adoption",
keywords="technology implementation",
keywords="cardiovascular diseases",
keywords="cardiovascular health",
keywords="Germany",
keywords="Austria",
keywords="Switzerland",
keywords="wearables",
keywords="apps",
keywords="smartphones",
keywords="Swiss Apple App",
keywords="Google Play Store",
keywords="reviews",
keywords="morbidity",
keywords="mortality",
keywords="well-being",
keywords="care management",
keywords="health technologies",
abstract="Background: Cardiovascular diseases (CVDs) continue to be the leading cause of global morbidity and mortality. Aiming to reduce the risk of CVD development and better manage them, an increasing number of individuals are adopting mobile health (mHealth) apps and wearable devices (wearables). These technologies provide critical insights into heart health and fitness, supporting users to monitor their lifestyle behaviors and adhere to preventative medication. Objective: In this review, we aimed to investigate the current state of mHealth apps and wearables designed for cardiovascular health, with a specific focus on the DACH region (Germany, Austria, and Switzerland). We assessed the benefits these technologies provide to clinicians and patients, particularly in addressing unmet needs like sex-specific symptoms, while also examining their potential integration into the broader health care ecosystem. Methods: To identify heart health apps, a keyword search was performed on both the Swiss Apple App Store and Google Play Stores. A separate search was performed on Google to identify heart health wearables. The identified apps and wearables were evaluated using the foundational and contextual criteria of the sociotechnical framework for assessing patient-facing eHealth tools. Results: After filtering out apps and wearables that did not meet our inclusion criteria, 20 apps and 22 wearables were included in the review. While all the apps were available in the DACH region, only 30\% (6/20) were specifically designed for these countries. Only 25\% (5/20) of the apps included sex-specific information; 40\% (8/20) provided information from evidence-based research, 35\% (7/20) provided general health information without academic and clinical references, and 25\% (5/20) did not include any evidence-based or general health information. While 20\% (4/20) of the included apps had clinical integration features such as clinician dashboards, only 10\% (2/20) had the potential to effectively enhance clinician workflows. Privacy policies were present in 95\% (19/20) of the apps, with 75\% (15/20) adhering to General Data Protection Regulation (GDPR) regulations; 1 app had no data protection policy. Only 20\% (4/20) of the apps were medically certified. For wearables, only 9\% (2/22) were tailored to the DACH region, and 40\% (9/22) addressed women's health. While around 60\% (13/22) offered features to support clinical integration, only 9\% (2/22) had the potential to improve clinical workflows. More than half (12/22) of the wearables were medically certified, and 77\% (17/22) referenced scientific or peer-reviewed research. All wearables included a privacy policy. Conclusions: While many mHealth tools for cardiovascular health are available, only a few provide meaningful value to both patients and clinicians or have the potential to integrate effectively into the health care system. Women's sex-specific needs are often overlooked, and the benefits for clinicians are limited. In addition, mHealth apps largely lack robust evidence, whereas wearables showed comparatively stronger support through evidence-based and medical certification. ",
doi="10.2196/65782",
url="https://mhealth.jmir.org/2025/1/e65782"
}


@Article{info:doi/10.2196/58264,
author="Elg, Mattias
and Kabel, Daan
and Gremyr, Ida
and Olsson, Jesper
and Martin, Jason
and Smith, Frida",
title="Identification and Categorization of the Distinct Purposes Underpinning the Use of Digital Health Care Self-Monitoring: Qualitative Study of Stakeholders in the Health Care Ecosystem",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="3",
volume="27",
pages="e58264",
keywords="self-monitoring",
keywords="healthcare provider",
keywords="medtech provider",
keywords="digital health",
keywords="healthcare ecosystem",
keywords="qualitative study",
keywords="technology",
keywords="semi structured interview",
keywords="macro perspective",
keywords="telehealth",
keywords="telemonitoring",
abstract="Background: Digital health care self-monitoring has gained prominence as a tool to address various challenges in health care, including patient autonomy, data-informed decision-making, and organizational improvements. However, integrating self-monitoring solutions across a diverse ecosystem of stakeholders---patients, health care providers, policy makers, and industry---can be complicated by differing priorities and needs. Objective: This study aimed to identify and categorize the distinct purposes underpinning the use of digital health care self-monitoring. By mapping these purposes, the research seeks to clarify how technology design and implementation can be better aligned with stakeholder expectations, thereby enhancing adoption and impact. Methods: A qualitative design was used, drawing on 31 in-depth, semistructured interviews conducted with stakeholders in the Swedish health care ecosystem. Participants included patients, advocacy groups, health care professionals, policy makers, pharmaceutical representatives, and technology developers. Data were analyzed thematically using an inductive coding approach supported by NVivo 12 (Lumivero). Emerging themes were refined through iterative discussion among the research team and validated by presentation to health care practitioners. Results: A total of 8 distinct purposes of digital health care self-monitoring emerged: (1) emancipate (enhance patient autonomy), (2) learn (understand health behaviors), (3) improve (enhance patient health), (4) engage (bolster patient involvement), (5) control (manage adherence and symptoms), (6) evaluate (assess health parameters), (7) innovate (advance interventions and processes), and (8) generate (drive new initiatives). These purposes form three categories of value creation: (1) improving the patient-provider link, (2) leveraging big data analytics for knowledge creation, and (3) using digital infrastructure to develop new care processes. Conclusions: Our findings demonstrate that digital health care self-monitoring serves multifaceted aims, ranging from individual patient empowerment to ecosystem-wide innovation. Designing and implementing these tools with an explicit understanding of all stakeholders' ``why'' can help address potential conflicts (eg, balancing patient autonomy with clinical control) and facilitate more holistic adoption. Ultimately, this study underscores the importance of clear, purpose-driven approaches to promote better health outcomes, knowledge generation, and care process improvements. ",
doi="10.2196/58264",
url="https://www.jmir.org/2025/1/e58264"
}


@Article{info:doi/10.2196/62822,
author="Lee, JuHee
and Yoo, Subin
and Kim, Yielin
and Kim, Eunyoung
and Park, Hyeran
and Sohn, H. Young
and Kim, Joong Yun
and Chung, Jong Seok
and Baik, Kyoungwon
and Kim, Kiyeon
and Yoo, Jee-Hye",
title="Effect of the Yon PD App on the Management of Self-Care in People With Parkinson Disease: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="2",
volume="27",
pages="e62822",
keywords="Parkinson disease",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="neurodegenerative disease",
keywords="geriatric",
keywords="quality of life",
keywords="bradykinesia",
keywords="nonmotor symptoms",
keywords="self-care",
keywords="motor symptoms",
keywords="cognitive impairment",
keywords="autonomic",
keywords="monitoring",
keywords="management",
keywords="randomized controlled trial",
abstract="Background: As the percentage of the older population increases, it is accompanied by an increase in the prevalence of Parkinson disease (PD). People with PD experience a range of nonmotor symptoms, including pain, constipation, dysphagia, sleep disturbances, and fatigue. Improving self-care is necessary for people with PD because it is a chronic disease that requires lifelong management. In our previous study, we developed a mobile app (Yon PD app) to monitor nonmotor symptoms of PD. In this study, we investigated the long-term effects of the app in a larger group of people. Objective: This study aimed to examine the effectiveness of a mobile app on the management of self-care in people with PD. Methods: This was a randomized controlled trial. People with PD aged ?50 years and able to use a smartphone were recruited from the neurology outpatient clinic of a tertiary hospital in South Korea. In total, 102 participants were enrolled in this study. The intervention group was requested to record 5 nonmotor symptoms (pain, constipation, dysphagia, sleep disturbances, and fatigue) for 12 weeks using the mobile app. The control group was requested to record these 5 nonmotor symptoms on a paper questionnaire. General characteristics including age, sex, level of education, disease severity, and comorbidities were examined at baseline. The degree of self-care was examined using the Self-Care of Chronic Illness Inventory at baseline, 6 weeks, and 12 weeks. At 12 weeks, satisfaction with the app was also examined. General characteristics and satisfaction with the app were analyzed using descriptive statistics. The effect of the app on self-care was analyzed using the repeated-measures ANOVA with an $\alpha$ level of .05. Results: In total, 93 participants were included in the analysis. There were 41 and 52 participants in the intervention and control groups, respectively. The general characteristics of the 2 groups were comparable. Monitoring nonmotor symptoms with the app effectively increased self-care maintenance (F2182=4.087; P=.02) and prevented a decrease in self-care monitoring (F2182=3.155; P=.045). However, using the app was ineffective in improving self-care management (F2182=1.348; P=.26). Self-care management gradually decreased over the 12-week period in both groups. The intervention (n=41) adherence rate reached 60.84\% at 6 weeks but decreased to 41.87\% by 12 weeks. Conclusions: Participants were able to improve the degree of self-care by monitoring their nonmotor symptoms using the app. However, additional strategies that increase motivation and enjoyment are required to improve adherence. Trial Registration: Clinical Research Information Service KCT0006433; https://tinyurl.com/3vmf435m ",
doi="10.2196/62822",
url="https://www.jmir.org/2025/1/e62822"
}


@Article{info:doi/10.2196/52694,
author="Tak, Won Yae
and Kim, Junetae
and Chung, Haekwon
and Lee, Byul Sae
and Park, Ja In
and Lee, Won Sei
and Jo, Min-Woo
and Lee, Won Jong
and Baek, Seunghee
and Lee, Yura",
title="Analysis of Metabolic and Quality-of-Life Factors in Patients With Cancer for a New Approach to Classifying Walking Habits: Secondary Analysis of a Randomized Controlled Trial",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="1",
volume="27",
pages="e52694",
keywords="telemedicine",
keywords="mobile phone",
keywords="physical activity",
keywords="mobile apps",
keywords="mobile health intervention",
keywords="cancer",
keywords="step count",
abstract="Background: As the number of people diagnosed with cancer continues to increase, self-management has become crucial for patients recovering from cancer surgery or undergoing chemotherapy. Technology has emerged as a key tool in supporting self-management, particularly through interventions that promote physical activity, which is important for improving health outcomes and quality of life for patients with cancer. Despite the growing availability of digital tools that facilitate physical activity tracking, high-level evidence of their long-term effectiveness remains limited. Objective: This study aimed to investigate the effect of long-term physical activity on patients with cancer by categorizing them into active and inactive groups based on step count time-series data using the mobile health intervention, the Walkon app (Swallaby Co, Ltd.). Methods: Patients with cancer who had previously used the Walkon app in a previous randomized controlled trial were chosen for this study. Walking step count data were acquired from the app users. Biometric measurements, including BMI, waist circumference, blood sugar levels, and body composition, along with quality of life (QOL) questionnaire responses (European Quality of Life 5 Dimensions 5 Level version and Health-related Quality of Life Instrument with 8 Items), were collected during both the baseline and 6-month follow-up at an outpatient clinic. To analyze step count patterns over time, the concept of sample entropy was used for patient clustering, distinguishing between the active walking group (AWG) and the inactive walking group (IWG). Statistical analysis was performed using the Shapiro-Wilk test for normality, with paired t tests for parametric data, Wilcoxon signed-rank tests for nonparametric data, and chi-square tests for categorical variables. Results: The proposed method effectively categorized the AWG (n=137) and IWG (n=75) based on step count trends, revealing significant differences in daily (4223 vs 5355), weekly (13,887 vs 40,247), and monthly (60,178 vs 174,405) step counts. Higher physical activity levels were observed in patients with breast cancer and younger individuals. In terms of biometric measurements, only waist circumference (P=.01) and visceral fat (P=.002) demonstrated a significant improvement exclusively within the AWG. Regarding QOL measurements, aspects such as energy (P=.01), work (P<.003), depression (P=.02), memory (P=.01), and happiness (P=.05) displayed significant improvements solely in the AWG. Conclusions: This study introduces a novel methodology for categorizing patients with cancer based on physical activity using step count data. Although significant improvements were noted in the AWG, particularly in QOL and specific physical metrics, differences in 6-month change between the AWG and IWG were statistically insignificant. These findings highlight the potential of digital interventions in improving outcomes for patients with cancer, contributing valuable insights into cancer care and self-management. Trial Registration: Clinical Research Information Service by Korea Centers for Diseases Control and Prevention, Republic of Korea KCT0005447; https://tinyurl.com/3zc7zvzz ",
doi="10.2196/52694",
url="https://www.jmir.org/2025/1/e52694"
}


@Article{info:doi/10.2196/69466,
author="Johnson, Hans
and Huang, David
and Liu, Vivian
and Ammouri, Al Mahmoud
and Jacobs, Christopher
and El-Osta, Austen",
title="Impact of Digital Engagement on Weight Loss Outcomes in Obesity Management Among Individuals Using GLP-1 and Dual GLP-1/GIP Receptor Agonist Therapy: Retrospective Cohort Service Evaluation Study",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="31",
volume="27",
pages="e69466",
keywords="obesity",
keywords="weight loss",
keywords="semaglutide",
keywords="tirzepatide",
keywords="digital health",
keywords="engagement",
keywords="behavior",
keywords="coaching",
keywords="retrospective study",
keywords="service evaluation",
abstract="Background: Obesity is a global public health challenge. Pharmacological interventions, such as glucagon-like peptide-1 (GLP-1) receptor agonists (eg, semaglutide) and dual GLP-1/gastric inhibitory polypeptide receptor agonists (eg, tirzepatide), have led to significant weight loss among users. Digital health platforms offering behavioral support may enhance the effectiveness of these medications. Objective: This retrospective service evaluation investigated the impact of engagement with an app-based digital weight loss program on weight loss outcomes among individuals using GLP-1 receptor agonists (semaglutide) and dual GLP-1/gastric inhibitory polypeptide receptor agonists (tirzepatide) in the United Kingdom over 5 months. Methods: Data were collected from the Voy weight loss digital health platform between February 2023 and August 2024. Participants were adults aged 18-75 years with a BMI ?30 or ?27.5 kg/m2 with the presence of obesity-related comorbidities who initiated a weight management program involving semaglutide or tirzepatide. Engagement was defined based on attendance at coaching sessions, frequency of app use, and regular weight tracking. Participants were categorized as ``engaged'' or ``nonengaged'' accordingly. Weight loss outcomes were assessed over a period of up to 5 months. Statistical analyses included chi-square tests, independent t tests, Kaplan-Meier survival analysis, and calculations of Cohen d for effect sizes. Results: A total of 57,975 participants were included in the analysis, with 31,407 (54.2\%) classified as engaged and 26,568 (45.8\%) as nonengaged. Engaged participants achieved significantly greater weight loss at each time point. At month 3, engaged participants had a mean weight loss of 9\% (95\% CI 9\% to 9.1\%) compared with 5.9\% (95\% CI 5.9\% to 6\%) in nonengaged participants (P<.001), representing a mean difference of 3.1 percentage points (95\% CI 3.1\% to 3.1\%). A Cohen d effect size of 0.89 indicated a large effect. At month 5, engaged participants had a mean weight loss of 11.53\% (95\% CI 11.5\% to 11.6\%) compared with 8\% (95\% CI 7.9\% to 8\%) in the nonengaged participants (P<.001). A Cohen d effect size of 0.56 indicated a moderate effect. Participants using tirzepatide achieved more significant weight loss than those using semaglutide at month 5 (13.9\%, 95\% CI 13.5\% to 14.3\% vs 9.5\%, 95\% CI 9.2\% to 9.7\%; P<.001). The proportion of engaged participants achieving ?5\%, ?10\%, and ?15\% weight loss was significantly higher than the nonengaged group at corresponding time points from months 3 to 5 respectively (P<.001). Conclusions: Engagement with a digital weight management platform significantly enhances weight loss outcomes among individuals using GLP-1 receptor agonists. The combination of pharmacotherapy and digital behavioral support offers a promising strategy to promote the supported self-care journey of individuals seeking clinically effective obesity management interventions. ",
doi="10.2196/69466",
url="https://www.jmir.org/2025/1/e69466"
}


@Article{info:doi/10.2196/57599,
author="Bou Rjeily, Nicole
and Sanjayan, Muraleetharan
and Guha Niyogi, Pratim
and Dewey, E. Blake
and Zambriczki Lee, Alexandra
and Hulett, Christy
and Dagher, Gabriella
and Hu, Chen
and Mazur, D. Rafal
and Kenney, M. Elena
and Brennan, Erin
and DuVal, Anna
and Calabresi, A. Peter
and Zipunnikov, Vadim
and Fitzgerald, C. Kathryn
and Mowry, M. Ellen",
title="Accelerometry-Assessed Physical Activity and Circadian Rhythm to Detect Clinical Disability Status in Multiple Sclerosis: Cross-Sectional Study",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Mar",
day="31",
volume="13",
pages="e57599",
keywords="multiple sclerosis",
keywords="disability",
keywords="progressive",
keywords="physical activity",
keywords="circadian rhythm",
keywords="accelerometer",
keywords="ActiGraph",
keywords="accelerometry",
abstract="Background: Tools for measuring clinical disability status in people with multiple sclerosis (MS) are limited. Accelerometry objectively assesses physical activity and circadian rhythmicity profiles in the real-world environment and may potentially distinguish levels of disability in MS. Objective: This study aims to determine if accelerometry can detect differences in physical activity and circadian rhythms between relapsing-remitting multiple sclerosis (RRMS) and progressive multiple sclerosis (PMS) and to assess the interplay within person between the 2 domains of physical activity (PA) and circadian rhythm (CR) in relation to MS type. Methods: This study represents an analysis of the baseline data from the prospective HEAL-MS (home-based evaluation of actigraphy to predict longitudinal function in multiple sclerosis) study. Participants were divided into 3 groups based on the Expanded Disability Status Scale (EDSS) criteria for sustained disability progression: RRMS-Stable, RRMS-Suspected progression, and PMS. Baseline visits occurred between January 2021 and March 2023. Clinical outcome measures were collected by masked examiners. Participants wore the GT9X Link ActiGraph on their nondominant wrists for 2 weeks. After adjusting for age, sex, and BMI, a logistic regression model was fitted to evaluate the association of each accelerometry metric with odds of PMS versus RRMS. We also evaluated the association of accelerometry metrics in differentiating the 2 RRMS subtypes. The Joint and Individual Variation Explained (JIVE) model was used to assess the codependencies between the PA and CR domains and their joint and individual association with MS subtype. Results: A total of 253 participants were included: 86 with RRMS-Stable, 82 with RRMS-Suspected progression, and 85 with PMS. Compared to RRMS, participants with PMS had lower total activity counts ($\beta$=?0.32, 95\% CI ?0.61 to ?0.03), lower time spent in moderate to vigorous physical activity ($\beta$=?0.01, 95\% CI ?0.02 to ?0.004), higher active-to-sedentary transition probability ($\beta$=5.68, 95\% CI 1.86-9.5), lower amplitude ($\beta$=?0.0004, 95\% CI ?0.0008 to ?0.0001), higher intradaily variability ($\beta$=4.64, 95\% CI 1.45-7.84), and lower interdaily stability ($\beta$=?4.43, 95\% CI ?8.77 to ?0.10). Using the JIVE model for PA and CR domains, PMS had higher first joint component ($\beta$=0.367, 95\% CI 0.088-0.656), lower PA-1 component ($\beta$=?0.441, 95\% CI ?0.740 to ?0.159), and lower PA-2 component ($\beta$=?0.415, 95\% CI ?0.717 to ?0.126) compared to RRMS. No significant differences were detected between the 2 RRMS subtypes except for lower relative amplitude in those with suspected progression ($\beta$=?5.26, 95\% CI ?10.80 to ?0.20). Conclusions: Accelerometry detected differences in physical activity patterns between RRMS and PMS. More advanced analytic techniques may help discern differences between the 2 RRMS subgroups. Longitudinal follow-up is underway to assess the potential for accelerometry to detect or predict disability progression. ",
doi="10.2196/57599",
url="https://mhealth.jmir.org/2025/1/e57599"
}


@Article{info:doi/10.2196/63168,
author="Park, Yoonseo
and Kim, Eun-Ji
and Park, Sewon
and Lee, Munjae",
title="Digital Health Intervention Effect on Older Adults With Chronic Diseases Living Alone: Systematic Review and Meta-Analysis of Randomized Controlled Trials",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="31",
volume="27",
pages="e63168",
keywords="digital health",
keywords="chronic diseases",
keywords="older adults",
keywords="independent living",
keywords="aging",
keywords="chronic disease",
keywords="living alone",
keywords="self-management",
keywords="medical cost",
keywords="cost management",
keywords="health promotion",
keywords="effectiveness",
keywords="quality of life",
keywords="physical activity",
keywords="health care",
keywords="health informatics",
keywords="systematic review",
keywords="meta-analysis",
keywords="PRISMA",
abstract="Background: The incidence of chronic diseases is increasing owing to the aging population; in particular, older adults living alone struggle with self-management and medical expenses. Digital health can contribute to medical cost management and health promotion, but its effectiveness for older adults living alone remains unclear. In a rapidly aging society, it is important to demonstrate the effect of digital health on improving the lives of older adults living alone and reducing the burden of chronic diseases. Objective: This study aims to examine the intervention effects of digital health on self-management, quality of life, and medical factors for older adults living alone with common chronic diseases such as cardiovascular disease, respiratory disease, and musculoskeletal disorders through a systematic literature review and meta-analysis. Methods: We searched the literature using 3 databases, including PubMed, CINAHL, and Cochrane CENTRAL, for literature published in overseas academic journals up to October 2024. The final 11 papers were used for analysis based on selection and exclusion criteria. Meta-analysis was used to calculate the mean difference and standardized mean difference (SMD) for the selected literature using RevMan (version 5.4; Cochrane). The effect size and heterogeneity were calculated through 95\% CI. Results: As a result of conducting a meta-analysis of 8 of 11 documents, there was a significant effect of self-management factors on moderate-to-vigorous physical activity (SMD=0.08; z=2.07; P=.04). However, among self-management factors, low-density lipoprotein cholesterol (SMD=--0.04; z=0.91; P=.36) did not show statistically significant results. Among the medical factors, general quality of life (SMD=0.11; z=0.93; P=.35), depression (SMD=--3.95; z=1.59; P=.11), and hospital days (SMD=--1.57; z=0.91; P=.36) also did not show statistically significant results. However, it was confirmed that they improved after a digital health intervention. Conclusions: This study demonstrated that digital health interventions are effective in improving physical activity in older adults with chronic diseases living alone. However, owing to the characteristics of older adults living alone, there is a need to further expand digital health to combine care services that can manage diseases at home. ",
doi="10.2196/63168",
url="https://www.jmir.org/2025/1/e63168"
}


@Article{info:doi/10.2196/56666,
author="May, Susann
and Seifert, Frances
and Bruch, Dunja
and Heinze, Martin
and Spethmann, Sebastian
and Muehlensiepen, Felix",
title="Insights Into How mHealth Applications Could Be Introduced Into Standard Hypertension Care in Germany: Qualitative Study With German Cardiologists and General Practitioners",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Mar",
day="28",
volume="13",
pages="e56666",
keywords="hypertension",
keywords="mHealth apps",
keywords="physicians",
keywords="qualitative study",
keywords="digitalization",
keywords="app",
keywords="application",
keywords="Germany",
keywords="blood pressure",
keywords="cardiologists",
keywords="thematic analysis",
keywords="general practitioner",
keywords="mobile phone",
abstract="Background: Mobile health (mHealth) apps provide innovative solutions for improving treatment adherence, facilitating lifestyle modifications, and optimizing blood pressure control in patients with hypertension. Despite their potential benefits, the adoption and recommendation of mHealth apps by physicians in Germany remain limited. This reluctance may be due to a lack of understanding of the factors influencing physicians' willingness to incorporate these digital tools into routine clinical practice. Understanding these factors is crucial for fostering greater integration of mHealth apps in hypertension care. Objective: The aim of this study was to explore the relationship between physicians' information needs and acceptance factors, and how these elements can support the effective integration of mHealth apps into daily medical routines. Methods: We conducted a qualitative study involving 24 semistructured telephone interviews with physicians, including 14 cardiologists and 10 general practitioners, who are involved in the treatment of hypertensive patients. Participants were selected through purposive sampling to ensure a diverse range of perspectives. Thematic analysis was conducted using MAXQDA software (Verbi GmbH) to identify key themes and subthemes related to the acceptance and use of mHealth apps. Results: The analysis revealed significant variability in physicians' information needs regarding mHealth apps, particularly concerning their functionalities, clinical benefits, and potential impact on patient outcomes. These informational gaps play a critical role in determining whether physicians are willing to recommend mHealth apps to their patients. Key determinants influencing acceptance were identified, including the availability of robust knowledge about the apps, high-quality and reliable data, generational shifts within the medical profession, solid evidence supporting the effectiveness of the mHealth apps, and clearly defined areas of application and responsibilities within the physician-patient relationship. The study found that acceptance of mHealth apps could be significantly increased through targeted educational initiatives, enhanced data quality, and better integration of these tools into existing clinical workflows. Furthermore, younger physicians, more familiar with digital technologies, demonstrated greater openness to using mHealth apps, suggesting that generational changes may drive future increases in adoption. Conclusions: The successful integration of mHealth apps into hypertension management requires a multifaceted approach that addresses both the informational and practical concerns of physicians. By disseminating comprehensive knowledge about the variety, functionality, and proven efficacy of hypertension-related mHealth apps, health care providers can be better equipped to use these tools effectively. This approach necessitates the implementation of various knowledge transfer strategies, such as targeted training programs, peer learning opportunities, and active engagement with digital health technologies. As physicians become more informed and confident in the use of mHealth apps, their acceptance and recommendation of these tools are likely to increase, leading to more widespread adoption. Overcoming current barriers related to information deficits and data quality is essential for ensuring that mHealth apps are optimally used in routine hypertension care, ultimately improving patient outcomes and enhancing the overall quality of care. Trial Registration: German Clinical Trials Register DRKS00029761; https://drks.de/search/de/trial/DRKS00029761 International Registered Report Identifier (IRRID): RR2-10.3389/fcvm.2022.1089968 ",
doi="10.2196/56666",
url="https://mhealth.jmir.org/2025/1/e56666"
}


@Article{info:doi/10.2196/63569,
author="Hestevik, Hillestad Christine
and Varsi, Cecilie
and {\O}ster{\aa}s, Nina
and Tveter, Therese Anne
and Skandsen, Jon
and Eik, Hedda",
title="Perspectives on and Experiences With Remote Monitoring and Patient-Initiated Care Among Norwegian Patients With Axial Spondyloarthritis: Qualitative Study",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="28",
volume="27",
pages="e63569",
keywords="remote monitoring",
keywords="patient-initiated care",
keywords="patient-reported outcome measures",
keywords="chronic disease",
keywords="rheumatology",
keywords="axial spondyloarthritis",
keywords="joint disease",
keywords="spine",
keywords="medication",
keywords="therapy",
keywords="rheumatic",
keywords="patient care",
keywords="randomized controlled trial",
keywords="interventions",
keywords="decision-making",
abstract="Background: Axial spondyloarthritis (axSpA) is a chronic inflammatory joint disease affecting the spine and sacroiliac joints, requiring frequent, lifelong monitoring and treatment. This involves regular symptom monitoring, assessing medication tolerance and side effects, and prompt therapy adjustments. Typically, patients with axSpA attend prescheduled hospital visits, but once stable disease has been attained, these seldom align with periods of high disease activity. Remote monitoring and patient-initiated care offer flexible, need-based, follow-up options. However, knowledge about how patients with axSpA perceive and experience these approaches is limited. To effectively implement these strategies in clinical practice, understanding patient perspectives is crucial. Objective: This study aims to explore how patients with axSpA perceive and experience remote monitoring and patient-initiated care. Methods: Our qualitative study was embedded in a randomized controlled trial. Participants were allocated to either usual care, remote monitoring, or patient-initiated care. The 2 intervention groups had no prescheduled visits and used a remote monitoring app, but only the remote monitoring group received monitoring by health care professionals. Semistructured interviews were conducted with 18 participants from the intervention groups to explore their experiences. The interviews were audio recorded, transcribed, anonymized, and analyzed using thematic analysis. Participants provided informed consent. Results: Eighteen patients (11 men and 7 women, aged 26-65 years) participated, 10 from the remote monitoring group and 8 from the patient-initiated care group. Transcripts were analyzed into four key themes: (1) ``I don't need to go to the hospital just to report I'm doing well.'' When patients felt well, they perceived in-person consultations as less important. They acknowledged health care resource challenges and were willing to adapt but expressed concerns about rapid technological advancement, fearing it could exclude vulnerable groups. They emphasized the need for shared decision-making in determining follow-up strategies; (2) ``It feels safer to meet healthcare personnel in person'' highlighted participants' preference for in-person interactions as a safety net for detecting changes or signs of disease. They felt more secure when communicating face-to-face with health care professionals; (3) Remote monitoring can promote a sense of freedom and self-efficacy. The app provided autonomy, enabling patients to monitor their health without disrupting daily routines and promoting their health competency; and (4) Practical challenges and limitations of technology affect sense of security. Concerns about app deactivation, digital privacy, and lack of personalized settings negatively affected confidence in technology and sense of security. Conclusions: Remote monitoring and patient-initiated care can adequately meet the needs of patients with axSpA with low disease activity, reducing unnecessary visits and enhancing self-efficacy. However, these approaches should not be one-size-fits-all. Care must adapt to evolving disease activity, circumstances, and preferences. Human interaction and support remain crucial, and future technological developments must address practical challenges to ensure user-friendly and reliable interfaces. ",
doi="10.2196/63569",
url="https://www.jmir.org/2025/1/e63569"
}


@Article{info:doi/10.2196/67178,
author="Skoric, James
and Lomanowska, M. Anna
and Janmohamed, Tahir
and Lumsden-Ruegg, Heather
and Katz, Joel
and Clarke, Hance
and Rahman, Abidur Quazi",
title="Predicting Clinical Outcomes at the Toronto General Hospital Transitional Pain Service via the Manage My Pain App: Machine Learning Approach",
journal="JMIR Med Inform",
year="2025",
month="Mar",
day="28",
volume="13",
pages="e67178",
keywords="chronic pain",
keywords="transitional pain",
keywords="pain interference",
keywords="machine learning",
keywords="prediction model",
keywords="manage my pain",
keywords="pain app",
keywords="clinical outcome",
keywords="Toronto",
keywords="Canada",
keywords="transitional pain service",
keywords="pain service",
keywords="pain",
keywords="app",
keywords="application",
keywords="prognosis",
keywords="chronic pain management",
keywords="digital health",
keywords="digital health tool",
keywords="pain management",
keywords="machine learning methods",
keywords="prediction",
keywords="machine learning models",
keywords="logistic regression",
abstract="Background: Chronic pain is a complex condition that affects more than a quarter of people worldwide. The development and progression of chronic pain are unique to each individual due to the contribution of interacting biological, psychological, and social factors. The subjective nature of the experience of chronic pain can make its clinical assessment and prognosis challenging. Personalized digital health apps, such as Manage My Pain (MMP), are popular pain self-tracking tools that can also be leveraged by clinicians to support patients. Recent advances in machine learning technologies open an opportunity to use data collected in pain apps to make predictions about a patient's prognosis. Objective: This study applies machine learning methods using real-world user data from the MMP app to predict clinically significant improvements in pain-related outcomes among patients at the Toronto General Hospital Transitional Pain Service. Methods: Information entered into the MMP app by 160 Transitional Pain Service patients over a 1-month period, including profile information, pain records, daily reflections, and clinical questionnaire responses, was used to extract 245 relevant variables, referred to as features, for use in a machine learning model. The machine learning model was developed using logistic regression with recursive feature elimination to predict clinically significant improvements in pain-related pain interference, assessed by the PROMIS Pain Interference 8a v1.0 questionnaire. The model was tuned and the important features were selected using the 10-fold cross-validation method. Leave-one-out cross-validation was used to test the model's performance. Results: The model predicted patient improvement in pain interference with 79\% accuracy and an area under the receiver operating characteristic curve of 0.82. It showed balanced class accuracies between improved and nonimproved patients, with a sensitivity of 0.76 and a specificity of 0.82. Feature importance analysis indicated that all MMP app data, not just clinical questionnaire responses, were key to classifying patient improvement. Conclusions: This study demonstrates that data from a digital health app can be integrated with clinical questionnaire responses in a machine learning model to effectively predict which chronic pain patients will show clinically significant improvement. The findings emphasize the potential of machine learning methods in real-world clinical settings to improve personalized treatment plans and patient outcomes. ",
doi="10.2196/67178",
url="https://medinform.jmir.org/2025/1/e67178"
}


@Article{info:doi/10.2196/63989,
author="Kim, Mi Sun
and Kim, Seul Da
and Jang, Yoonsung
and Kim, Kyoon Min
and Yu, Eun-Seung
and Han, Hyun Doug
and Kim, Jun Hee",
title="Evaluating the Effectiveness of a Mobile App for Breast Cancer Self-Management on Self-Efficacy: Nonrandomized Intervention Trial",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Mar",
day="26",
volume="13",
pages="e63989",
keywords="breast cancer",
keywords="mobile health",
keywords="mHealth",
keywords="health education",
keywords="self-efficacy",
keywords="psychological adjustments",
keywords="mobile phone",
abstract="Background: Numerous mobile apps have been developed for patients with cancer. However, there is still no comprehensive app for patients with breast cancer that integrates evidence-based medical information, psychological support, and schedule management through a multidisciplinary medical approach. Objective: We aimed to investigate whether a mobile app designed to assist in the self-management of patients with breast cancer is feasible and positively affects their self-efficacy and other psychological aspects. Methods: The Cancer Manager (CAMA) app was developed to assist in the self-management of patients with breast cancer and survivors of cancer according to cancer trajectory. Its functionalities include providing evidence-based digitalized information created by experts, managing patients' medication and medical appointment schedules, and providing a delayed question and answer system for patients to query health care professionals. In this nonrandomized intervention trial, we analyzed data from 66 patients with breast cancer, divided into experimental (CAMA: n=34, 52\%) and control (treatment as usual: n=32, 48\%) groups. Group allocation was determined based on the patient's willingness to use the app and access to compatible smartphones. Outcome measures included the Korean version of the Cancer Survivor Self-Efficacy Scale, the Korean version of the Mini-Mental Adjustment to Cancer (K-Mini-MAC) Scale, the World Health Organization Quality of Life Brief Version, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Menopause Emotional Symptoms Questionnaire (MESQ). A user satisfaction survey was also conducted. Results: Throughout the intervention period, the CAMA group (vs treatment as usual group) demonstrated significant improvements in the seeking help and support subscale of the Korean version of the Cancer Survivor Self-Efficacy Scale (F1,64=5.09; P=.03), the psychological well-being subscale of the World Health Organization Quality of Life Brief Version (F1,64=5.48; P=.02), the anxious preoccupation subscale (F1,64=5.49; P=.02) and positive attitude subscale (F1,64=5.44; P=.02) of the K-Mini-MAC Scale, PHQ-9 (F1,64=4.83; P=.03), GAD-7 (F1,64=5.48; P=.02), and MESQ (F1,64=4.30; P=.04). Changes in the anxious preoccupation subscale of the K-Mini-MAC Scale scores were positively correlated with changes in the PHQ-9 (r=0.46; P=.007) and GAD-7 (r=0.41; P=.02) scores and negatively correlated with changes in the positive attitude subscale of the K-Mini-MAC Scale scores (r=--0.36; P=.04). Changes in the PHQ-9 scores were positively correlated with changes in the GAD-7 (r=0.66; P<.001) and MESQ (r=0.35; P=.04) scores. The user satisfaction survey offered insights into the CAMA app's positive impact; trust-building outcomes; and opportunities for enhancement, such as the inclusion of communication tools and continued content enrichment. Conclusions: The mobile app for breast cancer self-management, CAMA, was deemed feasible and showed promise in improving the patients' self-efficacy regarding seeking help and support, positive attitude toward cancer, and psychological well-being. In addition, its use might help reduce anxious preoccupation with cancer, depressive mood, anxiety, and menopausal emotional symptoms. Trial Registration: Clinical Research Information Service KCT0007917; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=23348 ",
doi="10.2196/63989",
url="https://mhealth.jmir.org/2025/1/e63989"
}


@Article{info:doi/10.2196/58393,
author="Mbada, E. Chidozie
and Awosika, Akintunji Henry
and Sonuga, Ademola Oluwatobi
and Akande, Micheal
and Gebrye, Tadesse
and Woolf, Richard
and Fatoye, Francis",
title="Effect of Clinic-Based and Asynchronous Video-Based Exercise on Clinic and Psychosocial Outcomes in Patients With Knee Osteoarthritis: Quasi-Experimental Study",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="26",
volume="27",
pages="e58393",
keywords="knee osteoarthritis",
keywords="video",
keywords="physiotherapy",
keywords="exercise",
keywords="mobile phone",
keywords="telehealth",
keywords="telemedicine",
keywords="randomized",
keywords="controlled trial",
keywords="asynchronous",
keywords="rehabilitation",
keywords="knees",
keywords="joints",
keywords="osteoarthritis",
keywords="musculoskeletal",
keywords="rheumatology",
keywords="physical therapy",
abstract="Background: Telerehabilitation is promising for improving knee osteoarthritis, but the effect of different telerehabilitation strategies on knee osteoarthritis is unclear. Objective: This study aimed to examine the effect of a clinic-based strengthening exercise (CbSE) and asynchronous video-based strengthening exercise (AVbSE) on pain, range of motion, muscle strength, quality of life, and physical function among patients with knee osteoarthritis. Methods: A total of 52 consenting patients participated in this 8-week experimental study; they were assigned to the CbSE or AVbSE group at 2 different study sites. CbSE is a circuit exercise module comprising knee flexion and extension warm-up in sitting, quadriceps isometric setting, quadriceps strengthening exercise, hamstring clenches, wall squat, and a cooldown of knee flexion and extension. The AVbSE is an asynchronous video-based version of the CbSE. Results: This study spanned from March 31, 2021, to November 26, 2021. Eight out of 62 participants discontinued participation. Data collection and analysis have been completed. Significant differences were only observed in the mental health (t50=--3, P=.004), pain (t39.4=--3.6, P<.001), social support (t50=--2.7, P=.009), and social activities (t50=2.2, P=.03) domains of the Osteoarthritis Knee and Hip Quality of Life (OAKHQoL) questionnaire with higher scores in the AVbSE group at the end of week 4. At the end of week 8, significant differences were observed in mental health (t50=--2.1, P=.04) and pain (t37.3=--2.8, P=.008) measures with higher scores in AVbSE; however, a significantly higher score was observed in the CbSE group for the Quadruple Visual Analog Scale. No significant main effect of time was observed in this study, except in the muscle strength (F2100=1.5, P=.24), social support (F2100=2.5, P=.09), and social activity (F2100=0.7, P=.48) domains of the OAKHQoL questionnaire and activity limitation (F2100=0.1, P=.90), and performance restriction (F2100=1.3, P=.27) domains of the Ibadan Knee and Hip Osteoarthritis Outcome Measure (IKHOAM) questionnaire. There was no significant difference between groups in all OAKHQoL domains except social activities (mean 17.6, SD 1.2 vs 22.8, SD 1.2; P=.003) and average pain (2.8, SD 1.6 vs 2.3, SD 1.6; P=.03) with higher AVbSE mean scores. However, a higher score was observed for the CbSE group in the Quadruple Visual Analog Scale's least pain domain (1.2, SD 0.2 vs 0.7, SD 0.2; P=.04). Also, interaction effects showed that AVbSE scores were significantly higher for the OAKHQoL questionnaire's physical activity and mental health domains at all time points. However, the CbSE score was higher for the physical performance domain of the IKHOAM questionnaire in the eighth week. Conclusions: CbSE circuit training and its AVbSE variant effectively improve treatment outcomes and increase the quality of life of patients. While AVbSE was associated with higher improvement in most health-related quality of life domains, CbSE led to higher improvement in average pain. Trial Registration: Pan African Clinical Trial Registry PACTR202208515182119, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=23943 ",
doi="10.2196/58393",
url="https://www.jmir.org/2025/1/e58393"
}


@Article{info:doi/10.2196/67246,
author="Zhou, Xu-Hua
and Chen, Hui
and Yang, Weiwei
and Wang, Li
and Chen, Lin
and Zhu, Ying
and Zhang, Yingjun
and Shi, Mei
and Zhang, Qin",
title="Efficacy of eHealth Interventions for Hemodialysis Patients: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="26",
volume="27",
pages="e67246",
keywords="hemodialysis",
keywords="eHealth interventions",
keywords="quality of life",
keywords="treatment adherence",
keywords="anxiety",
keywords="depression",
keywords="meta-analysis",
keywords="kidney",
keywords="systematic review",
keywords="kidney diseases",
keywords="kidney function",
keywords="chronic diseases",
abstract="Background: Within hemodialysis patient populations, eHealth interventions have been considered as an alternative and complementary option to routine care services. However, the efficacy of eHealth interventions for hemodialysis patients remains poorly understood owing to a lack of rigorous quantitative evidence synthesis. Objective: This meta-analysis aimed to evaluate the efficacy of eHealth interventions in improving quality of life, treatment adherence, and psychological outcomes (anxiety and depression) among hemodialysis patients. In addition, the study sought to identify specific intervention components and methodological quality associated with enhanced quality of life and health outcomes in this population. Methods: A comprehensive search was performed across PubMed, Web of Science, Embase, CINAHL, Cochrane Library, PsycINFO, China National Knowledge Infrastructure, WanFang, China Science and Technology Journal Database, and China BioMedical Literature Database databases from their inception to September 7, 2024. Randomized controlled trials on eHealth interventions for hemodialysis patients published in English or Chinese were included. Critical appraisal was carried out independently by 2 reviewers to assess the bias risk of the studies included. Quantitative synthesis of the outcomes of interest was conducted using a random-effects model. The quality of evidence for the outcomes was evaluated following the Grading of Recommendations, Assessment, Development, and Evaluation approach. Results: A total of 17 randomized controlled trials involving 1728 participants were included in this meta-analysis out of 5741 articles identified in the initial database search and additional search references. In the 17 studies, 8 kinds of eHealth intervention delivery formats were used, including text messages, telephone sessions, video, network platforms, social media, computers, websites, and mobile apps. The majority of research studies used a single form of eHealth intervention, and 7 studies adopted a combined approach of 2 or more eHealth technologies. The duration of eHealth interventions demonstrated substantial variability across studies, spanning from 4 weeks to 12 months, of which 3 months was the most common. A total of 14 (82\%) studies were considered to have ``some concern'' about selection bias. In addition, 15 (88\%) trials were classified as having a ``high risk'' of performance and detection bias, and all trials were judged to be at ``low risk'' of attrition and reporting bias. The pooled results revealed a significant difference between the eHealth interventions and control groups on quality of life (standardized mean difference [SMD]=0.87, 95?\% CI 0.38 to 1.37, low certainty evidence), treatment adherence (SMD=1.11, 95?\% CI 0.30 to 1.91, moderate certainty evidence), anxiety (SMD=--2.11, 95?\% CI --3.25 to --0.97, moderate certainty evidence), and depression (SMD=--2.46, 95?\% CI --3.68 to --1.25, moderate certainty evidence). Conclusions: eHealth interventions could be a beneficial approach for improving quality of life and treatment adherence and reducing anxiety and depression among hemodialysis patients. However, future high-quality randomized controlled trials are essential to draw more reliable conclusions. Trial Registration: PROSPERO CRD42024589799; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024589799 ",
doi="10.2196/67246",
url="https://www.jmir.org/2025/1/e67246"
}


@Article{info:doi/10.2196/63704,
author="Rookes, Alanna Tasmin
and Batla, Amit
and Armstrong, Megan
and Ambler, Gareth
and Walters, Kate
and Schrag, Anette",
title="Patient Acceptability and Technical Reliability of Wearable Devices Used for Monitoring People With Parkinson Disease: Survey Study",
journal="JMIR Form Res",
year="2025",
month="Mar",
day="25",
volume="9",
pages="e63704",
keywords="Parkinson disease",
keywords="feasibility",
keywords="remote monitoring",
keywords="Parkinson",
keywords="acceptability",
keywords="reliability",
keywords="wearable devices",
keywords="wearable",
keywords="self-management",
keywords="quantitative assessments",
keywords="quantitative",
keywords="qualitative",
keywords="monitoring",
keywords="patient",
abstract="Background: Parkinson disease is a progressive neurodegenerative disorder with complex motor and nonmotor symptoms. To assess these, clinical assessments are completed, providing a snapshot of a person's experience. Monitoring Parkinson disease using wearable devices can provide continuous and objective data and capture information on movement patterns in daily life. Objective: The aim of the study is to assess patient acceptability and technical reliability of 2 wearable devices used in clinical trials (ActivInsights and Axivity AX3). Methods: Participants in a feasibility study testing a self-management toolkit (PD-Care) optionally wore a wearable device for 1 week, providing feedback through an open- and closed-question survey conducted over the telephone about the acceptability of wearing the device. The closed questions used a Likert scale from 1 to 5 (with 1=strongly agree and 5=strongly disagree) asking whether (1) the device was comfortable to wear, (2) the device was easy to put on, (3) the device was easy to wear, (4) the device was embarrassing to wear, and (5) if they were happy to wear the device for longer than 7 days. Differences in acceptability between devices were analyzed using Mann-Whitney U tests and Wilcoxon matched pairs signed rank tests. These were followed by open-ended questions asking (1) How did you find wearing the device? (2) How did you find putting the device on? (3) Did you take it off and why? (4) What was your overall impression? (5) Did you prefer the wrist- or trunk-worn device and why (Axivity AX3 only)? Results: A total of 22 of 32 (69\%) participants offered the device agreed to wear it. There were no significant differences in the demographic characteristics between those monitored and those who chose not to be. Acceptance with both devices was generally good. The ActivInsights device was more acceptable than the wrist- and trunk-worn Axivity AX3 devices, as more participants found it to be comfortable (n=15, 100\% vs n=5, 71\%; P=.02 and n=4, 57\%; P=.004, respectively), easy to wear (n=15, 100\% vs n=6, 86\%; P=.048 and n=3, 43\%; P=.004, respectively) and would wear for more than 7 days (n=13, 87\% vs n=4, 57\%; P=.02 and n=1, 14\%; P<.001, respectively). The trunk-worn Axivity AX3 device had the lowest acceptance rates, but there were no statistical differences in acceptability between the wrist- and trunk-worn Axivity AX3 devices (all P>.05). There were issues with battery life and recording errors in 3 of 14 (21\%) Axivity AX3 devices and upload failures in 3 of 15 (20\%) ActivInsights devices. Conclusions: Acceptability of wearables for monitoring Parkinson was satisfactory, especially when wrist-worn, although a few participants experienced difficulties in correct use, and there were some errors with the data upload. Trial Registration: ISRCTN Registry ISRCTN92831552; https://www.isrctn.com/ISRCTN92831552 ",
doi="10.2196/63704",
url="https://formative.jmir.org/2025/1/e63704"
}


@Article{info:doi/10.2196/64400,
author="Zhou, Jinyan
and Ding, Shanni
and Xu, Yihong
and Pan, Hongying",
title="Effects of Digital Intelligent Interventions on Self-Management of Patients With Diabetic Foot: Systematic Review",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="25",
volume="27",
pages="e64400",
keywords="diabetic foot",
keywords="self-management",
keywords="digital intelligent intervention",
keywords="systematic review",
keywords="mobile phone",
abstract="Background: Diabetic foot (DF) is one of the most common and serious complications of diabetes. Effective self-management by patients can delay disease progression and improve quality of life. Digital intelligent technologies have emerged as advantageous in assisting patients with chronic diseases in self-management. However, the impact of digital intelligent technologies on self-management of patients with DF remains unclear. Objective: This systematic review aimed to determine the effects of digital intelligent interventions on self-management in patients with DF. Methods: A systematic literature search was conducted across PubMed, Web of Science, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Cochrane Central Register of Controlled Trial, ProQuest, China National Knowledge Internet, WanFang, China Science and Technology Journal Database, and SinoMed up to February 6, 2025, to identify eligible articles. Randomized controlled trials (RCTs) that assessed the effects of digital intelligent interventions on self-management of patients with DF were included. In total, 2 researchers independently conducted literature screening, quality assessment, and data extraction. The Cochrane Risk of Bias 2.0 tool (revised version 2019) for RCTs was used to assess the quality of the studies. A qualitative synthesis was conducted on the extracted data. Results: In total, 1079 articles were retrieved, and 18 RCTs were included. All studies were rated as having a high risk of bias. The digital intelligent interventions in the included studies varied in forms, components, and durations. The intervention forms included WeChat (Tencent Holdings Limited; 7/18, 39\%), apps (4/18, 22\%), electronic platforms (3/18, 17\%), mixed interventions (3/18, 17\%), and smartphone thermography (1/18, 6\%). The intervention components included self-management education (17/18, 94\%), blood glucose and foot condition monitoring (8/18, 44\%), self-management supervision and follow-up (6/18, 33\%), and other components like foot risk assessment, foot care reminders, visit reminders, and remote consultations. Intervention durations ranged from 5 weeks to 12 months, with the majority (10/18, 56\%) lasting 6 months. Among the 18 included studies, 17 studies (17/18, 94\%) indicated that, compared with routine care, digital intelligent interventions significantly improved the self-management behaviors of patients with DF, including diabetes control, foot care behaviors, and blood glucose monitoring. Only 1 study (1/18, 6\%) showed that the effects of digital intelligent interventions were not significantly different from those of routine care. Conclusions: In this systematic review, evidence suggests that digital intelligent interventions can improve self-management behaviors and capabilities in patients with DF. However, due to the overall low quality of the included studies, current evidence should be interpreted and applied with caution. This field is still in the exploratory stage, with significant heterogeneity among different studies and a lack of consensus on intervention strategies, necessitating further exploration tailored to different populations. Future RCTs with large sample sizes and rigorous design are needed to develop high-quality evidence. Trial Registration: PROSPERO CRD42024524473; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024524473 ",
doi="10.2196/64400",
url="https://www.jmir.org/2025/1/e64400"
}


@Article{info:doi/10.2196/64505,
author="Bober, Timothy
and Garvin, Sophia
and Krall, Jodi
and Zupa, Margaret
and Low, Carissa
and Rosland, Ann-Marie",
title="Examining How Adults With Diabetes Use Technologies to Support Diabetes Self-Management: Mixed Methods Study",
journal="JMIR Diabetes",
year="2025",
month="Mar",
day="25",
volume="10",
pages="e64505",
keywords="diabetes",
keywords="self-management",
keywords="mobile health",
keywords="health technology",
keywords="continuous glucose monitors",
keywords="digital health literacy",
abstract="Background: Technologies such as mobile apps, continuous glucose monitors (CGMs), and activity trackers are available to support adults with diabetes, but it is not clear how they are used together for diabetes self-management. Objective: This study aims to understand how adults with diabetes with differing clinical profiles and digital health literacy levels integrate data from multiple behavior tracking technologies for diabetes self-management. Methods: Adults with type 1 or 2 diabetes who used ?1 diabetes medications responded to a web-based survey about health app and activity tracker use in 6 categories: blood glucose level, diet, exercise and activity, weight, sleep, and stress. Digital health literacy was assessed using the Digital Health Care Literacy Scale, and general health literacy was assessed using the Brief Health Literacy Screen. We analyzed descriptive statistics among respondents and compared health technology use using independent 2-tailed t tests for continuous variables, chi-square for categorical variables, and Fisher exact tests for digital health literacy levels. Semistructured interviews examined how these technologies were and could be used to support daily diabetes self-management. We summarized interview themes using content analysis. Results: Of the 61 survey respondents, 21 (34\%) were Black, 23 (38\%) were female, and 29 (48\%) were aged ?45 years; moreover, 44 (72\%) had type 2 diabetes, 36 (59\%) used insulin, and 34 (56\%) currently or previously used a CGM. Respondents had high levels of digital and general health literacy: 87\% (46/53) used at least 1 health app, 59\% (36/61) had used an activity tracker, and 62\% (33/53) used apps to track ?1 health behaviors. CGM users and nonusers used non-CGM health apps at similar rates (16/28, 57\% vs 12/20, 60\%; P=.84). Activity tracker use was also similar between CGM users and nonusers (20/33, 61\% vs 14/22, 64\%; P=.82). Respondents reported sharing self-monitor data with health care providers at similar rates across age groups (17/32, 53\% for those aged 18-44 y vs 16/29, 55\% for those aged 45-70 y; P=.87). Combined activity tracker and health app use was higher among those with higher Digital Health Care Literacy Scale scores, but this difference was not statistically significant (P=.09). Interviewees (18/61, 30\%) described using blood glucose level tracking apps to personalize dietary choices but less frequently used data from apps or activity trackers to meet other self-management goals. Interviewees desired data that were passively collected, easily integrated across data sources, visually presented, and tailorable to self-management priorities. Conclusions: Adults with diabetes commonly used apps and activity trackers, often alongside CGMs, to track multiple behaviors that impact diabetes self-management but found it challenging to link tracked behaviors to glycemic and diabetes self-management goals. The findings indicate that there are untapped opportunities to integrate data from apps and activity trackers to support patient-centered diabetes self-management. ",
doi="10.2196/64505",
url="https://diabetes.jmir.org/2025/1/e64505",
url="http://www.ncbi.nlm.nih.gov/pubmed/40131316"
}


@Article{info:doi/10.2196/64933,
author="Wu, J. Jennifer
and Graham, Ross
and {\c{C}}elebi, Julie
and Fraser, Kevin
and Gin, T. Geneen
and Dang, Laurel
and Hatamy, Esmatullah
and Walker, Amanda
and Barbato, Courtney
and Lunde, Ottar
and Coles, Lisa
and Agnihotri, Parag
and Morn, Cassandra
and Tai-Seale, Ming",
title="Factors Influencing Primary Care Physicians' Intent to Refer Patients With Hypertension to a Digital Remote Blood Pressure Monitoring Program: Mixed Methods Study",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="24",
volume="27",
pages="e64933",
keywords="digital health",
keywords="primary care",
keywords="electronic health records",
keywords="referral",
keywords="hypertension",
keywords="remote monitoring",
keywords="remote blood pressure",
keywords="digital technology",
keywords="mobile phone",
keywords="mixed method",
keywords="quantitative analysis",
keywords="linear regression",
keywords="clinical information",
abstract="Background: Primary care physicians' (PCP) referral rates to digital health programs are highly variable. This study explores whether knowledge of the digital remote blood pressure monitoring (RBPM) program and information on referral patterns influence PCPs' intention to refer patients. Objective: This study aims to examine the relationship between PCPs' knowledge of the digital RBPM program and information on their own prior referral rates versus their own with their peers' referral rates and their likelihood to refer patients to the digital RBPM program. Methods: This is a mixed methods study integrating quantitative analysis of electronic health record data regarding the frequency of PCPs' referrals of patients with hypertension to a digital health program and quantitative and qualitative analyses of survey data about PCPs' knowledge of the program and their intention to refer patients. PCPs responded to a clinical vignette featuring an eligible patient. They were randomized to either receive their own referral rate or their own plus their peers' referral rate. They were assessed on their intent to refer eligible future patients. Descriptive and multivariable linear regression analyses examined participant characteristics and the factors associated with their intent to refer patients. Narrative reasons for their intention to refer were thematically analyzed. Results: Of the 242 eligible PCPs invited to participate, 31\% (n=70) responded to the survey. From electronic health record data, the mean referral rate of patients per PCP was 11.80\% (SD 13.30\%). The mean self-reported knowledge of the digital health program was 6.47 (SD 1.81). The mean likelihood of referring an eligible patient (on a scale of 0 to 10, with 0 being not at all, and 10 being definitely) based on a vignette was 8.54 (SD 2.12). The own referral data group's mean likelihood to refer was 8.91 (SD 1.28), whereas the own plus peer prior referral data group was 8.35 (SD 2.19). Regression analyses suggested the intention to refer the vignette patient was significantly associated with their knowledge (coefficient 0.46, 95\% CI 0.20-0.73; P<.001), whereas the intention to refer future patients was significantly associated with their intent to refer the patient in the vignette (coefficient 0.62, 95\% CI 0.46-0.78; P<.001). No evidence of association was found on receiving own plus peer referral data compared with own referral data and intent to refer future patients (coefficient 0.23, 95\% CI --0.43 to 0.89; P=.48). Conclusions: Physicians' intention to refer patients to a novel digital health program can be extrapolated by examining their intention to refer an eligible patient portrayed in a vignette, which was found to be significantly influenced by their knowledge of the program. Future efforts should engage PCPs to better inform them so that more patients can benefit from the digital health program. ",
doi="10.2196/64933",
url="https://www.jmir.org/2025/1/e64933",
url="http://www.ncbi.nlm.nih.gov/pubmed/40126550"
}


@Article{info:doi/10.2196/60647,
author="Koch, Roland
and Steffen, Marie-Theres
and Wetzel, Anna-Jasmin
and Preiser, Christine
and Klemmt, Malte
and Ehni, Hans-J{\"o}rg
and Mueller, Regina
and Joos, Stefanie",
title="Exploring Laypersons' Experiences With a Mobile Symptom Checker App as an Interface Between eHealth Literacy, Health Literacy, and Health-Related Behavior: Qualitative Interview Study",
journal="JMIR Form Res",
year="2025",
month="Mar",
day="21",
volume="9",
pages="e60647",
keywords="symptom checker apps",
keywords="health literacy",
keywords="eHealth literacy",
keywords="qualitative research",
keywords="interview study",
keywords="artificial intelligence",
keywords="AI",
abstract="Background: Symptom checkers aim to help users recognize medical symptoms and recommend actions. However, they are not yet reliable for self-triage or diagnostics. Health literacy plays a role in their use, but the process from symptom recognition to health care consultation remains unclear. Objective: This qualitative observatory study explored how laypersons use symptom checkers, focusing on the process of use, entry points and outcomes, and the role of health literacy. Laypersons are defined as individuals who are neither medical professionals nor developers of such apps. Three research questions were addressed: (1) How do such users describe the process of using symptom checkers? (2) What are entry points and possible outcomes of symptom checker app use? (3) How are health literacy and eHealth literacy expressed during the use of symptom checker apps? Methods: As part of the Ethical, Legal, and Social Implications of Symptom Checker Apps in Primary Health Care project, 15 laypersons (n=9, 60\% female and n=6, 40\% male; mean age 30.7, SD 13.6 years) were interviewed about their experiences with the symptom checker Ada. The interviews were analyzed using an integrative approach combining social positioning, agency, and the Rubicon model as a heuristic framework. Results: App use follows a cyclic process comprising 4 steps: motivation (influenced by biography and context), intention formation (assigning a purpose), intention implementation (recruiting resources), and evaluation (transforming interactions into health-related insights). Biographical, social, and contextual factors shape process initiation. Users use symptom checkers for 3 main purposes: understanding their condition, receiving recommendations for action, and documenting or communicating health-related information. Each purpose requires specific planning and integration into health-related behaviors drawing on personal, social, and technological resources. Evaluation depends on contextual factors, app outputs, and the outcomes of users' health-related actions. Users assess whether the app aligns with their expectations, condition severity, and previous experiences, with health literacy playing a critical role in validation processes. Conclusions: Symptom checker use is a complex, cyclic process shaped by context, biography, and health literacy. Users are motivated by health concerns influenced by personal, social, and contextual factors, with trust and attitudes impacting initial engagement. Intention formation reflects a balance between user skills and context, where app outputs inform decisions but may not always lead to action, especially in ambiguous situations. Users rely on personal resources and social networks to integrate app use into health-related behaviors, highlighting the limitations of symptom checkers in providing social or empathetic support. Symptom checkers have the potential to serve as an interface between users and health care, but future development must address the complexity of their use to unlock this potential. International Registered Report Identifier (IRRID): RR2-10.2196/34026 ",
doi="10.2196/60647",
url="https://formative.jmir.org/2025/1/e60647"
}


@Article{info:doi/10.2196/60162,
author="Rafiei, Mahdie
and Das, Supratim
and Bakhtiari, Mohammad
and Roos, Maria Ewa
and Skou, T. S{\o}ren
and Gr{\o}nne, T. Dorte
and Baumbach, Jan
and Baumbach, Linda",
title="Personalized Predictions for Changes in Knee Pain Among Patients With Osteoarthritis Participating in Supervised Exercise and Education: Prognostic Model Study",
journal="JMIR Rehabil Assist Technol",
year="2025",
month="Mar",
day="21",
volume="12",
pages="e60162",
keywords="osteoarthritis",
keywords="prediction",
keywords="pain intensity",
keywords="exercise therapy",
keywords="machine learning",
abstract="Background: Knee osteoarthritis (OA) is a common chronic condition that impairs mobility and diminishes quality of life. Despite the proven benefits of exercise therapy and patient education in managing OA pain and functional limitations, these strategies are often underused. To motivate and enhance patient engagement, personalized outcome prediction models can be used. However, the accuracy of existing models in predicting changes in knee pain outcomes remains insufficiently examined. Objective: This study aims to validate existing models and introduce a concise personalized model predicting changes in knee pain from before to after participating in a supervised patient education and exercise therapy program (GLA:D) among patients with knee OA. Methods: Our prediction models leverage self-reported patient information and functional measures. To refine the number of variables, we evaluated the variable importance and applied clinical reasoning. We trained random forest regression models and compared the rate of true predictions of our models with those using average values. In supplementary analyses, we additionally considered recently added variables to the GLA:D registry. Results: We evaluated the performance of a full, continuous, and concise model including all 34 variables, all 11 continuous variables, and the 6 most predictive variables, respectively. All three models performed similarly and were comparable to the existing model, with R2 values of 0.31?0.32 and root-mean-squared errors of 18.65?18.85---despite our increased sample size. Allowing a deviation of 15 (visual analog scale) points from the true change in pain, our concise model correctly estimated the change in pain in 58\% of cases, while using average values that resulted in 51\% accuracy. Our supplementary analysis led to similar outcomes. Conclusions: Our concise personalized prediction model provides more often accurate predictions for changes in knee pain after the GLA:D program than using average pain improvement values. Neither the increase in sample size nor the inclusion of additional variables improved previous models. Based on current knowledge and available data, no better predictions are possible. Guidance is needed on when a model's performance is good enough for clinical practice use. ",
doi="10.2196/60162",
url="https://rehab.jmir.org/2025/1/e60162"
}


@Article{info:doi/10.2196/56227,
author="Zhu, Beiyao
and Zhu, Dian
and Xue, Xiao'ao
and Yang, Hongyi
and Zhang, Shurong",
title="Behavioral Therapy--Based Digital Interventions for Treating Osteoarthritis: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="19",
volume="27",
pages="e56227",
keywords="osteoarthritis",
keywords="digital intervention",
keywords="behavioral therapy",
keywords="treatment",
keywords="systematic review",
keywords="meta-analysis",
keywords="pain",
keywords="impairment",
keywords="quality of life",
keywords="socioeconomic burden",
keywords="psychotherapy-based digital intervention",
keywords="patient",
keywords="pain reduction",
abstract="Background: Osteoarthritis (OA) is characterized by pain, functional impairments, muscle weakness, and joint stiffness. Since OA heightens reliance on heath care resources and exacerbates socioeconomic burden, remote OA rehabilitation using digital technologies is rapidly evolving. Objective: The aim of this study was to analyze the efficacy of behavioral therapy--based digital interventions for patients with OA. Methods: This study is a systematic review of randomized controlled trials (RCTs) that assessed the effects of behavioral therapy--based digital intervention tools for OA. These RCTs were searched from inception to June 2023 in the Web of Science, Embase, Cochrane Library, Ovid, and PubMed databases. Results: Ten eligible RCTs comprising 1895 patients with OA were included. Digital tools based on either cognitive behavioral therapy (CBT) or behavior change technique (BCT) were investigated. All studies demonstrated low-to-moderate effects on pain reduction in the short term (standardized mean difference [SMD] --0.20, 95\% CI --0.35 to --0.05). Six studies reported improvement in physical function (SMD --0.20, 95\% CI --0.41 to 0.00), and 5 confirmed increased pain self-efficacy (SMD 0.22, 95\% CI 0.02-0.42). In subgroup analysis, compared with CBT, BCT-based digital interventions demonstrated their effects on pain reduction (SMD --0.25, 95\% CI --0.49 to 0.00) and physical function (SMD --0.26, 95\% CI --0.54 to --0.01) in the short term. In addition, physiotherapist involvement in treatment had a positive effect on pain control (SMD --0.14, 95\% CI --0.27 to --0.02). Furthermore, web-based digital tools improved physical function in the short term (SMD --0.28, 95\% CI --0.54 to --0.01). Conclusions: Moderate- and low-quality evidence supported that behavioral therapy--based digital tools improved pain intensity, physical function, and self-efficacy in the short term. However, affective interactions between patients and professionals may affect the clinical outcomes. Trial Registration: PROSPERO CRD42023430716; https://tinyurl.com/yc49vzyy ",
doi="10.2196/56227",
url="https://www.jmir.org/2025/1/e56227"
}


@Article{info:doi/10.2196/60588,
author="Carr, L. Alaina
and Jenkins, M. Angela
and Jonklaas, Jacqueline
and Gabriel, Kate
and Miller, E. Kristen
and Graves, D. Kristi",
title="Patient and Provider Perspectives of a Web-Based Intervention to Support Symptom Management After Radioactive Iodine Treatment for Differentiated Thyroid Cancer: Qualitative Study",
journal="JMIR Form Res",
year="2025",
month="Mar",
day="19",
volume="9",
pages="e60588",
keywords="iodine radioisotopes",
keywords="person-based approach",
keywords="self-management",
keywords="Social Cognitive Theory",
keywords="survivorship",
keywords="symptom burden",
keywords="thyroid neoplasms",
keywords="web-based intervention",
keywords="radioactive iodine treatment",
keywords="radiotherapy",
keywords="thyroid cancer",
keywords="qualitative",
keywords="quality of life",
keywords="survivorship care",
keywords="supportive care",
keywords="patient with cancer",
keywords="QoL",
keywords="cancer",
keywords="carcinoma",
keywords="malignancy",
keywords="tumor",
keywords="malignant",
keywords="oncology",
keywords="neoplasm",
keywords="benign",
keywords="neoplasia",
keywords="thyroid",
abstract="Background: Patients diagnosed with differentiated thyroid cancer (DTC) who receive radioactive iodine (RAI) treatment experience acute, medium, and late treatment effects. The timing and severity of these effects vary by individual; common posttreatment effects include dry mouth, salivary gland swelling, dry eyes, and nose bleeds. The nature of symptoms that patients experience after RAI treatment can significantly and negatively impact health-related quality of life. Adequate information during the postprimary treatment phase remains an unmet need among the population of patients diagnosed with DTC. Objective: This qualitative study aimed to identify and understand self-management strategies for RAI-specific symptom burden from the perspectives of patients and stakeholders (cancer care providers and patient advocates). An additional aim included assessing features and functionalities desirable in the development of a web-based intervention to engage patients in their self-management and thyroid cancer survivorship care. Methods: Following the Social Cognitive Theory framework and person-based principles, we conducted six focus groups with 22 patients diagnosed with DTC who completed RAI treatment and individual interviews with 12 stakeholders in DTC care. The interviews focused on participants' perspectives on current self-management strategies and mockups of a symptom management web-based intervention. Before focus groups and interviews, participants completed a demographics survey. Focus group discussions and interviews were transcribed and coded using content analysis. Interrater reliability was satisfactory (?=.88). Results: A total of 34 individuals (patients and stakeholders) participated in the study; the mean age was 45 (SD 13.4) and 45.3 (SD 13) years, respectively. Three domains emerged from qualitative interviews: (1) difficult-to-manage RAI symptoms: short, medium, and late treatment effects; (2) key intervention structure and content feedback on mockups; and (3) intervention content to promote RAI symptom management and survivorship care. Focus group participants identified the most prevalent RAI symptoms that were difficult to manage as: dry mouth (11/22, 50\%), salivary gland swelling (8/22, 36\%), and changes in taste (12/22, 55\%). Feedback elicited from both groups found education and symptom management mockup videos to be helpful in patient self-management of RAI symptoms, whereas patients and stakeholders provided mixed feedback on the benefits of a draft frequently asked questions page. Across focus groups and stakeholder interviews, nutrition-based symptom management strategies, communication with family members, and practical survivorship follow-up information emerged as helpful content to include in a future web-based supportive care intervention. Conclusions: Results suggest education and symptom management videos can empower patients with DTC to self-manage mild to moderate RAI symptoms on a web-based platform. Findings emphasized the need for additional information for patients related to ongoing care following RAI treatment including social support and thyroid cancer surveillance. The findings provide insights for theoretically informed interventions and recommendations for refinements in thyroid cancer survivorship from patient and provider perspectives. ",
doi="10.2196/60588",
url="https://formative.jmir.org/2025/1/e60588"
}


@Article{info:doi/10.2196/60019,
author="Yu, Tianzhi
and Li, Wanyu
and Liu, Yingchun
and Jin, Chunjie
and Wang, Zimin
and Cao, Hailong",
title="Application of Internet Hospitals in the Disease Management of Patients With Ulcerative Colitis: Retrospective Study",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="18",
volume="27",
pages="e60019",
keywords="inflammatory bowel disease",
keywords="ulcerative colitis",
keywords="intelligent diagnosis and treatment service",
keywords="internet hospital",
keywords="chronic disease management",
abstract="Background: Ulcerative colitis (UC) is a chronic disease characterized by frequent relapses, requiring long-term management and consuming substantial medical and social resources. Effective management of UC remains challenging due to the need for sustainable remission strategies, continuity of care, and access to medical services. Intelligent diagnosis refers to the use of artificial intelligence--driven algorithms to analyze patient-reported symptoms, generate diagnostic probabilities, and provide treatment recommendations through interactive tools. This approach could potentially function as a method for UC management. Objective: This study aimed to analyze the diagnosis and treatment data of UC from both physical hospitals and internet hospitals, highlighting the potential benefits of the intelligent diagnosis and treatment service model offered by internet hospitals. Methods: We collected data on the visits of patients with UC to the Department of Gastroenterology at Tianjin Medical University General Hospital. A total of 852 patients with UC were included between July 1, 2020, and June 31, 2023. Statistical methods, including chi-square tests for categorical variables, t tests for continuous variables, and rank-sum tests for visit numbers, were used to evaluate the medical preferences and expenses of patients with UC. Results: We found that internet hospitals and physical hospitals presented different medical service models due to the different distribution of medical needs and patient groups. Patients who chose internet hospitals focused on disease consultation and prescription medication (3295/3528, 93.40\%). Patients' medical preferences gradually shifted to web-based services provided by internet hospitals. Over time, 58.57\% (270/461) of patients chose either web-based services or a combination of web-based and offline services for UC diagnosis and treatment. The number of visits in the combination of web-based and offline service modes was the highest (mean 13.83, SD 11.07), and younger patients were inclined to visit internet hospitals (49.66\%>34.71\%). In addition, compared with physical hospitals, there was no difference in testing fees and examination fees for patients with UC in internet hospitals, but medicine fees were lower. Conclusions: The intelligent diagnosis and treatment model provided by internet hospitals demonstrates the potential benefits in managing UC, including feasibility, accessibility, convenience, and economics. ",
doi="10.2196/60019",
url="https://www.jmir.org/2025/1/e60019"
}


@Article{info:doi/10.2196/69100,
author="Main, Ashleigh
and McCartney, Haruno
and Ibrar, Maryam
and Muirhead, Fiona
and Mavroeidi, Alexandra
and Rai, Kaur Harleen
and Maguire, Roma",
title="Patients' Experiences of Digital Health Interventions for the Self-Management of Chronic Pain: Systematic Review and Thematic Synthesis",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="18",
volume="27",
pages="e69100",
keywords="chronic pain",
keywords="digital health",
keywords="digital tool",
keywords="digital health intervention",
keywords="mobile health",
keywords="mHealth",
keywords="eHealth",
keywords="self-management",
keywords="pain management",
keywords="person-centered",
keywords="patient experiences",
keywords="systematic review",
keywords="thematic synthesis",
abstract="Background: Research regarding the effectiveness of digital health interventions (DHIs) for people living with chronic pain is widely documented, although it is often measured against changes in clinical outcomes. To gain a comprehensive understanding of the full impact of DHIs, it is vital to understand the experience of individuals who are using them. An exploration of qualitative data regarding the experience of people living with chronic pain engaging with DHIs could provide a more in-depth account of how individuals interact and engage with such tools, uncovering the overall impact DHIs can have on the lives of people living with chronic pain. Objective: This qualitative systematic review and thematic synthesis aimed to appraise and synthesize relevant qualitative evidence on patients' experiences of engaging with DHIs for the self-management of chronic pain symptoms. Methods: A systematic literature search of qualitative and mixed methods studies published between 2013 and 2023 was conducted across 6 databases: MEDLINE, PubMed, Embase, CINAHL, PsycINFO, and Scopus. Eligible studies included adult patients aged ?18 years with a chronic pain diagnosis (ie, >12 weeks) reporting on the experience of engaging in a DHI for the self-management of chronic pain. The Critical Appraisal Skills Program checklist for qualitative research was used to appraise each study. Following a 3-step inductive thematic synthesis approach, the researcher performed line-by-line coding of each eligible article to identify descriptive themes. Through iterative evaluation of the descriptive themes, analytical themes that facilitated a deeper understanding of the data were derived. Results: In total, 37 qualitative and mixed methods studies were included in the review. Thematic synthesis revealed three overarching themes encompassing five subthemes: (1) personal growth, with 2 subthemes (gaining new insights and renewed mindset); (2) active involvement, with 3 subthemes (motivation, improved access, and health care decision-making); and (3) connectedness and support. Conclusions: A positive experience with DHIs among people living with chronic pain is achieved through an improved understanding of their condition, greater self-awareness of how symptoms impact their lives, and an increase in motivation to play an active role in their health care. DHIs promote the confidence and independence of people living with chronic pain, as well as facilitate a sense of ongoing support between routine appointments. However, DHIs may disempower people living with chronic pain by placing too much focus on their pain and should be used as an adjunct to existing care as opposed to replacing in-person appointments. To appropriately meet the needs of people living with chronic pain, the content and features of DHIs should be personalized. Development of future DHIs should use a co-design approach involving key stakeholders to ensure the needs of people living with chronic pain are met. Trial Registration: PROSPERO CRD42023445100; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023445100 International Registered Report Identifier (IRRID): RR2-10.2196/52469 ",
doi="10.2196/69100",
url="https://www.jmir.org/2025/1/e69100"
}


@Article{info:doi/10.2196/69204,
author="Du, ShanShan
and Zhao, Yining",
title="Enhancing Digital Health Interventions for Medication Adherence: Considerations for Broader Applicability and Long-Term Impact",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="14",
volume="27",
pages="e69204",
keywords="mobile apps",
keywords="digital health",
keywords="atrial fibrillation",
keywords="anticoagulants",
keywords="medication adherence",
keywords="mobile phone",
doi="10.2196/69204",
url="https://www.jmir.org/2025/1/e69204"
}


@Article{info:doi/10.2196/68292,
author="Edwards, A. Karlyn
and Dildine, C. Troy
and You, S. Dokyoung
and Herrick, M. Ashley
and Darnall, D. Beth
and Mackey, C. Sean
and Ziadni, S. Maisa",
title="Zoom-Delivered Empowered Relief for Chronic Pain: Observational Longitudinal Pilot Study Exploring Feasibility and Pain-Related Outcomes in Patients on Long-Term Opioids",
journal="JMIR Form Res",
year="2025",
month="Mar",
day="11",
volume="9",
pages="e68292",
keywords="Empowered Relief",
keywords="single session",
keywords="chronic pain",
keywords="prescription opioids",
keywords="telehealth",
keywords="daily data",
keywords="pain intensity",
keywords="pain catastrophizing",
abstract="Background: Patients with chronic pain on long-term opioid therapy often face barriers to accessing effective nonpharmacological treatments, including the burden of multiple sessions, lack of trained clinicians, and travel time. Empowered Relief (ER), a 2-hour, single-session pain relief skills class, can improve pain and quality of life among patients with chronic pain when delivered in person or virtually. Objective: This study examined the impact of Zoom-delivered ER among people with chronic pain on long-term opioid therapy. We assessed (1) the feasibility and acceptability of Zoom-delivered ER; (2) changes in pain and opioid use outcomes at 3 and 6 months after treatment; and (3) daily associations among pain, opioid dose, and the Pain Catastrophizing Scale (PCS) before and after treatment. Methods: During the early COVID-19 pandemic, we conducted an uncontrolled pilot study of a Zoom-delivered ER among 60 adults (n=45, 76\% female participants; n=52, 88\% White participants) experiencing chronic pain who were receiving daily prescribed opioids (?10 morphine-equivalent daily dose). Participants completed assessments at enrollment, before class, after class, 3 months after treatment, and 6 months after treatment. Furthermore, participants completed 2 daily assessment periods (spanning 14 consecutive days) before and after the class. We used a multilevel modeling approach to examine (1) the raw changes in PCS, average pain intensity, pain interference, and self-reported opioid dose at 3 and 6 months after treatment and (2) daily-level changes in average pain intensity and opioid dose before and after the class. Results: Of the 60 participants enrolled, 41 (68\%) attended the class and 24 (59\% of the 41 class attendees) reported satisfaction with the Zoom-delivered class. PCS score was significantly reduced at 3 months ($\beta$=--3.49, P=.01; Cohen d=0.35) and 6 months after treatment ($\beta$=--3.61, P=.01; Cohen d=0.37), and pain intensity was significantly reduced at 3 months ($\beta$=--0.56, P=.01; Cohen d=0.39) compared to enrollment. There were no significant reductions in pain interference or opioid dose. Across daily assessments, higher daily pain catastrophizing was associated with worse daily pain ($\beta$=.42, P<.001) and higher self-reported opioid use ($\beta$=3.14, P<.001); daily pain intensity significantly reduced after the class ($\beta$=--.50, P<.001). People taking prescribed opioids as needed trended toward decreasing their daily opioid use after the class ($\beta$=--9.31, P=.02), although this result did not survive correction for multiplicity. Conclusions: Improvements to future Zoom-delivered ER iterations are needed to improve feasibility and acceptability among people with chronic pain and daily prescribed opioid use. Despite this, findings show a promising preliminary impact of the intervention on pain outcomes. A larger randomized controlled trial of Zoom-delivered ER among this patient population is currently under way. ",
doi="10.2196/68292",
url="https://formative.jmir.org/2025/1/e68292"
}


@Article{info:doi/10.2196/53539,
author="Crafoord, Marie-Ther{\'e}se
and Ekstrand, Joakim
and Sundberg, Kay
and Nilsson, I. Marie
and Fjell, Maria
and Langius-Ekl{\"o}f, Ann",
title="Mobile Electronic Patient-Reported Outcomes and Interactive Support During Breast and Prostate Cancer Treatment: Health Economic Evaluation From Two Randomized Controlled Trials",
journal="JMIR Cancer",
year="2025",
month="Mar",
day="11",
volume="11",
pages="e53539",
keywords="cost-effectiveness",
keywords="ePRO",
keywords="mHealth",
keywords="disease monitoring",
keywords="cancer",
keywords="RCT",
keywords="randomized controlled trial",
keywords="controlled trials",
keywords="digital intervention",
keywords="patient-reported outcomes",
keywords="management",
keywords="payers' perspective",
keywords="health care costs",
keywords="apps",
keywords="prostate cancer",
keywords="breast cancer",
abstract="Background: Digital interventions for supportive care during cancer treatment incorporating electronic patient-reported outcomes (ePROs) can enhance early detection of symptoms and facilitate timely symptom management. However, economic evaluations are needed. Objective: This study aims to conduct a cost-utility analysis of an app for ePRO and interactive support from the perspective of the payer (Region Stockholm Health Care Organization) and to explore its impact on patient health care utilization and costs. Methods: Two open-label randomized controlled trials (RCTs) were conducted, including patients undergoing neoadjuvant chemotherapy for breast cancer (B-RCT; N=149) and radiotherapy for prostate cancer (P-RCT; N=150), recruited from oncology clinics at 2 university hospitals in Stockholm, Sweden. EORTC QLQ-C30 scores were mapped to EQ-5D-3L to calculate quality-adjusted life years (QALYs). Intervention and implementation costs and health care costs, obtained from an administrative database, were used to calculate incremental cost-effectiveness ratios (ICERs) in 3 ways: including all health care costs (ICERa), excluding nonacute health care costs (ICERb), and excluding health care costs altogether (ICERc). Nonparametric bootstrapping was used to explore ICER uncertainty. Health care costs were analyzed by classifying them as disease-related or acute. Results: In both RCT intervention groups, fewer QALYs were lost compared with the control group (P<.001). In the B-RCT, the mean intervention cost was {\texteuro}92 (SD {\texteuro}2; {\texteuro}1=US \$1.03). The mean cost for the intervention and all health care was {\texteuro}36,882 (SD {\texteuro}1032) in the intervention group and {\texteuro}35,427 (SD {\texteuro}959) in the control group (P<.001), with an ICERa of {\texteuro}202,368 (95\% CI {\texteuro}152,008-{\texteuro}252,728). The mean cost for the intervention and acute health care was {\texteuro}3585 (SD {\texteuro}480) in the intervention group and {\texteuro}3235 (SD {\texteuro}494) in the control group (P<.001). ICERb was {\texteuro}49,903 (95\% CI {\texteuro}37,049-{\texteuro}62,758) and ICERc was {\texteuro}13,213 (95\% CI {\texteuro}11,145-{\texteuro}15,281); 22 out of 74 (30\%) intervention group patients and 24 out of 75 (32\%) of the control group patients required acute inpatient care for fever. In the P-RCT, the mean intervention cost was {\texteuro}43 (SD {\texteuro}0.2). The mean cost for the intervention and all health care was {\texteuro}3419 (SD {\texteuro}739) in the intervention group and {\texteuro}3537 (SD {\texteuro}689) in the control group (P<.001), with an ICERa of --{\texteuro}1,092,136 (95\% CI --{\texteuro}3,274,774 to {\texteuro}1,090,502). The mean cost for the intervention and acute health care was {\texteuro}1219 (SD {\texteuro}593) in the intervention group and {\texteuro}802 (SD {\texteuro}281) in the control group (P<.001). ICERb was {\texteuro}745,987 (95\% CI --{\texteuro}247,317 to {\texteuro}1,739,292) and ICERc was {\texteuro}13,118 (95\% CI --68,468 to {\texteuro}94,704). As many as 10 out of the 75 (13\%) intervention group patients had acute inpatient care, with the most common symptom being dyspnea, while 9 out of the 75 (12\%) control group patients had acute inpatient care, with the most common symptom being urinary tract infection. Conclusions: ePRO and interactive support via an app generated a small improvement in QALYs at a low intervention cost and may be cost-effective, depending on the costs considered. Considerable variability in patient health care costs introduced uncertainty around the estimates, preventing a robust determination of cost-effectiveness. Larger studies examining cost-effectiveness from a societal perspective are needed. The study provides valuable insights into acute health care utilization during cancer treatment. Trial Registration: ClinicalTrials.gov NCT02479607; https://clinicaltrials.gov/ct2/show/NCT02479607, ClinicalTrials.gov NCT02477137; https://clinicaltrials.gov/ct2/show/NCT02477137 International Registered Report Identifier (IRRID): RR2-10.1186/s12885-017-3450-y ",
doi="10.2196/53539",
url="https://cancer.jmir.org/2025/1/e53539"
}


@Article{info:doi/10.2196/58882,
author="Kramer, L. Melissa
and Polo, Medina Jose
and Kumar, Nishant
and Mulgirigama, Aruni
and Benkiran, Amina",
title="Living With and Managing Uncomplicated Urinary Tract Infection: Mixed Methods Analysis of Patient Insights From Social Media",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="11",
volume="27",
pages="e58882",
keywords="acute cystitis",
keywords="bladder infection",
keywords="HCP interactions",
keywords="urology",
keywords="patient experience",
keywords="patient insights",
keywords="social media",
keywords="uncomplicated urinary tract infection",
keywords="urinary tract infection",
keywords="urinary",
keywords="women",
keywords="quality of life",
keywords="disease management",
keywords="cystitis",
keywords="healthcare professional",
keywords="self-management",
keywords="patient behavior",
keywords="UTI",
abstract="Background: Uncomplicated urinary tract infections (uUTIs) affect more than half of women in their lifetime and can impact on quality of life. We analyzed social media posts discussing uUTIs to gather insights into the patient experience, including aspects of their disease management journey and associated opinions and concerns. Objective: This study aims to gather patient experience insights by analyzing social media posts that discussed uUTI. Methods: A search string (``urinary tract infection'' [UTI] or ``bladder infection'' or ``cystitis'' or ``UTI'' not ``interstitial cystitis'') was used to identify posts from public blogs and patient forums (June 2021 to June 2023). Posts were excluded if they were not written in English or discussed complicated UTI (posts that mentioned ``pregnancy'' or ``pregnant'' or ``trimester'' or ``catheter'' or ``interstitial''). Posts were limited to publicly available sources and anonymized. The primary objective was to gather patient perspectives on key elements of the uUTI experience, including health care professional (HCP) interactions, diagnosis, treatment, and recurrence. Results: In total, more than 42,000 unique posts were identified (mostly from reddit.com; 29,506/42,265, 70\%) and >3600 posts were analyzed. Posts were most commonly from users in the United States (6707/11,180, 60\%), the United Kingdom (2261/11,180, 20\%), Canada (509/11,180, 5\%), Germany (356/11,180, 3\%), or India (320/11,180, 3\%). Six main themes were identified: symptom awareness and information seeking, HCP interactions, diagnosis and management challenges, management with antibiotics, self-management, and challenges with recurrent UTI. Most posts highlighted the importance of seeking professional medical advice, while some patients raised concerns regarding their HCP interactions and lack of shared decision-making. Patients searched for advice and guidance on the web prior to consulting an HCP, described their symptoms, and discussed lifestyle adjustments. Most patients tried self-management and shared their experiences with nonprescribed treatment options. There was general agreement among posts that antibiotics are necessary to cure UTIs and prevent associated complications. Conclusions: Social media posts provide valuable insight into the experiences and opinions of patients with uUTIs in Canada, Germany, India, the United Kingdom, and the United States. The insights from this study provide a more complete picture of patient behaviors and highlight the potential for HCP and patient education, as well as better communication through shared decision-making to improve care. ",
doi="10.2196/58882",
url="https://www.jmir.org/2025/1/e58882"
}


@Article{info:doi/10.2196/57649,
author="te Braake, Eline
and Vaseur, Roswita
and Gr{\"u}nloh, Christiane
and Tabak, Monique",
title="The State of the Art of eHealth Self-Management Interventions for People With Chronic Obstructive Pulmonary Disease: Scoping Review",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="10",
volume="27",
pages="e57649",
keywords="eHealth",
keywords="self-management",
keywords="interventions",
keywords="chronic obstructive pulmonary disease",
keywords="COPD",
keywords="review",
abstract="Background: Chronic obstructive pulmonary disease (COPD) is a common chronic incurable disease. Treatment of COPD often focuses on symptom management and progression prevention using pharmacological and nonpharmacological therapies (eg, medication, inhaler use, and smoking cessation). Self-management is an important aspect of managing COPD. Self-management interventions are increasingly delivered through eHealth, which may help people with COPD engage in self-management. However, little is known about the actual content of these eHealth interventions. Objective: This literature review aimed to investigate the state-of-the-art eHealth self-management technologies for COPD. More specifically, we aimed to investigate the functionality, modality, technology readiness level, underlying theories of the technology, the positive health dimensions addressed, the target population characteristics (ie, the intended population, the included population, and the actual population), the self-management processes, and behavior change techniques. Methods: A scoping review was performed to answer the proposed research questions. The databases PubMed, Scopus, PsycINFO (via EBSCO), and Wiley were searched for relevant articles. We identified articles published between January 1, 2012, and June 1, 2022, that described eHealth self-management interventions for COPD. Identified articles were screened for eligibility using the web-based software Rayyan.ai. Eligible articles were identified, assessed, and categorized by the reviewers, either directly or through a combination of methods, using Atlas.ti version 9.1.7.0. Thereafter, data were charted accordingly and presented with the purpose of giving an overview of currently available literature while highlighting existing gaps. Results: A total of 101 eligible articles were included. This review found that most eHealth technologies (91/101, 90.1\%) enable patients to self-monitor their symptoms using (smart) measuring devices (39/91, 43\%), smartphones (27/91, 30\%), or tablets (25/91, 27\%). The self-management process of ``taking ownership of health needs'' (94/101, 93.1\%), the behavior change technique of ``feedback and monitoring'' (88/101, 87\%), and the positive health dimension of ``bodily functioning'' (101/101, 100\%) were most often addressed. The inclusion criteria of studies and the actual populations reached show that a subset of people with COPD participate in eHealth studies. Conclusions: The current body of literature related to eHealth interventions has a strong tendency toward managing the physical aspect of COPD self-management. The necessity to specify inclusion criteria to control variables, combined with the practical challenges of recruiting diverse participants, leads to people with COPD being included in eHealth studies that only represent a subgroup of the whole population. Therefore, future research should be aware of this unintentional blind spot, make efforts to reach the underrepresented population, and address multiple dimensions of the positive health paradigm. ",
doi="10.2196/57649",
url="https://www.jmir.org/2025/1/e57649"
}


@Article{info:doi/10.2196/69068,
author="Hansun, Seng
and Argha, Ahmadreza
and Bakhshayeshi, Ivan
and Wicaksana, Arya
and Alinejad-Rokny, Hamid
and Fox, J. Greg
and Liaw, Siaw-Teng
and Celler, G. Branko
and Marks, B. Guy",
title="Diagnostic Performance of Artificial Intelligence--Based Methods for Tuberculosis Detection: Systematic Review",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="7",
volume="27",
pages="e69068",
keywords="AI",
keywords="artificial intelligence",
keywords="deep learning",
keywords="diagnostic performance",
keywords="machine learning",
keywords="PRISMA",
keywords="Preferred Reporting Items for Systematic Reviews and Meta-Analysis",
keywords="QUADAS-2",
keywords="Quality Assessment of Diagnostic Accuracy Studies version 2",
keywords="systematic literature review",
keywords="tuberculosis detection",
abstract="Background: Tuberculosis (TB) remains a significant health concern, contributing to the highest mortality among infectious diseases worldwide. However, none of the various TB diagnostic tools introduced is deemed sufficient on its own for the diagnostic pathway, so various artificial intelligence (AI)--based methods have been developed to address this issue. Objective: We aimed to provide a comprehensive evaluation of AI-based algorithms for TB detection across various data modalities. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) 2020 guidelines, we conducted a systematic review to synthesize current knowledge on this topic. Our search across 3 major databases (Scopus, PubMed, Association for Computing Machinery [ACM] Digital Library) yielded 1146 records, of which we included 152 (13.3\%) studies in our analysis. QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies version 2) was performed for the risk-of-bias assessment of all included studies. Results: Radiographic biomarkers (n=129, 84.9\%) and deep learning (DL; n=122, 80.3\%) approaches were predominantly used, with convolutional neural networks (CNNs) using Visual Geometry Group (VGG)-16 (n=37, 24.3\%), ResNet-50 (n=33, 21.7\%), and DenseNet-121 (n=19, 12.5\%) architectures being the most common DL approach. The majority of studies focused on model development (n=143, 94.1\%) and used a single modality approach (n=141, 92.8\%). AI methods demonstrated good performance in all studies: mean accuracy=91.93\% (SD 8.10\%, 95\% CI 90.52\%-93.33\%; median 93.59\%, IQR 88.33\%-98.32\%), mean area under the curve (AUC)=93.48\% (SD 7.51\%, 95\% CI 91.90\%-95.06\%; median 95.28\%, IQR 91\%-99\%), mean sensitivity=92.77\% (SD 7.48\%, 95\% CI 91.38\%-94.15\%; median 94.05\% IQR 89\%-98.87\%), and mean specificity=92.39\% (SD 9.4\%, 95\% CI 90.30\%-94.49\%; median 95.38\%, IQR 89.42\%-99.19\%). AI performance across different biomarker types showed mean accuracies of 92.45\% (SD 7.83\%), 89.03\% (SD 8.49\%), and 84.21\% (SD 0\%); mean AUCs of 94.47\% (SD 7.32\%), 88.45\% (SD 8.33\%), and 88.61\% (SD 5.9\%); mean sensitivities of 93.8\% (SD 6.27\%), 88.41\% (SD 10.24\%), and 93\% (SD 0\%); and mean specificities of 94.2\% (SD 6.63\%), 85.89\% (SD 14.66\%), and 95\% (SD 0\%) for radiographic, molecular/biochemical, and physiological types, respectively. AI performance across various reference standards showed mean accuracies of 91.44\% (SD 7.3\%), 93.16\% (SD 6.44\%), and 88.98\% (SD 9.77\%); mean AUCs of 90.95\% (SD 7.58\%), 94.89\% (SD 5.18\%), and 92.61\% (SD 6.01\%); mean sensitivities of 91.76\% (SD 7.02\%), 93.73\% (SD 6.67\%), and 91.34\% (SD 7.71\%); and mean specificities of 86.56\% (SD 12.8\%), 93.69\% (SD 8.45\%), and 92.7\% (SD 6.54\%) for bacteriological, human reader, and combined reference standards, respectively. The transfer learning (TL) approach showed increasing popularity (n=89, 58.6\%). Notably, only 1 (0.7\%) study conducted domain-shift analysis for TB detection. Conclusions: Findings from this review underscore the considerable promise of AI-based methods in the realm of TB detection. Future research endeavors should prioritize conducting domain-shift analyses to better simulate real-world scenarios in TB detection. Trial Registration: PROSPERO CRD42023453611; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023453611 ",
doi="10.2196/69068",
url="https://www.jmir.org/2025/1/e69068",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053773"
}


@Article{info:doi/10.2196/60391,
author="Shmilovitch, Haim Amit
and Katson, Mark
and Cohen-Shelly, Michal
and Peretz, Shlomi
and Aran, Dvir
and Shelly, Shahar",
title="GPT-4 as a Clinical Decision Support Tool in Ischemic Stroke Management: Evaluation Study",
journal="JMIR AI",
year="2025",
month="Mar",
day="7",
volume="4",
pages="e60391",
keywords="GPT-4",
keywords="ischemic stroke",
keywords="clinical decision support",
keywords="artificial intelligence",
keywords="neurology",
abstract="Background: Cerebrovascular diseases are the second most common cause of death worldwide and one of the major causes of disability burden. Advancements in artificial intelligence have the potential to revolutionize health care delivery, particularly in critical decision-making scenarios such as ischemic stroke management. Objective: This study aims to evaluate the effectiveness of GPT-4 in providing clinical support for emergency department neurologists by comparing its recommendations with expert opinions and real-world outcomes in acute ischemic stroke management. Methods: A cohort of 100 patients with acute stroke symptoms was retrospectively reviewed. Data used for decision-making included patients' history, clinical evaluation, imaging study results, and other relevant details. Each case was independently presented to GPT-4, which provided scaled recommendations (1-7) regarding the appropriateness of treatment, the use of tissue plasminogen activator, and the need for endovascular thrombectomy. Additionally, GPT-4 estimated the 90-day mortality probability for each patient and elucidated its reasoning for each recommendation. The recommendations were then compared with a stroke specialist's opinion and actual treatment decisions. Results: In our cohort of 100 patients, treatment recommendations by GPT-4 showed strong agreement with expert opinion (area under the curve [AUC] 0.85, 95\% CI 0.77-0.93) and real-world treatment decisions (AUC 0.80, 95\% CI 0.69-0.91). GPT-4 showed near-perfect agreement with real-world decisions in recommending endovascular thrombectomy (AUC 0.94, 95\% CI 0.89-0.98) and strong agreement for tissue plasminogen activator treatment (AUC 0.77, 95\% CI 0.68-0.86). Notably, in some cases, GPT-4 recommended more aggressive treatment than human experts, with 11 instances where GPT-4 suggested tissue plasminogen activator use against expert opinion. For mortality prediction, GPT-4 accurately identified 10 (77\%) out of 13 deaths within its top 25 high-risk predictions (AUC 0.89, 95\% CI 0.8077-0.9739; hazard ratio 6.98, 95\% CI 2.88-16.9; P<.001), outperforming supervised machine learning models such as PRACTICE (AUC 0.70; log-rank P=.02) and PREMISE (AUC 0.77; P=.07). Conclusions: This study demonstrates the potential of GPT-4 as a viable clinical decision-support tool in the management of acute stroke. Its ability to provide explainable recommendations without requiring structured data input aligns well with the routine workflows of treating physicians. However, the tendency toward more aggressive treatment recommendations highlights the importance of human oversight in clinical decision-making. Future studies should focus on prospective validations and exploring the safe integration of such artificial intelligence tools into clinical practice. ",
doi="10.2196/60391",
url="https://ai.jmir.org/2025/1/e60391",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053715"
}


@Article{info:doi/10.2196/66634,
author="Haughey, Marketa
and Neyens, M. David
and Hopkins, S. Casey
and Gonzaga, Christofer
and Harman, Melinda",
title="Identifying Strategies for Home Management of Ostomy Care: Content Analysis of YouTube",
journal="JMIR Hum Factors",
year="2025",
month="Mar",
day="6",
volume="12",
pages="e66634",
keywords="medical device usability",
keywords="digital health",
keywords="online support groups",
keywords="living with chronic medical conditions",
keywords="ostomy self-care",
keywords="YouTube",
keywords="patient education",
keywords="user needs assessment",
keywords="users experience",
keywords="social media",
keywords="ostomates",
keywords="colostomy",
keywords="ileostomy",
keywords="usability",
keywords="usefulness",
keywords="utility",
keywords="wearable device",
keywords="medical device",
keywords="support group",
keywords="socials",
keywords="social network",
keywords="ostomy",
keywords="digital",
keywords="digital technology",
keywords="digital intervention",
abstract="Background: The social media platform YouTube is a recognized educational resource for health information, but few studies have explored its value for conveying the lived experience of individuals managing chronic health conditions and end users' interactions with medical device technology. Our study explores self-care strategies and end user needs of people living with a stoma because patient education and engagement in ostomy self-care are essential for avoiding ostomy-related complications. Ostomy surgery creates a stoma (an opening) in the abdomen to alter the route of excreta from digestive and urinary organs into a detachable external pouching system. After hospital discharge, people who have undergone ostomies perform critical self-care tasks including frequent ostomy appliance changes and stomal and peristomal skin maintenance. Objective: The purpose of this study was to systematically assess YouTube videos narrated by people who have undergone ostomies about their ostomy self-care in home (nonhospital) settings with a focus on identifying end user needs and different strategies used by people who have undergone ostomies during critical self-care tasks. Methods: Using predefined search terms and clear inclusion and exclusion criteria, we identified YouTube videos depicting narrators who have undergone ostomies and their ostomy self-care in home settings. Using a consensus coding approach among 3 independent reviewers, all videos were analyzed to collect metadata, data of narrators who have undergone ostomies, and specific content data. Results: There were 65 user-generated YouTube videos that met the inclusion and exclusion criteria. These videos were posted by 28 unique content creators representing a broad range of ages who used a variety of supplies. The common challenges discussed were peristomal skin complications, inadequate appliance adhesion and subsequent leakage, and supplies-related challenges. Narrators who have undergone ostomies discussed various expert tricks and tips to successfully combat these challenges. Conclusions: This study used a novel approach to gain insights about end user interactions with medical devices while performing ostomy self-care, which are difficult to gain using traditional behavioral techniques. The analysis revealed that people who have undergone ostomies are willing to share their personal experience with ostomy self-care on the web and that these videos are viewed by the public. User-generated videos demonstrated a variety of supplies used, end user needs, and different strategies for performing ostomy self-care. Future research should examine how these findings connect to YouTube ostomy self-care content generated by health care professionals and organizations and to guidelines for ostomy self-care. ",
doi="10.2196/66634",
url="https://humanfactors.jmir.org/2025/1/e66634",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053741"
}


@Article{info:doi/10.2196/63805,
author="Jin, Xiaorong
and Zhang, Yimei
and Zhou, Min
and Mei, Qian
and Bai, Yangjuan
and Hu, Qiulan
and Wei, Wei
and Zhang, Xiong
and Ma, Fang",
title="An Actor-Partner Interdependence Mediation Model for Assessing the Association Between Health Literacy and mHealth Use Intention in Dyads of Patients With Chronic Heart Failure and Their Caregivers: Cross-Sectional Study",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Mar",
day="6",
volume="13",
pages="e63805",
keywords="chronic heart failure",
keywords="caregivers",
keywords="health literacy",
keywords="mHealth",
keywords="actor-partner interdependence mediation model",
keywords="mobile health",
abstract="Background: Chronic heart failure (CHF) has become a serious threat to the health of the global population. Self-management is the key to treating CHF, and the emergence of mobile health (mHealth) has provided new ideas for the self-management of CHF. Despite the many potential benefits of mHealth, public utilization of mHealth apps is low, and poor health literacy (HL) is a key barrier to mHealth use. However, the mechanism of the influence is unclear. Objective: The aim of this study is to explore the dyadic associations between HL and mHealth usage intentions in dyads of patients with CHF and their caregivers, and the mediating role of mHealth perceived usefulness and perceived ease of use in these associations. Methods: This study had a cross-sectional research design, with a sample of 312 dyads of patients with CHF who had been hospitalized in the cardiology departments of 2 tertiary care hospitals in China from March to October 2023 and their caregivers. A general information questionnaire, the Chinese version of the Heart Failure-Specific Health Literacy Scale, and the mHealth Intention to Use Scale were used to conduct the survey; the data were analyzed using the actor-partner interdependence mediation model. Results: The results of the actor-partner interdependent mediation analysis of HL, perceived usefulness of mHealth, and mHealth use intention among patients with CHF and their caregivers showed that all of the model's actor effects were valid ($\beta$=.26?0.45; P<.001), the partner effects were partially valid ($\beta$=.08?0.20; P<.05), and the mediation effects were valid ($\beta$=.002?0.242, 95\% CI 0.003?0.321; P<.05). Actor-partner interdependent mediation analyses of HL, perceived ease of use of mHealth, and mHealth use intention among patients with CHF and caregivers showed that the model's actor effect partially held ($\beta$=.17?0.71; P<.01), the partner effect partially held ($\beta$=.15; P<.01), and the mediation effect partially held ($\beta$=.355?0.584, 95\% CI 0.234?0.764; P<.001). Conclusions: Our study proposes that the HL of patients with CHF and their caregivers positively contributes to their own intention to use mHealth, suggesting that the use of mHealth by patients with CHF can be promoted by improving the HL of patients and caregivers. Our findings also suggest that the perceived usefulness of patients with CHF and caregivers affects patients' mHealth use intention, and therefore patients with CHF and their caregivers should be involved throughout the mHealth development process to improve the usability of mHealth for both patients and caregivers. This study emphasizes the key role of patients' perception that mHealth is easy to use in facilitating their use of mHealth. Therefore, it is recommended that the development of mHealth should focus on simplifying operational procedures and providing relevant operational training according to the needs of the patients when necessary. ",
doi="10.2196/63805",
url="https://mhealth.jmir.org/2025/1/e63805"
}


@Article{info:doi/10.2196/65938,
author="Barclay, Jayne
and Sullivan, Clair
and Beckmann, Michael
and Mattison, Graeme
and Runciman, Rebecca
and Martin, Elizabeth",
title="Use of Remote Assessment Tools to Substitute Routine Outpatient Care: Scoping Review",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="4",
volume="27",
pages="e65938",
keywords="remote assessment",
keywords="remote patient monitoring",
keywords="telemedicine",
keywords="mHealth",
keywords="applications",
keywords="patient-reported outcome measures",
keywords="self-reported",
keywords="health care cost reduction",
keywords="hybrid care models",
abstract="Background: The increasing global demand for health care, driven by demographic shifts, the rise of personalized medicine, and technological innovations necessitate novel approaches to health care delivery. Digital remote assessment tools have emerged as a promising solution, enabling hybrid care models that combine traditional and remote patient management. These tools support the quadruple aim of health care by enhancing the monitoring and evaluation of patient-reported data, thereby improving patient care, boosting operational efficiency, reducing costs, and improving the experience of patients and clinicians. This review seeks to understand how remote assessment tools are used for routine consultation substitution in adult tertiary care centers. Objective: This scoping review aims to evaluate the implementation and health outcomes of digital remote assessment tools used for routine consultation substitutions in adult tertiary care centers. The objectives include assessing the extent of use, types, and effectiveness of these tools in substituting conventional outpatient care. Methods: A comprehensive scoping review was conducted, adhering to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. The review focused on studies that used internet-dependent remote assessment technologies for patient data transfer in tertiary care settings. A detailed search strategy was used across multiple databases, with studies selected based on predefined inclusion and exclusion criteria. Data extraction and analysis were performed by independent reviewers, with a focus on the functionalities of the tools and their alignment with the Quadruple Aim of Healthcare. Results: The review included 12 studies, highlighting a growing interest in remote assessment technologies across diverse clinical settings. The interventions varied in length, from 4 weeks to 12 months, and demonstrated a range of functionalities, including symptom monitoring and postsurgical follow-ups. The use of these tools was associated with improved clinical outcomes, such as timely intervention for clinical deterioration and enhanced clinical protocol adherence. Additionally, a small number of studies identified potential cost savings in terms of reduced unplanned health care contacts and optimized clinical resource use. Patient and clinician experiences were generally positive, with high adherence to remote assessments and an appreciation for the personalized and timely care facilitated by these technologies. Barriers included high initial setup costs for digital technologies, leading to an inflated cost per patient in small sample studies. Conclusions: Digital remote assessment tools offer significant potential to enhance health care delivery by improving health outcomes, reducing costs, and enriching patient and clinician experiences. Their flexibility and adaptability make them suitable for various clinical contexts, supporting the personalization of care and operational efficiency. While digital remote assessment tools offer significant potential, careful consideration of implementation strategies, equity, cost, and clinician and patient experiences is crucial for successful clinical integration. ",
doi="10.2196/65938",
url="https://www.jmir.org/2025/1/e65938",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053751"
}


@Article{info:doi/10.2196/66804,
author="Yan, Mengyao
and Sun, Wendi
and Tan, Cheng
and Wu, Yibo
and Liu, Yuanli",
title="Analysis of Factors Influencing the Willingness of Chinese Older Adults to Use mHealth Devices: Nationwide Cross-Sectional Survey Study",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="4",
volume="27",
pages="e66804",
keywords="older adults",
keywords="mobile health devices",
keywords="health management",
keywords="medical services",
keywords="mobile phone",
abstract="Background: In addition to standard older adult care services, mobile medical devices have proved to be an effective tool for controlling the health of older adults. However, little is known about the variables driving the acceptance of these gadgets and the willingness of older adults in China to use them. Objective: This study aims to explore the factors that affect the use of mobile health (mHealth) devices by older adults in China, focusing on individual, social, and family influences. Methods: The Psychology and Behavior Investigation of Chinese Residents survey database provided the data for this study. The survey was conducted in 148 Chinese cities between June 20 and August 31, 2022. The parameters linked to older persons' desire to use mobile medical devices were determined by this study using a combination model of multiple stepwise linear regression and a classification and regression tree decision tree. Results: In total, 4085 older adults took part in the poll. On a scale of 0 to 100, the average score for willingness to adopt mHealth devices was 63.70 (SD 25.11). The results of the multiple stepwise linear regression showed that having a postgraduate degree and higher ($\beta$=.040; P=.007), being unemployed ($\beta$=.037; P=.02), having a high social status ($\beta$=.085; P<.001), possessing high health literacy ($\beta$=.089; P<.001), demonstrating high self-efficacy ($\beta$=.043; P=.02), not living with children ($\beta$=.0340; P=.02), having a household per capita monthly income of >Y4000 (US \$550) ($\beta$=.048; P=.002), experiencing high perceived social support ($\beta$=.096; P<.001), reporting a high quality of life ($\beta$=.149; P<.001), having higher levels of family communication ($\beta$=--.071; P<.001), having an identity bubble ($\beta$=.085; P<.001), not having chronic diseases ($\beta$=.049; P=.001), and experiencing mild depression ($\beta$=--.035; P=.02) were associated with older adults' willingness to use mHealth devices. The classification and regression tree decision tree model's findings demonstrated that the primary determinants of older adults' desire to use mHealth devices are quality of life, identity bubble, social status, health literacy, family health, and perceived social support. Conclusions: This study uses the Andersen Healthcare Utilization Model to investigate the effects of demand variables, enabling resources, and predisposing traits on older persons' propensity to use mHealth devices. These results offer reference data for the marketing and use of mHealth devices for older individuals in the future. The ultimate goal of this strategy is to create a balanced and harmonious integration of technology and humanistic care. ",
doi="10.2196/66804",
url="https://www.jmir.org/2025/1/e66804",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053781"
}


@Article{info:doi/10.2196/56254,
author="Wu, Jia
and Zeng, Youjia
and Yang, Jun
and Yao, Yutong
and Xu, Xiuling
and Song, Gaofeng
and Yi, Wuyong
and Wang, Taifen
and Zheng, Yihou
and Jia, Zhongwei
and Yan, Xiangyu",
title="Daily Treatment Monitoring for Patients Receiving Home-Based Peritoneal Dialysis and Prediction of Heart Failure Risk: mHealth Tool Development and Modeling Study",
journal="JMIR Form Res",
year="2025",
month="Mar",
day="3",
volume="9",
pages="e56254",
keywords="peritoneal dialysis",
keywords="mHealth",
keywords="patient management",
keywords="heart failure",
keywords="prediction model",
abstract="Background: Peritoneal dialysis is one of the major renal replacement modalities for patients with end-stage renal disease. Heart failure is a common adverse event among patients who undergo peritoneal dialysis treatment, especially for those who undergo continuous ambulatory peritoneal dialysis at home, because of the lack of professional input-output volume monitoring and management during treatment. Objective: This study aims to develop novel mobile health (mHealth) tools to improve the quality of home-based continuous ambulatory peritoneal dialysis treatment and to build a prediction model of heart failure based on the system's daily treatment monitoring data. Methods: The mHealth tools with a 4-layer system were designed and developed using Spring Boot, MyBatis Plus, MySQL, and Redis as backend technology stack, and Vue, Element User Interface, and WeChat Mini Program as front-end technology stack. Patients were recruited to use the tool during daily peritoneal dialysis treatment from January 1, 2017, to April 20, 2023. Logistic regression models based on real-time treatment monitoring data were used for heart failure prediction. The sensitivity, specificity, accuracy, and Youden index were calculated to evaluate the performance of the prediction model. In the sensitivity analysis, the ratio of patients with and without heart failure was set to 1:4 and 1:10, respectively, to better evaluate the stability of the prediction model. Results: A WeChat Mini Program named Futou Bao for patients and a patient data management platform for doctors was developed. Futou Bao included an intelligent data upload function module and an auxiliary function module. The doctor's data management platform consisted of 4 function modules, that is, patient management, data visualization and marking, data statistics, and system management. During the study period, the records of 6635 patients who received peritoneal dialysis treatment were uploaded in Futou Bao, with 0.71\% (47/6635) of them experiencing heart failure. The prediction model that included sex, age, and diastolic blood pressure was considered as the optimal model, wherein the sensitivity, specificity, accuracy, and Youden index were 0.75, 0.91, 0.89, and 0.66, respectively, with an area under the curve value of 0.879 (95\% CI 0.772-0.986) using the validation dataset. The sensitivity analysis showed stable results. Conclusions: This study provides a new home-based peritoneal dialysis management paradigm that enables the daily monitoring and early warning of heart failure risk. This novel paradigm is of great value for improving the efficiency, security, and personalization of peritoneal dialysis. ",
doi="10.2196/56254",
url="https://formative.jmir.org/2025/1/e56254",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053710"
}


@Article{info:doi/10.2196/58266,
author="Stein, Maike
and Stegherr, Regina
and Narayanaswami, Pushpa
and Legg, David
and Herdick, Meret
and Meisel, Andreas
and Gerischer, Lea
and Lehnerer, Sophie",
title="App- and Wearable-Based Remote Monitoring for Patients With Myasthenia Gravis and Its Specialists: Feasibility and Usability Study",
journal="JMIR Form Res",
year="2025",
month="Mar",
day="3",
volume="9",
pages="e58266",
keywords="myasthenia gravis",
keywords="myasthenia",
keywords="remote monitoring",
keywords="PROMs",
keywords="digital platform",
keywords="wearables",
keywords="telemedicine",
keywords="spirometry",
keywords="app",
keywords="usability",
keywords="feasibility",
keywords="autoimmune disorder",
keywords="web-based portal",
keywords="activity tracker",
keywords="communication",
keywords="wearable data",
keywords="digital tool",
keywords="mobile phone",
abstract="Background: Myasthenia gravis (MG) is rare, chronic autoimmune disorder of the neuromuscular junction that requires specialized care and often lifelong treatment, facing challenges due to its rarity and the limited availability of specialists. Telemedical solutions in specialized centers hold considerable promise in bridging this gap by increasing access to this care to a broader patient population in a timely manner. However, there is no research regarding interventional remote care solutions in the field of MG to date. Objective: This study aimed to assess the feasibility and usability among patients with MG and specialists of a telemedicine platform, tailored to patients with MG and designed to facilitate remote monitoring, treated in a specialized center. Methods: The telemedicine platform consisted of an app for patients and a web-based portal for physicians. Over a period of 3 months, 30 patients continuously monitored their vital parameters through external devices, including a digital spirometer and a wearable (activity tracker). Furthermore, patients completed 7 different patient-reported outcome measures (PROMs) through the app at predefined intervals. Specialists could review this monitoring data and adjust therapy as necessary. In addition, communication between patients and physicians was facilitated through a chat module. Feasibility was evaluated by total adherence rates for completing PROMs within the app, alongside the collection of spirometry and wearable data. Furthermore, user satisfaction was assessed among both patients with MG and physicians at the end of study. Results: Total adherence rates ranged from 74.3\% (1830/2464) to 97.9\% (327/334) across all data types, with the highest adherence observed for PROMs (1139/1179, 96.6\%), followed by spirometry (293/334, 87.7\%) and wearables (1830/2261, 80.9\%). Notably, patients wore the wearable longer than required by protocol and conducted a higher number of spirometry measurements during the study than required per protocol (median 20 h/d [IQR 15-24] vs 14 h/d and median 49 [IQR 15-59] measurements vs 11 measurements, respectively). Technical issues and discomfort with wearables were factors affecting lower adherence in some patients. The System Usability Scale yielded a median score of 85 indicating ``excellent usability.'' In addition, results from a more detailed user evaluation questionnaire showed high levels of user satisfaction among both patients and health care professionals across diverse categories, including their experience of the care program, communication, and evaluation of the program. Conclusions: Remote monitoring of patients with MG through the telemedical platform demonstrated good feasibility and acceptability, as evidenced by above-average adherence rates and user satisfaction for both patients and physicians. The majority of patients wanted to continue using the app. These findings highlight the potential for user-friendly digital tools to enhance care for patients with MG, although addressing technical challenges and ensuring patient comfort with wearables are essential for optimal implementation. Further research involving larger cohorts and longer study duration is warranted to validate these findings. Trial Registration: Deutsches Register Klinischer Studien DRKS00029907; https://drks.de/search/en/trial/DRKS00029907 ",
doi="10.2196/58266",
url="https://formative.jmir.org/2025/1/e58266"
}


@Article{info:doi/10.2196/48370,
author="Francis, Karlee
and Francis, Julie
and Latimer, Margot
and Gould, Hayley
and Blackmore, Shante
and MacLeod, Emily",
title="Development and Testing of the Kids Hurt App, a Web-Based, Pain Self-Report App for First Nations Youths: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2025",
month="Mar",
day="3",
volume="12",
pages="e48370",
keywords="app",
keywords="eHealth",
keywords="pain",
keywords="Indigenous",
keywords="First Nations",
keywords="children",
keywords="youths",
keywords="mobile phone",
abstract="Background: First Nations children and youths may have unique ways to convey their health needs that have not been recognized by health providers. This may contribute to the disparity between high rates of mental health and physical pain and low rates of treatment for the conditions they experience. Evidence suggests that a colonial history has resulted in poor experiences with the health care system, lack of trust with health providers, and miscommunication between clinicians and patients. Contemporary ways, using both Indigenous and Western knowledge, are needed to bridge the gap in communicating pain. Objective: The aim of this qualitative study was to test the usability and clinical feasibility of the Kids Hurt App with First Nations youths and clinicians working with youths. Methods: Using a Two-Eyed Seeing approach, the Kids Hurt App was developed using concepts from validated mood and pain assessment apps combined with community-based research that gathered First Nations youths and clinicians perspectives on quality, intensity, and location of pain and hurt. The Kids Hurt App contains 16 screens accessible on any web-based device. Results: In total, 3 rounds of low-fidelity testing (n=19), 2 rounds of high-fidelity testing (n=20), and 2 rounds of clinical feasibility testing (n=10) were conducted with First Nations youths (10?19 years) to determine the relevance, validity, and usability of the Kids Hurt App. High-fidelity testing was also conducted with 15 clinicians after completing the high-fidelity youth sessions. Youths had constructive suggestions that were used to improve the app in subsequent rounds of version testing. There was one main discrepancy between youths and clinicians related to preference for how best to visually convey pain. The youth's preference was maintained in the app. Conclusions: All youths in all rounds of testing indicated that they would use the Kids Hurt App if it was available to them in a health care setting, with most clinicians noting that the app would be useful in practice. ",
doi="10.2196/48370",
url="https://humanfactors.jmir.org/2025/1/e48370"
}


@Article{info:doi/10.2196/60096,
author="de Thurah, Lena
and Kiekens, Glenn
and Weermeijer, Jeroen
and Uyttebroek, Lotte
and Wampers, Martien
and Bonnier, Rafa{\"e}l
and Myin-Germeys, Inez",
title="Understanding Appropriation of Digital Self-Monitoring Tools in Mental Health Care: Qualitative Analysis",
journal="JMIR Hum Factors",
year="2025",
month="Mar",
day="3",
volume="12",
pages="e60096",
keywords="digital self-monitoring",
keywords="technology appropriation",
keywords="experience sampling method",
keywords="mental health care",
keywords="mental health",
keywords="self-monitoring",
keywords="digital health",
keywords="adoption",
keywords="implementation",
keywords="thematic",
keywords="usability",
keywords="interview",
keywords="experience",
keywords="attitude",
keywords="opinion",
keywords="perception",
keywords="perspective",
keywords="acceptance",
abstract="Background: Digital self-monitoring tools, such as the experience sampling method (ESM), enable individuals to collect detailed information about their mental health and daily life context and may help guide and support person-centered mental health care. However, similar to many digital interventions, the ESM struggles to move from research to clinical integration. To guide the implementation of self-monitoring tools in mental health care, it is important to understand why and how clinicians and clients adopted, adapted, and incorporated these tools in practice. Objective: Therefore, this study examined how clinicians and clients within a psychiatric center appropriated an ESM-based self-monitoring tool within their therapy. Methods: Twelve clinicians and 24 clients participated in the piloting of the ESM tool, IMPROVE. After utilizing the tool, 7 clinicians and 11 clients took part in semistructured interviews. A thematic framework analysis was performed focusing on participants' prior knowledge and expectations, actual use in practice, and potential future use of ESM tools. Results: Many participants experienced that the ESM tool provided useful information about clients' mental health, especially when clinicians and clients engaged in collaborative data interpretation. However, clinicians experienced several mismatches between system usability and their technical competencies, and many clients found it difficult to comply with the self-assessments. Importantly, most participants wanted to use digital self-monitoring tools in the future. Conclusions: Clinicians' and clients' choice to adopt and integrate self-monitoring tools in their practice seems to depend upon the perceived balance between the added benefits and the effort required to achieve them. Enhancing user support or redesigning ESM tools to reduce workload and data burden could help overcome implementation barriers. Future research should involve end users in the development of ESM self-monitoring tools for mental health care and further investigate the perspectives of nonadopters. ",
doi="10.2196/60096",
url="https://humanfactors.jmir.org/2025/1/e60096"
}


@Article{info:doi/10.2196/66441,
author="Xiao, Yuping
and Wang, Zhenzhen
and Zhang, Lintao
and Xie, Nina
and Chen, Fangyao
and Song, Zihao
and Zhao, Sha",
title="Effectiveness of Digital Diabetes Management Technology on Blood Glucose in Patients With Type 2 Diabetes at Home: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="3",
volume="27",
pages="e66441",
keywords="digital diabetes management",
keywords="type 2 diabetes",
keywords="patients",
keywords="home monitoring",
keywords="blood glucose management",
keywords="meta-analysis",
keywords="PRISMA",
abstract="Background: Patients with type 2 diabetes mellitus (T2DM) face elevated morbidity, mortality, and care costs. Digital self-monitoring of blood glucose (SMBG) can automatically upload data to apps, share the data with health care providers, reduce errors, and aid long-term diabetes management. Objective: This study aimed to assess the effectiveness of digital diabetes management techniques based on digital SMBG on blood glucose in patients with T2DM at home. Methods: A systematic search was conducted in PubMed, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, China Biomedical Literature Database, and Cochrane Library for articles published from the establishment of each database to December 25, 2023. Data were extracted independently by 2 researchers (YX and NX), and the risk of bias in individual trials was rated using the Cochrane risk-of-bias tool. A meta-analysis was conducted using RevMan 5.3 (Cochrane). Results: Twelve studies were included, involving 1669 participants. The meta-analysis found that in the digital diabetes management group, hemoglobin A1c (mean difference [MD] --0.52\%, 95\% CI --0.63\% to --0.42\%; P<.001), fasting blood sugar (MD --0.42, 95\% CI --0.65 to --0.19 mmol/L; P<.001), 2-hour postprandial blood sugar (MD --0.64, 95\% CI --0.97 to --0.32 mmol/L; P<.001), and BMI (MD --1.55, 95\% CI --2.92 to --0.17 kg/m2; P=.03) were each improved compared to the control group. Conclusions: Digital diabetes management has been shown to effectively improve blood glucose levels and BMI in individuals with T2DM in home settings. A key feature of successful digital health interventions is the frequent SMBG by patients, supported by dedicated health care professionals who provide timely, personalized, and responsive guidance. Trial Registration: PROSPERO CRD42024560431; https://tinyurl.com/yfam3nms ",
doi="10.2196/66441",
url="https://www.jmir.org/2025/1/e66441",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053775"
}


@Article{info:doi/10.2196/63780,
author="Evans, Kerrie
and Ko, Jonathan
and Ceprnja, Dragana
and Maka, Katherine
and Beales, Darren
and Sterling, Michele
and Bennell, L. Kim
and Jull, Gwendolen
and Hodges, W. Paul
and McKay, J. Marnee
and Rebbeck, J. Trudy",
title="Development and Implementation of MyPainHub, a Web-Based Resource for People With Musculoskeletal Conditions and Their Health Care Professionals: Mixed Methods Study",
journal="JMIR Form Res",
year="2025",
month="Feb",
day="24",
volume="9",
pages="e63780",
keywords="clinical pathways",
keywords="allied health",
keywords="self-management",
keywords="health information",
keywords="ehealth",
keywords="co-design",
abstract="Background: Musculoskeletal conditions, including low back pain (LBP), neck pain, and knee osteoarthritis, are the greatest contributors to years lived with disability worldwide. Resources aiming to aid both patients and health care professionals (HCPs) exist but are poorly implemented and adopted. Objective: We aimed to develop and implement MyPainHub, an evidence-based web-based resource designed to provide comprehensive, credible and accessible information for people with, and HCPs who manage, common musculoskeletal conditions. Methods: This mixed methods study adhered to the New South Wales Translational Research Framework and was evaluated against the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Consultation with key stakeholders (patients, HCPs, researchers, industry, consumer groups, and website developers) informed content, design, features, and functionality. Development then aimed to meet the identified need for a ``one-stop shop''---a central location for information about common musculoskeletal conditions tailored to a person's condition and risk of poor outcomes. MyPainHub was then developed through an iterative process and implementation strategies were tailored to different health care settings. Quantitative and qualitative evaluation occurred with patients and HCPs. Results: In total, 127 stakeholders participated in the development phase; initial consultation with them led to embedding 2 validated screening tools (the Short Form {\"O}rebro Musculoskeletal Pain Screening Questionnaire and the Keele STarT MSK tool) in MyPainHub to guide information tailoring for patients based on risk of poor outcomes. Development occurred in parallel and feedback from stakeholders informed design and content including structure, functionality, and phrasing and images to use to emphasize key points. Consultation resulted in information for patients being categorized using key guideline-based messages (general information, your pathway, exercise, and imaging) while information for clinicians was categorized into assessment, management, and prognosis. Implementation occurred in different health care settings with the most effective strategies being interactive education via webinars and workshops. The evaluation phase involved web-based questionnaires (patients: n=44; HCPs: n=29) and focus groups (patients: n=6; HCPs: n=6). Patients and HCPs found MyPainHub user-friendly, acceptable, credible, and potentially able to support self-management. Patient participants identified areas for improvement such as including more specific information on preventative measures and pain relief options. Despite positive feedback, only 35\% (10/29) of HCPs used MyPainHub with their patients. HCP participants identified challenges including insufficient training and lack of familiarity with using web-based resources in existing clinical workflows. Following implementation, the information contained on MyPainHub changed knowledge and practice for some patients and HCPs. Conclusions: Following extensive and iterative stakeholder engagement, MyPainHub was developed as an evidence-based web-based resource and perceived by patients and HCPs as user-friendly, credible, and acceptable. Active implementation strategies are required for adoption and implementation and greater training focusing on strategies to implement MyPainHub into clinical practice may be necessary. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000871145; https://tinyurl.com/438kkyt3 ",
doi="10.2196/63780",
url="https://formative.jmir.org/2025/1/e63780"
}


@Article{info:doi/10.2196/59032,
author="Rujeedawa, Tanzil
and Karimi, Zahabiya
and Wood, Helen
and Sangeorzan, Irina
and Smith, Roy
and Sadler, Iwan
and Martin-Moore, Esther
and Gardner, Adrian
and K Demetriades, Andreas
and Sinha, Rohitashwa
and Grahovac, Gordan
and Bateman, Antony
and Deakin, Naomi
and Davies, Benjamin",
title="Evaluation of Financial Support Workshops for Patients Under State Pension Age With Degenerative Cervical Myelopathy: Survey Study",
journal="JMIR Form Res",
year="2025",
month="Feb",
day="24",
volume="9",
pages="e59032",
keywords="myelopathy",
keywords="degenerative",
keywords="spine",
keywords="spinal",
keywords="benefits",
keywords="aid",
keywords="financial",
keywords="money",
keywords="income",
keywords="poverty",
keywords="disability",
keywords="disabled",
keywords="finance",
keywords="workshop",
keywords="education",
keywords="service",
keywords="access",
keywords="accessibility",
keywords="navigate",
keywords="confidence",
keywords="government",
abstract="Background: Degenerative cervical myelopathy (DCM), a form of slow-motion and progressive spinal cord injury caused by spinal cord compression secondary to degenerative pathology, leads to high levels of disability and dependence, and may reduce quality of life. Myelopathy.org is the first global scientific and clinical charity for DCM, providing an accessible platform freely disseminating information relevant to the DCM diagnosis and its treatment. Significant transient and long-term change to earnings do occur and can thrust individuals into poverty. People with DCM face many challenges accessing state financial assistance. This can have a cumulative negative financial effect due to the association between DCM and low socioeconomic index. Financial support available to patients under pension age include Universal Credit (UC), a payment that helps with living costs, and Personal Independence Payment (PIP), which helps with extra living costs if someone has both a long-term health condition or disability and difficulty doing certain everyday tasks. Objective: This study aimed to assess if delivering workshops centered around access to financial support could assist people with DCM living in the United Kingdom. Methods: A series of 2 internet-based workshops was targeted at accessing financial support for English patients under the state pension age, with an anonymized survey delivered to participants after each session. The first session was on UC and the second on PIP. The survey consisted of a mixture of Likert scales, free text and yes or no answers. Survey responses were analyzed using descriptive statistics and free text answers underwent inductive thematic analysis. Results: The average rating on the use of UC was 9.00/10. Presession self-rated confidence levels were 5.11/10 rising to 8.00/10. The mean score of wanting further similar sessions was 8.67/10 with 56\% (5/9) of participants wanting one-to-one sessions. For PIP, the average session use rating was 10/10. Presession self-rated confidence levels were 4.43/10 rising to 9.57/10. The mean score of wanting further similar sessions was 8.71/10, with 43\% (3/7) of participants wanting one-to-one sessions . Following inductive thematic analysis, themes regarding the usefulness of such sessions and the challenges to accessing financial support emerged. One participant gave negative feedback, which included the length of the session and perceived problems around confidentiality and data protection. Conclusions: The pilot series was largely perceived as a success, with participants finding them useful and increasing their self-rated confidence in navigating the UK financial support system. Given the small sample size, it is hard to predict the success of future sessions. Finally, given that the hurdles in accessing financial support extend beyond DCM, such workshops may be relevant to other organizations. ",
doi="10.2196/59032",
url="https://formative.jmir.org/2025/1/e59032"
}


@Article{info:doi/10.2196/59922,
author="Ding, E. Michael
and Traiba, Hajar
and Perez, R. Hector",
title="Virtual Reality Interventions and Chronic Pain: Scoping Review",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="18",
volume="27",
pages="e59922",
keywords="virtual reality",
keywords="chronic pain",
keywords="scoping review",
keywords="pain management",
keywords="efficacy",
keywords="anxiety disorders",
keywords="mood",
keywords="health condition",
keywords="health intervention",
keywords="adults",
keywords="aging",
keywords="therapeutic",
keywords="descriptive--analytical method",
keywords="monitoring",
keywords="US",
keywords="PRISMA",
abstract="Background: Virtual reality (VR) interventions have demonstrated efficacy for more than a decade for mood and anxiety disorders and emerging evidence suggests they can reduce pain symptoms in both acute and chronic pain. More recently, these interventions have abounded within the commercial and academic sectors, immersing participants within a virtual environment to confer health benefits to users. VR immersion can facilitate the delivery of health interventions by isolating participants from distractors and stressors in a therapeutic environment. While recent studies of VR interventions have exploded, they are not uniform in approach or device type, limiting generalizability. Recent scoping reviews on VR and chronic pain have focused on specific diseases or limited inquiries to specific interventions or study types. Objective: We conducted a scoping review to generate new knowledge about the sum total of VR studies on chronic pain with specific emphasis on the methods and results of each study, including (1) the type of interventions, (2) outcomes chosen, (3) samples studied, and (4) data generated. Methods: A scoping review was performed on the literature on VR and chronic pain to describe themes associated with the literature to date and identify important gaps and unanswered questions to guide future research. CINAHL [EBSCO] (Cumulative Index to Nursing and Allied Health Literature) and PubMed were queried for the terms ``virtual reality'' and ``pain,'' providing studies of chronic pain adult participants using VR delivered through headset displays. We included English-language manuscripts that had at least one VR intervention arm with adults with chronic pain. For this analysis, we only included VR interventions that were immersive (ie, using headsets). Non--study reports, studies with no specific chronic pain component, those not involving adults, and those using VR as part of a comprehensive rehabilitation program were excluded. A descriptive analytical method was used to extract data, compare studies, and contextualize the presented outcomes. Articles were categorized into several themes including the type of intervention, outcomes chosen, participant characteristics, degree to which immersion was achieved, and adverse effect monitoring and reporting. Results: A total of 36 articles were included in our analysis. We summarize the literature using 5 themes: (1) heterogeneity of chronic pain types, (2) highly variable intervention types, (3) highly variable secondary and exploratory outcomes, (4) immersion was highly variable between studies and not systemically explored in many articles, and (5) side effect monitoring was limited. Conclusions: The literature on VR in chronic pain is highly variable and lacks theoretical rigor. While there is emerging evidence that supports VR use in a wide variety of health conditions including chronic pain, future research should focus on producing theoretically rigorous work that focuses on mechanisms and that systematically assesses side effects to generate robust generalizable knowledge. ",
doi="10.2196/59922",
url="https://www.jmir.org/2025/1/e59922"
}


@Article{info:doi/10.2196/59575,
author="Walter, Uso
and Pennig, Stefan
and Bleckmann, Lothar
and R{\"o}schmann-Doose, Kristina
and Wittig, Thomas
and Thomsen, J{\"o}rn
and Schlee, Winfried",
title="Continuous Improvement of Chronic Tinnitus Through a 9-Month Smartphone-Based Cognitive Behavioral Therapy: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="18",
volume="27",
pages="e59575",
keywords="tinnitus",
keywords="chronic tinnitus",
keywords="mobile health app",
keywords="mHealth",
keywords="mobile app",
keywords="application",
keywords="smartphone",
keywords="digital health",
keywords="digital technology",
keywords="digital intervention",
keywords="cognitive behavioral therapy",
keywords="randomized controlled trial",
keywords="statistical analysis",
abstract="Background: Tinnitus is the perception of sound without an external auditive stimulus and can be a severe burden for affected patients. Medical guidelines recommend cognitive behavioral therapy (CBT) for tinnitus treatment, which effectively improves tinnitus-related distress and anxiety. Objective: This study investigates the outcome of a 9-month smartphone-based CBT for patients with tinnitus. Methods: The randomized controlled clinical trial in this study investigates the efficacy of a smartphone-based CBT for 187 patients with chronic tinnitus over a 9-month treatment period. In the initial 3 months, a waiting list design was applied, and in the subsequent study phase, the data of both treatment groups were collectively analyzed. The scores on the Tinnitus Questionnaire (TQ); 9-item Patient Health Questionnaire (PHQ-9); 9-item Self-Efficacy, Optimism, Pessimism (SWOP-K9) questionnaire; and 20-item Perceived Stress Questionnaire (PSQ-20) were assessed as endpoints after 3 and 9 months of treatment. Results: We observed a statistically significant reduction in the tinnitus burden in patients who received the smartphone-based CBT intervention. Although no changes were observed initially in the TQ sum scores in the waiting control group (baseline mean, 37.8, SD 4.7; 3 months mean 37.5, SD 4.8; analysis of covariance [ANCOVA] P=.52), the scores significantly decreased once the app-based CBT had commenced. Data pooled from both groups revealed significant reduction in the TQ sum score by 12.49 (SD 1.44) (ANCOVA, P<.001) and 18.48 (SD 1.85) (ANCOVA, P<.001) points after 3 and 9 months, respectively, which was also clinically important. The calculated Cohen d was 1.38. Similarly, the scores on PSQ-20 (--9.14 points; ANCOVA, P<.001), PHQ-9 (--2.47 points; ANCOVA, P<.001), and SWOP-K9 (0.17 points; ANCOVA, P<.001) were significantly improved at the end of the therapy, with corresponding intermediate effect sizes after 9 months. Conclusions: The data in our study provide evidence of statistically significant, clinically relevant, and continuous benefits of an app-based CBT intervention in patients with chronic tinnitus. Trial Registration: Deutsches Register Klinischer Studien DRKS00022973; https://drks.de/search/de/trial/DRKS00022973 ",
doi="10.2196/59575",
url="https://www.jmir.org/2025/1/e59575"
}


@Article{info:doi/10.2196/57826,
author="Griefahn, Annika
and Avermann, Florian
and Zalpour, Christoff
and Marshall, Percy Robert
and Cordon Morillas, In{\'e}s
and Luedtke, Kerstin",
title="Exploring the Effect of an 8-Week AI-Composed Exercise Program on Pain Intensity and Well-Being in Patients With Spinal Pain: Retrospective Cohort Analysis",
journal="JMIR Form Res",
year="2025",
month="Feb",
day="18",
volume="9",
pages="e57826",
keywords="exercise",
keywords="mHealth",
keywords="app engagement",
keywords="spinal pain",
keywords="artificial intelligence",
keywords="AI",
keywords="intensity",
keywords="well-being",
keywords="mobile health",
keywords="apps",
keywords="applications",
keywords="retrospective analysis",
keywords="physical activity",
keywords="adults",
keywords="questionnaire",
abstract="Background: Spinal pain, one of the most common musculoskeletal disorders (MSDs), significantly impacts the quality of life due to chronic pain and disability. Physical activity has shown promise in managing spinal pain, although optimizing adherence to exercise remains a challenge. The digital development of artificial intelligence (AI)-driven applications offers a possibility for guiding and supporting patients with MSDs in their daily lives. Objective: The trial aimed to investigate the effect of an 8-week AI-composed exercise program on pain intensity and well-being in patients with spinal pain. It also examined the relationship between exercise frequency, pain intensity, and well-being. In addition, app usage frequency was examined as a proxy for app engagement. Methods: Data from users who met the inclusion criteria were collected retrospectively from the medicalmotion app between January 1, 2020, and June 30, 2023. The intervention involved the use of the medicalmotion app, which provides 3?5 personalized exercises for each session based on individual user data. The primary outcomes assessed pain intensity and well-being using the numeric rating scale (NRS) and the Likert scale. Data were collected at baseline (t0), 4 weeks (t1), and 8 weeks (t2). The correlation between exercise frequency, pain intensity, and well-being was analyzed as a secondary outcome. In addition, average session length and frequency were measured to determine app engagement. Statistical analysis included ANOVA and Spearman correlation analysis. Results: The study included 379 participants with a mean age of 50.96 (SD 12.22) years. At t2, there was a significant reduction of 1.78 points on the NRS (P<.001). The score on the Likert scale for well-being improved by 3.11 points after 8 weeks. Pain intensity showed a negative correlation with the number of daily exercises performed at t1 and t2. Well-being had a small negative correlation with the average number of exercises performed per day. The average number of exercises performed per day was 3.58. The average session length was approximately 10 minutes, and the average interaction with the app was 49.2\% (n=27.6 days) of the 56 available days. Conclusions: Overall, the study demonstrates that an app-based intervention program can substantially reduce pain intensity and increase well-being in patients with spinal pain. This retrospective study showed that an app that digitizes multidisciplinary rehabilitation for the self-management of spinal pain significantly reduced user-reported pain intensity in a preselected population of app users. Trial Registration: OSF Registries osf.io/kjhef; https://osf.io/kjhef ",
doi="10.2196/57826",
url="https://formative.jmir.org/2025/1/e57826"
}


@Article{info:doi/10.2196/63209,
author="Li, Min
and Liu, Shiyu
and Yu, Binyang
and Li, Ning
and Lyu, Aili
and Yang, Haiyan
and He, Haiyan
and Zhang, Na
and Ma, Jingru
and Sun, Meichen
and Du, Hong
and Gao, Rui",
title="Assessing the Effectiveness of Digital Health Behavior Strategies on Type 2 Diabetes Management: Systematic Review and Network Meta-Analysis",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="14",
volume="27",
pages="e63209",
keywords="T2DM",
keywords="type 2 diabetes mellitus",
keywords="digital health interventions",
keywords="behavior strategy",
keywords="strategy combinations",
keywords="effectiveness",
keywords="network meta-analysis",
abstract="Background: Various mobile technologies and digital health interventions (DHIs) have been developed for type 2 diabetes mellitus (T2DM) management. Strategies are crucial for ensuring the effectiveness of DHIs. However, there is currently a lack of categorization and summarization of the strategies used in DHIs for T2DM. Objective: This study aims to (1) identify and categorize the strategies used in DHIs for T2DM management; (2) assess the effectiveness of these DHI strategies; and (3) compare and rank the efficacy of different strategy combinations on glycated hemoglobin A1c (HbA1c) levels, fasting blood glucose (FBG) levels, BMI, and weight loss. Methods: Relevant randomized controlled trials (RCTs) were extracted from PubMed, Web of Science, and Scopus databases. Three rounds of screening and selection were conducted. The strategies were identified and categorized based on the principles of behavior change techniques and behavior strategies. The synthesis framework for the assessment of health IT was used to structure the evaluation of the DHI strategies qualitatively. A network meta-analysis was performed to compare the efficacy of different strategy combinations. The data quality was assessed using the Cochrane Risk of Bias tool. Results: A total of 52 RCTs were included, identifying 63 strategies categorized into 19 strategy themes. The most commonly used strategies were guide, monitor, management, and engagement. Most studies reported positive or mixed outcomes for most indicators based on the synthesis framework for the assessment of health IT. Research involving a medium or high number of strategies was found to be more effective than research involving a low number of strategies. Of 52 RCTs, 27 (52\%) were included in the network meta-analysis. The strategy combination of communication, engagement, guide, and management was most effective in reducing HbA1c levels (mean difference [MD] --1.04, 95\% CI --1.55 to --0.54), while the strategy combination of guide, management, and monitor was effective in reducing FBG levels (MD --0.96, 95\% CI --1.86 to --0.06). The strategy combination of communication, engagement, goal setting, management, and support was most effective for BMI (MD --2.30, 95\% CI --3.16 to --1.44) and weight management (MD --6.50, 95\% CI --8.82 to --4.18). Conclusions: Several DHI strategy combinations were effective in reducing HbA1c levels, FBG levels, BMI, and weight in T2DM management. Health care professionals should be encouraged to apply these promising strategy combinations in DHIs during clinical care. Future research should further explore and optimize the design and implementation of strategies. Trial Registration: PROSPERO CRD42024544629; https://tinyurl.com/3zp2znxt ",
doi="10.2196/63209",
url="https://www.jmir.org/2025/1/e63209"
}


@Article{info:doi/10.2196/62706,
author="Blotenberg, Iris
and Boekholt, Melanie
and Lieberknecht, Nils
and S{\"a}ring, Paula
and Thyrian, Ren{\'e} Jochen",
title="Acceptance of Unsupervised App-Based Cognitive Assessment in Outpatient Care: An Implementation Study",
journal="JMIR Form Res",
year="2025",
month="Feb",
day="13",
volume="9",
pages="e62706",
keywords="mild cognitive impairment",
keywords="Alzheimer disease",
keywords="dementia",
keywords="cognition",
keywords="computerized assessment",
keywords="digital assessment",
keywords="digital cognitive biomarkers",
keywords="home-based assessment",
keywords="digital platform",
keywords="mobile phone",
abstract="Background: The use of unsupervised digital cognitive assessments provides considerable opportunities for early and comprehensive testing for Alzheimer disease, minimizing the demand on time and personnel resources in medical practices. However, the acceptance within health care has yet to be assessed. Objective: In this implementation study, the acceptance of an app-based, repeated cognitive assessment for early symptoms of Alzheimer disease in the outpatient care setting from both physicians' and patients' perspectives was examined. Methods: In total, 15 primary care practices participated, where patients with self- or relative-reported memory problems could be prescribed an app (neotivCare app [neotiv GmbH]) for comprehensive cognitive testing. Patients used the app to test their episodic memory function weekly for 12 weeks at home. After the testing period and the final consultation, physicians and patients received questionnaires to assess the app's acceptance. Results: We received completed questionnaires from physicians for 45 patients. In addition, we received 45 completed questionnaires from the patients themselves. The physicians reported that, for most patients, the app supported their decision-making in the diagnostic process (26/45, 58\%). In addition, most physicians found the app's information dependable (34/45, 76\%) and felt more certain in their decisions (38/45, 84\%). From the patients' perspective, a majority felt thoroughly tested (34/45, 76\%), and only a few considered the time commitment for the cognitive tests to be too burdensome (7/45, 16\%). Furthermore, despite the weekly cognitive testing and the lengthy 12-week testing period, a majority of patients participated in all tests (39/54, 72\%). Conclusions: Our results indicate a high level of acceptance by physicians and patients, suggesting significant potential for the implementation of unsupervised digital cognitive assessments into routine health care. In the future, acceptance should be assessed in large-scale studies, with a particular focus on the impact on health care delivery and patient outcomes. ",
doi="10.2196/62706",
url="https://formative.jmir.org/2025/1/e62706"
}


@Article{info:doi/10.2196/65923,
author="She, Jou Wan
and Siriaraya, Panote
and Iwakoshi, Hibiki
and Kuwahara, Noriaki
and Senoo, Keitaro",
title="An Explainable AI Application (AF'fective) to Support Monitoring of Patients With Atrial Fibrillation After Catheter Ablation: Qualitative Focus Group, Design Session, and Interview Study",
journal="JMIR Hum Factors",
year="2025",
month="Feb",
day="13",
volume="12",
pages="e65923",
keywords="atrial fibrillation",
keywords="explainable artificial intelligence",
keywords="explainable AI",
keywords="user-centered design",
keywords="prevention",
keywords="postablation monitoring",
abstract="Background: The opaque nature of artificial intelligence (AI) algorithms has led to distrust in medical contexts, particularly in the treatment and monitoring of atrial fibrillation. Although previous studies in explainable AI have demonstrated potential to address this issue, they often focus solely on electrocardiography graphs and lack real-world field insights. Objective: We addressed this gap by incorporating standardized clinical interpretation of electrocardiography graphs into the system and collaborating with cardiologists to co-design and evaluate this approach using real-world patient cases and data. Methods: We conducted a 3-stage iterative design process with 23 cardiologists to co-design, evaluate, and pilot an explainable AI application. In the first stage, we identified 4 physician personas and 7 explainability strategies, which were reviewed in the second stage. A total of 4 strategies were deemed highly effective and feasible for pilot deployment. On the basis of these strategies, we developed a progressive web application and tested it with cardiologists in the third stage. Results: The final progressive web application prototype received above-average user experience evaluations and effectively motivated physicians to adopt it owing to its ease of use, reliable information, and explainable functionality. In addition, we gathered in-depth field insights from cardiologists who used the system in clinical contexts. Conclusions: Our study identified effective explainability strategies, emphasized the importance of curating actionable features and setting accurate expectations, and suggested that many of these insights could apply to other disease care contexts, paving the way for future real-world clinical evaluations. ",
doi="10.2196/65923",
url="https://humanfactors.jmir.org/2025/1/e65923"
}


@Article{info:doi/10.2196/56737,
author="Xiao, Jian
and Li, Mengyao
and Cai, Ruwen
and Huang, Hangxing
and Yu, Huimin
and Huang, Ling
and Li, Jingyang
and Yu, Ting
and Zhang, Jiani
and Cheng, Shuqiao",
title="Smart Pharmaceutical Monitoring System With Personalized Medication Schedules and Self-Management Programs for Patients With Diabetes: Development and Evaluation Study",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="11",
volume="27",
pages="e56737",
keywords="pharmaceutical services",
keywords="diabetes",
keywords="self-management",
keywords="intelligent medication scheduling system",
keywords="drug database",
keywords="GPT-4",
abstract="Background: With the climbing incidence of type 2 diabetes, the health care system is under pressure to manage patients with this condition properly. Particularly, pharmacological therapy constitutes the most fundamental means of controlling blood glucose levels and preventing the progression of complications. However, its effectiveness is often hindered by factors such as treatment complexity, polypharmacy, and poor patient adherence. As new technologies, artificial intelligence and digital technologies are covering all aspects of the medical and health care field, but their application and evaluation in the domain of diabetes research remain limited. Objective: This study aims to develop and establish a stand-alone diabetes management service system designed to enhance self-management support for patients, as well as to assess its performance with experienced health care professionals. Methods: Diabetes Universal Medication Schedule (DUMS) system is grounded in official medicine instructions and evidence-based data to establish medication constraints and drug-drug interaction profiles. Individualized medication schedules and self-management programs were generated based on patient-specific conditions and needs, using an app framework to build patient-side contact pathways. The system's ability to provide medication guidance and health management was assessed by senior health care professionals using a 5-point Likert scale across 3 groups: outputs generated by the system (DUMS group), outputs refined by pharmacists (intervention group), and outputs generated by ChatGPT-4 (GPT-4 group). Results: We constructed a cloud-based drug information management system loaded with 475 diabetes treatment--related medications; 684 medication constraints; and 12,351 drug-drug interactions and theoretical supports. The generated personalized medication plan and self-management program included recommended dosing times, disease education, dietary considerations, and lifestyle recommendations to help patients with diabetes achieve correct medication use and active disease management. Reliability analysis demonstrated that the DUMS group outperformed the GPT-4 group in medication schedule accuracy and safety, as well as comprehensiveness and richness of the self-management program (P<.001). The intervention group outperformed the DUMS and GPT-4 groups on all indicator scores. Conclusions: DUMS's treatment monitoring service can provide reliable self-management support for patients with diabetes. ChatGPT-4, powered by artificial intelligence, can act as a collaborative assistant to health care professionals in clinical contexts, although its performance still requires further training and optimization. ",
doi="10.2196/56737",
url="https://www.jmir.org/2025/1/e56737"
}


@Article{info:doi/10.2196/60275,
author="Ray, Katherine Mary
and Fleming, Jorie
and Aschenbrenner, Andrew
and Hassenstab, Jason
and Redwine, Brooke
and Burns, Carissa
and Arbelaez, Maria Ana
and Vajravelu, Ellen Mary
and Hershey, Tamara",
title="Assessing Dynamic Cognitive Function in the Daily Lives of Youths With and Without Type 1 Diabetes: Usability Study",
journal="JMIR Form Res",
year="2025",
month="Feb",
day="11",
volume="9",
pages="e60275",
keywords="ecological momentary assessment",
keywords="EMA",
keywords="ambulatory",
keywords="smartphone",
keywords="continuous glucose monitoring",
keywords="CGM",
keywords="assessment",
keywords="daily lives",
keywords="youth",
keywords="type 1 diabetes",
keywords="diabetes",
keywords="feasibility study",
keywords="pilot study",
keywords="glycemic control",
keywords="environmental factor",
keywords="phone",
keywords="acceptability",
keywords="young",
keywords="cognitive test",
keywords="app",
keywords="application",
keywords="mobile phone",
abstract="Background: Studies have shown a relationship between worse glycemic control and lower cognitive scores in youths with type 1 diabetes (T1D). However, most studies assess long-term glucose control (eg, years-decades) and cognition at a single time point. Understanding this relationship at a higher temporal resolution (eg, minutes-hours) and in naturalistic settings has potential clinical implications. Newer technology (eg, continuous glucose monitoring [CGM] and ecological momentary assessment) provides a unique opportunity to explore the glucose dynamics that influence dynamic cognition; that is, cognitive functions that fluctuate short-term and are influenced by environmental factors. Objective: Before we can assess this relationship, we need to determine the feasibility of measuring cognition in youths in daily life and determine the plausibility of obtaining glucose variation with CGM to be integrated with real-time cognition measures. This study's purpose was to assess the acceptability of measuring dynamic cognition using a smartphone app and adherence to cognitive testing in daily life in youths with and without T1D. Further, we assessed CGM-derived glucose measures at temporally related timeframes to cognitive testing in naturalistic settings. Methods: Data were obtained from 3 studies including one in-laboratory study and 2 remote studies. For all studies, youths were asked to complete cognitive tests on the Ambulatory Research in Cognition (ARC) smartphone app that measured processing speed, associative memory, and working memory. For the in-laboratory study, youths completed testing 4 times during 1 session. For the remote studies, youths were asked to complete cognitive tests 5 times per day for either 10 or 14 consecutive days in daily life. Youths were asked to rate their impressions of the app. Youths with T1D wore a CGM. Results: 74 youths (n=53 control; n=21 T1D) aged 4?16 years participated. Youths generally reported liking or understanding the ARC app tasks in a laboratory and remote setting. Youths had high testing adherence in daily life (2350/3080 to 721/900, 76.3\%?80.2\%) and none dropped out. The percentage of measurements within each glycemic range taken immediately before the app's cognitive testing was 3\% (28/942) low glucose, 51\% (484/942) euglycemia, 23\% (221/942) high glucose, and 22\% (210/942) very high glucose. In the 2-hour window before each cognitive task, mean glucose was 182.5 (SD 76.2) mg/dL, SD in glucose was 27.1 mg/dL (SD 18.7), and the mean maximum difference between the highest and lowest glucose was 85.5 (SD 53.7) mg/dL. Conclusions: The results suggest that using the ARC smartphone app to assess dynamic cognitive functions in youths with and without T1D is feasible. Further, we showed CGM-derived glycemic variability at temporally associated timeframes of dynamic cognitive assessments. The next steps include using ecological momentary assessment in a fully powered study to determine the relationship between short-term glycemic control and cognition in youths with T1D. ",
doi="10.2196/60275",
url="https://formative.jmir.org/2025/1/e60275"
}


@Article{info:doi/10.2196/59841,
author="Clifford, Namuun
and Tunis, Rachel
and Ariyo, Adetimilehin
and Yu, Haoxiang
and Rhee, Hyekyun
and Radhakrishnan, Kavita",
title="Trends and Gaps in Digital Precision Hypertension Management: Scoping Review",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="10",
volume="27",
pages="e59841",
keywords="precision health",
keywords="hypertension",
keywords="digital health",
keywords="prediction models",
keywords="personalization",
keywords="phenotyping",
keywords="machine learning",
keywords="algorithms",
keywords="mobile apps",
keywords="mobile health",
abstract="Background: Hypertension (HTN) is the leading cause of cardiovascular disease morbidity and mortality worldwide. Despite effective treatments, most people with HTN do not have their blood pressure under control. Precision health strategies emphasizing predictive, preventive, and personalized care through digital tools offer notable opportunities to optimize the management of HTN. Objective: This scoping review aimed to fill a research gap in understanding the current state of precision health research using digital tools for the management of HTN in adults. Methods: This study used a scoping review framework to systematically search for articles in 5 databases published between 2013 and 2023. The included articles were thematically analyzed based on their precision health focus: personalized interventions, prediction models, and phenotyping. Data were extracted and summarized for study and sample characteristics, precision health focus, digital health technology, disciplines involved, and characteristics of personalized interventions. Results: After screening 883 articles, 46 were included; most studies had a precision health focus on personalized digital interventions (34/46, 74\%), followed by prediction models (8/46, 17\%) and phenotyping (4/46, 9\%). Most studies (38/46, 82\%) were conducted in or used data from North America or Europe, and 63\% (29/46) of the studies came exclusively from the medical and health sciences, with 33\% (15/46) of studies involving 2 or more disciplines. The most commonly used digital technologies were mobile phones (33/46, 72\%), blood pressure monitors (18/46, 39\%), and machine learning algorithms (11/46, 24\%). In total, 45\% (21/46) of the studies either did not report race or ethnicity data (14/46, 30\%) or partially reported this information (7/46, 15\%). For personalized intervention studies, nearly half (14/30, 47\%) used 2 or less types of data for personalization, with only 7\% (2/30) of the studies using social determinants of health data and no studies using physical environment or digital literacy data. Personalization characteristics of studies varied, with 43\% (13/30) of studies using fully automated personalization approaches, 33\% (10/30) using human-driven personalization, and 23\% (7/30) using a hybrid approach. Conclusions: This scoping review provides a comprehensive mapping of the literature on the current trends and gaps in digital precision health research for the management of HTN in adults. Personalized digital interventions were the primary focus of most studies; however, the review highlighted the need for more precise definitions of personalization and the integration of more diverse data sources to improve the tailoring of interventions and promotion of health equity. In addition, there were significant gaps in the reporting of race and ethnicity data of participants, underuse of wearable devices for passive data collection, and the need for greater interdisciplinary collaboration to advance precision health research in digital HTN management. Trial Registration: OSF Registries osf.io/yuzf8; https://osf.io/yuzf8 ",
doi="10.2196/59841",
url="https://www.jmir.org/2025/1/e59841"
}


@Article{info:doi/10.2196/67289,
author="Elkourdi, Farah
and Asan, Onur",
title="Community Caregivers' Perspectives on Health IT Use for Children With Medical Complexity: Qualitative Interview Study",
journal="JMIR Pediatr Parent",
year="2025",
month="Feb",
day="10",
volume="8",
pages="e67289",
keywords="pediatric care",
keywords="children with medical complexity",
keywords="family-centered care",
keywords="health information technology",
keywords="health care software solutions",
keywords="mobile phone",
keywords="artificial intelligence",
abstract="Background: Children with medical complexity represent a unique pediatric population requiring extensive health care needs and care coordination. Children with medical complexities have multiple significant chronic health problems that affect multiple organ systems and result in functional limitations and high health care needs or use. Often, there is a need for medical technology and total care for activities of daily living, much of which is provided at home by family and caregivers. Health IT (HIT) is a broad term that includes various technologies, such as patient portals, telemedicine, and mobile health apps. These tools can improve the care of children with medical complexity by enhancing communication, information exchange, medical safety, care coordination, and shared decision-making. In this study, we identified children with medical complexity as children aged <21 years who have >3 chronic health conditions. Community caregivers contribute to the care management of children with medical complexity, serving as advocates and coordinators, primary sources of information about children's needs, and facilitators of access to care. They are often the first point of contact for the families of children with medical complexity, particularly in vulnerable communities, including families in rural areas, low-income households, and non--English-speaking immigrant populations. Objective: This study aims to introduce the HIT needs and preferences for children with medical complexity from the perspective of community caregivers. By including their perspective on HIT development, we can better appreciate the challenges they face, the insights they offer, and the ways in which they bridge gaps in care, support, and resources. Methods: We conducted semistructured interviews (n=12) with formal community caregivers of children with medical complexity populations from a parent advocacy network on the US East Coast. Interviews were audio recorded via Zoom and then transcribed. An inductive thematic analysis was conducted to reveal HIT challenges and preferences for improving the care of children with medical complexity. Results: We categorized the interview results into themes and subthemes. There are four main themes: (1) telehealth transforming care for children with medical complexity during the COVID-19 pandemic, (2) suggested tools and technologies for care for children with medical complexity, (3) HIT feature preferences, and (4) transition to adult care. Each theme had multiple subthemes capturing all details related to design features of needed technologies. Conclusions: The study emphasizes the need to develop and enhance HIT for the care of children with medical complexity. The identified themes can serve as design guidelines for designers by establishing a foundation for user-centered HIT tools to effectively support children with medical complexity and their families. Telehealth and mobile health apps could improve care management and quality of life for children with medical complexity. ",
doi="10.2196/67289",
url="https://pediatrics.jmir.org/2025/1/e67289"
}


@Article{info:doi/10.2196/60888,
author="Luo, Aijing
and Chen, Wei
and Zhu, Hongtao
and Xie, Wenzhao
and Chen, Xi
and Liu, Zhenjiang
and Xin, Zirui",
title="Machine Learning in the Management of Patients Undergoing Catheter Ablation for Atrial Fibrillation: Scoping Review",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="10",
volume="27",
pages="e60888",
keywords="atrial fibrillation",
keywords="catheter ablation",
keywords="deep learning",
keywords="patient management",
keywords="prognosis",
keywords="quality assessment tools",
keywords="cardiac arrhythmia",
keywords="public health",
keywords="quality of life",
keywords="severe medical condition",
keywords="electrocardiogram",
keywords="electronic health record",
keywords="morbidity",
keywords="mortality",
keywords="thromboembolism",
keywords="clinical intervention",
abstract="Background: Although catheter ablation (CA) is currently the most effective clinical treatment for atrial fibrillation, its variable therapeutic effects among different patients present numerous problems. Machine learning (ML) shows promising potential in optimizing the management and clinical outcomes of patients undergoing atrial fibrillation CA (AFCA). Objective: This scoping review aimed to evaluate the current scientific evidence on the application of ML for managing patients undergoing AFCA, compare the performance of various models across specific clinical tasks within AFCA, and summarize the strengths and limitations of ML in this field. Methods: Adhering to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, relevant studies published up to October 7, 2023, were searched from PubMed, Web of Science, Embase, the Cochrane Library, and ScienceDirect. The final included studies were confirmed based on inclusion and exclusion criteria and manual review. The PROBAST (Prediction model Risk Of Bias Assessment Tool) and QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) methodological quality assessment tools were used to review the included studies, and narrative data synthesis was performed on the modeled results provided by these studies. Results: The analysis of 23 included studies showcased the contributions of ML in identifying potential ablation targets, improving ablation strategies, and predicting patient prognosis. The patient data used in these studies comprised demographics, clinical characteristics, various types of imaging (9/23, 39\%), and electrophysiological signals (7/23, 30\%). In terms of model type, deep learning, represented by convolutional neural networks, was most frequently applied (14/23, 61\%). Compared with traditional clinical scoring models or human clinicians, the model performance reported in the included studies was generally satisfactory, but most models (14/23, 61\%) showed a high risk of bias due to lack of external validation. Conclusions: Our evidence-based findings suggest that ML is a promising tool for improving the effectiveness and efficiency of managing patients undergoing AFCA. While guiding data preparation and model selection for future studies, this review highlights the need to address prevalent limitations, including lack of external validation, and to further explore model generalization and interpretability. ",
doi="10.2196/60888",
url="https://www.jmir.org/2025/1/e60888"
}


@Article{info:doi/10.2196/59161,
author="Lee, Kyungmi
and Azuero, Andres
and Engler, Sally
and Kumar, Sidharth
and Puga, Frank
and Wright, A. Alexi
and Kamal, Arif
and Ritchie, S. Christine
and Demiris, George
and Bakitas, A. Marie
and Odom, Nicholas J.",
title="Exploring the Relationship Between Smartphone GPS Patterns and Quality of Life in Patients With Advanced Cancer and Their Family Caregivers: Longitudinal Study",
journal="JMIR Form Res",
year="2025",
month="Feb",
day="7",
volume="9",
pages="e59161",
keywords="cancer",
keywords="digital phenotyping",
keywords="global positioning system",
keywords="quality of life",
keywords="smartphone",
keywords="mobile phone",
keywords="family caregiver",
abstract="Background: Patients with advanced cancer and their family caregivers often experience poor quality of life (QOL). Self-report measures are commonly used to quantify QOL of family caregivers but may have limitations such as recall bias and social desirability bias. Variables derived from passively obtained smartphone GPS data are a novel approach to measuring QOL that may overcome these limitations and enable detection of early signs of mental and physical health (PH) deterioration. Objective: This study explored the feasibility of a digital phenotyping approach by assessing participant adherence and examining correlations between smartphone GPS data and QOL levels among family caregivers and patients with advanced cancer. Methods: This was a secondary analysis involving 7 family caregivers and 4 patients with advanced cancer that assessed correlations between GPS sensor data captured by a personally owned smartphone and QOL self-report measures over 12 weeks through linear correlation coefficients. QOL as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health 10 was collected at baseline, 6, and 12 weeks. Using a Beiwe smartphone app, GPS data were collected and processed into variables including total distance, time spent at home, transition time, and number of significant locations. Results: The study identified relevant temporal correlations between QOL and smartphone GPS data across specific time periods. For instance, in terms of PH, associations were observed with the total distance traveled (12 and 13 wk, with r ranging 0.37 to 0.38), time spent at home (?4 to ?2 wk, with r ranging from ?0.41 to ?0.49), and transition time (?4 to ?2 wk, with r ranging ?0.38 to ?0.47). Conclusions: This research offers insights into using passively obtained smartphone GPS data as a novel approach for assessing and monitoring QOL among family caregivers and patients with advanced cancer, presenting potential advantages over traditional self-report measures. The observed correlations underscore the potential of this method to detect early signs of deteriorating mental health and PH, providing opportunities for timely intervention and support. ",
doi="10.2196/59161",
url="https://formative.jmir.org/2025/1/e59161"
}


@Article{info:doi/10.2196/68914,
author="Thiagarajan, Nishanth
and Tan, Chang Hong
and Rama Chandran, Suresh
and Lee, Ching Phong
and Chin, Ann Yun
and Zeng, Wanling
and Ho, Lin Emily Tse
and Carmody, David
and Goh, Su-Yen
and Bee, Mong Yong",
title="Web-Based, Algorithm-Guided Insulin Titration in Insulin-Treated Type 2 Diabetes: Pre-Post Intervention Study",
journal="JMIR Form Res",
year="2025",
month="Feb",
day="7",
volume="9",
pages="e68914",
keywords="diabetes",
keywords="insulin",
keywords="monitoring",
keywords="technology",
keywords="mobile",
keywords="app",
keywords="intervention",
abstract="Background: Self-monitoring of blood glucose (SMBG) using web-based diabetes management platforms has demonstrated promise in managing type 2 diabetes (T2D). However, the effectiveness of such systems incorporating algorithm-guided insulin titration has not been extensively studied in Asian populations. Objective: This study evaluates the efficacy and safety of the ALRT telehealth solution---a US Food and Drug Administration--cleared, web-based platform that integrates SMBG with algorithm-driven insulin dose adjustments---in improving glycemia in insulin-treated T2D. Methods: This 24-week, pre-post intervention study enrolled 25 adults with T2D (mean age 58.9, SD 7.0 y; n=14, 56\% male) on twice-daily premixed insulin. Inclusion criteria included a baseline hemoglobin A1c (HbA1c) level between 7.5\% to 9.9\% (58?86 mmol/mol), a BMI ?40 kg/m{\texttwosuperior}, and experience with SMBG. Participants uploaded twice-daily SMBG data weekly via a mobile app, which generated insulin titration recommendations based on a predefined algorithm. Physicians reviewed and approved the recommendations, which were then communicated back to participants via the app. The primary outcome was the change in HbA1c level from baseline to 24 weeks. Secondary outcomes included changes in fasting plasma glucose, insulin dose, hypoglycemia incidence, and SMBG adherence. Results: Participants achieved significant reductions in HbA1c level from 8.6\% (70 mmol/mol) at baseline to 7.4\% (57 mmol/mol) at 24 weeks (P<.001), with reductions of 0.8\% and 0.4\% in the first and second 12 weeks, respectively. Fasting plasma glucose decreased from 8.7 (SD 2.0) mmol/L to 7.1 (SD 1.4) mmol/L (P<.001). Mean total daily insulin dose increased modestly from 0.73 (SD 0.31) units/kg/day to 0.79 (SD 0.34) units/kg/day (P=.007). Participants demonstrated high adherence, completing 97.3\% (327/336) of prescribed SMBG measurements. During the study, 48\% (12/25) of participants experienced at least 1 hypoglycemia episode, predominantly mild hypoglycemia (85/96, 88.5\%; glucose 3.0?3.9 mmol/L). Hypoglycemia episodes increased from 24 during weeks 0?12 to 72 during weeks 13?24. There were no episodes of severe hypoglycemia requiring external assistance. BMI increased slightly from 29.0 (SD 3.6) kg/m{\texttwosuperior} to 29.5 (SD 3.6) kg/m{\texttwosuperior} (P=.03), reflecting a modest weight gain associated with improved glycemia. Conclusions: In conclusion, patients with insulin-treated T2D initiated on a web-based glucose monitoring system with algorithm-guided dosing recommendations showed significant improvement in glycemic control compared to baseline. High adherence rates underscore the feasibility of integrating algorithm-guided insulin titration into routine care. While hypoglycemia incidence rose slightly, episodes were predominantly mild, and no severe events occurred. This intervention shows promise for broader adoption in T2D management, particularly in resource-constrained settings. ",
doi="10.2196/68914",
url="https://formative.jmir.org/2025/1/e68914"
}


@Article{info:doi/10.2196/65140,
author="Astill Wright, Laurence
and Moore, Matthew
and Reeves, Stuart
and Vallejos, Perez Elvira
and Morriss, Richard",
title="Improving the Utility, Safety, and Ethical Use of a Passive Mood-Tracking App for People With Bipolar Disorder Using Coproduction: Qualitative Focus Group Study",
journal="JMIR Form Res",
year="2025",
month="Feb",
day="7",
volume="9",
pages="e65140",
keywords="mood monitoring",
keywords="ecological momentary assessment",
keywords="EMA",
keywords="passive ecological momentary assessment",
keywords="passive EMA",
keywords="bipolar disorder",
keywords="implementation",
keywords="qualitative",
keywords="mobile phone",
abstract="Background: Coproduction with users of new digital technology, such as passive mood monitoring, is likely to improve its utility, safety, and successful implementation via improved design and consideration of how such technology fits with their daily lives. Mood-monitoring interventions are commonly used by people with bipolar disorder (BD) and have promising potential for digitization using novel technological methods. Objective: This study aims to explore how a passive behavioral monitoring platform, Remote Assessment of Disease and Relapse, would meet the needs of people with BD by specifically considering purpose and function, diversity of need, personal preference, essential components and potential risks, and harms and mitigation strategies through an iterative coproduction process. Methods: A total of 17 people with BD were recruited via national charities. We conducted 3 web-based focus groups as a part of an iterative coproduction process in line with responsible research and innovation principles and with consideration of clinical challenges associated with BD. Data were analyzed thematically. Results were cross-checked by someone with lived experience of BD. Results: Focus groups were transcribed and analyzed using thematic analysis. Six themes were identified as follows: (1) the purpose of using the app, (2) desired features, (3) when to use the app, (4) risks of using the app, (5) sharing with family and friends, and (6) sharing with health care professionals. Conclusions: People with BD who are interested in using passive technology to monitor their mood wish to do so for a wide variety of purposes, identifying several preferences and potential risks. Principally, people with BD wished to use this novel technology to aid them in self-managing their BD with greater insight and a better understanding of potential triggers. We discuss key features that may aid this functionality and purpose, including crisis plans and sharing with others. Future development of passive mood-monitoring technologies should not assume that the involvement of formal mental health services is desired. ",
doi="10.2196/65140",
url="https://formative.jmir.org/2025/1/e65140",
url="http://www.ncbi.nlm.nih.gov/pubmed/39918865"
}


@Article{info:doi/10.2196/49654,
author="Sirohi, Diksha
and Ng, HM Cecilia
and Bidargaddi, Niranjan
and Slater, Helen
and Parker, Melissa
and Hull, Louise M.
and O'Hara, Rebecca",
title="Good-Quality mHealth Apps for Endometriosis Care: Systematic Search",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="7",
volume="27",
pages="e49654",
keywords="adenomyosis",
keywords="endometriosis",
keywords="m-health apps",
keywords="mobile apps",
keywords="digital health",
keywords="pelvic pain",
keywords="self-learning",
keywords="clinicians",
keywords="mHealth",
keywords="application",
keywords="endometriomas",
keywords="chocolate cysts",
keywords="uterus",
keywords="womb",
keywords="pain management",
keywords="women's health",
keywords="mobile phone",
abstract="Background: Mobile health (mHealth) apps are increasingly being used by community members to track symptoms and manage endometriosis. In addition, clinicians use mHealth apps for continued medical education and clinical decision-making and recommend good-quality apps to patients. However, poor-quality apps can spread misinformation or provide recommendations that are not evidence-based. Therefore, a critical evaluation is needed to assess and recommend good-quality endometriosis mHealth apps. Objective: This study aimed to evaluate the quality and provide recommendations for good quality endometriosis mHealth apps for the community and clinicians. Methods: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines informed the search of mHealth apps on the Google Play Store and Apple App Store. The search terms included ``endometriosis,'' ``adenomyosis,'' and ``pelvic pain.'' mHealth apps were eligible if they were (1) related to the search terms, (2) were in the English language, and (3) were available free of cost. Only the free content of the eligible mHealth apps was assessed. ENLIGHT, a validated evaluation tool for mobile and web-based interventions, was used to assess the quality across 7 domains such as usability, visual design, user engagement, content, therapeutic persuasiveness, therapeutic alliance, and general subjective evaluation. mHealth apps with a total score of ?3.5 were classified as ``good'' according to the ENLIGHT scoring system and are recommended as good-quality mHealth apps for endometriosis care. Results: In total, 42 mHealth apps were screened, and 19 were included in the quality assessment. A total of 6 good-quality mHealth apps were identified (QENDO, Bearable, Luna for Health, Matilda Health, Branch Health: Pain Management, and CHARLI Health). These apps provided symptom-tracking functions and self-management support. A total of 17 apps were designed for community use, while 2 apps provided a digital endometriosis classification tool to clinicians. Most mHealth apps scored well (?3.5) in the domains of usability (16/19, 84.2\%), visual design (14/19, 73.7\%), user engagement (11/19, 57.9\%), and content (15/19, 78.9\%). Few eHealth websites scored well on therapeutic persuasiveness (6/19, 31.6\%), therapeutic alliance (9/19, 47.4\%), and general subjective evaluation (6/19, 31.6\%). Conclusions: Although time and geographical location can influence the search results, we identified 6 ``good-quality'' endometriosis mHealth apps that can be recommended to the endometriosis community. mHealth apps designed for community use should evaluate their effectiveness on user's endometriosis knowledge, self-recommended management strategies, pain self-efficacy, user satisfaction, and user quality of life. Digital technology should be leveraged to develop mHealth apps for clinicians that contribute to continued medical education and assist clinical decision-making in endometriosis management. Factors that enhance usability, visual design, therapeutic persuasiveness, and therapeutic alliance should be incorporated to ensure successful and long-term uptake of mHealth apps. Trial Registration: PROSPERO CRD42020185475; https://tinyurl.com/384dkkmj ",
doi="10.2196/49654",
url="https://www.jmir.org/2025/1/e49654",
url="http://www.ncbi.nlm.nih.gov/pubmed/39918848"
}


@Article{info:doi/10.2196/58612,
author="Cordillet, S{\'e}bastien
and Drapier, Sophie
and Leh, Fr{\'e}d{\'e}rique
and Dumont, Audeline
and Bidet, Florian
and Bonan, Isabelle
and Jamal, Karim",
title="Detecting Freezing of Gait in Parkinson Disease Using Multiple Wearable Sensors Sets During Various Walking Tasks Relative to Medication Conditions (DetectFoG): Protocol for a Prospective Cohort Study",
journal="JMIR Res Protoc",
year="2025",
month="Feb",
day="6",
volume="14",
pages="e58612",
keywords="Parkinson",
keywords="detection",
keywords="freezing of gait",
keywords="sensor",
keywords="wearable",
keywords="freezing",
keywords="walk",
keywords="neurodegenerative",
keywords="movement",
abstract="Background: Freezing of gait (FoG) is one of the most disabling symptoms of Parkinson disease (PD). Detecting and monitoring episodes of FoG are important in the medical follow-up of patients to assess disease progression and functional impact and to adjust treatment accordingly. Although several questionnaires exist, they lack objectivity. Using wearable sensors such as inertial measurement units (IMUs) to detect FoG episodes offers greater objectivity and accuracy. There is no consensus on the number and location of IMU, type of algorithm, and method of triggering and scoring the FoG episodes. Objective: The objective of this study is to investigate the use of multiple wearable sensors sets to detect FoG in patients with PD during various walking tasks under different medication conditions. Methods: This single-center, prospective cohort study (DetectFoG) will include 18 patients with PD. Patients will be fitted with 7 IMUs and will walk a freezing-provoking path under different tasks---``single task,'' ``dual motor task,'' or ``dual cognitive task''---and medical conditions corresponding to levodopa medication (``on'' or ``off''). Passages will be videotaped, and 2 movement disorder specialists will identify FoG episodes in the videos. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the most effective combination of wearable sensors for detecting FoG episodes will be studied. Results: The study is currently in the data collection phase, having commenced recruitment in February 2024. Once all data have been gathered, the data analysis will commence. As of August 2024, 3 patients have been recruited. It is anticipated that the results will be published by the end of 2025. Conclusions: Detecting FoG episodes in various medical and clinical settings would provide a more comprehensive understanding of this phenomenon. Furthermore, it would enable reliable and objective monitoring of the progression of this symptom based on treatments and the natural course of the disease. This could serve as an objective tool for monitoring patients and assessing the severity and frequency of FoG. Trial Registration: Clinicaltrials.gov NCT05822258; https://www.clinicaltrials.gov/study/NCT05822258 International Registered Report Identifier (IRRID): DERR1-10.2196/58612 ",
doi="10.2196/58612",
url="https://www.researchprotocols.org/2025/1/e58612"
}


@Article{info:doi/10.2196/59817,
author="Kraft, A. Stephanie
and Chopra, Shaan
and Duran, C. Miriana
and Rojina, A. Janet
and Beretta, Abril
and L{\'o}pez, I. Katherine
and Javan, Russell
and Wilfond, S. Benjamin
and Rosenfeld, Margaret
and Fogarty, James
and Ko, K. Linda",
title="Perspectives of Hispanic and Latinx Community Members on AI-Enabled mHealth Tools: Qualitative Focus Group Study",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="6",
volume="27",
pages="e59817",
keywords="wearable electronic devices",
keywords="qualitative research",
keywords="mobile health",
keywords="mHealth",
keywords="digital health",
keywords="privacy",
keywords="data sharing",
keywords="artificial intelligence",
keywords="AI",
keywords="community",
keywords="chronic conditions",
keywords="chronic disease",
abstract="Background: Mobile health (mHealth) tools have the potential to reduce the burden of chronic conditions that disproportionately affect Hispanic and Latinx communities; however, digital divides in the access to and use of health technology suggest that mHealth has the potential to exacerbate, rather than reduce, these disparities. Objective: A key step toward developing health technology that is accessible and usable is to understand community member perspectives and needs so that technology is culturally relevant and appropriately contextualized. In this study, we aimed to examine the perspectives of Hispanic and Latinx community members in Washington State about mHealth. Methods: We recruited English- and Spanish-speaking Hispanic or Latinx adults to participate in web-based focus groups through existing community-based networks across rural and urban regions of Washington State. Focus groups included a presentation of narrative slideshow materials developed by the research team depicting mHealth use case examples of asthma in children and fall risk in older adults. Focus group questions asked participants to respond to the case examples and to further explore mHealth use preferences, benefits, barriers, and concerns. Focus group recordings were professionally transcribed, and Spanish transcripts were translated into English. We developed a qualitative codebook using deductive and inductive methods and then coded deidentified transcripts using the constant comparison method. The analysis team proposed themes based on review of coded data, which were validated through member checking with a community advisory board serving Latino individuals in the region and finalized through discussion with the entire research team. Results: Between May and September 2023, we conducted 8 focus groups in English or Spanish with 48 participants. Focus groups were stratified by language and region and included the following: 3 (n=18, 38\% participants) Spanish urban groups, 2 (n=14, 29\% participants) Spanish rural groups, 1 (n=6, 13\% participants) English urban group, and 2 (n=10, 21\% participants) English rural groups. We identified the following seven themes: (1) mHealth is seen as beneficial for promoting health and peace of mind; (2) some are unaware of, unfamiliar with, or uncomfortable with technology and may benefit from individualized support; (3) financial barriers limit access to mHealth; (4) practical considerations create barriers to using mHealth in daily life; (5) mHealth raises concern for overreliance on technology; (6) automated mHealth features are perceived as valuable but fallible, requiring human input to ensure accuracy; and (7) data sharing is seen as valuable for limited uses but raises privacy concerns. These themes illustrate key barriers to the benefits of mHealth that communities may face, provide insights into the role of mHealth within families, and examine the appropriate balance of data sharing and privacy protections. Conclusions: These findings offer important insights that can help advance the development of mHealth that responds to community values and priorities. ",
doi="10.2196/59817",
url="https://www.jmir.org/2025/1/e59817"
}


@Article{info:doi/10.2196/65615,
author="Chen, Ciao-Sin
and Dorsch, P. Michael
and Alsomairy, Sarah
and Griggs, J. Jennifer
and Jagsi, Reshma
and Sabel, Michael
and Stino, Amro
and Callaghan, Brian
and Hertz, L. Daniel",
title="Remote Monitoring of Chemotherapy-Induced Peripheral Neuropathy by the NeuroDetect iOS App: Observational Cohort Study of Patients With Cancer",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="5",
volume="27",
pages="e65615",
keywords="chemotherapy-induced peripheral neuropathy",
keywords="smartphone",
keywords="mobile health",
keywords="gait",
keywords="balance",
keywords="manual dexterity",
keywords="mobile phone",
keywords="chemotherapy",
keywords="peripheral neuropathy",
keywords="CIPN",
keywords="neurotoxic chemotherapy",
keywords="monitoring",
keywords="detection",
keywords="patient-reported outcomes",
keywords="mHealth",
keywords="application",
abstract="Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating adverse effect of neurotoxic chemotherapy characterized by symptoms such as numbness, tingling, and weakness. Effective monitoring and detection of CIPN are crucial for avoiding progression to irreversible symptoms. Due to the inconvenience of clinic-based objective assessment, CIPN detection relies primarily on patients' reporting of subjective symptoms, and patient-reported outcomes are used to facilitate CIPN detection. Our previous study found evidence that objective functional assessments completed within a smartphone app may differentiate patients with and those without CIPN after treatment. Objective: This prospective, longitudinal observational cohort study aimed to determine the feasibility and accuracy of app-based remote monitoring of CIPN in patients with cancer undergoing neurotoxic chemotherapeutic treatment and to conduct exploratory comparisons of app-based functional CIPN monitoring versus patient-reported outcome--only monitoring. Methods: The NeuroDetect app (Medable Inc) includes subjective EORTC (European Organization for Research and Treatment of Cancer) Quality of Life Questionnaire (QLQ)--20-item scale (CIPN20) and 6 objective functional assessments that use smartphone sensors to mimic neurological examinations, such as walking, standing, and manual dexterity tests. The functional assessment data were collected from patients with cancer undergoing neurotoxic chemotherapy, and a neurological examination was conducted at the end of treatment to diagnose CIPN in the feet (CIPN-f) or CIPN in the hands (CIPN-h). Various classification models including NeuroDetect features only (NeuroDetect Model) CIPN20-only (CIPN20 Model) or a combination of both (Combined Model) were trained and evaluated for accuracy in predicting CIPN probability. Results: Of the 45 patients who completed functional assessments and neurological examinations, 24 had CIPN-f, and 29 had CIPN-h. The NeuroDetect Model could discriminate between patients with and those without CIPN-f (area under the curve=83.8\%, comparison with no information rate P=.02) but not CIPN-h (area under the curve=67.9\%, P=.18). The rolling rotation features from the eyes-closed phase of the Romberg Stance assessment showed the greatest contribution to CIPN-f (40\% of total variable importance) and the Finger Tapping assessment showed the greatest contribution to CIPN-h (85\% of total variable importance). The NeuroDetect Model had numerically, and at some time points statistically, superior performance to the CIPN20 Model in both CIPN-f and CIPN-h, particularly before and early in treatment. The Combined Model numerically, though not statistically, outperformed either assessment strategy individually, indicating that the combination of functional and patient-reported assessment within a smartphone may be optimal to CIPN detection. Conclusions: Our findings demonstrate the feasibility of integrating subjective and objective CIPN assessment into a smartphone app for remote, longitudinal CIPN monitoring. Studies of larger patient cohorts are needed to refine the app-based CIPN detection models and determine whether their use in practice improves CIPN detection. ",
doi="10.2196/65615",
url="https://www.jmir.org/2025/1/e65615"
}


@Article{info:doi/10.2196/68324,
author="Thakur, Madhur
and Maurer, W. Eric
and Tran, Ngan Kim
and Tholkes, Anthony
and Rajamani, Sripriya
and Dwivedi, Roli",
title="Enhancing Health Equity and Patient Engagement in Diabetes Care: Technology-Aided Continuous Glucose Monitoring Pilot Implementation Project",
journal="JMIR Diabetes",
year="2025",
month="Feb",
day="5",
volume="10",
pages="e68324",
keywords="consumer health informatics",
keywords="patient engagement",
keywords="diabetes mellitus",
keywords="DM",
keywords="glucose monitoring",
keywords="continuous glucose monitoring",
keywords="CGM",
keywords="health equity",
keywords="health information technology",
keywords="patient centered care",
keywords="diabetes",
keywords="pharmacists",
keywords="clinicians",
keywords="nurses",
keywords="device",
keywords="patient monitoring",
keywords="technology-aided",
keywords="health informatics",
doi="10.2196/68324",
url="https://diabetes.jmir.org/2025/1/e68324"
}


@Article{info:doi/10.2196/66666,
author="Rudin, S. Robert
and Herman, M. Patricia
and Vining, Robert",
title="Addressing the ``Black Hole'' of Low Back Pain Care With Clinical Decision Support: User-Centered Design and Initial Usability Study",
journal="JMIR Form Res",
year="2025",
month="Feb",
day="4",
volume="9",
pages="e66666",
keywords="low back pain",
keywords="clinical decision support",
keywords="user-centered design",
keywords="usability",
keywords="back pain",
keywords="low back pain care",
keywords="pain",
keywords="clinical decision",
keywords="societal burden",
keywords="substantial",
keywords="burden",
keywords="evidence-based",
keywords="treatment",
keywords="diagnosis",
keywords="support tool",
keywords="clinicians",
keywords="chiropractic",
keywords="chiropractor",
keywords="reviews",
keywords="scenario-based interviews",
keywords="interviews",
abstract="Background: Low back pain (LBP) is a highly prevalent problem causing substantial personal and societal burden. Although there are specific types of LBP, each with evidence-based treatment recommendations, most patients receive a nonspecific diagnosis that does not facilitate evidence-based and individualized care. Objectives: We designed, developed, and initially tested the usability of a LBP diagnosis and treatment decision support tool based on the available evidence for use by clinicians who treat LBP, with an initial focus on chiropractic care. Methods: Our 3-step user-centered design approach consisted of identifying clinical requirements through the analysis of evidence reviews, iteratively identifying task-based user requirements and developing a working web-based prototype, and evaluating usability through scenario-based interviews and the System Usability Scale. Results: The 5 participating users had an average of 18.5 years of practicing chiropractic medicine. Clinical requirements included 44 patient interview and examination items. Of these, 13 interview items were enabled for all patients and 13 were enabled conditional on other input items. One examination item was enabled for all patients and 16 were enabled conditional on other items. One item was a synthesis of interview and examination items. These items provided evidence of 12 possible working diagnoses of which 3 were macrodiagnoses and 9 were microdiagnoses. Each diagnosis had relevant treatment recommendations and corresponding patient educational materials. User requirements focused on tasks related to inputting data, and reviewing and selecting working diagnoses, treatments, and patient education. User input led to key refinements in the design, such as organizing the input questions by microdiagnosis, adding a patient summary screen that persists during data input and when reviewing output, adding more information buttons and graphics to input questions, and providing traceability by highlighting the input items used by the clinical logic to suggest a working diagnosis. Users believed that it would be important to have the tool accessible from within an electronic health record for adoption within their workflows. The System Usability Scale score for the prototype was 84.75 (range: 67.5?95), considered as the top 10th percentile. Users believed that the tool was easy to use although it would require training and practice on the clinical content to use it effectively. With such training and practice, users believed that it would improve care and shed light on the ``black hole'' of LBP diagnosis and treatment. Conclusions: Our systematic process of defining clinical requirements and eliciting user requirements to inform a clinician-facing decision support tool produced a prototype application that was viewed positively and with enthusiasm by clinical users. With further planned development, this tool has the potential to guide clinical evaluation, inform more specific diagnosis, and encourage patient education and individualized treatment planning for patients with LBP through the application of evidence at the point of care. ",
doi="10.2196/66666",
url="https://formative.jmir.org/2025/1/e66666"
}


@Article{info:doi/10.2196/57379,
author="Kim, Yesol
and Kim, Geonah
and Cho, Hyeonmi
and Kim, Yeonju
and Choi, Mona",
title="Application of Patient-Generated Health Data Among Older Adults With Cancer: Scoping Review",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="4",
volume="27",
pages="e57379",
keywords="patient-generated health data",
keywords="wearable devices",
keywords="patient-reported outcomes",
keywords="patient-centered care",
keywords="older adults",
keywords="cancer",
keywords="scoping review",
abstract="Background: The advancement of information and communication technologies has spurred a growing interest in and increased applications of patient-generated health data (PGHD). In particular, PGHD may be promising for older adults with cancer who have increased survival rates and experience a variety of symptoms. Objective: This scoping review aimed to identify the characteristics of research on PGHD as applied to older adults with cancer and to assess the current use of PGHD. Methods: Guided by Arksey and O'Malley as well as the JBI (Joanna Briggs Institute) methodology for scoping reviews, 6 electronic databases were searched: PubMed, Embase, CINAHL, Cochrane Library, Scopus, and Web of Science. In addition, the reference lists of the selected studies were screened to identify gray literature. The researchers independently screened the literature according to the predefined eligibility criteria. Data from the selected studies were extracted, capturing study, participant, and PGHD characteristics. Results: Of the 1090 identified studies, 88 were selected. The publication trend gradually increased, with a majority of studies published since 2017 (69/88, 78\%). Almost half of the studies were conducted in North America (38/88, 43\%), followed by Europe (30/88, 34\%). The most common setting in which the studies were conducted was the participant's home (69/88, 78\%). The treatment status varied; the median sample size was 50 (IQR 33.8-84.0). The devices that were used to measure the PGHD were classified as research-grade wearable devices (57/113, 50.4\%), consumer-grade wearable devices (28/113, 24.8\%), or smartphones or tablet PCs for mobile apps (23/113, 20.4\%). More than half of the studies measured physical activity (69/123, 56.1\%), followed by patient-reported outcomes (23/123, 18.7\%), vital signs (13/123, 10.6\%), and sleep (12/123, 9.8\%). The PGHD were mainly collected passively (63/88, 72\%), and active collection methods were used from 2015 onward (20/88, 23\%). In this review, the stages of PGHD use were classified as follows: (1) identification, monitoring, review, and analysis (88/88, 100\%); (2) feedback and reporting (32/88, 39\%); (3) motivation (30/88, 34\%); and (4) education and coaching (19/88, 22\%). Conclusions: This scoping review provides a comprehensive summary of the overall characteristics and use stages of PGHD in older adults with various types and stages of cancer. Future research should emphasize the use of PGHD, which interacts with patients to provide patient-centered care through patient engagement. By enhancing symptom monitoring, enabling timely interventions, and promoting patient involvement, PGHD have the potential to improve the well-being of older adults with cancer, contributing to better health management and quality of life. Therefore, our findings may provide valuable insights into PGHD that health care providers and researchers can use for geriatric cancer care. Trial Registration: Open Science Framework Registry OSF.IO/FZRD5; https://doi.org/10.17605/OSF.IO/FZRD5 ",
doi="10.2196/57379",
url="https://www.jmir.org/2025/1/e57379"
}


@Article{info:doi/10.2196/58026,
author="Tacchino, Andrea
and Ponzio, Michela
and Confalonieri, Paolo
and Leocani, Letizia
and Inglese, Matilde
and Centonze, Diego
and Cocco, Eleonora
and Gallo, Paolo
and Paolicelli, Damiano
and Rovaris, Marco
and Sabattini, Loredana
and Tedeschi, Gioacchino
and Prosperini, Luca
and Patti, Francesco
and Sessa, Edoardo
and Pedrazzoli, Elisabetta
and Battaglia, Alberto Mario
and Brichetto, Giampaolo",
title="Effect of an Internet-Based Pilates Telerehabilitation Intervention in People With Multiple Sclerosis: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2025",
month="Feb",
day="3",
volume="14",
pages="e58026",
keywords="exergame",
keywords="MS-FIT",
keywords="Pilates",
keywords="Kinect",
keywords="multiple sclerosis",
keywords="exercise",
keywords="physical activity",
keywords="leisure time physical activity",
keywords="Timed Up and Go",
abstract="Background: Physical activity (PA) has been recommended in multiple sclerosis (MS) to maintain good physical fitness and mental health, reduce the severity of symptoms and risk of relapse, and improve quality of life. Pilates has been suggested as an ideal PA to manage physical, cognitive, and psychological symptoms of MS and a useful method to maintain and improve balance and gait. Objective: This paper presents the protocol for a study that aims to evaluate the efficacy on the physical domain (specifically balance and gait) of a home-based, self-managed PA intervention delivered through the MS-FIT exergame (HELAGLOBE Societ{\`a} a responsabilit{\`a} limitata). In addition, measures of cognitive performance, quality of life, and well-being will be considered. Methods: This is a 2-arm, multicenter, randomized controlled trial with 3 assessment points (baseline, 12 weeks postintervention, and 6 weeks follow-up). People with MS with mild disability, low risk of falling, preserved cognitive functions, and low anxiety and depression are potential eligible participants. The experimental group (MS-FIT) will self-administer the MS-FIT exergame at home in addition to their leisure-time physical activities. MS-FIT is an internet- and Pilates-based tool that uses the Microsoft Kinect Sensor V2. Participants in the control group will only have access to their leisure-time physical activities. Participants in the MS-FIT group will train at home with MS-FIT for 12 weeks and will be required to perform the exercises for a total of 30 minutes/day for at least 3 days/week. The primary outcome is the Timed Up and Go, a test designed to assess walking. We will also administer additional tests for motor function (visual analog scale 0-10, Timed 25-Foot Walk, Ambulation Index, 2-minute walk test, Twelve Item Multiple Sclerosis Walking Scale, Nine-Hole Peg Test), cognition (Brief International Cognitive Assessment for Multiple Sclerosis), fatigue (Modified Fatigue Impact Scale), quality of life (Multiple Sclerosis Quality of Life-54), well-being (Psychological Well-Being Scales), and PA (International Physical Activity Questionnaire and Minnesota Leisure Time Physical Activity Questionnaire). Acceptance and satisfaction with the intervention received (Client Satisfaction Questionnaire and an adapted version of the Tele-healthcare Satisfaction Questionnaire -- Wearable Technology) and subjective impressions of changes in performance (Patients' Global Impression of Change) will also be assessed. Results: Recruitment for the trial started on March 16, 2022, and the first participant was randomized the same day. Data analysis and results are expected to be published in 2025. Conclusions: Pilates has proven beneficial in several neurological diseases such as MS. With this study, we will provide evidence for the use in clinical practice of a digital tool for self-administered Pilates exercises at home as a complement to rehabilitation and for the continuity of care in MS. Trial Registration: ClinicalTrials.gov NCT04011579; https://tinyurl.com/2p9n4d2t International Registered Report Identifier (IRRID): DERR1-10.2196/58026 ",
doi="10.2196/58026",
url="https://www.researchprotocols.org/2025/1/e58026"
}


@Article{info:doi/10.2196/43618,
author="Berentsen, Birgitte
and Thuen, Camilla
and Hillestad, Randulff Eline Margrete
and Steinsvik, Kjelsvik Elisabeth
and Hausken, Trygve
and Hatlebakk, Gunnar Jan",
title="The Effects of Digital eHealth Versus Onsite 2-Day Group-Based Education in 255 Patients With Irritable Bowel Syndrome: Cohort Study",
journal="JMIR Hum Factors",
year="2025",
month="Feb",
day="3",
volume="12",
pages="e43618",
keywords="irritable bowel syndrome",
keywords="IBS",
keywords="eHealth",
keywords="internet-guided",
keywords="patient education",
keywords="self-management",
keywords="self-reported",
keywords="patient behavior",
keywords="quality of life",
keywords="QOL",
keywords="anxiety",
keywords="depression",
keywords="gastrointestinal",
keywords="physiotherapist",
keywords="kinesiology",
keywords="cognitive behavioural therapy",
keywords="CBT",
keywords="Hospital Anxiety and Depression Scale",
keywords="HADS",
keywords="client satisfaction questionnaire",
keywords="CSQ",
keywords="Mann-Whitney U test",
keywords="nonparametric",
keywords="Wilcoxon test",
keywords="neurogastroenterology",
abstract="Background: Irritable bowel syndrome (IBS) has a high worldwide prevalence and there are few effective treatment options. Patient education can influence patient behavior that subsequently may lead to changes in attitudes and skills necessary for maintenance or improvement in management of symptom severity and quality of life. However, as postdiagnostic patient education can be resource demanding, assessment of digital approaches and verification of their effectiveness is warranted. Objective: This cohort study aimed to investigate the effects of a digital web-based multidisciplinary eHealth program on the domains of symptom severity (Irritable Bowel Syndrome Symptom Severity Scale [IBS-SSS]), quality of life (irritable bowel syndrome quality of life [IBS-QOL]), anxiety and depression (Hospital Anxiety and Depression Scale), and a measure of general client satisfaction (client satisfaction questionnaire), compared with an onsite multidisciplinary 2-day group-based education program (``IBS-school''), in 2 cohorts of 255 patients with IBS. Methods: Patients diagnosed with IBS, aged 15-70 years, were enrolled after referral to the Section of Gastroenterology at Haukeland University Hospital, Norway. In total, 132 patients were recruited to the eHealth program and 123 to the IBS-school group for comparison. Data were self-reported and collected digitally at enrollment and after 3 months, between 2017 and 2019. Furthermore, 71 attending the eHealth program and 49 attending the IBS-school completed the questionnaires at 3 months. Intervention response was defined as a reduction of ?50 points on the IBS-SSS. Results: Patients attending the eHealth program reported a significant reduction in IBS symptom severity 3 months after treatment (n=71), compared with patients attending the IBS-school (n=50). Overall, patients categorized as intervention responders in both programs showed a significant reduction in symptom severity at 3 months. Here, 41\% (29/71) of patients attending the eHealth program reported a mean IBS-SSS reduction of 103 (SD 72.0) points (P<.001). In addition, these patients reported reduced anxiety (P>.001) and depression (P=.002) and enhanced quality of life (P=.03), especially the degrees of dysphoria, body image, food avoidance, health worry, interference with activity, relations, and social relations. Patients responding to the IBS-school intervention (18/50, 36\%) reported a mean IBS-SSS reduction of 119 (SD 86.2) points (P<.001), and reduced depression scores (P=.046), but no difference in overall quality of life. Both groups reported the respective interventions as ``good'' quality health care programs, scoring them 23.5 (SD 4)---the eHealth program 23.5 (SD 4), and the IBS-school 24.2 (SD 4)---on the client satisfaction questionnaire. Conclusions: We conclude that the digital multidisciplinary eHealth program has a significant effect on IBS symptom severity in a portion of patients; it is useful as a tool in disease self-management and does not result in worse symptom scores than an onsite multidisciplinary 2-day group-based education program after 3 months. We believe these results indicate that a digital eHealth approach is preferable to an onsite multidisciplinary 2-day group-based education program covering the same topics. ",
doi="10.2196/43618",
url="https://humanfactors.jmir.org/2025/1/e43618"
}


@Article{info:doi/10.2196/54147,
author="Manski-Nankervis, Jo-Anne
and Hunter, Barbara
and Lumsden, Natalie
and Laughlin, Adrian
and McMorrow, Rita
and Boyle, Douglas
and Chondros, Patty
and Jesudason, Shilpanjali
and Radford, Jan
and Prictor, Megan
and Emery, Jon
and Amores, Paul
and Tran-Duy, An
and Nelson, Craig",
title="Effectiveness of Electronic Quality Improvement Activities to Reduce Cardiovascular Disease Risk in People With Chronic Kidney Disease in General Practice: Cluster Randomized Trial With Active Control",
journal="JMIR Form Res",
year="2025",
month="Feb",
day="3",
volume="9",
pages="e54147",
keywords="primary care",
keywords="general practice",
keywords="clinical decision support",
keywords="chronic kidney disease",
keywords="cardiovascular disease",
keywords="cardiovascular",
keywords="clinical decision",
keywords="decision support",
keywords="support",
keywords="kidney",
keywords="kidney disease",
keywords="electronic medical record",
keywords="risk",
keywords="risk reduction",
keywords="pharmacological",
keywords="pharmacological therapy",
keywords="medical records",
keywords="logistic model",
abstract="Background: Future Health Today (FHT) is a program integrated with electronic medical record (EMR) systems in general practice and comprises (1) a practice dashboard to identify people at risk of, or with, chronic disease who may benefit from intervention; (2) active clinical decision support (CDS) at the point of care; and (3) quality improvement activities. One module within FHT aims to facilitate cardiovascular disease (CVD) risk reduction in people with chronic kidney disease (CKD) through the recommendation of angiotensin-converting enzyme inhibitor inhibitors (ACEI), angiotensin receptor blockers (ARB), or statins according to Australian guidelines (defined as appropriate pharmacological therapy). Objective: This study aimed to determine if the FHT program increases the proportion of general practice patients with CKD receiving appropriate pharmacological therapy (statins alone, ACEI or ARB alone, or both) to reduce CVD risk at 12 months postrandomization compared with active control (primary outcome). Methods: General practices recruited through practice-based research networks in Victoria and Tasmania were randomly allocated 1:1 to the FHT CKD module or active control. The intervention was delivered to practices between October 4, 2021, and September 30, 2022. Data extracted from EMRs for eligible patients identified at baseline were used to evaluate the trial outcomes at the completion of the intervention period. The primary analysis used an intention-to-treat approach. The intervention effect for the primary outcome was estimated with a marginal logistic model using generalized estimating equations with robust SE. Results: Overall, of the 734 eligible patients from 19 intervention practices and 715 from 21 control practices, 82 (11.2\%) and 70 (9.8\%), respectively, had received appropriate pharmacological therapy (statins alone, ACEI or ARB alone, or both) at 12 months postintervention to reduce CVD risk, with an estimated between-trial group difference (Diff) of 2.0\% (95\% CI --1.6\% to 5.7\%) and odds ratio of 1.24 (95\% CI 0.85 to 1.81; P=.26). Of the 470 intervention patients and 425 control patients that received a recommendation for statins, 61 (13\%) and 38 (9\%) were prescribed statins at follow-up (Diff 4.3\%, 95\% CI 0 to 8.6\%; odds ratio 1.55, 95\% CI 1.02 to 2.35; P=.04). There was no statistical evidence to support between-group differences in other secondary outcomes and general practice health care use. Conclusions: FHT harnesses the data stored within EMRs to translate guidelines into practice through quality improvement activities and active clinical decision support. In this instance, it did not result in a difference in prescribing or clinical outcomes except for small changes in statin prescribing. This may relate to COVID-19--related disruptions, technical implementation challenges, and recruiting higher performing practices to the trial. A separate process evaluation will further explore factors impacting implementation and engagement with FHT. Trial Registration: ACTRN12620000993998; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380119 ",
doi="10.2196/54147",
url="https://formative.jmir.org/2025/1/e54147"
}


@Article{info:doi/10.2196/67929,
author="Sugawara, Yuka
and Hirakawa, Yosuke
and Iwagami, Masao
and Inokuchi, Ryota
and Wakimizu, Rie
and Nangaku, Masaomi",
title="Metrics for Evaluating Telemedicine in Randomized Controlled Trials: Scoping Review",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="31",
volume="27",
pages="e67929",
keywords="patient experience",
keywords="patient-reported outcome",
keywords="quality of life",
keywords="quality-adjusted life year",
keywords="telehealth",
keywords="eHealth",
keywords="mobile phone",
keywords="metrics",
keywords="telemedicine",
keywords="systematic review",
keywords="scoping review",
keywords="review",
keywords="telecommunications",
keywords="database",
keywords="health care",
keywords="patient-centeredness",
keywords="patient satisfaction",
keywords="patient outcome",
keywords="clinical parameter",
keywords="cost-effectiveness",
keywords="evaluation metrics",
keywords="mHealth",
keywords="mobile health",
abstract="Background: Telemedicine involves medical, diagnostic, and treatment-related services using telecommunication technology. Not only does telemedicine contribute to improved patient quality of life and satisfaction by reducing travel time and allowing patients to be seen in their usual environment, but it also has the potential to improve disease management by making it easier for patients to see a doctor. Recently, owing to IT developments, research on telemedicine has been increasing; however, its usefulness and limitations in randomized controlled trials remain unclear because of the multifaceted effects of telemedicine. Furthermore, the specific metrics that can be used as cross-disciplinary indicators when comparing telemedicine and face-to-face care also remain undefined. Objective: This review aimed to provide an overview of the general and cross-disciplinarity metrics used to compare telemedicine with in-person care in randomized controlled trials. In addition, we identified previously unevaluated indicators and suggested those that should be prioritized in future clinical trials. Methods: MEDLINE and Embase databases were searched for publications that met the inclusion criteria according to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews). Original, English-language articles on randomized controlled trials comparing some forms of telemedicine with face-to-face care from January 2019 to March 2024 were included, and the basic information and general metrics used in these studies were summarized. Results: Of the 2275 articles initially identified, 79 were included in the final analysis. The commonly used metrics that can be used across medical specialties were divided into the following 3 categories: (1) patient-centeredness (67/79, 85\%), including patient satisfaction, workload, and quality of life; (2) patient outcomes (57/79, 72\%), including general clinical parameters such as death, admission, and adverse events; and (3) cost-effectiveness (40/79, 51\%), including cost assessment and quality-adjusted life year. Notably, only 25 (32\%) of 79 studies evaluated all the 3 categories. Other metrics, such as staff convenience, system usability, and environmental impact, were extracted as indicators in different directions from the three categories above, although few previous reports have evaluated them (staff convenience: 8/79, 10\%; system usability: 3/79, 4\%; and environmental impact: 2/79, 3\%). Conclusions: A significant variation was observed in the metrics used across previous studies. Notably, general indicators should be used to enhance the understandability of the results for people in other areas, even if disease-specific indicators are used. In addition, indicators should be established to include all three commonly used categories of measures to ensure a comprehensive evaluation: patient-centeredness, patient outcomes, and cost-effectiveness. Staff convenience, system usability, and environmental impact are important indicators that should be used in future trials. Moreover, standardization of the evaluation metrics is desired for future clinical trials and studies. Trial Registration: Open Science Forum Registries YH5S7; https://doi.org/10.17605/OSF.IO/YH5S7 ",
doi="10.2196/67929",
url="https://www.jmir.org/2025/1/e67929"
}


@Article{info:doi/10.2196/58938,
author="Fraterman, Itske
and Sacchi, Lucia
and Mallo, Henk
and Tibollo, Valentina
and Glaser, Catherina Savannah Lucia
and Medlock, Stephanie
and Cornet, Ronald
and Gabetta, Matteo
and Hisko, Vitali
and Khadakou, Vadzim
and Barkan, Ella
and Del Campo, Laura
and Glasspool, David
and Kogan, Alexandra
and Lanzola, Giordano
and Leizer, Roy
and Ottaviano, Manuel
and Peleg, Mor
and ?niata?a, Konrad
and Lisowska, Aneta
and Wilk, Szymon
and Parimbelli, Enea
and Quaglini, Silvana
and Rizzo, Mimma
and Locati, Deborah Laura
and Boekhout, Annelies
and van de Poll-Franse, V. Lonneke
and Wilgenhof, Sofie",
title="Exploring the Impact of the Multimodal CAPABLE eHealth Intervention on Health-Related Quality of Life in Patients With Melanoma Undergoing Immune-Checkpoint Inhibition: Prospective Pilot Study",
journal="JMIR Cancer",
year="2025",
month="Jan",
day="30",
volume="11",
pages="e58938",
keywords="eHealth",
keywords="melanoma",
keywords="cancer",
keywords="fatigue",
keywords="quality of life",
keywords="intervention",
keywords="pilot study",
keywords="exploratory",
keywords="health-related",
keywords="interventions",
keywords="symptom",
keywords="monitoring",
keywords="well-being",
keywords="immunotherapy",
keywords="immune-related",
keywords="immune-checkpoint inhibitor",
keywords="patient",
keywords="feasibility",
keywords="smartphone",
keywords="app",
keywords="smartwatch",
keywords="linear regression model",
keywords="mobile phone",
abstract="Background: Patients with melanoma receiving immunotherapy with immune-checkpoint inhibitors often experience immune-related adverse events, cancer-related fatigue, and emotional distress, affecting health-related quality of life (HRQoL) and clinical outcome to immunotherapy. eHealth tools can aid patients with cancer in addressing issues, such as adverse events and psychosocial well-being, from various perspectives. Objective: This study aimed to explore the effect of the Cancer Patients Better Life Experience (CAPABLE) system, accessed through a mobile app, on HRQoL compared with a matched historical control group receiving standard care. CAPABLE is an extensively tested eHealth app, including educational material, remote symptom monitoring, and well-being interventions. Methods: This prospective pilot study compared an exploratory cohort that received the CAPABLE smartphone app and a multisensory smartwatch for 6 months (intervention) to a 2:1 individually matched historical prospective control group. HRQoL data were measured with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 at baseline (T0), 3 months (T1), and 6 months (T2) after start of treatment. Mixed effects linear regression models were used to compare HRQoL between the 2 groups over time. Results: From the 59 eligible patients for the CAPABLE intervention, 31 (53\%) signed informed consent to participate. Baseline HRQoL was on average 10 points higher in the intervention group compared with controls, although equally matched on baseline and clinical characteristics. When correcting for sex, age, disease stage, and baseline scores, an adjusted difference in fatigue of ?5.09 (95\% CI ?15.20 to 5.02, P=.32) at month 3 was found. No significant nor clinically relevant adjusted differences on other HRQoL domains over time were found. However, information satisfaction was significantly higher in the CAPABLE group ($\beta$=8.71, 95\% CI 1.54?15.88, P=.02). Conclusions: The intervention showed a limited effect on HRQoL, although there was a small improvement in fatigue at 3 months, as well as information satisfaction. When aiming at personalized patient and survivorship care, further optimization and prospective investigation of eHealth tools is warranted. Trial Registration: ClinicalTrials NCT05827289; https://clinicaltrials.gov/study/NCT05827289 International Registered Report Identifier (IRRID): RR2-10.2196/49252 ",
doi="10.2196/58938",
url="https://cancer.jmir.org/2025/1/e58938"
}


@Article{info:doi/10.2196/63975,
author="Wang, Yachen
and Chai, Xin
and Wang, Yueqing
and Yin, Xuejun
and Huang, Xinying
and Gong, Qiuhong
and Zhang, Juan
and Shao, Ruitai
and Li, Guangwei",
title="Effectiveness of Different Intervention Modes in Lifestyle Intervention for the Prevention of Type 2 Diabetes and the Reversion to Normoglycemia in Adults With Prediabetes: Systematic Review and Meta-Analysis of Randomized Controlled Trials",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="29",
volume="27",
pages="e63975",
keywords="mobile phone",
keywords="prediabetic state",
keywords="digital health intervention",
keywords="intervention mode",
keywords="lifestyle intervention",
keywords="type 2 diabetes mellitus",
keywords="meta-analysis",
keywords="systematic review",
keywords="review",
abstract="Background: Lifestyle interventions have been acknowledged as effective strategies for preventing type 2 diabetes mellitus (T2DM). However, the accessibility of conventional face-to-face interventions is often limited. Digital health intervention has been suggested as a potential solution to overcome the limitation. Despite this, there remains a significant gap in understanding the effectiveness of digital health for individuals with prediabetes, particularly in reducing T2DM incidence and reverting to normoglycemia. Objective: This study aimed to assess the effectiveness of different intervention modes of digital health, face-to-face, and blended interventions, particularly the benefits of digital health intervention, in reducing T2DM incidence and facilitating the reversion to normoglycemia in adults with prediabetes compared to the usual care. Methods: We conducted a comprehensive search in 9 electronic databases, namely MEDLINE, Embase, ACP Journal Club, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Clinical Answers, Cochrane Methodology Register, Health Technology Assessment, and NHS Economic Evaluation Database through Ovid, from the inception to October 2024. This review included randomized controlled trials (RCTs) that studied the effectiveness of lifestyle interventions in adults with prediabetes. The overall intervention effect was synthesized using a random-effects model. The I{\texttwosuperior} statistic was used to assess heterogeneity across the RCTs. We performed a subgroup analysis to explore the effectiveness of digital health, face-to-face, and blended interventions compared with the control group, which received usual care. Results: From an initial 7868 records retrieved from 9 databases, we identified 54 articles from 31 RCTs. Our analysis showed that face-to-face interventions demonstrated a significant 46\% risk reduction in T2DM incidence (risk ratio [RR] 0.54, 95\% CI 0.47-0.63; I{\texttwosuperior}=43\%; P<.001), and a 46\% increase in the reversion to normoglycemia (RR 1.46, 95\% CI 1.11-1.91; I{\texttwosuperior}=82\%; P=.006), when compared with the control group. On the other hand, digital health interventions, compared with the control group, were associated with a 12\% risk reduction in T2DM incidence (RR 0.88, 95\% CI 0.77-1.01; I{\texttwosuperior}=0.6\%; P=.06). Moreover, the blended interventions combining digital and face-to-face interventions suggested a 37\% risk reduction in T2DM incidence (RR 0.63, 95\% CI 0.49-0.81;I{\texttwosuperior}<0.01\%; P<.001) and an 87\% increase in the reversion to normoglycemia (RR 1.87, 95\% CI 1.30-2.69; I{\texttwosuperior}=23\%; P=.001). However, no significant effect on the reversal of prediabetes to normoglycemia was observed from the digital health interventions. Conclusions: Face-to-face interventions have consistently demonstrated promising effectiveness in both reductions in T2DM incidence and reversion to normoglycemia in adults with prediabetes. However, the effectiveness of digital health interventions in these areas has not been sufficiently proven. Given these results, further research is required to provide more definitive evidence of digital health and blended interventions in T2DM prevention in the future. Trial Registration: PROSPERO CRD42023414313; https://tinyurl.com/55ac4j4n ",
doi="10.2196/63975",
url="https://www.jmir.org/2025/1/e63975"
}


@Article{info:doi/10.2196/63597,
author="Thiessen, Maclean
and Jewitt, Kellie
and Stromberg, Raina
and Lamontagne, Marie Janelle
and Richardson Tanguay, Genevieve
and Albo, Annette
and Thurston, Chantale
and McMillan, E. Diana",
title="Constructing TheKeep.Ca With Thrivers of Cancer in Manitoba, Canada, in Support of Enhancing Patient Engagement: Protocol for a Pragmatic Multimethods Study",
journal="JMIR Res Protoc",
year="2025",
month="Jan",
day="29",
volume="14",
pages="e63597",
keywords="patient engagement",
keywords="patient empowerment",
keywords="translational research",
keywords="patient recruitment",
keywords="development and research",
keywords="protocol",
keywords="Manitoba",
keywords="Canada",
keywords="cancer",
keywords="patient advisor",
keywords="website",
keywords="research platform",
keywords="thematic analysis",
keywords="semi-structured interview",
keywords="online infrastructure",
abstract="Background: TheKeep.Ca was built to facilitate engagement with those experiencing cancer in Manitoba, Canada. Constructed between 2020 and 2024 with a group of patient advisors, the website includes information on engagement activities including research participation, the patient advisor role, and how those experiencing cancer can access these Manitoba activities. A link allows visitors to register to be contacted about activities that match their demographics, cancer history, and activity preferences. After TheKeep.Ca was constructed, this protocol was developed to establish TheKeep.Ca as a platform for scientific research focused on optimally engaging those experiencing cancer. Objective: We asked the following questions: (1) What was the patient advisors' experience who participated in developing TheKeep.Ca? (2) What are the baseline characteristics of website traffic and registrants at TheKeep.Ca? (3) How does registering with TheKeep.Ca impact the cancer experience? Methods: The planned launch date for the website and initiation of research activities is January 2025. For objective 1, the active patient advisors (N=6) participating in the website project will be invited to participate in project activities including with responses to a question prompt sheet, semistructured audio-recorded interviews, or both. Responses and interviews will be analyzed using reflexive thematic analysis to understand and inform practices for patient engagement on projects. At the website launch, TheKeep.Ca will become publicly accessible and indexable on internet search engines, but no additional promotional interventions will take place in the initial 6 months resulting in visitors primarily from web search traffic. For objective 2, Google Analytics and website registrant data collected during the first six months will be analyzed to obtain baseline characteristics of website visitors. For objective 3, an online survey will be emailed to registrants six months after the website launch characterizing their website experience, the activities they participated in, and collecting feedback on the website. For objectives 2 and 3, quantitative data will be analyzed using both descriptive and inferential statistics, and qualitative data from open-ended questions will be analyzed using thematic analysis guided by an inductive descriptive semantic approach. Results: This study was approved by the University of Manitoba Health Research Ethics Board on December 12, 2024 (HS26614-H2024L263). Institutional approval from CancerCare Manitoba is pending as of December 23, 2024. Findings from objective 1 are expected to be finalized within the first six months after the website launch. Those from objectives 2 and 3 are expected by the 12-month mark. Reporting will include peer-reviewed journals, conferences, and a lay-language summary on TheKeep.Ca. Conclusions: The research outlined in this protocol will facilitate understanding patient advisors' experience in developing TheKeep.Ca. It will also characterize the website' effectiveness and its impact on the cancer experience, providing a baseline and direction for future research and development. International Registered Report Identifier (IRRID): PRR1-10.2196/63597 ",
doi="10.2196/63597",
url="https://www.researchprotocols.org/2025/1/e63597"
}


@Article{info:doi/10.2196/57540,
author="Del Moral Trinidad, Eduardo Luis
and Andrade Villanueva, Federico Jaime
and Mart{\'i}nez Ayala, Pedro
and Cabrera Silva, Ismael Rodolfo
and Herrera Godina, Guadalupe Melva
and Gonz{\'a}lez-Hern{\'a}ndez, Alicia Luz",
title="Effectiveness of an mHealth Intervention With Short Text Messages to Promote Treatment Adherence Among HIV-Positive Mexican Adults: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Jan",
day="28",
volume="13",
pages="e57540",
keywords="HIV",
keywords="treatment adherence",
keywords="mobile health",
keywords="mHealth",
keywords="mHealth intervention",
keywords="randomized clinical trial",
keywords="text messages",
keywords="eHealth intervention",
keywords="sexual health",
keywords="randomized controlled trial",
keywords="RCT",
abstract="Background: HIV continues to be a public health concern in Mexico and Latin America due to an increase in new infections, despite a decrease being observed globally. Treatment adherence is a pillar for achieving viral suppression. It prevents the spread of the disease at a community level and improves the quality and survival of people living with HIV. Thus, it is important to implement strategies to achieve sustained treatment adherence. Objective: The objective of this study is to evaluate the effectiveness of a mobile health (mHealth) intervention based on SMS text messages to increase antiretroviral therapy (ART) adherence for HIV-positive adults. Methods: A randomized controlled trial was performed at the Hospital Civil de Guadalajara -- Fray Antonio Alcalde on HIV-positive adults who had initiated ART. The mHealth intervention included the use of SMS text messages as a reminder system for upcoming medical examinations and ART resupply to increase adherence. This intervention was provided to 40 participants for a 6-month period. A control group (n=40) received medical attention by the standard protocol used in the hospital. Intervention effectiveness was assessed by quantifying CD4+ T cells and viral load, as well as a self-report of adherence by the patient. Results: The intervention group had greater adherence to ART than the control group (96\% vs 92\%; P<.001). In addition, the intervention group had better clinical characteristics, including a lower viral load (141 copies/mL vs 2413 copies/mL; P<.001) and a trend toward higher CD4+ T cells counts (399 cells/$\mu$L vs 290 cells/$\mu$L; P=.15). Conclusions: These results show that an mHealth intervention significantly improves ART adherence. Implementing mHealth programs could enhance the commitment of HIV-positive adults to their treatment. Trial Registration: ClinicalTrials.gov NCT05187741; https://clinicaltrials.gov/study/NCT05187741 ",
doi="10.2196/57540",
url="https://mhealth.jmir.org/2025/1/e57540"
}


@Article{info:doi/10.2196/66694,
author="Li, Ming-wei
and Tsai, Yao-Chou
and Yang, Shei-Dei Stephen
and Pong, Yuan-Hung
and Tsai, Yu-Ting
and Tsai, Fang-Sheng Vincent",
title="The Evolution of Uroflowmetry and Bladder Diary and the Emerging Trend of Using Home Devices From Hospital to Home",
journal="Interact J Med Res",
year="2025",
month="Jan",
day="28",
volume="14",
pages="e66694",
keywords="lower urinary tract symptoms",
keywords="uroflowmetry",
keywords="bladder diary",
keywords="home devices",
keywords="bladder",
keywords="noninvasive",
keywords="evaluations",
keywords="viewpoint",
keywords="diagnostic",
keywords="mobile health",
doi="10.2196/66694",
url="https://www.i-jmr.org/2025/1/e66694"
}


@Article{info:doi/10.2196/67969,
author="Subramanian, Ajan
and Cao, Rui
and Naeini, Kasaeyan Emad
and Aqajari, Hossein Seyed Amir
and Hughes, D. Thomas
and Calderon, Michael-David
and Zheng, Kai
and Dutt, Nikil
and Liljeberg, Pasi
and Salanter{\"a}, Sanna
and Nelson, M. Ariana
and Rahmani, M. Amir",
title="Multimodal Pain Recognition in Postoperative Patients: Machine Learning Approach",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="27",
volume="9",
pages="e67969",
keywords="pain intensity recognition",
keywords="multimodal information fusion",
keywords="signal processing",
keywords="weak supervision",
keywords="health care",
keywords="pain intensity",
keywords="pain recognition",
keywords="machine learning approach",
keywords="acute pain",
keywords="pain assessment",
keywords="behavioral pain",
keywords="pain measurement",
keywords="pain monitoring",
keywords="multimodal machine learning--based framework",
keywords="machine learning--based framework",
keywords="electrocardiogram",
keywords="electromyogram",
keywords="electrodermal activity",
keywords="self-reported pain level",
keywords="clinical pain management",
abstract="Background: Acute pain management is critical in postoperative care, especially in vulnerable patient populations that may be unable to self-report pain levels effectively. Current methods of pain assessment often rely on subjective patient reports or behavioral pain observation tools, which can lead to inconsistencies in pain management. Multimodal pain assessment, integrating physiological and behavioral data, presents an opportunity to create more objective and accurate pain measurement systems. However, most previous work has focused on healthy subjects in controlled environments, with limited attention to real-world postoperative pain scenarios. This gap necessitates the development of robust, multimodal approaches capable of addressing the unique challenges associated with assessing pain in clinical settings, where factors like motion artifacts, imbalanced label distribution, and sparse data further complicate pain monitoring. Objective: This study aimed to develop and evaluate a multimodal machine learning--based framework for the objective assessment of pain in postoperative patients in real clinical settings using biosignals such as electrocardiogram, electromyogram, electrodermal activity, and respiration rate (RR) signals. Methods: The iHurt study was conducted on 25 postoperative patients at the University of California, Irvine Medical Center. The study captured multimodal biosignals during light physical activities, with concurrent self-reported pain levels using the Numerical Rating Scale. Data preprocessing involved noise filtering, feature extraction, and combining handcrafted and automatic features through convolutional and long-short-term memory autoencoders. Machine learning classifiers, including support vector machine, random forest, adaptive boosting, and k-nearest neighbors, were trained using weak supervision and minority oversampling to handle sparse and imbalanced pain labels. Pain levels were categorized into baseline and 3 levels of pain intensity (1-3). Results: The multimodal pain recognition models achieved an average balanced accuracy of over 80\% across the different pain levels. RR models consistently outperformed other single modalities, particularly for lower pain intensities, while facial muscle activity (electromyogram) was most effective for distinguishing higher pain intensities. Although single-modality models, especially RR, generally provided higher performance compared to multimodal approaches, our multimodal framework still delivered results that surpassed most previous works in terms of overall accuracy. Conclusions: This study presents a novel, multimodal machine learning framework for objective pain recognition in postoperative patients. The results highlight the potential of integrating multiple biosignal modalities for more accurate pain assessment, with particular value in real-world clinical settings. ",
doi="10.2196/67969",
url="https://formative.jmir.org/2025/1/e67969"
}


@Article{info:doi/10.2196/54324,
author="Bodner, Emma
and Roth, Lena
and Wiencke, Kathleen
and Bischoff, Christian
and Schwarz, EH Peter",
title="Effect of Multimodal App-Based Interventions on Glycemic Control in Patients With Type 2 Diabetes: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="24",
volume="27",
pages="e54324",
keywords="app-based interventions",
keywords="diabetes mellitus type 2",
keywords="digital health",
keywords="real world evidence",
keywords="pragmatic trials",
keywords="ehealth",
keywords="mhealth",
keywords="HbA1c",
keywords="systematic review",
keywords="meta-analysis",
keywords="interventions",
keywords="app",
keywords="glycemic",
keywords="patients",
keywords="type 2 diabetes",
abstract="Background: Digital technologies for type 2 diabetes mellitus (T2DM) care hold great potential to improve patients' health in the long term. Only a subset of telemedicine offerings are digital interventions that meet the criteria for prescribable digitale Gesundheitsanwendung (digital health apps; DiGAs) in Germany. Digital treatments further provide vast amounts of patient data that are important to generate evidence. Objective: This systematic review aims to analyze the efficacy of multimodal digital therapies that mainly meet the DiGA criteria for patients with T2DM and to elicit the potential of such therapies. This includes evidence from randomized controlled trials (RCTs) as well as from real-world data. The outcome of interest was a reduction in glycated hemoglobin (hemoglobin A1c [HbA1c]; long-term blood glucose measurements). Methods: A systematic literature search was conducted in the literature bases PubMed, LIVIVO, and Cochrane, based on the predefined PICO (Population; Intervention; Control; Outcome) scheme. Identified studies were assessed for risk of bias, pragmatism, and overall quality of evidence. Meta-analyses were conducted for between group differences using RCTs only, and for within-group differences using RCTs and non-RCTs, to examine the effect of the interventions on HbA1c. Results: In total, 795 records were identified, of which 24 were eligible for this systematic review and 23 studies were eligible for the meta-analysis. The results of the meta-analyses showed significant and clinically relevant reductions in HbA1c in patients with T2DM. Regarding the between-group difference for HbA1c reduction, the pooled effect of the RCTs showed a reduction of --0.36\% (95\% CI --0.59\% to --0.14\%; P<.001), favoring app-based interventions. The average mean within-group reduction in HbA1c was --0.79 (95\% CI --1.02 to --0.55), with no significant difference between RCTs (--0.69, 95\% CI --1.13 to --0.24) and non-RCTs (--0.87, 95\% CI --1.16 to --0.57; P<.01, differences between RCTs and RCTs P=.44). A pragmatism rating showed that both study types were on average (very) pragmatic, that is, close to usual care. However, the overall quality of evidence was low to very low. Conclusions: This systematic review shows that digital therapies that mainly meet the DiGA criteria can effectively improve HbA1c in patients with T2DM. The integration of digital health care into usual care holds great potential and should be considered as a complementary option to usual care in the future. Trial Registration: PROSPERO CRD42023440203; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=440203 ",
doi="10.2196/54324",
url="https://www.jmir.org/2025/1/e54324"
}


@Article{info:doi/10.2196/57659,
author="Glaser, Caterina Savannah Lucia
and Fraterman, Itske
and van Brummelen, Noah
and Tibollo, Valentina
and Del Campo, Maria Laura
and Mallo, Henk
and Wilgenhof, Sofie
and Wilk, Szymon
and Gisko, Vitali
and Khadakou, Vadzim
and Cornet, Ronald
and Ottaviano, Manuel
and Medlock, Stephanie",
title="Usability and Usefulness of a Symptom Management Coaching System for Patients With Cancer Treated With Immune Checkpoint Inhibitors: Comparative Mixed Methods Study",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="23",
volume="9",
pages="e57659",
keywords="oncology",
keywords="usability",
keywords="usefulness",
keywords="symptom management",
keywords="coaching system",
keywords="patients with cancer",
keywords="immune checkpoint inhibitors",
keywords="comparative qualitative study",
keywords="medication",
keywords="eHealth applications",
keywords="caregivers",
keywords="cancer treatment",
keywords="patient education",
keywords="well-being interventions",
keywords="acceptability",
keywords="melanoma",
keywords="renal cell carcinoma",
keywords="immunotherapy",
abstract="Background: The prognosis for patients with several types of cancer has substantially improved following the introduction of immune checkpoint inhibitors, a novel type of immunotherapy. However, patients may experience symptoms both from the cancer itself and from the medication. A prototype of the eHealth tool Cancer Patients Better Life Experience (CAPABLE) was developed to facilitate symptom management, aimed at patients with melanoma and renal cell carcinoma treated with immunotherapy. Better usability of such eHealth tools can lead to improved user well-being and reduced risk of harm. It is unknown for usability evaluations whether certain usability problems would only be evident to patients whose condition closely resembles the target population, or if a broader group of patients would lead to the identification of a broader range of potential usability issues. Objective: This study aims to evaluate the CAPABLE prototype by conducting tests to assess usability, user experience, and perceived acceptability among end users, and to assess any agreements or differences in the results of our wide range of participants. Methods: This usability study was executed by interviewing participants with a melanoma or renal cell carcinoma diagnosis who have received immunotherapy and participants without direct experience with the targeted cancer types who have not received immunotherapy. Participants were asked to review the concept of the tool, perform think-aloud tasks, and complete the System Usability Scale and a Perceived Usefulness questionnaire. Usability problems were extracted from the interview data by independent coding and mapped to an eHealth Usability Problem Framework. Results: We included 21 participants in the study, aged 29 to 73 years; 13 participants who had received immunotherapy and 8 participants who had not received immunotherapy. In total, 76 usability problems were identified. A total of 22 usability problems were in the task-technology fit category of the usability framework, mostly regarding the coaching and symptom functionality of the prototype. Critical problems regarding the symptom monitoring functionality were mainly found by participants who had received immunotherapy. For 8 out of 10 statements in the Perceived Usefulness questionnaire, more than 75\% of participants agreed or strongly agreed. The overall mean System Usability Scale score was 80 out of 100 (SD 11.3). Conclusions: Despite identified usability issues, participants responded positively to the Perceived Usefulness questionnaire regarding the evaluated tool. Further analysis of the usability problems indicates that it was essential to include participants who matched the target end users. Participants treated with immunotherapy, specifically with previous experience in immune-related adverse events, encountered critical problems with symptom reporting that would not have been identified if these participants were not included. For other tasks and functionalities, it seems likely that loosening the inclusion criteria would have resulted in sufficient feedback without critical missing usability issues. ",
doi="10.2196/57659",
url="https://formative.jmir.org/2025/1/e57659"
}


@Article{info:doi/10.2196/60238,
author="Gong, Ke
and Chen, Yifan
and Song, Xinyue
and Fu, Zhizhong
and Ding, Xiaorong",
title="Causal Inference for Hypertension Prediction With Wearable Electrocardiogram and Photoplethysmogram Signals: Feasibility Study",
journal="JMIR Cardio",
year="2025",
month="Jan",
day="23",
volume="9",
pages="e60238",
keywords="hypertension",
keywords="causal inference",
keywords="wearable physiological signals",
keywords="electrocardiogram",
keywords="photoplethysmogram",
abstract="Background: Hypertension is a leading cause of cardiovascular disease and premature death worldwide, and it puts a heavy burden on the health care system. Therefore, it is very important to detect and evaluate hypertension and related cardiovascular events to enable early prevention, detection, and management. Hypertension can be detected in a timely manner with cardiac signals, such as through an electrocardiogram (ECG) and photoplethysmogram (PPG), which can be observed via wearable sensors. Most previous studies predicted hypertension from ECG and PPG signals with extracted features that are correlated with hypertension. However, correlation is sometimes unreliable and may be affected by confounding factors. Objective: The aim of this study was to investigate the feasibility of predicting the risk of hypertension by exploring features that are causally related to hypertension via causal inference methods. Additionally, we paid special attention to and verified the reliability and effectiveness of causality compared to correlation. Methods: We used a large public dataset from the Aurora Project, which was conducted by Microsoft Research. The dataset included diverse individuals who were balanced in terms of gender, age, and the condition of hypertension, with their ECG and PPG signals simultaneously acquired with wrist-worn wearable devices. We first extracted 205 features from the ECG and PPG signals, calculated 6 statistical metrics for these 205 features, and selected some valuable features out of the 205 features under each statistical metric. Then, 6 causal graphs of the selected features for each kind of statistical metric and hypertension were constructed with the equivalent greedy search algorithm. We further fused the 6 causal graphs into 1 causal graph and identified features that were causally related to hypertension from the causal graph. Finally, we used these features to detect hypertension via machine learning algorithms. Results: We validated the proposed method on 405 subjects. We identified 24 causal features that were associated with hypertension. The causal features could detect hypertension with an accuracy of 89\%, precision of 92\%, and recall of 82\%, which outperformed detection with correlation features (accuracy of 85\%, precision of 88\%, and recall of 77\%). Conclusions: The results indicated that the causal inference--based approach can potentially clarify the mechanism of hypertension detection with noninvasive signals and effectively detect hypertension. It also revealed that causality can be more reliable and effective than correlation for hypertension detection and other application scenarios. ",
doi="10.2196/60238",
url="https://cardio.jmir.org/2025/1/e60238"
}


@Article{info:doi/10.2196/50014,
author="Delvall{\'e}e, Marion
and Guerraoui, Abdallah
and Tchetgnia, Lucas
and Grangier, Jean-Pierre
and Amamra, Nassira
and Camarroque, Anne-Laure
and Haesebaert, Julie
and Caillette-Beaudoin, Agn{\`e}s",
title="Barriers and Facilitators in Implementing a Telemonitoring Application for Patients With Chronic Kidney Disease and Health Professionals: Ancillary Implementation Study of the NeLLY (New Health e-Link in the Lyon Region) Stepped-Wedge Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Jan",
day="22",
volume="13",
pages="e50014",
keywords="telehealth",
keywords="telemonitoring",
keywords="chronic kidney disease",
keywords="implementation",
keywords="Consolidated Framework for Implementation Research",
keywords="Technology Acceptance Model",
abstract="Background: The use of telemonitoring to manage renal function in patients with chronic kidney disease (CKD) is recommended by health authorities. However, despite these recommendations, the adoption of telemonitoring by both health care professionals and patients faces numerous challenges. Objective: This study aims to identify barriers and facilitators in the implementation of a telemonitoring program for patients with CKD, as perceived by health care professionals and patients, and to explore factors associated with the adoption of the program. This study serves as a process evaluation conducted alongside the cost-effectiveness NeLLY (New Health e-Link in the Lyon Region) trial. Methods: A mixed methods approach combining a quantitative questionnaire and semistructured interviews was conducted among nurses, nephrologists, and patients with stages 3 and 4 CKD across 10 renal care centers in France that have implemented telemonitoring. The Technology Acceptance Model (TAM) and the Consolidated Framework for Implementation Research (CFIR) were used to design the questionnaires and interview guides. The dimensions investigated included ease of use, perceived usefulness, and intention to use (TAM), as well as characteristics of the intervention, local and general context, individual factors, and processes (CFIR). The adoption of telemonitoring was assessed based on the frequency with which patients connected to the telemonitoring device. Determinants of telemonitoring use were analyzed using nonparametric tests, specifically the Wilcoxon-Mann-Whitney and Kruskal-Wallis tests. Thematic analysis was conducted on the transcriptions of semistructured interviews. Both quantitative and qualitative results, including data from patients and professionals, were integrated to provide a comprehensive understanding of the factors associated with the use of remote monitoring in CKD. Results: A total of 42 professionals and 128 patients with CKD responded to our questionnaire. Among these, 11 professionals and 13 patients participated in interviews. Nurses, who were responsible for patient follow-up, regularly used telemonitoring (8/13, 62\%, at least once a month), while nephrologists, who were responsible for prescribing it, were primarily occasional users (5/8, 63\%, using it less than once a month). Among professionals, the main obstacles identified were the heavy workload generated by telemonitoring, lack of training, and insufficient support for nurses. Among the 128 patients, 46 (35.9\%) reported using the application at least once a week. The main barriers for patients were issues related to computer use, as well as the lack of feedback and communication with health care professionals. The main facilitators identified by both professionals and patients for using telemonitoring were the empowerment of patients in managing their health and the reduction of the burden associated with CKD. Conclusions: Improving adherence to telemonitoring in the context of CKD requires collaborative efforts from both professionals and patients. Our results provide insights that can inform the design of effective, theory-driven interventions aimed at improving telemonitoring adoption and usage. ",
doi="10.2196/50014",
url="https://mhealth.jmir.org/2025/1/e50014"
}


@Article{info:doi/10.2196/60479,
author="Zvulunov, Alex
and Lenevich, Stepan
and Migacheva, Natalia",
title="Mobile Health App as an Auxiliary Tool in Management of Atopic Dermatitis in Children: Randomized Controlled Trial",
journal="JMIR Dermatol",
year="2025",
month="Jan",
day="22",
volume="8",
pages="e60479",
keywords="atopic dermatitis",
keywords="skin",
keywords="disease management",
keywords="children",
keywords="pediatric",
keywords="feasibility",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="eczema",
keywords="Atopic App",
keywords="dermatology",
abstract="Background: Mobile health apps can boost treatment adherence and support disease management at home. The Atopic App and web-based Atopic School patient education program offer a chance to enhance adherence to atopic dermatitis (AD) management. Objective: We aim to evaluate the feasibility, acceptability, and preliminary efficacy of the Atopic App mobile health intervention in the managing of AD in children. Methods: A randomized controlled study in children with AD divided participants into 3 groups: a control group (no app), an observational group with the app, and an interventional group with investigator supervision. Patients were examined at screening and follow-up visits 1 and 2 at 3-month intervals. Outcome measures included SCORAD (Scoring Atopic Dermatitis) for objective severity and Patient-Oriented Eczema Measure (POEM) for subjective effectiveness. Statistical analysis used paired t tests (2-tailed), the Mann-Whitney U test, and multiple regression. Results: Fifty-eight participants entered this study (38 boys and 20 girls): group 1 (control) comprised 17 patients, while experimental groups 2 and 3 consisted of 20 and 21 patients, respectively. The rates of missed appointments were similar and statistically insignificant across the groups. All groups showed a significant decrease in SCORAD and POEM scores (P<.05). Usage of the app for ?8 days showed a more significant decrease in severity scores compared to those who used it for ?7 days, or did not use it at all. Participants who used the app for ?8 days had a median SCORAD of 6.25 (95\% CI 4.6?14.1; IQR 4-16.3) at visit 1, significantly lower than nonusers (17.9, 95\% CI 13.9?24.0; IQR 13.9-24; P=.03) and those using it ?7 days (13, 95\% CI 9.35?27; IQR 7.2-27; P=.04). Their median POEM of 2 (95\% CI 1.0?4.5; IQR 1-5.3) was also significantly lower than those using the app ?7 days (9, 95\% CI 2?12; IQR 2-12; P=.04) and lower, though not significantly, than nonusers (7, 95\% CI 1?9; IQR 1-9; P=.14). Additionally, using the Atopic App for ?8 days after the screening visit strongly predicted a decrease in both SCORAD and POEM scores (P=.01 and P=.04, respectively). The time since the screening visit significantly predicted increased outcome scores, while prescriptions of topical calcineurin inhibitors, oral antihistamines, and oral antibiotics were weak and insignificant predictors of score changes. Conclusions: Our findings indicate that the Atopic App is helpful tool in managing AD in children, and they underscore the potential of mobile health interventions in the disease management. Trial Registration: ClinicalTrials.gov NCT06412094; https://clinicaltrials.gov/study/NCT06412094 ",
doi="10.2196/60479",
url="https://derma.jmir.org/2025/1/e60479"
}


@Article{info:doi/10.2196/52159,
author="Bruch, Aimee
and Weigandt, Wanja
and Schardt, Yannic
and Herr, Raphael
and Benecke, Johannes
and Schmieder, Astrid",
title="Improving Outcomes and Quality of Life for Patients With Hand and Foot Eczema: Randomized Study of a Patient-Centered Monitoring App",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="21",
volume="27",
pages="e52159",
keywords="hand and foot eczema",
keywords="eHealth",
keywords="mHealth",
keywords="teledermatology",
keywords="telemedicine",
keywords="disease management",
keywords="smartphone application",
keywords="mental health",
keywords="eczema",
keywords="clinical outcome",
keywords="quality of life",
keywords="dermatology",
keywords="pain",
keywords="motor skills",
keywords="educational",
keywords="support",
keywords="mobile phone",
abstract="Background: Hand and foot eczema is a frequent chronic dermatological condition. The persistent itching, pain, and blistering can impair hand and foot function, leading to difficulties in performing tasks requiring fine motor skills. In addition, the impact on the quality of life for affected patients is significant, as the symptoms can be extremely uncomfortable and disruptive to daily activities. By incorporating digital health apps and educational programs into the management of hand and foot eczema, patients may receive ongoing support, optimize their clinical outcomes, and ultimately enhance their overall quality of life. Objective: The purpose of this study was to evaluate the effect of a smartphone app combined with educational training on the clinical outcomes and mental health of patients with chronic hand and foot eczema during a 60-week study period. Methods: Patients in the intervention group participated in an educational program focused on chronic hand and foot eczema at baseline and had in-person visits at weeks 0, 12, 24, 36, and 60, as well as access to our study smartphone app. The app allowed patients to upload pictures of their hands and feet and answer questions about pain severity, itching, mood, and quality of life. A chat function was also available for patients to contact their dermatologist. The control group received only the in-person study visits described above. Results: A total of 87 patients were included in the study and randomized to the intervention (n=43) or control (n=44) groups. In total, 23 patients from the intervention group and 34 patients from the control group completed the study. Throughout the 60-week study period, a significant reduction in Hand Eczema Severity Index (HECSI) was consistently observed in all patients (week 60: linear regression coefficient [Coef]=--1.108; P?.001). A trend toward a greater improvement of the HECSI in the intervention group compared to the control group was noticed (week 60: Coef=0.597; P=.05). Subgroup analysis revealed that patients who used the app with a usage frequency of less than 20\% demonstrated a significant reduction in the HECSI from week 0 to week 60 (week 60: Coef=--1.275; P=.04) and a significant reduction in the Dermatology Life Quality Index (week 60: Coef=--1.246; P=.04) compared to the control group. We were able to demonstrate a significant correlation between the HECSI calculated based on pictures uploaded by patients through the app and the HECSI assessed during personal visits ($\rho$=0.885; P<.001), despite the potentially lower image quality of the pictures uploaded through the app. Conclusions: This study provides further evidence that digital health apps can provide valuable support in improving patient clinical outcomes and management, especially as the app-based assessment of hand and feed images appears to be reliable. Trial Registration: Deutsches Register Klinischer Studien DRKS00020963; https://drks.de/search/de/trial/DRKS00020963 ",
doi="10.2196/52159",
url="https://www.jmir.org/2025/1/e52159"
}


@Article{info:doi/10.2196/58093,
author="Inayama, Yoshihide
and Yamaguchi, Ken
and Mizuno, Kayoko
and Tanaka-Mizuno, Sachiko
and Koike, Ayami
and Higashiyama, Nozomi
and Taki, Mana
and Yamanoi, Koji
and Murakami, Ryusuke
and Hamanishi, Junzo
and Yoshida, Satomi
and Mandai, Masaki
and Kawakami, Koji",
title="Changes in Physical Activity Across Cancer Diagnosis and Treatment Based on Smartphone Step Count Data Linked to a Japanese Claims Database: Retrospective Cohort Study",
journal="JMIR Cancer",
year="2025",
month="Jan",
day="20",
volume="11",
pages="e58093",
keywords="cancer",
keywords="lifelog data",
keywords="physical activity",
keywords="quality of life",
keywords="step count",
keywords="Japanese",
keywords="database",
keywords="smartphone",
keywords="mobile app",
keywords="exercise",
keywords="mobile phone",
abstract="Background: Although physical activity (PA) is recommended for patients with cancer, changes in PA across cancer diagnosis and treatment have not been objectively evaluated. Objective: This study aimed to assess the impact of cancer diagnosis and treatment on PA levels. Methods: This was a retrospective cohort study using a Japanese claims database provided by DeSC Healthcare Inc, in which daily step count data, derived from smartphone pedometers, are linked to the claims data. In this study, we included patients newly diagnosed with cancer, along with those newly diagnosed with diabetes mellitus for reference. We collected data between April 2014 and September 2021 and analyzed them. The observation period spanned from 6 months before diagnosis to 12 months after diagnosis. We applied a generalized additive mixed model with a cubic spline to describe changes in step counts before and after diagnosis. Results: We analyzed the step count data of 326 patients with malignant solid tumors and 1388 patients with diabetes. Patients with cancer exhibited a 9.6\% (95\% CI 7.1\%-12.1\%; P<.001) reduction in step counts from baseline at the start of the diagnosis month, which further deepened to 12.4\% (95\% CI 9.5\%-15.2\%; P<.001) at 3 months and persisted at 7.1\% (95\% CI 4.2\%-10.0\%; P<.001) at 12 months, all relative to baseline. Conversely, in patients with diabetes, step counts remained relatively stable after diagnosis, with a slight upward trend, resulting in a change of +0.6\% (95\% CI --0.6\% to 1.9\%; P=.31) from baseline at 3 months after diagnosis. At 12 months after diagnosis, step counts remained decreased in the nonendoscopic subdiaphragmatic surgery group, with an 18.0\% (95\% CI 9.1\%-26.2\%; P<.001) reduction, whereas step counts returned to baseline in the laparoscopic surgery group (+0.3\%, 95\% CI --6.3\% to 7.5\%; P=.93). Conclusions: The analysis of objective pre- and postdiagnostic step count data provided fundamental information crucial for understanding changes in PA among patients with cancer. While cancer diagnosis and treatment reduced PA, the decline may have already started before diagnosis. The study findings may help tailor exercise recommendations based on lifelog data for patients with cancer in the future. ",
doi="10.2196/58093",
url="https://cancer.jmir.org/2025/1/e58093",
url="http://www.ncbi.nlm.nih.gov/pubmed/39726139"
}


@Article{info:doi/10.2196/64267,
author="Yakubu, I. Titilola
and Jhajj, Poonamdeep
and Pawer, Samantha
and West, C. Nicholas
and Amed, Shazhan
and Tang, S. Tricia
and G{\"o}rges, Matthias",
title="Exploring the Needs and Preferences of Users and Parents to Design a Mobile App to Deliver Mental Health Peer Support to Adolescents With Type 1 Diabetes: Qualitative Study",
journal="JMIR Diabetes",
year="2025",
month="Jan",
day="20",
volume="10",
pages="e64267",
keywords="peer support",
keywords="type 1 diabetes",
keywords="digital interventions",
keywords="diabetes distress",
keywords="depression",
keywords="mental health",
keywords="focus groups",
keywords="disease management",
keywords="adolescent",
keywords="parent",
keywords="mobile app",
keywords="mHealth",
keywords="type 1",
keywords="diabetes",
keywords="qualitative study",
keywords="physical health",
keywords="psychological",
keywords="emotional health",
keywords="mental health support",
keywords="thematic analysis",
keywords="data collection",
keywords="mobile health",
abstract="Background: Beyond physical health, managing type 1 diabetes (T1D) also encompasses a psychological component, including diabetes distress, that is, the worries, fears, and frustrations associated with meeting self-care demands over the lifetime. While digital health solutions have been increasingly used to address emotional health in diabetes, these technologies may not uniformly meet the unique concerns and technological savvy across all age groups. Objective: This study aimed to explore the mental health needs of adolescents with T1D, determine their preferred modalities for app-based mental health support, and identify desirable design features for peer-delivered mental health support modeled on an app designed for adults with T1D. Methods: A semistructured qualitative focus group study was conducted with adolescents with T1D and parents of adolescents with T1D. Data were collected through pre--focus group surveys, including sociodemographic background, diabetes status, health care experiences, and focus group sessions, including their opinions on peer support and technology. A thematic analysis following an inductive and iterative process was performed to develop themes and subthemes from the collected information. Results: Focus group participants included 10 adolescents (mean 16, SD 1 years; 8/10, 80\% female; who had been living with diabetes for an average of 9, SD 5 years) and 10 parents (mean age 51, SD 7 years; 9/10, 90\% female). Four core themes emerged: (1) experience: navigating adolescence with T1D, (2) empowerment: support systems that enabled better management of their T1D, (3) obstacles: societal barriers that affect adolescents' T1D management, and (4) innovation: adolescent-driven preferences for digital peer support platforms. Conclusions: App-based peer support offers a promising avenue for addressing the mental health needs of adolescents with T1D. Understanding the unique support needs of these adolescents and using this information to suggest design considerations for a mental health peer support app is an important step toward addressing their complex emotional and social challenges. ",
doi="10.2196/64267",
url="https://diabetes.jmir.org/2025/1/e64267"
}


@Article{info:doi/10.2196/55835,
author="Kanai, Masashi
and Miki, Takahiro
and Sakoda, Toshiya
and Hagiwara, Yuta",
title="The Effect of Combining mHealth and Health Professional--Led Intervention for Improving Health-Related Outcomes in Chronic Diseases: Systematic Review and Meta-Analysis",
journal="Interact J Med Res",
year="2025",
month="Jan",
day="20",
volume="14",
pages="e55835",
keywords="mHealth",
keywords="systematic reviews",
keywords="meta-analysis",
keywords="chronic diseases",
keywords="global health",
keywords="technology",
keywords="health care",
keywords="interventions",
keywords="chronic conditions",
keywords="health care professionals",
keywords="World Health Organization",
keywords="physical activity",
keywords="web-based",
abstract="Background: Chronic diseases such as diabetes and cardiovascular disease are global health challenges, affecting millions of people worldwide. Traditional health care often falls short in chronic disease management. This has led to the exploration of innovative solutions, such as mobile health (mHealth) technologies. mHealth, which leverages mobile and wireless technologies, has the potential to transform health care delivery by providing continuous, accessible, and personalized care. However, the effectiveness of mHealth, particularly when integrated with traditional health care interventions delivered by professionals, warrants comprehensive investigation. Understanding the combined impact of mHealth and professional-led interventions is critical to maximizing the potential of mHealth to improve patient outcomes and adherence. Objective: This study aims to investigate the effectiveness of combining mHealth and health professional--led intervention for improving health-related outcomes in chronic diseases Methods: This systematic review and meta-analysis focused on randomized controlled trials. We searched Web of Science, CENTRAL, MEDLINE, and CINAHL through July 17, 2023. The study targeted patients aged 18 years and older, experiencing at least 1 chronic condition. The interventions were a combination of mHealth and the use of a health care professional. The comparison groups consisted of participants receiving either general care and follow-up or those using mHealth devices without any health care professional involvement. The outcomes measured in this review included hemoglobin A1c (HbA1c), quality of life (QoL), and physical activity. Results: The study included 26 research papers, encompassing 7360 individuals. Meta-analysis was conducted for HbA1c, QoL, and physical activity. For HbA1c, short-term improvement was significant (standardized mean difference [SMD] --0.43; 95\% CI --0.64 to --0.21; I2=69\%) and medium term (SMD --0.49; 95\% CI --0.49 to --0.09; I2=21\%). However, in the long term, the improvement was not significant (SMD --0.23; 95\% CI --0.49 to 0.03; I2=88\%). For QoL, significant improvements were observed in the short term (SMD --0.23; 95\% CI --0.42 to --0.05; I2=62\%), and in the medium term (SMD --0.16; 95\% CI --0.24 to --0.07; I2=0\%). In the long term, however, the improvement was not significant (SMD --0.12; 95\% CI --0.41 to 0.16; I2=71\%). For physical activity, both subjective (questionnaire) and objective (number of steps) outcomes were analyzed. In the short term, subjective outcomes showed significant improvement (SMD 0.31; 95\% CI 0.12-0.50; I2=0\%), while objective outcomes did not (SMD 0.11; 95\% CI --0.05 to 0.27; I2=0\%). Medium- and long-term subjective outcomes showed no significant improvement. Meta-analysis for objective outcomes in the medium and long term was not possible due to insufficient studies. Conclusions: This study confirmed short- and medium-term benefits of mHealth combined with professional interventions for HbA1c, QoL, and short-term physical activity, supporting effective chronic disease management. ",
doi="10.2196/55835",
url="https://www.i-jmr.org/2025/1/e55835"
}


@Article{info:doi/10.2196/60150,
author="Tang, Dongmei
and Peng, Yuzhu
and Gu, Dantong
and Wu, Yongzhen
and Li, Huawei",
title="Digital Frequency Customized Relieving Sound for Chronic Subjective Tinnitus Management: Prospective Controlled Study",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="17",
volume="27",
pages="e60150",
keywords="tinnitus",
keywords="digital frequency customized relieving sound",
keywords="unmodified music",
keywords="sound therapy",
keywords="prospective study",
keywords="mobile phone",
abstract="Background: Tinnitus is a major health issue, but currently no tinnitus elimination treatments exist for chronic subjective tinnitus. Acoustic therapy, especially personalized acoustic therapy, plays an increasingly important role in tinnitus treatment. With the application of smartphones, personalized acoustic stimulation combined with smartphone apps will be more conducive to the individualized treatment and management of patients with tinnitus. Objective: The aim of this study was to evaluate the efficacy of a new personalized approach known as the digital frequency customized relieving sound (DFCRS) for tinnitus treatment and to explore the factors that may influence its therapeutic effect. Methods: Patients with subjective tinnitus were enrolled in this study from July 14, 2020, to May 24, 2021, in the tinnitus specialist clinic of Eye and ENT Hospital, Fudan University, Shanghai, China. In this nonrandomized concurrent controlled trial, a total of 107 participants were assigned to listen to personalized DFCRS through our developed app, while the other 77 participants who did not want to download and use the app were assigned to listen to unmodified music (UM). All the recruits were instructed to listen to DFCRS or UM for at least 2 hours a day and complete follow-up assessments at baseline, 1, 2, and 3 months. Multidimensional assessment scales, that is, Tinnitus Handicapped Inventory (THI), Hospital Anxiety and Depression Scale (HADS), Athens Insomnia Scale (AIS), Fear of Tinnitus Questionnaire (FTQ), and Tinnitus Catastrophizing Scale (TCS) were used to evaluate the severity of tinnitus and the quality of life. Linear mixed models were used to test for changes in the THI scores across 3 months of acoustic treatment between group (DFCRS or UM treatment) and time. A multiclass logistic model was built with a stepwise function to determine the influence of the different covariates on the effects of acoustic treatment. Results: The results of the multidimensional assessment scales after 3 months of treatment showed that DFCRS-treated patients had significant tinnitus relief compared to those in the UM group. Linear mixed models revealed a significant reduction in the THI scores over time (P<.001), with the DFCRS group showing significantly greater improvement than the UM group (P<.001). At 3 months, 92.5\% (99/107) of the patients undergoing DFCRS reported tinnitus relief or disappearance, and longer daily treatment time was associated with better outcomes (P=.007). Multiclass logistic regression confirmed that longer treatment time (odds ratio [OR] 13.07-64.78; P<.001) and more severe tinnitus at baseline (OR 10.46-83.71; P<.001) predicted better treatment response. All secondary outcomes (HADS, AIS, FTQ, TCS) showed significant improvements over time (P<.001). Conclusions: Our study suggests that DFCRS is a new promising and noninvasive therapy for chronic tinnitus, and it can be delivered through a mobile app to bring more convenience to patients with tinnitus. ",
doi="10.2196/60150",
url="https://www.jmir.org/2025/1/e60150"
}


@Article{info:doi/10.2196/60326,
author="Kirkham, M. Aidan
and Fergusson, A. Dean
and Presseau, Justin
and McIsaac, I. Daniel
and Shorr, Risa
and Roberts, J. Derek",
title="Strategies to Improve Health Care Provider Prescription of and Patient Adherence to Guideline-Recommended Cardiovascular Medications for Atherosclerotic Occlusive Disease: Protocol for Two Systematic Reviews and Meta-Analyses of Randomized Controlled Trials",
journal="JMIR Res Protoc",
year="2025",
month="Jan",
day="16",
volume="14",
pages="e60326",
keywords="coronary artery disease",
keywords="cerebrovascular disease",
keywords="peripheral artery disease",
keywords="polyvascular disease",
keywords="underprescription",
keywords="nonadherence",
keywords="implementation strategy",
keywords="adherence-supporting strategy",
keywords="statins",
keywords="antiplatelets",
keywords="antihypertensives",
keywords="guideline-recommended medications",
keywords="implementation",
keywords="atherosclerosis",
keywords="patient adherence",
keywords="RCT",
keywords="randomized controlled trials",
keywords="PRISMA",
abstract="Background: In patients with atherosclerotic occlusive diseases, systematic reviews and meta-analyses of randomized controlled trials (RCTs) report that antiplatelets, statins, and antihypertensives reduce the risk of major adverse cardiac events, need for revascularization procedures, mortality, and health care resource use. However, evidence suggests that these patients are not prescribed these medications adequately or do not adhere to them once prescribed. Objective: We aim to systematically review and meta-analyze RCTs examining the effectiveness of implementation or adherence-supporting strategies for improving health care provider prescription of, or patient adherence to, guideline-recommended cardiovascular medications in patients with atherosclerotic occlusive disease. Methods: We designed and reported the protocol according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis-Protocols) statement. We will search MEDLINE, Embase, The Cochrane Central Register of Controlled Trials, PsycINFO, and CINAHL from their inception. RCTs examining implementation or adherence-supporting strategies for improving prescription of, or adherence to, guideline-recommended cardiovascular medications in adults with cerebrovascular disease, coronary artery disease, peripheral artery disease, or polyvascular disease (>1 of these diseases) will be included. Two investigators will independently review identified titles/abstracts and full-text studies, extract data, assess the risk of bias (using the Cochrane tool), and classify implementation or adherence-supporting strategies using the refined Cochrane Effective Practice and Organization of Care (EPOC) taxonomy (for strategies aimed at improving prescription) and Behavior Change Wheel (BCW; for adherence-supporting strategies). We will narratively synthesize data describing which implementation or adherence-supporting strategies have been evaluated across RCTs, and their reported effectiveness at improving prescription of, or adherence to, guideline-recommended cardiovascular medications (primary outcomes) and patient-important outcomes and health care resource use (secondary outcomes) within refined EPOC taxonomy levels and BCW interventions and policies. Where limited clinical heterogeneity exists between RCTs, estimates describing the effectiveness of implementation or adherence-supporting strategies within different refined EPOC taxonomy levels and BCW interventions and policies will be pooled using random-effects models. Stratified meta-analyses and meta-regressions will assess if strategy effectiveness varies by recruited patient populations, prescriber types, clinical practice settings, and study design characteristics. GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) will be used to communicate evidence certainty. Results: The search was completed on June 6, 2023. Database searches and the PubMed ``related articles'' feature identified 4319 unique citations for title/abstract screening. We are currently screening titles/abstracts. Conclusions: These studies will identify which implementation and adherence-supporting strategies are being used (and in which combinations) across RCTs for improving the prescription of, or adherence to, guideline-recommended cardiovascular medications in adults with atherosclerotic occlusive diseases. They will also determine the effectiveness of currently trialed implementation and adherence-supporting strategies, and whether effectiveness varies by patient, prescriber, or clinical practice setting traits. Trial Registration: PROSPERO CRD42023461317; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=461317;   PROSPERO CRD42023461299; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=461299 ",
doi="10.2196/60326",
url="https://www.researchprotocols.org/2025/1/e60326"
}


@Article{info:doi/10.2196/57991,
author="Sekandi, Nabbuye Juliet
and Buregyeya, Esther
and Zalwango, Sarah
and Nakkonde, Damalie
and Kaggwa, Patrick
and Quach, Thu Trang Ho
and Asiimwe, David
and Atuyambe, Lynn
and Dobbin, Kevin",
title="Effectiveness of a Mobile Health Intervention (DOT Selfie) in Increasing Treatment Adherence Monitoring and Support for Patients With Tuberculosis in Uganda: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Jan",
day="16",
volume="13",
pages="e57991",
keywords="tuberculosis",
keywords="digital adherence technologies",
keywords="video-observed treatment",
keywords="video directly observed treatment",
keywords="directly observed therapy",
keywords="adherence",
keywords="mHealth",
keywords="Uganda",
keywords="Africa",
abstract="Background: Directly observed therapy (DOT) is the standard method for monitoring adherence to tuberculosis (TB) treatment. However, implementing DOT poses challenges for both patients and providers due to limited financial and human resources. Increasing evidence suggests that emerging digital adherence technologies, such as video directly observed therapy (VDOT), can serve as viable alternatives. Objective: This study aims to evaluate the effectiveness of VDOT compared with usual care directly observed therapy (UCDOT). Methods: Between July 2020 and October 2021, we conducted a 2-arm, parallel-group, open-label randomized trial with a 1:1 assignment to receive either the VDOT intervention (n=72) or UCDOT (n=72) for treatment adherence monitoring at public health clinics in Kampala, Uganda. Each group was further stratified to ensure equal numbers of males and females. Eligible patients were aged 18-65 years, had a confirmed diagnosis of TB, and were undergoing daily treatment. The VDOT group was provided with a smartphone equipped with an app, while the UCDOT group followed the routine monitoring practices outlined by the Uganda National TB Program. We tested the hypothesis that VDOT was more effective than UCDOT for monitoring medication adherence. The primary outcome was adherence, defined as having ?80\% of the expected doses observed during the 6-month treatment period. An intention-to-treat analysis was conducted, and multivariable logistic regression was used to estimate the effect of the intervention on adherence monitoring. Adjusted relative risk ratios and their corresponding 95\% CIs are presented. Secondary outcomes included treatment completion, loss to follow-up, death, and reasons for missed videos in the intervention group. Results: The intention-to-treat analysis included 142 participants, with 2 excluded due to discontinuation of medication within the first week after enrollment. The median age of participants was 34 (IQR 26-45) years. The median fraction of expected doses observed (FEDO) was significantly higher in the VDOT group compared with the UCDOT group (100, IQR 80-100 vs 30, IQR 10-60, respectively; P<.001). When using a FEDO cutoff of ?80\% to define optimal adherence, 63 of 142 (44\%) patients met the threshold, with a significant difference between the VDOT and UCDOT groups (56/71, 79\% vs 7/71, 10\%, P<.001). After adjusting for confounders, VDOT users were significantly more likely to achieve ?80\% of their expected doses observed compared with UCDOT users (adjusted risk ratio 8.4, 95\% CI 4.16-17.0). The most common reasons for failing to submit videos of medication intake were an uncharged phone battery, forgetting to record videos during medication intake, and losing the smartphone. Conclusions: Enhanced VDOT was more effective than UCDOT in increasing adherence monitoring among patients with TB in Uganda. This evidence highlights the potential of digital technologies to improve treatment adherence monitoring and support in high TB burden settings with limited human resources. Trial Registration: ClinicalTrials.gov NCT04134689; http://clinicaltrials.gov/ct2/show/NCT04134689 ",
doi="10.2196/57991",
url="https://mhealth.jmir.org/2025/1/e57991",
url="http://www.ncbi.nlm.nih.gov/pubmed/39715573"
}


@Article{info:doi/10.2196/60382,
author="McCage, Sydney
and Walker, Kristin
and Cornelius, Talea
and Parker, A. Robert
and Dams-O'Connor, Kristen
and Dickerson, Brad
and Ritchie, Christine
and Vranceanu, Ana-Maria
and Bannon, Sarah",
title="A Live Video Resiliency Dyadic Intervention for Persons With Dementia and Their Care-Partners Early After Diagnosis: Protocol for Open Pilot of Resilient Together for Dementia",
journal="JMIR Res Protoc",
year="2025",
month="Jan",
day="15",
volume="14",
pages="e60382",
keywords="dementia",
keywords="dyad",
keywords="emotional distress",
keywords="intervention",
keywords="diagnosis",
keywords="telehealth",
keywords="resilient",
keywords="dyadic intervention",
keywords="care-partner",
keywords="Alzheimer's disease",
keywords="ADRD",
keywords="psychosocial",
keywords="depression",
abstract="Background: Alzheimer disease and related dementias (ADRDs) are increasingly common progressive conditions that have a substantial impact on individuals and their primary care partners---together described as a dyad. The stressors experienced by dyad members at around the time of ADRD diagnosis commonly produce clinically elevated emotional distress (ie, depression and anxiety symptoms), which can become chronic and negatively impact health, relationships, and the overall quality of life. Dyads commonly report unmet needs for early support to address these challenges early after diagnosis. Objective: This study is part of a larger study that has the primary objective to develop, adapt, and establish the feasibility of Resilient Together for Dementia (RT-ADRD), a novel dyadic skills-based intervention aimed at preventing chronic emotional distress early after diagnosis. The present study protocol describes an open pilot of the RT-ADRD intervention. This study will allow the study team to gather feedback on intervention components, administration of study measures, issues within general protocol, and perceptions about live video interventions prior to a larger feasibility trial. Methods: All study procedures will be conducted on the web (via phone and health care system--supported videoconferencing) to optimize accessibility, inclusion, and representativeness. Eligible dyads will include couples (up to N=10) referred from Mount Sinai Hospital (MSH) clinics within 3 months of an ADRD diagnosis. Dyads will be referred by their diagnosing clinicians (eg, neurologists, geriatricians, and neuropsychologists) and screened for eligibility. Eligible dyads will have at least one member who exhibits clinically elevated emotional distress and will demonstrate capacity to consent to research participation on a standardized assessment. Consenting dyads will complete baseline assessments of emotional distress, quality of life, relationship functioning, and resiliency skills. Dyads will then participate in 6 weekly RT-ADRD sessions together (30-60 minutes each). After the conclusion of the intervention, dyad members will complete posttest assessments with similar measures as the pretest. Finally, dyads will participate together in a single 60-minute exit interview to gather information on intervention content and procedures to refine the intervention before a pilot feasibility trial. Results: This study has been approved by the MSH institutional review board and is registered on ClinicalTrials.gov (NCT06421545). We anticipate that the study will be completed by late 2024. Conclusions: We will use these results to administer changes and develop procedures for a pilot feasibility trial of RT-ADRD relative to a minimally enhanced control condition. Our study will allow us to gather comprehensive information on proposed RT-ADRD procedures and content and the best ways of delivering prevention-focused interventions to reduce the potential for chronic emotional distress stemming from ADRDs. International Registered Report Identifier (IRRID): DERR1-10.2196/60382 ",
doi="10.2196/60382",
url="https://www.researchprotocols.org/2025/1/e60382"
}


@Article{info:doi/10.2196/56463,
author="Lakshman, Pavithra
and Gopal, T. Priyanka
and Khurdi, Sheen",
title="Effectiveness of Remote Patient Monitoring Equipped With an Early Warning System in Tertiary Care Hospital Wards: Retrospective Cohort Study",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="15",
volume="27",
pages="e56463",
keywords="continuous vitals monitoring",
keywords="remote patient monitoring",
keywords="early warning system",
keywords="hospital wards",
keywords="retrospective",
keywords="cohort study",
keywords="early deterioration monitoring",
keywords="patient care",
keywords="decision making",
keywords="clinical information",
abstract="Background: Monitoring vital signs in hospitalized patients is crucial for evaluating their clinical condition. While early warning scores like the modified early warning score (MEWS) are typically calculated 3 to 4 times daily through spot checks, they might not promptly identify early deterioration. Leveraging technologies that provide continuous monitoring of vital signs, combined with an early warning system, has the potential to identify clinical deterioration sooner. This approach empowers health care providers to intervene promptly and effectively. Objective: This study aimed to assess the impact of a Remote Patient Monitoring System (RPMS) with an automated early warning system (R-EWS) on patient safety in noncritical care at a tertiary hospital. R-EWS performance was compared with a simulated Modified Early Warning System (S-MEWS) and a simulated threshold-based alert system (S-Threshold). Methods: Patient outcomes, including intensive care unit (ICU) transfers due to deterioration and discharges for nondeteriorating cases, were analyzed in Ramaiah Memorial Hospital's general wards with RPMS. Sensitivity, specificity, chi-square test for alert frequency distribution equality, and the average time from the first alert to ICU transfer in the last 24 hours was determined. Alert and patient distribution by tiers and vitals in R-EWS groups were examined. Results: Analyzing 905 patients, including 38 with deteriorations, R-EWS, S-Threshold, and S-MEWS generated more alerts for deteriorating cases. R-EWS showed high sensitivity (97.37\%) and low specificity (23.41\%), S-Threshold had perfect sensitivity (100\%) but low specificity (0.46\%), and S-MEWS demonstrated moderate sensitivity (47.37\%) and high specificity (81.31\%). The average time from initial alert to clinical deterioration was at least 18 hours for RPMS and S-Threshold in deteriorating participants. R-EWS had increased alert frequency and a higher proportion of critical alerts for deteriorating cases. Conclusions: This study underscores R-EWS role in early deterioration detection, emphasizing timely interventions for improved patient outcomes. Continuous monitoring enhances patient safety and optimizes care quality. ",
doi="10.2196/56463",
url="https://www.jmir.org/2025/1/e56463"
}


@Article{info:doi/10.2196/55586,
author="Kitsiou, Spyros
and Gerber, S. Ben
and Buchholz, W. Susan
and Kansal, M. Mayank
and Sun, Jiehuan
and Pressler, J. Susan",
title="Patient-Centered mHealth Intervention to Improve Self-Care in Patients With Chronic Heart Failure: Phase 1 Randomized Controlled Trial",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="15",
volume="27",
pages="e55586",
keywords="mHealth",
keywords="app",
keywords="digital health",
keywords="telehealth",
keywords="text messaging",
keywords="smartphone",
keywords="wearable electronic devices",
keywords="heart failure",
keywords="self-care",
keywords="self-management",
keywords="randomized controlled trial",
keywords="cardiology",
keywords="SMS",
abstract="Background: Heart failure (HF) is one of the most common causes of hospital readmission in the United States. These hospitalizations are often driven by insufficient self-care. Commercial mobile health (mHealth) technologies, such as consumer-grade apps and wearable devices, offer opportunities for improving HF self-care, but their efficacy remains largely underexplored. Objective: The objective of this study was to examine the feasibility, acceptability, safety, and preliminary efficacy of a patient-centered mHealth intervention (iCardia4HF) that integrates 3 consumer mHealth apps and devices (Heart Failure Health Storylines, Fitbit, and Withings) with a program of individually tailored SMS text messages to improve HF self-care. Methods: We conducted a phase 1 randomized controlled trial. Eligible patients had stage C HF, were aged ?40 years, and had New York Heart Association (NYHA) class I, II, or III HF. Patients were randomly assigned to either iCardia4HF plus usual care or to usual care only and were observed for 8 weeks. Key feasibility measures were recruitment and retention rates. The primary efficacy outcome was change in HF self-care subscale scores (maintenance, symptom perception, and self-care management) at 8 weeks, assessed with the Self-Care Heart Failure Index (SCHFI; version 7.2). Key secondary outcomes were modifiable behaviors targeted by the intervention (health beliefs, self-efficacy, and HF knowledge), health status, and adherence to daily self-monitoring of 2 core vital signs (body weight and blood pressure). Results: A total of 27 patients were enrolled in the study and randomly assigned to iCardia4HF (n=13, 48\%) or usual care (n=14, 52\%). Of these 27 patients, 11 (41\%) in the intervention group (iCardia4HF) and 14 (52\%) in the usual care group started their assigned care and were included in the full analysis. Patients' mean age was 56 (SD 8.3) years, 44\% (11/25) were female, 92\% (23/25) self-reported race as Black, 76\% (19/25) had NYHA class II or III HF, and 60\% (15/25) had HF with reduced left ventricular ejection fraction. Participant retention, completion of study visits, and adherence to using the mHealth apps and devices for daily self-monitoring were high (>80\%). At 8 weeks, the mean group differences in changes in the SCHFI subscale scores favored the intervention over the control group: maintenance (Cohen d=0.19, 95\% CI --0.65 to 1.02), symptom perception (Cohen d=0.33, 95\% CI --0.51 to 1.17), and self-care management (Cohen d=0.25, 95\% CI --0.55 to 1.04). The greatest improvements in terms of effect size were observed in self-efficacy (Cohen d=0.68) and health beliefs about medication adherence (Cohen d=0.63) and self-monitoring adherence (Cohen d=0.94). There were no adverse events due to the intervention. Conclusions: iCardia4HF was found to be feasible, acceptable, and safe. A larger trial with a longer follow-up duration is warranted to examine its efficacy among patients with HF. Trial Registration: ClinicalTrials.gov NCT03642275; https://clinicaltrials.gov/study/NCT03642275 ",
doi="10.2196/55586",
url="https://www.jmir.org/2025/1/e55586"
}


@Article{info:doi/10.2196/63941,
author="Simioni, Lisa
and Tessitore, Elena
and Hagberg, Hamdi
and Schneider-Paccot, Aur{\'e}lie
and Blondon, Katherine
and Gschwind, Liliane
and Meyer, Philippe
and Ehrler, Frederic",
title="Cardiomeds, an mHealth App for Self-Management to Support Swiss Patients With Heart Failure: 2-Stage Mixed Methods Usability Study",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="15",
volume="9",
pages="e63941",
keywords="usability",
keywords="medication",
keywords="mobile health",
keywords="mHealth",
keywords="Cardiomeds",
keywords="mobile app",
keywords="patient empowerment",
keywords="eHealth",
keywords="smartphone",
keywords="heart failure",
keywords="HF",
keywords="chronic disease",
keywords="interactive",
keywords="self-monitoring",
keywords="usability test",
keywords="mobile phone",
abstract="Background: Mobile health apps have shown promising results in improving self-management of several chronic diseases in patients. We have developed a mobile health app (Cardiomeds) dedicated to patients with heart failure (HF). This app includes an interactive medication list; daily self-monitoring of symptoms, weight, blood pressure, and heart rate; and educational information on HF delivered through various formats. Objective: This study aimed to perform a mixed methods usability study of Cardiomeds. Methods: Smartphone users with HF were recruited from the HF outpatient clinic at the University Hospital of Geneva. The usability test was conducted in 2 stages, with modifications made to the app after the first stage to address major usability issues. Each stage required 10 participants to perform 14 tasks, such as entering vital signs, entering a new medication and time of intake, or finding information about HF. Each task was timed, sessions were recorded, and all data were anonymized. After completing the tasks, patients completed the System Usability Scale 10-item questionnaire and answered 5 open questions about their perceptions of Cardiomeds. Results: Twenty patients with HF, 75\% (15/20) of whom were men, with a mean age of 55 years, were included in this study. The average time to complete all 14 tasks was 18 (SD 5.7) minutes. Manual medication entry was the most time-consuming task, taking an average of 154.40 (SD 68.08) seconds in the first stage, 103.10 (SD 42.76) seconds in the second stage, and 128 (SD 63) seconds overall. The mean overall success rate was 77\% (SD 0.23\%) for the first stage and 94\% (SD 0.07\%) for the second stage. A total of 30\% (3/10) of participants in the first stage completed all tasks without any help compared with 50\% (5/10) of participants during the second stage. The average System Usability Scale score was 80\% (SD 17\%), showing a slight increase from 79\% (SD 16\%) in the first stage to 80\% (SD 28\%) in the second stage, which qualifies the app as ``good'' in terms of usability. Between the 2 stages, part of the app interface was redesigned to address the key issues identified in the first stage. Despite these improvements, problems related to guidance were frequent and comprised 36\% (8/22) of the problems in the first stage and 40\% (6/15) in the second stage. In response to open questions, 85\% (17/20) of the participants responded that they would like to use the app when it became available. Conclusions: The usability test indicated that Cardiomeds is a suitable and user-friendly app for patients with HF. The app will be further tested in a randomized clinical trial (2022-00731) after acute HF hospitalization to assess its impact on patients' knowledge about HF, self-care, and quality of life. ",
doi="10.2196/63941",
url="https://formative.jmir.org/2025/1/e63941",
url="http://www.ncbi.nlm.nih.gov/pubmed/39813081"
}


@Article{info:doi/10.2196/59871,
author="Chiang, Yueh-Tao
and Yu, Hsing-Yi
and Tsay, Pei-Kwei
and Chen, Chi-Wen
and Chang, Chi-Wen
and Hsu, Chien-Lung
and Lo, Fu-Sung
and Moons, Philip",
title="Effectiveness of the User-Centered ``Healthcare CEO'' App for Patients With Type 1 Diabetes Transitioning From Adolescence to Early Adulthood: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2025",
month="Jan",
day="13",
volume="14",
pages="e59871",
keywords="type 1 diabetes",
keywords="transition",
keywords="mobile health",
keywords="treatment fidelity",
keywords="diabetes",
keywords="user-centered",
keywords="adolescence",
keywords="teenager",
keywords="app",
keywords="adolescent patients",
keywords="early adulthood",
abstract="Background: Young patients aged 16 to 25 years with type 1 diabetes (T1D) often encounter challenges related to deteriorating disease control and accelerated complications. Mobile apps have shown promise in enhancing self-care among youth with diabetes. However, inconsistent findings suggest that further evidence is necessary to confirm the effectiveness of app-based interventions. Objective: This study aims to evaluate the effectiveness of the Healthcare CEO app in patients with T1D transitioning from adolescence to early adulthood. Methods: A 2 arms, double-blind, randomized controlled trial will be conducted over a 9-month period, with strategies designed to enhance treatment fidelity. The study expects to enroll 96 patients with T1D, aged 16 to 25 years. Participants will be randomly assigned to either the experimental or control group through central randomization. The intervention will be implemented using the Healthcare CEO app, which consists of 11 interfaces. The research will compare differences in disease control outcomes, confidence in self-management, self-care behaviors, emotional distress, quality of life, and specific diabetes-related knowledge between the 2 groups at baseline and 3, 6, and 9 months after intervention. Additionally, changes within the experimental group will be analyzed before and after the intervention. Results: The study was funded in August 2020. It was originally scheduled from August 2020 to July 2022 but was interrupted by the COVID-19 pandemic after enrolling 38 participants, with preliminary results anticipated for publication by November 2024. Recruitment resumed in August 2023, with findings expected to be finalized by July 2025. Conclusions: The Healthcare CEO app is a comprehensive solution tailored specifically for individuals with T1D transitioning from adolescence to early adulthood. This innovative app has the potential to improve the quality of care for adolescents with T1D during this critical stage and may serve as valuable evidence in support of app-based intervention strategies. Trial Registration: ClinicalTrials.gov NCT05022875; https://www.clinicaltrials.gov/study/NCT05022875 International Registered Report Identifier (IRRID): DERR1-10.2196/59871 ",
doi="10.2196/59871",
url="https://www.researchprotocols.org/2025/1/e59871"
}


@Article{info:doi/10.2196/67554,
author="Li, Chenxi
and Guo, Lixin
and Shi, Lixin
and Chen, Li
and Chen, Liming
and Xue, Yaoming
and Li, Hong
and Liang, Yuzhen
and Yang, Jing
and Wang, Weimin
and Zhu, Dalong",
title="Effectiveness and Safety of the TRIO Optimal Health Management Program in Patients With Type 2 Diabetes Mellitus Initiating Basal Insulin Therapy: Prospective Observational Real-World Study",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="13",
volume="27",
pages="e67554",
keywords="type 2 diabetes",
keywords="TRIO optimal health management program",
keywords="initiating basal insulin therapy",
keywords="glycemic control",
keywords="real-world study",
abstract="Background: Diabetes, a chronic disease necessitating long-term treatment and self-management, presents significant challenges for patients who spend most of their treatment time outside of hospitals. The potential of digital therapeutics for diabetes has garnered recognition from different organizations. Although some prior studies have demonstrated successful reductions in patients' blood glucose levels and body weight through digital diabetes programs, many studies were limited by including patients with prediabetes, including patients treated with mostly premixed insulin, or evaluating user engagement outcomes rather than clinical outcomes. Consequently, limited evidence remains regarding the effectiveness of health management mobile apps specifically designed for patients with type 2 diabetes mellitus (T2DM) initiating basal insulin (BI). Based on this, a data-based and artificial intelligence management system named ``TRIO'' was developed to provide patients with more personalized intervention methods in stages, in groups, and around the clock. TRIO assists doctors and nurses in achieving better blood glucose controls, truly carries out standardized management around patients, and allows them to have a higher quality of life. TRIO represents the 3 essential pillars in comprehensive diabetes management: physician, nurse, and patient. Objective: This prospective observational study evaluated the effectiveness and safety of the TRIO optimal health management program for patients with T2DM initiating BI therapy in a real-world setting. Methods: Patients aged 18-85 years with inadequate glycemic control (baseline hemoglobin A1c [HbA1c] ?7\%) starting BI therapy were enrolled in outpatient and inpatient settings. The study lasted 3 months, with health education and phone-based follow-up assessments. Data collected included patient characteristics, medical history, baseline diabetes conditions, treatment compliance, glycemic control, and safety indicators. Results: A total of 199,431 patients were included, and 118,134 patients completed the 3-month follow-up between December 1, 2019, and December 31, 2021, involving 574 hospitals in China. The mean baseline HbA1c was 9.2\%, the mean duration of diabetes was 7.3 years, and 80.4\% (1,59,930/1,98,969) of patients were using BI with oral antihyperglycemic drugs. After the intervention, mean HbA1c decreased by --2.59\% from baseline, with 55.6\% (28,858/51,912) achieving the target HbA1c level of <7\%. Patients who set lower fasting plasma glucose goals (<6.1 mmol/L) showed more significant HbA1c reductions (P<.001) and higher target achievement than those with fasting plasma glucose goals of ?6.1 mmol/L. Factors such as complications, diabetes duration, and baseline HbA1c levels influenced the magnitude of HbA1c reduction. The presence of complications, shorter diabetes duration, and higher baseline HbA1c were significantly associated with increased hypoglycemia incidence risk (all P<.05). Conclusions: The TRIO optimal health management program effectively improved glycemic control in patients with T2DM initiating BI therapy. Individualized treatment approaches considering patient characteristics and glycemic goals are vital for optimal outcomes. ",
doi="10.2196/67554",
url="https://www.jmir.org/2025/1/e67554"
}


@Article{info:doi/10.2196/52764,
author="Holley, Dan
and Brooks, Amanda
and Hartz, Matthew
and Rao, Sudhir
and Zaubler, Thomas",
title="mHealth-Augmented Care for Reducing Depression Symptom Severity Among Patients With Chronic Pain: Exploratory, Retrospective Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Jan",
day="10",
volume="13",
pages="e52764",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="behavioral health care",
keywords="depression",
keywords="mental health",
keywords="screening",
keywords="pain",
keywords="chronic pain",
keywords="psychiatric screenings",
keywords="digital health care",
keywords="psychiatry",
keywords="psychiatric",
keywords="longitudinal",
keywords="assessment",
keywords="behavioral",
keywords="self-help",
keywords="integrated",
keywords="comorbidity",
keywords="augmented care",
abstract="Background: Depression and chronic pain are commonly comorbid, mutually reinforcing, and debilitating. Emerging approaches to mobile behavioral health care (mHealth) promise to improve outcomes for patients with comorbid depression and chronic pain by integrating with existing care models to bolster support and continuity between clinical visits; however, the evidence base supporting the use of mHealth to augment care for this patient population is limited. Objective: To develop an evidence base that sets the stage for future research, we aimed to explore the associations between changes in depression severity and various integrated care models, with and without mHealth augmentation, among patients with comorbid depression and nonmalignant chronic pain. Methods: Our team leveraged retrospective, real-world data from 3837 patients with comorbid depression and nonmalignant chronic pain who received integrated behavioral health care (IBH) at a subspecialty pain clinic. We analyzed one IBH-only, non-mHealth cohort (n=2765), an mHealth-augmented cohort (n=844), and a collaborative care (CoCM)+mHealth cohort (n=136), which were supported by the NeuroFlow mHealth platform, and a pre-CoCM mHealth cohort (n=92), which was supported by the mHealth platform for 3 months prior to beginning the chronic pain treatment. We evaluated changes in depression severity between treatment cohorts via longitudinal analyses of both clinician- and mHealth-administered Patient Health Questionnaire-9 (PHQ-9) assessments. Results: mHealth-augmented integrated care led to significantly greater proportions of patients reaching clinical benchmarks for reduction (725/844, 86\% vs 2112/2765, 76\%), response (689/844, 82\% vs 2027/2765, 73\%), and remission (629/844, 75\% vs 1919/2765, 69\%) compared with integrated care alone. Furthermore, hierarchical regression modeling revealed that patients who received mHealth-augmented psychiatric CoCM experienced the greatest sustained reductions in on-average depression severity compared with other cohorts, irrespective of clinical benchmarks. In addition, patients who engaged with an mHealth platform before entering CoCM experienced a 7.2\% reduction in average depression severity before starting CoCM treatment. Conclusions: Our findings suggest that mHealth platforms have the potential to improve treatment outcomes for patients with comorbid chronic pain and depression by providing remote measurement--based care, tailored interventions, and improved continuity between appointments. Moreover, our study set the stage for further research, including randomized controlled trials to evaluate causal relationships between mHealth engagement and treatment outcomes in integrated care settings. ",
doi="10.2196/52764",
url="https://mhealth.jmir.org/2025/1/e52764"
}


@Article{info:doi/10.2196/58384,
author="Kang, Xin
and Zhang, Yiping
and Sun, Chaonan
and Zhang, Jiaxin
and Che, Zhe
and Zang, Jinhui
and Zhang, Rongzhi",
title="Effectiveness of Virtual Reality Training in Improving Outcomes for Dialysis Patients: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="8",
volume="27",
pages="e58384",
keywords="virtual reality",
keywords="VR",
keywords="training",
keywords="dialysis",
keywords="hemodialysis",
keywords="peritoneal dialysis",
keywords="chronic kidney disease",
keywords="rehabilitation",
keywords="quality of life",
keywords="meta-analysis",
abstract="Background: Virtual reality (VR) training uses computer-generated simulations that enable users to engage with immersive virtual environments, simulating real-world activities or therapeutic exercises. This technology is increasingly recognized as a promising intervention to address the physical and psychological challenges faced by dialysis patients, who frequently experience diminished physical function, social isolation, and emotional distress associated with prolonged treatment regimens. Given the increasing prevalence of dialysis patients and the limitations of conventional rehabilitation approaches, VR presents a novel, interactive method that has the potential to enhance patient well-being and improve quality of life. Objective: This meta-analysis aimed to evaluate the effectiveness of VR training interventions for dialysis patients, with a focus on assessing their impact on motor abilities, psychological symptoms (specifically anxiety and depression), social functioning, and self-efficacy. This analysis also explores whether VR can offer comprehensive benefits to support both the physical and mental health of dialysis patients. Methods: The meta-analysis was conducted following Cochrane guidelines. Comprehensive searches were performed across major databases, including China National Knowledge Infrastructure, Wanfang database, China Science and Technology Journal Database, China Biomedical Literature database, Cochrane library, Web of Science, PubMed, and Embase, encompassing all studies up to December 2023. Inclusion criteria targeted studies assessing VR's impact on motor performance, psychological well-being, social functioning, and self-efficacy in dialysis patients. Two reviewers independently extracted data and assessed methodological quality using Cochrane's risk of bias criteria, ensuring data synthesis reliability. Results: A total of 12 studies, involving 625 dialysis patients in total, met the inclusion criteria. The meta-analysis demonstrated that VR training led to significant improvements across multiple domains. VR interventions were associated with improved physical capacity, evidenced by higher scores in the 6-minute walk test (standardized mean difference [SD]=29.36, 95\% CI 14.32-44.4, P<.001, I2=46\%). VR training was associated with significant reductions in depression (SD=--6.30, 95\% CI --7.14 to --5.47, P<.001, I2=96\%) and anxiety (SD=--8.91, 95\% CI --9.69 to --8.14, P<.001, I2=95\%). In addition, VR interventions enhanced social functioning (SD=16.20, 95\% CI 14.49-17.9, P<.001, I2=72\%), and improved self-efficacy (SD=20.47, 95\% CI 18.55-22.39, P<.001, I2=99\%). However, VR training did not yield significant differences in gait speed, balance, or functional tests (Ten Sit-to-Stand Test, Five Sit-to-Stand Test, Sixty Sit-to-Stand Test, Timed Up and Go Test, and fatigue) compared with control groups. Conclusions: The findings suggest that VR training is a promising intervention for dialysis patients, providing benefits in physical endurance, social engagement, and psychological well-being. Despite these advantages, VR remains underused among peritoneal dialysis patients compared with hemodialysis patients. Further studies with larger sample sizes and more refined experimental designs are recommended to validate these results and support VR as a complementary tool in the holistic care of dialysis patients. ",
doi="10.2196/58384",
url="https://www.jmir.org/2025/1/e58384"
}


@Article{info:doi/10.2196/63653,
author="Hartch, Christa
and Dietrich, S. Mary
and Lancaster, Jeanette B.
and Mulvaney, A. Shelagh
and Stolldorf, P. Deonni",
title="Satisfaction and Usability of a Commercially Available Medication Adherence App (Medisafe) Among Medically Underserved Patients With Chronic Illnesses: Survey Study",
journal="JMIR Hum Factors",
year="2025",
month="Jan",
day="7",
volume="12",
pages="e63653",
keywords="medication adherence",
keywords="mHealth",
keywords="mobile phone",
keywords="app",
keywords="medically underserved",
keywords="chronic disease",
keywords="satisfaction",
keywords="usage",
keywords="health disparities",
abstract="Background: Research supports the use of mobile phone apps to promote medication adherence, but the use of and satisfaction with these apps among medically underserved patients with chronic illnesses remain unclear. Objective: This study reports on the overall use of and satisfaction with a medication adherence app (Medisafe) in a medically underserved population. Methods: Medically underserved adults who received care for one or more chronic illnesses at a federally qualified health center (FQHC) were randomized to an intervention group in a larger randomized controlled trial and used the app for 1 month (n=30), after which they completed a web-based survey. Objective data on app usage were provided as secondary data by the app company. Results: The participants were very satisfied with the app, with all participants (30/30, 100\%) somewhat or strongly agreeing that they would recommend the app to family and friends. Participants strongly agreed (28/30, 93\%) that the reminders helped them remember to take their medications at the correct time each day, and they (28/30, 93\%) found the app easy to use. Additional features accessed by some included educational features and the adherence report. Participants noted the helpfulness of having a medication list on their phones, and some used it during medication reconciliation at doctor visits. Use of the Medfriend feature, which alerts a social support person if a medication is missed, was low (n=2), but those who used it were very positive about the feature. Conclusions: A commercially available medication adherence app was found to be useful by participants, and they were satisfied with the app and the additional features provided. The use of medication adherence mobile phone apps has the potential to positively influence chronic disease management in a medically underserved population on a large scale. Trial Registration: ClinicalTrials.gov NCT05098743; https://clinicaltrials.gov/study/NCT05098743 ",
doi="10.2196/63653",
url="https://humanfactors.jmir.org/2025/1/e63653"
}


@Article{info:doi/10.2196/65578,
author="Chen, Fu-Yu
and Lin, Tzu-Yao
and Huang, Yi-Cheng
and Widianawati, Evina",
title="Effectiveness of Using a Digital Wearable Plantar Pressure Device to Detect Muscle Fatigue: Within-Subject, Repeated Measures Experimental Design",
journal="JMIR Hum Factors",
year="2025",
month="Jan",
day="7",
volume="12",
pages="e65578",
keywords="muscle fatigue",
keywords="plantar pressure sensors",
keywords="wearable devices",
keywords="home-based monitoring",
abstract="Background: Muscle fatigue, characterized by reduced force generation during repetitive contractions, impacts older adults doing daily activities and athletes during sports activities. While various sensors detect muscle fatigue via muscle activity, biochemical markers, and kinematic parameters, a real-time wearable solution with high usability remains limited. Plantar pressure monitoring detects muscle fatigue through foot loading changes, seamlessly integrating into footwear to improve the usability and compliance for home-based monitoring. Objective: This study aimed to investigate the effects of muscle fatigue on plantar pressure measurements using a self-developed wearable plantar pressure system. Methods: Twelve healthy participants completed a 5-minute calf muscle fatigue protocol. The plantar pressures and surface electromyography (sEMG) activity of the gastrocnemius muscles were recorded before and after exercise. The plantar pressures at 6 regions and the median frequency (MDF) of sEMG were analyzed to quantify fatigue. Results: The self-developed foot pressure system showed a significant decrease in plantar pressure peak values at the heel of the left (P=.003) and right feet (P=.001) and at the lateral toe of the left (P=.001) and right feet (P=.026). A significant increase was observed at the metatarsal head of both the left foot (P=.001) and the right foot (P=.017). The MDF of sEMG signals significantly decreased in the left (P=.001) and right gastrocnemius (P<.001). Conclusions: Plantar pressure changes and sEMG signals effectively detect gastrocnemius muscle fatigue using the proposed wearable system, supporting the development of a wearable solution for detecting muscle fatigue suitable for home-use. ",
doi="10.2196/65578",
url="https://humanfactors.jmir.org/2025/1/e65578"
}


@Article{info:doi/10.2196/65888,
author="Naranjo-Rojas, Anisbed
and Perula-de Torres, {\'A}ngel Luis
and Cruz-Mosquera, Eccehomo Freiser
and Molina-Recio, Guillermo",
title="Efficacy and Acceptability of a Mobile App for Monitoring the Clinical Status of Patients With Chronic Obstructive Pulmonary Disease Receiving Home Oxygen Therapy: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="6",
volume="27",
pages="e65888",
keywords="m-Health",
keywords="chronic obstructive pulmonary disease",
keywords="quality of life",
keywords="mobile health applications",
keywords="home oxygen therapy",
keywords="mobile phone",
abstract="Background: Chronic obstructive pulmonary disease (COPD) primarily originates from exposure to tobacco smoke, although factors, such as air pollution and exposure to chemicals, also play a role. One of the primary treatments for COPD is oxygen therapy, which helps manage dyspnea and improve survival rates. Mobile health (mHealth) technologies have demonstrated significant potential in monitoring patients with chronic diseases, offering new avenues for enhancing patient care and disease management. Objective: The purpose of this study was to evaluate the efficacy and acceptability of a mobile app designed for the clinical monitoring of patients with COPD and home oxygen (HO) therapy, compared with conventional monitoring in real-world community settings. Methods: A parallel-group, nonblinded, multicenter randomized controlled trial was conducted with 45 participants; the intervention group (IG), which used the mobile app in addition to conventional monitoring (n=23) and the control group, which received only conventional monitoring (n=22), administered by therapists over a duration of 3 months. The primary outcomes included the chronic obstructive pulmonary disease assessment test (CAT) score, the level of dyspnea measured by the Borg scale, and oxygen saturation percentage, assessed at both the beginning and end of the trial. Secondary outcomes included the frequency of app use, the number of hospitalizations, and survival rates. In addition, a satisfaction survey and an interview were conducted with the IG. Results: The median use of the mobile app was 21 (IQR 16-28) days. At the end of the follow-up, the Borg dyspnea scale was significantly lower in patients who used the mobile app for HO therapy monitoring (mean 0.6, SD 0.8 vs mean 4.1, SD 1.4; P=.001). Regarding the impact of COPD on quality of life, as measured by the CAT, no differences were found in the scores between baseline and end-of-follow-up within the control group. However, a significant decrease was observed in the IG (baseline median CAT 27, IQR 23-31 vs final median CAT 22, IQR 14-28; P<.001). In addition, the CAT score was significantly higher in patients receiving conventional monitoring compared with those monitored with the mobile app (median 30, IQR 23-32 vs median 22, IQR 14-28; P=.02). Conclusions: The use of the mobile app, AppO2 (SINCO), designed for the clinical monitoring of patients with COPD and HO therapy, is associated with improved quality of life. In addition, the app is highly accepted by users, promotes self-care, and fosters patient confidence in managing their own condition. Trial Registration: ClinicalTrials NCT04820790; https://clinicaltrials.gov/study/NCT04820790 International Registered Report Identifier (IRRID): RR2-https://doi.org/10.1186/s12875-021-01450-8 ",
doi="10.2196/65888",
url="https://www.jmir.org/2025/1/e65888"
}


@Article{info:doi/10.2196/54975,
author="Sang, Ling
and Zheng, Bixin
and Zeng, Xianzheng
and Liu, Huizhen
and Jiang, Qing
and Liu, Maotong
and Zhu, Chenyu
and Wang, Maoying
and Yi, Zengwei
and Song, Keyu
and Song, Li",
title="Effectiveness of Outpatient Chronic Pain Management for Middle-Aged Patients by Internet Hospitals: Retrospective Cohort Study",
journal="JMIR Med Inform",
year="2024",
month="Dec",
day="30",
volume="12",
pages="e54975",
keywords="chronic pain management",
keywords="internet hospital",
keywords="physical hospital",
keywords="quality of life",
keywords="outpatient care",
keywords="telemedicine",
keywords="digital health",
abstract="Background: Chronic pain is widespread and carries a heavy disease burden, and there is a lack of effective outpatient pain management. As an emerging internet medical platform in China, internet hospitals have been successfully applied for the management of chronic diseases. There are also a certain number of patients with chronic pain that use internet hospitals for pain management. However, no studies have investigated the effectiveness of pain management via internet hospitals. Objective: The aim of this retrospective cohort study was to explore the effectiveness of chronic pain management by internet hospitals and their advantages and disadvantages compared to traditional physical hospital visits. Methods: This was a retrospective cohort study. Demographic information such as the patient's sex, age, and number of visits was obtained from the IT center. During the first and last patient visits, information on outcome variables such as the Brief Pain Inventory (BPI), medical satisfaction, medical costs, and adverse drug events was obtained through a telephone follow-up. All patients with chronic pain who had 3 or more visits (internet or offline) between September 2021, and February 2023, were included. The patients were divided into an internet hospital group and a physical hospital group, according to whether they had web-based or in-person consultations, respectively. To control for confounding variables, propensity score matching was used to match the two groups. Matching variables included age, sex, diagnosis, and number of clinic visits. Results: A total of 122 people in the internet hospital group and 739 people in the physical hospital group met the inclusion criteria. After propensity score matching, 77 patients in each of the two groups were included in the analysis. There was not a significant difference in the quality of life (QOL; QOL assessment was part of the BPI scale) between the internet hospital group and the physical hospital group (P=.80), but the QOL of both groups of patients improved after pain management (internet hospital group: P<.001; physical hospital group: P=.001). There were no significant differences in the pain relief rate (P=.25) or the incidence of adverse events (P=.60) between the two groups. The total cost (P<.001) and treatment-related cost (P<.001) of the physical hospital group were higher than those of the internet hospital group. In addition, the degree of satisfaction in the internet hospital group was greater than that in the physical hospital group (P=.01). Conclusions: Internet hospitals are an effective way of managing chronic pain. They can improve patients' QOL and satisfaction, reduce treatment costs, and can be used as part of a multimodal strategy for chronic pain self-management. ",
doi="10.2196/54975",
url="https://medinform.jmir.org/2024/1/e54975"
}


@Article{info:doi/10.2196/60066,
author="Hodgson, William
and Kirk, Alison
and Lennon, Marilyn
and Janssen, Xanne",
title="Exploring the Use of Activity Trackers to Support Physical Activity and Reduce Sedentary Behavior in Adults Diagnosed With Type 2 Diabetes: Qualitative Interview Study Using the RE-AIM Framework",
journal="JMIR Diabetes",
year="2024",
month="Dec",
day="30",
volume="9",
pages="e60066",
keywords="type 2 diabetes",
keywords="physical activity",
keywords="sedentary behavior",
keywords="Fitbit",
keywords="activity tracker",
keywords="My Diabetes My Way",
keywords="RE-AIM framework",
keywords="diabetes care",
keywords="clinical care",
keywords="thematic analysis",
keywords="health promotion",
abstract="Background: The prevalence of type 2 diabetes in adults worldwide is increasing. Low levels of physical activity and sedentary behavior are major risk factors for developing the disease. Physical activity interventions incorporating activity trackers can reduce blood glucose levels in adults diagnosed with type 2 diabetes. The My Diabetes My Way website is a support and educational platform for people diagnosed with diabetes and health care professionals. Users of the My Diabetes My Way website can upload their Fitbit (Google Inc) activity data into the system but this is not presently being analyzed and used routinely within clinical care. Developers of the My Diabetes My Way system are planning to allow different makes of activity trackers to be integrated with the platform. Objective: This qualitative study aimed to explore (through the RE-AIM [reach, effectiveness, adoption, implementation, and maintenance] framework) views from adults diagnosed with type 2 diabetes and health care professionals on the integration of activity trackers into type 2 diabetes care. Methods: Overall, 12 adults diagnosed with type 2 diabetes and 9 health care professionals (4 general practitioners, 1 consultant, 2 diabetes nurses, 1 practice nurse, and 1 physical activity advisor) were recruited through social media and professional contacts. Semistructured one-to-one interviews were conducted. Abductive thematic analysis was undertaken, and main themes and subthemes were identified. The RE-AIM framework was used to evaluate the themes with respect to the wider use of activity trackers and the My Diabetes My Way platform within type 2 diabetes clinical care. Results: Overall, 6 main themes (awareness, access, cost, promotion, support, and technology and data) and 20 subthemes were identified. Evaluation using the 5 RE-AIM dimensions found that reach could be improved by raising awareness of the My Diabetes My Way platform and the ability to upload activity tracker data into the system. Effectiveness could be improved by implementing appropriate personalized measures of health benefits and providing appropriate support for patients and health care staff. Adoption could be improved by better promotion of the intervention among stakeholders and the development of joint procedures. Implementation could be improved through the development of an agreed protocol, staff training, and introducing measurements of costs. Maintenance could be improved by supporting all patients for long-term engagement and measuring improvements to patients' health. Conclusions: Through this study, we identified how the reach, effectiveness, adoption, implementation, and maintenance of integrating activity trackers into adult type 2 diabetes care could be improved. ",
doi="10.2196/60066",
url="https://diabetes.jmir.org/2024/1/e60066"
}


@Article{info:doi/10.2196/59333,
author="Apsey, Chloe
and Di Florio, Arianna
and Stawarz, Katarzyna",
title="Developing a Mood and Menstrual Tracking App for People With Premenstrual Dysphoric Disorder: User-Centered Design Study",
journal="JMIR Form Res",
year="2024",
month="Dec",
day="24",
volume="8",
pages="e59333",
keywords="premenstrual dysphoric disorder",
keywords="menstrual tracking",
keywords="mood tracking",
keywords="mobile health",
keywords="mHealth",
keywords="user-centered design",
keywords="menstrual",
keywords="tracking app",
keywords="hormonal fluctuations",
keywords="mood monitoring",
keywords="menstruation",
abstract="Background: People with premenstrual dysphoric disorder (PMDD) experience a range of symptoms that increase and decline as a result of the natural hormonal fluctuations of the menstrual cycle. For the diagnosis of PMDD, symptom severity needs to be recorded daily for at least two symptomatic cycles. In recent years, the rise in interest in Femtech (tools and technology developed to address women's health issues) has resulted in a large quantity of ``period-tracking apps'' being developed and downloaded. However, there is not currently a menstrual and mood tracking app that has the full capabilities to accurately capture the symptoms of PMDD to aid with diagnosis. Objective: This study aimed to collect feedback and insights from potential users (ie, people with lived experience of PMDD or severe premenstrual syndrome) to inform the development of a prototype app that could support prospective mood monitoring of PMDD symptoms for research, and to support diagnosis. Methods: We conducted two user-centered design studies. Study 1 consisted of 4 interviews with individual participants who had taken part in our previous web-based mood tracking study for PMDD. During the interviews, participants were encouraged to identify the strengths and weaknesses of the existing web-based mood tracking system. Study 2 consisted of 2 workshops with a total of 8 participants, in which participants were asked to discuss the needs and desirable features they would like in a PMDD-specific tracking app. Interviews and workshops were recorded, and the transcripts were analyzed inductively following a thematic approach. Results: A total of four themes were identified from the interviews and workshops with potential users: (1) ease of use as a key consideration for users with PMDD; (2) avoiding a reductionist approach for a broad range of symptoms; (3) recognizing the importance of correct language; and (4) integrating features for the users' benefits. These suggestions align with the current understanding of the implications of PMDD symptoms on daily activities and with findings from previous research on encouraging long-term engagement with apps. Conclusions: To meet the needs of potential users with PMDD or suspected PMDD, there needs to be a special consideration to how their symptoms impact the way they might interact with the app. In order for users to want to interact with the app daily, particularly during the days where they may not have symptoms to track, the app needs to be simple yet engaging. In addition, if the app provides insights and feedback that can benefit the well-being of the users, it is suggested that this could ensure prolonged use. ",
doi="10.2196/59333",
url="https://formative.jmir.org/2024/1/e59333"
}


@Article{info:doi/10.2196/56954,
author="Eze, E. Chinwe
and Dorsch, P. Michael
and Coe, B. Antoinette
and Lester, A. Corey
and Buis, R. Lorraine
and Farris, B. Karen",
title="Behavioral Factors Related to Participation in Remote Blood Pressure Monitoring Among Adults With Hypertension: Cross-Sectional Study",
journal="JMIR Form Res",
year="2024",
month="Dec",
day="23",
volume="8",
pages="e56954",
keywords="remote blood pressure monitoring",
keywords="telemonitoring",
keywords="hypertension",
keywords="blood pressure",
keywords="technology",
keywords="health behaviors",
keywords="quantitative",
keywords="cross-sectional study",
keywords="United States",
keywords="lack of awareness",
keywords="health information",
keywords="health provider",
keywords="electronic communication channels",
keywords="adult",
keywords="aging",
keywords="mobile phone",
abstract="Background: Remote blood pressure (BP) monitoring (RBPM) or BP telemonitoring is beneficial in hypertension management. People with hypertension involved in telemonitoring of BP often have better BP control than those in usual care. However, most reports on RBPM are from intervention studies. Objective: This study aimed to assess participant characteristics and technology health behaviors associated with RBPM participation in a wider population with hypertension. This study will help us understand the predictors of RBPM participation and consider how to increase it. Methods: This was a quantitative, cross-sectional survey study of people with hypertension in the United States. The inclusion criteria included people aged ?18 years with a hypertension diagnosis or who self-reported they have hypertension, had a prescription of at least one hypertension medication, understood the English language, and were willing to participate. The survey included demographics, technology health behaviors, and RBPM participation questions. The survey was self-administered on the Qualtrics platform and followed the CHERRIES (Checklist for Reporting Results of Internet E-Surveys) checklist. The primary dependent variable was participation in RBPM. Results: In total, 507 people with hypertension participated in the survey. The mean age for all respondents was 60 (SD 14.7) years. The respondents were mostly female (306/507, 60.4\%), non-Hispanic (483/507, 95.3\%), and White (429/507, 84.6\%). A little over half of the respondents reported having had hypertension for 5 years or more (287/507, 56.6\%). About one-third of participants were aware of RBPM (165/507, 32.5\%), and 11.8\% (60/507) were enrolled in RBPM. The mean age of those engaging in RBPM and non-RBPM was 46.2 (SD 14.7) and 62 (SD 13.7) years, respectively. The most common reasons for not participating in RBPM were because their health provider did not ask the participant to participate (247/447, 55.3\%) and their lack of awareness of RBPM (190/447, 42.5\%). Most respondents in the RBPM group measure their BP at home (55/60, 91.7\%), and 61.7\% (37/60) engage in daily BP measurement, compared with 62.6\% (280/447) and 25.1\% (112/447), respectively, among the non-RBPM group. A greater number of those in the RBPM group reported tracking their BP measurements with mobile health (mHealth; 37/60, 61.7\%) than those in the non-RBPM group (70/447, 15.6\%). The electronic health records or patient portal was the most common channel of RBPM communication between the respondents and their health care providers. The significant predictors of participation in RBPM were RBPM awareness (adjusted odds ratio [AOR] 34.65, 95\% CI 11.35?150.31; P<.001) and sharing health information electronically with a health provider (AOR 4.90, 95\% CI 1.39?21.64; P=.01) among all participants. However, the significant predictor of participation in RBPM among participants who were aware of RBPM was sharing health information electronically with a health provider (AOR 6.99, 95\% CI 1.62?47.44; P=.007). Conclusions: Participation in RBPM is likely to increase with increased awareness, health providers' recommendations, and tailoring RBPM services to patients' preferred electronic communication channels. ",
doi="10.2196/56954",
url="https://formative.jmir.org/2024/1/e56954"
}


@Article{info:doi/10.2196/48170,
author="Lally, Phillippa
and May, N. Christine
and Mitchell, Siobhan E.
and McCallum, Meaghan
and Michaelides, Andreas
and Fisher, Abigail",
title="Prototype of an App Designed to Support Self-Management for Health Behaviors and Weight in Women Living With Breast Cancer: Qualitative User Experience Study",
journal="JMIR Cancer",
year="2024",
month="Dec",
day="20",
volume="10",
pages="e48170",
keywords="breast cancer",
keywords="self-management",
keywords="app",
keywords="health behaviors",
keywords="weight",
keywords="prototype",
keywords="user experience",
keywords="development",
keywords="application",
keywords="coaching",
keywords="peer support",
keywords="oncology",
abstract="Background: Accessible self-management interventions are required to support people living with breast cancer. Objective: This was an industry-academic partnership study that aimed to collect qualitative user experience data of a prototype app with built-in peer and coach support designed to support the management of health behaviors and weight in women living with breast cancer. Methods: Participants were aged ?18 years, were diagnosed with breast cancer of any stage within the last 5 years, had completed active treatment, and were prescribed oral hormone therapy. Participants completed demographic surveys and were asked to use the app for 4 weeks. Following this, they took part in in-depth qualitative interviews about their experiences. These were analyzed using thematic analysis. Results: Eight participants (mean age, 45 years; mean time since diagnosis, 32 months) were included. Of the 8 participants, 7 (88\%) were white, 6 (75\%) had a graduate degree or above, and 6 (75\%) had stage I-III breast cancer. Four overarching themes were identified: (1) Support for providing an app earlier in the care pathway; (2) Desire for more weight-focused content tailored to the breast cancer experience; (3) Tracking of health behaviors that are generally popular; and (4) High value of in-app social support. Conclusions: This early user experience work showed that women with breast cancer found an app with integrated social and psychological support appealing to receive support for behavior change and weight management or self-management. However, many features were recommended for further development. This work is the first step in an academic-industry collaboration that would ultimately aim to develop and empirically test a supportive app that could be integrated into the cancer care pathway. ",
doi="10.2196/48170",
url="https://cancer.jmir.org/2024/1/e48170"
}


@Article{info:doi/10.2196/57774,
author="Mi, Z. Ranran
and Yang, Fan Ellie
and Tahk, Alexander
and Tarfa, Adati
and Cotter, M. Lynne
and Lu, Linqi
and Yang, Sijia
and Gustafson Sr, H. David
and Westergaard, Ryan
and Shah, Dhavan",
title="mHealth Engagement for Antiretroviral Medication Adherence Among People With HIV and Substance Use Disorders: Observational Study",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="20",
volume="26",
pages="e57774",
keywords="information and communication technologies",
keywords="ICTs",
keywords="mHealth",
keywords="medication adherence",
keywords="HIV care",
keywords="antiretroviral therapy",
keywords="substance use",
keywords="social support",
keywords="patient management",
keywords="health disparities",
keywords="information technology",
keywords="communication technology",
keywords="mobile health",
keywords="app",
keywords="clinic",
keywords="United States",
keywords="participants",
keywords="mobile phone",
abstract="Background: Despite the increasing popularity of mobile health (mHealth) technologies, little is known about which types of mHealth system engagement might affect the maintenance of antiretroviral therapy among people with HIV and substance use disorders. Objective: This study aimed to use longitudinal and detailed system logs and weekly survey data to test a mediation model, where mHealth engagement indicators were treated as predictors, substance use and confidence in HIV management were treated as joint mediators, and antiretroviral therapy adherence was treated as the outcome. We further distinguished the initiation and intensity of system engagement by mode (expression vs reception) and by communication levels (intraindividual vs dyadic vs network). Methods: Tailored for people with HIV living with substance use disorders, the mHealth app was distributed among 208 participants aged >18 years from 2 US health clinics. Supervised by medical professionals, participants received weekly surveys through the app to report their health status and medication adherence data. System use was passively collected through the app, operationalized as transformed click-level data, aggregated weekly, and connected to survey responses with a 7-day lagged window. Using the weekly check-in record provided by participants as the unit of analysis (N=681), linear regression and structure equation models with cluster-robust SEs were used for analyses, controlling within-person autocorrelation and group-level error correlations. Racial groups were examined as moderators in the structure equation models. Results: We found that (1) intensity, not initiation, of system use; (2) dyadic message expression and reception; and (3) network expression positively predicted medication adherence through joint mediators (substance use and confidence in HIV management). However, intraindividual reception (ie, rereading saved entries for personal motivation) negatively predicts medication adherence through joint mediators. We also found Black participants have distinct usage patterns, suggesting the need to tailor mHealth interventions for this subgroup. Conclusions: These findings highlight the importance of considering the intensity of system engagement, rather than initiation alone, when designing mHealth interventions for people with HIV and tailoring these systems to Black communities. ",
doi="10.2196/57774",
url="https://www.jmir.org/2024/1/e57774"
}


@Article{info:doi/10.2196/53677,
author="Bernard, M. Renaldo
and Seijas, Vanessa
and Davis, Micheal
and Volkova, Anel
and Diviani, Nicola
and L{\"u}scher, Janina
and Sabariego, Carla",
title="Self-Management Support Apps for Spinal Cord Injury: Results of a Systematic Search in App Stores and Mobile App Rating Scale Evaluation",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Dec",
day="19",
volume="12",
pages="e53677",
keywords="mobile phone",
keywords="mobile health",
keywords="mHealth",
keywords="eHealth",
keywords="telemedicine",
keywords="telehealth",
keywords="spinal cord injury",
keywords="self-management",
keywords="internet-based intervention",
keywords="world wide web",
keywords="systematic review",
keywords="review",
abstract="Background: The use of mobile technology to meet health needs, widely referred to as mobile health (mHealth), has played a critical role in providing self-management support for chronic health conditions. However, despite its potential benefits, mHealth technologies such as self-management support apps for spinal cord injury (SCI) have received little research attention, and an understanding of their public availability is lacking. Therefore, an overview of these apps is needed to complement findings from the literature for a complete understanding of mHealth self-management support tools for SCI to support the selection and improvement of existing apps and the development of new ones. Objective: This study aimed to identify and describe quantity, quality, focus, strengths, and weaknesses of self-management support apps for SCI available on major mobile app digital distribution platforms. Methods: A systematic search of the Google Play Store and Apple App Store was conducted to identify and summarize apps for SCI that have been updated since 2017. A supplementary systematic literature review was conducted across 11 bibliographic databases to identify publications that provided more detailed descriptions of the identified apps than what is typically available in app stores. The data synthesis was guided by self-management tasks and skills taxonomies. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines informed the reporting. Results: The 13 apps included in the final synthesis were launched between 2013 and 2021, mostly originating in the United States, with availability in 72 countries and support for 14 languages. Most apps used the Android operating system (10/13, 77\%), while 31\% (4/13) used iOS. The identified apps mainly focused on activities of daily living, physical activity promotion, health literacy, and therapeutic exercise. All 3 self-management tasks (medical, role, and emotional management) and most self-management skills and support activities were supported by the apps. The mean Mobile App Rating Scale score was 3.86 (SD 0.54), indicating good overall quality. No publications were found describing these apps. Conclusions: Despite their good overall quality, as measured by the Mobile App Rating Scale assessment, the 13 identified apps, alone or combined, do not appear to offer a comprehensive self-management approach that incorporates theory-based strategies. Besides working to improve comprehensiveness, future research and practice should consider adopting new technologies, such as artificial intelligence, to enhance future self-management support apps for SCI. Furthermore, adopting new app development methods, such as low-code development platforms, could help reduce barriers to development, such as time, cost, and securing scarce expertise. ",
doi="10.2196/53677",
url="https://mhealth.jmir.org/2024/1/e53677"
}


@Article{info:doi/10.2196/56917,
author="van Leersum, Margaretha Catharina
and Bults, Marloes
and Siebrand, Egbert
and Olthuis, Josef Theodorus Johannes
and Bekhuis, Marije Robin Enya
and Konijnendijk, Johanneke Annemieke Ari{\"e}nne
and den Ouden, Maria Marjolein Elisabeth",
title="Exploring Opportunities and Challenges for the Spread, Scale-Up, and Sustainability of mHealth Apps for Self-Management of Patients With Type 2 Diabetes Mellitus in the Netherlands: Citizen Science Approach",
journal="JMIR Diabetes",
year="2024",
month="Dec",
day="17",
volume="9",
pages="e56917",
keywords="mHealth",
keywords="type 2 diabetes mellitus",
keywords="implementation",
keywords="self-management",
keywords="health care system",
keywords="citizen science",
keywords="mobile health",
keywords="mobile app",
keywords="digital health",
keywords="digital technology",
keywords="digital intervention",
keywords="smartphone",
keywords="diabetes",
keywords="DM",
keywords="type 2 diabetes",
keywords="type 1 diabetes",
abstract="Background: Technologies evolve at a breakneck pace, and the success of mobile health (mHealth) for people with type 2 diabetes mellitus (T2DM) depends on whether health care professionals, care management, government regulators, and consumers will adopt the technology as a viable solution to enhance patient self-management. Objective: In this study, we explored the challenges of the implementation of mHealth apps in care for patients with T2DM and determined to what extent these challenges complicate the dissemination, limit scale-up, and influence the sustainability of technological interventions for patients with T2DM. Methods: The nonadoption, abandonment, and challenges to scale-up, spread, and sustainability (NASSS) framework served as the basis for our study. The 7 domains of the NASSS framework were explored with a citizen science approach using questionnaires, semistructured in-depth interviews, and focus groups together with patients with T2DM, care professionals, technology developers, policy officers, and a patient organization. Results: Regarding the domain ``condition,'' being aware of their condition and changing lifestyle were crucial for patients with T2DM to get to grips with their life. The rapid development of health apps for T2DM was highlighted in the domain ``technology.'' Users should be aware of these apps and know how to use them. The domain ``value proposition'' included the patient perspective and elaborated on personal values, as well as care professionals who focus on personalized care and pressure on health care. Regarding the ``adopters,'' it is crucial to know who needs to use and introduce the apps. Responsibility, a shared vision, and resistance among care professionals were mentioned as important determinants for ``organization.'' Finally, the domain ``wider system'' showed the importance of involving multiple institutes, care guidelines, and reimbursements. Conclusions: This study investigated the implementation of mHealth apps in an early stage of the implementation process. Key stakeholders were involved, who attributed to the possibilities and limitations of the implementation. It is crucial to have a clear vision from an organizational perspective and specific prerequisites for implementation strategies at micro, meso, and macro levels. Essential strategies at the national level include guidelines for regulations, privacy, and security; the integration of mHealth into T2DM care guidelines; and sufficient reimbursement by health insurers. ",
doi="10.2196/56917",
url="https://diabetes.jmir.org/2024/1/e56917"
}


@Article{info:doi/10.2196/65469,
author="Wickham, P. Aidan
and Hewings-Martin, Yella
and Goddard, GB Frederick
and Rodgers, K. Allison
and Cunningham, C. Adam
and Prentice, Carley
and Wilks, Octavia
and Kaplan, C. Yusuf
and Marhol, Andrei
and Meczner, Andr{\'a}s
and Stsefanovich, Heorhi
and Klepchukova, Anna
and Zhaunova, Liudmila",
title="Exploring Self-Reported Symptoms for Developing and Evaluating Digital Symptom Checkers for Polycystic Ovarian Syndrome, Endometriosis, and Uterine Fibroids: Exploratory Survey Study",
journal="JMIR Form Res",
year="2024",
month="Dec",
day="12",
volume="8",
pages="e65469",
keywords="polycystic ovary syndrome",
keywords="PCOS",
keywords="self-assessment",
keywords="self-reported",
keywords="endometriosis",
keywords="uterine fibroids",
keywords="symptoms",
keywords="digital symptom checker",
keywords="women's health",
keywords="gynecological conditions",
keywords="reproductive health",
abstract="Background: Reproductive health conditions such as polycystic ovary syndrome (PCOS), endometriosis, and uterine fibroids pose a significant burden to people who menstruate, health care systems, and economies. Despite clinical guidelines for each condition, prolonged delays in diagnosis are commonplace, resulting in an increase to health care costs and risk of health complications. Symptom checker apps have the potential to significantly reduce time to diagnosis by providing users with health information and tools to better understand their symptoms. Objective: This study aims to study the prevalence and predictive importance of self-reported symptoms of PCOS, endometriosis, and uterine fibroids, and to explore the efficacy of 3 symptom checkers (developed by Flo Health UK Limited) that use self-reported symptoms when screening for each condition. Methods: Flo's symptom checkers were transcribed into separate web-based surveys for PCOS, endometriosis, and uterine fibroids, asking respondents their diagnostic history for each condition. Participants were aged 18 years or older, female, and living in the United States. Participants either had a confirmed diagnosis (condition-positive) and reported symptoms retrospectively as experienced at the time of diagnosis, or they had not been examined for the condition (condition-negative) and reported their current symptoms as experienced at the time of surveying. Symptom prevalence was calculated for each condition based on the surveys. Least absolute shrinkage and selection operator regression was used to identify key symptoms for predicting each condition. Participants' symptoms were processed by Flo's 3 single-condition symptom checkers, and accuracy was assessed by comparing the symptom checker output with the participant's condition designation. Results: A total of 1317 participants were included with 418, 476, and 423 in the PCOS, endometriosis, and uterine fibroids groups, respectively. The most prevalent symptoms for PCOS were fatigue (92\%), feeling anxious (87\%), BMI over 25 (84\%); for endometriosis: very regular lower abdominal pain (89\%), fatigue (85\%), and referred lower back pain (80\%); for uterine fibroids: fatigue (76\%), bloating (69\%), and changing sanitary protection often (68\%). Symptoms of anovulation and amenorrhea (long periods, irregular cycles, and absent periods), and hyperandrogenism (excess hair on chin and abdomen, scalp hair loss, and BMI over 25) were identified as the most predictive symptoms for PCOS, while symptoms related to abdominal pain and the effect pain has on life, bleeding, and fertility complications were among the most predictive symptoms for both endometriosis and uterine fibroids. Symptom checker accuracy was 78\%, 73\%, and 75\% for PCOS, endometriosis, and uterine fibroids, respectively. Conclusions: This exploratory study characterizes self-reported symptomatology and identifies the key predictive symptoms for 3 reproductive conditions. The Flo symptom checkers were evaluated using real, self-reported symptoms and demonstrated high levels of accuracy. ",
doi="10.2196/65469",
url="https://formative.jmir.org/2024/1/e65469"
}


@Article{info:doi/10.2196/53576,
author="Pong, Candelyn
and Tseng, Wen Rachel Marjorie Wei
and Tham, Chung Yih
and Lum, Elaine",
title="Current Implementation of Digital Health in Chronic Disease Management: Scoping Review",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="12",
volume="26",
pages="e53576",
keywords="digital health",
keywords="telemedicine",
keywords="chronic disease",
keywords="noncommunicable disease",
keywords="implementation science",
keywords="evidence-based practice",
keywords="mobile phone",
abstract="Background: Approximately 1 in 3 adults live with multiple chronic diseases. Digital health is being harnessed to improve continuity of care and management of chronic diseases. However, meaningful uptake of digital health for chronic disease management remains low. It is unclear how these innovations have been implemented and evaluated. Objective: This scoping review aims to identify how digital health innovations for chronic disease management have been implemented and evaluated: what implementation frameworks, methods, and strategies were used; how successful these strategies were; key barriers and enablers to implementation; and lessons learned and recommendations shared by study authors. Methods: We used the Joanna Briggs Institute methodology for scoping reviews. Five databases were searched for studies published between January 2015 and March 2023: PubMed, Scopus, CINAHL, PsycINFO, and IEEE Xplore. We included primary studies of any study design with any type of digital health innovations for chronic diseases that benefit patients, caregivers, or health care professionals. We extracted study characteristics; type of digital health innovation; implementation frameworks, strategies, and outcome measures used; barriers and enablers to implementation; lessons learned; and recommendations reported by study authors. We used established taxonomies to synthesize extracted data. Extracted barriers and enablers were grouped into categories for reporting. Descriptive statistics were used to consolidate extracted data. Results: A total of 252 studies were included, comprising mainly mobile health (107/252, 42.5\%), eHealth (61/252, 24.2\%), and telehealth (97/252, 38.5\%), with some studies involving more than 1 innovation. Only 23 studies (23/252, 9.1\%) reported using an implementation science theory, model, or framework; the most common were implementation theories, classic theories, and determinant frameworks, with 7 studies each. Of 252 studies, 144 (57.1\%) used 2 to 5 implementation strategies. Frequently used strategies were ``obtain and use patient or consumer feedback'' (196/252, 77.8\%); ``audit and provide feedback'' (106/252, 42.1\%); and piloting before implementation or ``stage implementation scale-up'' (85/252, 33.7\%). Commonly measured implementation outcomes were acceptability, feasibility, and adoption of the digital innovation. Of 252 studies, 247 studies (98\%) did not measure service outcomes, while patient health outcomes were measured in 89 studies (35.3\%). The main method used to assess outcomes was surveys (173/252, 68.7\%), followed by interviews (95/252, 37.7\%). Key barriers impacting implementation were data privacy concerns and patient preference for in-person consultations. Key enablers were training for health care workers and personalization of digital health features to patient needs. Conclusions: This review generated a summary of how digital health in chronic disease management is currently implemented and evaluated and serves as a useful resource for clinicians, researchers, health system managers, and policy makers planning real-world implementation. Future studies should investigate whether using implementation science frameworks, including how well they are used, would yield better outcomes compared to not using them. ",
doi="10.2196/53576",
url="https://www.jmir.org/2024/1/e53576"
}


@Article{info:doi/10.2196/53873,
author="Lee, Kiseong
and Chung, Yoongi
and Kim, Ji-Su",
title="Research Trends on Metabolic Syndrome in Digital Health Care Using Topic Modeling: Systematic Search of Abstracts",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="12",
volume="26",
pages="e53873",
keywords="metabolic syndrome",
keywords="digital health care",
keywords="topic modeling",
keywords="text network analysis",
keywords="research trends",
keywords="prevention",
keywords="management",
keywords="telemedicine",
keywords="wearable",
keywords="devices",
keywords="apps",
keywords="applications",
keywords="methodological",
keywords="cardiovascular disease",
abstract="Background: Metabolic syndrome (MetS) is a prevalent health condition that affects 20\%-40\% of the global population. Lifestyle modification is essential for the prevention and management of MetS. Digital health care, which incorporates technologies like wearable devices, mobile apps, and telemedicine, is increasingly becoming integral to health care systems. By analyzing existing research trends in the application of digital health care for MetS management, this study identifies gaps in current knowledge and suggests avenues for future research. Objective: This study aimed to identify core keywords, topics, and research trends concerning the use of digital health care in the management of MetS. Methods: A systematic search of abstracts from peer-reviewed papers was conducted across 6 academic databases. Following eligibility screening, 162 abstracts were selected for further analysis. The methodological approach included text preprocessing, text network analysis, and topic modeling using the BERTopic algorithm. Results: Analysis of the 162 selected abstracts yielded a keyword network comprising 1047 nodes and 34,377 edges. The top 5 core keywords were identified as ``MetS,'' ``use,'' ``patient,'' ``health,'' and ``intervention.'' We identified 12 unique topics, with topic 1 focusing on the use of telehealth for self-management of diabetes. The diversity of the 12 topics reflected various aspects of digital health care, including telehealth for diabetes management, electronic health records for MetS complications, and wearable devices for monitoring metabolic status. Research trends showed an expanding field of precision medicine driven by the demand for tailored interventions and the significant impact of the COVID-19 pandemic. Conclusions: By analyzing past research trends and extracting data from scholarly databases, this study has provided valuable insights that can guide future investigations in the field of digital health care and MetS management. ",
doi="10.2196/53873",
url="https://www.jmir.org/2024/1/e53873",
url="http://www.ncbi.nlm.nih.gov/pubmed/39666378"
}


@Article{info:doi/10.2196/54678,
author="Ong, Anthony
and Wilcox, Kenneth
and Reid, Carrington M.
and Wethington, Elaine
and Cintron, Dakota
and Addington, Elizabeth
and Goktas, Selin
and Moskowitz, Judith",
title="Targeting Daily Positive Events to Improve Emotional and Functional Well-Being in Adults With Fibromyalgia: Insights From the LARKSPUR Randomized Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="10",
volume="26",
pages="e54678",
keywords="positive affect",
keywords="chronic pain",
keywords="chronic condition",
keywords="long-term pain",
keywords="positive psychology",
keywords="positive events",
keywords="fibromyalgia",
keywords="mHealth",
keywords="app",
keywords="digital technology",
keywords="digital interventions",
keywords="gerontology",
keywords="geriatrics",
keywords="older adult",
keywords="aging",
keywords="well-being",
abstract="Background: Fibromyalgia is a chronic pain condition characterized by widespread musculoskeletal pain, fatigue, and cognitive difficulties, affecting individuals across all age groups. Positive affect (PA) interventions have shown promise in enhancing emotional well-being and pain management in patients with diverse chronic pain conditions. However, the efficacy of internet-delivered PA interventions for individuals with fibromyalgia remains understudied. Objective: This randomized controlled trial investigated the efficacy of a web-based PA regulation intervention---Lessons in Affect Regulation to Keep Stress and Pain Under Control (LARKSPUR)---in enhancing emotional and functional well-being among adults with fibromyalgia syndrome. Methods: A total of 95 participants with fibromyalgia syndrome aged 50 years and older (89/95, 94\% female) were randomized to one of two fully automated conditions: (1) LARKSPUR (n=49) or (2) emotion reporting/attention control (n=46). At the postintervention and 1-month follow-up time points, participants completed 7 consecutive, end-of-day, web-based reports capturing positive events (PE), pain, fatigue, PA, and negative affect. Results: Compared to control, LARKSPUR resulted in greater improvements in daily affective responsivity to PE at the postintervention time point, including greater reductions in negative affect (bL--bC=--0.06, 95\% highest posterior density interval [HPD] --0.10 to --0.02) and increases in PA (bL--bC=0.10, 95\% HPD 0.02-0.19). Furthermore, across the postintervention and 1-month follow-up time points, LARKSPUR led to greater reductions in pain (bL--bC=--0.20, 95\% HPD --0.36 to --0.04) and fatigue (bL--bC=--0.24, 95\% HPD --0.41 to --0.06) following PE. Conclusions: This randomized controlled trial provides initial evidence that a web-based PA skills intervention can enhance emotional well-being and reduce pain and fatigue in aging adults with fibromyalgia. Trial Registration: ClinicalTrials.gov NCT04869345; https://clinicaltrials.gov/study/NCT04869345 ",
doi="10.2196/54678",
url="https://www.jmir.org/2024/1/e54678"
}


@Article{info:doi/10.2196/55925,
author="Gagnon, Marie-Pierre
and Ouellet, Steven
and Attisso, Eug{\`e}ne
and Supper, Wilfried
and Amil, Samira
and Rh{\'e}aume, Caroline
and Paquette, Jean-S{\'e}bastien
and Chabot, Christian
and Laferri{\`e}re, Marie-Claude
and Sasseville, Maxime",
title="Wearable Devices for Supporting Chronic Disease Self-Management: Scoping Review",
journal="Interact J Med Res",
year="2024",
month="Dec",
day="9",
volume="13",
pages="e55925",
keywords="chronic diseases",
keywords="self-care",
keywords="self-management",
keywords="empowerment",
keywords="mobile health",
keywords="mHealth",
keywords="wearable",
keywords="devices",
keywords="scoping",
keywords="review",
keywords="mobile phone",
keywords="PRISMA",
abstract="Background: People with chronic diseases can benefit from wearable devices in managing their health and encouraging healthy lifestyle habits. Wearables such as activity trackers or blood glucose monitoring devices can lead to positive health impacts, including improved physical activity adherence or better management of type 2 diabetes. Few literature reviews have focused on the intersection of various chronic diseases, the wearable devices used, and the outcomes evaluated in intervention studies, particularly in the context of primary health care. Objective: This study aims to identify and describe (1) the chronic diseases represented in intervention studies, (2) the types or combinations of wearables used, and (3) the health or health care outcomes assessed and measured. Methods: We conducted a scoping review following the Joanna Briggs Institute guidelines, searching the MEDLINE and Web of Science databases for studies published between 2012 and 2022. Pairs of reviewers independently screened titles and abstracts, applied the selection criteria, and performed full-text screening. We included interventions using wearables that automatically collected and transmitted data to adult populations with at least one chronic disease. We excluded studies with participants with only a predisposition to develop a chronic disease, hospitalized patients, patients with acute diseases, patients with active cancer, and cancer survivors. We included randomized controlled trials and cohort, pretest-posttest, observational, mixed methods, and qualitative studies. Results: After the removal of 1987 duplicates, we screened 4540 titles and abstracts. Of the remaining 304 articles after exclusions, we excluded 215 (70.7\%) full texts and included 89 (29.3\%). Of these 89 texts, 10 (11\%) were related to the same interventions as those in the included studies, resulting in 79 studies being included. We structured the results according to chronic disease clusters: (1) diabetes, (2) heart failure, (3) other cardiovascular conditions, (4) hypertension, (5) multimorbidity and other combinations of chronic conditions, (6) chronic obstructive pulmonary disease, (7) chronic pain, (8) musculoskeletal conditions, and (9) asthma. Diabetes was the most frequent health condition (18/79, 23\% of the studies), and wearable activity trackers were the most used (42/79, 53\% of the studies). In the 79 included studies, 74 clinical, 73 behavioral, 36 patient technology experience, 28 health care system, and 25 holistic or biopsychosocial outcomes were reported. Conclusions: This scoping review provides an overview of the wearable devices used in chronic disease self-management intervention studies, revealing disparities in both the range of chronic diseases studied and the variety of wearable devices used. These findings offer researchers valuable insights to further explore health care outcomes, validate the impact of concomitant device use, and expand their use to other chronic diseases. Trial Registration: Open Science Framework Registries (OSF) s4wfm; https://osf.io/s4wfm ",
doi="10.2196/55925",
url="https://www.i-jmr.org/2024/1/e55925"
}


@Article{info:doi/10.2196/55161,
author="Wetzel, Anna-Jasmin
and Preiser, Christine
and M{\"u}ller, Regina
and Joos, Stefanie
and Koch, Roland
and Henking, Tanja
and Haumann, Hannah",
title="Unveiling Usage Patterns and Explaining Usage of Symptom Checker Apps: Explorative Longitudinal Mixed Methods Study",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="9",
volume="26",
pages="e55161",
keywords="self-triage",
keywords="eHealth",
keywords="self-diagnosis",
keywords="mHealth",
keywords="mobile health",
keywords="usage",
keywords="patterns",
keywords="predicts",
keywords="prediction",
keywords="symptoms checker",
keywords="apps",
keywords="applications",
keywords="explorative longitudinal study",
keywords="self care",
keywords="self management",
keywords="self-rated",
keywords="mixed method",
keywords="circumstances",
keywords="General Linear Mixed Models",
keywords="GLMM",
keywords="qualitative data",
keywords="content analysis",
keywords="Kuckartz",
keywords="survey",
keywords="participants",
keywords="users",
abstract="Background: Symptom checker apps (SCA) aim to enable individuals without medical training to classify perceived symptoms and receive guidance on appropriate actions, such as self-care or seeking professional medical attention. However, there is a lack of detailed understanding regarding the contexts in which individuals use SCA and their opinions on these tools. Objective: This mixed methods study aims to explore the circumstances under which medical laypeople use SCA and to identify which aspects users find noteworthy after using SCA. Methods: A total of 48 SCA users documented their medical symptoms, provided open-ended responses, and recorded their SCA use along with other variables over 6 weeks in a longitudinal study. Generalized linear mixed models with and those without regularization were applied to consider the hierarchical structure of the data, and the models' outcomes were evaluated for comparison. Qualitative data were analyzed through Kuckartz qualitative content analysis. Results: Significant predictors of SCA use included the initial occurrence of symptoms, day of measurement (odds ratio [OR] 0.97), self-rated health (OR 0.80, P<.001), and the following International Classification in Primary Care-2--classified symptoms, that are general and unspecified (OR 3.33, P<.001), eye (OR 5.56, P=.001), cardiovascular (OR 8.33, P<.001), musculoskeletal (OR 5.26, P<.001), and skin (OR 4.76, P<.001). The day of measurement and self-rated health showed minor importance due to their small effect sizes. Qualitative analysis highlighted four main themes: (1) reasons for using SCA, (2) diverse affective responses, (3) a broad spectrum of behavioral reactions, and (4) unmet needs including a lack of personalization. Conclusions: The emergence of new and unfamiliar symptoms was a strong determinant for SCA use. Specific International Classification in Primary Care--rated symptom clusters, particularly those related to cardiovascular, eye, skin, general, and unspecified symptoms, were also highly predictive of SCA use. The varied applications of SCA fit into the concept of health literacy as bricolage, where SCA is leveraged as flexible tools by patients based on individual and situational requirements, functioning alongside other health care resources. ",
doi="10.2196/55161",
url="https://www.jmir.org/2024/1/e55161"
}


@Article{info:doi/10.2196/59588,
author="Gustafson Sr, H. David
and Mares, Marie-Louise
and Johnston, Darcie
and Vjorn, J. Olivia
and Curtin, J. John
and Landucci, Gina
and Pe-Romashko, Klaren
and Gustafson Jr, H. David
and Shah, V. Dhavan",
title="An eHealth Intervention to Improve Quality of Life, Socioemotional, and Health-Related Measures Among Older Adults With Multiple Chronic Conditions: Randomized Controlled Trial",
journal="JMIR Aging",
year="2024",
month="Dec",
day="6",
volume="7",
pages="e59588",
keywords="eHealth",
keywords="telemedicine",
keywords="aged",
keywords="geriatrics",
keywords="multiple chronic conditions",
keywords="social support",
keywords="quality of life",
keywords="primary care",
keywords="mobile phone",
keywords="smartphone",
abstract="Background: In the United States, over 60\% of adults aged 65 years or older have multiple chronic health conditions, with consequences that include reduced quality of life, increasingly complex but less person-centered treatment, and higher health care costs. A previous trial of ElderTree, an eHealth intervention for older adults, found socioemotional benefits for those with high rates of primary care use. Objective: This study tested the effectiveness of an ElderTree intervention designed specifically for older patients with multiple chronic conditions to determine whether combining it with primary care improved socioemotional and physical outcomes. Methods: In a nonblinded randomized controlled trial, 346 participants recruited from primary care clinics were assigned 1:1 to the ElderTree intervention or an attention control and were followed for 12 months. All participants were aged 65 years or older and had electronic health record diagnoses of at least three of 11 chronic conditions. Primary outcomes were mental and physical quality of life, psychological well-being (feelings of competence, connectedness, meaningfulness, and optimism), and loneliness. Tested mediators of the effects of the study arm (ElderTree vs active control) on changes in primary outcomes over time were 6-month changes in health coping, motivation, feelings of relatedness, depression, and anxiety. Tested moderators were sex, scheduled health care use, and number of chronic conditions. Data sources were surveys at baseline and 6 and 12 months comprising validated scales, and continuously collected ElderTree usage. Results: At 12 months, 76.1\% (134/176) of ElderTree participants were still using the intervention. There was a significant effect of ElderTree (vs control) on improvements over 12 months in mental quality of life (arm {\texttimes} timepoint interaction: b=0.76, 95\% CI 0.14-1.37; P=.02; 12-month ?d=0.15) but no such effect on the other primary outcomes of physical quality of life, psychological well-being, or loneliness. Sex moderated the effects of the study arm over time on mental quality of life (b=1.33, 95\% CI 0.09-2.58; P=.04) and psychological well-being (b=1.13, 95\% CI 0.13-2.12; P=.03), with stronger effects for women than men. The effect of the study arm on mental quality of life was mediated by 6-month improvements in relatedness ($\alpha$=1.25, P=.04; b=0.31, P<.001). Analyses of secondary and exploratory outcomes showed minimal effects of ElderTree. Conclusions: Consistent with the previous iteration of ElderTree, the current iteration designed for older patients with multiple chronic conditions showed signs of improving socioemotional outcomes but no impact on physical outcomes. This may reflect the choice of chronic conditions for inclusion, which need not have impinged on patients' physical quality of life. Two ongoing trials are testing more specific versions of ElderTree targeting older patients coping with (1) chronic pain and (2) greater debilitation owing to at least 5 chronic conditions. Trial Registration: ClinicalTrials.gov NCT03387735; https://clinicaltrials.gov/study/NCT03387735 International Registered Report Identifier (IRRID): RR2-10.2196/25175 ",
doi="10.2196/59588",
url="https://aging.jmir.org/2024/1/e59588"
}


@Article{info:doi/10.2196/55635,
author="Lee, Ting-Yi
and Chen, Ching-Hsuan
and Chen, I-Ming
and Chen, Hsi-Chung
and Liu, Chih-Min
and Wu, Shu-I
and Hsiao, Kate Chuhsing
and Kuo, Po-Hsiu",
title="Dynamic Bidirectional Associations Between Global Positioning System Mobility and Ecological Momentary Assessment of Mood Symptoms in Mood Disorders: Prospective Cohort Study",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="6",
volume="26",
pages="e55635",
keywords="ecological momentary assessment",
keywords="digital phenotyping",
keywords="GPS mobility",
keywords="bipolar disorder",
keywords="major depressive disorder",
keywords="GPS",
keywords="global positioning system",
keywords="mood disorders",
keywords="assessment",
keywords="depression",
keywords="anxiety",
keywords="digital phenotype",
keywords="smartphone app",
keywords="technology",
keywords="behavioral changes",
keywords="patient",
keywords="monitoring",
abstract="Background: Although significant research has explored the digital phenotype in mood disorders, the time-lagged and bidirectional relationship between mood and global positioning system (GPS) mobility remains relatively unexplored. Leveraging the widespread use of smartphones, we examined correlations between mood and behavioral changes, which could inform future scalable interventions and personalized mental health monitoring. Objective: This study aims to investigate the bidirectional time lag relationships between passive GPS data and active ecological momentary assessment (EMA) data collected via smartphone app technology. Methods: Between March 2020 and May 2022, we recruited 45 participants (mean age 42.3 years, SD 12.1 years) who were followed up for 6 months: 35 individuals diagnosed with mood disorders referred by psychiatrists and 10 healthy control participants. This resulted in a total of 5248 person-days of data. Over 6 months, we collected 2 types of smartphone data: passive data on movement patterns with nearly 100,000 GPS data points per individual and active data through EMA capturing daily mood levels, including fatigue, irritability, depressed, and manic mood. Our study is limited to Android users due to operating system constraints. Results: Our findings revealed a significant negative correlation between normalized entropy (r=--0.353; P=.04) and weekly depressed mood as well as between location variance (r=--0.364; P=.03) and depressed mood. In participants with mood disorders, we observed bidirectional time-lagged associations. Specifically, changes in homestay were positively associated with fatigue ($\beta$=0.256; P=.03), depressed mood ($\beta$=0.235; P=.01), and irritability ($\beta$=0.149; P=.03). A decrease in location variance was significantly associated with higher depressed mood the following day ($\beta$=--0.015; P=.009). Conversely, an increase in depressed mood was significantly associated with reduced location variance the next day ($\beta$=--0.869; P<.001). These findings suggest a dynamic interplay between mood symptoms and mobility patterns. Conclusions: This study demonstrates the potential of utilizing active EMA data to assess mood levels and passive GPS data to analyze mobility behaviors, with implications for managing disease progression in patients. Monitoring location variance and homestay can provide valuable insights into this process. The daily use of smartphones has proven to be a convenient method for monitoring patients' conditions. Interventions should prioritize promoting physical movement while discouraging prolonged periods of staying at home. ",
doi="10.2196/55635",
url="https://www.jmir.org/2024/1/e55635"
}


@Article{info:doi/10.2196/60380,
author="Wu, Yibo
and Zhang, Jinzi
and Ge, Pu
and Duan, Tingyu
and Zhou, Junyu
and Wu, Yiwei
and Zhang, Yuening
and Liu, Siyu
and Liu, Xinyi
and Wan, Erya
and Sun, Xinying",
title="Application of Chatbots to Help Patients Self-Manage Diabetes: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="3",
volume="26",
pages="e60380",
keywords="artificial intelligence",
keywords="chatbot",
keywords="diabetes",
keywords="health education",
keywords="self-management",
keywords="systematic review",
abstract="Background: The number of people with diabetes is on the rise globally. Self-management and health education of patients are the keys to control diabetes. With the development of digital therapies and artificial intelligence, chatbots have the potential to provide health-related information and improve accessibility and effectiveness in the field of patient self-management. Objective: This study systematically reviews the current research status and effectiveness of chatbots in the field of diabetes self-management to support the development of diabetes chatbots. Methods: A systematic review and meta-analysis of chatbots that can help patients with diabetes with self-management was conducted. PubMed and Web of Science databases were searched using keywords around diabetes, chatbots, conversational agents, virtual assistants, and more. The search period was from the date of creation of the databases to January 1, 2023. Research articles in English that fit the study topic were selected, and articles that did not fit the study topic or were not available in full text were excluded. Results: In total, 25 studies were included in the review. In terms of study type, all articles could be classified as systematic design studies (n=8, 32\%), pilot studies (n=8, 32\%), and intervention studies (n=9, 36\%). Many articles adopted a nonrandomized controlled trial design in intervention studies (n=6, 24\%), and there was only 1 (4\%) randomized controlled trial. In terms of research strategy, all articles can be divided into quantitative studies (n=10, 40\%), mixed studies (n=6, 24\%), and qualitative studies (n=1, 4\%). The evaluation criteria for chatbot effectiveness can be divided into technical performance evaluation, user experience evaluation, and user health evaluation. Most chatbots (n=17, 68\%) provided education and management focused on patient diet, exercise, glucose monitoring, medications, and complications, and only a few studies (n=2, 8\%) provided education on mental health. The meta-analysis found that the chatbot intervention was effective in lowering blood glucose (mean difference 0.30, 95\% CI 0.04-0.55; P=.02) and had no significant effect in reducing weight (mean difference 1.41, 95\% CI --2.29 to 5.11; P=.46) compared with the baseline. Conclusions: Chatbots have potential for the development of self-management for people with diabetes. However, the evidence level of current research is low, and higher level research (such as randomized controlled trials) is needed to strengthen the evidence base. More use of mixed research in the research strategy is needed to fully use the strengths of both quantitative and qualitative research. Appropriate and innovative theoretical frameworks should be used in the research to provide theoretical support for the study. In addition, researchers should focus on the personalized and user-friendly interactive features of chatbots, as well as improvements in study design. ",
doi="10.2196/60380",
url="https://www.jmir.org/2024/1/e60380"
}


@Article{info:doi/10.2196/60892,
author="Oppelaar, C. Martinus
and van Helvoort, AC Hanneke
and Bannier, AGE Michiel
and Reijers, HE Monique
and van der Vaart, Hester
and van der Meer, Renske
and Altenburg, Josje
and Conemans, Lennart
and Rottier, L. Bart
and Nuijsink, Marianne
and van den Wijngaart, S. Lara
and Merkus, JFM Peter
and Roukema, Jolt",
title="Accuracy, Reproducibility, and Responsiveness to Treatment of Home Spirometry in Cystic Fibrosis: Multicenter, Retrospective, Observational Study",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="3",
volume="26",
pages="e60892",
keywords="telemonitoring",
keywords="digital health",
keywords="telespirometry",
keywords="remote monitoring",
keywords="cystic fibrosis",
keywords="pediatrics",
keywords="reliability",
keywords="mobile phone",
keywords="hereditary",
keywords="chronic pulmonary inflammation",
keywords="pulmonary infections",
keywords="morbidity",
keywords="mortality",
keywords="chronic respiratory disease",
abstract="Background: Portable spirometers are increasingly used to measure lung function at home, but doubts about the accuracy of these devices persist. These doubts stand in the way of the digital transition of chronic respiratory disease care, hence there is a need to address the accuracy of home spirometry in routine care across multiple settings and ages. Objective: This study aimed to assess the accuracy, reproducibility, and responsiveness to the treatment of home spirometry in long-term pediatric and adult cystic fibrosis care. Methods: This retrospective observational study was carried out in 5 Dutch cystic fibrosis centers. Home spirometry outcomes (forced expiratory volume in one second [FEV1], and forced vital capacity [FVC]) for 601 anonymized users were collected during 3 years. For 81 users, data on clinic spirometry and elexacaftor/tezacaftor/ivacaftor (ETI) use were available. Accuracy was assessed using Bland-Altman plots for paired clinic-home measurements on the same day and within 7 days of each other (nearest neighbor). Intratest reproducibility was assessed using the American Thoracic Society/European Respiratory Society repeatability criteria, the coefficient of variation, and spirometry quality grades. Responsiveness was measured by the percentage change in home spirometry outcomes after the start of ETI. Results: Bland-Altman analysis was performed for 86 same-day clinic-home spirometry pairs and for 263 nearest neighbor clinic-home spirometry pairs (n=81). For both sets and for both FEV1 and FVC, no heteroscedasticity was present and hence the mean bias was expressed as an absolute value. Overall, home spirometry was significantly lower than clinic spirometry (mean $\Delta$FEV1clinic-home 0.13 L, 95\% CI 0.10 to 0.19; mean $\Delta$FVCclinic-home 0.20 L, 95\% CI 0.14 to 0.25) and remained lower than clinic spirometry independent of age and experience. One-way ANOVA with post hoc comparisons showed significantly lower differences in clinic-home spirometry in adults than in children ($\Delta$mean 0.11, 95\% CI --0.20 to --0.01) and teenagers ($\Delta$mean 0.14, 95\% CI --0.25 to --0.02). For reproducibility analyses, 2669 unique measurement days of 311 individuals were included. Overall, 87.3\% (2331/2669) of FEV1 measurements and 74.3\% (1985/2669) of FVC measurements met reproducibility criteria. Kruskal-Wallis with pairwise comparison demonstrated that for both FVC and FEV1, coefficient of variation was significantly lower in adults than in children and teenagers. A total of 5104 unique home measurements were graded. Grade E was given to 2435 tests as only one home measurement was performed. Of the remaining 2669 tests, 43.8\% (1168/2669) and 43.6\% (1163/2669) received grade A and B, respectively. The median percentage change in FEV1 from baseline after initiation of ETI was 19.2\% after 7-14 days and remained stable thereafter (n=33). Conclusions: Home spirometry is feasible but not equal to clinic spirometry. Home spirometry can confirm whether lung functions remain stable, but the context of measurement and personal trends are more relevant than absolute outcomes. ",
doi="10.2196/60892",
url="https://www.jmir.org/2024/1/e60892"
}


@Article{info:doi/10.2196/53430,
author="Richardson, Leanne
and Noori, Nihal
and Fantham, Jack
and Timlin, Gregor
and Siddle, James
and Godec, Thomas
and Taylor, Mike
and Baum, Charles",
title="Personalized Smartphone-Enabled Assessment of Blood Pressure and Its Treatment During the SARS-CoV-2 COVID-19 Pandemic in Patients From the CURE-19 Study: Longitudinal Observational Study",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Dec",
day="3",
volume="12",
pages="e53430",
keywords="digital diary",
keywords="hypertension",
keywords="blood pressure",
keywords="remote monitoring",
keywords="smartphone app",
keywords="mobile phone",
keywords="app",
keywords="monitoring",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="digital intervention",
keywords="management",
keywords="observational study",
keywords="deployment",
keywords="feasibility",
keywords="use",
keywords="safety",
keywords="medication",
keywords="symptoms",
keywords="community",
keywords="systolic",
keywords="diastolic",
keywords="utilization",
abstract="Background: The use of digital interventions by patients for remote monitoring and management of health and disease is increasing. This observational study examined the feasibility, use, and safety of a digital smartphone app for routine monitoring of blood pressure (BP), medication, and symptoms of COVID-19 during the COVID-19 pandemic. Objective: The objective of this study was to deploy and test electronic data recording using a smartphone app developed for routine monitoring of BP in patients with primary hypertension. We tested the app for ease of data entry in BP management and tracking symptoms of new-onset COVID-19 to determine if participants found this app approach useful and sustainable. Methods: This remote, decentralized, 12-week, prospective, observational study was conducted in a community setting within the United States. Participants were approached and recruited from affiliated sites where they were enrolled in an ongoing remote decentralized study (CURE-19) of participants experiencing the COVID-19 pandemic. Potential participants were asked to complete a digital screener to determine eligibility and given informed consent forms to read and consent to using the Curebase digital platform. Following enrollment, participants downloaded the digital app to their smartphones for all data collection. Participants recorded daily BP, associated medication use, and emergent symptoms associated with SARS-CoV-2 infection. In addition, usability (adherence, acceptability, and user experience) was assessed using standard survey questions. Adverse events were collected based on participant self-report. Compliance and engagement were determined from user data entry rates. Feasibility and participant feedback were assessed upon study completion using the User Experience Questionnaire. Results: Of the 389 participants who enrolled in and completed the study, 380 (98\%) participants downloaded and entered BP routines in week 1. App engagement remained high; 239 (62.9\%) of the 380 participants remained in the study for the full 12-week observation period, and 201 (84.1\%) of the 239 participants entered full BP routines into the digital app 80\% or more of the time. The smartphone app scored an overall positive evaluation as assessed by the User Experience Questionnaire and was benchmarked as ``excellent'' for domains of perspicuity, efficiency, and dependability and ``above average'' for domains of attractiveness and stimulation. Highly adherent participants with hypertension demonstrated well-controlled BP, with no significant changes in average systolic or diastolic BP between week 1 and week 12 (all P>.05). Participants were able to record BP medications and symptoms of SARS-CoV-2 infection. No adverse events attributable to the use of the smartphone app were reported during the observational period. Conclusions: The high retention, engagement and acceptability and positive feedback in this study demonstrates that routine monitoring of BP and medications using a smartphone app is feasible for patients with hypertension in a community setting. Remote monitoring of BP and data collection could be coupled with hypertensive medication in a combination product (drug+digital) for precision management of hypertension. ",
doi="10.2196/53430",
url="https://mhealth.jmir.org/2024/1/e53430"
}


@Article{info:doi/10.2196/57708,
author="Uzzaman, Nazim
and Hammersley, Victoria
and McClatchey, Kirstie
and Sheringham, Jessica
and Singh, Diksha
and Habib, Monsur G. M.
and Pinnock, Hilary",
title="Effectiveness and Acceptability of Asynchronous Digital Health in Asthma Care: Mixed Methods Systematic Review",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="3",
volume="26",
pages="e57708",
keywords="digital health",
keywords="asthma",
keywords="asynchronous",
keywords="asthma care",
keywords="effectiveness",
keywords="acceptability",
keywords="mixed-methods review",
keywords="systematic review",
keywords="barrier",
keywords="remote synchronous",
keywords="chronic respiratory disease",
keywords="self-management",
keywords="digital technology",
keywords="asynchronous consultation",
keywords="caregiver",
keywords="PRISMA",
abstract="Background: Asynchronous digital health (eg, web-based portal, text, and email communication) can overcome practical barriers associated with in-person and remote synchronous (real-time) consultations. However, little is known about the effectiveness and acceptability of asynchronous digital health to support care for individuals with asthma (eg, asthma reviews). Objective: We aimed to systematically review the qualitative and quantitative evidence on the role of asynchronous digital health for asthma care. Methods: Following Cochrane methodology, we searched 6 databases (January 2001-July 2022; search update: September 2023) for quantitative, qualitative, or mixed methods studies supporting asthma care using asynchronous digital health. Screening and data extraction were duplicated. We assessed the risk of bias in the clinical outcomes of randomized controlled trials included in the meta-analysis using the revised Cochrane risk of bias tool. For the remaining studies, we evaluated the methodological quality using the Downs and Black checklist, critical appraisal skills program, and mixed methods appraisal tool for quantitative, qualitative, and mixed methods studies, respectively. We determined the confidence in the evidence using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) criteria. We conducted a meta-analysis of trial data and a thematic analysis of qualitative data. Results: We included 30 studies (20 quantitative, 6 qualitative, and 4 mixed methods) conducted in 9 countries involving individuals with asthma, their caregivers, and health care professionals. Asynchronous digital consultations linked with other functionalities, compared to usual care, improved asthma control (standardized mean difference 0.32, 95\% CI 0.02-0.63; P=.04) and reduced hospitalizations (risk ratio 0.36; 95\% CI 0.14-0.94; P=.04). However, there were no significant differences in quality of life (standardized mean difference 0.16; 95\% CI --0.12 to 0.43; P=.26) or emergency department visits (risk ratio 0.83; 95\% CI 0.33-2.09; P=.69). Patients appreciated the convenience of asynchronous digital health, though health care professionals expressed concerns. Successful implementation necessitated an organizational approach. Integrative synthesis underscored the ease of asking questions, monitoring logs, and medication reminders as key digital functionalities. Conclusions: Despite low confidence in evidence, asynchronous consultation supported by digital functionalities is an effective and convenient option for nonemergency asthma care. This type of consultation, well accepted by individuals with asthma and their caregivers, offers opportunities for those facing challenges with traditional synchronous consultations due to lifestyle or geographic constraints. However, efficient organizational strategies are needed to manage the associated workload. Trial Registration: PROSPERO CRD42022344224; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=344224 International Registered Report Identifier (IRRID): RR2-10.1371/journal.pone.0281538 ",
doi="10.2196/57708",
url="https://www.jmir.org/2024/1/e57708"
}


@Article{info:doi/10.2196/62831,
author="Miyakoshi, Takashi
and Ito, M. Yoichi",
title="Association of Blood Glucose Data With Physiological and Nutritional Data From Dietary Surveys and Wearable Devices: Database Analysis",
journal="JMIR Diabetes",
year="2024",
month="Dec",
day="3",
volume="9",
pages="e62831",
keywords="PhysioNet",
keywords="Empatica",
keywords="Dexcom",
keywords="acceleration",
keywords="heart rate",
keywords="temperature",
keywords="electrodermal activity",
abstract="Background: Wearable devices can simultaneously collect data on multiple items in real time and are used for disease detection, prediction, diagnosis, and treatment decision-making. Several factors, such as diet and exercise, influence blood glucose levels; however, the relationship between blood glucose and these factors has yet to be evaluated in real practice. Objective: This study aims to investigate the association of blood glucose data with various physiological index and nutritional values using wearable devices and dietary survey data from PhysioNet, a public database. Methods: Three analytical methods were used. First, the correlation of each physiological index was calculated and examined to determine whether their mean values or SDs affected the mean value or SD of blood glucose. To investigate the impact of each physiological indicator on blood glucose before and after the time of collection of blood glucose data, lag data were collected, and the correlation coefficient between blood glucose and each physiological indicator was calculated for each physiological index. Second, to examine the relationship between postprandial blood glucose rise and fall and physiological and dietary nutritional assessment indices, multiple regression analysis was performed on the relationship between the slope before and after the peak in postprandial glucose over time and physiological and dietary nutritional indices. Finally, as a supplementary analysis to the multiple regression analysis, a 1-way ANOVA was performed to compare the relationship between the upward and downward slopes of blood glucose and the groups above and below the median for each indicator. Results: The analysis revealed several indicators of interest: First, the correlation analysis of blood glucose and physiological indices indicated meaningful relationships: acceleration SD (r=--0.190 for lag data at --15-minute values), heart rate SD (r=--0.121 for lag data at --15-minute values), skin temperature SD (r=--0.121), and electrodermal activity SD (r=--0.237) for lag data at --15-minute values. Second, in multiple regression analysis, physiological indices (temperature mean: t=2.52, P=.01; acceleration SD: t=--2.06, P=.04; heart rate\_30 SD: t=--2.12, P=.04; electrodermal activity\_90 SD: t=1.97, P=.049) and nutritional indices (mean carbohydrate: t=6.53, P<.001; mean dietary fiber: t=--2.51, P=.01; mean sugar: t=--3.72, P<.001) were significant predictors. Finally, the results of the 1-way ANOVA corroborated the findings from the multiple regression analysis. Conclusions: Similar results were obtained from the 3 analyses, consistent with previous findings, and the relationship between blood glucose, diet, and physiological indices in the real world was examined. Data sharing facilitates the accessibility of wearable data and enables statistical analyses from various angles. This type of research is expected to be more common in the future. ",
doi="10.2196/62831",
url="https://diabetes.jmir.org/2024/1/e62831"
}


@Article{info:doi/10.2196/54826,
author="Diez Alvarez, Sergio
and Fellas, Antoni
and Wynne, Katie
and Santos, Derek
and Sculley, Dean
and Acharya, Shamasunder
and Navathe, Pooshan
and Giron{\`e}s, Xavier
and Coda, Andrea",
title="The Role of Smartwatch Technology in the Provision of Care for Type 1 or 2 Diabetes Mellitus or Gestational Diabetes: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Dec",
day="3",
volume="12",
pages="e54826",
keywords="diabetes mellitus",
keywords="flash glucose monitoring",
keywords="digital health",
keywords="smartwatch",
keywords="smartphones",
keywords="mHealth",
keywords="mobile health",
keywords="glucose monitoring",
keywords="diabetes",
keywords="gestational diabetes",
keywords="systematic review",
keywords="smartwatch technology",
keywords="blood glucose",
keywords="medication adherence",
keywords="self-monitoring",
keywords="usability",
keywords="feasibility",
keywords="mobile phone",
abstract="Background: The use of smart technology in the management of all forms of diabetes mellitus has grown significantly in the past 10 years. Technologies such as the smartwatch have been proposed as a method of assisting in the monitoring of blood glucose levels as well as other alert prompts such as medication adherence and daily physical activity targets. These important outcomes reach across all forms of diabetes and have the potential to increase compliance of self-monitoring with the aim of improving long-term outcomes such as hemoglobin A1c (HbA1c). Objective: This systematic review aims to explore the literature for evidence of smartwatch technology in type 1, 2, and gestational diabetes. Methods: A systematic review was undertaken by searching Ovid MEDLINE and CINAHL databases. A second search using all identified keywords and index terms was performed on Ovid MEDLINE (January 1966 to August 2023), Embase (January 1980 to August 2023), Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Library, latest issue), CINAHL (from 1982), IEEE Xplore, ACM Digital Libraries, and Web of Science databases. Type 1, type 2, and gestational diabetes were eligible for inclusion. Quantitative studies such as prospective cohort or randomized clinical trials that explored the feasibility, usability, or effect of smartwatch technology in people with diabetes were eligible. Outcomes of interest were changes in blood glucose or HbA1c, physical activity levels, medication adherence, and feasibility or usability scores. Results: Of the 8558 titles and abstracts screened, 5 studies were included for qualitative synthesis in this review. A total of 322 participants with either type 1 or type 2 diabetes mellitus were included in the review. A total of 4 studies focused on the feasibility and usability of smartwatch technology in diabetes management. One study conducted a proof-of-concept randomized clinical trial including smartwatch technology for exercise time prescriptions for participants with type 2 diabetes mellitus. Adherence of participants to smartwatch technology varied between included studies, with one reporting input submissions of 58\% and another reporting that participants logged 50\% more entries than they were required to. One study reported significantly improved glycemic control with integrated smartwatch technology, with increased exercise prescriptions; however, this study was not powered and required a longer observational period. Conclusions: This systematic review has highlighted the lack of robust randomized clinical trials that explore the efficacy of smartwatch technology in the management of patients with type 1, type 2, and gestational diabetes. Further research is required to establish the role of integrated smartwatch technology in important outcomes such as glycemic control, exercise participation, drug adherence, and diet monitoring in people with all forms of diabetes mellitus. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019136825; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=136825 ",
doi="10.2196/54826",
url="https://mhealth.jmir.org/2024/1/e54826"
}


@Article{info:doi/10.2196/53834,
author="McCann, Lisa
and Lewis, Liane
and Oduntan, Olubukola
and Harris, Jenny
and Darley, Andrew
and Berg, V. Geir
and Lubowitzki, Simone
and Cheevers, Katy
and Miller, Morven
and Armes, Jo
and Ream, Emma
and Fox, Patricia
and Furlong, Patricia Eileen
and Gaiger, Alexander
and Kotronoulas, Grigorios
and Patiraki, Elisabeth
and Katsaragakis, Stylianos
and McCrone, Paul
and Miaskowski, Christine
and Cardone, Antonella
and Orr, Dawn
and Flowerday, Adrian
and Skene, Simon
and Moore, Margaret
and De Souza, Nicosha
and Donnan, Peter
and Maguire, Roma",
title="Patients' and Clinicians' Experiences Using a Real-Time Remote Monitoring System for Chemotherapy Symptom Management (ASyMS): Qualitative Study",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="3",
volume="26",
pages="e53834",
keywords="cancer",
keywords="clinician experiences",
keywords="digital interventions",
keywords="patient experiences",
keywords="remote monitoring",
keywords="qualitative methods",
abstract="Background: Patients receiving chemotherapy require ongoing symptom monitoring and management to optimize their outcomes. In recent years, digital remote monitoring interventions have emerged to provide enhanced cancer care delivery experiences to patients and clinicians. However, patient and clinician experiential evaluations of these technologies are rare. Therefore, we explored user experiences and perceptions of one such intervention---Advanced Symptom Management System (ASyMS)---after its scaled deployment in the context of the Electronic Symptom Management System Remote Technology (eSMART) trial. The eSMART trial was a large, multicenter randomized controlled trial to evaluate the efficacy of ASyMS in 12 clinical sites in 5 European countries. Objective: In this qualitative study, both patients' and clinicians' experiences of using ASyMS for up to 6 cycles of chemotherapy were explored to understand the impact of ASyMS on patients' experiences, clinical practice, and supportive care delivery. Methods: For this analysis, individual, semistructured, one-to-one interviews with 29 patients with breast, colorectal, and hematological cancers and 18 clinicians from Austria, Greece, Ireland, Norway, and the United Kingdom were conducted. Interviews focused on patients' and clinicians' experiences of using ASyMS, care organization and changes in practice following the introduction of ASyMS, perceived changes in care associated with the use of ASyMS, and its potential for future integration into routine chemotherapy care pathways. Results: Thematic analysis identified several themes that describe patients' and clinicians' experiences using ASyMS. One central orienting theme---ASyMS as a facilitator of change---was supported by 5 key themes associated with human and technology monitoring: reassurance, enhanced communications and relationships, knowing what is ``normal'' and what is to be expected, enhancing cancer care experiences, and informing future cancer care. Conclusions: This study is the first to evaluate both patients' and clinicians' experiences of using a digital health intervention to remotely monitor chemotherapy symptoms across 5 countries. Experiences with ASyMS were positive from both patients' and clinicians' perspectives, although some improvements to support the wider-scale rollout and sustained implementation were identified. Overall, this study demonstrates that real-time remote monitoring systems can help patients feel more reassured during their chemotherapy treatments and can help clinicians provide the right care, at the right time, and in the right place. Trial Registration: ClinicalTrials.gov NCT02356081; https://clinicaltrials.gov/study/NCT02356081 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2016-015016 ",
doi="10.2196/53834",
url="https://www.jmir.org/2024/1/e53834"
}


@Article{info:doi/10.2196/54127,
author="Nong, Thu Trang Thi
and Nguyen, Hoang Giang
and Lepe, Alexander
and Tran, Bich Thuy
and Nguyen, Phuong Lan Thi
and Koot, R. Jaap A.",
title="Challenges and Opportunities in Digital Screening for Hypertension and Diabetes Among Community Groups of Older Adults in Vietnam: Mixed Methods Study",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="2",
volume="26",
pages="e54127",
keywords="NCD screening",
keywords="DHIS2 tracker",
keywords="District Health Information Software, version 2 tracker",
keywords="digital application",
keywords="ISHC health volunteers",
keywords="non-communicable diseases",
keywords="prevention",
keywords="Vietnam",
keywords="mobile phone",
abstract="Background: The project of scaling up noncommunicable disease (NCD) interventions in Southeast Asia aimed to strengthen the prevention and control of hypertension and diabetes, focusing on primary health care and community levels. In Vietnam, health volunteers who were members of the Intergenerational Self-Help Clubs (ISHCs) implemented community-based NCD screening and health promotion activities in communities. The ISHC health volunteers used an app based on District Health Information Software, version 2 (DHIS2) tracker (Society for Health Information Systems Programmes, India) to record details of participants during screening and other health activities. Objective: This study aimed to assess the strengths, barriers, and limitations of the NCD screening app used by the ISHC health volunteers on tablets and to provide recommendations for further scaling up. Methods: A mixed methods observational study with a convergent parallel design was performed. For the quantitative data analysis, 2 rounds of screening data collected from all 59 ISHCs were analyzed on completeness and quality. For the qualitative analysis, 2 rounds of evaluation of the screening app were completed. Focus group discussions with ISHC health volunteers and club management boards and in-depth interviews with members of the Association of the Elderly and Commune Health Station staff were performed. Results: In the quantitative analysis, data completeness of all 6704 screenings (n=3485 individuals) was very high. For anthropomorphic measurements, such as blood pressure, body weight, and abdominal circumference, less than 1\% errors were found. The data on NCD risk factors were not adequately recorded in 1908 (29.5\%) of the screenings. From the qualitative analysis, the NCD screening app was appreciated by ISHC health volunteers and supervisors, as an easier and more efficient way to report to higher levels, secure data, and strengthen relationships with relevant stakeholders, using tablets to connect to the internet and internet-based platforms to access information for self-learning and sharing to promote a healthy lifestyle as the strengths. The barriers and limitations reported by the respondents were a non--age-friendly app, incomplete translation of parts of the app into Vietnamese, some issues with the tablet's display, lack of sharing of responsibilities among the health volunteers, and suboptimal involvement of the health sector; limited digital literacy among ISHC health volunteers. Recommendations are continuous capacity building, improving app issues, improving tablet issues, and involving relevant stakeholders or younger members in technology adoption to support older people. Conclusions: The implementation of the NCD screening app by ISHC volunteers can be an effective way to improve community-led NCD screening and increase the uptake of NCD prevention and management services at the primary health care level. However, our study has shown that some barriers need to be addressed to maximize the efficient use of the app by ISHC health volunteers to record, report, and manage the screening data. ",
doi="10.2196/54127",
url="https://www.jmir.org/2024/1/e54127"
}


@Article{info:doi/10.2196/57652,
author="Iino, Haru
and Kizaki, Hayato
and Imai, Shungo
and Hori, Satoko",
title="Medication Management Initiatives Using Wearable Devices: Scoping Review",
journal="JMIR Hum Factors",
year="2024",
month="Nov",
day="27",
volume="11",
pages="e57652",
keywords="medication adherence",
keywords="scoping review",
keywords="database search",
keywords="integrated medication management",
keywords="drug",
keywords="pharmacy",
keywords="pharmacology",
keywords="pharmacotherapy",
keywords="pharmaceutics",
keywords="medication",
keywords="adherence",
keywords="wearable",
keywords="synthesis",
keywords="review methods",
keywords="digital health",
abstract="Background: Wearable devices (WDs) have evolved beyond simple fitness trackers to sophisticated health monitors capable of measuring vital signs, such as heart rate and blood oxygen levels. Their application in health care, particularly medication management, is an emerging field poised to significantly enhance patient adherence to treatment regimens. Despite their widespread use and increasing incorporation into clinical trials, a comprehensive review of WDs in terms of medication adherence has not been conducted. Objective: This study aimed to conduct a comprehensive scoping review to evaluate the impact of WDs on medication adherence across a variety of diseases, summarizing key research findings, outcomes, and challenges encountered. Methods: Adhering to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, a structured search was conducted across MEDLINE, Web of Science, and Embase databases, covering the literature from January 1, 2010, to September 30, 2022. The search strategy was based on terms related to WDs and medication adherence, specifically focusing on empirical studies to ensure the inclusion of original research findings. Studies were selected based on their relevance to medication adherence, usage of WDs in detecting medication-taking actions, and their role in integrated medication management systems. Results: We screened 657 articles and identified 18 articles. The identified studies demonstrated the diverse applications of WDs in enhancing medication adherence across diseases such as Parkinson disease, diabetes, and cardiovascular conditions. The geographical distribution and publication years of these studies indicate a growing interest in this research area. The studies were divided into three types: (1) studies reporting a correlation between data from WDs or their usage and medication adherence or drug usage as outcomes, (2) studies using WDs to detect the act of medication-taking itself, and (3) studies proposing an integrated medication management system that uses WDs in managing medication. Conclusions: WDs are increasingly being recognized for their potential to enhance medication management and adherence. This review underscores the need for further empirical research to validate the effectiveness of WDs in real-life settings and explore their use in predicting adherence based on activity rhythms and activities. Despite technological advancements, challenges remain regarding the integration of WDs into routine clinical practice. Future research should focus on leveraging the comprehensive data provided by WDs to develop personalized medication management strategies that can improve patient outcomes. ",
doi="10.2196/57652",
url="https://humanfactors.jmir.org/2024/1/e57652"
}


@Article{info:doi/10.2196/58036,
author="Grechuta, Klaudia
and Shokouh, Pedram
and Alhussein, Ahmad
and M{\"u}ller-Wieland, Dirk
and Meyerhoff, Juliane
and Gilbert, Jeremy
and Purushotham, Sneha
and Rolland, Catherine",
title="Benefits of Clinical Decision Support Systems for the Management of Noncommunicable Chronic Diseases: Targeted Literature Review",
journal="Interact J Med Res",
year="2024",
month="Nov",
day="27",
volume="13",
pages="e58036",
keywords="clinical decision support system",
keywords="digital health",
keywords="chronic disease management",
keywords="electronic health records",
keywords="noncommunicable diseases",
keywords="targeted literature review",
keywords="mobile phone",
abstract="Background: Clinical decision support systems (CDSSs) are designed to assist in health care delivery by supporting medical practice with clinical knowledge, patient information, and other relevant types of health information. CDSSs are integral parts of health care technologies assisting in disease management, including diagnosis, treatment, and monitoring. While electronic medical records (EMRs) serve as data repositories, CDSSs are used to assist clinicians in providing personalized, context-specific recommendations derived by comparing individual patient data to evidence-based guidelines. Objective: This targeted literature review (TLR) aimed to identify characteristics and features of both stand-alone and EMR-integrated CDSSs that influence their outcomes and benefits based on published scientific literature. Methods: A TLR was conducted using the Embase, MEDLINE, and Cochrane databases to identify data on CDSSs published in a 10-year frame (2012-2022). Studies on computerized, guideline-based CDSSs used by health care practitioners with a focus on chronic disease areas and reporting outcomes for CDSS utilization were eligible for inclusion. Results: A total of 49 publications were included in the TLR. Studies predominantly reported on EMR-integrated CDSSs (ie, connected to an EMR database; n=32, 65\%). The implementation of CDSSs varied globally, with substantial utilization in the United States and within the domain of cardio-renal-metabolic diseases. CDSSs were found to positively impact ``quality assurance'' (n=35, 69\%) and provide ``clinical benefits'' (n=20, 41\%), compared to usual care. Among CDSS features, treatment guidance and flagging were consistently reported as the most frequent elements for enhancing health care, followed by risk level estimation, diagnosis, education, and data export. The effectiveness of a CDSS was evaluated most frequently in primary care settings (n=34, 69\%) across cardio-renal-metabolic disease areas (n=32, 65\%), especially in diabetes (n=13, 26\%). Studies reported CDSSs to be commonly used by a mixed group (n=27, 55\%) of users including physicians, specialists, nurses or nurse practitioners, and allied health care professionals. Conclusions: Overall, both EMR-integrated and stand-alone CDSSs showed positive results, suggesting their benefits to health care providers and potential for successful adoption. Flagging and treatment recommendation features were commonly used in CDSSs to improve patient care; other features such as risk level estimation, diagnosis, education, and data export were tailored to specific requirements and collectively contributed to the effectiveness of health care delivery. While this TLR demonstrated that both stand-alone and EMR-integrated CDSSs were successful in achieving clinical outcomes, the heterogeneity of included studies reflects the evolving nature of this research area, underscoring the need for further longitudinal studies to elucidate aspects that may impact their adoption in real-world scenarios. ",
doi="10.2196/58036",
url="https://www.i-jmr.org/2024/1/e58036"
}


@Article{info:doi/10.2196/60731,
author="Nagino, Ken
and Sung, Jaemyoung
and Midorikawa-Inomata, Akie
and Akasaki, Yasutsugu
and Adachi, Takeya
and Ebihara, Nobuyuki
and Fukuda, Ken
and Fukushima, Atsuki
and Fujio, Kenta
and Okumura, Yuichi
and Eguchi, Atsuko
and Fujimoto, Keiichi
and Shokirova, Hurramhon
and Yee, Alan
and Morooka, Yuki
and Huang, Tianxiang
and Hirosawa, Kunihiko
and Nakao, Shintaro
and Kobayashi, Hiroyuki
and Inomata, Takenori",
title="Minimal Clinically Important Differences With the Outcomes of the App-Based Japanese Allergic Conjunctival Diseases Quality of Life Questionnaire: Cross-Sectional Observational Study",
journal="JMIR Form Res",
year="2024",
month="Nov",
day="26",
volume="8",
pages="e60731",
keywords="allergic conjunctivitis",
keywords="hay fever",
keywords="Japanese Allergic Conjunctival Disease Quality of Life Questionnaire",
keywords="minimal clinically important difference",
keywords="pollinosis",
keywords="telemedicine",
keywords="mobile phone",
abstract="Background: Assessing changes in quality of life in patients with hay fever--related allergic conjunctivitis requires validated and clinically meaningful metrics. A minimal clinically important difference (MCID) that can be applied to assess Domain II of the Japanese Allergic Conjunctival Disease Quality of Life Questionnaire (JACQLQ) in a smartphone app setting has yet to be determined. Objective: This cross-sectional observational study aimed to determine MCIDs for the app-based JACQLQ in assessing hay fever--related allergic conjunctivitis. Methods: This study used data from a crowdsourced, cross-sectional, observational study conducted via the smartphone app ``AllerSearch'' between February 1, 2018, and May 1, 2020. Participants were recruited through digital media and social networking platforms and voluntarily provided electronic informed consent. Participants completed the JACQLQ, which includes items on daily activity and psychological well-being, as well as a visual analog scale to measure stress levels related to hay fever. Data were collected through the app, ensuring comprehensive user input. MCIDs were determined using both anchor- and distribution-based methods. The face scale of the JACQLQ Domain III and stress level scale for hay fever were used as anchors to estimate the MCID; ranges were derived from these MCID estimates. In the distribution-based method, MCIDs were calculated using half the SD and SE of the JACQLQ Domain II scores. SEs were derived from the intraclass correlation coefficient of an app-based JACQLQ test-retest reliability metric. Results: A total of 17,597 individuals were identified, of which 15,749 individuals provided electronic consent. After excluding those with incomplete data, 7590 participants with hay fever were included in the study (mean age 35.3, SD 13.9 years; n=4331, 57.1\% of women). MCID ranges calculated using the anchor-based method were 1.0-6.9, 1.2-5.6, and 2.1-12.6 for daily activity, psychological well-being, and total JACQLQ Domain II scores, respectively. Using the distribution-based method, the intraclass correlation coefficients were odds ratio (OR) 0.813 (95\% CI 0.769-0.849) for daily activity, OR 0.791 (95\% CI 0.743-0.832) for psychological well-being, and OR 0.841 (95\% CI 0.791-0.864) for total JACQLQ Domain II scores. In addition, the distribution-based method resulted in 2 MCIDs based on half the SD and SE of measurement for daily activity (4.8 and 4.2), psychological well-being (3.4 and 3.1), and total JACQLQ Domain II (7.8 and 6.4) scores. The final suggested MCID ranges for daily activity, psychological well-being, and total JACQLQ Domain II scores were 4.2-6.0, 3.1-4.7, and 6.4-10.5, respectively. Conclusions: MCID ranges for the JACQLQ estimation could help to standardize the app-based quality of life assessment for patients with hay fever--related allergic conjunctivitis. These MCIDs enhanced the precision of remote symptom monitoring and facilitated timely, data-driven interventions, ultimately improving the overall management and outcomes of allergic conjunctivitis through mobile health platforms. ",
doi="10.2196/60731",
url="https://formative.jmir.org/2024/1/e60731"
}


@Article{info:doi/10.2196/56556,
author="Li, ZhiRu
and Lu, FangYan
and Wu, JingYun
and Bao, RuiJie
and Rao, YuXin
and Yang, Yun
and Wang, Huafen",
title="Usability and Effectiveness of eHealth and mHealth Interventions That Support Self-Management and Health Care Transition in Adolescents and Young Adults With Chronic Disease: Systematic Review",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="26",
volume="26",
pages="e56556",
keywords="eHealth",
keywords="mHealth",
keywords="mobile health",
keywords="chronic disease",
keywords="healthcare transition",
keywords="self-management",
keywords="adolescents",
keywords="young adults",
keywords="chronic illness",
keywords="systematic review",
keywords="digital health",
keywords="health education",
keywords="social support",
keywords="symptom tracking",
keywords="monitoring",
keywords="effectiveness",
abstract="Background: With advances in medical technologies, more children with chronic diseases are now living on into adulthood. The development of proficient self-management skills is essential for adolescents and young adults to transition from pediatric to adult health care services. An innovative way to improve the current care model and foster self-management skills could be through eHealth or mHealth (mobile health) interventions, in particular, when considering the rising ownership of digital technology by adolescents and young adults. Objective: This systematic review aimed to evaluate the features, acceptability, usability, engagement, and intervention efficacy of eHealth and mHealth interventions that support self-management and health care transition in adolescents and young adults with chronic disease. Methods: This review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines (registration number CRD42023378355). We systematically searched the MEDLINE complete, Embase, Cochrane Library, CINAHL complete, and ProQuest Health \& Medical complete. We considered only articles published in or since 2019, as we aimed to extend the data collected by 2 previous systematic reviews. Results: A total of 16,752 studies were screened. After removing duplicates, 14,507 studies were excluded based on the title and abstract. Ultimately, 22 studies were included. The interventions ranged from simple text messages to complex interventions involving web-based games and engagement of health care providers, which were summarized into 6 themes: medication monitoring and reminders, symptom tracking and monitoring, management goal setting, knowledge education and self-management skills training, incentives and reinforcement, and communication. Most adolescents and young adults felt the eHealth and mHealth interventions were feasible, as they were convenient, easy to use, and accessible in the context of helping manage their health. However, user engagement was variable and presented a gradual decline in youth engagement with these apps over time. Barriers that prevent user engagement are diverse, such as time-consuming video uploads, noncontinuous access to a phone, reading literacy levels, language, and false impressions. Moreover, adolescents and young adults had different preferred styles of message delivery and functions, especially the engaging elements, disease-specific information, and opportunities to communicate with peers, health care providers, and app teams. Conclusions: There remains limited data about the effectiveness of eHealth and mHealth interventions facilitating the self-management and health care transition of adolescents and young adults with chronic diseases. Based on the available evidence, they were receptive to and interested in receiving information and managing their health using mobile apps or websites. Considering adolescents and young adults had different preferred styles of message delivery and features, to improve user engagement and provide focused interventions, it would be better to involve them early in the design process to identify their specific needs, as well as collaborate with health care providers and app teams to obtain suggestions. ",
doi="10.2196/56556",
url="https://www.jmir.org/2024/1/e56556",
url="http://www.ncbi.nlm.nih.gov/pubmed/39589770"
}


@Article{info:doi/10.2196/58261,
author="Xie, Junan
and Li, Shilin
and Song, Zhen
and Shu, Lin
and Zeng, Qing
and Huang, Guozhi
and Lin, Yihuan",
title="Functional Monitoring of Patients With Knee Osteoarthritis Based on Multidimensional Wearable Plantar Pressure Features: Cross-Sectional Study",
journal="JMIR Aging",
year="2024",
month="Nov",
day="25",
volume="7",
pages="e58261",
keywords="knee osteoarthritis",
keywords="KOA",
keywords="40-m fast-paced walk test",
keywords="40mFPWT",
keywords="timed up-and-go test",
keywords="TUGT",
keywords="timed up and go",
keywords="TUG",
keywords="functional assessment",
keywords="monitoring",
keywords="wearable",
keywords="gait",
keywords="walk test",
keywords="plantar",
keywords="knee",
keywords="joint",
keywords="arthritis",
keywords="gait analysis",
keywords="regression model",
keywords="machine learning",
abstract="Background: Patients with knee osteoarthritis (KOA) often present lower extremity motor dysfunction. However, traditional radiography is a static assessment and cannot achieve long-term dynamic functional monitoring. Plantar pressure signals have demonstrated potential applications in the diagnosis and rehabilitation monitoring of KOA. Objective: Through wearable gait analysis technology, we aim to obtain abundant gait information based on machine learning techniques to develop a simple, rapid, effective, and patient-friendly functional assessment model for the KOA rehabilitation process to provide long-term remote monitoring, which is conducive to reducing the burden of social health care system. Methods: This cross-sectional study enrolled patients diagnosed with KOA who were able to walk independently for 2 minutes. Participants were given clinically recommended functional tests, including the 40-m fast-paced walk test (40mFPWT) and timed up-and-go test (TUGT). We used a smart shoe system to gather gait pressure data from patients with KOA. The multidimensional gait features extracted from the data and physical characteristics were used to establish the KOA functional feature database for the plantar pressure measurement system. 40mFPWT and TUGT regression prediction models were trained using a series of mature machine learning algorithms. Furthermore, model stacking and average ensemble learning methods were adopted to further improve the generalization performance of the model. Mean absolute error (MAE), mean absolute percentage error (MAPE), and root mean squared error (RMSE) were used as regression performance metrics to evaluate the results of different models. Results: A total of 92 patients with KOA were included, exhibiting varying degrees of severity as evaluated by the Kellgren and Lawrence classification. A total of 380 gait features and 4 physical characteristics were extracted to form the feature database. Effective stepwise feature selection determined optimal feature subsets of 11 variables for the 40mFPWT and 10 variables for the TUGT. Among all models, the weighted average ensemble model using 4 tree-based models had the best generalization performance in the test set, with an MAE of 2.686 seconds, MAPE of 9.602\%, and RMSE of 3.316 seconds for the prediction of the 40mFPWT and an MAE of 1.280 seconds, MAPE of 12.389\%, and RMSE of 1.905 seconds for the prediction of the TUGT. Conclusions: This wearable plantar pressure feature technique can objectively quantify indicators that reflect functional status and is promising as a new tool for long-term remote functional monitoring of patients with KOA. Future work is needed to further explore and investigate the relationship between gait characteristics and functional status with more functional tests and in larger sample cohorts. ",
doi="10.2196/58261",
url="https://aging.jmir.org/2024/1/e58261"
}


@Article{info:doi/10.2196/54206,
author="Ma, Jianwei
and Wang, Jiangyuan
and Ying, Jiapei
and Xie, Shasha
and Su, Qin
and Zhou, Tianmeng
and Han, Fuman
and Xu, Jiayan
and Zhu, Siyi
and Yuan, Chenyi
and Huang, Ziyuan
and Xu, Jingfang
and Chen, Xuyong
and Bian, Xueyan",
title="Long-Term Efficacy of an AI-Based Health Coaching Mobile App in Slowing the Progression of Nondialysis-Dependent Chronic Kidney Disease: Retrospective Cohort Study",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="25",
volume="26",
pages="e54206",
keywords="artificial intelligence",
keywords="chronic kidney disease",
keywords="eHealth care",
keywords="mobile app",
keywords="self-management",
keywords="kidney function",
keywords="telemedicine",
keywords="app",
keywords="health coaching",
keywords="CKD",
keywords="mobile phone",
abstract="Background: Chronic kidney disease (CKD) is a significant public health concern. Therefore, practical strategies for slowing CKD progression and improving patient outcomes are imperative. There is limited evidence to substantiate the efficacy of mobile app--based nursing systems for decelerating CKD progression. Objective: This study aimed to evaluate the long-term efficacy of the KidneyOnline intelligent care system in slowing the progression of nondialysis-dependent CKD. Methods: In this retrospective study, the KidneyOnline app was used for patients with CKD in China who were registered between January 2017 and April 2023. Patients were divided into 2 groups: an intervention group using the app's nurse-led, patient-oriented management system and a conventional care group that did not use the app. Patients' uploaded health data were processed via deep learning optical character recognition, and the artificial intelligence (AI) system provided personalized health care plans and interventions. Conversely, the conventional care group received suggestions from nephrologists during regular visits without AI. Monitoring extended for an average duration of 2.1 (SD 1.4) years. The study's objective is to assess the app's effectiveness in preserving kidney function. The primary outcome was the estimated glomerular filtration rate slope over the follow-up period, and secondary outcomes included changes in albumin-to-creatinine ratio (ACR) and mean arterial pressure. Results: A total of 12,297 eligible patients were enrolled for the analysis. Among them, 808 patients were successfully matched using 1:1 propensity score matching, resulting in 404 (50\%) patients in the KidneyOnline care system group and another 404 (50\%) patients in the conventional care group. The estimated glomerular filtration rate slope in the KidneyOnline care group was significantly lower than that in the conventional care group (odds ratio --1.3, 95\% CI --2.4 to --0.1 mL/min/1.73 m2 per year vs odds ratio --2.8, 95\% CI --3.8 to --1.9 mL/min/1.73 m2 per year; P=.009). Subgroup analysis revealed that the effect of the KidneyOnline care group was more significant in male patients, patients older than 45 years, and patients with worse baseline kidney function, higher blood pressure, and heavier proteinuria. After 3 and 6 months, the mean arterial pressure in the KidneyOnline care group decreased to 85.6 (SD 9.2) and 83.6 (SD 10.5) mm Hg, respectively, compared to 94.9 (SD 10.6) and 95.2 (SD 11.6) mm Hg in the conventional care group (P<.001). The ACR in the KidneyOnline care group showed a more significant reduction after 3 and 6 months (736 vs 980 mg/g and 572 vs 840 mg/g; P=.07 and P=.03); however, there was no significant difference in ACR between the two groups at the end of the follow-up period (618 vs 639 mg/g; P=.90). Conclusions: The utilization of KidneyOnline, an AI-based, nurse-led, patient-centered care system, may be beneficial in slowing the progression of nondialysis-dependent CKD. ",
doi="10.2196/54206",
url="https://www.jmir.org/2024/1/e54206",
url="http://www.ncbi.nlm.nih.gov/pubmed/39402012"
}


@Article{info:doi/10.2196/58441,
author="Wettstein, Reto
and Sedaghat-Hamedani, Farbod
and Heinze, Oliver
and Amr, Ali
and Reich, Christoph
and Betz, Theresa
and Kayvanpour, Elham
and Merzweiler, Angela
and B{\"u}sch, Christopher
and Mohr, Isabell
and Friedmann-Bette, Birgit
and Frey, Norbert
and Dugas, Martin
and Meder, Benjamin",
title="A Remote Patient Monitoring System With Feedback Mechanisms Using a Smartwatch: Concept, Implementation, and Evaluation Based on the activeDCM Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Nov",
day="22",
volume="12",
pages="e58441",
keywords="wearable",
keywords="consumer device",
keywords="mobile phone",
keywords="mobile health",
keywords="telemedicine",
keywords="remote patient monitoring",
keywords="usability",
keywords="Health Level 7 Fast Healthcare Interoperability Resources",
keywords="HL7 FHIR",
keywords="cardiology",
keywords="heart failure",
keywords="dilated cardiomyopathy",
abstract="Background: Technological advances allow for recording and sharing health-related data in a patient-centric way using smartphones and wearables. Secure sharing of such patient-generated data with physicians would enable close management of individual health trajectories, monitoring of risk factors, and asynchronous feedback. However, most remote patient monitoring (RPM) systems currently available are not fully integrated into hospital IT systems or lack a patient-centric design. Objective: The objective of this study was to conceptualize and implement a user-friendly, reusable, interoperable, and secure RPM system incorporating asynchronous feedback mechanisms using a broadly available consumer wearable (Apple Watch). In addition, this study sought to evaluate factors influencing patient acceptance of such systems. Methods: The RPM system requirements were established through focus group sessions. Subsequently, a system concept was designed and implemented using an iterative approach ensuring technical feasibility from the beginning. To assess clinical feasibility, the system was used as part of the activeDCM prospective randomized interventional study focusing on dilated cardiomyopathy. Each patient used the system for at least 12 months. The System Usability Scale was used to measure usability from a subjective patient perspective. In addition, an evaluation was conducted on the objective wearable interaction frequency as well as the completeness of transmitted data classified into sensor-based health data (SHD) and patient-reported outcome measures (PROMs). Descriptive statistics using box plots and bootstrapped multiple linear regression with 95\% CIs were used for evaluation analyzing the influence of age, sex, device experience, and intervention group membership. Results: The RPM system comprised 4 interoperable components: patient devices, a data server, a data viewer, and a notification service. The system was evaluated with 95 consecutive patients with dilated cardiomyopathy (28/95, 29\% female; mean age 50, SD 12 y) who completed the activeDCM study protocol. The system's app achieved a mean System Usability Scale score of 78 (SD 17), which was most influenced by device experience. In total, 87\% (83/95) of the patients could integrate the use of the app well or very well into their daily routine, and 71\% (67/95) saw a benefit of the RPM system for management of their health condition. On average, patients interacted with the wearable on 61\% (SD 26\%) of days enrolled in the study. SHD were available on average for 78\% (SD 23\%) of days, and PROM data were available on 64\% (SD 27\%) of weeks enrolled in the study. Wearable interaction frequency, SHD, and PROM completeness were most influenced by intervention group membership. Conclusions: Our results mark a first step toward integrating RPM systems based on a consumer wearable device for primary patient input into standardized clinical workflows. They can serve as a blueprint for creating a user-friendly, reusable, interoperable, and secure RPM system that can be integrated into patients' daily routines. ",
doi="10.2196/58441",
url="https://mhealth.jmir.org/2024/1/e58441"
}


@Article{info:doi/10.2196/63434,
author="Mitchell, E. Suzanne
and Kallen, A. Michael
and Troost, P. Jonathan
and De La Cruz, A. Barbara
and Bragg, Alexa
and Martin-Howard, Jessica
and Moldovan, Ioana
and Miner, A. Jennifer
and Jack, W. Brian
and Carlozzi, E. Noelle",
title="Four New Patient-Reported Outcome Measures Examining Health-Seeking Behavior in Persons With Type 2 Diabetes Mellitus (REDD-CAT): Instrument Development Study",
journal="JMIR Diabetes",
year="2024",
month="Nov",
day="22",
volume="9",
pages="e63434",
keywords="diabetes mellitus",
keywords="social determinants of health",
keywords="patient-reported outcome measures",
keywords="outcomes assessment",
keywords="health care",
keywords="patient reported",
keywords="health-seeking behavior",
keywords="type 2 diabetes",
keywords="hospitalization",
keywords="diabetes computer adaptive test",
keywords="primary care",
keywords="socioeconomic",
keywords="assessments",
abstract="Background: The management of type 2 diabetes mellitus (T2DM) includes mastery of complex care activities, self-management skills, and routine health care encounters to optimize glucose control and achieve good health. Given the lifelong course of T2DM, patients are faced with navigating complex medical and disease-specific information. This health-seeking behavior is a driver of health disparities and is associated with hospitalization and readmission. Given that health-seeking behavior is a potentially intervenable social determinant of health, a better understanding of how people navigate these complex systems is warranted. Objective: To address this need, we aimed to develop new patient-reported outcome (PRO) measures that evaluate health-seeking behavior in persons with T2DM. These new PROs were designed to be included in the Re-Engineered Discharge for Diabetes-Computer Adaptive Test (REDD-CAT) measurement system, which includes several other PROs that capture the importance of social determinants of health. Methods: Overall, 225 participants with T2DM completed 56 self-report items that examined health-seeking behaviors. Classical Test Theory and Item Response Theory were used for measurement development. Exploratory factor analysis (EFA; criterion ratio of eigenvalue 1 to eigenvalue 2 being >4; variance for eigenvalue 1 ?40\%) and confirmatory factor analysis (CFA; criterion 1-factor CFA loading <.50; 1-factor CFA residual correlation >.20; comparative fit index ?0.90; Tucker-Lewis index ?0.90; root mean square error of approximation <0.15) were used to determine unidimensional sets of items. Items with sparse responses, low-adjusted total score correlations, nonmonotonicity, low factor loading, and high residual correlations of high error modification indices were candidates for exclusion. A constrained graded response model was used to examine item misfit, and differential item functioning was examined to identify item bias. Cronbach $\alpha$ was used to examine internal consistency reliability for the new PROs (criterion ?0.70), and floor and ceiling effects were examined (criterion ?20\%). Results: Four unidimensional sets of items were supported by EFA (all EFA eigenvalue ratios >4; variance for eigenvalue 1=41.4\%-67.3\%) and CFA (fit statistics all exceeded criterion values). This included (1) ``Health-Seeking Behavior: PCP-Specific'' (6 items); (2) ``Health-Seeking Behavior: General Beliefs'' (13 items); (3) ``Health-Seeking Behavior: Family or Friends-Specific'' (5 items); and (4) ``Health-Seeking Behavior: Internet-Specific'' (4 items). All items were devoid of differential item functioning for age, sex, education, or socioeconomic status factors. ``Health-Seeking Behavior: General Beliefs'' was developed to include both a computer adaptive test and a 6-item short form version; all other PROs were developed as static short forms. The psychometric reliability of these new PROs was supported; internal consistency ranged from acceptable to excellent (Cronbach $\alpha$=.78-.91), and measures were free of significant floor or ceiling effects (floor effects range: 0\%-8.9\%; ceiling effects range: 0\%-8.4\%). Conclusions: The new REDD-CAT Health-Seeking Behavior PROs provide reliable assessments of health-seeking behaviors among those with T2DM. ",
doi="10.2196/63434",
url="https://diabetes.jmir.org/2024/1/e63434",
url="http://www.ncbi.nlm.nih.gov/pubmed/39576685"
}


@Article{info:doi/10.2196/65010,
author="Yoon, Minjae
and Lee, Hyun Ji
and Kim, In-Cheol
and Lee, Ju-Hee
and Kim, Mi-Na
and Kim, Hack-Lyoung
and Lee, Sunki
and Kim, Jai In
and Choi, Seonghoon
and Park, Sung-Ji
and Hur, Taeho
and Hussain, Musarrat
and Lee, Sungyoung
and Choi, Dong-Ju",
title="Smartphone App for Improving Self-Awareness of Adherence to Edoxaban Treatment in Patients With Atrial Fibrillation (ADHERE-App Trial): Randomized Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="21",
volume="26",
pages="e65010",
keywords="mobile apps",
keywords="digital health",
keywords="atrial fibrillation",
keywords="anticoagulants",
keywords="medication adherence",
keywords="mobile phone",
abstract="Background: Adherence to oral anticoagulant therapy is essential to prevent ischemic stroke in patients with atrial fibrillation (AF). Objective: This study aimed to evaluate whether smartphone app--based interventions improve medication adherence in patients with AF. Methods: This open-label, multicenter randomized controlled trial (ADHERE-App [Self-Awareness of Drug Adherence to Edoxaban Using an Automatic App Feedback System] study) enrolled patients with AF treated with edoxaban for stroke prevention. They were randomly assigned to app-conditioned feedback (intervention; n=248) and conventional treatment (control; n=250) groups. The intervention group received daily alerts via a smartphone app to take edoxaban and measure blood pressure and heart rate at specific times. The control group received only standard, guideline-recommended care. The primary end point was edoxaban adherence, measured by pill count at 3 or 6 months. Medication adherence and the proportion of adequate medication adherence, which was defined as ?95\% of continuous medication adherence, were evaluated. Results: Medication adherence at 3 or 6 months was not significantly different between the intervention and control groups (median 98\%, IQR 95\%-100\% vs median 98\%, IQR 91\%-100\% at 3 months, P=.06; median 98\%, IQR 94.5\%-100\% vs median 97.5\%, IQR 92.8\%-100\% at 6 months, P=.15). However, the proportion of adequate medication adherence (?95\%) was significantly higher in the intervention group at both time points (76.8\% vs 64.7\% at 3 months, P=.01; 73.9\% vs 61\% at 6 months, P=.007). Among patients aged >65 years, the intervention group showed a higher medication adherence value and a higher proportion of adequate medication adherence (?95\%) at 6 months. Conclusions: There was no difference in edoxaban adherence between the groups. However, the proportion of adequate medication adherence was higher in the intervention group, and the benefit of the smartphone app--based intervention on medication adherence was more pronounced among older patients than among younger patients. Given the low adherence to oral anticoagulants, especially among older adults, using a smartphone app may potentially improve medication adherence. Trial Registration: International Clinical Trials Registry Platform KCT0004754; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=28496\&search\_page=L International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-048777 ",
doi="10.2196/65010",
url="https://www.jmir.org/2024/1/e65010",
url="http://www.ncbi.nlm.nih.gov/pubmed/39570659"
}


@Article{info:doi/10.2196/56473,
author="Alomar, Dalia
and Almashmoum, Maryam
and Eleftheriou, Iliada
and Whelan, Pauline
and Ainsworth, John",
title="The Impact of Patient Access to Electronic Health Records on Health Care Engagement: Systematic Review",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="20",
volume="26",
pages="e56473",
keywords="electronic health records",
keywords="personal health record",
keywords="health care engagement",
keywords="empowerment",
keywords="patient experience",
keywords="patient satisfaction",
keywords="health care services",
keywords="systematic review",
abstract="Background: Health information technologies, including electronic health records (EHRs), have revolutionized health care delivery. These technologies promise to enhance the efficiency and quality of care through improved patient health information management. Despite the transformative potential of EHRs, the extent to which patient access contributes to increased engagement with health care services within different clinical setting remains a distinct and underexplored facet. Objective: This systematic review aims to investigate the impact of patient access to EHRs on health care engagement. Specifically, we seek to determine whether providing patients with access to their EHRs contributes to improved engagement with health care services. Methods: A comprehensive systematic review search was conducted across various international databases, including Ovid MEDLINE, Embase, PsycINFO, and CINAHL, to identify relevant studies published from January 1, 2010, to November 15, 2023. The search on these databases was conducted using a combination of keywords and Medical Subject Heading terms related to patient access to electronic health records, patient engagement, and health care services. Studies were included if they assessed the impact of patient access to EHRs on health care engagement and provided evidence (quantitative or qualitative) for that. The guidelines of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 statement were followed for study selection, data extraction, and quality assessment. The included studies were assessed for quality using the Mixed Methods Appraisal Tool, and the results were reported using a narrative synthesis. Results: The initial search from the databases yielded 1737 studies, to which, after scanning their reference lists, we added 10 studies. Of these 1747 studies, 18 (1.03\%) met the inclusion criteria for the final review. The synthesized evidence from these studies revealed a positive relationship between patient access to EHRs and health care engagement, addressing 6 categories of health care engagement dimensions and outcomes, including treatment adherence and self-management, patient involvement and empowerment, health care communication and relationship, patient satisfaction and health outcomes, use of health care resources, and usability concerns and barriers. Conclusions: The findings suggested a positive association between patient access to EHRs and health care engagement. The implications of these findings for health care providers, policy makers, and patients should be considered, highlighting the potential benefits and challenges associated with implementing and promoting patient access to EHRs. Further research directions have been proposed to deepen our understanding of this dynamic relationship. ",
doi="10.2196/56473",
url="https://www.jmir.org/2024/1/e56473"
}


@Article{info:doi/10.2196/59138,
author="Kang, Ye Ji
and Jung, Weon
and Kim, Ji Hyun
and An, Hyun Ji
and Yoon, Hee
and Kim, Taerim
and Chang, Hansol
and Hwang, Yeon Sung
and Park, Eun Jong
and Lee, Tak Gun
and Cha, Chul Won
and Heo, Sejin
and Lee, Uk Se",
title="Temporary Telemedicine Policy and Chronic Disease Management in South Korea: Retrospective Analysis Using National Claims Data",
journal="JMIR Public Health Surveill",
year="2024",
month="Nov",
day="20",
volume="10",
pages="e59138",
keywords="telemedicine",
keywords="public health",
keywords="medication adherence",
keywords="COVID-19",
keywords="chronic diseases",
abstract="Background: Since its introduction, telemedicine for patients with chronic diseases has been studied in various clinical settings. However, there is limited evidence of the effectiveness and medical safety of the nationwide adoption of telemedicine. Objective: This study aimed to analyze the effects of telemedicine on chronic diseases during the COVID-19 pandemic under a temporary telemedicine policy in South Korea using national claims data. Methods: Health insurance claims data were extracted over 2 years: 1 year before (from February 24, 2019, to February 23, 2020) and 1 year after the policy was implemented (from February 24, 2020, to February 23, 2021). We included all patients who used telemedicine at least once in the first year after the policy was implemented and compared them with a control group of patients who never used telemedicine. The comparison focused on health care use; the medication possession ratio (MPR); and admission rates to general wards (GWs), emergency departments (EDs), and intensive care units (ICUs) using difference-in-differences analysis. A total of 4 chronic diseases were targeted: hypertension, diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), and common mental disorders. Results: A total of 1,773,454 patients with hypertension; 795,869 patients with DM; 37,460 patients with COPD; and 167,084 patients with common mental disorders were analyzed in this study. Patients diagnosed with hypertension or DM showed increased MPRs without an increase in GW, ED, or ICU admission rates during the policy year. Moreover, patients in the DM group who did not use telemedicine had higher rates of ED, GW, and ICU admissions, and patients in the hypertension group had higher rates of GW or ICU admissions after 1 year of policy implementation. This trend was not evident in COPD and common mental disorders. Conclusions: The temporary telemedicine policy was effective in increasing medication adherence and reducing admission rates for patients with hypertension and DM; however, the efficacy of the policy was limited for patients with COPD and common mental disorders. Future studies are required to demonstrate the long-term effects of telemedicine policies with various outcome measures reflecting disease characteristics. ",
doi="10.2196/59138",
url="https://publichealth.jmir.org/2024/1/e59138"
}


@Article{info:doi/10.2196/58892,
author="Chan, Zhong Pin
and Jin, Eric
and Jansson, Miia
and Chew, Jocelyn Han Shi",
title="AI-Based Noninvasive Blood Glucose Monitoring: Scoping Review",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="19",
volume="26",
pages="e58892",
keywords="artificial intelligence",
keywords="blood glucose",
keywords="diabetes",
keywords="noninvasive",
keywords="self-monitoring",
keywords="machine learning",
keywords="scoping review",
keywords="monitoring",
keywords="management",
keywords="health informatics",
keywords="deep learning",
keywords="accuracy",
keywords="heterogeneity",
keywords="mobile phone",
abstract="Background: Current blood glucose monitoring (BGM) methods are often invasive and require repetitive pricking of a finger to obtain blood samples, predisposing individuals to pain, discomfort, and infection. Noninvasive blood glucose monitoring (NIBGM) is ideal for minimizing discomfort, reducing the risk of infection, and increasing convenience. Objective: This review aimed to map the use cases of artificial intelligence (AI) in NIBGM. Methods: A systematic scoping review was conducted according to the Arksey O'Malley five-step framework. Eight electronic databases (CINAHL, Embase, PubMed, Web of Science, Scopus, The Cochrane-Central Library, ACM Digital Library, and IEEE Xplore) were searched from inception until February 8, 2023. Study selection was conducted by 2 independent reviewers, descriptive analysis was conducted, and findings were presented narratively. Study characteristics (author, country, type of publication, study design, population characteristics, mean age, types of noninvasive techniques used, and application, as well as characteristics of the BGM systems) were extracted independently and cross-checked by 2 investigators. Methodological quality appraisal was conducted using the Checklist for assessment of medical AI. Results: A total of 33 papers were included, representing studies from Asia, the United States, Europe, the Middle East, and Africa published between 2005 and 2023. Most studies used optical techniques (n=19, 58\%) to estimate blood glucose levels (n=27, 82\%). Others used electrochemical sensors (n=4), imaging (n=2), mixed techniques (n=2), and tissue impedance (n=1). Accuracy ranged from 35.56\% to 94.23\% and Clarke error grid (A+B) ranged from 86.91\% to 100\%. The most popular machine learning algorithm used was random forest (n=10) and the most popular deep learning model was the artificial neural network (n=6). The mean overall checklist for assessment of medical AI score on the included papers was 33.5 (SD 3.09), suggesting an average of medium quality. The studies reviewed demonstrate that some AI techniques can accurately predict glucose levels from noninvasive sources while enhancing comfort and ease of use for patients. However, the overall range of accuracy was wide due to the heterogeneity of models and input data. Conclusions: Efforts are needed to standardize and regulate the use of AI technologies in BGM, as well as develop consensus guidelines and protocols to ensure the quality and safety of AI-assisted monitoring systems. The use of AI for NIBGM is a promising area of research that has the potential to revolutionize diabetes management. ",
doi="10.2196/58892",
url="https://www.jmir.org/2024/1/e58892"
}


@Article{info:doi/10.2196/57360,
author="Preiser, Christine
and Radionova, Natalia
and {\"O}g, Eylem
and Koch, Roland
and Klemmt, Malte
and M{\"u}ller, Regina
and Ranisch, Robert
and Joos, Stefanie
and Rieger, A. Monika",
title="The Doctors, Their Patients, and the Symptom Checker App: Qualitative Interview Study With General Practitioners in Germany",
journal="JMIR Hum Factors",
year="2024",
month="Nov",
day="18",
volume="11",
pages="e57360",
keywords="symptom checker app",
keywords="qualitative interviews",
keywords="general practice",
keywords="perceived work-related psychosocial stress",
keywords="job satisfaction",
keywords="professional identity",
keywords="medical diagnosis",
abstract="Background: Symptom checkers are designed for laypeople and promise to provide a preliminary diagnosis, a sense of urgency, and a suggested course of action. Objective: We used the international symptom checker app (SCA) Ada App as an example to answer the following question: How do general practitioners (GPs) experience the SCA in relation to the macro, meso, and micro level of their daily work, and how does this interact with work-related psychosocial resources and demands? Methods: We conducted 8 semistructured interviews with GPs in Germany between December 2020 and February 2022. We analyzed the data using the integrative basic method, an interpretative-reconstructive method, to identify core themes and modes of thematization. Results: Although most GPs in this study were open to digitization in health care and their practice, only one was familiar with the SCA. GPs considered the SCA as part of the ``unorganized stage'' of patients' searching about their conditions. Some preferred it to popular search engines. They considered it relevant to their work as soon as the SCA would influence patients' decisions to see a doctor. Some wanted to see the results of the SCA in advance in order to decide on the patient's next steps. GPs described the diagnostic process as guided by shared decision-making, with the GP taking the lead and the patient deciding. They saw diagnosis as an act of making sense of data, which the SCA would not be able to do, despite the huge amounts of data. Conclusions: GPs took a techno-pragmatic view of SCA. They operate in a health care system of increasing scarcity. They saw the SCA as a potential work-related resource if it helped them to reduce administrative tasks and unnecessary patient contacts. The SCA was seen as a potential work-related demand if it increased workload, for example, if it increased patients' anxiety, was too risk-averse, or made patients more insistent on their own opinions. ",
doi="10.2196/57360",
url="https://humanfactors.jmir.org/2024/1/e57360"
}


@Article{info:doi/10.2196/60966,
author="Aguas, Mariam
and Del Hoyo, Javier
and Vicente, Raquel
and Barreiro-de Acosta, Manuel
and Melcarne, Luigi
and Hernandez-Camba, Alejandro
and Madero, Luc{\'i}a
and Arroyo, Teresa Mar{\'i}a
and Sicilia, Beatriz
and Chaparro, Mar{\'i}a
and Martin-Arranz, Dolores Mar{\'i}a
and Pajares, Ram{\'o}n
and Mesonero, Francisco
and Ma{\~n}osa, Miriam
and Martinez, Pilar
and Chac{\'o}n, Silvia
and Tosca, Joan
and Mar{\'i}n, Sandra
and Sanroman, Luciano
and Calvo, Marta
and Monfort, David
and Saiz, Empar
and Zabana, Yamile
and Guerra, Ivan
and Varela, Pilar
and Baydal, Virginia
and Faubel, Raquel
and Corsino, Pilar
and Porto-Silva, Sol
and Brunet, Eduard
and Gonz{\'a}lez, Melodi
and Guti{\'e}rrez, Ana
and Nos, Pilar",
title="Telemonitoring of Active Inflammatory Bowel Disease Using the App TECCU: Short-Term Results of a Multicenter Trial of GETECCU",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="18",
volume="26",
pages="e60966",
keywords="clinical trial",
keywords="telemonitoring",
keywords="inflammatory bowel disease",
keywords="Crohn disease",
keywords="ulcerative colitis",
keywords="quality of life",
keywords="socioeconomical and psychological end points",
keywords="health outcomes",
keywords="remission time",
abstract="Background: Telemonitoring for inflammatory bowel disease (IBD) has not consistently demonstrated superiority over standard care; however, noninferiority may be an acceptable outcome if remote care proves to be more efficient. Objective: This study aims to compare the remission time and quality of life of patients with active IBD managed through standard care versus the TECCU (Telemonitoring of Crohn Disease and Ulcerative Colitis) app. Methods: A 2-arm, randomized, multicenter trial with a noninferiority design was conducted across 24 hospitals in Spain. The study included adult patients with IBD who were starting immunosuppressive or biological therapy. Participants were randomized into 2 groups: the telemonitoring group (G\_TECCU) and the standard care group (G\_Control). The follow-up schedule for the telemonitoring group (G\_TECCU) was based on contacts via the TECCU app, while the control group (G\_Control) adhered to standard clinical practice, which included in-person visits and telephone calls. In both groups, treatment adjustments were made based on the progression of disease activity and medication adherence, assessed using specific indices and biological markers at each check-up. The primary outcome was the duration of remission after 12 weeks, while secondary outcomes included quality of life, medication adherence, adverse events, and patient satisfaction. Results: Of the 169 patients enrolled, 158 were randomized and 150 were analyzed per protocol: telemonitoring (n=71) and control (n=79). After 12 weeks, the time in clinical remission was not inferior in the telemonitoring group (mean 4.20, SD 3.73 weeks) compared with the control group (mean 4.32, SD 3.28 weeks), with a mean difference between arms of --0.12 weeks (95\% CI --1.25 to 1.01; noninferiority P=.02). The mean reduction in C-reactive protein values was --15.40 mg/L (SD 90.15 mg/L; P=.19) in the G\_TECCU group and --13.16 mg/L (SD 54.61 mg/L; P=.05) in the G\_Control group, with no significant differences between the 2 arms (P=.73). Similarly, the mean improvement in fecal calprotectin levels was 832.3 mg/L (SD 1825.0 mg/L; P=.003) in the G\_TECCU group and 1073.5 mg/L (SD 3105.7 mg/L; P=.03) in the G\_Control group; however, the differences were not statistically significant (P=.96). Quality of life improved in both groups, with a mean increase in the 9-item Inflammatory Bowel Disease Questionnaire score of 13.44 points (SD 19.1 points; P<.001) in the G\_TECCU group and 18.23 points (SD 22.9 points; P=.001) in the G\_Control group. Additionally, the proportion of patients who adhered to their medication significantly increased from 35\% (25/71) to 68\% (48/71) in the G\_TECCU group (P=.001) and from 46\% (36/79) to 73\% (58/79) in the G\_Control group (P=.001). The satisfaction rate remained stable at around 90\%, although noninferiority was not demonstrated for the secondary outcomes. Conclusions: Telemonitoring patients with active IBD is not inferior to standard care for achieving and maintaining short-term remission. The TECCU app may serve as a viable alternative follow-up tool, pending confirmation of improved health outcomes and cost-effectiveness over the long-term. Trial Registration: ClinicalTrials.gov NCT06031038; https://clinicaltrials.gov/ct2/show/NCT06031038 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.9639 ",
doi="10.2196/60966",
url="https://www.jmir.org/2024/1/e60966",
url="http://www.ncbi.nlm.nih.gov/pubmed/39189160"
}


@Article{info:doi/10.2196/50959,
author="Zhou, Zhiheng
and Jin, Danian
and He, Jinghua
and Zhou, Shengqing
and Wu, Jiang
and Wang, Shuangxi
and Zhang, Yang
and Feng, Tianyuan",
title="Digital Health Platform for Improving the Effect of the Active Health Management of Chronic Diseases in the Community: Mixed Methods Exploratory Study",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="18",
volume="26",
pages="e50959",
keywords="information platform",
keywords="active health",
keywords="chronic disease management",
keywords="effectiveness",
keywords="community",
keywords="digital health",
keywords="health literacy",
keywords="cardio-cerebrovascular disease",
keywords="China",
abstract="Background: China is vigorously promoting the health management of chronic diseases and exploring digital active health management. However, as most medical information systems in China have been built separately, there is poor sharing of medical information. It is difficult to achieve interconnectivity among community residents' self-testing information, community health care information, and hospital health information, and digital chronic disease management has not been widely applied in China. Objective: This study aimed to build a digital health platform and improve the effectiveness of full-cycle management for community chronic diseases through digital active health management. Methods: This was a single-arm pre-post intervention study involving the development and use of a digital health platform (2-year intervention; 2020 to 2022). The digital health platform included the ``i Active Health'' applet for residents and the active health information system (cardio-cerebrovascular disease risk management system) for medical teams. The digital active health management of chronic diseases involved creating health streets, providing internet-assisted full-cycle active health services for residents, implementing internet-based community management for hypertension and diabetes, and performing real-time quantitative assessment and hierarchical management of residents' risks of cardio-cerebrovascular disease. After the 2-year intervention, management effectiveness was evaluated. Results: We constructed a digital health platform with interconnected health information and implemented a digital active health management model. After the intervention, the 2-way referral between community health care institutions and hospitals increased. Residents' health literacy rate increased from 30.6\% (3062/10,000) in 2020 to 49.9\% (4992/10,000) in 2022, with improvements in health knowledge, health behavior, and health skills. Moreover, the risk of cardio-cerebrovascular disease decreased after the intervention. The community hypertension and diabetes standardized management rates increased from 59.6\% (2124/3566) and 55.8\% (670/1200) in 2020 to 75.0\% (3212/4285) and 69.4\% (1686/2430) in 2022, respectively. The control rates of blood pressure in patients with hypertension and blood sugar in patients with diabetes increased from 51.7\% (1081/2091) and 42.0\% (373/888) in 2020 to 81.2\% (1698/2091) and 73.0\% (648/888) in 2022, respectively. The intervention improved patients' BMI, waist circumference, blood uric acid levels, and low-density lipoprotein cholesterol levels. The drug compliance rate of patients with hypertension and diabetes increased from 33.6\% (703/2091) and 36.0\% (320/888) in 2020 to 73.3\% (1532/2091) and 75.8\% (673/888) in 2022, respectively. The intervention greatly improved the diet behavior, exercise behavior, and drinking behavior of patients with hypertension and diabetes. Conclusions: Our digital health platform can effectively achieve the?interconnection and exchange of different health information. The digital active health management carried out with the assistance of this platform improved the effectiveness of community chronic disease management. Thus, the platform is worth promoting and applying in practice. ",
doi="10.2196/50959",
url="https://www.jmir.org/2024/1/e50959"
}


@Article{info:doi/10.2196/60049,
author="Chien, Shih-Ying",
title="Mobile App for Patients With Chronic Obstructive Pulmonary Diseases During Home-Based Exercise Care: Usability Study",
journal="JMIR Hum Factors",
year="2024",
month="Nov",
day="15",
volume="11",
pages="e60049",
keywords="digital health",
keywords="chronic obstructive pulmonary disease",
keywords="COPD",
keywords="usability",
keywords="telerehabilitation",
keywords="mobile health app",
abstract="Background: Digital health tools have demonstrated promise in the treatment and self-management of chronic diseases while also serving as an important means for reducing the workload of health care professionals (HCPs) and enhancing the quality of care. However, these tools often merely undergo large-scale testing or enter the market without undergoing rigorous user experience analysis in the early stages of their development, leading to frequent instances of low use or failure. Objective: This study aims to assess the usability of and satisfaction with a mobile app designed for the clinical monitoring of patients with chronic obstructive pulmonary disease undergoing pulmonary rehabilitation at home. Methods: This study used a mixed methods approach involving two key stakeholders---patients with chronic obstructive pulmonary disease and HCPs---across three phases: (1) mobile app mock-up design, (2) usability testing, and (3) satisfaction evaluation. Using convenience sampling, participants were grouped as HCPs (n=12) and patients (n=18). Each received a tablet with mock-ups for usability testing through interviews, with audio recordings transcribed and analyzed anonymously in NVivo12.0, focusing on mock-up features and usability insights. Task difficulty was rated from 1 (very easy) to 5 (very difficult), with noncompletion deemed a critical error. Usability satisfaction was measured on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree). Results: The research indicated a notable difference in app usability perceptions: 66\% (8/12) of HCPs found tasks ``very easy,'' compared to only 22\% (4/18) of patients. Despite this, no participant made critical errors or withdrew, and satisfaction was high. HCPs completed tasks in about 20 minutes, while patients took 30. Older adults faced challenges with touch screens and scroll menus, suggesting the need for intuitive design aids like auditory support and visual health progress indicators, such as graphs. HCPs noted potential data delays affecting service, while non--native-speaking caregivers faced interpretation challenges. A secure pairing system for privacy in teleconsultations proved difficult for older users; a simpler icon-based system is recommended. This study highlights the need to consider stakeholder abilities in medical app design to enhance function implementation. Conclusions: Most HCPs (11/12, 91\%) found the app intuitive, though they recommended adding icons to show patient progress to support clinical decisions. In contrast, 62\% (11/18) of patients struggled with tablet navigation, especially with connectivity features. To ensure equitable access, the design should accommodate older users with diverse abilities. Despite challenges, both groups reported high satisfaction, with patients expressing a willingness to learn and recommending the app. These positive usability evaluations suggest that, with design improvements, such apps could see increased use in home-based care. ",
doi="10.2196/60049",
url="https://humanfactors.jmir.org/2024/1/e60049"
}


@Article{info:doi/10.2196/51900,
author="Deinboll, Anne
and Moe, Fredriksen Cathrine
and Ludvigsen, Spliid Mette",
title="Participation in eHealth Communication Interventions Among Patients Undergoing Hemodialysis: Scoping Review",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="11",
volume="26",
pages="e51900",
keywords="eHealth",
keywords="electronic health records",
keywords="hemodialysis",
keywords="patient participation",
keywords="renal dialysis",
keywords="renal insufficiency",
keywords="chronic",
keywords="mobile phone",
abstract="Background: eHealth communication interventions have been shown to offer individuals with chronic kidney disease the opportunity to embrace dialysis therapies with greater confidence, the potential to obtain better clinical outcomes, and an increased quality of life. eHealth is an emerging field that offers diverse, flexible designs and delivery options. However, existing evidence on eHealth communication among patients undergoing hemodialysis is sparse and scattered and lacks systematization. Objective: This scoping review aims to identify and map the current evidence on patient participation in eHealth communication interventions. We aimed to map the associations between interventions and electronic health records, the participative role of individuals living with chronic kidney disease and undergoing hemodialysis, and the barriers to and facilitators of patient involvement in eHealth communication with health care professionals. Methods: This study used the Joanna Briggs Institute methodology for conducting a scoping review. Studies eligible for inclusion were those that included adult patients (aged >18 y) undergoing all types of hemodialysis, including prescheduled in-center hemodialysis and conventional home-based hemodialysis. Systematic searches were completed in Ovid MEDLINE, Ovid Embase, EBSCOhost CINAHL with Full Text, Scopus, and ProQuest Dissertations and Theses. Extracted data from the included studies were presented in figures and tables along with descriptions that responded to the research questions. This review was reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Results: In total, 9 peer-reviewed studies were included. The main result was a low participative patient role and a vaguely described link to electronic health records. The key participative facilitators were availability of and access to the intervention; security, trust, and confidence; patient knowledge of their health situation and use of self-care; and patient preparedness for an uncertain future health situation and the ability to relate to family and friends about it. The key participative barriers were lack of availability of and access to information, mistrust and lack of safety, lack of knowledge of health situation and self-care, and relational issues. All barriers and facilitators were related to health literacy. Conclusions: This scoping review summarizes 4 specific and 3 nonspecific eHealth communication interventions developed and evaluated in various studies involving patients receiving hemodialysis. A knowledge gap exists between low levels of patient participation in eHealth communication and patients' limited access to electronic health records. eHealth communication interventions should implement patient participation and focus on the fact that different modalities of eHealth communication can complement face-to-face communication. International Registered Report Identifier (IRRID): RR2-10.2196/38615 ",
doi="10.2196/51900",
url="https://www.jmir.org/2024/1/e51900"
}


@Article{info:doi/10.2196/65277,
author="An, Jinghui
and Shi, Fengwu
and Wang, Huajun
and Zhang, Hang
and Liu, Su",
title="Evaluating the Sensitivity of Wearable Devices in Posttranscatheter Aortic Valve Implantation Functional Assessment",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Nov",
day="8",
volume="12",
pages="e65277",
keywords="aortic valve",
keywords="implantation functional",
keywords="wearable devices",
doi="10.2196/65277",
url="https://mhealth.jmir.org/2024/1/e65277"
}


@Article{info:doi/10.2196/60787,
author="Wang, Tzu
and Huang, Yen-Ming
and Chan, Hsun-Yu",
title="Exploration of Features of Mobile Applications for Medication Adherence in Asia: Narrative Review",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="8",
volume="26",
pages="e60787",
keywords="Asia",
keywords="adherence",
keywords="application",
keywords="feature",
keywords="medication",
keywords="mobile",
abstract="Background: Medication is crucial for managing chronic diseases, yet adherence rates are often suboptimal. With advanced integration of IT and mobile internet into health care, mobile apps present a substantial opportunity for improving adherence by incorporating personalized educational, behavioral, and organizational strategies. However, determining the most effective features and functionalities for these apps within the specific health care context in Asia remains a challenge. Objective: We aimed to review the existing literature, focusing on Asian countries, to identify the optimal features of mobile apps that can effectively enhance medication adherence within the unique context of Asian societies. Methods: We conducted a narrative review with the SPIDER (sample, phenomenon of interest, design, evaluation, research type) tool. We identified studies on mobile apps for medication adherence from January 2019 to August 2024 on PubMed and Scopus. Key search terms included ``Asia,'' ``chronic disease,'' ``app,'' ``application,'' ``survey,'' ``experiment,'' ``questionnaire,'' ``group,'' ``medical adherence,'' ``medication adherence,'' ``case-control,'' ``cohort study,'' ``randomized controlled trial,'' ``clinical trial,'' ``observational study,'' ``qualitative research,'' ``mixed methods,'' and ``analysis,'' combined using logical operators ``OR'' and ``AND.'' The features of mobile apps identified in the studies were evaluated, compared, and summarized based on their disease focuses, developers, target users, features, usability, and use. Results: The study identified 14 mobile apps designed to enhance medication adherence. Of these, 11 were developed by research teams, while 3 were created by commercial companies or hospitals. All the apps incorporated multiple features to support adherence, with reminders being the most common, present in 11 apps. Patient community forums were the least common, appearing in only 1 app. In total, 6 apps provided lifestyle modification functions, offering dietary and exercise recommendations, generating individualized plans, and monitoring progress. In addition, 6 apps featured health data recording and monitoring functions, with 4 allowing users to export and share records with researchers or health care professionals. Many apps included communication features, with 10 enabling feedback from researchers or health care professionals and 7 offering web-based consultation services. Educational content was available in 8 apps, and 7 used motivation strategies to encourage adherence. Six studies showed that mobile apps improved clinical outcomes, such as blood glucose, lipid, and pressure, while reducing adverse events and boosting physical activities. Twelve studies noted positive humanistic effects, including better medication adherence, quality of life, and user satisfaction. Conclusions: This review has identified key components integrated into mobile apps to support medication adherence. However, the lack of government and corporate involvement in their development limits the generalizability of any individual app. Beyond basic reminder functions, features such as multiuser support, feedback mechanisms, web-based consultations, motivational tools, and socialization features hold significant promise for improving medication adherence. Further pragmatic research is necessary to validate the effectiveness of these selected apps in enhancing adherence. ",
doi="10.2196/60787",
url="https://www.jmir.org/2024/1/e60787"
}


@Article{info:doi/10.2196/56437,
author="Reilly, D. Erin
and Kelly, M. Megan
and Grigorian, L. Hannah
and Waring, E. Molly
and Quigley, S. Karen
and Hogan, P. Timothy
and Heapy, A. Alicia
and Drebing, E. Charles
and Volonte, Matias
and Kathawalla, Ummul-Kiram
and Robins, E. Hannah
and Bernice, Katarina
and Bickmore, Timothy",
title="Virtual Coach--Guided Online Acceptance and Commitment Therapy for Chronic Pain: Pilot Feasibility Randomized Controlled Trial",
journal="JMIR Form Res",
year="2024",
month="Nov",
day="8",
volume="8",
pages="e56437",
keywords="chronic pain",
keywords="randomized controlled trial",
keywords="usability",
keywords="acceptance and commitment therapy",
keywords="embodied conversational agent",
keywords="veterans",
abstract="Background: Veterans are disproportionately affected by chronic pain, with high rates of pain diagnoses (47\%-56\%) and a 40\% higher rate of prevalence of severe pain than nonveterans. This is often accompanied by negative functional outcomes and higher mortality. Combined with research suggesting medical treatments for chronic pain are often insufficient, there is an urgent need for nonmedical pain self-management programs. An interactive online platform to deliver an efficacious treatment for chronic pain such as acceptance and commitment therapy (ACT) could be a valuable option to assist veterans with pain care at home. Objective: This study aims to evaluate the virtual coach--guided Veteran ACT for Chronic Pain (VACT-CP) online program compared to a waitlist and treatment as usual (WL+TAU) control group through a small pilot feasibility randomized controlled trial. The primary aim was to evaluate the feasibility and acceptability of VACT-CP and study procedures, such as ease of recruitment, treatment receptivity, attrition and retention, sustained participation, system usability, and assessment of trial procedures. Secondary aims explored differences in the VACT-CP and WL+TAU groups on pre- and posttest (week 7) outcome measures for pain, mental health, functioning, and ACT processes. Methods: Veterans with chronic pain were recruited and randomized to either the VACT-CP (n=20) or the WL+TAU (n=22) group in a parallel group trial design. Self-report surveys were administered to participants at baseline (week 0), at the intervention midpoint (week 3), immediately after the intervention (week 7), and at the 1-month follow-up (week 11). We used Wilcoxon signed rank tests with the intention-to-treat sample to describe changes in secondary outcomes from pre- to postintervention within each group. Results: Study procedures showed good feasibility related to recruitment, enrollment, randomization, and study completion rates. Participants reported that VACT-CP was easy to use (System Usability Scale: mean 79.6, SD 12.8; median 82.5, IQR 70-87.5); they completed an average of 5 of the 7 total VACT-CP modules with high postintervention satisfaction rates. Qualitative feedback suggested a positive response to program usability, content tailoring, veteran centeredness, and perceived impact on pain management. Although the pilot feasibility trial was not powered to detect differences in clinical outcomes and significant findings should be interpreted with caution, the VACT-CP group experienced significant increases in chronic pain acceptance (P<.001) and decreases in depressive symptoms (P=.03). Conclusions: VACT-CP showed encouraging evidence of feasibility, usability, and acceptance, while also providing promising initial results in improving a key process in ACT for chronic pain---chronic pain acceptance---after online program use. A full-scale efficacy trial is needed to assess changes in clinical outcomes. Trial Registration: ClinicalTrials.gov NCT03655132; http://clinicaltrials.gov/ct2/show/NCT03655132 International Registered Report Identifier (IRRID): RR2-10.2196/45887 ",
doi="10.2196/56437",
url="https://formative.jmir.org/2024/1/e56437"
}


@Article{info:doi/10.2196/62641,
author="Patel, Atushi
and Maruthananth, Kevin
and Matharu, Neha
and Pinto, D. Andrew
and Hosseini, Banafshe",
title="Early Warning Systems for Acute Respiratory Infections: Scoping Review of Global Evidence",
journal="JMIR Public Health Surveill",
year="2024",
month="Nov",
day="7",
volume="10",
pages="e62641",
keywords="early warning systems",
keywords="acute respiratory infections",
keywords="early detection systems",
abstract="Background: Early warning systems (EWSs) are tools that integrate clinical observations to identify patterns indicating increased risks of clinical deterioration, thus facilitating timely and appropriate interventions. EWSs can mitigate the impact of global infectious diseases by enhancing information exchange, monitoring, and early detection. Objective: We aimed to evaluate the effectiveness of EWSs in acute respiratory infections (ARIs) through a scoping review of EWSs developed, described, and implemented for detecting novel, exotic, and re-emerging ARIs. Methods: We searched Ovid MEDLINE ALL, Embase, Cochrane Library (Wiley), and CINAHL (Ebsco). The search was conducted on October 03, 2023. Studies that implemented EWSs for the detection of acute respiratory illnesses were included. Covidence was used for citation management, and a modified Critical Appraisal Skills Programme (CASP) checklist was used for quality assessment. Results: From 5838 initial articles, 29 met the inclusion criteria for this review. Twelve studies evaluated the use of EWSs within community settings, ranging from rural community reporting networks to urban online participatory surveillance platforms. Five studies focused on EWSs that used data from hospitalization and emergency department visits. These systems leveraged clinical and admission data to effectively detect and manage local outbreaks of respiratory infections. Two studies focused on the effectiveness of existing surveillance systems, assessing their adaptability and responsiveness to emerging threats and how they could be improved based on past performance. Four studies highlighted the integration of machine learning models to improve the predictive accuracy of EWSs. Three studies explored the applications of national EWSs in different health care settings and emphasized their potential in predicting clinical deterioration and facilitating early intervention. Lastly, 3 studies addressed the use of surveillance systems in aged-care facilities, highlighting the unique challenges and needs of monitoring and responding to health threats in environments housing vulnerable populations. The CASP tool revealed that most studies were relevant, reliable, and of high value (score 6: 11/29, 38\%; score 5: 9/29, 31\%). The common limitations included result generalizability, selection bias, and small sample size for model validation. Conclusions: This scoping review confirms the critical role of EWSs in enhancing public health responses to respiratory infections. Although the effectiveness of these systems is evident, challenges related to generalizability and varying methodologies suggest a need for continued innovation and standardization in EWS development. ",
doi="10.2196/62641",
url="https://publichealth.jmir.org/2024/1/e62641"
}


@Article{info:doi/10.2196/60190,
author="Markowitz, Benjamin
and de Sequeira, Stephanie
and Najam, Adhiyat
and Pritlove, Cheryl
and Greenberg, Dana
and Greenberg, Marley
and Chan, Chee-Mei
and Lakhanpal, Gurpreet
and Jagadeesh, Samyukta
and Mukerji, Geetha
and Shulman, Rayzel
and Witteman, O. Holly
and Yu, H. Catherine
and Booth, L. Gillian
and Parsons, A. Janet
and ",
title="Beyond Hemoglobin A1c---Outcomes That Matter to Individuals With Type 1 Diabetes in Adopting Digital Health Interventions for Self-Management Support: Qualitative Study",
journal="JMIR Diabetes",
year="2024",
month="Nov",
day="7",
volume="9",
pages="e60190",
keywords="T1D self-management",
keywords="patient reported outcomes",
keywords="patient reported outcome measures",
keywords="virtual care",
keywords="mobile phone",
keywords="type 1 diabetes",
abstract="Background: Type 1 diabetes is a demanding chronic condition that requires diligent blood glucose monitoring and timely insulin administration by patients who must integrate self-management into their daily lives. Objective: This study aimed to better understand what outcome measures are important to individuals living with type 1 diabetes (T1D) in Ontario, Canada, to help inform the development of type 1 diabetes virtual self-management Education and support (T1ME) trial. Methods: A qualitative approach was used, in which we conducted 6 focus groups with a total of 24 adult participants living with T1D (from age 18 to >65 years) in Ontario. Each focus group was semistructured in nature; participants were encouraged to talk openly about their experiences with T1D self-management and provide their perspectives on more focused topics such as technology and relationships with health care providers. Results: An interpretive analysis helped us devise a framework for our results that centered around 6 main discussion themes: (1) adapting self-management to meet evolving needs, (2) looking ``beyond A1c'' toward more personalized indicators of glycemic management, (3) the benefits and challenges of adopting new T1D technology, (4) establishing trusting relationships with diabetes care providers, (5) perceived benefits of peer support, and (6) pre-- and post--COVID-19 perspectives on virtual care. Conclusions: Our goal is for these findings to help facilitate the development of patient-oriented outcome measures that are in line with the unique needs and preferences of T1D patients in this new, more virtual landscape of clinical care, education, and self-management support. ",
doi="10.2196/60190",
url="https://diabetes.jmir.org/2024/1/e60190"
}


@Article{info:doi/10.2196/59897,
author="Berger, Mathilde
and Deblock-Bellamy, Anne
and Ch{\`e}ze, Laurence
and Robert, Thomas
and Desrosiers, J. Julie
and Christe, Guillaume
and Bertrand, Martine Anne",
title="Exploring the Needs of People With Chronic Low Back Pain and Health Care Professionals for mHealth Devices to Support Self-Managed Physical Activity and Pain: User-Centered Design Approach",
journal="JMIR Hum Factors",
year="2024",
month="Nov",
day="7",
volume="11",
pages="e59897",
keywords="chronic low back pain",
keywords="needs",
keywords="self-management",
keywords="physical activity",
keywords="mobile health",
keywords="mHealth",
keywords="user-centered design",
abstract="Background: Chronic low back pain (CLBP) is a major economic and social problem worldwide. Despite the variety of recommended treatments, long-term self-management of this condition is complex and requires the development of innovative interventions. Mobile health (mHealth) technologies hold great promise for the management of chronic pain, particularly to support physical activity. However, their implementation is challenged by a lack of user compliance and limited engagement, which may be due to insufficient consideration of the needs of potential users during development. Objective: This study aims to explore the needs of people with CLBP and health care professionals regarding mHealth technologies to support self-managed physical activity, and to delineate design recommendations based on identified needs. Methods: A participatory study was conducted using a 3-phase, user-centered design approach: needs investigation with a group of experts in a workshop (phase 1), needs exploration with end users in focus groups (phase 2), and validation of needs using Delphi questionnaires followed by the development of a set of recommendations (phase 3). Results: A total of 121 people with CLBP, expert patients, health care professionals, rehabilitation researchers, and biomechanical engineers participated in this study. The results indicated how technology could help people with CLBP overcome their difficulties with managing physical activity. Specific needs were formulated concerning device objectives, expected strategies, functionalities, technical features, conditions of use, and potential facilitators and barriers to use. These needs were validated by consensus from the potential end users and translated into design recommendations. Conclusions: This study provides design recommendations for the development of an mHealth device specifically adapted for people with CLBP. ",
doi="10.2196/59897",
url="https://humanfactors.jmir.org/2024/1/e59897"
}


@Article{info:doi/10.2196/58413,
author="Chung, young Wou
and Yoon, Jinsik
and Yoon, Dukyong
and Kim, Songsoo
and Kim, Yujeong
and Park, Eun Ji
and Kang, Ae Young",
title="Development and Validation of Deep Learning--Based Infectivity Prediction in Pulmonary Tuberculosis Through Chest Radiography: Retrospective Study",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="7",
volume="26",
pages="e58413",
keywords="pulmonary tuberculosis",
keywords="chest radiography",
keywords="artificial intelligence",
keywords="tuberculosis",
keywords="TB",
keywords="smear",
keywords="smear test",
keywords="culture test",
keywords="diagnosis",
keywords="treatment",
keywords="deep learning",
keywords="CXR",
keywords="PTB",
keywords="management",
keywords="cost effective",
keywords="asymptomatic infection",
keywords="diagnostic tools",
keywords="infectivity",
keywords="AI tool",
keywords="cohort",
abstract="Background: Pulmonary tuberculosis (PTB) poses a global health challenge owing to the time-intensive nature of traditional diagnostic tests such as smear and culture tests, which can require hours to weeks to yield results. Objective: This study aimed to use artificial intelligence (AI)--based chest radiography (CXR) to evaluate the infectivity of patients with PTB more quickly and accurately compared with traditional methods such as smear and culture tests. Methods: We used DenseNet121 and visualization techniques such as gradient-weighted class activation mapping and local interpretable model-agnostic explanations to demonstrate the decision-making process of the model. We analyzed 36,142 CXR images of 4492 patients with PTB obtained from Severance Hospital, focusing specifically on the lung region through segmentation and cropping with TransUNet. We used data from 2004 to 2020 to train the model, data from 2021 for testing, and data from 2022 to 2023 for internal validation. In addition, we used 1978 CXR images of 299 patients with PTB obtained from Yongin Severance Hospital for external validation. Results: In the internal validation, the model achieved an accuracy of 73.27\%, an area under the receiver operating characteristic curve of 0.79, and an area under the precision-recall curve of 0.77. In the external validation, it exhibited an accuracy of 70.29\%, an area under the receiver operating characteristic curve of 0.77, and an area under the precision-recall curve of 0.8. In addition, gradient-weighted class activation mapping and local interpretable model-agnostic explanations provided insights into the decision-making process of the AI model. Conclusions: This proposed AI tool offers a rapid and accurate alternative for evaluating PTB infectivity through CXR, with significant implications for enhancing screening efficiency by evaluating infectivity before sputum test results in clinical settings, compared with traditional smear and culture tests. ",
doi="10.2196/58413",
url="https://www.jmir.org/2024/1/e58413"
}


@Article{info:doi/10.2196/57115,
author="Jin, Xiaorong
and Zhang, Yimei
and Zhou, Min
and Zhang, Xiong
and Mei, Qian
and Bai, Yangjuan
and Wei, Wei
and Ma, Fang",
title="Experiences With mHealth Use Among Patient-Caregiver Dyads With Chronic Heart Failure: Qualitative Study",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="31",
volume="26",
pages="e57115",
keywords="chronic heart failure",
keywords="informal caregiver",
keywords="mHealth",
keywords="experience",
keywords="dyad",
abstract="Background: Chronic heart failure has become a serious threat to the health of the global population, and self-management is key to treating chronic heart failure. The emergence of mobile health (mHealth) provides new ideas for the self-management of chronic heart failure in which the informal caregiver plays an important role. Current research has mainly studied the experiences with using mHealth among patients with chronic heart failure from the perspective of individual patients, and there is a lack of research from the dichotomous perspective. Objective: The aim of this study was to explore the experiences with mHealth use among patients with chronic heart failure and their informal caregivers from a dichotomous perspective. Methods: This descriptive phenomenological study from a post-positivist perspective used a dyadic interview method, and face-to-face semistructured interviews were conducted with patients with chronic heart failure and their informal caregivers. Data were collected and managed using NVivo 12 software, and data analysis used thematic analysis to identify and interpret participants' experiences and perspectives. The thematic analysis included familiarizing ourselves with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the report. Results: A total of 14 dyads of patients with chronic heart failure and their informal caregivers (13 men and 15 women) participated in this study, including 3 couples and 11 parent-child pairs. We constructed 4 key themes and their subthemes related to the experiences with mHealth use: (1) opposing experiences with mHealth as human interaction or trauma (great experience with mHealth use; trauma), (2) supplement instead of replacement (it is useful but better as a reference; offline is unavoidable sometimes), (3) both agreement and disagreement over who should be the adopter of mHealth (achieving consensus regarding who should adopt mHealth; conflict occurs when considering patients as the adopter of mHealth), (4) for better mHealth (applying mHealth with caution; suggestions for improved mHealth). Conclusions: This study reported that the experiences with mHealth use among patients with chronic heart failure and their informal caregivers were mixed, and it highlighted the human touch of mHealth and the importance of network security. These results featured mHealth as a complement to offline hospitals rather than a replacement. In the context of modern or changing Chinese culture, we encourage patients to use mHealth by themselves and their informal caregivers to provide help when necessary. In addition, we need to use mHealth carefully, and future mHealth designs should focus more on ease of use and be oriented more toward older adults. ",
doi="10.2196/57115",
url="https://www.jmir.org/2024/1/e57115"
}


@Article{info:doi/10.2196/57289,
author="B{\'a}ez Guti{\'e}rrez, Nerea
and Rodr{\'i}guez Ramallo, H{\'e}ctor
and Mendoza-Zambrano, Mar{\'i}a Elva
and Brown Arreola, Berenice
and Santos Ramos, Bernardo
and Abdel-kader Mart{\'i}n, Laila
and Otero Candelera, Remedios",
title="Smartphone Apps for Pulmonary Hypertension: Systematic Search and Content Evaluation",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Oct",
day="30",
volume="12",
pages="e57289",
keywords="pulmonary hypertension",
keywords="mobile apps",
keywords="smartphone",
keywords="eHealth",
keywords="mHealth",
keywords="app",
keywords="hypertension",
keywords="chronic condition",
keywords="mobile health app",
keywords="monitoring",
keywords="systematic search",
keywords="app development",
keywords="clinical validation",
keywords="evaluation",
keywords="pulmonary",
abstract="Background: Pulmonary hypertension (PH) is a chronic and complex condition, requiring consistent management and education. The widespread use of smartphones has opened possibilities for mobile health apps to support both patients and health care professionals in monitoring and managing PH more effectively. Objective: This study aimed to identify and assess the quality of free smartphone apps for PH targeted at either patients or health care professionals. Methods: A systematic search was conducted on freely available apps for patients with PH and health care professionals, accessed from a Spanish IP address, on Android (Google Play) and iOS (App Store) platforms. Searches were performed in October 2022 and 2023. Apps were independently analyzed by two reviewers, focusing on general characteristics. Quality assessment was based on the Mobile Application Rating Scale (MARS) framework, and Mann-Whitney U tests compared mean MARS scores against specific variables. Results: In the overall study, 21 apps were identified. In the 2022 search, 19 apps were listed (9 iOS, 7 Android, 3 available on both platforms). In the subsequent 2023 search, 16 apps were identified (6 Android, 7 iOS, 3 available on both platforms). Of those identified in 2022, 14 remained available in 2023, with only 7 updated since 2022. In addition, 12 apps targeted patients or the general population, while 9 targeted health care professionals; none involved patients in the development or design. Conversely, 13 apps involving health care professionals were identified. There were 10 apps that received pharmaceutical industry funding. The primary goal for 81\% (17/21) of the apps was to disseminate general information about PH. The overall mean MARS quality was acceptable in 2022 and 2023, with mean ratings of 3.1 (SD 0.6) and 3.3 (SD 0.5), respectively. The functionality category achieved the highest scores in both years, indicating ease of use and intuitive navigation. In contrast, the subjective quality domain consistently received the lowest ratings in the MARS assessment across both years. None of the apps underwent clinical testing themselves; however, 2 incorporated tools or algorithms derived from trials. The overall quality of iOS apps statistically outperformed that of Android apps in both years (P<.05). Furthermore, the involvement of health care professionals in app development was associated with enhanced quality, a trend observed in both years (P=.003 for both years). Conclusions: This review of mobile health apps for PH reveals their emergent development stage, with generally acceptable quality but lacking refinement. It highlights the critical role of health care professionals in app development, as they contribute significantly to quality and reliability. Despite this, a notable stagnation in app quality and functionality improvement over 2 years points to a need for continuous innovation and clinical validation for effective clinical integration. This research advocates for future app developers to actively engage with health care professionals, integrate patient insights, and mandate rigorous clinical validation for PH management. ",
doi="10.2196/57289",
url="https://mhealth.jmir.org/2024/1/e57289"
}


@Article{info:doi/10.2196/51753,
author="Le Roux, Enora
and Ursino, Moreno
and Milovanovic, Ivana
and Picq, Paul
and Haignere, Jeremie
and Rault, Gilles
and Pougheon Bertrand, Dominique
and Alberti, Corinne",
title="Home-Based Connected Devices Combined With Statistical Process Control for the Early Detection of Respiratory Exacerbations by Patients With Cystic Fibrosis: Pilot Interventional Study With a Pre-Post Design",
journal="JMIR Form Res",
year="2024",
month="Oct",
day="28",
volume="8",
pages="e51753",
keywords="connected devices",
keywords="cystic fibrosis",
keywords="patient education",
keywords="self-management",
keywords="medical device",
keywords="home monitoring",
keywords="remote monitoring",
keywords="statistical process control",
keywords="connected health",
keywords="alerts",
abstract="Background: Currently, patients with cystic fibrosis do not routinely monitor their respiratory function at home. Objective: This study aims to assess the clinical validity of using different connected health devices at home to measure 5 physiological parameters to help prevent exacerbations on a personalized basis from the perspective of patient empowerment. Methods: A multicenter interventional pilot study including 36 patients was conducted. Statistical process control---the cumulative sum control chart (CUSUM)---was used with connected health device measures with the objective of sending patients alerts at a relevant time in order to identify their individual risk of exacerbations. Associated patient education was delivered. Quantitative and qualitative data were collected. Results: One-half (18/36) of the patients completed the protocol through the end of the study. During the 12-month intervention, 6162 measures were collected with connected health devices, 387 alerts were sent, and 33 exacerbations were reported. The precision of alerts to detect exacerbations was weak for all parameters, which may be partly related to the low compliance of patients with the measurements. However, a decrease in the median number of exacerbations from 12 months before the study to after the 12-month intervention was observed for patients. Conclusions: The use of connected health devices associated with statistical process control showed that it was not acceptable for all patients, especially because of the burden related to measurements. However, the results suggest that it may be promising, after adaptations, for early identification and better management of exacerbations. Trial Registration: ClinicalTrials.gov NCT03304028; https://clinicaltrials.gov/study/NCT03304028 ",
doi="10.2196/51753",
url="https://formative.jmir.org/2024/1/e51753"
}


@Article{info:doi/10.2196/63776,
author="Saliasi, Ina
and Lan, Romain
and Rhanoui, Maryem
and Fraticelli, Laurie
and Viennot, St{\'e}phane
and Tardivo, Delphine
and Cl{\'e}ment, C{\'e}line
and du Sartz de Vigneulles, Benjamin
and Bernard, Sandie
and Darlington-Bernard, Adeline
and Dussart, Claude
and Bourgeois, Denis
and Carrouel, Florence",
title="French Version of the User Mobile Application Rating Scale: Adaptation and Validation Study",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Oct",
day="24",
volume="12",
pages="e63776",
keywords="mHealth",
keywords="mobile health",
keywords="mobile health apps",
keywords="eHealth",
keywords="Mobile Application Rating Scale, user version",
keywords="mobile apps",
keywords="quality assessment tool",
keywords="uMARS",
abstract="Background: Managing noncommunicable diseases effectively requires continuous coordination and monitoring, often facilitated by eHealth technologies like mobile health (mHealth) apps. The end-user version of the Mobile Application Rating Scale is a valuable tool for assessing the quality of mHealth apps from the user perspective. However, the absence of a French version restricts its use in French-speaking countries, where the evaluation and regulation of mHealth apps are still lacking, despite the increasing number of apps and their strong relevance in health care. Objective: This study aims to translate and culturally adapt a French version of the user Mobile Application Rating Scale (uMARS-F) and to test its overall and internal reliability. Methods: Cross-cultural adaptation and translation followed the universalist approach. The uMARS-F was evaluated as part through a cohort study using the French mHealth app ``MonSherpa'' (Qare). Participants were French-speaking adults with Apple or Android phones, excluding those with difficulty understanding French, prior app use, or physical limitations. They assessed the app using the uMARS-F twice (T1 and T2) 1 week apart. Scores for each section and overall were assessed for normal distribution using the Shapiro-Wilk test and presented as mean (SD), and potential floor or ceiling effects were calculated accordingly. Overall reliability was evaluated using intraclass correlation coefficients and internal reliability using Cronbach $\alpha$. Concordance between the 3 subscales (objective quality, subjective quality, and perceived impact), 4 sections, and 26 items at T1 and T2 was evaluated using the paired t test (2-tailed) and Pearson correlation. Results: In total, 167 participants assessed the app at both T1 and T2 (100\% compliance). Among them, 49.7\% (n=83) were female, and 50.3\% (n=84) were male, with a mean age of 43 (SD 16) years. The uMARS-F intraclass correlation coefficients were excellent for objective quality (0.959), excellent for subjective quality (0.993), and moderate for perceived impact (0.624). Cronbach $\alpha$ was good for objective quality (0.881), acceptable for subjective quality (0.701), and excellent for perceived impact (0.936). The paired t tests (2-tailed) demonstrated similar scores between the 2 assessments (P>.05), and the Pearson correlation coefficient indicated high consistency in each subscale, section, and item (r>0.76 and P<.001). The reliability and validity of the measures were similar to those found in the original English version as well as in the Spanish, Japanese, Italian, Greek, and Turkish versions that have already been translated and validated. Conclusions: The uMARS-F is a valid tool for end users to assess the quality of mHealth apps in French-speaking countries. The uMARS-F used in combination with the French version of the Mobile Application Rating Scale could enable health care professionals and public health authorities to identify reliable, high-quality, and valid apps for patients and should be part of French health care education programs. ",
doi="10.2196/63776",
url="https://mhealth.jmir.org/2024/1/e63776"
}


@Article{info:doi/10.2196/63707,
author="Gibson, Irene
and Neubeck, Lis
and Corcoran, Marissa
and Morland, Chris
and Donovan, Steve
and Jones, Jennifer
and Costello, Caroline
and Hynes, Lisa
and Harris, Aisling
and Harrahill, Mary
and Lillis, Mary
and Atrey, Alison
and Ski, F. Chantal
and Savickas, Vilius
and Byrne, Molly
and Murphy, W. Andrew
and McEvoy, William John
and Wood, David
and Jennings, Catriona",
title="Development of a Digital Health Intervention for the Secondary Prevention of Cardiovascular Disease (INTERCEPT): Co-Design and Usability Testing Study",
journal="JMIR Hum Factors",
year="2024",
month="Oct",
day="23",
volume="11",
pages="e63707",
keywords="cardiovascular disease",
keywords="secondary prevention",
keywords="digital health",
keywords="intervention development",
keywords="co-design",
keywords="usability testing",
keywords="mobile health",
keywords="usability",
keywords="design",
keywords="conline workshop",
keywords="social support",
keywords="behavioral change",
keywords="self-monitoring",
abstract="Background: Secondary prevention is an important strategy to reduce the burden of cardiovascular disease (CVD), a leading cause of death worldwide. Despite the growing evidence for the effectiveness of digital health interventions (DHIs) for the secondary prevention of CVD, the majority are designed with minimal input from target end users, resulting in poor uptake and usage. Objective: This study aimed to optimize the acceptance and effectiveness of a DHI for the secondary prevention of CVD through co-design, integrating end users' perspectives throughout. Methods: A theory-driven, person-based approach using co-design was adopted for the development of the DHI, known as INTERCEPT. This involved a 4-phase iterative process using online workshops. In phase 1, a stakeholder team of health care professionals, software developers, and public and patient involvement members was established. Phase 2 involved identification of the guiding principles, content, and design features of the DHI. In phase 3, DHI prototypes were reviewed for clarity of language, ease of navigation, and functionality. To anticipate and interpret DHI usage, phase 4 involved usability testing with participants who had a recent cardiac event (<2 years). To assess the potential impact of usability testing, the System Usability Scale was administered before and after testing. The GUIDED (Guidance for Reporting Intervention Development Studies in Health Research) checklist was used to report the development process. Results: Five key design principles were identified: simplicity and ease of use, behavioral change through goal setting and self-monitoring, personalization, system credibility, and social support. Usability testing resulted in 64 recommendations for the app, of which 51 were implemented. Improvements in System Usability Scale scores were observed when comparing the results before and after implementing the recommendations (61 vs 83; P=.02). Conclusions: Combining behavior change theory with a person-based, co-design approach facilitated the development of a DHI for the secondary prevention of CVD that optimized responsiveness to end users' needs and preferences, thereby potentially improving future engagement. ",
doi="10.2196/63707",
url="https://humanfactors.jmir.org/2024/1/e63707",
url="http://www.ncbi.nlm.nih.gov/pubmed/39441626"
}


@Article{info:doi/10.2196/54370,
author="Ar{\'e}valo Avalos, R. Marvyn
and Patel, Ashwin
and Duru, Haci
and Shah, Sanjiv
and Rivera, Madeline
and Sorrentino, Eleanor
and Dy, Marika
and Sarkar, Urmimala
and Nguyen, H. Kim
and Lyles, R. Courtney
and Aguilera, Adrian",
title="Implementation of a Technology-Enabled Diabetes Self-Management Peer Coaching Intervention for Patients With Poorly Controlled Diabetes: Quasi-Experimental Case Study",
journal="JMIR Diabetes",
year="2024",
month="Oct",
day="15",
volume="9",
pages="e54370",
keywords="type 2 diabetes",
keywords="type 1 diabetes",
keywords="diabetes experiences",
keywords="eHealth",
keywords="mHealth",
keywords="peer coaching",
keywords="peer coach",
keywords="peer support",
keywords="self-management",
keywords="social determinants of health",
keywords="behavioral determinants of health",
abstract="Background: Patients with diabetes experience worse health outcomes and greater health care expenditure. Improving diabetes outcomes requires involved self-management. Peer coaching programs can help patients engage in self-management while addressing individual and structural barriers. These peer coaching programs can be scaled with digital platforms to efficiently connect patients with peer supporters who can help with diabetes self-management. Objective: This study aimed to evaluate the implementation of a technology-enabled peer coaching intervention to support diabetes self-management among patients with uncontrolled diabetes. Methods: MetroPlusHealth, a predominant Medicaid health maintenance organization based in New York City, partnered with Pyx Health to enroll 300 Medicaid patients with uncontrolled diabetes into its 6-month peer coaching intervention. Pyx Health peer coaches conduct at least 2 evidence-based and goal-oriented coaching sessions per month with their assigned patients. These sessions are focused on addressing both behavioral and social determinants of health (SDoH) with the goal of helping patients increase their diabetes self-management literacy, implement self-management behaviors, and reduce barriers to ongoing self-care. Data analyzed in this study included patient demographic data, clinical data (patient's hemoglobin A1c [HbA1c]), and program implementation data including types of behavioral determinants of health and SDoH reported by patients and types of interventions used by peer coaches. Results: A total of 330 patients enrolled in the peer mentoring program and 2118 patients were considered to be on a waitlist group and used as a comparator. Patients who enrolled in the peer coaching program were older; more likely to be English speakers, female, and African American; and less likely to be White or Asian American or Pacific Islander than those in the waitlist condition, and had similar HbA1c laboratory results at baseline (intervention group 10.59 vs waitlist condition 10.62) Patients in the enrolled group had on average a --1.37 point reduction in the HbA1c score (n=70; pre: 10.99, post 9.62; P<.001), whereas patients in the waitlist group had a --0.16 reduction in the HbA1c score (n=207; pre 9.75, post 9.49; P<.001). Among a subsample of participants enrolled in the program with at least 2 HbA1c scores, we found that endorsement of emotional health issues ($\beta$=1.344; P=.04) and medication issues ($\beta$=1.36; P=.04) were significantly related to increases in HbA1c. Conclusions: This analysis of a technology-enabled 1-on-1 peer coaching program showed improved HbA1c levels for program participants relative to nonprogram participants. Results suggested participants with emotional stressors and medication management issues had worse outcomes and many preferred to connect through phone calls versus an app. These findings support the effectiveness of digital programs with multimodal approaches that include human support for improving diabetes self-management in a typically marginalized population with significant SDoH barriers. ",
doi="10.2196/54370",
url="https://diabetes.jmir.org/2024/1/e54370"
}


@Article{info:doi/10.2196/51239,
author="Oh, Sung-Hee
and Kang, Jae-Heon
and Kwon, Jin-Won",
title="Information and Communications Technology--Based Monitoring Service for Tailored Chronic Disease Management in Primary Care: Cost-Effectiveness Analysis Based on ICT-CM Trial Results",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="11",
volume="26",
pages="e51239",
keywords="mHealth",
keywords="mobile health",
keywords="smartphone application",
keywords="cost-effectiveness analysis",
keywords="hypertension",
keywords="diabetes mellitus",
keywords="primary care",
keywords="artificial intelligence",
keywords="applications digital health",
keywords="mobile phone",
abstract="Background: Information and communications technology--based tailored management (TM) intervention is a novel automatic system in which a smartphone app for the management of patients with hypertension and diabetes, the provider web, and Bluetooth devices are linked. However, little evidence exists regarding the cost-effectiveness of the interventions using mobile apps. Objective: This study aimed to assess the cost-effectiveness of TM intervention for adult patients with hypertension or diabetes in primary care compared with usual care (UC). Methods: Cost-effectiveness analysis using a Markov model was conducted from the Korean health care system perspective. Based on 6-month outcome data from an information and communications technology--based tailored chronic disease management (ICT-CM) trial, effectiveness over a lifetime beyond the trial periods was extrapolated using a cardiovascular disease risk prediction model. Costs were estimated using ICT-CM trial data and national health insurance claims data. Health utility weights were obtained from the Korea National Health and Nutrition Examination Survey. Results: In the base-case analysis, compared with UC, TM was more costly (US \$23,157 for TM vs US \$22,391 for UC) and more effective (12.006 quality-adjusted life-years [QALYs] for TM vs 11.868 QALYs for UC). The incremental cost-effectiveness ratio was US \$5556 per QALY gained. Probabilistic sensitivity analysis showed that the probability of TM being cost-effective compared with UC was approximately 97\% at an incremental cost-effectiveness ratio threshold of US \$26,515 (KRW 35 million) per QALY gained. Conclusions: Compared with UC, TM intervention is a cost-effective option for patients with hypertension or diabetes in primary care settings. The study results can assist policy makers in making evidence-based decisions when implementing accessible chronic disease management services. ",
doi="10.2196/51239",
url="https://www.jmir.org/2024/1/e51239"
}


@Article{info:doi/10.2196/55208,
author="Greenleaf, R. Abigail
and Francis, Sarah
and Zou, Jungang
and Farley, M. Shannon
and Lekhela, T{\vs}epang
and Asiimwe, Fred
and Chen, Qixuan",
title="Influenza-Like Illness in Lesotho From July 2020 to July 2021: Population-Based Participatory Surveillance Results",
journal="JMIR Public Health Surveill",
year="2024",
month="Oct",
day="8",
volume="10",
pages="e55208",
keywords="surveillance",
keywords="participatory surveillance",
keywords="influenza-like illness",
keywords="COVID-19",
keywords="cell phone",
keywords="sub-Saharan Africa",
keywords="population-based",
keywords="Lesotho",
keywords="SARS-CoV-2",
keywords="technology",
keywords="epidemiology",
keywords="adult",
keywords="data collection",
keywords="innovation",
keywords="mobile phone",
keywords="cellphone",
abstract="Background: Participatory surveillance involves at-risk populations reporting their symptoms using technology. In Lesotho, a landlocked country of 2 million people in Southern Africa, laboratory and case-based COVID-19 surveillance systems were complemented by a participatory surveillance system called ``LeCellPHIA'' (Lesotho Cell Phone Population-Based HIV Impact Assessment Survey). Objective: This report describes the person, place, and time characteristics of influenza-like illness (ILI) in Lesotho from July 15, 2020, to July 15, 2021, and reports the risk ratio of ILI by key demographic variables. Methods: LeCellPHIA employed interviewers to call participants weekly to inquire about ILI. The average weekly incidence rate for the year-long period was created using a Quasi-Poisson model, which accounted for overdispersion. To identify factors associated with an increased risk of ILI, we conducted a weekly data analysis by fitting a multilevel Poisson regression model, which accounted for 3 levels of clustering. Results: The overall response rate for the year of data collection was 75\%, which resulted in 122,985 weekly reports from 1776 participants. ILI trends from LeCellPHIA mirrored COVID-19 testing data trends, with an epidemic peak in mid to late January 2021. Overall, any ILI symptoms (eg, fever, dry cough, and shortness of breath) were reported at an average weekly rate of 879 per 100,000 (95\% CI 782?988) persons at risk. Compared to persons in the youngest age group (15?19 years), all older age groups had an elevated risk of ILI, with the highest risk of ILI in the oldest age group (?60 years; risk ratio 2.6, 95\% CI 1.7?3.8). Weekly data were shared in near real time with the National COVID-19 Secretariat and other stakeholders to monitor ILI trends, identify and respond to increases in reports of ILI, and inform policies and practices designed to reduce COVID-19 transmission in Lesotho. Conclusions: LeCellPHIA, an innovative and cost-effective system, could be replicated in countries where cell phone ownership is high but internet use is not yet high enough for a web- or app-based surveilance system. ",
doi="10.2196/55208",
url="https://publichealth.jmir.org/2024/1/e55208"
}


@Article{info:doi/10.2196/56547,
author="Ikuta, Kasumi
and Aishima, Miya
and Noguchi-Watanabe, Maiko
and Fukui, Sakiko",
title="Feasibility of Monitoring Heart and Respiratory Rates Using Nonwearable Devices and Consistency of the Measured Parameters: Pilot Feasibility Study",
journal="JMIR Hum Factors",
year="2024",
month="Oct",
day="8",
volume="11",
pages="e56547",
keywords="heart rate",
keywords="older adults",
keywords="respiratory rate",
keywords="nonwearable devices",
keywords="vital signs",
abstract="Background: As Japan is the world's fastest-aging society with a declining population, it is challenging to secure human resources for care providers. Therefore, the Japanese government is promoting digital transformation and the use of nursing care equipment, including nonwearable devices that monitor heart and respiratory rates. However, the feasibility of monitoring heart and respiratory rates with nonwearable devices and the consistency of the rates measured have not been reported. Objective: In this study, we focused on a sheet-type nonwearable device (Safety Sheep Sensor) introduced in many nursing homes. We evaluated the feasibility of monitoring heart rate (HR) and respiratory rate (RR) continuously using nonwearable devices and the consistency of the HR and RR measured. Methods: A sheet-type nonwearable device that measured HR and RR every minute through body vibrations was placed under the mattress of each participant. The participants in study 1 were healthy individuals aged 20?60 years (n=21), while those in study 2 were older adults living in multidwelling houses and required nursing care (n=20). The HR was measured using standard methods by the nurse and using the wearable device (Silmee Bar-type Lite sensor), and RR was measured by the nurse. The primary outcome was the mean difference in HR and RR between nonwearable devices and standard methods. Results: The mean difference in HR was ?0.32 (SD 3.12) in study 1 and 0.04 (SD: 3.98) in study 2; both the differences were within the predefined accepted discrepancies (<5 beats/min). The mean difference in RR was ?0.98 (SD 3.01) in study 1 and ?0.49 (SD 2.40) in study 2; both the differences were within the predefined accepted discrepancies (3 breaths/min). Conclusions: HR and RR measurements obtained using the nonwearable devices and the standard method were similar. Continuous monitoring of vital signs using nonwearable devices can aid in the early detection of abnormal conditions in older people. ",
doi="10.2196/56547",
url="https://humanfactors.jmir.org/2024/1/e56547"
}


@Article{info:doi/10.2196/56674,
author="Tr{\`o}, Rosella
and Orecchia, Angelica
and Disma, Nicola
and Uva, Paolo
and Cavanna, Roberto
and Zanardi, Nicol{\`o}
and Torre, Michele
and Fato, Massimo Marco",
title="Comparison of Analgesia Methods Through a Web Platform in Patients Undergoing Thoracic Surgery: Pilot Design, Implementation, and Validation Study",
journal="JMIR Form Res",
year="2024",
month="Oct",
day="8",
volume="8",
pages="e56674",
keywords="pectus excavatum",
keywords="pain assessment",
keywords="web platform",
keywords="health care informatics",
abstract="Background: Pain management is a vital and essential part of postoperative pectus excavatum (PE) care. Given the lack of an international consensus on guidelines for postoperative handling and evaluation, further research is necessary to compare the efficacy of existing pain management methods regarding pain relief, side effects, and long-term outcomes. In this context, the use of eHealth solutions for data mining can enhance data collection efficiency, reduce errors, and improve patient engagement. However, these digital health care frameworks are currently underused in the context of pain management for PE. Objective: This research is part of the broader Cryoanalgesia for Pain Management After Pectus Excavatum Repair (COPPER) study conducted by Giannina Gaslini Children's Hospital to address postoperative pain and recovery in PE patients treated with either standard thoracic epidural analgesia or cryoanalgesia, which is considered its innovative alternative approach. Specifically, this work is aimed at introducing a valuable tool for a comprehensive and quantitative comparison of the 2 analgesia strategies. The tool is a web and mobile app designed to facilitate data collection, management, and analysis of clinical data for pain assessment. Methods: The adopted approach involves a careful design based on clinician input, resulting in an intuitive app structure with 3 main screens. Digital surveys are borrowed from paper surveys, including medical history and preoperative, postoperative, and follow-up evaluations. XTENS 2.0 was used to manage the data, and Ionic facilitated cross-platform app development, ensuring secure and adaptable data handling. Results: Preliminary analysis on a pilot cohort of 72 patients (36 treated with standard therapy and 36 treated with cryoanalgesia) indicated successful patient enrollment and balanced representation across treatment groups and genders. Notably, hospital stay was significantly shorter with cryoanalgesia than with standard therapy (Mann-Whitney-Wilcoxon 2-sided test with Bonferroni correction; P<.001; U statistic=287.5), validating its treatment efficacy. Conclusions: This work is a step toward modernizing health care through digital transformation and patient-centered models. The app shows promise in streamlined data collection and patient engagement, although improvements in multilingual support, data validation, and incentivization of questionnaire completion are warranted. Overall, this study highlights the potential of digital health solutions in revolutionizing health care practices, fostering patient involvement, and improving care quality. ",
doi="10.2196/56674",
url="https://formative.jmir.org/2024/1/e56674"
}


@Article{info:doi/10.2196/60834,
author="Aguilera, Adrian
and Ar{\'e}valo Avalos, Marvyn
and Xu, Jing
and Chakraborty, Bibhas
and Figueroa, Caroline
and Garcia, Faviola
and Rosales, Karina
and Hernandez-Ramos, Rosa
and Karr, Chris
and Williams, Joseph
and Ochoa-Frongia, Lisa
and Sarkar, Urmimala
and Yom-Tov, Elad
and Lyles, Courtney",
title="Effectiveness of a Digital Health Intervention Leveraging Reinforcement Learning: Results From the Diabetes and Mental Health Adaptive Notification Tracking and Evaluation (DIAMANTE) Randomized Clinical Trial",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="8",
volume="26",
pages="e60834",
keywords="digital health",
keywords="physical activity",
keywords="mobile phone",
keywords="text messages",
keywords="SMS",
keywords="steps",
keywords="walking",
keywords="diabetes",
keywords="depression",
keywords="reinforcement learning",
keywords="exercise",
keywords="machine learning",
abstract="Background: Digital and mobile health interventions using personalization via reinforcement learning algorithms have the potential to reach large number of people to support physical activity and help manage diabetes and depression in daily life. Objective: The Diabetes and Mental Health Adaptive Notification and Tracking Evaluation (DIAMANTE) study tested whether a digital physical activity intervention using personalized text messaging via reinforcement learning algorithms could increase step counts in a diverse, multilingual sample of people with diabetes and depression symptoms. Methods: From January 2020 to June 2022, participants were recruited from 4 San Francisco, California--based public primary care clinics and through web-based platforms to participate in the 24-week randomized controlled trial. Eligibility criteria included English or Spanish language preference and a documented diagnosis of diabetes and elevated depression symptoms. The trial had 3 arms: a Control group receiving a weekly mood monitoring message, a Random messaging group receiving randomly selected feedback and motivational text messages daily, and an Adaptive messaging group receiving text messages selected by a reinforcement learning algorithm daily. Randomization was performed with a 1:1:1 allocation. The primary outcome, changes in daily step counts, was passively collected via a mobile app. The primary analysis assessed changes in daily step count using a linear mixed-effects model. An a priori subanalysis compared the primary step count outcome within recruitment samples. Results: In total, 168 participants were analyzed, including those with 24\% (40/168) Spanish language preference and 37.5\% (63/168) from clinic-based recruitment. The results of the linear mixed-effects model indicated that participants in the Adaptive arm cumulatively gained an average of 3.6 steps each day (95\% CI 2.45-4.78; P<.001) over the 24-week intervention (average of 608 total steps), whereas both the Control and Random arm participants had significantly decreased rates of change. Postintervention estimates suggest that participants in the Adaptive messaging arm showed a significant step count increase of 19\% (606/3197; P<.001), in contrast to 1.6\% (59/3698) and 3.9\% (136/3480) step count increase in the Random and Control arms, respectively. Intervention effectiveness differences were observed between participants recruited from the San Francisco clinics and those recruited via web-based platforms, with the significant step count trend persisting across both samples for participants in the Adaptive group. Conclusions: Our study supports the use of reinforcement learning algorithms for personalizing text messaging interventions to increase physical activity in a diverse sample of people with diabetes and depression. It is the first to test this approach in a large, diverse, and multilingual sample. Trial Registration: ClinicalTrials.gov NCT03490253; https://clinicaltrials.gov/study/NCT03490253 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-034723 ",
doi="10.2196/60834",
url="https://www.jmir.org/2024/1/e60834",
url="http://www.ncbi.nlm.nih.gov/pubmed/39378080"
}


@Article{info:doi/10.2196/54405,
author="Suresh Kumar, Sagar
and Connolly, Patricia
and Maier, Anja",
title="Considering User Experience and Behavioral Approaches in the Design of mHealth Interventions for Atrial Fibrillation: Systematic Review",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="4",
volume="26",
pages="e54405",
keywords="atrial fibrillation",
keywords="wearable devices",
keywords="lifestyle modification",
keywords="user experience",
keywords="design for behavior change",
keywords="systems thinking",
keywords="cardiac disease",
keywords="stroke",
keywords="heart disease",
keywords="complication",
keywords="mobile health",
keywords="systematic review",
keywords="usability",
keywords="mHealth",
keywords="intervention",
abstract="Background: Atrial fibrillation (AF) is a leading chronic cardiac disease associated with an increased risk of stroke, cardiac complications, and general mortality. Mobile health (mHealth) interventions, including wearable devices and apps, can aid in the detection, screening, and management of AF to improve patient outcomes. The inclusion of approaches that consider user experiences and behavior in the design of health care interventions can increase the usability of mHealth interventions, and hence, hopefully, yield an increase in positive outcomes in the lives of users. Objective: This study aims to show how research has considered user experiences and behavioral approaches in designing mHealth interventions for AF detection, screening, and management; the phases of designing complex interventions from the UK Medical Research Council (MRC) were referenced: namely, identification, development, feasibility, evaluation, and implementation. Methods: Studies published until September 7, 2022, that examined user experiences and behavioral approaches associated with mHealth interventions in the context of AF were extracted from multiple databases. The PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines were used. Results: A total of 2219 records were extracted, with only 55 records reporting on usability, user experiences, or behavioral approaches more widely for designing mHealth interventions in the context of AF. When mapping the studies onto the phases of the UK MRC's guidance for developing and evaluating complex interventions, the following was found: in the identification phase, there were significant differences between the needs of patients and health care workers. In the development phase, user perspectives guided the iterative development of apps, interfaces, and intervention protocols in 4 studies. Most studies (43/55, 78\%) assessed the usability of interventions in the feasibility phase as an outcome, although the data collection tools were not designed together with users and stakeholders. Studies that examined the evaluation and implementation phase entailed reporting on challenges in user participation, acceptance, and workflows that could not be captured by studies in the previous phases. To realize the envisaged human behavior intended through treatment, review results highlight the scant inclusion of behavior change approaches for mHealth interventions across multiple levels of sociotechnical health care systems. While interventions at the level of the individual (micro) and the level of communities (meso) were found in the studies reviewed, no studies were found intervening at societal levels (macro). Studies also failed to consider the temporal variation of user goals and feedback in the design of long-term behavioral interventions. Conclusions: In this systematic review, we proposed 2 contributions: first, mapping studies to different phases of the MRC framework for developing and evaluating complex interventions, and second, mapping behavioral approaches to different levels of health care systems. Finally, we discuss the wider implications of our results in guiding future mHealth research. ",
doi="10.2196/54405",
url="https://www.jmir.org/2024/1/e54405"
}


@Article{info:doi/10.2196/59098,
author="Bilbrey, Tim
and Martin, Jenny
and Zhou, Wen
and Bai, Changhao
and Vaswani, Nitin
and Shah, Rishab
and Chokshi, Sara
and Chen, Xi
and Bhusri, Satjit
and Niemi, Samantha
and Meng, Hongdao
and Lei, Zhen",
title="A Dual-Modality Home-Based Cardiac Rehabilitation Program for Adults With Cardiovascular Disease: Single-Arm Remote Clinical Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Oct",
day="1",
volume="12",
pages="e59098",
keywords="cardiac rehabilitation",
keywords="telehealth",
keywords="mHealth",
keywords="digital health",
keywords="exercise",
keywords="quality of life",
keywords="myocardial infarction",
keywords="app",
keywords="application",
keywords="physical fitness",
keywords="self-management",
keywords="disease management",
abstract="Background: Cardiac rehabilitation (CR) is a safe, effective intervention for individuals with cardiovascular disease (CVD). However, a majority of eligible patients do not complete CR. Growing evidence suggests that home-based cardiac rehabilitation (HBCR) programs are comparable in effectiveness and safety with traditional center-based programs. More research is needed to explore different ways to deliver HBCR programs to patients with CVD. Objective: We aimed to assess the feasibility and impact of a digital HBCR program (RecoveryPlus.Health) that integrates both telehealth and mHealth modalities on functional exercise capacity, resting heart rate, and quality of life among adults with CVD. Methods: This 12-week prospective, single-arm remote clinical trial used a within-subject design. We recruited adults with CVD (aged ?40 years) from the community with a CR-eligible diagnosis (stable angina pectoris, myocardial infarction, and heart failure) between May and August 2023. All enrolled patients referred to the RPH clinic in Roanoke, Texas, were included. The care team provided guideline-concordant CR services to study participants via two modalities: (1) a synchronous telehealth exercise training through videoconferencing; and (2) an asynchronous mobile health (mHealth) coaching app (RPH app). Baseline intake survey, electronic health record, and app log data were used to extract individual characteristics, care processes, and platform engagement data. Feasibility was measured by program completion rate and CR service use. Efficacy was measured by changes in the 6-minute walk test, resting heart rate, and quality of life (12-Item Short-Form Health Survey) before and after the 12-week program. Paired t tests were used to examine pre- and postintervention changes in the outcome variables. Results: In total, 162 met the inclusion criteria and 75 (46.3\%) consented and were enrolled (mean age 64, SD 10.30 years; male: n=37, 49\%; White: n=46, 61\%). Heart failure was the most common diagnosis (37/75, 49\%). In total, 62/75 (83\%) participants completed the 12-week study and used the telehealth modality with 9.63 (SD 3.33) sessions completed, and 59/75 (79\%) used the mHealth modality with 10.97 (SD 11.70) sessions completed. Post intervention, 50/62 (81\%) participants' performance in the 6-minute walk test had improved, with an average improvement of 40 (SD 63.39) m (95\% CI 25.6-57.1). The average 12-Item Short-Form Health Survey's physical and mental summary scores improved by 2.7 (SD 6.47) points (95\% CI 1.1-4.3) and 2.2 (SD 9.09) points (95\% CI 0.1-4.5), respectively. There were no changes in resting heart rate and no exercise-related adverse events were reported. Conclusions: The RecoveryPlus.Health digital HBCR program showed feasibility and efficacy in a group of nationally recruited patients with CVD. The findings add to the evidence that a telehealth and mHealth dual-modality HBCR program may be a promising approach to overcome some of the main barriers to improving CR access in the United States. Trial Registration: ClinicalTrials.gov NCT05804500; https://clinicaltrials.gov/search?cond=NCT05804500 ",
doi="10.2196/59098",
url="https://mhealth.jmir.org/2024/1/e59098",
url="http://www.ncbi.nlm.nih.gov/pubmed/39150858"
}


@Article{info:doi/10.2196/58079,
author="Podda, Jessica
and Grange, Erica
and Susini, Alessia
and Tacchino, Andrea
and Di Antonio, Federica
and Pedull{\`a}, Ludovico
and Brichetto, Giampaolo
and Ponzio, Michela",
title="Italian Version of the mHealth App Usability Questionnaire (Ita-MAUQ): Translation and Validation Study in People With Multiple Sclerosis",
journal="JMIR Hum Factors",
year="2024",
month="Sep",
day="30",
volume="11",
pages="e58079",
keywords="mHealth",
keywords="multiple sclerosis",
keywords="cognitive assessment",
keywords="questionnaire validation",
keywords="usability",
keywords="mHealth app",
keywords="mHealth application",
keywords="validation study",
keywords="MAUQ",
keywords="app usability",
keywords="telemedicine",
keywords="disability",
keywords="usability questionnaire",
keywords="mobile health",
abstract="Background: Telemedicine and mobile health (mHealth) apps have emerged as powerful tools in health care, offering convenient access to services and empowering participants in managing their health. Among populations with chronic and progressive disease such as multiple sclerosis (MS), mHealth apps hold promise for enhancing self-management and care. To be used in clinical practice, the validity and usability of mHealth tools should be tested. The most commonly used method for assessing the usability of electronic technologies are questionnaires. Objective: This study aimed to translate and validate the English version of the mHealth App Usability Questionnaire into Italian (ita-MAUQ) in a sample of people with MS. Methods: The 18-item mHealth App Usability Questionnaire was forward- and back-translated from English into Italian by an expert panel, following scientific guidelines for translation and cross-cultural adaptation. The ita-MAUQ (patient version for stand-alone apps) comprises 3 subscales, which are ease of use, interface and satisfaction, and usefulness. After interacting with DIGICOG-MS (Digital Assessment of Cognitive Impairment in Multiple Sclerosis), a novel mHealth app for cognitive self-assessment in MS, people completed the ita-MAUQ and the System Usability Scale, included to test construct validity of the translated questionnaire. Confirmatory factor analysis, internal consistency, test-retest reliability, and construct validity were assessed. Known-groups validity was examined based on disability levels as indicated by the Expanded Disability Status Scale (EDSS) score and gender. Results: In total, 116 people with MS (female n=74; mean age 47.2, SD 14 years; mean EDSS 3.32, SD 1.72) were enrolled. The ita-MAUQ demonstrated acceptable model fit, good internal consistency (Cronbach $\alpha$=0.92), and moderate test-retest reliability (intraclass coefficient correlation 0.84). Spearman coefficients revealed significant correlations between the ita-MAUQ total score; the ease of use (5 items), interface and satisfaction (7 items), and usefulness subscales; and the System Usability Scale (all P values <.05). Known-group analysis found no difference between people with MS with mild and moderate EDSS (all P values >.05), suggesting that ambulation ability, mainly detected by the EDSS, did not affect the ita-MAUQ scores. Interestingly, a statistical difference between female and male participants concerning the ease of use ita-MAUQ subscale was found (P=.02). Conclusions: The ita-MAUQ demonstrated high reliability and validity and it might be used to evaluate the usability, utility, and acceptability of mHealth apps in people with MS. ",
doi="10.2196/58079",
url="https://humanfactors.jmir.org/2024/1/e58079"
}


@Article{info:doi/10.2196/59587,
author="Ortiz, L. Bengie
and Gupta, Vibhuti
and Kumar, Rajnish
and Jalin, Aditya
and Cao, Xiao
and Ziegenbein, Charles
and Singhal, Ashutosh
and Tewari, Muneesh
and Choi, Won Sung",
title="Data Preprocessing Techniques for AI and Machine Learning Readiness: Scoping Review of Wearable Sensor Data in Cancer Care",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Sep",
day="27",
volume="12",
pages="e59587",
keywords="machine learning",
keywords="artificial intelligence",
keywords="preprocessing",
keywords="wearables",
keywords="mobile phone",
keywords="cancer care",
abstract="Background: Wearable sensors are increasingly being explored in health care, including in cancer care, for their potential in continuously monitoring patients. Despite their growing adoption, significant challenges remain in the quality and consistency of data collected from wearable sensors. Moreover, preprocessing pipelines to clean, transform, normalize, and standardize raw data have not yet been fully optimized. Objective: This study aims to conduct a scoping review of preprocessing techniques used on raw wearable sensor data in cancer care, specifically focusing on methods implemented to ensure their readiness for artificial intelligence and machine learning (AI/ML) applications. We sought to understand the current landscape of approaches for handling issues, such as noise, missing values, normalization or standardization, and transformation, as well as techniques for extracting meaningful features from raw sensor outputs and converting them into usable formats for subsequent AI/ML analysis. Methods: We systematically searched IEEE Xplore, PubMed, Embase, and Scopus to identify potentially relevant studies for this review. The eligibility criteria included (1) mobile health and wearable sensor studies in cancer, (2) written and published in English, (3) published between January 2018 and December 2023, (4) full text available rather than abstracts, and (5) original studies published in peer-reviewed journals or conferences. Results: The initial search yielded 2147 articles, of which 20 (0.93\%) met the inclusion criteria. Three major categories of preprocessing techniques were identified: data transformation (used in 12/20, 60\% of selected studies), data normalization and standardization (used in 8/20, 40\% of the selected studies), and data cleaning (used in 8/20, 40\% of the selected studies). Transformation methods aimed to convert raw data into more informative formats for analysis, such as by segmenting sensor streams or extracting statistical features. Normalization and standardization techniques usually normalize the range of features to improve comparability and model convergence. Cleaning methods focused on enhancing data reliability by handling artifacts like missing values, outliers, and inconsistencies. Conclusions: While wearable sensors are gaining traction in cancer care, realizing their full potential hinges on the ability to reliably translate raw outputs into high-quality data suitable for AI/ML applications. This review found that researchers are using various preprocessing techniques to address this challenge, but there remains a lack of standardized best practices. Our findings suggest a pressing need to develop and adopt uniform data quality and preprocessing workflows of wearable sensor data that can support the breadth of cancer research and varied patient populations. Given the diverse preprocessing techniques identified in the literature, there is an urgency for a framework that can guide researchers and clinicians in preparing wearable sensor data for AI/ML applications. For the scoping review as well as our research, we propose a general framework for preprocessing wearable sensor data, designed to be adaptable across different disease settings, moving beyond cancer care. ",
doi="10.2196/59587",
url="https://mhealth.jmir.org/2024/1/e59587",
url="http://www.ncbi.nlm.nih.gov/pubmed/38626290"
}


@Article{info:doi/10.2196/56162,
author="Muehlensiepen, Felix
and Bruch, Dunja
and Seifert, Frances
and Wengemuth, Eileen
and Heinze, Martin
and Spethmann, Sebastian
and May, Susann",
title="mHealth Apps for Hypertension Self-Management: Interview Study Among Patient-Users",
journal="JMIR Form Res",
year="2024",
month="Sep",
day="27",
volume="8",
pages="e56162",
keywords="hypertension",
keywords="mobile health",
keywords="mHealth apps",
keywords="digital health",
keywords="patient perspective",
keywords="qualitative study",
keywords="cardiology",
abstract="Background: Hypertension is a major risk factor for cardiovascular disease, affecting over a billion people worldwide. Mobile health (mHealth) apps have emerged as effective tools for managing hypertension, offering capabilities for monitoring blood pressure, fostering lifestyle changes, and improving treatment adherence. Objective: This study aimed to explore patient-users' perspectives on the hypertension care mHealth app Hypertension.APP, focusing on its accessibility, expected benefits, potential risks, and role in hypertension management in Germany. Methods: A qualitative study was conducted involving semistructured interviews with 20 patient-users of a hypertension care mHealth app, Hypertension.APP. Participants were recruited between January and June 2023 using purposive sampling. Verbatim transcripts were analyzed using qualitative content analysis. Results: Participants primarily discovered the app independently, driven by recent hypertension diagnoses and insufficient information from health care professionals regarding effective self-management strategies for their blood pressure. They valued the app for its continuous monitoring and feedback capabilities, aiding in understanding their condition and making lifestyle adjustments. Risks were perceived as minimal, mainly concerning data privacy and potential overreliance on the app. The app became integral to patient-users' hypertension management by offering consistent information and support. The integration into formal health care was limited, as patient-users felt that health care professionals did not accept the use of the technology or might have even felt intimidated to use it. Conclusions: Among the sample studied, mHealth apps like Hypertension.APP were valued for their continuous monitoring and educational content, aiding in hypertension management. The findings suggest potential benefits of mHealth apps for effective hypertension care among patients who are health- and digitally literate as well as self-effective. There is a critical need for better integration of these apps into routine health care practices, as perceived by the app users. Given the small and specific sample of this qualitative study, further quantitative research with a broader and more varied participant group is necessary to validate these findings. Trial Registration: Deutsches Register Klinischer Studien DRKS00029761; https://tinyurl.com/r33ru22s ",
doi="10.2196/56162",
url="https://formative.jmir.org/2024/1/e56162"
}


@Article{info:doi/10.2196/59469,
author="Stankoski, Simon
and Kiprijanovska, Ivana
and Gjoreski, Martin
and Panchevski, Filip
and Sazdov, Borjan
and Sofronievski, Bojan
and Cleal, Andrew
and Fatoorechi, Mohsen
and Nduka, Charles
and Gjoreski, Hristijan",
title="Controlled and Real-Life Investigation of Optical Tracking Sensors in Smart Glasses for Monitoring Eating Behavior Using Deep Learning: Cross-Sectional Study",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Sep",
day="26",
volume="12",
pages="e59469",
keywords="chewing detection",
keywords="eating detection",
keywords="smart glasses",
keywords="automatic dietary monitoring",
keywords="eating behavior",
abstract="Background: The increasing prevalence of obesity necessitates innovative approaches to better understand this health crisis, particularly given its strong connection to chronic diseases such as diabetes, cancer, and cardiovascular conditions. Monitoring dietary behavior is crucial for designing effective interventions that help decrease obesity prevalence and promote healthy lifestyles. However, traditional dietary tracking methods are limited by participant burden and recall bias. Exploring microlevel eating activities, such as meal duration and chewing frequency, in addition to eating episodes, is crucial due to their substantial relation to obesity and disease risk. Objective: The primary objective of the study was to develop an accurate and noninvasive system for automatically monitoring eating and chewing activities using sensor-equipped smart glasses. The system distinguishes chewing from other facial activities, such as speaking and teeth clenching. The secondary objective was to evaluate the system's performance on unseen test users using a combination of laboratory-controlled and real-life user studies. Unlike state-of-the-art studies that focus on detecting full eating episodes, our approach provides a more granular analysis by specifically detecting chewing segments within each eating episode. Methods: The study uses OCO optical sensors embedded in smart glasses to monitor facial muscle activations related to eating and chewing activities. The sensors measure relative movements on the skin's surface in 2 dimensions (X and Y). Data from these sensors are analyzed using deep learning (DL) to distinguish chewing from other facial activities. To address the temporal dependence between chewing events in real life, we integrate a hidden Markov model as an additional component that analyzes the output from the DL model. Results: Statistical tests of mean sensor activations revealed statistically significant differences across all 6 comparison pairs (P<.001) involving 2 sensors (cheeks and temple) and 3 facial activities (eating, clenching, and speaking). These results demonstrate the sensitivity of the sensor data. Furthermore, the convolutional long short-term memory model, which is a combination of convolutional and long short-term memory neural networks, emerged as the best-performing DL model for chewing detection. In controlled laboratory settings, the model achieved an F1-score of 0.91, demonstrating robust performance. In real-life scenarios, the system demonstrated high precision (0.95) and recall (0.82) for detecting eating segments. The chewing rates and the number of chews evaluated in the real-life study showed consistency with expected real-life eating behaviors. Conclusions: The study represents a substantial advancement in dietary monitoring and health technology. By providing a reliable and noninvasive method for tracking eating behavior, it has the potential to revolutionize how dietary data are collected and used. This could lead to more effective health interventions and a better understanding of the factors influencing eating habits and their health implications. ",
doi="10.2196/59469",
url="https://mhealth.jmir.org/2024/1/e59469",
url="http://www.ncbi.nlm.nih.gov/pubmed/39325528"
}


@Article{info:doi/10.2196/48020,
author="Griffin, C. Ashley
and Mentch, Lucas
and Lin, Feng-Chang
and Chung, E. Arlene",
title="mHealth Physical Activity and Patient-Reported Outcomes in Patients With Inflammatory Bowel Diseases: Cluster Analysis",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="24",
volume="26",
pages="e48020",
keywords="inflammatory bowel diseases",
keywords="patient-reported outcome measures",
keywords="cluster analysis",
keywords="wearable electronic devices",
keywords="medical informatics",
keywords="mHealth",
keywords="mobile health",
keywords="physical activity",
keywords="bowel disease",
keywords="psychosocial",
keywords="smartphone",
keywords="wearables",
keywords="mobile phone",
abstract="Background: Regular physical activity is associated with improved quality of life in patients with inflammatory bowel diseases (IBDs), although much of the existing research is based on self-reported data. Wearable devices provide objective data on many rich physical activity dimensions including steps, duration, distance, and intensity. Little is known about how patients with IBDs engage in these varying dimensions of exercise and how it may influence their symptom and disease-specific patient-reported outcomes (PROs). Objective: This study aims to (1) cluster physical activity patterns from consumer-grade wearable devices and (2) assess the relationship between the clusters and PROs in patients with IBDs. Methods: We conducted a cross-sectional and longitudinal cohort study among adults with IBDs in the Crohn's and Colitis Foundation IBD Partners cohort. Participants contribute physical activity data through smartphone apps or wearable devices in a bring-your-own-device model. Participants also complete biannual PRO questionnaires from the Patient-Reported Outcomes Measurement Information System short forms and IBD-specific questionnaires. K-means cluster analysis was used to generate physical activity clusters based on 3 key features: number of steps, duration of moderate to vigorous activity (minutes), and distance of activity (miles). Based on the clusters, we conducted a cross-sectional analysis to examine differences in mean questionnaire scores and participant characteristics using one-way ANOVA and chi-square tests. We also conducted a longitudinal analysis to examine individual cluster transitions among participants who completed multiple questionnaires, and mean differences in questionnaire scores were compared using 2-tailed paired sample t tests across 6-month periods. Results: Among 430 participants comprising 1255 six-week physical activity periods, we identified clusters of low (33.7\%, n=423), moderate (46\%, n=577), and high (20.3\%, n=255) physical activity. Scores varied across clusters for depression (P=.004), pain interference (P<.001), fatigue (P<.001), sleep disturbance (P<.001), social satisfaction (P<.001), and short Crohn Disease Activity Index (P<.001), with those in the low activity cluster having the worst scores. Sociodemographic characteristics also differed, and those with low physical activity were older (P=.002), had higher BMIs (P<.001), and had longer disease durations (P=.02) compared to other clusters. Among 246 participants who completed at least 2 consecutive questionnaires consisting of 726 questionnaire periods, 67.8\% (n=492) remained in the same cluster, and only 1.2\% (n=9) moved to or from the furthest clusters of low and high activity across 6-month periods. Conclusions: For patients with IBDs, there were positive associations between physical activity and PROs related to disease activity and psychosocial domains. Physical activity patterns mostly did not fluctuate over time, suggesting little variation in exercise levels in the absence of an intervention. The use of real-world data to identify subgroups with similar lifestyle behaviors could be leveraged to develop targeted interventions that provide support for psychosocial symptoms and physical activity for personalized IBD care. ",
doi="10.2196/48020",
url="https://www.jmir.org/2024/1/e48020"
}


@Article{info:doi/10.2196/50508,
author="Eaton, Cyd
and Vallejo, Natalie
and McDonald, Xiomara
and Wu, Jasmine
and Rodr{\'i}guez, Rosa
and Muthusamy, Nishanth
and Mathioudakis, Nestoras
and Riekert, A. Kristin",
title="User Engagement With mHealth Interventions to Promote Treatment Adherence and Self-Management in People With Chronic Health Conditions: Systematic Review",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="24",
volume="26",
pages="e50508",
keywords="mobile health",
keywords="mHealth",
keywords="digital health",
keywords="treatment adherence",
keywords="self-management",
keywords="user engagement",
keywords="chronic health conditions",
keywords="mobile phone",
abstract="Background: There are numerous mobile health (mHealth) interventions for treatment adherence and self-management; yet, little is known about user engagement or interaction with these technologies. Objective: This systematic review aimed to answer the following questions: (1) How is user engagement defined and measured in studies of mHealth interventions to promote adherence to prescribed medical or health regimens or self-management among people living with a health condition? (2) To what degree are patients engaging with these mHealth interventions? (3) What is the association between user engagement with mHealth interventions and adherence or self-management outcomes? (4) How often is user engagement a research end point? Methods: Scientific database (Ovid MEDLINE, Embase, Web of Science, PsycINFO, and CINAHL) search results (2016-2021) were screened for inclusion and exclusion criteria. Data were extracted in a standardized electronic form. No risk-of-bias assessment was conducted because this review aimed to characterize user engagement measurement rather than certainty in primary study results. The results were synthesized descriptively and thematically. Results: A total of 292 studies were included for data extraction. The median number of participants per study was 77 (IQR 34-164). Most of the mHealth interventions were evaluated in nonrandomized studies (157/292, 53.8\%), involved people with diabetes (51/292, 17.5\%), targeted medication adherence (98/292, 33.6\%), and comprised apps (220/292, 75.3\%). The principal findings were as follows: (1) >60 unique terms were used to define user engagement; ``use'' (102/292, 34.9\%) and ``engagement'' (94/292, 32.2\%) were the most common; (2) a total of 11 distinct user engagement measurement approaches were identified; the use of objective user log-in data from an app or web portal (160/292, 54.8\%) was the most common; (3) although engagement was inconsistently evaluated, most of the studies (99/195, 50.8\%) reported >1 level of engagement due to the use of multiple measurement methods or analyses, decreased engagement across time (76/99, 77\%), and results and conclusions suggesting that higher engagement was associated with positive adherence or self-management (60/103, 58.3\%); and (4) user engagement was a research end point in only 19.2\% (56/292) of the studies. Conclusions: The results revealed major limitations in the literature reviewed, including significant variability in how user engagement is defined, a tendency to rely on user log-in data over other measurements, and critical gaps in how user engagement is evaluated (infrequently evaluated over time or in relation to adherence or self-management outcomes and rarely considered a research end point). Recommendations are outlined in response to our findings with the goal of improving research rigor in this area. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42022289693; https://www.crd.york.ac.uk/prospero/display\_record.php?ID=CRD42022289693 ",
doi="10.2196/50508",
url="https://www.jmir.org/2024/1/e50508",
url="http://www.ncbi.nlm.nih.gov/pubmed/39316431"
}


@Article{info:doi/10.2196/58089,
author="Elser, Alexander
and Kopkow, Christian
and Sch{\"a}fer, Georg Axel",
title="Implementation of a Virtual Reality Intervention in Outpatient Physiotherapy for Chronic Pain: Protocol for a Pilot Implementation Study",
journal="JMIR Res Protoc",
year="2024",
month="Sep",
day="23",
volume="13",
pages="e58089",
keywords="chronic pain",
keywords="implementation",
keywords="virtual reality",
keywords="VR",
keywords="physiotherapy",
keywords="virtual reality intervention",
keywords="pain",
keywords="outpatient",
keywords="chronic pain conditions",
keywords="evidence-based",
abstract="Background: Chronic pain is a global health issue that causes physical, psychological, and social disabilities for patients, as well as high costs for societies. Virtual reality (VR) is a new treatment that provides an opportunity to narrow the gap between clinical practice and recommended care in the use of patient education and behavioral interventions in the outpatient physiotherapy setting. However, there is currently no implementation strategy to integrate VR treatments into this setting. Objective: This protocol outlines a pilot implementation study that aims to (1) identify barriers and facilitators for implementing a VR intervention in outpatient physiotherapy care for people with chronic pain and (2) develop and pilot test an implementation strategy in 5 practices in Germany. Methods: The study consists of 4 phases. The first phase involves adapting the treatment protocol of the VR intervention to the local context of outpatient physiotherapy practices in Germany. The second phase includes the collection of barriers and facilitators through semistructured interviews from physiotherapists and the development of a theory-driven implementation strategy based on the Theoretical Domains framework and the Behavior Change Wheel. This strategy will be applied in the third phase, which will also include a 6-month span of using VR interventions in practices, along with a process evaluation. The fourth phase consists of semistructured interviews to evaluate the developed implementation strategy. Results: The recruitment process and phase 1, including the adaptation of the treatment protocol, have already been completed. We recruited 5 physiotherapy practices in Lower Saxony, Germany, where the VR intervention will be implemented. The collection of barriers and facilitators through semistructured interviews is scheduled to begin in February 2024. Conclusions: This pilot implementation study aims to develop a theory-driven implementation strategy for integrating a VR intervention into outpatient physiotherapy care for people with chronic pain. The identified barriers and facilitators, along with the implementation strategy, will serve as a starting point for future randomized controlled implementation studies in different settings to refine the implementation process and integrate VR interventions into the outpatient care of people with chronic pain. Trial Registration: German Clinical Trials Register DRKS00030862; https://tinyurl.com/3zf7uujx International Registered Report Identifier (IRRID): DERR1-10.2196/58089 ",
doi="10.2196/58089",
url="https://www.researchprotocols.org/2024/1/e58089"
}


@Article{info:doi/10.2196/52964,
author="Vincent, Rapha{\"e}l
and Charron, Maxime
and Lafrance, Simon
and Cormier, Audrey-Anne
and Kairy, Dahlia
and Desmeules, Fran{\c{c}}ois",
title="Investigating the Use of Telemedicine by Health Care Providers to Diagnose and Manage Patients With Musculoskeletal Disorders: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="23",
volume="26",
pages="e52964",
keywords="telemedicine",
keywords="musculoskeletal diseases",
keywords="physical examination",
keywords="diagnosis",
keywords="treatment",
keywords="health care",
keywords="telecare",
keywords="meta-analysis",
keywords="systematic review",
keywords="telehealth",
keywords="orthopedic",
keywords="test",
keywords="musculoskeletal disorder",
keywords="MSKD",
keywords="older adult",
keywords="older adults",
keywords="older person",
keywords="older people",
keywords="aging",
keywords="musculoskeletal",
keywords="mobile phone",
abstract="Background: Access to care is a major challenge for patients with musculoskeletal disorders (MSKDs). Telemedicine is one of the solutions to improve access to care. However, initial remote diagnosis of MSKDs involves some challenges, such as the impossibility of touching the patient during the physical examination, which makes it more complex to obtain a valid diagnosis. No meta-analysis has been performed to date to synthesize evidence regarding the initial assessment including a physical evaluation using telemedicine to diagnose patients with MSKDs. Objective: This study aims to appraise the evidence on diagnostic and treatment plan concordance between remote assessment using synchronous or asynchronous forms of telemedicine and usual in-person assessment for the initial evaluation of various MSKDs. Methods: An electronic search was conducted up to August 2023 using terms related to telemedicine and assessment of MSKDs. Methodological quality of studies was assessed with the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Random-effect model meta-analyses were performed. The Grading of Recommendations, Assessment, Development, and Evaluations framework was used to synthesize the quality and certainty of the evidence. Results: A total of 23 concordance studies were eligible and included adult participants (N=1493) with various MSKDs. On the basis of high certainty, pooled $\kappa$ and prevalence-adjusted and bias-adjusted $\kappa$ for the diagnostic concordance between remote and in-person assessments of MSKDs were 0.80 (95\% CI 0.72-0.89; 7 studies, 353 patients) and 0.83 (95\% CI 0.76-0.89; 6 studies, 306 patients). On the basis of moderate certainty, pooled Gwet AC1 for treatment plan concordance between remote and in-person assessments of MSKDs was 0.90 (95\% CI 0.80-0.99; 2 studies, 142 patients). Conclusions: The diagnostic concordance for MSKDs is good to very good. Treatment plan concordance is probably good to excellent. Studies evaluating the accuracy to detect red and yellow flags as well as the potential increase in associated health care resources use, such as imaging tests, are needed. ",
doi="10.2196/52964",
url="https://www.jmir.org/2024/1/e52964"
}


@Article{info:doi/10.2196/56549,
author="Huang, Huei-Ling
and Chao, Yi-Ping
and Kuo, Chun-Yu
and Sung, Ya-Li
and Shyu, L. Yea-Ing
and Hsu, Wen-Chuin",
title="Development of a Dementia Case Management Information System App: Mixed Methods Study",
journal="JMIR Aging",
year="2024",
month="Sep",
day="23",
volume="7",
pages="e56549",
keywords="case management",
keywords="dementia",
keywords="health information systems",
keywords="mobile apps",
keywords="user needs",
keywords="mobile phone",
abstract="Background: Case managers for persons with dementia not only coordinate patient care but also provide family caregivers with educational material and available support services. Taiwan uses a government-based information system for monitoring the provision of health care services. Unfortunately, scheduling patient care and providing information to family caregivers continues to be paper-based, which results in a duplication of patient assessments, complicates scheduling of follow-ups, and hinders communication with caregivers, which limits the ability of case managers to provide cohesive, quality care. Objective: This multiphase study aimed to develop an electronic information system for dementia care case managers based on their perceived case management needs and what they would like included in an electronic health care app. Methods: Case managers were recruited to participate (N=63) by purposive sampling from 28 facilities representing two types of community-based dementia care centers in Taiwan. A dementia case management information system (DCMIS) app was developed in four phases. Phase 1 assessed what should be included in the app by analyzing qualitative face-to-face or internet-based interviews with 33 case managers. Phase 2 formulated a framework for the app to support case managers based on key categories identified in phase 1. During phase 3, a multidisciplinary team of information technology engineers and dementia care experts developed the DCMIS app: hardware and software components were selected, including platforms for messaging, data management, and security. The app was designed to eventually interface with a family caregiver app. Phase 4 involved pilot-testing the DCMIS app with a second group of managers (n=30); feedback was provided via face-to-face interviews about their user experience. Results: Findings from interviews in phase 1 indicated the DCMIS framework should include unified databases for patient reminder follow-up scheduling, support services, a health education module, and shared recordkeeping to facilitate teamwork, networking, and communication. The DCMIS app was built on the LINE (LY Corporation) messaging platform, which is the mobile app most widely used in Taiwan. An open-source database management system allows secure entry and storage of user information and patient data. Case managers had easy access to educational materials on dementia and caregiving for persons living with dementia that could be provided to caregivers. Interviews with case managers following pilot testing indicated that the DCMIS app facilitated the completion of tasks and management responsibilities. Some case managers thought it would be helpful to have a DCMIS desktop computer system rather than a mobile app. Conclusions: Based on pilot testing, the DCMIS app could reduce the growing challenges of high caseloads faced by case managers of persons with dementia, which could improve continuity of care. These findings will serve as a reference when the system is fully developed and integrated with the electronic health care system in Taiwan. ",
doi="10.2196/56549",
url="https://aging.jmir.org/2024/1/e56549"
}


@Article{info:doi/10.2196/56816,
author="Butler, Sonia
and Sculley, Dean
and Santos, Derek
and Giron{\`e}s, Xavier
and Singh-Grewal, Davinder
and Coda, Andrea",
title="Development and Delivery of an Integrated Digital Health Care Approach for Children With Juvenile Idiopathic Arthritis: Usability Study",
journal="JMIR Pediatr Parent",
year="2024",
month="Sep",
day="17",
volume="7",
pages="e56816",
keywords="phone app",
keywords="smart watch",
keywords="juvenile idiopathic arthritis",
keywords="pain",
keywords="medication adherence",
keywords="physical activity",
keywords="integrated care",
keywords="medication",
keywords="development",
keywords="usability study",
keywords="chronic inflammatory disorder",
keywords="children",
keywords="child",
keywords="usability",
keywords="survey",
keywords="thematic analysis",
keywords="gamification",
keywords="modules",
keywords="web-based platform",
keywords="support",
abstract="Background: Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disorder with no cure. Most children are prescribed several medications aimed at controlling disease activity, managing symptoms, and reducing pain. Physical activity is also encouraged to retain musculoskeletal function. The primary determinants of treatment success are maintaining long-term adherence, ongoing monitoring by a pediatric rheumatologist, and involvement of an interdisciplinary team. To support these goals, a new digital intervention was developed, InteractiveClinics, which aimed to prompt children to take their medications, report pain levels, and increase their physical activity. Objective: This study aims to evaluate the usability of InteractiveClinics among children with JIA. Methods: As part of this pediatric cross-sectional study, 12 children were asked to wear a smartwatch for 2 weeks, which was synchronized to the InteractiveClinics phone app and web-based platform. Personalized notifications were sent daily to the watch and phone, to prompt and record medication adherence and pain level assessment. Physical activity was automatically recorded by the watch. At the end of the study, all children and parents completed a postintervention survey. Written comments were also encouraged to gain further feedback. Descriptive statistics were used to summarize the survey results, and all qualitative data underwent thematic analysis. Results: Twelve children aged 10 to 18 years (mean 14.2, SD 3.1 years; female: n=8, 66.7\%) and 1 parent for each child (n=12; female: n=8, 66.7\%) were enrolled in the study. Based on the highest and lowest agreement areas of the survey, most children and parents liked the smartwatch and web-based platform; they found it easy to learn and simple to use. They were also satisfied with the pain and physical activity module. However, usability and acceptability barriers that hindered uptake were identified in the phone app and medication module. Children required a unique in-app experience, and their suggestive improvements included more personalization within the app; simplification by removing all links not relevant to antirheumatic medications; flexibility in response times; improved conferment through gamification; additional comment fields for the input of more data, such as medication side effects or pain-related symptoms; more detailed graphical illustrations of the physical activity module, including a breakdown of metrics; and importantly, interconnections between modules, because medication adherence, pain levels, and physical activity can each influence the other. They were, overall, improving usefulness for children and parents. Conclusions: The usability of InteractiveClinics was positive. Children and parents liked the watch and web-based platform and were satisfied with the pain and physical activity module. However, children wanted a unique in-app experience through more personalization, simplification, flexibility, conferment, comment fields, graphical illustrations, a breakdown of metrics, and interconnections. Certainly, inclusions are needed to promote user adoption and advancement of new validated digital health interventions in pediatric rheumatology, to support the delivery of integrated care. Trial Registration: ANZCTR ACTRN12616000665437; https://tinyurl.com/mwwfje8r ",
doi="10.2196/56816",
url="https://pediatrics.jmir.org/2024/1/e56816"
}


@Article{info:doi/10.2196/58526,
author="Akyirem, Samuel
and Wagner, Julie
and Chen, N. Helen
and Lipson, Joanna
and Minchala, Maritza
and Cortez, Karina
and Whittemore, Robin",
title="Recommendations to Address Barriers to Patient Portal Use Among Persons With Diabetes Seeking Care at Community Health Centers: Interview Study With Patients and Health Care Providers",
journal="JMIR Diabetes",
year="2024",
month="Sep",
day="16",
volume="9",
pages="e58526",
keywords="community health centers",
keywords="patient portal",
keywords="type 2 diabetes",
keywords="self-management",
keywords="qualitative study",
keywords="mobile phone",
abstract="Background: Community health centers (CHCs) are safety-net health care facilities in the United States that provide care for a substantial number of low-income, non-English speaking adults with type 2 diabetes (T2D). Whereas patient portals have been shown to be associated with significant improvements in diabetes self-management and outcomes, they remain underused in CHCs. In addition, little is known about the specific barriers to and facilitators of patient portal use in CHCs and strategies to address the barriers. Objective: The objectives of this qualitative study were to explore the barriers to and facilitators of the use of patient portals for managing diabetes in 2 CHCs from the perspective of adults with T2D and clinicians (community health workers, nurses, nurse practitioners, and physicians) and to make recommendations on strategies to enhance use. Methods: A qualitative description design was used. A total of 21 participants (n=13, 62\% clinicians and n=8, 38\% adults with T2D) were purposively and conveniently selected from 2 CHCs. Adults with T2D were included if they were an established patient of one of the partner CHCs, aged ?18 years, diagnosed with T2D ?6 months, and able to read English or Spanish. Clinicians at our partner CHCs who provided care or services for adults with T2D were eligible for this study. Semistructured interviews were conducted in either Spanish or English based on participant preference. Interviews were audio-recorded and transcribed. Spanish interviews were translated into English by a bilingual research assistant. Data were collected between October 5, 2022, and March 16, 2023. Data were analyzed using a rapid content analysis method. Standards of rigor were implemented. Results: Themes generated from interviews included perceived usefulness and challenges of the patient portal, strategies to improve patient portal use, and challenges in diabetes self-management. Participants were enthusiastic about the potential of the portal to improve access to health information and patient-clinician communication. However, challenges of health and technology literacy, maintaining engagement, and clinician burden were identified. Standardized implementation strategies were recommended to raise awareness of patient portal benefits, provide simplified training and technology support, change clinic workflow to triage messages, customize portal notification messages, minimize clinician burden, and enhance the ease with which blood glucose data can be uploaded into the portal. Conclusions: Adults with T2D and clinicians at CHCs continue to report pervasive challenges to patient portal use in CHCs. Providing training and technical support on patient portal use for patients with low health literacy at CHCs is a critical next step. Implementing standardized patient portal strategies to address the unique needs of patients receiving care at CHCs also has the potential to improve health equity and health outcomes associated with patient portal use. ",
doi="10.2196/58526",
url="https://diabetes.jmir.org/2024/1/e58526"
}


@Article{info:doi/10.2196/57108,
author="Debeij, M. Suzanne
and Aardoom, J. Jiska
and Haaksma, L. Miriam
and Stoop, M. Wieteke A.
and van Dam van Isselt, F. El{\'e}onore
and Kasteleyn, J. Marise",
title="The Potential Use and Value of a Wearable Monitoring Bracelet for Patients With Chronic Obstructive Pulmonary Disease: Qualitative Study Investigating the Patient and Health Care Professional Perspectives",
journal="JMIR Form Res",
year="2024",
month="Sep",
day="13",
volume="8",
pages="e57108",
keywords="eHealth",
keywords="Chronic Obstructive Pulmonary Disease",
keywords="COPD",
keywords="wearable",
keywords="exacerbation",
keywords="self-management",
keywords="monitoring bracelet",
keywords="remote monitoring",
keywords="mobile phone",
abstract="Background: The occurrence of exacerbations has major effects on the health of people with chronic obstructive pulmonary disease (COPD). Monitoring devices that measure (vital) parameters hold promise for timely identification and treatment of exacerbations. Stakeholders' perspectives on the use of monitoring devices are of importance for the successful development and implementation of a device. Objective: This study aimed to explore the potential use and value of a wearable monitoring bracelet (MB) for patients with COPD at high risk for exacerbation. The perspectives of health care professionals as well as patients were examined, both immediately after hospitalization and over a longer period. Furthermore, potential facilitators and barriers to the use and implementation of an MB were explored. Methods: Data for this qualitative study were collected from January to April 2023. A total of 11 participants (eg, n=6 health care professionals [HCPs], 2 patients, and 3 additional patients) participated. In total, 2 semistructured focus groups were conducted via video calls; 1 with HCPs of various professional backgrounds and 1 with patients. In addition, 3 semistructured individual interviews were held with patients. The interviews and focus groups addressed attitudes, wishes, needs, as well as factors that could either support or impede the potential MB use. Data from interviews and focus groups were coded and analyzed according to the principles of the framework method. Results: HCPs and patients both predominantly emphasized the importance of an MB in terms of promptly identifying exacerbations by detecting deviations from normal (vital) parameters, and subsequently alerting users. According to HCPs, this is how an MB should support the self-management of patients. Most participants did not anticipate major differences in value and use of an MB between the short-term and the long-term periods after hospitalization. Facilitators of the potential use and implementation of an MB that participants highlighted were ease of use and some form of support for patients in using an MB and interpreting the data. HCPs as well as patients expressed concerns about potential costs as a barrier to use and implementation. Another barrier that HCPs mentioned, was the prerequisite of digital literacy for patients to be able to interpret and react to the data from an MB. Conclusions: HCPs and patients both recognize that an MB could be beneficial and valuable to patients with COPD at high risk for exacerbation, in the short as well as the long term. In particular, they perceived value in supporting self-management of patients with COPD. Stakeholders would be able to use the obtained insights in support of the effective implementation of MBs in COPD patient care, which can potentially improve health care and the overall well-being of patients with COPD. ",
doi="10.2196/57108",
url="https://formative.jmir.org/2024/1/e57108"
}


@Article{info:doi/10.2196/53064,
author="Glavas, Costas
and Scott, David
and Sood, Surbhi
and George, S. Elena
and Daly, M. Robin
and Gvozdenko, Eugene
and de Courten, Barbora
and Jansons, Paul",
title="Exploring the Feasibility of Digital Voice Assistants for Delivery of a Home-Based Exercise Intervention in Older Adults With Obesity and Type 2 Diabetes Mellitus: Randomized Controlled Trial",
journal="JMIR Aging",
year="2024",
month="Sep",
day="13",
volume="7",
pages="e53064",
keywords="older adults",
keywords="type 2 diabetes mellitus",
keywords="voice activation",
keywords="digital health",
keywords="exercise",
abstract="Background: Current clinical guidelines for the management of type 2 diabetes mellitus (T2DM) in older adults recommend the use of antihyperglycemic medications, monitoring of blood glucose levels, regular exercise, and a healthy diet to improve glycemic control and reduce associated comorbidities. However, adherence to traditional exercise programs is poor (<35\%). Common barriers to adherence include fear of hypoglycemia and the need for blood glucose level monitoring before exercise. Digital health strategies offer great promise for managing T2DM as they facilitate patient-practitioner communication, support self-management, and improve access to health care services for underserved populations. We have developed a novel web-based software program allowing practitioners to create tailored interventions and deliver them to patients via digital voice assistants (DVAs) in their own homes. Objective: We aim to evaluate the feasibility of a 12-week, home-based, personalized lifestyle intervention delivered and monitored by DVAs for older adults with obesity and T2DM. Methods: In total, 50 older adults with obesity aged 50-75 years with oral hypoglycemic agent--treated T2DM were randomized to the intervention (DVA, n=25) or a control group (n=25). Participants allocated to the DVA group were prescribed a home-based muscle strengthening exercise program ({\textasciitilde}20- to 30-min sessions) and healthy eating intervention, delivered via DVAs (Alexa Echo Show 8; Amazon) using newly developed software (``Buddy Link''; Great Australian Pty Ltd). Control group participants received generalized physical activity information via email. Outcomes were feasibility, DVA usability (System Usability Scale), and objectively assessed physical activity and sedentary time (wrist-worn accelerometers). Results: In total, 45 (90\%) out of 50 participants completed this study. Mean adherence to prescribed exercise was 85\% (SD 43\%) with no intervention-related adverse events. System usability was rated above average (70.4, SD 16.9 out of 100). Compared with controls, the DVA group significantly decreased sedentary time (mean difference --67, SD 23; 95\% CI --113 to --21 min/d), which was represented by a medium to large effect size (d=--0.6). Conclusions: A home-based lifestyle intervention delivered and monitored by health professionals using DVAs was feasible for reducing sedentary behavior and increasing moderate-intensity activity in older adults with obesity and T2DM. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621000307808; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381364\&isReview=true ",
doi="10.2196/53064",
url="https://aging.jmir.org/2024/1/e53064"
}


@Article{info:doi/10.2196/53805,
author="Liu, Ming
and Wu, Xiaoqian
and Li, Ziyu
and Tan, Dongmei
and Huang, Cheng",
title="Assessment of Eye Care Apps for Children and Adolescents Based on the Mobile App Rating Scale: Content Analysis and Quality Assessment",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Sep",
day="13",
volume="12",
pages="e53805",
keywords="Mobile apps",
keywords="Eye care",
keywords="Myopia",
keywords="MARS",
keywords="Children",
keywords="Adolescent",
keywords="Quality Assessment",
keywords="Content Analysis",
keywords="mhealth",
keywords="China",
abstract="Background: In China, the current situation of myopia among children and adolescents is very serious. Prevention and control of myopia are inhibited by the lack of medical resources and the low awareness about eye care. Nevertheless, mobile apps provide an effective means to solve these problems. Since the health app market in China is still immature, it has become particularly important to conduct a study to assess the quality of eye-care apps to facilitate the development of better eye-care service strategies. Objective: This study aimed to evaluate the quality, functionality, medical evidence, and professional background of eye-care apps targeting children and adolescents in the Chinese app stores. Methods: A systematic search on iOS and Android app stores was performed to identify eye-care apps for children and adolescents. The general characteristics, development context, and functional features of the apps were described. Quality assessment of the apps was completed by 2 independent researchers using the Mobile App Rating Scale. Results: This study included 29 apps, of which 17 (59\%) were developed by commercial organizations and 12 (41\%) had a design with relevant scientific basis. The main built-in functions of these apps include self-testing (18/29, 62\%), eye exercises (16/29, 55\%), and eye-care education (16/29, 55\%). The mean overall quality of eye-care apps was 3.49 (SD 0.33), with a score ranging from 2.89 to 4.39. The overall Mobile App Rating Scale score exhibited a significant positive correlation with the subscale scores (r=0.81-0.91; P<.001). In addition, although most apps provided basic eye-care features, there are some deficiencies. For example, only a few apps were developed with the participation of medical organizations or professional ophthalmologists, and most of the apps were updated infrequently, failing to provide the latest eye-care information and technology in a timely manner. Conclusions: In general, the quality of eye-care apps for children and teenagers in Chinese app stores is good. These apps fulfill users' needs for eye-care services to a certain extent, but they still suffer from insufficient medical background, low user engagement, and untimely updates. In order to further improve the effectiveness of eye-care apps, cooperation with medical institutions and professional ophthalmologists should be strengthened to enhance the scientific and authoritative nature of the apps. At the same time, interactive features and regular updates should be added to enhance user participation and the continuity of the apps. This study provides a reference for future development or improvement of eye-care apps, which can help promote myopia prevention and control. ",
doi="10.2196/53805",
url="https://mhealth.jmir.org/2024/1/e53805"
}


@Article{info:doi/10.2196/53455,
author="Po, Hui-Wen
and Chu, Ying-Chien
and Tsai, Hui-Chen
and Lin, Chen-Liang
and Chen, Chung-Yu
and Ma, Huei-Ming Matthew",
title="Efficacy of Remote Health Monitoring in Reducing Hospital Readmissions Among High-Risk Postdischarge Patients: Prospective Cohort Study",
journal="JMIR Form Res",
year="2024",
month="Sep",
day="13",
volume="8",
pages="e53455",
keywords="telemonitoring",
keywords="discharge planning",
keywords="case manager",
keywords="hospital readmission",
keywords="telehealth",
keywords="remote healthcare",
keywords="high-risk",
keywords="post-discharge",
keywords="respiratory disease",
keywords="respiratory diseases",
keywords="cardiovascular disease",
keywords="cardiovascular diseases",
keywords="case management",
keywords="patient education",
keywords="readmission",
keywords="health status tracking",
keywords="care guidance",
keywords="medical advice",
keywords="male",
keywords="men",
keywords="older adult",
keywords="older adults",
keywords="elder",
keywords="elderly",
keywords="older person",
keywords="older people",
keywords="home monitoring",
keywords="physiological signal",
keywords="physiological signals",
keywords="mobile phone",
abstract="Background: Patients with respiratory or cardiovascular diseases often experience higher rates of hospital readmission due to compromised heart-lung function and significant clinical symptoms. Effective measures such as discharge planning, case management, home telemonitoring follow-up, and patient education can significantly mitigate hospital readmissions. Objective: This study aimed to determine the efficacy of home telemonitoring follow-up in reducing hospital readmissions, emergency department (ED) visits, and total hospital days for high-risk postdischarge patients. Methods: This prospective cohort study was conducted between July and October 2021. High-risk patients were screened for eligibility and enrolled in the study. The intervention involved implementing home digital monitoring to track patient health metrics after discharge, with the aim of reducing hospital readmissions and ED visits. High-risk patients or their primary caregivers received education on using communication measurement tools and recording and uploading data. Before discharge, patients were familiarized with these tools, which they continued to use for 4 weeks after discharge. A project manager monitored the daily uploaded health data, while a weekly video appointment with the program coordinator monitored the heart and breathing sounds of the patients, tracked health status changes, and gathered relevant data. Care guidance and medical advice were provided based on symptoms and physiological signals. The primary outcomes of this study were the number of hospital readmissions and ED visits within 3 and 6 months after intervention. The secondary outcomes included the total number of hospital days and patient adherence to the home monitoring protocol. Results: Among 41 eligible patients, 93\% (n=38) were male, and 46\% (n=19) were aged 41-60 years, while 46\% (n=19) were aged 60 years or older. The study revealed that home digital monitoring significantly reduced hospitalizations, ED visits, and total hospital stay days at 3 and 6 months after intervention. At 3 months after intervention, average hospitalizations decreased from 0.45 (SD 0.09) to 0.19 (SD 0.09; P=.03), and average ED visits decreased from 0.48 (SD 0.09) to 0.06 (SD 0.04; P<.001). Average hospital days decreased from 6.61 (SD 2.25) to 1.94 (SD 1.15; P=.08). At 6 months after intervention, average hospitalizations decreased from 0.55 (SD 0.11) to 0.23 (SD 0.09; P=.01), and average ED visits decreased from 0.55 (SD 0.11) to 0.23 (SD 0.09; P=.02). Average hospital days decreased from 7.48 (SD 2.32) to 6.03 (SD 3.12; P=.73). Conclusions: By integrating home telemonitoring with regular follow-up, our research demonstrates a viable approach to reducing hospital readmissions and ED visits, ultimately improving patient outcomes and reducing health care costs. The practical application of telemonitoring in a real-world setting showcases its potential as a scalable solution for chronic disease management. ",
doi="10.2196/53455",
url="https://formative.jmir.org/2024/1/e53455"
}


@Article{info:doi/10.2196/60023,
author="Koo, Dae-Jeong
and Moon, Sun-Joon
and Moon, Suhyeon
and Park, Eun Se
and Rhee, Eun-Jung
and Lee, Won-Young
and Park, Cheol-Young",
title="Long-Term Glycemic Control Improvement After the Home and Self-Care Program for Patients With Type 1 Diabetes: Real-World--Based Cohort Study",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="11",
volume="26",
pages="e60023",
keywords="type 1 diabetes",
keywords="structured education",
keywords="home health care",
keywords="glycated hemoglobin",
keywords="continuous glucose monitoring",
keywords="mobile phone",
abstract="Background: The prevalence of type 1 diabetes (T1D) is increasing worldwide, with a much higher proportion of adult patients. However, achieving stable glycemic control is difficult in these patients. Objective: After periodic implementation of structured education for patients with T1D through the Home and Self-Care Program, a pilot home health care project promoted by the Korean government, we evaluated the program's effects on glycemic control. Methods: This study was conducted from April 2020 to March 2023. We analyzed 119 participants with T1D aged >15 years. Nursing and nutrition education were provided separately up to 4 times per year, with physician consultation up to 6 times per year. A distinguishing feature of this study compared with previous ones was the provision of remote support using a general-purpose smartphone communication app offered up to 12 times annually on an as-needed basis to enhance the continuity of in-person education effects. Patients were followed up on at average intervals of 3 months for up to 24 months. The primary end point was the mean difference in glycated hemoglobin (HbA1c) at each follow-up visit from baseline. For continuous glucose monitoring (CGM) users, CGM metrics were also evaluated. Results: The mean HbA1c level of study participants was 8.6\% at baseline (mean duration of T1D 10.02, SD 16.10 y). The HbA1c level reduction in participants who received at least 1 structured educational session went from 1.63\% (SD 2.03\%; P<.001; adjustment model=1.69\%, 95\% CI 1.24\%-2.13\% at the first follow-up visit) to 1.23\% (SD 1.31\%; P=.01; adjustment model=1.28\%, 95\% CI 0.78\%-1.79\% at the eighth follow-up visit). In the adjustment model, the actual mean HbA1c values were maintained between a minimum of 7.33\% (95\% CI 7.20\%-7.46\% at the first follow-up visit) and a maximum of 7.62\% (95\% CI 7.41\%-7.82\% at the sixth follow-up visit). Among CGM users, after at least 1 session, the mean time in the target range was maintained between 61.59\% (adjusted model, 95\% CI 58.14\%-65.03\% at the second follow-up visit) and 54.7\% (95\% CI 50.92\%-58.48\% at the eighth follow-up visit), consistently staying above 54.7\% (corresponding to an HbA1c level of <7.6\%). The mean time below the target range (TBR) also gradually improved to the recommended range (?4\% for TBR of <70 mg/dL and ?1\% for TBR of <54 mg/dL). Conclusions: The Home and Self-Care Program protocol for glycemic control in patients with T1D is effective, producing significant improvement immediately and long-term maintenance effects, including on CGM indexes. ",
doi="10.2196/60023",
url="https://www.jmir.org/2024/1/e60023"
}


@Article{info:doi/10.2196/57033,
author="Galati, Adriano
and Kriara, Lito
and Lindemann, Michael
and Lehner, Rea
and Jones, JB",
title="User Experience of a Large-Scale Smartphone-Based Observational Study in Multiple Sclerosis: Global, Open-Access, Digital-Only Study",
journal="JMIR Hum Factors",
year="2024",
month="Sep",
day="11",
volume="11",
pages="e57033",
keywords="smartphone",
keywords="multiple sclerosis",
keywords="user experience",
keywords="retention",
keywords="digital health",
keywords="digital health technology",
keywords="mobile phone",
abstract="Background: The Floodlight Open app is a digital health technology tool (DHTT) that comprises remote, smartphone sensor--based tests (daily activities) for assessing symptoms of multiple sclerosis (MS). User acquisition, engagement, and retention remain a barrier to successfully deploying such tools. Objective: This study aims to quantitatively and qualitatively investigate key user experience (UX) factors associated with the Floodlight Open app. Methods: Floodlight Open is a global, open-access, digital-only study designed to understand the drivers and barriers in deploying a DHTT in a naturalistic setting without supervision and onboarding by a clinician. Daily activities included tests assessing cognition (Information Processing Speed and Information Processing Speed Digit--Digit), hand-motor function (Pinching Test and Draw a Shape Test), and postural stability and gait (Static Balance Test, U-Turn Test, and Two-Minute Walk Test [2MWT]). All daily activities except the 2MWT were taken in a fixed sequence. Qualitative UX was studied through semistructured interviews in a substudy of US participants with MS. The quantitative UX analysis investigated the impact of new UX design features on user engagement and retention in US participants for 3 separate test series: all daily activities included in the fixed sequence (DA), all daily activities included in the fixed sequence except the Static Balance Test and U-Turn Test (DAx), and the 2MWT. Results: The qualitative UX substudy (N=22) revealed the need for 2 new UX design features: a more seamless user journey during the activation process that eliminates the requirement of switching back and forth between the app and the email that the participants received upon registration, and configurable reminders and push notifications to help plan and remind the participants to complete their daily activities. Both UX design features were assessed in the quantitative UX analysis. Introducing the more seamless user journey (original user journey: n=608; more seamless user journey: n=481) improved the conversion rate of participants who enrolled in the study and proceeded to successfully activate the app from 53.9\% (328/608) to 74.6\% (359/481). Introducing reminders and push notifications (with reminders and notifications: n=350; without reminders and notifications: n=172) improved continuous usage time (proportion of participants with ?3 consecutive days of usage: DA and DAx: {\textasciitilde}30\% vs {\textasciitilde}12\%; 2MWT: {\textasciitilde}30\% vs {\textasciitilde}20\%); test completion rates (maximum number of test series completed: DA: 279 vs 64; DAx: 283 vs 126; 2MWT: 302 vs 76); and user retention rates (at day 30: DA: 53/172, 30.8\% vs 34/350, 9.7\%; DAx: 53/172, 30.8\% vs 60/350, 17.1\%; 2MWT: 39/172, 22.6\% vs 22/350, 6.2\%). Inactivity times remained comparable. Conclusions: The remote assessment of MS with DHTTs is a relatively nascent but growing field of research. The continued assessment and improvement of UX design features can play a crucial role in the successful long-term adoption of new DHTTs. ",
doi="10.2196/57033",
url="https://humanfactors.jmir.org/2024/1/e57033"
}


@Article{info:doi/10.2196/52167,
author="Chikwetu, Lucy
and Vakili, Parker
and Takais, Andrew
and Younes, Rabih",
title="Central Hemodynamic and Thermoregulatory Responses to Food Intake as Potential Biomarkers for Eating Detection: Systematic Review",
journal="Interact J Med Res",
year="2024",
month="Sep",
day="10",
volume="13",
pages="e52167",
keywords="eating detection",
keywords="eating moment recognition",
keywords="postprandial physiological responses",
keywords="postprandial physiology",
keywords="eating",
keywords="food",
keywords="consumption",
keywords="postprandial",
keywords="hemodynamics prandial",
keywords="thermoregulation",
keywords="physiological",
keywords="heart rate",
keywords="vital",
keywords="vitals",
keywords="wearable",
keywords="wearables",
keywords="thermoregulatory hemodynamic",
keywords="biomarker",
keywords="biomarkers",
keywords="diet",
keywords="dietary",
keywords="monitoring",
keywords="detect",
keywords="detection",
keywords="detecting",
keywords="synthesis",
keywords="review methods",
keywords="review methodology",
keywords="systematic",
keywords="sensor",
keywords="sensors",
keywords="digital health",
abstract="Background: Diet-related diseases, such as type 2 diabetes, require strict dietary management to slow down disease progression and call for innovative management strategies. Conventional diet monitoring places a significant memory burden on patients, who may not accurately remember details of their meals and thus frequently falls short in preventing disease progression. Recent advances in sensor and computational technologies have sparked interest in developing eating detection platforms. Objective: This review investigates central hemodynamic and thermoregulatory responses as potential biomarkers for eating detection. Methods: We searched peer-reviewed literature indexed in PubMed, Web of Science, and Scopus on June 20, 2022, with no date limits. We also conducted manual searches in the same databases until April 21, 2024. We included English-language papers demonstrating the impact of eating on central hemodynamics and thermoregulation in healthy individuals. To evaluate the overall study quality and assess the risk of bias, we designed a customized tool inspired by the Cochrane assessment framework. This tool has 4 categories: high, medium, low, and very low. A total of 2 independent reviewers conducted title and abstract screening, full-text review, and study quality and risk of bias analysis. In instances of disagreement between the 2 reviewers, a third reviewer served as an adjudicator. Results: Our search retrieved 11,450 studies, and 25 met our inclusion criteria. Among the 25 included studies, 32\% (8/25) were classified as high quality, 52\% (13/25) as medium quality, and 16\% (4/25) as low quality. Furthermore, we found no evidence of publication bias in any of the included studies. A consistent postprandial increase in heart rate, cardiac output, and stroke volume was observed in at least 95\% (heart rate: 19/19, cardiac output: 18/19, stroke volume: 11/11) of the studies that investigated these variables' responses to eating. Specifically, cardiac output increased by 9\%-100\%, stroke volume by 18\%-41\%, and heart rate by 6\%-21\% across these studies. These changes were statistically significant (P<.05). In contrast, the 8 studies that investigated postprandial thermoregulatory effects displayed grossly inconsistent results, showing wide variations in response with no clear patterns of change, indicating a high degree of variability among these studies. Conclusions: Our findings demonstrate that central hemodynamic responses, particularly heart rate, hold promise for wearable-based eating detection, as cardiac output and stroke volume cannot be measured by any currently available noninvasive medical or consumer-grade wearables. Trial Registration: PROSPERO CRD42022360600; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=360600 ",
doi="10.2196/52167",
url="https://www.i-jmr.org/2024/1/e52167"
}


@Article{info:doi/10.2196/56650,
author="Huang, Sijia
and Wang, Yiyue
and Li, Gen
and Hall, J. Brian
and Nyman, J. Thomas",
title="Digital Mental Health Interventions for Alleviating Depression and Anxiety During Psychotherapy Waiting Lists: Systematic Review",
journal="JMIR Ment Health",
year="2024",
month="Sep",
day="10",
volume="11",
pages="e56650",
keywords="digital health",
keywords="digital technology",
keywords="digital intervention",
keywords="digital interventions",
keywords="waiting list",
keywords="digital mental health intervention",
keywords="DMHI",
keywords="digital mental health interventions",
keywords="DMHIs",
keywords="digital mental health",
keywords="mental health intervention",
keywords="mental health interventions",
keywords="mental health",
keywords="mental illness",
keywords="mental disease",
keywords="mental diseases",
keywords="mental illnesses",
keywords="depression",
keywords="depressed",
keywords="major depressive disorder",
keywords="MDD",
keywords="depressive disorder",
keywords="depressive",
keywords="anxiety",
keywords="anxious",
keywords="self-guided",
keywords="self-guidance",
keywords="self-mediated",
keywords="self-mediation",
keywords="systematic review",
keywords="systematic reviews",
keywords="mood disorder",
keywords="therapy",
keywords="tele-therapy",
keywords="web-based therapy",
abstract="Background: Depression and anxiety have become increasingly prevalent across the globe. The rising need for treatment and the lack of clinicians has resulted in prolonged waiting times for patients to receive their first session. Responding to this gap, digital mental health interventions (DMHIs) have been found effective in treating depression and anxiety and are potentially promising pretreatments for patients who are awaiting face-to-face psychotherapy. Nevertheless, whether digital interventions effectively alleviate symptoms for patients on waiting lists for face-to-face psychotherapy remains unclear. Objective: This review aimed to synthesize the effectiveness of DMHIs for relieving depression and anxiety symptoms of patients on waiting lists for face-to-face therapy. This review also investigated the features, perceived credibility, and usability of DMHIs during waiting times. Methods: In this systematic review, we searched PubMed, PsycINFO, Cochrane, and Web of Science for research studies investigating the effectiveness of DMHIs in reducing either depression or anxiety symptoms among individuals waiting for face-to-face psychotherapy. The search was conducted in June 2024, and we have included the studies that met the inclusion criteria and were published before June 6, 2024. Results: Of the 9267 unique records identified, 8 studies met the eligibility criteria and were included in the systematic review. Five studies were randomized controlled trials (RCTs), and 3 studies were not. Among the RCTs, we found that digital interventions reduced depression and anxiety symptoms, but the majority of interventions were not more effective compared to the control groups where participants simply waited or received a self-help book. For the non-RCTs, the interventions also reduced symptoms, but without control groups, the interpretation of the findings is limited. Finally, participants in the included studies perceived the digital interventions to be credible and useful, but high dropout rates raised concerns about treatment adherence. Conclusions: Due to the lack of effective interventions among the reviewed studies, especially among the RCTs, our results suggest that waiting list DMHIs are not more effective compared to simply waiting or using a self-help book. However, more high-quality RCTs with larger sample sizes are warranted in order to draw a more robust conclusion. Additionally, as this review revealed concerns regarding the high dropout rate in digital interventions, future studies could perhaps adopt more personalized and human-centered functions in interventions to increase user engagement, with the potential to increase treatment adherence and effectiveness. ",
doi="10.2196/56650",
url="https://mental.jmir.org/2024/1/e56650",
url="http://www.ncbi.nlm.nih.gov/pubmed/39255015"
}


@Article{info:doi/10.2196/60621,
author="Werner, E. Nicole
and Morgen, Makenzie
and Kooiman, Sophie
and Jolliff, Anna
and Warner, Gemma
and Feinstein, James
and Chui, Michelle
and Katz, Barbara
and Storhoff, Brittany
and Sodergren, Kristan
and Coller, Ryan",
title="Effectiveness of a Mobile App (Meds@HOME) to Improve Medication Safety for Children With Medical Complexity: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Sep",
day="9",
volume="13",
pages="e60621",
keywords="medication safety",
keywords="children with medical complexity",
keywords="caregiving",
keywords="polypharmacy",
keywords="medication management",
abstract="Background: This study will pilot-test the mobile app, Medication Safety @HOME---Meds@HOME intervention to improve medication administration accuracy, reduce preventable adverse drug events, and ultimately improve chronic care management for children with medical complexity (CMC). The Meds@HOME app was co-designed with CMC families, secondary caregivers (SCGs), and health professionals to support medication management for primary caregivers (PCGs) and SCGs of CMC. We hypothesize that Meds@HOME will improve caregivers' medication administration accuracy, reduce preventable adverse drug events, and ultimately improve chronic care management. Objective: This study aims to evaluate the effectiveness of Meds@HOME on medication administration accuracy for PCGs and SCGs. Methods: This study will recruit up to 152 PCGs and 304 SCGs of CMC who are prescribed at least 1 scheduled high-risk medication and receive care at the University of Wisconsin American Family Children's Hospital. PCGs will be randomly assigned, for the 6-month trial, to either the control group (not trialing Meds@HOME) or the intervention group (trialing Meds@HOME) using 1:1 ratio. The Meds@HOME app allows caregivers to create a child profile, store medication and care instructions, and receive reminders for upcoming and overdue care routines and medication refills. Surveys completed both at the start and end of the trial measure demographics, medication delivery knowledge, confidence in the CMC's caregiving network, and comfort with medical information. Univariate and multivariate generalized estimation equations will be used for primary statistical analysis. The primary outcome is the PCG's rate of medication administration accuracy measured as correct identification of each of the following for a randomly selected high-risk medication: indication, formulation, dose, frequency, and route at baseline and after 6 months. Secondary outcomes include SCG medication administration accuracy (indication, formulation, dose, frequency, and route), count of University of Wisconsin hospital and emergency department encounters, PCG-reported medication adherence, count of deaths, and PCG medication confidence and understanding. Results: Recruitment for this study began on November 29, 2023. As of May 15, 2024, we have enrolled 94/152 (62\%) PCGs. We expect recruitment to end by August 1, 2024, and the final participant will complete the study by January 28, 2025, at which point we will start analyzing the complete responses. We expect publication of results at the end of 2025. Conclusions: The Meds@HOME mobile app provides a promising strategy for improving PCG medication safety for CMC who take high-risk medications. In addition, this protocol highlights novel procedures for recruiting SCGs of CMC. In the future, this app could be used more broadly across diverse caregiving networks to navigate complex medication routines and promote medication safety. Trial Registration: ClinicalTrials.gov NCT05816590; https://clinicaltrials.gov/study/NCT05816590 International Registered Report Identifier (IRRID): DERR1-10.2196/60621 ",
doi="10.2196/60621",
url="https://www.researchprotocols.org/2024/1/e60621"
}


@Article{info:doi/10.2196/52143,
author="Glyde, Granger Henry Mark
and Morgan, Caitlin
and Wilkinson, A. Tom M.
and Nabney, T. Ian
and Dodd, W. James",
title="Remote Patient Monitoring and Machine Learning in Acute Exacerbations of Chronic Obstructive Pulmonary Disease: Dual Systematic Literature Review and Narrative Synthesis",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="9",
volume="26",
pages="e52143",
keywords="acute exacerbations of COPD",
keywords="chronic obstructive pulmonary disease",
keywords="exacerbate",
keywords="exacerbation",
keywords="exacerbations",
keywords="remote patient monitoring",
keywords="RPM",
keywords="predict",
keywords="prediction",
keywords="predictions",
keywords="predictive",
keywords="machine learning",
keywords="monitoring",
keywords="remote",
keywords="COPD",
keywords="pulmonary",
keywords="respiratory",
keywords="lung",
keywords="lungs",
keywords="literature review",
keywords="literature reviews",
keywords="synthesis",
keywords="narrative review",
keywords="narrative reviews",
keywords="review methods",
keywords="review methodology",
abstract="Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with high mortality, morbidity, and poor quality of life and constitute a substantial burden to patients and health care systems. New approaches to prevent or reduce the severity of AECOPD are urgently needed. Internationally, this has prompted increased interest in the potential of remote patient monitoring (RPM) and digital medicine. RPM refers to the direct transmission of patient-reported outcomes, physiological, and functional data, including heart rate, weight, blood pressure, oxygen saturation, physical activity, and lung function (spirometry), directly to health care professionals through automation, web-based data entry, or phone-based data entry. Machine learning has the potential to enhance RPM in chronic obstructive pulmonary disease by increasing the accuracy and precision of AECOPD prediction systems. Objective: This study aimed to conduct a dual systematic review. The first review focuses on randomized controlled trials where RPM was used as an intervention to treat or improve AECOPD. The second review examines studies that combined machine learning with RPM to predict AECOPD. We review the evidence and concepts behind RPM and machine learning and discuss the strengths, limitations, and clinical use of available systems. We have generated a list of recommendations needed to deliver patient and health care system benefits. Methods: A comprehensive search strategy, encompassing the Scopus and Web of Science databases, was used to identify relevant studies. A total of 2 independent reviewers (HMGG and CM) conducted study selection, data extraction, and quality assessment, with discrepancies resolved through consensus. Data synthesis involved evidence assessment using a Critical Appraisal Skills Programme checklist and a narrative synthesis. Reporting followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: These narrative syntheses suggest that 57\% (16/28) of the randomized controlled trials for RPM interventions fail to achieve the required level of evidence for better outcomes in AECOPD. However, the integration of machine learning into RPM demonstrates promise for increasing the predictive accuracy of AECOPD and, therefore, early intervention. Conclusions: This review suggests a transition toward the integration of machine learning into RPM for predicting AECOPD. We discuss particular RPM indices that have the potential to improve AECOPD prediction and highlight research gaps concerning patient factors and the maintained adoption of RPM. Furthermore, we emphasize the importance of a more comprehensive examination of patient and health care burdens associated with RPM, along with the development of practical solutions. ",
doi="10.2196/52143",
url="https://www.jmir.org/2024/1/e52143"
}


@Article{info:doi/10.2196/59444,
author="Tak, Won Yae
and Lee, Won Jong
and Kim, Junetae
and Lee, Yura",
title="Predicting Long-Term Engagement in mHealth Apps: Comparative Study of Engagement Indices",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="9",
volume="26",
pages="e59444",
keywords="treatment adherence and compliance",
keywords="patient compliance",
keywords="medication adherence",
keywords="digital therapeutics",
keywords="engagement index",
keywords="mobile phone",
abstract="Background: Digital health care apps, including digital therapeutics, have the potential to increase accessibility and improve patient engagement by overcoming the limitations of traditional facility-based medical treatments. However, there are no established tools capable of quantitatively measuring long-term engagement at present. Objective: This study aimed to evaluate an existing engagement index (EI) in a commercial health management app for long-term use and compare it with a newly developed EI. Methods: Participants were recruited from cancer survivors enrolled in a randomized controlled trial that evaluated the impact of mobile health apps on recovery. Of these patients, 240 were included in the study and randomly assigned to the Noom app (Noom Inc). The newly developed EI was compared with the existing EI, and a long-term use analysis was conducted. Furthermore, the new EI was evaluated based on adapted measurements from the Web Matrix Visitor Index, focusing on click depth, recency, and loyalty indices. Results: The newly developed EI model outperformed the existing EI model in terms of predicting EI of a 6- to 9-month period based on the EI of a 3- to 6-month period. The existing model had a mean squared error of 0.096, a root mean squared error of 0.310, and an R2 of 0.053. Meanwhile, the newly developed EI models showed improved performance, with the best one achieving a mean squared error of 0.025, root mean squared error of 0.157, and R2 of 0.610. The existing EI exhibited significant associations: the click depth index (hazard ratio [HR] 0.49, 95\% CI 0.29-0.84; P<.001) and loyalty index (HR 0.17, 95\% CI 0.09-0.31; P<.001) were significantly associated with improved survival, whereas the recency index exhibited no significant association (HR 1.30, 95\% CI 1.70-2.42; P=.41). Among the new EI models, the EI with a menu combination of menus available in the app's free version yielded the most promising result. Furthermore, it exhibited significant associations with the loyalty index (HR 0.32, 95\% CI 0.16-0.62; P<.001) and the recency index (HR 0.47, 95\% CI 0.30-0.75; P<.001). Conclusions: The newly developed EI model outperformed the existing model in terms of the prediction of long-term user engagement and compliance in a mobile health app context. We emphasized the importance of log data and suggested avenues for future research to address the subjectivity of the EI and incorporate a broader range of indices for comprehensive evaluation. ",
doi="10.2196/59444",
url="https://www.jmir.org/2024/1/e59444",
url="http://www.ncbi.nlm.nih.gov/pubmed/39250192"
}


@Article{info:doi/10.2196/56580,
author="Shi, Weihong
and Zhang, Yuhang
and Bian, Yanyan
and Chen, Lixia
and Yuan, Wangshu
and Zhang, Houqiang
and Feng, Qiyang
and Zhang, Huiling
and Liu, Diana
and Lin, Ye",
title="The Physical and Psychological Effects of Telerehabilitation-Based Exercise for Patients With Nonspecific Low Back Pain: Prospective Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Sep",
day="6",
volume="12",
pages="e56580",
keywords="nonspecific low back pain",
keywords="telerehabilitation",
keywords="physical therapy",
keywords="low back pain",
keywords="back pain",
keywords="psychological",
keywords="exercise",
keywords="randomized controlled trial",
keywords="efficacy",
keywords="medical infrastructure",
keywords="pain intensity",
keywords="quality of life",
keywords="health survey",
keywords="therapeutic",
keywords="mobile phone",
abstract="Background: Physical therapy has demonstrated efficacy in managing nonspecific low back pain (NLBP) among patients. Nevertheless, the prevalence of NLBP poses a challenge, as the existing medical infrastructure may be insufficient to care for the large patient population, particularly in geographically remote regions. Telerehabilitation emerges as a promising method to address this concern by offering a method to deliver superior medical care to a greater number of patients with NLBP. Objective: The purpose of this study is to demonstrate the physical and psychological effectiveness of a user-centered telerehabilitation program, consisting of a smartphone app and integrated sensors, for patients with NLBP. Methods: This was a single-center, prospective, randomized controlled trial for individuals with NLBP for a duration exceeding 3 months. All participants were assigned randomly to either the telerehabilitation-based exercise group (TBEG) or the outpatient-based exercise group (OBEG). All participants completed a 30-minute regimen of strength and stretching exercises 3 times per week, for a total of 8 weeks, and were required to complete assessment questionnaires at 0, 2, 4, and 8 weeks. The TBEG completed home-based exercises and questionnaires using a telerehabilitation program, while the OBEG completed them in outpatient rehabilitation. The Oswestry Disability Index (ODI) served as the primary outcome measure, assessing physical disability. Secondary outcomes included the Numeric Pain Rating Scale, Fear-Avoidance Beliefs Questionnaire, and 36-item Short-Form Health Survey. Results: In total, 54 of 129 eligible patients were enrolled and randomly assigned to the study. The completion of all the interventions and assessments in the TBEG and OBEG was 89\% (24/27) and 81\% (22/27). The findings indicate that no statistical significance was found in the difference of ODI scores between the TBEG and the OBEG at 2 weeks (mean difference ?0.91; odds ratio [OR] 0.78, 95\% CI ?5.96 to 4.14; P=.72), 4 weeks (mean difference ?3.80; OR 1.33, 95\% CI ?9.86 to ?2.25; P=.21), and 8 weeks (mean difference ?3.24; OR 0.92, 95\% CI ?8.65 to 2.17; P=.24). The improvement of the ODI in the TBEG (mean ?16.42, SD 7.30) and OBEG (mean ?13.18, SD 8.48) was higher than 10 after an 8-week intervention. No statistically significant differences were observed between the 2 groups at the 8-week mark regarding the Fear-Avoidance Beliefs Questionnaire (mean difference 8.88; OR 1.04, 95\% CI ?2.29 to 20.06; P=.12) and Numeric Pain Rating Scale (mean difference ?0.39; OR 0.44, 95\% CI ?2.10 to 1.31; P=.64). In the subgroup analysis, there was no statistically significant difference in outcomes between the 2 groups. Conclusions: Telerehabilitation interventions demonstrate comparable therapeutic efficacy for individuals with NLBP when compared to conventional outpatient-based physical therapy, yielding comparable outcomes in pain reduction and improvement in functional limitations. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300068984; https://www.chictr.org.cn/showproj.html?proj=189852 ",
doi="10.2196/56580",
url="https://mhealth.jmir.org/2024/1/e56580"
}


@Article{info:doi/10.2196/53512,
author="Hermsen, Sander
and Tump, Danielle
and Wentink, Eva
and Duijvestein, Marjolijn",
title="Investigating Patient Perspectives on Using eHealth Technologies for the Self-Management of Inflammatory Bowel Disease: Mixed Methods Study",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="6",
volume="26",
pages="e53512",
keywords="information and communication technology",
keywords="ICT",
keywords="self-management",
keywords="inflammatory bowel disease",
keywords="IBD",
keywords="smart toilet seat",
keywords="mobile phone",
abstract="Background: Inflammatory bowel disease (IBD) poses significant challenges for patients, requiring continuous monitoring and self-management to improve quality of life. Objective: This study aims to investigate the viewpoints of individuals living with IBD on the use of information and communication technology (ICT) for the self-management of their condition, with a particular focus on the concept of a ``smart'' toilet seat as an example of ICT for IBD self-management. Methods: We conducted an analysis of questionnaire responses obtained from 724 participants. They were encouraged to share their use cases and identify any perceived barriers associated with ICT adoption for managing their condition. To assess their responses, we used descriptive quantitative analysis, summative content analysis, and thematic qualitative analysis. We combined these results in an epistemic network analysis to look for meaningful patterns in the responses. Results: Of the 724 participants, more than half (n=405, 55.9\%) were already using various forms of ICT for IBD self-management. The primary factor influencing their use of ICT was their affinity for interacting with technology. Distinct differences emerged between individuals who were using ICT and those who were not, particularly regarding their perceived use cases and concerns. Conclusions: This study provides valuable insights into the perspectives of individuals with IBD on the use of ICT for self-management. To facilitate wider adoption, addressing privacy concerns, ensuring data security, and establishing reliable ICT integration will be critical. ",
doi="10.2196/53512",
url="https://www.jmir.org/2024/1/e53512",
url="http://www.ncbi.nlm.nih.gov/pubmed/39240663"
}


@Article{info:doi/10.2196/49029,
author="Mahmoudi, Ebrahim
and Yejong Yoo, Paul
and Chandra, Ananya
and Cardoso, Roberta
and Denner Dos Santos, Carlos
and Majnemer, Annette
and Shikako, Keiko",
title="Gamification in Mobile Apps for Children With Disabilities: Scoping Review",
journal="JMIR Serious Games",
year="2024",
month="Sep",
day="6",
volume="12",
pages="e49029",
keywords="mobile health",
keywords="mHealth",
keywords="gamification",
keywords="children with disabilities",
keywords="mobile phone",
abstract="Background: Children with disabilities face numerous challenges in accessing health services. Mobile health is an emerging field that could significantly reduce health inequities by providing more accessible services. Many mobile apps incorporate gamification elements such as feedback, points, and stories to increase engagement and motivation; however, little is known about how gamification has been incorporated in mobile apps for children with disabilities. Objective: This scoping review aims to identify and synthesize the existing research evidence on the use of gamification in mobile apps for children with disabilities. Specifically, the objectives were to (1) identify the categories of these mobile apps (eg, treatment and educational) (2), describe the health-related outcomes they target, (3) assess the types and levels of gamification elements used within these apps, and (4) determine the reasons for incorporating gamification elements into mobile apps. Methods: We searched MEDLINE, PsycINFO, CINAHL, Embase, the ACM Digital Library, and IEEE Xplore databases to identify papers published between 2008 and 2023. Original empirical research studies reporting on gamified mobile apps for children with disabilities that implemented at least 1 gamification strategy or tactic were included. Studies investigating serious games or full-fledged games were excluded. Results: A total of 38 studies reporting on 32 unique gamified mobile apps were included. Findings showed that gamified apps focus on communication skills and oral health in children with autism spectrum disorder while also addressing self-management and academic skills for other disability groups. Gamified mobile apps have demonstrated potential benefits across different populations and conditions; however, there were mixed results regarding their impact.?The gamification strategies included fun and playfulness (23/32, 72\%), feedback on performance (17/32, 53\%), and reinforcement (17/32, 53\%) in more than half of apps, whereas social connectivity was used as a gamification strategy in only 4 (12\%) mobile apps. There were 2 main reasons for integrating gamification elements into mobile apps described in 16 (42\%) studies: increasing user engagement and motivation and enhancing intervention effects. Conclusions: This scoping review offers researchers a comprehensive review of the gamification elements currently used in mobile apps for the purposes of treatment, education, symptom management, and assessment for children with disabilities. In addition, it indicates that studies on certain disability groups and examinations of health-related outcomes have been neglected, highlighting the need for further investigations in these areas. Furthermore, research is needed to investigate the effectiveness of mobile-based gamification elements on health and health behavior outcomes, as well as the healthy development of children with disabilities. ",
doi="10.2196/49029",
url="https://games.jmir.org/2024/1/e49029",
url="http://www.ncbi.nlm.nih.gov/pubmed/39240675"
}


@Article{info:doi/10.2196/57196,
author="De Lucia, Annalisa
and Donisi, Valeria
and Pasini, Ilenia
and Polati, Enrico
and Del Piccolo, Lidia
and Schweiger, Vittorio
and Perlini, Cinzia",
title="Perspectives and Experiences on eHealth Solutions for Coping With Chronic Pain: Qualitative Study Among Older People Living With Chronic Pain",
journal="JMIR Aging",
year="2024",
month="Sep",
day="5",
volume="7",
pages="e57196",
keywords="older adults",
keywords="qualitative method",
keywords="pain",
keywords="coping strategies",
keywords="eHealth",
keywords="pain management",
keywords="mobile phone",
abstract="Background: Chronic noncancer pain (CNCP) is a major health issue among the older population, affecting multiple aspects of individual functioning. Recently, the use of eHealth solutions has been proposed in supporting chronic pain self-management even among older adults, although some barriers have emerged. Few qualitative studies, with none conducted in Mediterranean countries, have explored older people's experiences and perceptions regarding the types of strategies used to cope with chronic pain and eHealth tools for chronic pain management. Objective: This study's objectives were to explore the perspectives and experiences of older adults regarding the coping strategies used to manage chronic pain, the use of digital technologies in everyday life, and the potentiality and barriers in using those technologies for health and pain management. Methods: A multimethod approach (ie, self-report questionnaires and a semistructured interview) has been adopted targeting older adults (ie, those who are aged 65 to 80 years and presenting different types of CNCP) who are attending a pain therapy center in Italy. Qualitative answers were analyzed using thematic analysis. Results: Overall, participants reported using a variety of pain coping strategies; however, they showed an attitude of resignation to their CNCP condition. Nearly 70\% (12/18) of the interviewees referred to using digital technologies for purposes related to health and pain management, mostly involving very basic management activities. The participants' opinions on the useful functions that need to be incorporated in eHealth tools for chronic pain management have been categorized into four themes: (1) specific pain self-management skills, (2) support in organizing various health-related aspects, (3) sharing experiences with others, and (4) increasing pain-related personal knowledge. Conversely, the following potential barriers to adopting eHealth tools emerged: (1) computer illiteracy, (2) negative effects or risks, (3) impersonal interaction, and (4) physical limitations. Conclusions: The use of eHealth solutions still seems low, often being accompanied by a perceived lack of digital skills or attitude among a sample of older adults from Italy with CNCP. Before introducing innovative eHealth solutions, it would be of primary importance to take action to enhance, on the one hand, self-efficacy in pain management and, on the other, the digital literacy level among older people. ",
doi="10.2196/57196",
url="https://aging.jmir.org/2024/1/e57196",
url="http://www.ncbi.nlm.nih.gov/pubmed/39235831"
}


@Article{info:doi/10.2196/57601,
author="Suffoletto, Brian
and Kim, David
and Toth, Caitlin
and Mayer, Waverly
and Glaister, Sean
and Cinkowski, Chris
and Ashenburg, Nick
and Lin, Michelle
and Losak, Michael",
title="Feasibility of Measuring Smartphone Accelerometry Data During a Weekly Instrumented Timed Up-and-Go Test After Emergency Department Discharge: Prospective Observational Cohort Study",
journal="JMIR Aging",
year="2024",
month="Sep",
day="4",
volume="7",
pages="e57601",
keywords="older adult",
keywords="older adults",
keywords="elder",
keywords="elderly",
keywords="older person",
keywords="older people",
keywords="ageing",
keywords="aging",
keywords="gait",
keywords="balance",
keywords="fall",
keywords="falls",
keywords="functional decline",
keywords="fall risk",
keywords="fall risks",
keywords="mobility",
keywords="phone",
keywords="sensors",
keywords="patient monitoring",
keywords="monitoring",
keywords="emergency department",
keywords="emergency departments",
keywords="ED",
keywords="emergency room",
keywords="ER",
keywords="discharge",
keywords="mobile application",
keywords="mobile applications",
keywords="app",
keywords="apps",
keywords="application",
keywords="applications",
keywords="digital health",
keywords="digital technology",
keywords="digital intervention",
keywords="digital interventions",
keywords="smartphone",
keywords="smartphones",
keywords="prediction",
keywords="mobile phone",
abstract="Background: Older adults discharged from the emergency department (ED) face elevated risk of falls and functional decline. Smartphones might enable remote monitoring of mobility after ED discharge, yet their application in this context remains underexplored. Objective: This study aimed to assess the feasibility of having older adults provide weekly accelerometer data from an instrumented Timed Up-and-Go (TUG) test over an 11-week period after ED discharge. Methods: This single-center, prospective, observational, cohort study recruited patients aged 60 years and older from an academic ED. Participants downloaded the GaitMate app to their iPhones that recorded accelerometer data during 11 weekly at-home TUG tests. We measured adherence to TUG test completion, quality of transmitted accelerometer data, and participants' perceptions of the app's usability and safety. Results: Of the 617 approached patients, 149 (24.1\%) consented to participate, and of these 149 participants, 9 (6\%) dropped out. Overall, participants completed 55.6\% (912/1639) of TUG tests. Data quality was optimal in 31.1\% (508/1639) of TUG tests. At 3-month follow-up, 83.2\% (99/119) of respondents found the app easy to use, and 95\% (114/120) felt safe performing the tasks at home. Barriers to adherence included the need for assistance, technical issues with the app, and forgetfulness. Conclusions: The study demonstrates moderate adherence yet high usability and safety for the use of smartphone TUG tests to monitor mobility among older adults after ED discharge. Incomplete TUG test data were common, reflecting challenges in the collection of high-quality longitudinal mobility data in older adults. Identified barriers highlight the need for improvements in user engagement and technology design. ",
doi="10.2196/57601",
url="https://aging.jmir.org/2024/1/e57601"
}


@Article{info:doi/10.2196/55852,
author="Pohl, Petra
and Klerfors, Karoline
and Kj{\"o}rk, K. Emma",
title="Evaluation of a Digital Previsit Tool for Identifying Stroke-Related Health Problems Before a Follow-Up Visit (Part 1): Survey Study",
journal="JMIR Hum Factors",
year="2024",
month="Sep",
day="3",
volume="11",
pages="e55852",
keywords="e-health",
keywords="stroke",
keywords="Strokeh{\"a}lsa",
keywords="follow-up",
keywords="previsit",
keywords="person-centred care",
keywords="health literacy",
keywords="digital tool",
keywords="shared decision-making",
keywords="survey",
keywords="mobile phone",
abstract="Background: Stroke may lead to various disabilities, and a structured follow-up visit is strongly recommended within a few months after an event. To facilitate this visit, the digital previsit tool ``Strokehealth'' was developed for patients to fill out in advance. The concept Strokeh{\"a}lsa (or Strokehealth) was initially developed in-house as a Windows application, later incorporated in 1177.se. Objective: The study's primary objective was to use a patient satisfaction survey to evaluate the digital previsit tool Strokehealth when used before a follow-up visit, with a focus on feasibility and relevance from the perspective of people with stroke. Our secondary objective was to explore the extent to which the previsit tool identified stroke-related health problems. Methods: Between November 2020 and June 2021, a web-based survey was sent to patients who were scheduled for a follow-up visit after discharge from a stroke unit and had recently filled in the previsit tool. The survey covered demographic characteristics, internet habits, and satisfaction rated using 5 response options. Descriptive statistics were used to present data from both the previsit tool and the survey. We also compared the characteristics of those who completed the previsit tool and those who did not, using nonparametric statistics. Free-text responses were thematically analyzed. Results: All patients filling out the previsit tool (80/171; age: median 67, range 32-91 years) were community-dwelling. Most had experienced a mild stroke and reported a median of 2 stroke-related health problems (range 0-8), and they were significantly younger than nonresponders (P<.001). The survey evaluating the previsit tool was completed by 73\% (58/80; 39 men). The majority (48/58, 83\%) reported using the internet daily. Most respondents (56/58, 97\%) were either satisfied (n=15) or very satisfied (n=41) with how well the previsit tool captured their health problems. The highest level of dissatisfaction was related to the response options in Strokehealth (n=5). Based on the free-text answers to the survey, we developed 4 themes. First, Strokehealth was perceived to provide a structure that ensured that issues would be emphasized and considered. Second, user-friendliness and accessibility were viewed as acceptable, although respondents suggested improvements. Third, participants raised awareness about being approached digitally for communication and highlighted the importance of how to be approached. Fourth, their experiences with Strokehealth were influenced by their perceptions of the explanatory texts, the response options, and the possibility of elaborating on their answers in free text. Conclusions: People with stroke considered the freely available previsit tool Strokehealth feasible for preparing in advance for a follow-up visit. Despite high satisfaction with how well the tool captured their health problems, participants indicated that additional free-text responses and revised information could enhance usability. Improvements need to be considered in parallel with qualitative data to ensure that the tool meets patient needs. Trial Registration: Researchweb 275135; https://www.researchweb.org/is/vgr/project/275135 ",
doi="10.2196/55852",
url="https://humanfactors.jmir.org/2024/1/e55852"
}


@Article{info:doi/10.2196/60773,
author="He, Yunfan
and Chen, Han
and Xiang, Peng
and Zhao, Min
and Li, Yingjun
and Liu, Yongcheng
and Wang, Tong
and Liang, Jun
and Lei, Jianbo",
title="Establishing an Evaluation Indicator System for User Satisfaction With Hypertension Management Apps: Combining User-Generated Content and Analytic Hierarchy Process",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="3",
volume="26",
pages="e60773",
keywords="hypertension management",
keywords="mobile health",
keywords="user satisfaction",
keywords="evaluation indicator system",
keywords="analytic hierarchy process",
abstract="Background: Hypertension management apps (HMAs) can be effective in controlling blood pressure, but their actual impact is often suboptimal. Establishing a user satisfaction evaluation indicator system for HMAs can assist app developers in enhancing app design and functionality, while also helping users identify apps that best meet their needs. This approach aims to improve the overall effectiveness of app usage. Objective: This study aims to systematically collect data on HMAs and their user reviews in the United States and China. It analyzes app usage patterns and functional characteristics, identifies factors influencing user satisfaction from existing research, and develops a satisfaction evaluation indicator system to provide more accurate recommendations for improving user satisfaction. Methods: We conducted a descriptive statistical analysis to assess the development status of HMAs in both countries and applied the task-technology fit model to evaluate whether the app functionalities align with business needs. We separately summarized the factors influencing user satisfaction in both countries from previous research, utilized the analytic hierarchy process to develop an evaluation indicator system for HMA user satisfaction, and calculated satisfaction levels. Based on these findings, we propose improvements to enhance app functionality and user satisfaction. Results: In terms of current development status, there were fewer HMAs and user reviews in China compared with the United States. Regarding app functional availability, fewer than 5\% (4/91) of the apps achieved a demand fulfillment rate exceeding 80\% (8/10). Overall, user satisfaction in both countries was low. Conclusions: In the United States, user satisfaction was lowest for advertising distribution, data synchronization, and reliability. By contrast, Chinese apps need improvements in cost efficiency and compatibility. ",
doi="10.2196/60773",
url="https://www.jmir.org/2024/1/e60773",
url="http://www.ncbi.nlm.nih.gov/pubmed/39226103"
}


@Article{info:doi/10.2196/59013,
author="Goeldner, Moritz
and Gehder, Sara",
title="Digital Health Applications (DiGAs) on a Fast Track: Insights From a Data-Driven Analysis of Prescribable Digital Therapeutics in Germany From 2020 to Mid-2024",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="29",
volume="26",
pages="e59013",
keywords="digital health application",
keywords="DiGA",
keywords="data-driven analysis",
keywords="clinical evidence",
keywords="health economics",
keywords="positive care effect",
keywords="medical benefit",
keywords="patient-relevant structural and procedural improvements",
keywords="pSVV",
keywords="digital health care act",
abstract="Background: This study aimed to analyze the rapidly evolving ecosystem of digital health applications (Digitale Gesundheitsanwendung; DiGAs) in Germany, spurred by the 2019 Digital Healthcare Act. With over 73 million people in Germany now having access to DiGAs, these prescribable digital health apps and web-based applications represent a substantial stride in health care modernization, supporting both patients and health care providers with digital solutions for disease management and care improvement. Objective: Through a data-driven approach, this research aimed to unpack the complexities of DiGA market dynamics, economic factors, and clinical evidence, offering insights into their impact over the past years. Methods: The analysis draws from a range of public data sources, including the DiGA directory, statutory health insurance reports, app store feedback, and clinical study results. Results: As of July 1, 2024, there are 56 DiGAs listed by the Federal Institute for Drugs and Medical Devices (Bundesinstitut f{\"u}r Arzneimittel und Medizinprodukte), divided into 35 permanently and 21 preliminarily listed applications. Our findings reveal that a majority of DiGAs extend beyond the intended 1-year period to achieve permanent listing, reflecting the extensive effort required to demonstrate clinical efficacy. Economic analysis uncovered a dynamic pricing landscape, with initial prices ranging from approximately {\texteuro}200 to {\texteuro}700 ({\texteuro}1=US \$1.07), averaging at a median of {\texteuro}514 for a 3-month DiGA prescription. Following negotiations or arbitration board decisions, prices typically see a 50\% reduction, settling at a median of {\texteuro}221. Prescription data offer valuable insights into DiGA acceptance, with total prescriptions jumping from around 41,000 in the first period to 209,000 in the latest reporting period. The analysis of the top 15 DiGAs, representing 82\% of the total prescriptions, shows that these best-performing apps receive from a minimum of 8 to a maximum of 77 daily prescriptions, with native apps and early market entrants achieving higher rates. Clinical evidence from all 35 permanently listed DiGAs indicates a uniform preference for randomized controlled trials to validate primary end points, with no noteworthy use of alternative study designs encouraged in the Digital Healthcare Act and related regulations. Moreover, all evaluated DiGAs focused on medical benefits, with health status improvement as a key end point, suggesting an underuse of patient-relevant structural and procedural improvement in demonstrating health care impact. Conclusions: This study highlights the growth and challenges within the DiGA sector, suggesting areas for future research, such as the exploration of new study designs and the potential impact of patient-relevant structural and procedural improvements. For DiGA manufacturers, the strategic advantage of early market entry is emphasized. Overall, this paper underscores the evolving landscape of digital health, advocating for a nuanced understanding of digital health technology integration in Germany and beyond. ",
doi="10.2196/59013",
url="https://www.jmir.org/2024/1/e59013"
}


@Article{info:doi/10.2196/53119,
author="Cescon, Corrado
and Landolfi, Giuseppe
and Bonomi, Niko
and Derboni, Marco
and Giuffrida, Vincenzo
and Rizzoli, Emilio Andrea
and Maino, Paolo
and Koetsier, Eva
and Barbero, Marco",
title="Automated Pain Spots Recognition Algorithm Provided by a Web Service--Based Platform: Instrument Validation Study",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Aug",
day="27",
volume="12",
pages="e53119",
keywords="pain drawing",
keywords="image processing",
keywords="body charts",
keywords="scan",
keywords="pain",
keywords="draw",
keywords="drawing",
keywords="scanner",
keywords="scanners",
keywords="app",
keywords="apps",
keywords="applications",
keywords="device",
keywords="devices",
keywords="image",
keywords="images",
keywords="smartphone",
keywords="smartphones",
keywords="scale",
keywords="musculoskeletal",
keywords="body chart",
keywords="accuracy",
keywords="reliability",
keywords="accurate",
keywords="reliable",
keywords="picture",
keywords="pictures",
keywords="mobile phone",
abstract="Background: Understanding the causes and mechanisms underlying musculoskeletal pain is crucial for developing effective treatments and improving patient outcomes. Self-report measures, such as the Pain Drawing Scale, involve individuals rating their level of pain on a scale. In this technique, individuals color the area where they experience pain, and the resulting picture is rated based on the depicted pain intensity. Analyzing pain drawings (PDs) typically involves measuring the size of the pain region. There are several studies focusing on assessing the clinical use of PDs, and now, with the introduction of digital PDs, the usability and reliability of these platforms need validation. Comparative studies between traditional and digital PDs have shown good agreement and reliability. The evolution of PD acquisition over the last 2 decades mirrors the commercialization of digital technologies. However, the pen-on-paper approach seems to be more accepted by patients, but there is currently no standardized method for scanning PDs. Objective: The objective of this study was to evaluate the accuracy of PD analysis performed by a web platform using various digital scanners. The primary goal was to demonstrate that simple and affordable mobile devices can be used to acquire PDs without losing important information. Methods: Two sets of PDs were generated: one with the addition of 216 colored circles and another composed of various red shapes distributed randomly on a frontal view body chart of an adult male. These drawings were then printed in color on A4 sheets, including QR codes at the corners in order to allow automatic alignment, and subsequently scanned using different devices and apps. The scanners used were flatbed scanners of different sizes and prices (professional, portable flatbed, and home printer or scanner), smartphones with varying price ranges, and 6 virtual scanner apps. The acquisitions were made under normal light conditions by the same operator. Results: High-saturation colors, such as red, cyan, magenta, and yellow, were accurately identified by all devices. The percentage error for small, medium, and large pain spots was consistently below 20\% for all devices, with smaller values associated with larger areas. In addition, a significant negative correlation was observed between the percentage of error and spot size (R=?0.237; P=.04). The proposed platform proved to be robust and reliable for acquiring paper PDs via a wide range of scanning devices. Conclusions: This study demonstrates that a web platform can accurately analyze PDs acquired through various digital scanners. The findings support the use of simple and cost-effective mobile devices for PD acquisition without compromising the quality of data. Standardizing the scanning process using the proposed platform can contribute to more efficient and consistent PD analysis in clinical and research settings. ",
doi="10.2196/53119",
url="https://mhealth.jmir.org/2024/1/e53119"
}


@Article{info:doi/10.2196/49868,
author="van Tilburg, Leendert Mark
and Spin, Ivar
and Pisters, F. Martijn
and Staal, Bart J.
and Ostelo, WJG Raymond
and van der Velde, Miriam
and Veenhof, Cindy
and Kloek, JJ Corelien",
title="Barriers and Facilitators to the Implementation of Digital Health Services for People With Musculoskeletal Conditions in the Primary Health Care Setting: Systematic Review",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="27",
volume="26",
pages="e49868",
keywords="eHealth",
keywords="primary health care",
keywords="musculoskeletal problems",
keywords="implementation science",
keywords="systematic review",
keywords="mobile phone",
abstract="Background: In recent years, the effectiveness and cost-effectiveness of digital health services for people with musculoskeletal conditions have increasingly been studied and show potential. Despite the potential of digital health services, their use in primary care is lagging. A thorough implementation is needed, including the development of implementation strategies that potentially improve the use of digital health services in primary care. The first step in designing implementation strategies that fit the local context is to gain insight into determinants that influence implementation for patients and health care professionals. Until now, no systematic overview has existed of barriers and facilitators influencing the implementation of digital health services for people with musculoskeletal conditions in the primary health care setting. Objective: This systematic literature review aims to identify barriers and facilitators to the implementation of digital health services for people with musculoskeletal conditions in the primary health care setting. Methods: PubMed, Embase, and CINAHL were searched for eligible qualitative and mixed methods studies up to March 2024. Methodological quality of the qualitative component of the included studies was assessed with the Mixed Methods Appraisal Tool. A framework synthesis of barriers and facilitators to implementation was conducted using the Consolidated Framework for Implementation Research (CFIR). All identified CFIR constructs were given a reliability rating (high, medium, or low) to assess the consistency of reporting across each construct. Results: Overall, 35 studies were included in the qualitative synthesis. Methodological quality was high in 34 studies and medium in 1 study. Barriers (--) of and facilitators (+) to implementation were identified in all 5 CFIR domains: ``digital health characteristics'' (ie, commercial neutral [+], privacy and safety [--], specificity [+], and good usability [+]), ``outer setting'' (ie, acceptance by stakeholders [+], lack of health care guidelines [--], and external financial incentives [--]), ``inner setting'' (ie, change of treatment routines [+ and --], information incongruence (--), and support from colleagues [+]), ``characteristics of the healthcare professionals'' (ie, health care professionals' acceptance [+ and --] and job satisfaction [+ and --]), and the ``implementation process'' (involvement [+] and justification and delegation [--]). All identified constructs and subconstructs of the CFIR had a high reliability rating. Some identified determinants that influence implementation may be facilitators in certain cases, whereas in others, they may be barriers. Conclusions: Barriers and facilitators were identified across all 5 CFIR domains, suggesting that the implementation process can be complex and requires implementation strategies across all CFIR domains. Stakeholders, including digital health intervention developers, health care professionals, health care organizations, health policy makers, health care funders, and researchers, can consider the identified barriers and facilitators to design tailored implementation strategies after prioritization has been carried out in their local context. ",
doi="10.2196/49868",
url="https://www.jmir.org/2024/1/e49868",
url="http://www.ncbi.nlm.nih.gov/pubmed/39190440"
}


@Article{info:doi/10.2196/55254,
author="Szeto, Kimberley
and Arnold, John
and Horsfall, Marie Erin
and Sarro, Madeline
and Hewitt, Anthony
and Maher, Carol",
title="Establishing a Consensus-Based Framework for the Use of Wearable Activity Trackers in Health Care: Delphi Study",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Aug",
day="23",
volume="12",
pages="e55254",
keywords="wearable activity tracker",
keywords="health care",
keywords="physical activity",
keywords="sedentary behavior",
keywords="wearable",
keywords="wearables",
keywords="wearable tracker",
keywords="tracker",
keywords="wearable technology",
keywords="support",
keywords="exercise",
keywords="prevention",
keywords="management",
keywords="monitor",
keywords="promote",
keywords="survey",
keywords="utility",
abstract="Background: Physical activity (PA) plays a crucial role in health care, providing benefits in the prevention and management of many noncommunicable diseases. Wearable activity trackers (WATs) provide an opportunity to monitor and promote PA in various health care settings. Objective: This study aimed to develop a consensus-based framework for the optimal use of WATs in health care. Methods: A 4-round Delphi survey was conducted, involving a panel (n=58) of health care professionals, health service managers, and researchers. Round 1 used open-response questions to identify overarching themes. Rounds 2 and 3 used 9-point Likert scales to refine participants' opinions and establish consensus on key factors related to WAT use in health care, including metrics, device characteristics, clinical populations and settings, and software considerations. Round 3 also explored barriers and mitigating strategies to WAT use in clinical settings. Insights from Rounds 1-3 informed a draft checklist designed to guide a systematic approach to WAT adoption in health care. In Round 4, participants evaluated the draft checklist's clarity, utility, and appropriateness. Results: Participation rates for rounds 1 to 4 were 76\% (n=44), 74\% (n=43), 74\% (n=43), and 66\% (n=38), respectively. The study found a strong interest in using WATs across diverse clinical populations and settings. Key metrics (step count, minutes of PA, and sedentary time), device characteristics (eg, easy to charge, comfortable, waterproof, simple data access, and easy to navigate and interpret data), and software characteristics (eg, remote and wireless data access, access to multiple patients' data) were identified. Various barriers to WAT adoption were highlighted, including device-related, patient-related, clinician-related, and system-level issues. The findings culminated in a 12-item draft checklist for using WATs in health care, with all 12 items endorsed for their utility, clarity, and appropriateness in Round 4. Conclusions: This study underscores the potential of WATs in enhancing patient care across a broad spectrum of health care settings. While the benefits of WATs are evident, successful integration requires addressing several challenges, from technological developments to patient education and clinician training. Collaboration between WAT manufacturers, researchers, and health care professionals will be pivotal for implementing WATs in the health care sector. ",
doi="10.2196/55254",
url="https://mhealth.jmir.org/2024/1/e55254",
url="http://www.ncbi.nlm.nih.gov/pubmed/39178034"
}


@Article{info:doi/10.2196/56380,
author="Miki, Takahiro
and Yamada, Junya
and Ishida, Shinpei
and Sakui, Daisuke
and Kanai, Masashi
and Hagiwara, Yuta",
title="Exploring the Feasibility and Initial Impact of an mHealth-Based Disease Management Program for Chronic Ischemic Heart Disease: Formative Study",
journal="JMIR Form Res",
year="2024",
month="Aug",
day="22",
volume="8",
pages="e56380",
keywords="mobile health",
keywords="chronic ischemic heart disease",
keywords="disease management program",
keywords="mobile phone",
keywords="behavior change",
abstract="Background: Ischemic heart disease (IHD) is a leading cause of morbidity and mortality worldwide, requiring innovative management strategies. Traditional disease management programs often struggle to maintain patient engagement and ensure long-term adherence to lifestyle modifications and treatment plans. Mobile health (mHealth) technologies have emerged as a promising approach to address these challenges by providing continuous, personalized support and monitoring. However, the reported use and effectiveness of mHealth in the management of chronic diseases, such as IHD, have not been fully explored. Objective: The primary aim of this study was to evaluate the feasibility and initial impact of an mHealth-based disease management program on coronary risk factors, specifically focusing on low-density lipoprotein cholesterol (LDL-C) levels, in individuals with chronic IHD. This formative study assessed changes in LDL-C and other metabolic health indicators over a 6-month period to determine the initial impact of the program on promoting cardiovascular health and lifestyle modification. Methods: This study was conducted using data from 266 individuals enrolled in an mHealth-based disease management program between December 2018 and October 2022. Eligibility was based on a documented history of IHD, with participants undergoing a comprehensive cardiac risk assessment before enrollment. The program included biweekly telephone sessions, health tracking via a smartphone app, and regular progress reports to physicians. The study measured change in LDL-C levels as the primary outcome, with secondary outcomes including body weight, triglyceride levels, and other metabolic health indicators. Statistical analysis used paired 2-tailed t tests and stratified analyses to assess the impact of the program. Results: Participants experienced a significant reduction in LDL-C, with LDL-C levels decreasing from a mean of 98.82 (SD 40.92) mg/dL to 86.62 (SD 39.86) mg/dL (P<.001). The intervention was particularly effective in individuals with high baseline LDL-C levels. Additional improvements were seen in body weight and triglyceride levels, suggesting a broader impact on metabolic health. Program adherence and engagement metrics suggested high participant satisfaction and compliance. Conclusions: The results of this study suggest that the mHealth-based disease management program is feasible and has an initial positive impact on reducing LDL-C levels and improving metabolic health in individuals with chronic IHD. However, the study design does not allow for a definitive conclusion regarding whether mHealth-based disease management programs are more effective than traditional face-to-face care. Future studies are needed to further validate these findings and to examine the comparative effectiveness of these interventions in more detail. ",
doi="10.2196/56380",
url="https://formative.jmir.org/2024/1/e56380"
}


@Article{info:doi/10.2196/54511,
author="Niyomyart, Atsadaporn
and Ruksakulpiwat, Suebsarn
and Benjasirisan, Chitchanok
and Phianhasin, Lalipat
and Nigussie, Kabtamu
and Thorngthip, Sutthinee
and Shamita, Gazi
and Thampakkul, Jai
and Begashaw, Lidya",
title="Current Status of Barriers to mHealth Access Among Patients With Stroke and Steps Toward the Digital Health Era: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Aug",
day="22",
volume="12",
pages="e54511",
keywords="digital health",
keywords="mHealth",
keywords="barrier",
keywords="stroke",
keywords="systematic review",
keywords="mobile phones",
abstract="Background: Mobile health (mHealth) offers significant benefits for patients with stroke, facilitating remote monitoring and personalized health care solutions beyond traditional settings. However, there is a dearth of comprehensive data, particularly qualitative insights, on the barriers to mHealth access. Understanding these barriers is crucial for devising strategies to enhance mHealth use among patients with stroke. Objective: This study aims to examine the recent literature focusing on barriers to mHealth access among patients with stroke. Methods: A systematic search of PubMed, MEDLINE, Web of Science, and CINAHL Plus Full Text was conducted for literature published between 2017 and 2023. Abstracts and full texts were independently screened based on predetermined inclusion and exclusion criteria. Data synthesis was performed using the convergent integrated analysis framework recommended by the Joanna Briggs Institute. Results: A total of 12 studies met the inclusion criteria. The majority were qualitative studies (about 42\%), followed by mixed methods (25\%), pilot studies (about 17\%), nonrandomized controlled trials (about 8\%), and observational studies (about 8\%). Participants included patients with stroke, caregivers, and various health care professionals. The most common mHealth practices were home-based telerehabilitation (30\%) and poststroke mHealth and telecare services (20\%). Identified barriers were categorized into two primary themes: (1) at the patient level and (2) at the health provider-patient-device interaction level. The first theme includes 2 subthemes: health-related issues and patient acceptability. The second theme encompassed 3 subthemes: infrastructure challenges (including software, networking, and hardware), support system deficiencies, and time constraints. Conclusions: This systematic review underscores significant barriers to mHealth adoption among patients with stroke. Addressing these barriers in future research is imperative to ensure that mHealth solutions effectively meet patients' needs. ",
doi="10.2196/54511",
url="https://mhealth.jmir.org/2024/1/e54511"
}


@Article{info:doi/10.2196/54604,
author="Silvera-Tawil, David
and Cameron, Jan
and Li, Jane
and Varnfield, Marlien
and Allan, P. Liam
and Harris, Mitch
and Lannin, A. Natasha
and Redd, Christian
and Cadilhac, A. Dominique",
title="Multicomponent Support Program for Secondary Prevention of Stroke Using Digital Health Technology: Co-Design Study With People Living With Stroke or Transient Ischemic Attack",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="22",
volume="26",
pages="e54604",
keywords="mobile app",
keywords="stroke",
keywords="transient ischemic attack",
keywords="health service delivery",
keywords="mobile health",
keywords="mHealth",
keywords="mobile phone",
abstract="Background: Few individuals (<2\%) who experience a stroke or transient ischemic attack (TIA) participate in secondary prevention lifestyle programs. Novel approaches that leverage digital health technology may provide a viable alternative to traditional interventions that support secondary prevention in people living with stroke or TIA. To be successful, these strategies should focus on user needs and preferences and be acceptable to clinicians and people living with stroke or TIA. Objective: This study aims to co-design, with people with lived experience of stroke or TIA (referred to as consumers) and clinicians, a multicomponent digital technology support program for secondary prevention of stroke. Methods: A consumer user needs survey (108 items) was distributed through the Australian Stroke Clinical Registry and the Stroke Association of Victoria. An invitation to a user needs survey (135 items) for clinicians was circulated via web-based professional forums and national organizations (eg, the Stroke Telehealth Community of Practice Microsoft Teams Channel) and the authors' research networks using Twitter (subsequently rebranded X, X Corp) and LinkedIn (LinkedIn Corp). Following the surveys, 2 rounds of user experience workshops (design and usability testing workshops) were completed with representatives from each end user group (consumers and clinicians). Feedback gathered after each round informed the final design of the digital health program. Results: Overall, 112 consumers (male individuals: n=63, 56.3\%) and 54 clinicians (female individuals: n=43, 80\%) responded to the survey; all items were completed by 75.8\% (n=85) of consumers and 78\% (n=42) of clinicians. Most clinicians (46/49, 94\%) indicated the importance of monitoring health and lifestyle measures more frequently than current practice, particularly physical activity, weight, and sleep. Most consumers (87/96, 90\%) and clinicians (41/49, 84\%) agreed that providing alerts about potential deterioration in an individual's condition were important functions for a digital program. Intention to use a digital program for stroke prevention and discussing the data collected during face-to-face consultations was high (consumers: 79/99, 80\%; clinicians 36/42, 86\%). In addition, 7 consumers (male individuals: n=5, 71\%) and 9 clinicians (female individuals: n=6, 67\%) took part in the user experience workshops. Participants endorsed using a digital health program to help consumers manage stroke or TIA and discussed preferred functions and health measures in a digital solution for secondary prevention of stroke. They also noted the need for a mobile app that is easy to use. Clinician feedback highlighted the need for a customizable clinician portal that captures individual consumer goals. Conclusions: Following an iterative co-design process, supported by evidence from user needs surveys and user experience workshops, a consumer-facing app that integrates wearable activity trackers and a clinician web portal were designed and developed to support secondary prevention of stroke. Feasibility testing is currently in progress to assess acceptability and use. ",
doi="10.2196/54604",
url="https://www.jmir.org/2024/1/e54604",
url="http://www.ncbi.nlm.nih.gov/pubmed/39172512"
}


@Article{info:doi/10.2196/52196,
author="Castillo-Valdez, Fernando Pedro
and Rodriguez-Salvador, Marisela
and Ho, Yuh-Shan",
title="Scientific Production Dynamics in mHealth for Diabetes: Scientometric Analysis",
journal="JMIR Diabetes",
year="2024",
month="Aug",
day="22",
volume="9",
pages="e52196",
keywords="competitive technology intelligence",
keywords="diabetes",
keywords="digital health care",
keywords="mobile health",
keywords="mHealth",
keywords="scientometrics",
keywords="mobile phone",
abstract="Background: The widespread use of mobile technologies in health care (mobile health; mHealth) has facilitated disease management, especially for chronic illnesses such as diabetes. mHealth for diabetes is an attractive alternative to reduce costs and overcome geographical and temporal barriers to improve patients' conditions. Objective: This study aims to reveal the dynamics of scientific publications on mHealth for diabetes to gain insights into who are the most prominent authors, countries, institutions, and journals and what are the most cited documents and current hot spots. Methods: A scientometric analysis based on a competitive technology intelligence methodology was conducted. An innovative 8-step methodology supported by experts was executed considering scientific documents published between 1998 and 2021 in the Science Citation Index Expanded database. Publication language, publication output characteristics, journals, countries and institutions, authors, and most cited and most impactful articles were identified. Results: The insights obtained show that a total of 1574 scientific articles were published by 7922 authors from 90 countries, with an average of 15 (SD 38) citations and 6.5 (SD 4.4) authors per article. These documents were published in 491 journals and 92 Web of Science categories. The most productive country was the United States, followed by the United Kingdom, China, Australia, and South Korea, and the top 3 most productive institutions came from the United States, whereas the top 3 most cited articles were published in 2016, 2009, and 2017 and the top 3 most impactful articles were published in 2016 and 2017. Conclusions: This approach provides a comprehensive knowledge panorama of research productivity in mHealth for diabetes, identifying new insights and opportunities for research and development and innovation, including collaboration with other entities, new areas of specialization, and human resource development. The findings obtained are useful for decision-making in policy planning, resource allocation, and identification of research opportunities, benefiting researchers, health professionals, and decision makers in their efforts to make significant contributions to the advancement of diabetes science. ",
doi="10.2196/52196",
url="https://diabetes.jmir.org/2024/1/e52196",
url="http://www.ncbi.nlm.nih.gov/pubmed/39172508"
}


@Article{info:doi/10.2196/56960,
author="Rothman, Brian
and Slomkowski, Mary
and Speier, Austin
and Rush, John A.
and Trivedi, H. Madhukar
and Lawson, Erica
and Fahmy, Michael
and Carpenter, Daniel
and Chen, Dalei
and Forbes, Ainslie",
title="Evaluating the Efficacy of a Digital Therapeutic (CT-152) as an Adjunct to Antidepressant Treatment in Adults With Major Depressive Disorder: Protocol for the MIRAI Remote Study",
journal="JMIR Res Protoc",
year="2024",
month="Aug",
day="20",
volume="13",
pages="e56960",
keywords="adherence",
keywords="digital placebo",
keywords="sham control",
keywords="cognitive-emotional training",
keywords="Emotional Faces Memory Task",
keywords="mobile phone",
abstract="Background: Major depressive disorder (MDD) is common worldwide and can be highly disabling. People with MDD face many barriers to treatment and may not experience full symptom relief even when treated. Therefore, new treatment modalities are needed for MDD. Digital therapeutics (DTx) may provide people with MDD an additional treatment option. Objective: This study aimed to describe a phase 3 remote, multicenter, randomized, masked, sham-controlled trial evaluating the efficacy of a smartphone app--based DTx (CT-152) in adult participants diagnosed with MDD, used as an adjunct to antidepressant therapy (ADT). Methods: Participants aged 22-64 years with a current primary diagnosis of MDD and an inadequate response to ADT were included. Participants were randomized 1:1 to CT-152 or a sham DTx. CT-152 is a smartphone app--based DTx that delivers a cognitive-emotional and behavioral therapeutic intervention. The core components of CT-152 are the Emotional Faces Memory Task exercises, brief lessons to learn and apply key therapeutic skills, and SMS text messaging to reinforce lessons and encourage engagement with the app. The sham DTx is a digital working memory exercise with emotionally neutral stimuli designed to match CT-152 for time and attention. Participants took part in the trial for up to 13 weeks. The trial included a screening period of up to 3 weeks, a treatment period of 6 weeks, and an extension period of 4 weeks to assess the durability of the effect. Sites and participants had the option of an in-person or remote screening visit; the remaining trial visits were remote. Efficacy was evaluated using the Montgomery-{\AA}sberg Depression Rating Scale, the Generalized Anxiety Disorder-7, Clinical Global Impression--Severity scale, the Patient Health Questionnaire-9, and the World Health Organization Disability Assessment Schedule 2.0. The durability of the effect was evaluated with the Montgomery-{\AA}sberg Depression Rating Scale and Generalized Anxiety Disorder-7 scale. Adverse events were also assessed. Satisfaction, measured by the Participant and Healthcare Professional Satisfaction Scales, and health status, measured by the EQ-5D-5L, were summarized using descriptive statistics. Results: This study was initiated in February 2021 and had a primary completion date in October 2022. Conclusions: This represents the methodological design for the first evaluation of CT-152 as an adjunct to ADT. This study protocol is methodologically robust and incorporates many aspects of conventional pivotal pharmaceutical phase 3 trial design, such as randomization and safety end points. Novel considerations included the use of a sham comparator, masking considerations for visible app content, and outcome measures relevant to DTx. The rigor of this methodology will provide a more comprehensive understanding of the effectiveness of CT-152. Trial Registration: ClinicalTrials.gov NCT04770285; https://clinicaltrials.gov/study/NCT04770285 International Registered Report Identifier (IRRID): RR1-10.2196/56960 ",
doi="10.2196/56960",
url="https://www.researchprotocols.org/2024/1/e56960"
}


@Article{info:doi/10.2196/59358,
author="Shi, Lin-Hong Jenny
and Sit, Wing-Shan Regina",
title="Impact of 25 Years of Mobile Health Tools for Pain Management in Patients With Chronic Musculoskeletal Pain: Systematic Review",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="16",
volume="26",
pages="e59358",
keywords="mHealth",
keywords="mobile health",
keywords="mobile app",
keywords="chronic musculoskeletal pain",
keywords="pain management",
keywords="patient compliance",
keywords="adherence",
keywords="usability",
keywords="feasibility",
keywords="acceptability",
keywords="PRISMA",
abstract="Background: Mobile technologies are increasingly being used in health care and public health practice for patient communication, monitoring, and education. Mobile health (mHealth) tools have also been used to facilitate adherence to chronic musculoskeletal pain (CMP) management, which is critical to achieving improved pain outcomes, quality of life, and cost-effective health care. Objective: The aim of this systematic review was to evaluate the 25-year trend of the literature on the adherence, usability, feasibility, and acceptability of mHealth interventions in CMP management among patients and health care providers. Methods: We searched the PubMed, Cochrane CENTRAL, MEDLINE, EMBASE, and Web of Science databases for studies assessing the role of mHealth in CMP management from January 1999 to December 2023. Outcomes of interest included the effect of mHealth interventions on patient adherence; pain-specific clinical outcomes after the intervention; and the usability, feasibility, and acceptability of mHealth tools and platforms in chronic pain management among target end users. Results: A total of 89 articles (26,429 participants) were included in the systematic review. Mobile apps were the most commonly used mHealth tools (78/89, 88\%) among the included studies, followed by mobile app plus monitor (5/89, 6\%), mobile app plus wearable sensor (4/89, 4\%), and web-based mobile app plus monitor (1/89, 1\%). Usability, feasibility, and acceptability or patient preferences for mHealth interventions were assessed in 26\% (23/89) of the studies and observed to be generally high. Overall, 30\% (27/89) of the studies used a randomized controlled trial (RCT), cohort, or pilot design to assess the impact of the mHealth intervention on patients' adherence, with significant improvements (all P<.05) observed in 93\% (25/27) of these studies. Significant (judged at P<.05) between-group differences were reported in 27 of the 29 (93\%) RCTs that measured the effect of mHealth on CMP-specific clinical outcomes. Conclusions: There is great potential for mHealth tools to better facilitate adherence to CMP management, and the current evidence supporting their effectiveness is generally high. Further research should focus on the cost-effectiveness of mHealth interventions for better incorporating these tools into health care practices. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42024524634; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=524634 ",
doi="10.2196/59358",
url="https://www.jmir.org/2024/1/e59358"
}


@Article{info:doi/10.2196/53509,
author="Cheng, Yu-Shan
and Lin, Cheng-Pei
and Chen, Anny Lu-Yen
and Hwang, Wei-Ren
and Lin, Yi-Chun
and Chen, Yu-Chi",
title="Short-Term Effects of an eHealth Care Experiential Learning Program Among Patients With Type 2 Diabetes: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="16",
volume="26",
pages="e53509",
keywords="diabetes",
keywords="eHealth literacy",
keywords="eHealth",
keywords="patient engagement",
keywords="experiential learning theory",
keywords="experimental learning theory",
keywords="type 2 diabetes",
keywords="randomized controlled trial",
abstract="Background: Type 2 diabetes is a chronic disease with a significant medical burden. eHealth care integrates medicine and technology to enhance the outcomes of such patients; however, adequate eHealth literacy (eHL) is necessary for that to happen. Fostering eHL is crucial for patients with diabetes to engage with eHealth care and receive quality care and timely support. Experiential learning theory can enhance patients' eHL and skills to use eHealth care technology in their daily care. Objective: This study explored the effectiveness of an eHealth care experiential learning program in improving eHL, patient health engagement, and eHealth care use status among patients with type 2 diabetes in 3 months. Methods: In this randomized controlled trial, patients under case management services from various clinics in Taiwan were randomly assigned to either the intervention group receiving the 6-session eHealth care experiential learning program or the control group receiving the usual care. Data were collected using structured questionnaires at 3 time points: pretest, postintervention, and 3 months after the intervention. Descriptive data were presented using frequency distribution, percentage, mean, and SD. The outcomes were analyzed using a generalized estimating equation method by intention-to-treat analysis. Results: A total of 92 participants (46 in each group) were recruited in this study. Of these, 86 completed the course and follow-up evaluations with a mean age of 62.38 (SD 12.91) years. After completing the intervention, the intervention group had significantly higher posttest scores in eHL ($\beta$=19.94, SE 3.52; P<.001), patient health engagement ($\beta$=.28, SE 0.13; P=.04), and eHealth use ($\beta$=3.96, SE 0.42; P<.001) than the control group. Furthermore, the intervention group maintained these significant improvements in eHL ($\beta$=18.19, SE 3.82; P<.001) and eHealth use ($\beta$=3.87, SE 0.49; P<.001) after 3 months. Conclusions: Participating in the eHealth care experiential learning program resulted in significant improvements in eHL, patient health engagement, and eHealth use among patients with type 2 diabetes. Our interventional program can inform future clinical practice and policies to strengthen self-management skills and facilitate the use of health technology in caring for patients with chronic diseases. Trial Registration: ClinicalTrials.gov NCT05180604; https://clinicaltrials.gov/ct2/show/NCT05180604 ",
doi="10.2196/53509",
url="https://www.jmir.org/2024/1/e53509"
}


@Article{info:doi/10.2196/55625,
author="Armfield, Nigel
and Elphinston, Rachel
and Liimatainen, Jenna
and Scotti Requena, Simone
and Eather, Chloe-Emily
and Edirippulige, Sisira
and Ritchie, Carrie
and Robins, Sarah
and Sterling, Michele",
title="Development and Use of Mobile Messaging for Individuals With Musculoskeletal Pain Conditions: Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Aug",
day="14",
volume="12",
pages="e55625",
keywords="musculoskeletal",
keywords="pain",
keywords="SMS text messaging",
keywords="mobile health",
keywords="mHealth",
keywords="intervention design",
keywords="design",
keywords="scoping review",
keywords="musculoskeletal pain",
keywords="development",
keywords="mobile messaging",
keywords="behavior change",
keywords="efficacy",
keywords="effectiveness",
keywords="messaging",
keywords="implementation",
keywords="sustainability",
keywords="mobile phone",
abstract="Background: Population studies show that musculoskeletal conditions are a leading contributor to the total burden of healthy life lost, second only to cancer and with a similar burden to cardiovascular disease. Prioritizing the delivery of effective treatments is necessary, and with the ubiquity of consumer smart devices, the use of digital health interventions is increasing. Messaging is popular and easy to use and has been studied for a range of health-related uses, including health promotion, encouragement of behavior change, and monitoring of disease progression. It may have a useful role to play in the management and self-management of musculoskeletal conditions. Objective: Previous reviews on the use of messaging for people with musculoskeletal conditions have focused on synthesizing evidence of effectiveness from randomized controlled trials. In this review, our objective was to map the musculoskeletal messaging literature more broadly to identify information that may inform the design of future messaging interventions and summarize the current evidence of efficacy, effectiveness, and economics. Methods: Following a prepublished protocol developed using the Joanna Briggs Institute Manual for Evidence Synthesis, we conducted a comprehensive scoping review of the literature (2010-2022; sources: PubMed, CINAHL, Embase, and PsycINFO) related to SMS text messaging and app-based messaging for people with musculoskeletal conditions. We described our findings using tables, plots, and a narrative summary. Results: We identified a total of 8328 papers for screening, of which 50 (0.6\%) were included in this review (3/50, 6\% previous reviews and 47/50, 94\% papers describing 40 primary studies). Rheumatic diseases accounted for the largest proportion of the included primary studies (19/40, 48\%), followed by studies on multiple musculoskeletal conditions or pain sites (10/40, 25\%), back pain (9/40, 23\%), neck pain (1/40, 3\%), and ``other'' (1/40, 3\%). Most studies (33/40, 83\%) described interventions intended to promote positive behavior change, typically by encouraging increased physical activity and exercise. The studies evaluated a range of outcomes, including pain, function, quality of life, and medication adherence. Overall, the results either favored messaging interventions or had equivocal outcomes. While the theoretical underpinnings of the interventions were generally well described, only 4\% (2/47) of the papers provided comprehensive descriptions of the messaging intervention design and development process. We found no relevant economic evaluations. Conclusions: Messaging has been used for the care and self-management of a range of musculoskeletal conditions with generally favorable outcomes reported. However, with few exceptions, design considerations are poorly described in the literature. Further work is needed to understand and disseminate information about messaging content and message delivery characteristics, such as timing and frequency specifically for people with musculoskeletal conditions. Similarly, further work is needed to understand the economic effects of messaging and practical considerations related to implementation and sustainability. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-048964 ",
doi="10.2196/55625",
url="https://mhealth.jmir.org/2024/1/e55625"
}


@Article{info:doi/10.2196/53909,
author="Zhou, Peng
and Li, Hui
and Pang, Xueying
and Wang, Ting
and Wang, Yan
and He, Hongye
and Zhuang, Dongmei
and Zhu, Furong
and Zhu, Rui
and Hu, Shaohua",
title="Effect of a Mobile Health--Based Remote Interaction Management Intervention on the Quality of Life and Self-Management Behavior of Patients With Low Anterior Resection Syndrome: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="13",
volume="26",
pages="e53909",
keywords="mHealth",
keywords="low anterior resection syndrome",
keywords="quality of life",
keywords="sphincter-preserving surgery",
keywords="randomized controlled trial",
keywords="mobile health",
keywords="mobile phone",
abstract="Background: People who undergo sphincter-preserving surgery have high rates of anorectal functional disturbances, known as low anterior resection syndrome (LARS). LARS negatively affects patients' quality of life (QoL) and increases their need for self-management behaviors. Therefore, approaches to enhance self-management behavior and QoL are vital. Objective: This study aims to assess the effectiveness of a remote digital management intervention designed to enhance the QoL and self-management behavior of patients with LARS. Methods: From July 2022 to May 2023, we conducted a single-blinded randomized controlled trial and recruited 120 patients with LARS in a tertiary hospital in Hefei, China. All patients were randomly assigned to the intervention group (using the ``e-bowel safety'' applet and monthly motivational interviewing) or the control group (usual care and an information booklet). Our team provided a 3-month intervention and followed up with all patients for an additional 3 months. The primary outcome was patient QoL measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30. The secondary outcomes were evaluated using the Bowel Symptoms Self-Management Behaviors Questionnaire, LARS score, and Perceived Social Support Scale. Data collection occurred at study enrollment, the end of the 3-month intervention, and the 3-month follow-up. Generalized estimating equations were used to analyze changes in all outcome variables. Results: In the end, 111 patients completed the study. In the intervention group, 5 patients withdrew; 4 patients withdrew in the control group. Patients in the intervention group had significantly larger improvements in the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 total score (mean difference 11.51; 95\% CI 10.68-12.35; Cohen d=1.73) and Bowel Symptoms Self-Management Behaviors Questionnaire total score (mean difference 8.80; 95\% CI 8.28-9.32; Cohen d=1.94) than those in the control group. This improvement effect remained stable at 3-month follow-up (mean difference 14.47; 95\% CI 13.65-15.30; Cohen d=1.58 and mean difference 8.85; 95\% CI 8.25-9.42; Cohen d=2.23). The LARS score total score had significantly larger decreases after intervention (mean difference --3.28; 95\% CI --4.03 to --2.54; Cohen d=--0.39) and at 3-month follow-up (mean difference --6.69; 95\% CI --7.45 to --5.93; Cohen d=--0.69). The Perceived Social Support Scale total score had significantly larger improvements after intervention (mean difference 0.47; 95\% CI 0.22-0.71; Cohen d=1.81). Conclusions: Our preliminary findings suggest that the mobile health--based remote interaction management intervention significantly enhanced the self-management behaviors and QoL of patients with LARS, and the effect was sustained. Mobile health--based remote interventions become an effective method to improve health outcomes for many patients with LARS. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200061317; https://tinyurl.com/tmmvpq3 ",
doi="10.2196/53909",
url="https://www.jmir.org/2024/1/e53909"
}


@Article{info:doi/10.2196/53355,
author="Chen, Tingting
and Zhao, Wenbo
and Pei, Qianqian
and Chen, Yanru
and Yin, Jinmei
and Zhang, Min
and Wang, Cheng
and Zheng, Jing",
title="Efficacy of a Web-Based Home Blood Pressure Monitoring Program in Improving Predialysis Blood Pressure Control Among Patients Undergoing Hemodialysis: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Aug",
day="9",
volume="12",
pages="e53355",
keywords="hemodialysis",
keywords="hypertension",
keywords="home blood pressure monitoring",
keywords="eHealth",
keywords="randomized controlled trial",
abstract="Background: Hypertension is highly prevalent among patients undergoing hemodialysis, with a significant proportion experiencing poorly controlled blood pressure (BP). Digital BP management in this population has been underused. Objective: This study aimed to explore the efficacy of a web-based home BP monitoring (HBPM) program in improving predialysis BP control and enhancing knowledge, perception, and adherence to HBPM among patients with hypertension undergoing hemodialysis. Methods: A multicenter, open-label, randomized controlled trial was conducted at 2 hemodialysis units. Patients were randomly allocated in a 1:1 ratio to either the web-based HBPM program as the intervention group or to usual care as the control group over a 6-month period. The primary outcomes were the predialysis BP control rate, defined as less than 140/90 mm Hg, and the predialysis systolic and diastolic BP, assessed from baseline to the 6-month follow-up. Secondary outcomes included patient knowledge, perception, and adherence to HBPM, evaluated using the HBPM Knowledge Questionnaire, HBPM Perception Scale, and HBPM Adherence Scale, respectively. A generalized estimating equations analysis was used to analyze the primary outcomes in the intention-to-treat analysis. Results: Of the 165 patients enrolled in the program (n=84, 50.9\% in the web-based HBPM group and n=81, 49.1\% in the control group), 145 (87.9\%) completed the follow-up assessment. During the follow-up period, 11 instances of hypotension occurred in 9 patients in the web-based HBPM group, compared to 15 instances in 14 patients in the control group. The predialysis BP control rate increased from 30\% (25/84) to 48\% (40/84) in the web-based HBPM group after the 6-month intervention, whereas in the control group, it decreased from 37\% (30/81) to 25\% (20/81; $\chi$22=16.82, P<.001; odds ratio 5.11, 95\% CI 2.14-12.23, P<.001). The web-based HBPM group demonstrated a significant reduction after the 6-month intervention in the predialysis systolic BP (t163=2.46, P=.02; $\beta$=?6.09, 95 \% CI ?10.94 to ?1.24, P=.01) and the predialysis diastolic BP (t163=3.20, P=.002; $\beta$=?4.93, 95\% CI ?7.93 to ?1.93, P=.001). Scores on the HBPM Knowledge Questionnaire (t163=?9.18, P<.001), HBPM Perception Scale (t163=?10.65, P<.001), and HBPM Adherence Scale (t163=?8.04, P<.001) were significantly higher after 6 months of intervention. Conclusions: The implementation of a web-based HBPM program can enhance predialysis BP control and the knowledge, perception, and adherence to HBPM among patients undergoing hemodialysis. This web-based HBPM program should be promoted in appropriate clinical settings. Trial Registration: China Clinical Trial Registration Center ChiCTR2100051535; https://www.chictr.org.cn/showproj.html?proj=133286 ",
doi="10.2196/53355",
url="https://mhealth.jmir.org/2024/1/e53355"
}


@Article{info:doi/10.2196/54762,
author="Otten, Marina
and Djamei, Vahid
and Augustin, Matthias",
title="Development, Feasibility, and Acceptability of the Electronic Patient Benefit Index for Psoriasis in Clinical Practice: Mixed Methods Study",
journal="JMIR Dermatol",
year="2024",
month="Aug",
day="9",
volume="7",
pages="e54762",
keywords="patient-reported outcomes",
keywords="Patient Benefit Index",
keywords="dermatology",
keywords="psoriasis",
keywords="feasibility",
keywords="acceptability",
keywords="eHealth",
keywords="digital health",
keywords="dermatologist",
keywords="dermatologists",
keywords="skin",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="application",
keywords="applications",
keywords="digital technology",
keywords="digital intervention",
keywords="digital interventions",
keywords="smartphone",
keywords="smartphones",
keywords="mobile phone",
abstract="Background: Patient-reported outcomes are relevant in clinical practice showing patient benefits, supporting clinicians' decision-making, and contributing to the delivery of high standards of care. Digital monitoring of patient-reported outcomes is still rare. The Patient Benefit Index (PBI) measures benefits and goals from patients' views and may be relevant for regular documentation and shared decision-making. Objective: This study aimed to develop electronic versions of the PBI to examine their feasibility and acceptability in clinical practice for patients with psoriasis. Methods: We developed an app and a web version of the existing, valid PBI using focus groups and cognitive debriefings with patients before conducting a quantitative survey on its feasibility and acceptability. Conduction took part in an outpatient dermatology care unit in Germany. Descriptive and subgroup analyses were conducted. Results: A total of 139 patients completed the electronic PBIs (ePBIs) and took part in the survey. The ePBI was understandable (n=129-137, 92.8\%-98.6\%) and feasible, for example, easy to read (n=135, 97.1\%) and simple to handle (n=137, 98.5\%). Acceptability was also high, for example, patients can imagine using and discussing the ePBI data in practice (n=91, 65.5\%) and documenting it regularly (n=88, 63.3\%). They believe it could support treatment decisions (n=118, 84.9\%) and improve communication with their physician (n=112, 81.3\%). They can imagine filling in electronic questionnaires regularly (n=118, 84.9\%), even preferring electronic over paper versions (n=113, 81.2\%). Older and less educated people show less feasibility, but the latter expected the relationship with their physician to improve and would be more willing to invest time or effort. Conclusions: The app and web version of the PBI are usable and acceptable for patients offering comprehensive documentation and patient participation in practice. An implementation strategy should consider patients' needs, barriers, and facilitators but also physicians' attitudes and requirements from the health care system. ",
doi="10.2196/54762",
url="https://derma.jmir.org/2024/1/e54762"
}


@Article{info:doi/10.2196/51872,
author="Vesinurm, M{\"a}rt
and Maunula, Anna
and Olli, P{\"a}ivi
and Lillrank, Paul
and Ij{\"a}s, Petra
and Torkki, Paulus
and M{\"a}kitie, Laura
and Laakso, M. Sini",
title="Effects of a Digital Care Pathway for Multiple Sclerosis: Observational Study",
journal="JMIR Hum Factors",
year="2024",
month="Aug",
day="7",
volume="11",
pages="e51872",
keywords="digital care pathway",
keywords="multiple sclerosis",
keywords="patient satisfaction",
keywords="outcome",
keywords="patient reported outcome measures",
keywords="resource usage",
keywords="telemedicine",
keywords="digital care",
keywords="outpatient clinic",
keywords="quality of life",
keywords="quality of care",
keywords="communication",
keywords="caregiver",
keywords="chronic condition",
keywords="strategy",
keywords="long-term",
keywords="patient engagement",
keywords="digital health service",
abstract="Background: Helsinki University Hospital has developed a digital care pathway (DCP) for people with multiple sclerosis (MS) to improve the care quality. DCP was designed for especially newly diagnosed patients to support adaptation to a chronic disease. Objective: This study investigated the MS DCP user behavior and its impact on patient education-mediated changes in health care use, patient-perceived impact of MS on psychological and physical functional health, and patient satisfaction. Methods: We collected data from the service launch in March 2020 until the end of 2022 (observation period). The number of users, user logins, and their timing and messages sent were collected. The association of the DCP on health care use was studied in a case-control setting in which patients were allowed to freely select whether they wanted to use the service (DCP group n=63) or not (control group n=112). The number of physical and remote appointments either to a doctor, nurse, or other services were considered in addition to emergency department visits and inpatient days. The follow-up time was 1 year (study period). Furthermore, a subgroup of 36 patients was recruited to fill out surveys on net promoter score (NPS) at 3, 6, and 12 months, and their physical and psychological functional health (Multiple Sclerosis Impact Scale) at 0, 3, 6, and 12 months. Results: During the observation period, a total of 225 patients had the option to use the service, out of whom 79.1\% (178/225) logged into the service. On average, a user of the DCP sent 6.8 messages and logged on 7.4 times, with 72.29\% (1182/1635) of logins taking place within 1 year of initiating the service. In case-control cohorts, no statistically significant differences between the groups were found for physical doctors' appointments, remote doctors' contacts, physical nurse appointments, remote nurse contacts, emergency department visits, or inpatient days. However, the MS DCP was associated with a 2.05 (SD 0.48) visit increase in other services, within 1 year from diagnosis. In the prospective DCP-cohort, no clinically significant change was observed in the physical functional health between the 0 and 12-month marks, but psychological functional health was improved between 3 and 6 months. Patient satisfaction improved from the NPS index of 21 (favorable) at the 3-month mark to the NPS index of 63 (excellent) at the 12-month mark. Conclusions: The MS DCP has been used by a majority of the people with MS as a complementary service to regular operations, and we find high satisfaction with the service. Psychological health was enhanced during the use of MS DCP. Our results indicate that DCPs hold great promise for managing chronic conditions such as MS. Future studies should explore the potential of DCPs in different health care settings and patient subgroups. ",
doi="10.2196/51872",
url="https://humanfactors.jmir.org/2024/1/e51872"
}


@Article{info:doi/10.2196/52973,
author="Kashyap, Nick
and Sebastian, Tresa Ann
and Lynch, Chris
and Jansons, Paul
and Maddison, Ralph
and Dingler, Tilman
and Oldenburg, Brian",
title="Engagement With Conversational Agent--Enabled Interventions in Cardiometabolic Disease Management: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2024",
month="Aug",
day="7",
volume="13",
pages="e52973",
keywords="cardiometabolic disease",
keywords="cardiovascular disease",
keywords="diabetes",
keywords="chronic disease",
keywords="chatbot",
keywords="acceptability",
keywords="technology acceptance model",
keywords="design",
keywords="natural language processing",
keywords="adult",
keywords="heart failure",
keywords="digital health intervention",
keywords="Australia",
keywords="systematic review",
keywords="meta-analysis",
keywords="digital health",
keywords="conversational agent--enabled",
keywords="health informatics",
keywords="management",
abstract="Background: Cardiometabolic diseases (CMDs) are a group of interrelated conditions, including heart failure and diabetes, that increase the risk of cardiovascular and metabolic complications. The rising number of Australians with CMDs has necessitated new strategies for those managing these conditions, such as digital health interventions. The effectiveness of digital health interventions in supporting people with CMDs is dependent on the extent to which users engage with the tools. Augmenting digital health interventions with conversational agents, technologies that interact with people using natural language, may enhance engagement because of their human-like attributes. To date, no systematic review has compiled evidence on how design features influence the engagement of conversational agent--enabled interventions supporting people with CMDs. This review seeks to address this gap, thereby guiding developers in creating more engaging and effective tools for CMD management. Objective: The aim of this systematic review is to synthesize evidence pertaining to conversational agent--enabled intervention design features and their impacts on the engagement of people managing CMD. Methods: The review is conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and reported in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Searches will be conducted in the Ovid (Medline), Web of Science, and Scopus databases, which will be run again prior to manuscript submission. Inclusion criteria will consist of primary research studies reporting on conversational agent--enabled interventions, including measures of engagement, in adults with CMD. Data extraction will seek to capture the perspectives of people with CMD on the use of conversational agent--enabled interventions. Joanna Briggs Institute critical appraisal tools will be used to evaluate the overall quality of evidence collected. Results: This review was initiated in May 2023 and was registered with the International Prospective Register of Systematic Reviews (PROSPERO) in June 2023, prior to title and abstract screening. Full-text screening of articles was completed in July 2023 and data extraction began August 2023. Final searches were conducted in April 2024 prior to finalizing the review and the manuscript was submitted for peer review in July 2024. Conclusions: This review will synthesize diverse observations pertaining to conversational agent--enabled intervention design features and their impacts on engagement among people with CMDs. These observations can be used to guide the development of more engaging conversational agent--enabled interventions, thereby increasing the likelihood of regular intervention use and improved CMD health outcomes. Additionally, this review will identify gaps in the literature in terms of how engagement is reported, thereby highlighting areas for future exploration and supporting researchers in advancing the understanding of conversational agent--enabled interventions. Trial Registration: PROSPERO CRD42023431579; https://tinyurl.com/55cxkm26 International Registered Report Identifier (IRRID): DERR1-10.2196/52973 ",
doi="10.2196/52973",
url="https://www.researchprotocols.org/2024/1/e52973",
url="http://www.ncbi.nlm.nih.gov/pubmed/39110504"
}


@Article{info:doi/10.2196/55650,
author="Idalski Carcone, April
and Holtz, E. Bree
and Reardon, Madeleine
and Vesey, Dariane
and Ellis, A. Deborah
and Parks, Michael",
title="Meeting the Needs of Emerging Adults With Type 1 Diabetes Living in a Rural Area With Mobile Health Interventions: Focus Group Study",
journal="JMIR Form Res",
year="2024",
month="Aug",
day="7",
volume="8",
pages="e55650",
keywords="emerging adults",
keywords="type 1 diabetes",
keywords="intervention",
keywords="qualitative",
keywords="mHealth",
keywords="mobile phone",
keywords="smartphone",
abstract="Background: Emerging adults (EAs; age 18-30 years) with type 1 diabetes (T1D) have more challenges with diabetes management and glycemic control than other age groups. Living in a rural community introduces additional unique diabetes care challenges due to limited access to specialty care and ancillary support services. Yet, few interventions have been developed to improve diabetes management in rural-dwelling EAs with T1D. Objective: This study aimed to understand the diabetes management experiences of older adolescents and EAs (age 16-25 years) with T1D living in a rural area and to assess their perceptions of the acceptability of 4 fully automated mobile health (mHealth) interventions to support diabetes management. Methods: EAs were identified by clinical staff through convenience sampling. In total, 8 EAs participated in 1 focus group and 1 EA completed an individual interview; all data were collected over Zoom. Facilitators explored EAs' experiences living in a rural community with T1D and discussed EAs' impressions of, feedback on, and recommendations for improving 4 mHealth interventions to meet the specific needs of EAs with T1D living in rural communities. Discussions were transcribed and analyzed using conventional content analysis. Results: In total, 9 EAs (aged 18.8, SD 2.7 years; 5, 56\% men; 8, 89\% White) with a duration of diabetes of 8.6 (SD 4.3) years participated. They described experiences with diabetes stigma (attributing diabetes to poor lifestyle choices) and feelings of self-consciousness (hyperawareness) in their rural communities. They attributed these experiences to the small size of their communities (``everyone knows'') and community members' lack of knowledge about diabetes (unable to differentiate between type 1 and type 2 diabetes). In contrast, EAs reported high levels of social support for diabetes and diabetes care from family, friends, and other community members, but low support for medical needs. The location of their diabetes care providers and the limited accessibility of diabetes-specific and general medical care services in their local community created a challenging medical care context. Overall, EAs found mHealth interventions appealing due to their digital delivery and highlighted features that increased accessibility (voiceovers and simple, jargon-free language), individualization (ability to tailor intervention content and delivery), and applicability to their own lives and other EAs with T1D (relatability of vignettes and other content). EAs suggestions for improving the interventions included more opportunities to tailor the interventions to their preferences (greater frequency and duration, ability to adapt content to emerging needs), increasing opportunities for peer support within the interventions (friend and significant other as identified support person, connecting with peers beyond their local community), and making the tone of intervention components more casual and engaging. Conclusions: mHealth interventions aligned with EAs' needs and preferences are a promising strategy to support EAs in communities where social support and resources might be limited. Trial Registration: N/A, not a clinical trial ",
doi="10.2196/55650",
url="https://formative.jmir.org/2024/1/e55650",
url="http://www.ncbi.nlm.nih.gov/pubmed/39110496"
}


@Article{info:doi/10.2196/55123,
author="Keikhosrokiani, Pantea
and Polus, Manria
and Guardado Medina, Sharon
and Isomursu, Minna",
title="The Effectiveness of Medical Adherence Mobile Health Solutions for Individuals With Epilepsy: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2024",
month="Aug",
day="6",
volume="13",
pages="e55123",
keywords="digital care pathway",
keywords="epilepsy",
keywords="mHealth",
keywords="mobile health",
keywords="effectiveness",
keywords="systematic review",
keywords="management",
keywords="medical adherence",
keywords="patient outcomes",
keywords="digital health",
keywords="design",
keywords="eHealth solutions",
keywords="health care professionals",
abstract="Background: Epilepsy requires continuous management and treatment to optimize patient outcomes. The advancement of digital health has led to the development of various mobile health (mHealth) tools designed to enhance treatment adherence among individuals with epilepsy. These solutions offer crucial support through features such as reminders, educational resources, personalized feedback, assistance with managing costs, shared decision-making, and access to supportive communities. To design effective medication adherence mHealth solutions, it is essential to evaluate the effectiveness of existing mHealth tools, understand the unique circumstances of different patients, and identify the roles of health care professionals within the digital care pathway. Existing studies on epilepsy primarily focus on self-management, whereas the effectiveness and usability of medical adherence mHealth solutions often remain overlooked. Furthermore, the involvement of health care professionals in digital care pathways for epilepsy as well as the impact of adherence mHealth solutions on the patient experience have not been adequately explored. Objective: This study aims to assess the effectiveness of current mHealth solutions designed to improve medical adherence among patients with epilepsy. Furthermore, the study will examine the experiences of patients using mHealth solutions for maintaining medical adherence in epilepsy care. Finally, this review intends to determine the roles of health care professionals within mHealth systems aimed at supporting adherence to medication among patients with epilepsy. Methods: A systematic literature review has been selected as the appropriate method to address the research questions, adhering to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The inclusion and exclusion criteria have been carefully selected, and both qualitative and quantitative analyses will be used to analyze the results. The expected results will mainly focus on the comparison, classification, and analysis of the effectiveness of current medical adherence mHealth tools. Moreover, the patient experiences using available medical adherence mHealth tools for epilepsy will be assessed. Finally, the role of health care professionals in the epilepsy digital care pathway will be explored, with emphasis on medical adherence. Results: The initial search, full-text screening, and data extraction have been carried out. Thirty-three papers were included in the final stage of the review. The study is expected to be completed by October 2024. Conclusions: To enhance the digital care pathway for epilepsy, a medical adherence mHealth solution should be personalized, manage medications, include an alarm system, track seizures, support consultations, and offer updated treatment plans. This study aims to understand how findings from the research questions can improve mHealth solutions for individuals with epilepsy. Insights from this research on the effectiveness of current mHealth adherence solutions will provide guidance for developing future mHealth systems, making them more efficient and effective in managing epilepsy. Trial Registration: PROSPERO CRD4202347400; https://tinyurl.com/48mfx22e International Registered Report Identifier (IRRID): DERR1-10.2196/55123 ",
doi="10.2196/55123",
url="https://www.researchprotocols.org/2024/1/e55123"
}


@Article{info:doi/10.2196/54942,
author="Oppelaar, C. Martinus
and Emond, Yvette
and Bannier, E. Michiel A. G.
and Reijers, E. Monique H.
and van der Vaart, Hester
and van der Meer, Renske
and Altenburg, Josje
and Conemans, Lennart
and Rottier, L. Bart
and Nuijsink, Marianne
and van den Wijngaart, S. Lara
and Merkus, M. Peter J. F.
and Heinen, Maud
and Roukema, Jolt",
title="Potential, Pitfalls, and Future Directions for Remote Monitoring of Chronic Respiratory Diseases: Multicenter Mixed Methods Study in Routine Cystic Fibrosis Care",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="6",
volume="26",
pages="e54942",
keywords="telemonitoring",
keywords="digital health",
keywords="chronic respiratory diseases",
keywords="telespirometry",
keywords="interviews",
keywords="mixed methods",
keywords="qualitative study",
keywords="remote monitoring",
keywords="evaluation",
keywords="cystic fibrosis",
keywords="pediatrics",
keywords="mixed method",
keywords="observational study",
keywords="health care professionals",
keywords="semistructured interview",
keywords="psychosocial",
keywords="clinicians",
keywords="researchers",
keywords="policy makers",
keywords="telehealth",
abstract="Background: The current literature inadequately addresses the extent to which remote monitoring should be integrated into care models for chronic respiratory diseases (CRDs). Objective: This study examined a remote monitoring program (RMP) in cystic fibrosis (CF) by exploring experiences, future perspectives, and use behavior over 3 years, with the aim of developing future directions for remote monitoring in CRDs. Methods: This was a mixed methods, multicenter, observational study in 5 Dutch CF centers following a sequential explanatory design. Self-designed questionnaires using the technology acceptance model were sent out to people with CF who had a minimum of 12 months of experience with the RMP and local health care professionals (HCPs). Questionnaire outcomes were used to inform semistructured interviews with HCPs and people with CF. Qualitative findings were reported following the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist. Anonymous data on use frequency of all people with CF were analyzed. Results: Between the second quarter of 2020 and the end of 2022, a total of 608 people with CF were enrolled in the program, and a total of 9418 lung function tests and 2631 symptom surveys were conducted. In total, 65\% (24/37) of HCPs and 89\% (72/81) of people with CF responded to the questionnaire, and 7 HCPs and 12 people with CF participated in semistructured interviews. Both people with CF and HCPs were positive about remote monitoring in CF care and found the RMP a good addition to daily care (people with CF: 44/72, 61\%; HCPs: 21/24, 88\%). Benefits ranged from supporting individual patients to reducing health care consumption. The most valued monitoring tool was home spirometry by both people with CF (66/72, 92\%) and HCPs (22/24, 92\%). Downsides included the potential to lose sight of patients and negative psychosocial effects, as 17\% (12/72) of people with CF experienced some form of stress due to the RMP. A large majority of people with CF (59/72, 82\%) and HCPs (22/24, 92\%) wanted to keep using the RMP in future, with 79\% (19/24) of HCPs and 75\% (54/72) of people with CF looking forward to more replacement of in-person care with digital care during periods of well-being. Future perspectives for the RMP were centered on creating hybrid care models, personalizing remote care, and balancing individual benefits with monitoring burden. Conclusions: Remote monitoring has considerable potential in supporting people with CF and HCPs within the CF care model. We identified 4 practice-based future directions for remote monitoring in CF and CRD care. The strategies, ranging from patient driven to prediction driven, can help clinicians, researchers, and policy makers navigate the rapidly changing digital health field, integrate remote monitoring into local care models, and align remote care with patient and clinician needs. ",
doi="10.2196/54942",
url="https://www.jmir.org/2024/1/e54942",
url="http://www.ncbi.nlm.nih.gov/pubmed/39106098"
}


@Article{info:doi/10.2196/46220,
author="Lonati, Caterina
and Wellhausen, Marie
and Pennig, Stefan
and R{\"o}hr{\ss}en, Thomas
and Kircelli, Fatih
and Arendt, Svenja
and Tschulena, Ulrich",
title="The Use of a Novel Virtual Reality Training Tool for Peritoneal Dialysis: Qualitative Assessment Among Health Care Professionals",
journal="JMIR Med Educ",
year="2024",
month="Aug",
day="6",
volume="10",
pages="e46220",
keywords="peritoneal dialysis",
keywords="virtual reality",
keywords="patient education",
keywords="patient training",
keywords="chronic kidney disease",
keywords="nursing",
keywords="qualitative assessment",
abstract="Background: Effective peritoneal dialysis (PD) training is essential for performing dialysis at home and reducing the risk of peritonitis and other PD-related infections. Virtual reality (VR) is an innovative learning tool that is able to combine theoretical information, interactivity, and behavioral instructions while offering a playful learning environment. To improve patient training for PD, Fresenius Medical Care launched the stay{\textbullet}safe MyTraining VR, a novel educational program based on the use of a VR headset and a handheld controller. Objective: This qualitative assessment aims to investigate opinions toward the new tool among the health care professionals (HCPs) who were responsible for implementing the VR application. Methods: We recruited nursing staff and nephrologists who have gained practical experience with the stay{\textbullet}safe MyTraining VR within pilot dialysis centers. Predetermined open-ended questions were administered during individual and group video interviews. Results: We interviewed 7 HCPs who have 2 to 20 years of experience in PD training. The number of patients trained with the stay{\textbullet}safe MyTraining VR ranged from 2 to 5 for each professional. The stay{\textbullet}safe MyTraining VR was well accepted and perceived as a valuable supplementary tool for PD training. From the respondents' perspective, the technology improved patients' learning experience by facilitating the internalization of both medical information and procedural skills. HCPs highlighted that the opportunity offered by VR to reiterate training activities in a positive and safe learning environment, according to each patient's needs, can facilitate error correction and implement a standardized training curriculum. However, VR had limited use in the final phase of the patient PD training program, where learners need to get familiar with the handling of the materials. Moreover, the traditional PD training was still considered essential to manage the emotional and motivational aspects and address any patient-specific application-oriented questions. In addition to its use within PD training, VR was perceived as a useful tool to support the decision-making process of patients and train other HCPs. Moreover, VR introduction was associated with increased efficiency and productivity of HCPs because it enabled them to perform other activities while the patient was practicing with the device. As for patients' acceptance of the new tool, interviewees reported positive feedback, including that of older adults. Limited use with patients experiencing dementia or severe visual impairment or lacking sensomotoric competence was mentioned. Conclusions: The stay{\textbullet}safe MyTraining VR is suggested to improve training efficiency and efficacy and thus could have a positive impact in the PD training scenario. Our study offers a process proposal that can serve as a guide to the implementation of a VR-based PD training program within other dialysis centers. Dedicated research is needed to assess the operational benefits and the consequences on patient management. ",
doi="10.2196/46220",
url="https://mededu.jmir.org/2024/1/e46220",
url="http://www.ncbi.nlm.nih.gov/pubmed/39106093"
}


@Article{info:doi/10.2196/54876,
author="Xiang, Xiao-Na
and Wang, Ze-Zhang
and Hu, Jing
and Zhang, Jiang-Yin
and Li, Ke
and Chen, Qi-Xu
and Xu, Fa-Shu
and Zhang, Yue-Wen
and He, Hong-Chen
and He, Cheng-Qi
and Zhu, Si-Yi",
title="Telehealth-Supported Exercise or Physical Activity Programs for Knee Osteoarthritis: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="2",
volume="26",
pages="e54876",
keywords="telehealth",
keywords="knee osteoarthritis",
keywords="physical activities",
keywords="quality of life",
keywords="systematic review and meta-analysis",
keywords="systematic review",
keywords="meta-analysis",
keywords="knee",
keywords="physical activity",
keywords="exercise",
keywords="chronic disease",
keywords="chronic disease management",
keywords="effectiveness",
keywords="physical function",
keywords="self-efficacy",
abstract="Background: The integration of telehealth-supported programs in chronic disease management has become increasingly common. However, its effectiveness for individuals with knee osteoarthritis (KOA) remains unclear. Objective: This study aimed to assess the effectiveness of telehealth-supported exercise or physical activity programs for individuals with KOA. Methods: A comprehensive literature search encompassing Embase, MEDLINE, CENTRAL, Web of Science, PubMed, Scopus, PEDro, GreyNet, and medRxiv from inception to September 2023 was conducted to identify randomized controlled trials comparing telehealth-supported exercise or physical activity programs to a control condition for KOA. Data were extracted and qualitatively synthesized across eligible studies, and a meta-analysis was performed to evaluate the effects. The study was reported according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020. Results: In total, 23 studies met eligibility criteria, with 20 included in the meta-analysis. Results showed that telehealth-supported exercise or physical activity programs reduced pain (g=--0.39; 95\% CI --0.67 to --0.11; P<.001), improved physical activity (g=0.13; 95\% CI 0.03-0.23; P=.01), and enhanced physical function (g=--0.51; 95\% CI --0.98 to --0.05; P=.03). Moreover, significant improvements in quality of life (g=0.25; 95\% CI 0.14-0.36; P<.001), self-efficacy for pain (g=0.72; 95\% CI 0.53-0.91; P<.001), and global improvement (odds ratio 2.69, 95\% CI 1.41-5.15; P<.001) were observed. However, self-efficacy for physical function (g=0.14; 95\% CI --0.26 to 0.53; P=.50) showed insignificant improvements. Subgroup analyses based on the World Health Organization classification of digital health (pain: $\chi$22=6.5; P=.04 and physical function: $\chi$22=6.4; P=.04), the type of teletechnology in the intervention group (pain: $\chi$24=4.8; P=.31 and function: $\chi$24=13.0; P=.01), and active or inactive controls (pain: $\chi$21=5.3; P=.02 and physical function: $\chi$21=3.4; P=.07) showed significant subgroup differences. Conclusions: Telehealth-supported exercise or physical activity programs might reduce knee pain and improve physical activity, physical function, quality of life, self-efficacy, and global improvement in individuals with KOA. Future research should consider longer implementation durations and assess the feasibility of incorporating wearables and standardized components into large-scale interventions to evaluate the effects. Trial Registration: PROSPERO CRD42022359658; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=359658 ",
doi="10.2196/54876",
url="https://www.jmir.org/2024/1/e54876"
}


@Article{info:doi/10.2196/50849,
author="den Braber, Niala
and Braem, R. Carlijn I.
and Vollenbroek-Hutten, R. Miriam M.
and Hermens, J. Hermie
and Urgert, Thomas
and Yavuz, S. Utku
and Veltink, H. Peter
and Laverman, D. Gozewijn",
title="Consequences of Data Loss on Clinical Decision-Making in Continuous Glucose Monitoring: Retrospective Cohort Study",
journal="Interact J Med Res",
year="2024",
month="Jul",
day="31",
volume="13",
pages="e50849",
keywords="continuous glucose monitoring",
keywords="missing data",
keywords="clinical decision-making",
keywords="clinical targets",
keywords="time below range",
keywords="TBR",
keywords="diabetes mellitus",
keywords="data interpretation",
keywords="clinical practice",
keywords="data analysis",
keywords="continuous glucose monitoring metrics",
keywords="glucose",
keywords="diabetes",
keywords="diabetic",
keywords="metrics",
keywords="data loss",
keywords="decision-making",
keywords="decision support",
keywords="missing values",
keywords="data science",
abstract="Background: The impact of missing data on individual continuous glucose monitoring (CGM) data is unknown but can influence clinical decision-making for patients. Objective: We aimed to investigate the consequences of data loss on glucose metrics in individual patient recordings from continuous glucose monitors and assess its implications on clinical decision-making. Methods: The CGM data were collected from patients with type 1 and 2 diabetes using the FreeStyle Libre sensor (Abbott Diabetes Care). We selected 7-28 days of 24 hours of continuous data without any missing values from each individual patient. To mimic real-world data loss, missing data ranging from 5\% to 50\% were introduced into the data set. From this modified data set, clinical metrics including time below range (TBR), TBR level 2 (TBR2), and other common glucose metrics were calculated in the data sets with and that without data loss. Recordings in which glucose metrics deviated relevantly due to data loss, as determined by clinical experts, were defined as expert panel boundary error ($\epsilon$EPB). These errors were expressed as a percentage of the total number of recordings. The errors for the recordings with glucose management indicator <53 mmol/mol were investigated. Results: A total of 84 patients contributed to 798 recordings over 28 days. With 5\%-50\% data loss for 7-28 days recordings, the $\epsilon$EPB varied from 0 out of 798 (0.0\%) to 147 out of 736 (20.0\%) for TBR and 0 out of 612 (0.0\%) to 22 out of 408 (5.4\%) recordings for TBR2. In the case of 14-day recordings, TBR and TBR2 episodes completely disappeared due to 30\% data loss in 2 out of 786 (0.3\%) and 32 out of 522 (6.1\%) of the cases, respectively. However, the initial values of the disappeared TBR and TBR2 were relatively small (<0.1\%). In the recordings with glucose management indicator <53 mmol/mol the $\epsilon$EPB was 9.6\% for 14 days with 30\% data loss. Conclusions: With a maximum of 30\% data loss in 14-day CGM recordings, there is minimal impact of missing data on the clinical interpretation of various glucose metrics. Trial Registration: ClinicalTrials.gov NCT05584293; https://clinicaltrials.gov/study/NCT05584293 ",
doi="10.2196/50849",
url="https://www.i-jmr.org/2024/1/e50849"
}


@Article{info:doi/10.2196/49089,
author="Perry, Betty Melissa
and Taylor, Sally
and Khatoon, Binish
and Vercell, Amy
and Faivre-Finn, Corinne
and Velikova, Galina
and Marsden, Antonia
and Heal, Calvin
and Yorke, Janelle",
title="Examining the Effectiveness of Electronic Patient-Reported Outcomes in People With Cancer: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="31",
volume="26",
pages="e49089",
keywords="telemedicine",
keywords="patient-reported outcome measure",
keywords="neoplasms",
keywords="quality of life",
keywords="systematic review",
keywords="meta-analysis",
keywords="randomized controlled trial",
abstract="Background: Electronic patient-reported outcomes (ePROs) are commonly used in oncology clinical practice and have shown benefits for patients and health resource use. Objective: The aim of this study was to compare the isolated effect of administering ePROs to patients with cancer versus a control condition. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Randomized controlled trials evaluating ePRO interventions that aimed to improve health-related outcomes among patients with cancer were included. The primary outcome was health-related quality of life (HRQOL), and the secondary outcomes were symptoms, hospital admissions, unplanned visits, chemotherapy completion, survival, and satisfaction with care. The effect sizes of ePROs on health-related outcomes were analyzed as standardized mean differences (SMDs) with 95\% CIs using a random effects model. Results: The search identified 10,965 papers, of which 19 (0.17\%) from 15 studies were included. The meta-analysis showed an improvement in HRQOL at 3 months, measured by the Functional Assessment of Cancer Therapy--General (SMD 0.29, 95\% CI 0.19 to 0.39), and at 6 months, assessed using various HRQOL measures (SMD 0.21, 95\% CI 0.11 to 0.30). Of the 15 studies, 9 (60\%) reported a positive signal on HRQOL, with two-thirds of the studies (n=6, 67\%) including tailored patient advice and two-thirds (n=6, 67\%) using clinician alert systems. Conclusions: The meta-analysis showed an improvement in HRQOL at 6 months and in Functional Assessment of Cancer Therapy--General scores at 3 months for studies that included tailored advice and clinician alerts, suggesting that these elements may improve ePRO effectiveness. The findings will provide guidance for future use and help health care professionals choose the most suitable ePRO features for their patients. Trial Registration: PROSPERO CRD42020175007; https://tinyurl.com/5cwmy3j6 ",
doi="10.2196/49089",
url="https://www.jmir.org/2024/1/e49089"
}


@Article{info:doi/10.2196/50527,
author="Mazzocato, Pamela
and Luckhaus, Linnea Jamie
and Malmqvist Castillo, Moa
and Burnett, Johan
and Hager, Andreas
and Oates, Gabriela
and Wannheden, Carolina
and Savage, Carl",
title="A Patient-Driven Mobile Health Innovation in Cystic Fibrosis Care: Comparative Cross-Case Study",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="31",
volume="26",
pages="e50527",
keywords="chronic illness",
keywords="implementation",
keywords="adoption",
keywords="spread",
keywords="patient-driven innovation",
keywords="mHealth",
keywords="mobile health",
keywords="innovation",
keywords="health care provider",
keywords="motivation",
keywords="interdependency",
keywords="adaptability",
abstract="Background: Patient-driven innovation in health care is an emerging phenomenon with benefits for patients with chronic conditions, such as cystic fibrosis (CF). However, previous research has not examined what may facilitate or hinder the implementation of such innovations from the provider perspective. Objective: The aim of this study was to explain variations in the adoption of a patient-driven innovation among CF clinics. Methods: A comparative multiple-case study was conducted on the adoption of a patient-controlled app to support self-management and collaboration with health care professionals (HCPs). Data collection and analysis were guided by the nonadoption, abandonment, spread, scale-up, and sustainability and complexity assessment tool (NASSS-CAT) framework. Data included user activity levels of patients and qualitative interviews with staff at 9 clinics (n=8, 88.9\%, in Sweden; n=1, 11.1\%, in the United States). We calculated the maximum and mean percentage of active users at each clinic and performed statistical process control (SPC) analysis to explore how the user activity level changed over time. Qualitative data were subjected to content analysis and complexity analysis and used to generate process maps. All data were then triangulated in a cross-case analysis. Results: We found no evidence of nonadoption or clear abandonment of the app. Distinct patterns of innovation adoption were discernable based on the maximum end-user activity for each clinic, which we labeled as low (16\%-23\%), middle (25\%-47\%), or high (58\%-95\%) adoption. SPC charts illustrated that the introduction of new app features and research-related activity had a positive influence on user activity levels. Variation in adoption was associated with providers' perceptions of care process complexity. A higher perceived complexity of the value proposition, adopter system, and organization was associated with lower adoption. In clinics that adopted the innovation early or those that relied on champions, user activity tended to plateau or decline, suggesting a negative impact on sustainability. Conclusions: For patient-driven innovations to be adopted and sustained in health care, understanding patient-provider interdependency and providers' perspectives on what generates value is essential. ",
doi="10.2196/50527",
url="https://www.jmir.org/2024/1/e50527",
url="http://www.ncbi.nlm.nih.gov/pubmed/39083342"
}


@Article{info:doi/10.2196/46319,
author="Chen, Wenfei
and Chen, Jiana
and Jiang, Shaojun
and Wang, Chunhua
and Zhang, Jinhua",
title="Web-Based Warfarin Management (Alfalfa App) Versus Traditional Warfarin Management: Multicenter Prospective Cohort Study",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="29",
volume="26",
pages="e46319",
keywords="warfarin",
keywords="telemedicine",
keywords="smart phone application",
keywords="anti-coagulation management",
keywords="management",
keywords="cohort study",
keywords="application",
keywords="chronic disease",
keywords="support",
keywords="effectiveness",
keywords="online model",
keywords="patient management",
abstract="Background: Poor anticoagulation management of warfarin may lead to patient admission, prolonged hospital stays, and even death due to anticoagulation-related adverse events. Traditional non--web-based outpatient clinics struggle to provide ideal anticoagulation management services for patients, and there is a need to explore a safer, more effective, and more convenient mode of warfarin management. Objective: This study aimed to compare differences in the quality of anticoagulation management and clinical adverse events between a web-based management model (via a smartphone app) and the conventional non--web-based outpatient management model. Methods: This study is a prospective cohort research that includes multiple national centers. Patients meeting the nadir criteria were split into a web-based management group using the Alfalfa app or a non--web-based management group with traditional outpatient management, and they were then monitored for a 6-month follow-up period to collect coagulation test results and clinical events. The effectiveness and safety of the 2 management models were assessed by the following indicators: time in therapeutic range (TTR), bleeding events, thromboembolic events, all-cause mortality events, cumulative event rates, and the distribution of the international normalized ratio (INR). Results: This national multicenter cohort study enrolled 522 patients between June 2019 and May 2021, with 519 (99\%) patients reaching the follow-up end point, including 260 (50\%) in the non--web-based management group and 259 (50\%) in the web-based management group. There were no observable differences in baseline characteristics between the 2 patient groups. The web-based management group had a significantly higher TTR than the non--web-based management group (82.4\% vs 71.6\%, P<.001), and a higher proportion of patients received effective anticoagulation management (81.2\% vs 63.5\%, P<.001). The incidence of minor bleeding events in the non--web-based management group was significantly higher than that in the web-based management group (12.1\% vs 6.6\%, P=.048). Between the 2 groups, there was no statistically significant difference in the incidence of severe bleeding and thromboembolic and all-cause death events. In addition, compared with the non--web-based management group, the web-based management group had a lower proportion of INR in the extreme subtreatment range (17.6\% vs 21.3\%) and severe supertreatment range (0\% vs 0.8\%) and a higher proportion in the treatment range (50.4\% vs 43.1\%), with statistical significance. Conclusions: Compared with traditional non--web-based outpatient management, web-based management via the Alfalfa app may be more beneficial because it can enhance patient anticoagulation management quality, lower the frequency of small bleeding events, and improve INR distribution. ",
doi="10.2196/46319",
url="https://www.jmir.org/2024/1/e46319",
url="http://www.ncbi.nlm.nih.gov/pubmed/39073869"
}


@Article{info:doi/10.2196/55366,
author="De Lucia, Annalisa
and Perlini, Cinzia
and Chiarotto, Alessandro
and Pachera, Sara
and Pasini, Ilenia
and Del Piccolo, Lidia
and Donisi, Valeria",
title="eHealth-Integrated Psychosocial and Physical Interventions for Chronic Pain in Older Adults: Scoping Review",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="29",
volume="26",
pages="e55366",
keywords="chronic pain",
keywords="older adults",
keywords="eHealth",
keywords="scoping review",
keywords="psychological intervention",
keywords="physical intervention",
keywords="multimodal intervention",
keywords="biopsychosocial model for chronic pain",
keywords="self-management",
keywords="mobile phone",
abstract="Background: Chronic noncancer pain (CNCP) is highly present among older adults, affecting their physical, psychological, and social functioning. A biopsychosocial multimodal approach to CNCP management is currently extensively suggested by international clinical practice guidelines. Recently, the growing development and application of eHealth within pain management has yielded encouraging results in terms of effectiveness and feasibility; however, its use among the older population remains underexamined. Objective: The overall aim of this scoping review was to systematically map existing literature about eHealth multimodal interventions (including both physical and psychosocial components) targeting older adults with CNCP. Methods: This review adhered to the JBI methodology, a protocol was a priori registered as a preprint on the medRxiv platform, and the results were reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Four electronic databases (PubMed, Cochrane Central Register of Controlled Trials, Web of Science, and PsycINFO) were systematically searched for relevant articles. Studies were included if they reported on multimodal interventions (including both physical and psychosocial components) delivered through any eHealth modality to an older population with any type of CNCP. Two reviewers selected the studies: first by screening titles and abstracts and second by screening full-text articles. The quality of the included studies was evaluated using the Quality Assessment Tool for Studies with Diverse Designs. The results of the studies were summarized narratively. Results: A total of 9 studies (n=6, 67\% published between 2021 and 2023) with quality rated as medium to high were included, of which 7 (78\%) were randomized controlled trials (n=5, 71\% were pilot and feasibility studies). All the included studies evaluated self-management interventions, most of them (n=7, 78\%) specifically designed for older adults. The participants were aged between 65 and 75 years on average (mean 68.5, SD 3.5 y) and had been diagnosed with different types of CNCP (eg, osteoarthritis and chronic low back pain). Most of the included studies (5/9, 56\%) involved the use of multiple eHealth modalities, with a higher use of web-based programs and video consulting. Only 1 (11\%) of the 9 studies involved a virtual reality--based intervention. The evaluated interventions showed signs of effectiveness in the targeted biopsychosocial outcomes, and the participants' engagement and ratings of satisfaction were generally positive. However, several research gaps were identified and discussed. Conclusions: Overall, of late, there has been a growing interest in the potential that eHealth multimodal interventions offer in terms of improving pain, physical, and psychosocial outcomes in older adults with CNCP. However, existing literature on this topic still seems scarce and highly heterogeneous, with few proper randomized controlled trials, precluding robust conclusions. Several gaps emerged in terms of the older population considered and the lack of evaluation of comorbidities. International Registered Report Identifier (IRRID): RR2-10.1101/2023.07.27.23293235 ",
doi="10.2196/55366",
url="https://www.jmir.org/2024/1/e55366",
url="http://www.ncbi.nlm.nih.gov/pubmed/39073865"
}


@Article{info:doi/10.2196/55421,
author="Cruz-Cobo, Celia
and Bernal-Jim{\'e}nez, {\'A}ngeles Mar{\'i}a
and Calle, Germ{\'a}n
and Gheorghe, Luciana Livia
and Guti{\'e}rrez-Barrios, Alejandro
and Ca{\~n}adas, Dolores
and Tur, A. Josep
and V{\'a}zquez-Garc{\'i}a, Rafael
and Santi-Cano, Jos{\'e} Mar{\'i}a",
title="Efficacy of a Mobile Health App (eMOTIVA) Regarding Compliance With Cardiac Rehabilitation Guidelines in Patients With Coronary Artery Disease: Randomized Controlled Clinical Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jul",
day="25",
volume="12",
pages="e55421",
keywords="coronary event",
keywords="coronary heart disease",
keywords="eHealth",
keywords="lifestyle",
keywords="mHealth",
keywords="mobile health",
abstract="Background: Cardiac rehabilitation is fundamental among patients recovering from a coronary event, and mHealth technology may constitute a useful tool that provides guidelines based on scientific evidence in an entertaining, attractive, and user-friendly format. Objective: This study aimed to compare the efficacy of an mHealth intervention involving the eMOTIVA app and that of usual care regarding compliance with cardiac rehabilitation guidelines in terms of lifestyle, cardiovascular risk factors, and satisfaction among patients with acute coronary syndrome. Methods: A randomized controlled clinical trial with a parallel group design was conducted. It included 300 patients (mHealth group, 150; control group, 150) who underwent percutaneous coronary intervention for acute coronary syndrome. Both groups underwent evaluations initially (during hospitalization) and after 3 and 6 months (face-to-face consultations). The eMOTIVA app incorporates a virtual classroom providing audio and video information about a healthy lifestyle, a section for self-recording cardiovascular risk factors, and a section for feedback messages and gamification. The primary outcome variables were (1) adherence to the Mediterranean diet and the frequency of consumption of food; (2) physical activity level, sedentary time, and exercise capacity; (3) smoking cessation and nicotine dependence; (4) level of knowledge about cardiovascular risk factors; and (5) app satisfaction and usability. Results: The study analyzed 287 patients (mHealth group, 145; control group, 142). Most participants were male (207/300, 69.0\%), and the mean age was 62.53 (SD 8.65) years. Significant improvements were observed in the mHealth group compared with the control group at 6 months in terms of (1) adherence to the Mediterranean diet (mean 11.92, SD 1.70 vs 8.92, SD 2.66 points; P<.001) and frequency of eating foods (red meat [?1/week]: 141/143, 97.9\% vs 96/141, 68.1\%; industrial pastries [<2/week]: 129/143, 89.6\% vs 80/141, 56.8\%; oily fish [?2/week]: 124/143, 86.1\% vs 64/141, 41.4\%; vegetables [?2/day]: 130/143, 90.3\% vs 78/141, 55.3\%; fruit [?2/day]: 128/143, 88.9\% vs 85/141, 60.2\%; all P<.001); (2) physical activity (mean 2112.66, SD 1196.67 vs 1372.60, SD 944.62 metabolic equivalents/week; P<.001) and sedentary time (mean 8.38, SD 1.88 vs 9.59, SD 2.09 hours; P<.001); (3) exercise capacity (distance: mean 473.49, SD 102.28 vs 447.25, SD 93.68 meters; P=.04); and (4) level of knowledge (mean 117.85, SD 3.83 vs 111.00, SD 7.11 points; P<.001). App satisfaction was high (mean 42.53, SD 6.38 points), and its usability was excellent (mean 95.60, SD 4.03 points). Conclusions: With the eMOTIVA app, favorable results were obtained in the intervention group in terms of adherence to the Mediterranean diet, frequency of eating certain foods, physical activity, sedentary time, exercise capacity, knowledge level, systolic blood pressure, heart rate, and blood sugar level. Furthermore, participants reported high app satisfaction and rated its usability as excellent. Thus, this innovative tool is very promising. Trial Registration: ClinicalTrials.gov NCT05247606; https://clinicaltrials.gov/study/NCT05247606 ",
doi="10.2196/55421",
url="https://mhealth.jmir.org/2024/1/e55421"
}


@Article{info:doi/10.2196/55927,
author="Li, Linger
and Li, Pengfei
and Wang, Kun
and Zhang, Liang
and Ji, Hongwei
and Zhao, Hongqin",
title="Benchmarking State-of-the-Art Large Language Models for Migraine Patient Education: Performance Comparison of Responses to Common Queries",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="23",
volume="26",
pages="e55927",
keywords="migraine",
keywords="large language models",
keywords="patient education",
keywords="ChatGPT",
keywords="Google Bard",
keywords="language model",
keywords="education",
keywords="headache",
keywords="accuracy",
keywords="OpenAI",
keywords="AI",
keywords="artificial intelligence",
keywords="AI-assisted",
keywords="holistic",
keywords="migraine management",
keywords="management",
doi="10.2196/55927",
url="https://www.jmir.org/2024/1/e55927"
}


@Article{info:doi/10.2196/55542,
author="Knitza, Johannes
and Tascilar, Koray
and Fuchs, Franziska
and Mohn, Jacob
and Kuhn, Sebastian
and Bohr, Daniela
and Muehlensiepen, Felix
and Bergmann, Christina
and Labinsky, Hannah
and Morf, Harriet
and Araujo, Elizabeth
and Englbrecht, Matthias
and Vorbr{\"u}ggen, Wolfgang
and von der Decken, Cay-Benedict
and Kleinert, Stefan
and Ramming, Andreas
and Distler, W. J{\"o}rg H.
and Bartz-Bazzanella, Peter
and Vuillerme, Nicolas
and Schett, Georg
and Welcker, Martin
and Hueber, Axel",
title="Diagnostic Accuracy of a Mobile AI-Based Symptom Checker and a Web-Based Self-Referral Tool in Rheumatology: Multicenter Randomized Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="23",
volume="26",
pages="e55542",
keywords="symptom checker",
keywords="artificial intelligence",
keywords="eHealth",
keywords="diagnostic decision support system",
keywords="rheumatology",
keywords="decision support",
keywords="decision",
keywords="diagnostic",
keywords="tool",
keywords="rheumatologists",
keywords="symptom assessment",
keywords="resources",
keywords="randomized controlled trial",
keywords="diagnosis",
keywords="decision support system",
keywords="support system",
keywords="support",
abstract="Background: The diagnosis of inflammatory rheumatic diseases (IRDs) is often delayed due to unspecific symptoms and a shortage of rheumatologists. Digital diagnostic decision support systems (DDSSs) have the potential to expedite diagnosis and help patients navigate the health care system more efficiently. Objective: The aim of this study was to assess the diagnostic accuracy of a mobile artificial intelligence (AI)--based symptom checker (Ada) and a web-based self-referral tool (Rheport) regarding IRDs. Methods: A prospective, multicenter, open-label, crossover randomized controlled trial was conducted with patients newly presenting to 3 rheumatology centers. Participants were randomly assigned to complete a symptom assessment using either Ada or Rheport. The primary outcome was the correct identification of IRDs by the DDSSs, defined as the presence of any IRD in the list of suggested diagnoses by Ada or achieving a prespecified threshold score with Rheport. The gold standard was the diagnosis made by rheumatologists. Results: A total of 600 patients were included, among whom 214 (35.7\%) were diagnosed with an IRD. Most frequent IRD was rheumatoid arthritis with 69 (11.5\%) patients. Rheport's disease suggestion and Ada's top 1 (D1) and top 5 (D5) disease suggestions demonstrated overall diagnostic accuracies of 52\%, 63\%, and 58\%, respectively, for IRDs. Rheport showed a sensitivity of 62\% and a specificity of 47\% for IRDs. Ada's D1 and D5 disease suggestions showed a sensitivity of 52\% and 66\%, respectively, and a specificity of 68\% and 54\%, respectively, concerning IRDs. Ada's diagnostic accuracy regarding individual diagnoses was heterogenous, and Ada performed considerably better in identifying rheumatoid arthritis in comparison to other diagnoses (D1: 42\%; D5: 64\%). The Cohen $\kappa$ statistic of Rheport for agreement on any rheumatic disease diagnosis with Ada D1 was 0.15 (95\% CI 0.08-0.18) and with Ada D5 was 0.08 (95\% CI 0.00-0.16), indicating poor agreement for the presence of any rheumatic disease between the 2 DDSSs. Conclusions: To our knowledge, this is the largest comparative DDSS trial with actual use of DDSSs by patients. The diagnostic accuracies of both DDSSs for IRDs were not promising in this high-prevalence patient population. DDSSs may lead to a misuse of scarce health care resources. Our results underscore the need for stringent regulation and drastic improvements to ensure the safety and efficacy of DDSSs. Trial Registration: German Register of Clinical Trials DRKS00017642; https://drks.de/search/en/trial/DRKS00017642 ",
doi="10.2196/55542",
url="https://www.jmir.org/2024/1/e55542"
}


@Article{info:doi/10.2196/55757,
author="Kerr, David
and Ahn, David
and Waki, Kayo
and Wang, Jing
and Breznen, Boris
and Klonoff, C. David",
title="Digital Interventions for Self-Management of Type 2 Diabetes Mellitus: Systematic Literature Review and Meta-Analysis",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="22",
volume="26",
pages="e55757",
keywords="coaching",
keywords="digital health",
keywords="eHealth",
keywords="meta-analysis",
keywords="patient empowerment",
keywords="patient engagement",
keywords="self-care",
keywords="systematic review",
keywords="telemedicine",
keywords="type 2 diabetes",
keywords="digital interventions",
keywords="self-management",
keywords="systematic literature review",
keywords="effectiveness",
keywords="efficacy",
keywords="safety",
keywords="meta-regression",
abstract="Background: The proliferation of digital technology has the potential to transform diabetes management. One of the critical aspects of modern diabetes management remains the achievement of glycemic targets to avoid acute and long-term complications. Objective: This study aims to describe the landscape of evidence pertaining to the relative effectiveness or efficacy and safety of various digital interventions for the self-management of type 2 diabetes mellitus (T2DM), with a primary focus on reducing glycated hemoglobin A1c (HbA1c) levels. Methods: A systematic literature review (SLR) was conducted by searching Embase, MEDLINE, and CENTRAL on April 5, 2022. Study selection, data extraction, and quality assessment were performed by 2 independent reviewers. Eligibility criteria for the SLR included randomized controlled trials (RCTs) and comparative observational studies evaluating interventions containing both human (eg, coaching) and digital components (eg, glucose meter) in adult patients with T2DM. The primary meta-analysis was restricted to studies that reported laboratory-measured HbA1c. In secondary analyses, meta-regression was performed with the intensity of coaching in the digital intervention as a categorical covariate. Results: In total, 28 studies were included in this analysis. Most studies (23/28, 82\%) used the reduction of HbA1c levels as the primary end point, either directly or as a part of a multicomponent outcome. In total, 21 studies reported statistically significant results with this primary end point. When stratified into 3 intervention categories by the intensity of the intervention supporting the digital health technology (analyzing all 28 studies), the success rate appeared to be proportional to the coaching intensity (ie, higher-intensity studies reported higher success rates). When the analysis was restricted to RCTs using the comparative improvement of HbA1c levels, the effectiveness of the interventions was less clear. Only half (12/23, 52\%) of the included RCTs reported statistically significant results. The meta-analyses were broadly aligned with the results of the SLR. The primary analysis estimated a greater reduction in HbA1c associated with digital interventions compared with usual care (--0.31\%, 95\% CI --0.45\% to --0.16\%; P<.001). Meta-regression estimated reductions of --0.45\% (95\% CI --0.81\% to --0.09\%; P=.02), --0.29\% (95\% CI --0.48\% to --0.11\%; P=.003), and --0.28\% (95\% CI --0.65\% to 0.09\%; P=.20) associated with high-, medium-, and low-intensity interventions, respectively. Conclusions: These findings suggest that reducing HbA1c levels in individuals with T2DM with the help of digital interventions is feasible, effective, and acceptable. One common feature of effective digital health interventions was the availability of timely and responsive personalized coaching by a dedicated health care professional. ",
doi="10.2196/55757",
url="https://www.jmir.org/2024/1/e55757",
url="http://www.ncbi.nlm.nih.gov/pubmed/39037772"
}


@Article{info:doi/10.2196/48582,
author="Little, L. Claire
and Schultz, M. David
and House, Thomas
and Dixon, G. William
and McBeth, John",
title="Identifying Weekly Trajectories of Pain Severity Using Daily Data From an mHealth Study: Cluster Analysis",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jul",
day="19",
volume="12",
pages="e48582",
keywords="mobile health",
keywords="mHealth",
keywords="pain",
keywords="cluster",
keywords="trajectory",
keywords="k-medoids",
keywords="transition",
keywords="forecast",
keywords="mobile phone",
abstract="Background: People with chronic pain experience variability in their trajectories of pain severity. Previous studies have explored pain trajectories by clustering sparse data; however, to understand daily pain variability, there is a need to identify clusters of weekly trajectories using daily pain data. Between-week variability can be explored by quantifying the week-to-week movement between these clusters. We propose that future work can use clusters of pain severity in a forecasting model for short-term (eg, daily fluctuations) and longer-term (eg, weekly patterns) variability. Specifically, future work can use clusters of weekly trajectories to predict between-cluster movement and within-cluster variability in pain severity. Objective: This study aims to understand clusters of common weekly patterns as a first stage in developing a pain-forecasting model. Methods: Data from a population-based mobile health study were used to compile weekly pain trajectories (n=21,919) that were then clustered using a k-medoids algorithm. Sensitivity analyses tested the impact of assumptions related to the ordinal and longitudinal structure of the data. The characteristics of people within clusters were examined, and a transition analysis was conducted to understand the movement of people between consecutive weekly clusters. Results: Four clusters were identified representing trajectories of no or low pain (1714/21,919, 7.82\%), mild pain (8246/21,919, 37.62\%), moderate pain (8376/21,919, 38.21\%), and severe pain (3583/21,919, 16.35\%). Sensitivity analyses confirmed the 4-cluster solution, and the resulting clusters were similar to those in the main analysis, with at least 85\% of the trajectories belonging to the same cluster as in the main analysis. Male participants spent longer (participant mean 7.9, 95\% bootstrap CI 6\%-9.9\%) in the no or low pain cluster than female participants (participant mean 6.5, 95\% bootstrap CI 5.7\%-7.3\%). Younger people (aged 17-24 y) spent longer (participant mean 28.3, 95\% bootstrap CI 19.3\%-38.5\%) in the severe pain cluster than older people (aged 65-86 y; participant mean 9.8, 95\% bootstrap CI 7.7\%-12.3\%). People with fibromyalgia (participant mean 31.5, 95\% bootstrap CI 28.5\%-34.4\%) and neuropathic pain (participant mean 31.1, 95\% bootstrap CI 27.3\%-34.9\%) spent longer in the severe pain cluster than those with other conditions, and people with rheumatoid arthritis spent longer (participant mean 7.8, 95\% bootstrap CI 6.1\%-9.6\%) in the no or low pain cluster than those with other conditions. There were 12,267 pairs of consecutive weeks that contributed to the transition analysis. The empirical percentage remaining in the same cluster across consecutive weeks was 65.96\% (8091/12,267). When movement between clusters occurred, the highest percentage of movement was to an adjacent cluster. Conclusions: The clusters of pain severity identified in this study provide a parsimonious description of the weekly experiences of people with chronic pain. These clusters could be used for future study of between-cluster movement and within-cluster variability to develop accurate and stakeholder-informed pain-forecasting tools. ",
doi="10.2196/48582",
url="https://mhealth.jmir.org/2024/1/e48582",
url="http://www.ncbi.nlm.nih.gov/pubmed/39028557"
}


@Article{info:doi/10.2196/53652,
author="Wu, Weizi
and Graziano, Teresa
and Salner, Andrew
and Chen, Ming-Hui
and Judge, P. Michelle
and Cong, Xiaomei
and Xu, Wanli",
title="Acceptability, Effectiveness, and Roles of mHealth Applications in Supporting Cancer Pain Self-Management: Integrative Review",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jul",
day="18",
volume="12",
pages="e53652",
keywords="cancer pain",
keywords="self-management",
keywords="mHealth applications",
keywords="integrative review",
keywords="cancer survivors",
abstract="Background: ?Cancer pain remains highly prevalent and persistent throughout survivorship, and it is crucial to investigate the potential of leveraging the advanced features of mobile health (mHealth) apps to empower individuals to self-manage their pain. Objective: ?This review aims to comprehensively understand the acceptability, users' experiences, and effectiveness of mHealth apps in supporting cancer pain self-management. Methods: ?We conducted an integrative review following Souza and Whittemore and Knafl's 6 review processes. Literature was searched in PubMed, Scopus, CINAHL Plus with Full Text, PsycINFO, and Embase, from 2013 to 2023. Keywords including ``cancer patients,'' ``pain,'' ``self-management,'' ``mHealth applications,'' and relevant synonyms were used in the search. The Johns Hopkins research evidence appraisal tool was used to evaluate the quality of eligible studies. A narrative synthesis was conducted to analyze the extracted data. Results: ?A total of 20 studies were included, with the overall quality rated as high (n=15) to good (n=5). Using mHealth apps to monitor and manage pain was acceptable for most patients with cancer. The internal consistency of the mHealth in measuring pain was 0.96. The reported daily assessment or engagement rate ranged from 61.9\% to 76.8\%. All mHealth apps were designed for multimodal interventions. Participants generally had positive experiences using pain apps, rating them as enjoyable and user-friendly. In addition, 6 studies reported significant improvements in health outcomes, including enhancement in pain remission (severity and intensity), medication adherence, and a reduced frequency of breakthrough pain. The most frequently highlighted roles of mHealth apps included pain monitoring, tracking, reminders, education facilitation, and support coordination. Conclusions: ?mHealth apps are effective and acceptable in supporting pain self-management. They offer a promising multi-model approach for patients to monitor, track, and manage their pain. These findings provide evidence-based insights for leveraging mHealth apps to support cancer pain self-management. More high-quality studies are needed to examine the effectiveness of digital technology--based interventions for cancer pain self-management and to identify the facilitators and barriers to their implementation in real-world practice. ",
doi="10.2196/53652",
url="https://mhealth.jmir.org/2024/1/e53652"
}


@Article{info:doi/10.2196/49393,
author="Davis, Adrian C.
and Miller, Madeleine
and McLean, P. Carmen",
title="The Impact of User Engagement With Exposure Components on Posttraumatic Stress Symptoms in an mHealth Mobile App: Secondary Analysis of a Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jul",
day="18",
volume="12",
pages="e49393",
keywords="posttraumatic stress disorder",
keywords="PTSD",
keywords="mHealth apps",
keywords="user engagement",
keywords="mHealth interventions",
keywords="digital interventions",
keywords="veterans",
abstract="Background: Mobile mental health apps are a cost-effective option for managing mental health problems, such as posttraumatic stress disorder (PTSD). The efficacy of mobile health (mHealth) apps depends on engagement with the app, but few studies have examined how users engage with different features of mHealth apps for PTSD. Objective: This study aims to examine the relationship between app engagement indices and PTSD symptom reduction using data from an unblinded pilot randomized controlled trial of ``Renew'' (Vertical Design), an exposure-based app for PTSD with and without coaching support. Because exposure is an effective approach for treating PTSD, we expected that engagement with exposure activities would be positively related to symptom reduction, over and above overall app usage. Methods: Participants were veterans (N=69) with clinically significant PTSD symptoms who were recruited online using Facebook advertisements and invited to use the Renew app as often as they wanted over a 6-week period. Participants completed screening and assessments online but provided informed consent, toured the app, and completed feedback interviews via telephone. We assessed users' self-reported PTSD symptoms before and after a 6-week intervention period and collected app usage data using a research-instrumented dashboard. To examine overall app engagement, we used data on the total time spent in the app, the number of log-in days, and the number of points that the user gained in the app. To examine engagement with exposure components, we used data on total time spent completing exposure activities (both in vivo and imaginal), the number of in vivo exposure activities completed, and the number of characters written in response to imaginal exposure prompts. We used hierarchical regression analyses to test the effect of engagement indices on change in PTSD symptoms. Results: Usage varied widely. Participants spent an average of 166.09 (SD 156.52) minutes using Renew, over an average of 14.7 (SD 10.71) mean log-in days. Engagement with the exposure components of the app was positively associated with PTSD symptom reduction (F6,62=2.31; P=.04). Moreover, this relationship remained significant when controlling for overall engagement with the app ($\Delta$F3,62=4.42; P=.007). The number of characters written during imaginal exposure ($\beta$=.37; P=.009) and the amount of time spent completing exposure activities ($\beta$=.36; P=.03) were significant contributors to the model. Conclusions: To our knowledge, this is the first study to show a relationship between symptom improvement and engagement with the active therapeutic components of an mHealth app (ie, exposure) for PTSD. This relationship held when controlling for overall app use, which suggests that it was engagement with exposure, specifically, that was associated with symptom change. Future work to identify ways of promoting greater engagement with self-guided exposure may help improve the effectiveness of mHealth apps for PTSD. Trial Registration: ClinicalTrials.gov NCT04155736; https://clinicaltrials.gov/ct2/show/NCT04155736 ",
doi="10.2196/49393",
url="https://mhealth.jmir.org/2024/1/e49393"
}


@Article{info:doi/10.2196/56226,
author="Chen, Xiaolan
and Zhang, Han
and Li, Zhiwen
and Liu, Shuang
and Zhou, Yuqi",
title="Continuous Monitoring of Heart Rate Variability and Respiration for the Remote Diagnosis of Chronic Obstructive Pulmonary Disease: Prospective Observational Study",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jul",
day="18",
volume="12",
pages="e56226",
keywords="continuous monitoring",
keywords="chronic obstructive pulmonary disease",
keywords="COPD diagnosis",
keywords="prospective study",
keywords="ROC curve",
keywords="heart rate variability",
keywords="respiratory rate",
keywords="heart rate",
keywords="noncontact bed sensors",
abstract="Background: Conventional daytime monitoring in a single day may be influenced by factors such as motion artifacts and emotions, and continuous monitoring of nighttime heart rate variability (HRV) and respiration to assist in chronic obstructive pulmonary disease (COPD) diagnosis has not been reported yet. Objective: The aim of this study was to explore and compare the effects of continuously monitored HRV, heart rate (HR), and respiration during night sleep on the remote diagnosis of COPD. Methods: We recruited patients with different severities of COPD and healthy controls between January 2021 and November 2022. Vital signs such as HRV, HR, and respiration were recorded using noncontact bed sensors from 10 PM to 8 AM of the following day, and the recordings of each patient lasted for at least 30 days. We obtained statistical means of HRV, HR, and respiration over time periods of 7, 14, and 30 days by continuous monitoring. Additionally, the effects that the statistical means of HRV, HR, and respiration had on COPD diagnosis were evaluated at different times of recordings. Results: In this study, 146 individuals were enrolled: 37 patients with COPD in the case group and 109 participants in the control group. The median number of continuous night-sleep monitoring days per person was 56.5 (IQR 32.0-113.0) days. Using the features regarding the statistical means of HRV, HR, and respiration over 1, 7, 14, and 30 days, binary logistic regression classification of COPD yielded an accuracy, Youden index, and area under the receiver operating characteristic curve of 0.958, 0.904, and 0.989, respectively. The classification performance for COPD diagnosis was directionally proportional to the monitoring duration of vital signs at night. The importance of the features for diagnosis was determined by the statistical means of respiration, HRV, and HR, which followed the order of respiration > HRV > HR. Specifically, the statistical means of the duration of respiration rate faster than 21 times/min (RRF), high frequency band power of 0.15-0.40 Hz (HF), and respiration rate (RR) were identified as the top 3 most significant features for classification, corresponding to cutoff values of 0.1 minute, 1316.3 nU, and 16.3 times/min, respectively. Conclusions: Continuous monitoring of nocturnal vital signs has significant potential for the remote diagnosis of COPD. As the duration of night-sleep monitoring increased from 1 to 30 days, the statistical means of HRV, HR, and respiration showed a better reflection of an individual's health condition compared to monitoring the vital signs in a single day or night, and better was the classification performance for COPD diagnosis. Further, the statistical means of RRF, HF, and RR are crucial features for diagnosing COPD, demonstrating the importance of monitoring HRV and respiration during night sleep. ",
doi="10.2196/56226",
url="https://mhealth.jmir.org/2024/1/e56226"
}


@Article{info:doi/10.2196/47904,
author="Bai, Xinrui
and Zhang, Hongyan
and Jiao, Yanxia
and Yuan, Chenlu
and Ma, Yuxia
and Han, Lin",
title="Digital Health Interventions for Chronic Wound Management: A Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="16",
volume="26",
pages="e47904",
keywords="chronic wounds",
keywords="digital health interventions",
keywords="wound healing",
keywords="meta-analysis",
keywords="systematic review",
keywords="digital technologies",
keywords="mobile health",
keywords="eHealth",
keywords="telemedicine",
keywords="telehealth",
abstract="Background: Digital health interventions (DHIs) have shown promising results for the management of chronic wounds. However, its effectiveness compared to usual care and whether variability in the type of intervention affects wound outcomes are unclear. Objective: The main objective was to determine the effectiveness of DHIs on wound healing outcomes in adult patients with chronic wounds. The secondary objectives were to assess if there was any variation in wound healing outcomes across the various types of DHIs. Methods: In total, 9 databases were searched for the literature up to August 1, 2023. Randomized controlled trials (RCTs), cohort studies, and quasi-experimental studies comparing the efficacy of DHIs with controls in improving wound outcomes in adult patients with chronic wounds were included. Study selection, data extraction, and risk of bias assessment were conducted independently by 2 reviewers. We assessed the quality of each RCT, cohort study, and quasi-experimental study separately using the Cochrane risk of bias tool, ROBINS-I, and the Joanna Briggs Institute Critical Appraisal tools checklists. Relative risks (RRs) and 95\% CIs were pooled using the random effects model, and heterogeneity was assessed by the I2 statistic. Subgroup analysis and sensitivity analysis were also performed. Results: A total of 25 studies with 8125 patients were included in this systematic review, while only 20 studies with 6535 patients were included in the meta-analysis. Efficacy outcomes in RCTs showed no significant differences between the DHIs and control groups in terms of wound healing (RR 1.02, 95\% CI 0.93-1.12; P=.67) and all-cause mortality around 1 year (RR 1.08, 95\% CI 0.55-2.12; P=.83). Compared with the control group, the use of DHIs was associated with significant changes in adverse events (RR 0.44, 95\% CI 0.22-0.89; P=.02). Subgroup analysis suggested a positive effect of the digital platforms in improving wound healing (RR 2.19, 95\% CI 1.35-3.56; P=.002). Although meta-analysis was not possible in terms of wound size, cost analysis, patient satisfaction, and wound reporting rates, most studies still demonstrated that DHIs were not inferior to usual care in managing chronic wounds. Conclusions: The findings of our study demonstrate the viability of adopting DHIs to manage chronic wounds. However, more prominent, high-quality RCTs are needed to strengthen the evidence, and more detailed clinical efficacy research is required. Trial Registration: PROSPERO CRD42023392415; https://tinyurl.com/4ybz6bs9 ",
doi="10.2196/47904",
url="https://www.jmir.org/2024/1/e47904",
url="http://www.ncbi.nlm.nih.gov/pubmed/39012684"
}


@Article{info:doi/10.2196/55617,
author="Charifson, Mia
and Wen, Timothy
and Zell, Bonnie
and Vaidya, Priyanka
and Rios, I. Cynthia
and Fagbohun, Funsho C.
and Fulcher, Isabel",
title="Impact of Remote Blood Pressure Monitoring Device Connectivity on Engagement Among Pregnant Individuals Enrolled in the Delfina Care Platform: Observational Study",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jul",
day="12",
volume="12",
pages="e55617",
keywords="blood pressure",
keywords="hypertension",
keywords="remote patient monitoring",
keywords="pregnancy",
keywords="digital health",
keywords="remote monitoring",
keywords="user engagement",
keywords="users",
keywords="connected",
keywords="unconnected",
keywords="comparison",
keywords="patient engagement",
keywords="prospective pregnancy cohort",
keywords="device",
keywords="devices",
keywords="female",
keywords="females",
keywords="women",
keywords="logistic regression",
keywords="Poisson",
doi="10.2196/55617",
url="https://mhealth.jmir.org/2024/1/e55617"
}


@Article{info:doi/10.2196/55716,
author="Marcuzzi, Anna
and Klevanger, Elisabeth Nina
and Aasdahl, Lene
and Gismervik, Sigmund
and Bach, Kerstin
and Mork, Jarle Paul
and Nordstoga, Lovise Anne",
title="An Artificial Intelligence--Based App for Self-Management of Low Back and Neck Pain in Specialist Care: Process Evaluation From a Randomized Clinical Trial",
journal="JMIR Hum Factors",
year="2024",
month="Jul",
day="9",
volume="11",
pages="e55716",
keywords="low back pain",
keywords="neck pain",
keywords="self-management",
keywords="smartphone app",
keywords="process evaluation",
keywords="focus group",
keywords="focus groups",
keywords="musculoskeletal",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="applications",
keywords="usage",
keywords="interview",
keywords="interviews",
keywords="qualitative",
keywords="engagement",
abstract="Background: Self-management is endorsed in clinical practice guidelines for the care of musculoskeletal pain. In a randomized clinical trial, we tested the effectiveness of an artificial intelligence--based self-management app (selfBACK) as an adjunct to usual care for patients with low back and neck pain referred to specialist care. Objective: This study is a process evaluation aiming to explore patients' engagement and experiences with the selfBACK app and specialist health care practitioners' views on adopting digital self-management tools in their clinical practice. Methods: App usage analytics in the first 12 weeks were used to explore patients' engagement with the SELFBACK app. Among the 99 patients allocated to the SELFBACK interventions, a purposive sample of 11 patients (aged 27-75 years, 8 female) was selected for semistructured individual interviews based on app usage. Two focus group interviews were conducted with specialist health care practitioners (n=9). Interviews were analyzed using thematic analysis. Results: Nearly one-third of patients never accessed the app, and one-third were low users. Three themes were identified from interviews with patients and health care practitioners: (1) overall impression of the app, where patients discussed the interface and content of the app, reported on usability issues, and described their app usage; (2) perceived value of the app, where patients and health care practitioners described the primary value of the app and its potential to supplement usual care; and (3) suggestions for future use, where patients and health care practitioners addressed aspects they believed would determine acceptance. Conclusions: Although the app's uptake was relatively low, both patients and health care practitioners had a positive opinion about adopting an app-based self-management intervention for low back and neck pain as an add-on to usual care. Both described that the app could reassure patients by providing trustworthy information, thus empowering them to take actions on their own. Factors influencing app acceptance and engagement, such as content relevance, tailoring, trust, and usability properties, were identified. Trial Registration: ClinicalTrials.gov NCT04463043; https://clinicaltrials.gov/study/NCT04463043 ",
doi="10.2196/55716",
url="https://humanfactors.jmir.org/2024/1/e55716",
url="http://www.ncbi.nlm.nih.gov/pubmed/38980710"
}


@Article{info:doi/10.2196/55732,
author="Gunn, Rose
and Watkins, L. Shelby
and Boston, Dave
and Rosales, Gabriela A.
and Massimino, Stefan
and Navale, Suparna
and Fitzpatrick, L. Stephanie
and Dickerson, John
and Gold, Rachel
and Lee, George
and McMullen, K. Carmit",
title="Evaluation of a Remote Patient Monitoring Program During the COVID-19 Pandemic: Retrospective Case Study With a Mixed Methods Explanatory Sequential Design",
journal="JMIR Form Res",
year="2024",
month="Jul",
day="9",
volume="8",
pages="e55732",
keywords="Patient-generated health data",
keywords="telemedicine",
keywords="telehealth",
keywords="diabetes mellitus",
keywords="hypertension",
keywords="self-management",
keywords="patient portal",
keywords="implementation science",
keywords="COVID-19: pandemic",
keywords="community health center",
keywords="chronic condition",
keywords="remote patient monitoring",
abstract="Background: Community health center (CHC) patients experience a disproportionately high prevalence of chronic conditions and barriers to accessing technologies that might support the management of these conditions. One such technology includes tools used for remote patient monitoring (RPM), the use of which surged during the COVID-19 pandemic. Objective: The aim of this study was to assess how a CHC implemented an RPM program during the COVID-19 pandemic. Methods: This retrospective case study used a mixed methods explanatory sequential design to evaluate a CHC's implementation of a suite of RPM tools during the COVID-19 pandemic. Analyses used electronic health record--extracted health outcomes data and semistructured interviews with the CHC's staff and patients participating in the RPM program. Results: The CHC enrolled 147 patients in a hypertension RPM program. After 6 months of RPM use, mean systolic blood pressure (BP) was 13.4 mm Hg lower and mean diastolic BP 6.4 mm Hg lower, corresponding with an increase in hypertension control (BP<140/90 mm Hg) from 33.3\% of patients to 81.5\%. Considerable effort was dedicated to standing up the program, reinforced by organizational prioritization of chronic disease management, and by a clinician who championed program implementation. Noted barriers to implementation of the RPM program were limited initial training, lack of sustained support, and complexities related to the RPM device technology. Conclusions: While RPM technology holds promise for addressing chronic disease management, successful RPM program requires substantial investment in implementation support and technical assistance. ",
doi="10.2196/55732",
url="https://formative.jmir.org/2024/1/e55732",
url="http://www.ncbi.nlm.nih.gov/pubmed/38980716"
}


@Article{info:doi/10.2196/48802,
author="Park, Sunghee
and Lee, Sohye
and Howard, Sheri
and Yi, Jeeseon",
title="Technology-Based Music Interventions to Reduce Anxiety and Pain Among Patients Undergoing Surgery or Procedures: Systematic Review of the Literature",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jul",
day="8",
volume="12",
pages="e48802",
keywords="technology",
keywords="music intervention",
keywords="anxiety",
keywords="pain",
abstract="Background: Hospitalized patients undergoing surgery or procedures may experience negative symptoms. Music is a nonpharmacological complementary approach and is used as an intervention to reduce anxiety, stress, and pain in these patients. Recently, music has been used conveniently in clinical situations with technology devices, and the mode of providing music is an important factor in technology-based music interventions. However, many reviews have focused only on the effectiveness of music interventions. Objective: We aimed to review randomized controlled trials (RCTs) of technology-based music interventions for reducing anxiety and pain among patients undergoing surgery or procedures. We examined the clinical situation, devices used, delivery methods, and effectiveness of technology-based music interventions in primary articles. Methods: The search was performed in the following 5 electronic databases: PubMed, MEDLINE (OvidSP), CINAHL complete, PSYCINFO, and Embase. This systematic review focused on technology-based music interventions. The following articles were included: (1) RCTs, (2) studies using interactive technology (eg, smartphones, mHealth, tablets, applications, and virtual reality), (3) empirical studies reporting pain and anxiety outcomes, and (4) English articles published from 2018 to 2023 (as of January 18, 2023). The risk of bias was assessed using the Cochrane Risk of Bias tool version 2. Results: Among 292 studies identified, 21 met the inclusion criteria and were included. Of these studies, 9 reported that anxiety scores decreased after music interventions and 7 reported that pain could be decreased before, during, and after procedures. The methodology of the music intervention was important to the results on anxiety and pain in the clinical trials. More than 50\% (13/21, 62\%) of the studies included in this review allowed participants to select themes themselves. However, it was difficult to distinguish differences in effects depending on the device or software used for the music interventions. Conclusions: Technology-based music interventions could help reduce anxiety and pain among patients undergoing surgery or procedures. The findings of this review could help medical teams to choose a practical methodology for music interventions. Future studies should examine the effects of advanced technology-based music interventions using smart devices and software that promote interactions between medical staff and patients. ",
doi="10.2196/48802",
url="https://mhealth.jmir.org/2024/1/e48802"
}


@Article{info:doi/10.2196/56664,
author="Kim, Hyun Soo
and Kim, Kyoung-A
and Chu, Hui Sang
and Kim, Hyunji
and Joo, Jin Dong
and Lee, Geun Jae
and Choi, JiYeon",
title="Self-Management Using eHealth Technologies for Liver Transplant Recipients: Scoping Review",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="4",
volume="26",
pages="e56664",
keywords="liver transplantation",
keywords="self-management",
keywords="transplant management",
keywords="eHealth",
keywords="eHealth technology",
keywords="digital health",
keywords="review",
keywords="mobile phone",
keywords="liver transplant",
keywords="liver disease",
keywords="scoping review",
abstract="Background: Liver transplantation has become increasingly common as a last-resort treatment for end-stage liver diseases and liver cancer, with continually improving success rates and long-term survival rates. Nevertheless, liver transplant recipients face lifelong challenges in self-management, including immunosuppressant therapy, lifestyle adjustments, and navigating complex health care systems. eHealth technologies hold the potential to aid and optimize self-management outcomes, but their adoption has been slow in this population due to the complexity of post--liver transplant management. Objective: This study aims to examine the use of eHealth technologies in supporting self-management for liver transplant recipients and identify their benefits and challenges to suggest areas for further research. Methods: Following the Arksey and O'Malley methodology for scoping reviews, we conducted a systematic search of 5 electronic databases: PubMed, CINAHL, Embase, PsycINFO, and Web of Science. We included studies that (1) examined or implemented eHealth-based self-management, (2) included liver transplant recipients aged ?18 years, and (3) were published in a peer-reviewed journal. We excluded studies that (1) were case reports, conference abstracts, editorials, or letters; (2) did not focus on the posttransplantation phase; (3) did not focus on self-management; and (4) did not incorporate the concept of eHealth or used technology solely for data collection. The quality of the selected eHealth interventions was evaluated using (1) the Template for Intervention Description and Replication guidelines and checklist and (2) the 5 core self-management skills identified by Lorig and Holman. Results: Of 1461 articles, 15 (1.03\%) studies were included in the final analysis. Our findings indicate that eHealth-based self-management strategies for adult liver transplant recipients primarily address lifestyle management, medication adherence, and remote monitoring, highlighting a notable gap in alcohol relapse interventions. The studies used diverse technologies, including mobile apps, videoconferencing, and telehealth platforms, but showed limited integration of decision-making or resource use skills essential for comprehensive self-management. The reviewed studies highlighted the potential of eHealth in enhancing individualized health care, but only a few included collaborative features such as 2-way communication or tailored goal setting. While adherence and feasibility were generally high in many interventions, their effectiveness varied due to diverse methodologies and outcome measures. Conclusions: This scoping review maps the current literature on eHealth-based self-management support for liver transplant recipients, assessing its potential and challenges. Future studies should focus on developing predictive models and personalized eHealth interventions rooted in patient-generated data, incorporating digital human-to-human interactions to effectively address the complex needs of liver transplant recipients. This review emphasizes the need for future eHealth self-management research to address the digital divide, especially with the aging liver transplant recipient population, and ensure more inclusive studies across diverse ethnicities and regions. ",
doi="10.2196/56664",
url="https://www.jmir.org/2024/1/e56664"
}


@Article{info:doi/10.2196/50186,
author="Ali, Suad
and Alizai, Hira
and Hagos, Jemal Delal
and Rubio, Ramos Sindy
and Calabia, Dale
and Serrano Jimenez, Penelope
and Senthil, Aarif Vinuu
and Appel, Lora",
title="mHealth Apps for Dementia, Alzheimer Disease, and Other Neurocognitive Disorders: Systematic Search and Environmental Scan",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jul",
day="3",
volume="12",
pages="e50186",
keywords="dementia",
keywords="Alzheimer disease",
keywords="mHealth",
keywords="mobile health",
keywords="apps",
keywords="lifestyle behaviors",
keywords="mobile phone",
abstract="Background: Lifestyle behaviors including exercise, sleep, diet, stress, mental stimulation, and social interaction significantly impact the likelihood of developing dementia. Mobile health (mHealth) apps have been valuable tools in addressing these lifestyle behaviors for general health and well-being, and there is growing recognition of their potential use for brain health and dementia prevention. Effective apps must be evidence-based and safeguard user data, addressing gaps in the current state of dementia-related mHealth apps. Objective: This study aims to describe the scope of available apps for dementia prevention and risk factors, highlighting gaps and suggesting a path forward for future development. Methods: A systematic search of mobile app stores, peer-reviewed literature, dementia and Alzheimer association websites, and browser searches was conducted from October 19, 2022, to November 2, 2022. A total of 1044 mHealth apps were retrieved. After screening, 152 apps met the inclusion criteria and were coded by paired, independent reviewers using an extraction framework. The framework was adapted from the Silberg scale, other scoping reviews of mHealth apps for similar populations, and background research on modifiable dementia risk factors. Coded elements included evidence-based and expert credibility, app features, lifestyle elements of focus, and privacy and security. Results: Of the 152 apps that met the final selection criteria, 88 (57.9\%) addressed modifiable lifestyle behaviors associated with reducing dementia risk. However, many of these apps (59/152, 38.8\%) only addressed one lifestyle behavior, with mental stimulation being the most frequently addressed. More than half (84/152, 55.2\%) scored 2 points out of 9 on the Silberg scale, with a mean score of 2.4 (SD 1.0) points. Most of the 152 apps did not disclose essential information: 120 (78.9\%) did not disclose expert consultation, 125 (82.2\%) did not disclose evidence-based information, 146 (96.1\%) did not disclose author credentials, and 134 (88.2\%) did not disclose their information sources. In addition, 105 (69.2\%) apps did not disclose adherence to data privacy and security practices. Conclusions: There is an opportunity for mHealth apps to support individuals in engaging in behaviors linked to reducing dementia risk. While there is a market for these products, there is a lack of dementia-related apps focused on multiple lifestyle behaviors. Gaps in the rigor of app development regarding evidence base, credibility, and adherence to data privacy and security standards must be addressed. Following established and validated guidelines will be necessary for dementia-related apps to be effective and advance successfully. ",
doi="10.2196/50186",
url="https://mhealth.jmir.org/2024/1/e50186"
}


@Article{info:doi/10.2196/54926,
author="G{\"o}rges, Matthias
and Sujan, Jonath
and West, C. Nicholas
and Sreepada, Syamala Rama
and Wood, D. Michael
and Payne, A. Beth
and Shetty, Swati
and Gelinas, P. Jean
and Sutherland, M. Ainsley",
title="Postsurgical Pain Risk Stratification to Enhance Pain Management Workflow in Adult Patients: Design, Implementation, and Pilot Evaluation",
journal="JMIR Perioper Med",
year="2024",
month="Jul",
day="2",
volume="7",
pages="e54926",
keywords="patient-oriented research",
keywords="patient-reported outcome measures",
keywords="risk prediction",
keywords="pain",
keywords="individualized risk",
keywords="surgery",
keywords="anesthesia",
keywords="opioid analgesia",
keywords="short-term opioid use",
keywords="care planning",
keywords="digital health platforms",
abstract="Background: Exposure to opioids after surgery is the initial contact for some people who develop chronic opioid use disorder. Hence, effective postoperative pain management, with less reliance on opioids, is critical. The Perioperative Opioid Quality Improvement (POQI) program developed (1) a digital health platform leveraging patient-survey-reported risk factors and (2) a postsurgical pain risk stratification algorithm to personalize perioperative care by integrating several commercially available digital health solutions into a combined platform. Development was reduced in scope by the COVID-19 pandemic. Objective: This pilot study aims to assess the screening performance of the risk algorithm, quantify the use of the POQI platform, and evaluate clinicians' and patients' perceptions of its utility and benefit. Methods: A POQI platform prototype was implemented in a quality improvement initiative at a Canadian tertiary care center and evaluated from January to September 2022. After surgical booking, a preliminary risk stratification algorithm was applied to health history questionnaire responses. The estimated risk guided the patient assignment to a care pathway based on low or high risk for persistent pain and opioid use. Demographic, procedural, and medication administration data were extracted retrospectively from the electronic medical record. Postoperative inpatient opioid use of >90 morphine milligram equivalents per day was the outcome used to assess algorithm performance. Data were summarized and compared between the low- and high-risk groups. POQI use was assessed by completed surveys on postoperative days 7, 14, 30, 60, 90, and 120. Semistructured patient and clinician interviews provided qualitative feedback on the platform. Results: Overall, 276 eligible patients were admitted for colorectal procedures. The risk algorithm stratified 203 (73.6\%) as the low-risk group and 73 (26.4\%) as the high-risk group. Among the 214 (77.5\%) patients with available data, high-risk patients were younger than low-risk patients (age: median 53, IQR 40-65 years, vs median 59, IQR 49-69 years, median difference five years, 95\% CI 1-9; P=.02) and were more often female patients (45/73, 62\% vs 80/203, 39.4\%; odds ratio 2.5, 95\% CI 1.4-4.5; P=.002). The risk stratification was reasonably specific (true negative rate=144/200, 72\%) but not sensitive (true positive rate=10/31, 32\%). Only 39.7\% (85/214) patients completed any postoperative quality of recovery questionnaires (only 14, 6.5\% patients beyond 60 days after surgery), and 22.9\% (49/214) completed a postdischarge medication survey. Interviewed participants welcomed the initiative but noted usability issues and poor platform education. Conclusions: An initial POQI platform prototype was deployed operationally; the risk algorithm had reasonable specificity but poor sensitivity. There was a significant loss to follow-up in postdischarge survey completion. Clinicians and patients appreciated the potential impact of preemptively addressing opioid exposure but expressed shortcomings in the platform's design and implementation. Iterative platform redesign with additional features and reevaluation are required before broader implementation. ",
doi="10.2196/54926",
url="https://periop.jmir.org/2024/1/e54926"
}


@Article{info:doi/10.2196/57863,
author="Buis, R. Lorraine
and Kim, Junhan
and Sen, Ananda
and Chen, Dongru
and Dawood, Katee
and Kadri, Reema
and Muladore, Rachelle
and Plegue, Melissa
and Richardson, R. Caroline
and Djuric, Zora
and McNaughton, Candace
and Hutton, David
and Robert, P. Lionel
and Park, Young Sun
and Levy, Phillip",
title="The Effect of an mHealth Self-Monitoring Intervention (MI-BP) on Blood Pressure Among Black Individuals With Uncontrolled Hypertension: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jun",
day="28",
volume="12",
pages="e57863",
keywords="blood pressure",
keywords="hypertension",
keywords="mobile health",
keywords="mHealth",
keywords="mobile phone",
keywords="smartphone",
abstract="Background: Hypertension is one of the most important cardiovascular disease risk factors and affects >100 million American adults. Hypertension-related health inequities are abundant in Black communities as Black individuals are more likely to use the emergency department (ED) for chronic disease--related ambulatory care, which is strongly linked to lower blood pressure (BP) control, diminished awareness of hypertension, and adverse cardiovascular events. To reduce hypertension-related health disparities, we developed MI-BP, a culturally tailored multibehavior mobile health intervention that targeted behaviors of BP self-monitoring, physical activity, sodium intake, and medication adherence in Black individuals with uncontrolled hypertension recruited from ED and community-based settings. Objective: We sought to determine the effect of MI-BP on BP as well as secondary outcomes of physical activity, sodium intake, medication adherence, and BP control compared to enhanced usual care control at 1-year follow-up. Methods: We conducted a 1-year, 2-group randomized controlled trial of the MI-BP intervention compared to an enhanced usual care control group where participants aged 25 to 70 years received a BP cuff and hypertension-related educational materials. Participants were recruited from EDs and other community-based settings in Detroit, Michigan, where they were screened for initial eligibility and enrolled. Baseline data collection and randomization occurred approximately 2 and 4 weeks after enrollment to ensure that participants had uncontrolled hypertension and were willing to take part. Data collection visits occurred at 13, 26, 39, and 52 weeks. Outcomes of interest included BP (primary outcome) and physical activity, sodium intake, medication adherence, and BP control (secondary outcomes). Results: We obtained consent from and enrolled 869 participants in this study yet ultimately randomized 162 (18.6\%) participants. At 1 year, compared to the baseline, both groups showed significant decreases in systolic BP (MI-BP group: 22.5 mm?Hg decrease in average systolic BP and P<.001; control group: 24.1 mm?Hg decrease and P<.001) adjusted for age and sex, with no significant differences between the groups (time-by-arm interaction: P=.99). Similar patterns where improvements were noted in both groups yet no differences were found between the groups were observed for diastolic BP, physical activity, sodium intake, medication adherence, and BP control. Large dropout rates were observed in both groups (approximately 60\%). Conclusions: Overall, participants randomized to both the enhanced usual care control and MI-BP conditions experienced significant improvements in BP and other outcomes; however, differences between groups were not detected, speaking to the general benefit of proactive outreach and engagement focused on cardiometabolic risk reduction in urban-dwelling, low-socioeconomic-status Black populations. High dropout rates were found and are likely to be expected when working with similar populations. Future work is needed to better understand engagement with mobile health interventions, particularly in this population. Trial Registration: ClinicalTrials.gov NCT02955537; https://clinicaltrials.gov/study/NCT02955537 International Registered Report Identifier (IRRID): RR2-10.2196/12601 ",
doi="10.2196/57863",
url="https://mhealth.jmir.org/2024/1/e57863"
}


@Article{info:doi/10.2196/56196,
author="Mercadal-Orfila, Gabriel
and Herrera-P{\'e}rez, Salvador
and Piqu{\'e}, N{\'u}ria
and Mateu-Amengual, Francesc
and Ventayol-Bosch, Pedro
and Maestre-Fullana, Antonia Mar{\'i}a
and Serrano-L{\'o}pez de las Hazas, Ignacio Joaqu{\'i}n
and Fern{\'a}ndez-Cort{\'e}s, Francisco
and Barcel{\'o}-Sans{\'o}, Francesc
and Rios, Santiago",
title="Implementing Systematic Patient-Reported Measures for Chronic Conditions Through the Naveta Value-Based Telemedicine Initiative: Observational Retrospective Multicenter Study",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jun",
day="28",
volume="12",
pages="e56196",
keywords="chronic conditions",
keywords="eHealth",
keywords="value-based care",
keywords="patient-reported outcome measures",
keywords="patient-reported experience measures",
keywords="questionnaires",
keywords="response rate",
keywords="telemedicine platform",
abstract="Background: Patient-reported outcome and experience measures can play a critical role in providing patient-centered and value-based health care to a growing population of patients who are chronically ill. Value-based telemedicine platforms such as the Naveta initiative may facilitate the effective integration of these tools into health care systems. Objective: This study aims to evaluate the response rate to electronic patient-reported outcome measures (ePROMs) and electronic patient-reported experience measures (ePREMs) among patients participating in the Naveta telemedicine initiative and its correlations with sociodemographic and clinical characteristics, as well as the evolution of the response rates over time. Methods: Between January 1, 2021, and June 30, 2023, a total of 53,364 ePREMs and ePROMs for 20 chronic conditions were administered through the Naveta-Phemium platform. Descriptive statistics were used to summarize continuous and categorical variables. Differences in response rates within each sociodemographic variable were analyzed using logistic regression models, with significance assessed via chi-square and post hoc Tukey tests. Two-way ANOVA was used to examine the interaction between time interval and disease type on response rate evolution. Results: A total of 3372 patients with severe chronic diseases from 64 public hospitals in Spain participated in the Naveta health questionnaire project. The overall response rate to ePROMs and ePREMs during the first 2.5 years of the Naveta initiative was 46.12\% (24,704/53,364), with a baseline rate of 53.33\% (7198/13,496). Several sociodemographic factors correlated with lower response rates, including male gender, older age, lower education level, frequent alcohol use, being a student, and not being physically active. There were also significant variations in response rates among different types of chronic conditions (P<.001), with the highest rates being for respiratory (433/606, 71.5\%), oncologic (200/319, 62.7\%), digestive (2247/3601, 62.4\%), and rheumatic diseases (7506/12,982, 57.82\%) and the lowest being for HIV infection (7473/22,695, 32.93\%). During the first 6 months of follow-up, the response rates decreased in all disease types, except in the case of the group of patients with oncologic disease, among whom the response rate increased up to 100\% (6/6). Subsequently, the overall response rate approached baseline levels. Conclusions: Recognizing the influence of sociodemographic factors on response rates is critical to identifying barriers to participation in telemonitoring programs and ensuring inclusiveness in patient-centered health care practices. The observed decline in response rates at follow-up may be due to survey fatigue, highlighting the need for strategies to mitigate this effect. In addition, the variation in response rates across chronic conditions emphasizes the importance of tailoring telemonitoring approaches to specific patient populations. ",
doi="10.2196/56196",
url="https://mhealth.jmir.org/2024/1/e56196",
url="http://www.ncbi.nlm.nih.gov/pubmed/38545697"
}


@Article{info:doi/10.2196/55361,
author="Gerald Dcruz, Julian
and Yeh, Paichang",
title="The Accuracy of Pulse Oxygen Saturation, Heart Rate, Blood Pressure, and Respiratory Rate Raised by a Contactless Telehealth Portal: Validation Study",
journal="JMIR Form Res",
year="2024",
month="Jun",
day="28",
volume="8",
pages="e55361",
keywords="medical devices",
keywords="mHealth",
keywords="vital signs",
keywords="measurements validity",
keywords="validation",
keywords="validity",
keywords="device",
keywords="devices",
keywords="vital",
keywords="vitals",
keywords="accuracy",
keywords="pulse",
keywords="oxygen",
keywords="saturation",
keywords="heart rate",
keywords="blood pressure",
keywords="respiration",
keywords="respiratory",
keywords="telehealth",
keywords="telemedicine",
keywords="eHealth",
keywords="e-health",
keywords="self-check",
keywords="self-checker",
keywords="breathing",
keywords="portal",
keywords="portals",
keywords="self-checking",
keywords="self-monitor",
keywords="self-monitoring",
abstract="Background: The traditional measurement of heart rate (HR), oxygen saturation (SpO2), blood pressure (BP), and respiratory rate (RR) via physical examination can be challenging, and the recent pandemic has accelerated trends toward telehealth and remote monitoring. Instead of going to the physician to check these vital signs, measuring them at home would be more convenient. Vital sign monitors, also known as physiological parameter monitors, are electronic devices that measure and display biological information about patients under constant monitoring. Objective: The purpose of this study was to validate the accuracy of the pulse SpO2, HR, BP, and RR raised by Docsun Telehealth Portal by comparing it with approved medical devices. Methods: This is a noninvasive, self-check, system-based study conducted to validate the detection of vital signs (SpO2, HR, BP, and RR) raised by Docsun Telehealth Portal. The input for software processing involves facial screening without any accessories on the face, scanning directly through the software application portal. The participant's facial features are detected and screened for the extraction of necessary readings. Results: For the validation of HR, SpO2, BP, and RR measurements, the main outcomes were the mean of the absolute difference between the respective investigational devices and the reference values as well as the absolute percentage difference between the respective investigational devices and the reference values. If the HR was within {\textpm}10\% of the reference standard or 5 beats per minute, it was considered acceptable for clinical purposes. The average absolute difference between the Docsun Telehealth Portal and the reference values was 1.41 (SD 1.14) beats per minute. The mean absolute percentage difference was 1.69\% (SD 1.37). Therefore, the Docsun Telehealth Portal met the predefined accuracy cutoff for HR measurements. If the RR was within {\textpm}10\% of the reference standard or 3 breaths per minute, it was considered acceptable for clinical purposes. The average absolute difference between the Docsun Telehealth Portal and the reference values was 0.86 breaths per minute. The mean absolute percentage difference was 4.72\%. Therefore, the Docsun Telehealth Portal met the predefined accuracy cutoff for RR measurements. SpO2 levels were considered acceptable if the average absolute difference between the Docsun Telehealth Portal and the reference values was {\textpm}3\%. The mean absolute percentage difference was 0.59\%. Therefore, the Docsun Telehealth Portal met the predefined accuracy cutoff for SpO2 measurements. The Docsun Telehealth Portal predicted systolic BP with an accuracy of 94.81\% and diastolic BP with an accuracy of 95.71\%. Conclusions: The results of the study show that the accuracy of the HR, BP, SpO2, and RR values raised by the Docsun Telehealth Portal, compared against the clinically approved medical devices, proved to be accurate by meeting predefined accuracy guidelines. ",
doi="10.2196/55361",
url="https://formative.jmir.org/2024/1/e55361",
url="http://www.ncbi.nlm.nih.gov/pubmed/38598698"
}


@Article{info:doi/10.2196/57404,
author="Bass, Alec
and G{\'e}phine, Sarah
and Martin, Micka{\"e}l
and Belley, Marianne
and Robic, Manon
and Fabre, Claudine
and Grosbois, Jean-Marie
and Dion, Genevi{\`e}ve
and Saey, Didier
and Chambellan, Arnaud
and Maltais, Fran{\c{c}}ois",
title="Assessing Functional Capacity in Directly and Remotely Monitored Home-Based Settings in Individuals With Chronic Respiratory Diseases: Protocol for a Multinational Validation Study",
journal="JMIR Res Protoc",
year="2024",
month="Jun",
day="28",
volume="13",
pages="e57404",
keywords="chronic obstructive pulmonary disease",
keywords="COPD",
keywords="exercise capacity test",
keywords="interstitial lung diseases",
keywords="physiotherapy",
keywords="rehabilitation",
keywords="telerehabilitation",
keywords="validation study",
keywords="stepper test",
abstract="Background: Pulmonary rehabilitation is widely recommended to improve functional status and as secondary and tertiary prevention in individuals with chronic pulmonary diseases. Unfortunately, access to timely and appropriate rehabilitation remains limited. To help close this inaccessibility gap, telerehabilitation has been proposed. However, exercise testing is necessary for effective and safe exercise prescription. Current gold-standard tests, such as maximal cardiopulmonary exercise testing (CPET) and the 6-minute walk test (6MWT), are poorly adapted to home-based or telerehabilitation settings. This was an obstacle to the continuity of services during the COVID-19 pandemic. It is essential to validate tests adapted to these new realities, such as the 6-minute stepper test (6MST). This test, strongly inspired by 6MWT, consists of taking as many steps as possible on a ``stepper'' for 6 minutes. Objective: This study aims to evaluate the metrological qualities of 6MST by (1) establishing concurrent validity and agreement between the 6MST and CPET, as well as with the 6MWT; (2) determining test-retest reliability in a home-based setting with direct and remote (videoconferencing) monitoring; and (3) documenting adverse events and participant perspectives when performing the 6MST in home-based settings. Methods: Three centers (Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Qu{\'e}bec in Qu{\'e}bec, Groupement des H{\^o}pitaux de l'Institut Catholique de Lille in France, and FormAction Sant{\'e} in France) will be involved in this multinational project, which is divided into 2 studies. For study 1 (objective 1), 30 participants (Qu{\'e}bec, n=15; France, n=15) will be recruited. Two laboratory visits will be performed to assess anthropometric data, pulmonary function, and the 3 exercise tolerance tests (CPET, 6MWT, and 6MST). Concurrent validity (paired sample t tests and Pearson correlations) and agreement (Bland-Altman plots with 95\% agreement limits) will be evaluated. For study 2 (objectives 2 and 3), 52 participants (Qu{\'e}bec, n=26; France, n=26) will be recruited. Following a familiarization trial (trial 1), the 6MST will be conducted on 2 separate occasions (trials 2 and 3), once under direct supervision and once under remote supervision, in a randomized order. Paired sample t test, Bland-Altman plots, and intraclass correlations will be used to compare trials 2 and 3. A semistructured interview will be conducted after the third trial to collect participants' perspectives. Results: Ethical approval was received for this project (October 12, 2023, in Qu{\'e}bec and September 25, 2023, in France) and the first participant was recruited in February 2024. Conclusions: This study innovates by validating a new clinical test necessary for the development and implementation of new models of rehabilitation adapted to home and telerehabilitation contexts. This study also aligns with the United Nations Sustainable Development Goals by contributing to augmenting health care service delivery (goal 3) and reducing health care access inequalities (goal 11). Trial Registration: ClinicalTrials.gov NCT06447831; https://clinicaltrials.gov/study/NCT06447831 International Registered Report Identifier (IRRID): DERR1-10.2196/57404 ",
doi="10.2196/57404",
url="https://www.researchprotocols.org/2024/1/e57404",
url="http://www.ncbi.nlm.nih.gov/pubmed/38941132"
}


@Article{info:doi/10.2196/58503,
author="LoCastro, Marissa
and Wang, Ying
and Yu, Tristan
and Mortaz-Hedjri, Soroush
and Mendler, Jason
and Norton, Sally
and Bernacki, Rachelle
and Carroll, Thomas
and Klepin, Heidi
and Wedow, Lucy
and Goonan, Sean
and Erdos, Hannah
and Bagnato, Brenda
and Liesveld, Jane
and Huselton, Eric
and Kluger, Benzi
and Loh, Poh Kah",
title="Clinicians' Perspectives on the Telehealth Serious Illness Care Program for Older Adults With Myeloid Malignancies: Single-Arm Pilot Study",
journal="JMIR Form Res",
year="2024",
month="Jun",
day="27",
volume="8",
pages="e58503",
keywords="serious illness conversations",
keywords="serious illness conversation",
keywords="SIC",
keywords="Serious Illness Care Program",
keywords="SICP",
keywords="hematologic malignancy",
keywords="geriatric oncology",
keywords="acute myeloid leukemia",
keywords="AML",
keywords="myelodysplastic syndrome",
keywords="MDS",
keywords="cancer",
keywords="oncology",
keywords="oncologist",
keywords="oncologists",
keywords="metastases",
keywords="telemedicine",
keywords="telehealth",
keywords="tele-medicine",
keywords="tele-health",
abstract="Background: Serious illness conversations may help patients avoid unwanted treatments. We previously piloted the telehealth Serious Illness Care Program (SICP) for older adults with acute myeloid leukemia and myelodysplastic syndrome. Objective: In this study, we aimed to understand the experience of the telehealth SICP from the clinician's perspective. Methods: We studied 10 clinicians who delivered the telehealth SICP to 20 older adults with acute myeloid leukemia or myelodysplastic syndrome. Quantitative outcomes included confidence and acceptability. Confidence was measured using a 22-item survey (range 1-7; a higher score is better). Acceptability was measured using an 11-item survey (5-point Likert scale). Hypothesis testing was performed at $\alpha$=.10 (2-tailed) due to the pilot nature and small sample size. Clinicians participated in audio-recorded qualitative interviews at the end of the study to discuss their experience. Results: A total of 8 clinicians completed the confidence measure and 7 clinicians completed the acceptability measure. We found a statistically significant increase in overall confidence (mean increase of 0.5, SD 0.6; P=.03). The largest increase in confidence was in helping families with reconciliation and goodbye (mean 1.4, SD 1.5; P=.04). The majority of clinicians agreed that the format was simple (6/7, 86\%) and easy to use (6/7, 86\%). Clinicians felt that the telehealth SICP was effective in understanding their patients' values about end-of-life care (7/7, 100\%). A total of three qualitative themes emerged: (1) the telehealth SICP deepened relationships and renewed trust; (2) each telehealth SICP visit felt unique and personal in a positive way; and (3) uninterrupted, unrushed time optimized the visit experience. Conclusions: The telehealth SICP increased confidence in having serious illness conversations while deepening patient-clinician relationships. Trial Registration: ClinicalTrials.gov NCT04745676; https://www.clinicaltrials.gov/study/NCT04745676 ",
doi="10.2196/58503",
url="https://formative.jmir.org/2024/1/e58503",
url="http://www.ncbi.nlm.nih.gov/pubmed/38935428"
}


@Article{info:doi/10.2196/57519,
author="Bratches, R. Reed W.
and Cohen, Jeffrey
and Carpenter-Song, Elizabeth
and Mistler, Lisa
and Barr, J. Paul",
title="The Feasibility and Acceptability of Sharing Video Recordings of Amyotrophic Lateral Sclerosis Clinical Encounters With Patients and Their Caregivers: Pilot Randomized Clinical Trial",
journal="JMIR Form Res",
year="2024",
month="Jun",
day="26",
volume="8",
pages="e57519",
keywords="feasibility",
keywords="acceptability",
keywords="amyotrophic lateral sclerosis",
keywords="digital intervention",
keywords="ALS",
keywords="video recording",
abstract="Background: Multidisciplinary clinics (MDCs) provide benefits to patients with amyotrophic lateral sclerosis (ALS) and their caregivers, but MDC visits are information-heavy and can last 4 hours, with patients and caregivers meeting with multiple specialists within each MDC visit. There are questions about the effectiveness of current methods of sharing information from MDCs with patients. Video recordings are a promising new method of sharing information that may allow patients and caregivers to revisit the MDC and remind them of clinical recommendations and conversations. Objective: The objective of this trial is to determine the feasibility and acceptability of sharing information through video recordings of ALS MDC visits with patients and caregivers. Methods: This study was a randomized, controlled pilot trial with 3 months of follow-up from April 2021 to March 2022 in a rural multidisciplinary neurology clinic. We recruited patients with ALS, their caregivers, and their clinicians. Patients and their caregivers were randomized to either receive their normal after-visit summary (treatment as usual) or to receive their normal after-visit summary and a video recording of their MDC visit (video). Each specialist visit had its own recording and was accessible by patients and caregivers using a secure web-based platform called HealthPAL over a 3-month follow-up period. Primary study outcomes were feasibility and acceptability of the video intervention measured by recruitment rate (target: 70\%), percentage of participants watching videos (target: 75\%), and the Feasibility of Intervention Measure and Acceptability of Intervention Measure (targets: 3/5). We hypothesized that video recording would be feasible and acceptable to patients and their caregivers. Results: Of the 30 patients approached, 24 were recruited, while all caregivers (n=21) and clinicians (n=34) approached were recruited. A total of 144 specialist visits were recorded, approximately 12 specialist visits at a median of one MDC visit per patient. Of the recorded patients, 75\% (9/12) viewed videos. High median intervention feasibility (4, SD 0.99) and acceptability (4, SD 1.22) of intervention measures were reported by patients and caregivers in the intervention arm. High median intervention feasibility (5, SD 0.21) and acceptability (4.88, SD 0.4) were reported by clinicians. Of the 24 patients, 50\% (n=12) did not complete a 3-month follow-up, primarily due to death (n=10). Conclusions: Video recording is highly feasible and acceptable for patients, caregivers, and clinicians at a rural ALS clinic. Our level of attrition is a useful benchmark for future studies in MDC populations. Despite high rates of patient death, 1-week assessments highlight the value of recordings for both patients and caregivers. Trial Registration: ClinicalTrials.gov NCT04719403; https://clinicaltrials.gov/study/NCT04719403 ",
doi="10.2196/57519",
url="https://formative.jmir.org/2024/1/e57519"
}


@Article{info:doi/10.2196/53807,
author="Xu, Stanley
and Sy, S. Lina
and Hong, Vennis
and Holmquist, J. Kimberly
and Qian, Lei
and Farrington, Paddy
and Bruxvoort, J. Katia
and Klein, P. Nicola
and Fireman, Bruce
and Han, Bing
and Lewin, J. Bruno",
title="Ischemic Stroke After Bivalent COVID-19 Vaccination: Self-Controlled Case Series Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Jun",
day="25",
volume="10",
pages="e53807",
keywords="ischemic stroke",
keywords="bivalent COVID-19 vaccine",
keywords="influenza vaccine",
keywords="self-controlled case series",
keywords="coadministration",
keywords="ischemic",
keywords="stroke",
keywords="TIA",
keywords="transient ischemic attack",
keywords="ischemia",
keywords="cardiovascular",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="vaccine",
keywords="vaccines",
keywords="vaccination",
keywords="association",
keywords="correlation",
keywords="risk",
keywords="risks",
keywords="adverse",
keywords="side effect",
keywords="subgroup analyses",
keywords="subgroup analysis",
keywords="bivalent",
keywords="influenza",
keywords="infectious",
keywords="respiratory",
keywords="incidence",
keywords="case series",
abstract="Background: The potential association between bivalent COVID-19 vaccination and ischemic stroke remains uncertain, despite several studies conducted thus far. Objective: This study aimed to evaluate the risk of ischemic stroke following bivalent COVID-19 vaccination during the 2022-2023 season. Methods: A self-controlled case series study was conducted among members aged 12 years and older who experienced ischemic stroke between September 1, 2022, and March 31, 2023, in a large health care system. Ischemic strokes were identified using International Classification of Diseases, Tenth Revision codes in emergency departments and inpatient settings. Exposures were Pfizer-BioNTech or Moderna bivalent COVID-19 vaccination. Risk intervals were prespecified as 1-21 days and 1-42 days after bivalent vaccination; all non--risk-interval person-time served as the control interval. The incidence of ischemic stroke was compared in the risk interval and control interval using conditional Poisson regression. We conducted overall and subgroup analyses by age, history of SARS-CoV-2 infection, and coadministration of influenza vaccine. When an elevated risk was detected, we performed a chart review of ischemic strokes and analyzed the risk of chart-confirmed ischemic stroke. Results: With 4933 ischemic stroke events, we found no increased risk within the 21-day risk interval for the 2 vaccines and by subgroups. However, risk of ischemic stroke was elevated within the 42-day risk interval among individuals aged younger than 65 years with coadministration of Pfizer-BioNTech bivalent and influenza vaccines on the same day; the relative incidence (RI) was 2.13 (95\% CI 1.01-4.46). Among those who also had a history of SARS-CoV-2 infection, the RI was 3.94 (95\% CI 1.10-14.16). After chart review, the RIs were 2.34 (95\% CI 0.97-5.65) and 4.27 (95\% CI 0.97-18.85), respectively. Among individuals aged younger than 65 years who received Moderna bivalent vaccine and had a history of SARS-CoV-2 infection, the RI was 2.62 (95\% CI 1.13-6.03) before chart review and 2.24 (95\% CI 0.78-6.47) after chart review. Stratified analyses by sex did not show a significantly increased risk of ischemic stroke after bivalent vaccination. Conclusions: While the point estimate for the risk of chart-confirmed ischemic stroke was elevated in a risk interval of 1-42 days among individuals younger than 65 years with coadministration of Pfizer-BioNTech bivalent and influenza vaccines on the same day and among individuals younger than 65 years who received Moderna bivalent vaccine and had a history of SARS-CoV-2 infection, the risk was not statistically significant. The potential association between bivalent vaccination and ischemic stroke in the 1-42--day analysis warrants further investigation among individuals younger than 65 years with influenza vaccine coadministration and prior SARS-CoV-2 infection. Furthermore, the findings on ischemic stroke risk after bivalent COVID-19 vaccination underscore the need to evaluate monovalent COVID-19 vaccine safety during the 2023-2024 season. ",
doi="10.2196/53807",
url="https://publichealth.jmir.org/2024/1/e53807",
url="http://www.ncbi.nlm.nih.gov/pubmed/38916940"
}


@Article{info:doi/10.2196/56074,
author="Podda, Jessica
and Tacchino, Andrea
and Ponzio, Michela
and Di Antonio, Federica
and Susini, Alessia
and Pedull{\`a}, Ludovico
and Battaglia, Alberto Mario
and Brichetto, Giampaolo",
title="Mobile Health App (DIGICOG-MS) for Self-Assessment of Cognitive Impairment in People With Multiple Sclerosis: Instrument Validation and Usability Study",
journal="JMIR Form Res",
year="2024",
month="Jun",
day="20",
volume="8",
pages="e56074",
keywords="cognitive assessment",
keywords="cognitive impairment",
keywords="digital health",
keywords="mHealth app",
keywords="multiple sclerosis",
keywords="self-management",
keywords="usability",
abstract="Background: Mobile health (mHealth) apps have proven useful for people with multiple sclerosis (MS). Thus, easy-to-use digital solutions are now strongly required to assess and monitor cognitive impairment, one of the most disturbing symptoms in MS that is experienced by almost 43\% to 70\% of people with MS. Therefore, we developed DIGICOG-MS (Digital assessment of Cognitive Impairment in Multiple Sclerosis), a smartphone- and tablet-based mHealth app to self-assess cognitive impairment in MS. Objective: This study aimed to test the validity and usability of the novel mHealth app with a sample of people with MS. Methods: DIGICOG-MS includes 4 digital tests assumed to evaluate the most affected cognitive domains in MS (visuospatial memory [VSM], verbal memory [VM], semantic fluency [SF], and information processing speed [IPS]) and inspired by traditional paper-based tests that assess the same cognitive functions (10/36 Spatial Recall Test, Rey Auditory Verbal Learning Test, Word List Generation, Symbol Digit Modalities Test). Participants were asked to complete both digital and traditional assessments in 2 separate sessions. Convergent validity was analyzed using the Pearson correlation coefficient to determine the strength of the associations between digital and traditional tests. To test the app's reliability, the agreement between 2 repeated measurements was assessed using intraclass correlation coefficients (ICCs). Usability of DIGICOG-MS was evaluated using the System Usability Scale (SUS) and mHealth App Usability Questionnaire (MAUQ) administered at the conclusion of the digital session. Results: The final sample consisted of 92 people with MS (60 women) followed as outpatients at the Italian Multiple Sclerosis Society (AISM) Rehabilitation Service of Genoa (Italy). They had a mean age of 51.38 (SD 11.36) years, education duration of 13.07 (SD 2.74) years, disease duration of 12.91 (SD 9.51) years, and a disability level (Expanded Disability Status Scale) of 3.58 (SD 1.75). Relapsing-remitting MS was most common (68/92, 74\%), followed by secondary progressive (15/92, 16\%) and primary progressive (9/92, 10\%) courses. Pearson correlation analyses indicated significantly strong correlations for VSM, VM, SF, and IPS (all P<.001), with r values ranging from 0.58 to 0.78 for all cognitive domains. Test-retest reliability of the mHealth app was excellent (ICCs>0.90) for VM and IPS and good for VSM and SF (ICCs>0.80). Moreover, the SUS score averaged 84.5 (SD 13.34), and the mean total MAUQ score was 104.02 (SD 17.69), suggesting that DIGICOG-MS was highly usable and well appreciated. Conclusions: The DIGICOG-MS tests were strongly correlated with traditional paper-based evaluations. Furthermore, people with MS positively evaluated DIGICOG-MS, finding it highly usable. Since cognitive impairment poses major limitations for people with MS, these findings open new paths to deploy digital cognitive tests for MS and further support the use of a novel mHealth app for cognitive self-assessment by people with MS in clinical practice. ",
doi="10.2196/56074",
url="https://formative.jmir.org/2024/1/e56074",
url="http://www.ncbi.nlm.nih.gov/pubmed/38900535"
}


@Article{info:doi/10.2196/49978,
author="Xiao, Yi-Zhen
and Chen, Xiao-Jia
and Sun, Xiao-Ling
and Chen, Huan
and Luo, Yu-Xia
and Chen, Yuan
and Liang, Ye-Mei",
title="Effect of Implementing an Informatization Case Management Model on the Management of Chronic Respiratory Diseases in a General Hospital: Retrospective Controlled Study",
journal="JMIR Med Inform",
year="2024",
month="Jun",
day="19",
volume="12",
pages="e49978",
keywords="chronic disease management",
keywords="chronic respiratory disease",
keywords="hospital information system",
keywords="informatization",
keywords="information system",
keywords="respiratory",
keywords="pulmonary",
keywords="breathing",
keywords="implementation",
keywords="care management",
keywords="disease management",
keywords="chronic obstructive pulmonary disease",
keywords="case management",
abstract="Background: The use of chronic disease information systems in hospitals and communities plays a significant role in disease prevention, control, and monitoring. However, there are several limitations to these systems, including that the platforms are generally isolated, the patient health information and medical resources are not effectively integrated, and the ``Internet Plus Healthcare'' technology model is not implemented throughout the patient consultation process. Objective: The aim of this study was to evaluate the efficiency of the application of a hospital case management information system in a general hospital in the context of chronic respiratory diseases as a model case. Methods: A chronic disease management information system was developed for use in general hospitals based on internet technology, a chronic disease case management model, and an overall quality management model. Using this system, the case managers provided sophisticated inpatient, outpatient, and home medical services for patients with chronic respiratory diseases. Chronic respiratory disease case management quality indicators (number of managed cases, number of patients accepting routine follow-up services, follow-up visit rate, pulmonary function test rate, admission rate for acute exacerbations, chronic respiratory diseases knowledge awareness rate, and patient satisfaction) were evaluated before (2019?2020) and after (2021?2022) implementation of the chronic disease management information system. Results: Before implementation of the chronic disease management information system, 1808 cases were managed in the general hospital, and an average of 603 (SD 137) people were provided with routine follow-up services. After use of the information system, 5868 cases were managed and 2056 (SD 211) patients were routinely followed-up, representing a significant increase of 3.2 and 3.4 times the respective values before use (U=342.779; P<.001). With respect to the quality of case management, compared to the indicators measured before use, the achievement rate of follow-up examination increased by 50.2\%, the achievement rate of the pulmonary function test increased by 26.2\%, the awareness rate of chronic respiratory disease knowledge increased by 20.1\%, the retention rate increased by 16.3\%, and the patient satisfaction rate increased by 9.6\% (all P<.001), while the admission rate of acute exacerbation decreased by 42.4\% (P<.001) after use of the chronic disease management information system. Conclusions: Use of a chronic disease management information system improves the quality of chronic respiratory disease case management and reduces the admission rate of patients owing to acute exacerbations of their diseases. ",
doi="10.2196/49978",
url="https://medinform.jmir.org/2024/1/e49978"
}


@Article{info:doi/10.2196/50248,
author="Arshed, Muhammad
and Mahmud, Aidalina
and Minhat, Sakdiah Halimatus
and Lim, Ying Poh
and Zakar, Rubeena",
title="Effectiveness of a Multifaceted Mobile Health Intervention (Multi-Aid-Package) in Medication Adherence and Treatment Outcomes Among Patients With Hypertension in a Low- to Middle-Income Country: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jun",
day="19",
volume="12",
pages="e50248",
keywords="mobile health",
keywords="mHealth",
keywords="intervention",
keywords="medication adherence",
keywords="hypertension",
keywords="low- to middle-income country",
keywords="effectiveness",
keywords="randomized controlled trial",
keywords="Pakistan",
keywords="drug adherence",
keywords="tool",
keywords="mHealth module",
keywords="self-efficacy",
keywords="systolic blood pressure",
keywords="feedback",
abstract="Background: The high prevalence of uncontrolled hypertension in Pakistan is predominantly attributed to poor medication adherence. As more than 137 million people in Pakistan use cell phones, a suitable mobile health (mHealth) intervention can be an effective tool to overcome poor medication adherence. Objective: We sought to determine whether a novel mHealth intervention is useful in enhancing antihypertensive therapy adherence and treatment outcomes among patients with hypertension in a low- to middle-income country. Methods: A 6-month parallel, single-blinded, superiority randomized controlled trial recruited 439 patients with hypertension with poor adherence to antihypertensive therapy and access to smartphones. An innovative, multifaceted mHealth intervention (Multi-Aid-Package), based on the Health Belief Model and containing reminders (written, audio, visual), infographics, video clips, educational content, and 24/7 individual support, was developed for the intervention group; the control group received standard care. The primary outcome was self-reported medication adherence measured using the Self-Efficacy for Appropriate Medication Adherence Scale (SEAMS) and pill counting; the secondary outcome was systolic blood pressure (SBP) change. Both outcomes were evaluated at baseline and 6 months. Technology acceptance feedback was also assessed at the end of the study. A generalized estimating equation was used to control the covariates associated with the probability of affecting adherence to antihypertensive medication. Results: Of 439 participants, 423 (96.4\%) completed the study. At 6 months post intervention, the median SEAMS score was statistically significantly higher in the intervention group compared to the controls (median 32, IQR 11 vs median 21, IQR 6; U=10,490, P<.001). Within the intervention group, there was an increase in the median SEAMS score by 12.5 points between baseline and 6 months (median 19.5, IQR 5 vs median 32, IQR 11; P<.001). Results of the pill-counting method showed an increase in adherent patients in the intervention group compared to the controls (83/220, 37.2\% vs 2/219, 0.9\%; P<.001), as well as within the intervention group (difference of n=83, 37.2\% of patients, baseline vs 6 months; P<.001). There was a statistically significant difference in the SBP of 7 mmHg between the intervention and control groups (P<.001) at 6 months, a 4 mmHg reduction (P<.001) within the intervention group, and a 3 mmHg increase (P=.314) within the controls. Overall, the number of patients with uncontrolled hypertension decreased by 46 in the intervention group (baseline vs 6 months), but the control group remained unchanged. The variables groups (adjusted odds ratio [AOR] 1.714, 95\% CI 2.387-3.825), time (AOR 1.837, 95\% CI 1.625-2.754), and age (AOR 1.618, 95\% CI 0.225-1.699) significantly contributed (P<.001) to medication adherence. Multi-Aid-Package received a 94.8\% acceptability score. Conclusions: The novel Multi-Aid-Package is an effective mHealth intervention for enhancing medication adherence and treatment outcomes among patients with hypertension in a low- to middle-income country. Trial Registration: ClinicalTrials.gov NCT04577157; https://clinicaltrials.gov/study/NCT04577157 ",
doi="10.2196/50248",
url="https://mhealth.jmir.org/2024/1/e50248"
}


@Article{info:doi/10.2196/55751,
author="Porta, X{\`e}nia
and Nieto, Rub{\'e}n
and Serrat, Mayte
and Bourdin Kreitz, Pierre",
title="Perception of People Diagnosed With Fibromyalgia About Information and Communication Technologies for Chronic Pain Management: Cross-Sectional Survey Study",
journal="JMIR Form Res",
year="2024",
month="Jun",
day="18",
volume="8",
pages="e55751",
keywords="fibromyalgia",
keywords="chronic pain",
keywords="pain management",
keywords="information and communication technologies",
keywords="use",
keywords="satisfaction",
abstract="Background: Chronic pain is prevalent in our society, with conditions such as fibromyalgia being notably widespread. The gold standard for aiding individuals dealing with chronic pain involves interdisciplinary approaches rooted in a biopsychosocial perspective. Regrettably, access to such care is difficult for most of the people in need. Information and communication technologies (ICTs) have been used as a way of overcoming access barriers (among other advantages). Objective: This study addressed the little explored area of how individuals with fibromyalgia use and perceive different types of ICTs for pain management. Methods: A cross-sectional study was conducted using an online survey. This survey was created to assess the use of different ICT tools for pain management, satisfaction with the tools used, and perceived advantages and disadvantages. In addition, data collection encompassed sociodemographic variables and pain-related variables, pain intensity, the impact of pain on daily life activities, and fear of movement/injury beliefs. In total, 265 individuals diagnosed with fibromyalgia completed the survey. Results: Only 2 (0.75\%) participants reported not having used any ICT tool for pain management. Among those who used ICT tools, an average of 10.94 (SD 4.48) of 14 different tools were used, with the most used options being instant messaging apps, websites dedicated to managing fibromyalgia, phone calls with health professionals, and online multimedia resources. Satisfaction rates were relatively modest (mean 2.09, SD 0.38) on a scale from 0 to 5, with instant messaging apps, phone calls with health professionals, fibromyalgia management websites, and online multimedia resources being the ones with higher satisfaction. Participants appreciated the ability to receive treatment from home, access to specialized treatment, and using ICTs as a supplement to in-person interventions. However, they also highlighted drawbacks, such as a lack of close contact with health professionals, difficulty expressing emotions, and a lack of knowledge or resources to use ICTs. The use of ICTs was influenced by age and educational background. Additionally, there was a negative correlation between satisfaction with ICT tools and fear of movement/injury. Conclusions: People with fibromyalgia are prone to using ICTs for pain management, especially those tools that allow them to be in contact with health professionals and have access to online resources. However, there is still a need to improve ICT tools since satisfaction ratings are modest. Moreover, strategies aimed at older people, those with lower levels of education, and those with higher levels of fear of movement/injury can be useful to potentiate the use of ICTs among them. ",
doi="10.2196/55751",
url="https://formative.jmir.org/2024/1/e55751"
}


@Article{info:doi/10.2196/48605,
author="Shen, Hongxia
and van der Kleij, Rianne
and van der Boog, M. Paul J.
and Chavannes, H. Niels",
title="Developing a Tailored eHealth Self-Management Intervention for Patients With Chronic Kidney Disease in China: Intervention Mapping Approach",
journal="JMIR Form Res",
year="2024",
month="Jun",
day="13",
volume="8",
pages="e48605",
keywords="eHealth",
keywords="self-management",
keywords="intervention mapping",
keywords="chronic kidney disease",
keywords="intervention development",
keywords="mobile phone",
abstract="Background: Chronic kidney disease (CKD) is a major public health concern. Adequate self-management skills are vital to reduce CKD burden, optimize patient health outcomes, and control health care expenditures. Using eHealth to support CKD self-management has the potential to promote healthy behaviors and improve health outcomes of patients with CKD. However, knowledge of the implementation of such interventions in general, and in China specifically, is still limited. Objective: This study aims to develop a tailored eHealth self-management intervention for patients with CKD in China based on the Dutch Medical Dashboard (MD) eHealth self-management intervention. Methods: We used an intervention mapping approach. In phase 1, a systematic review and 2 qualitative studies were conducted to examine the needs, beliefs, and perceptions of patients with CKD and health care professionals regarding CKD self-management and eHealth interventions. Afterward, key factors gathered from the aforementioned studies were categorized following the 5 domains of the Consolidated Framework for Implementation Research (CFIR). In phase 2, we specified program outcomes, performance objectives, determinants, theory-based methods, and practical strategies. Knowledge obtained from previous results was combined to complement core components of the MD self-management intervention and adapt them for Chinese patients with CKD. Additionally, the CFIR--Expert Recommendations for Implementing Change Matching Tool was pragmatically used to generate a list of potential implementation strategies to address the key factors influencing the implementation of eHealth CKD self-management interventions, and implementation strategies were discussed and finalized with the intervention monitoring group. Results: An overview of the CFIR domains showed the essential factors influencing the implementation of eHealth CKD self-management interventions in Chinese settings, including ``knowledge and beliefs'' in the domain ``individual characteristics,'' ``quality and advantage of eHealth intervention'' in the domain ``intervention characteristics,'' ``compatibility'' in the domain ``inner setting,'' and ``cultural context'' in the domain ``outer setting.'' To ensure the effectiveness of the Dutch MD--based self-management intervention, we did not change the core self-management intervention components of MD that underlie its effectiveness, such as self-monitoring. We identified surface-level cultural adaptations involving customizing intervention content, messages, and approaches to the observable cultural characteristics of the local population to enhance the intervention's appeal, receptivity, and feasibility, such as providing video or voice call options to support interactions with health care professionals. Furthermore, the adapted modules such as Knowledge Center and My Self-Monitoring were developed in a mobile health app. Conclusions: Our study resulted in the delivery of a culturally tailored, standardized eHealth self-management intervention for patients with CKD in China that has the potential to optimize patients' self-management skills and improve health status and quality of life. Moreover, our study's research approach and results can inform future research on the tailoring and translation of evidence-based, eHealth self-management interventions to various contexts. Trial Registration: ClinicalTrials.gov NCT04212923; https://classic.clinicaltrials.gov/ct2/show/NCT04212923 ",
doi="10.2196/48605",
url="https://formative.jmir.org/2024/1/e48605",
url="http://www.ncbi.nlm.nih.gov/pubmed/38869943"
}


@Article{info:doi/10.2196/50224,
author="Geeraerts, Joran
and de Nooijer, Kim
and Pivodic, Lara
and De Ridder, Mark
and Van den Block, Lieve",
title="Intensive Longitudinal Methods Among Adults With Breast or Lung Cancer: Scoping Review",
journal="J Med Internet Res",
year="2024",
month="Jun",
day="12",
volume="26",
pages="e50224",
keywords="diary",
keywords="ecological momentary assessment",
keywords="neoplasms",
keywords="quality of life",
keywords="self-report",
keywords="telemedicine",
keywords="scoping review",
keywords="longitudinal methods",
keywords="breast cancer",
keywords="lung cancer",
keywords="patients with cancer",
keywords="cancer",
keywords="intensive monitoring",
keywords="advanced disease stages",
keywords="mobile phone",
abstract="Background: Intensive longitudinal methods offer a powerful tool for capturing daily experiences of individuals. However, its feasibility, effectiveness, and optimal methodological approaches for studying or monitoring experiences of oncology patients remain uncertain. Objective: This scoping review aims to describe to what extent intensive longitudinal methods with daily electronic assessments have been used among patients with breast or lung cancer and with which methodologies, associated outcomes, and influencing factors. Methods: We searched the electronic databases (PubMed, Embase, and PsycINFO) up to January 2024 and included studies reporting on the use of these methods among adults with breast or lung cancer. Data were extracted on population characteristics, intensive monitoring methodologies used, study findings, and factors influencing the implementation of these methods in research and clinical practice. Results: We identified 1311 articles and included 52 articles reporting on 41 studies. Study aims and intensive monitoring methodologies varied widely, but most studies focused on measuring physical and psychological symptom constructs, such as pain, anxiety, or depression. Compliance and attrition rates seemed acceptable for most studies, although complete methodological reporting was often lacking. Few studies specifically examined these methods among patients with advanced cancer. Factors influencing implementation were linked to both patient (eg, confidence with intensive monitoring system) and methodology (eg, option to use personal devices). Conclusions: Intensive longitudinal methods with daily electronic assessments hold promise to provide unique insights into the daily lives of patients with cancer. Intensive longitudinal methods may be feasible among people with breast or lung cancer. Our findings encourage further research to determine optimal conditions for intensive monitoring, specifically in more advanced disease stages. ",
doi="10.2196/50224",
url="https://www.jmir.org/2024/1/e50224",
url="http://www.ncbi.nlm.nih.gov/pubmed/38865186"
}


@Article{info:doi/10.2196/54579,
author="Delage, No{\'e}mie
and Cantagrel, Nathalie
and Soriot-Thomas, Sandrine
and Frost, Marie
and Deleens, Rodrigue
and Ginies, Patrick
and Eschalier, Alain
and Corteval, Alice
and Laveyssi{\`e}re, Alicia
and Phalip, Jules
and Bertin, C{\'e}lian
and Pereira, Bruno
and Chenaf, Chouki
and Doreau, Bastien
and Authier, Nicolas
and 
and Kerckhove, Nicolas",
title="Mobile Health App and Web Platform (eDOL) for Medical Follow-Up of Patients With Chronic Pain: Cohort Study Involving the French eDOL National Cohort After 1 Year",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jun",
day="12",
volume="12",
pages="e54579",
keywords="mHealth",
keywords="mobile health",
keywords="eHealth",
keywords="self-monitoring",
keywords="chronic pain",
keywords="observational study",
abstract="Background: Chronic pain affects approximately 30\% of the general population, severely degrades quality of life and professional life, and leads to additional health care costs. Moreover, the medical follow-up of patients with chronic pain remains complex and provides only fragmentary data on painful daily experiences. This situation makes the management of patients with chronic pain less than optimal and may partly explain the lack of effectiveness of current therapies. Real-life monitoring of subjective and objective markers of chronic pain using mobile health (mHealth) programs could better characterize patients, chronic pain, pain medications, and daily impact to help medical management. Objective: This cohort study aimed to assess the ability of our mHealth tool (eDOL) to collect extensive real-life medical data from chronic pain patients after 1 year of use. The data collected in this way would provide new epidemiological and pathophysiological data on chronic pain. Methods: A French national cohort of patients with chronic pain treated at 18 pain clinics has been established and followed up using mHealth tools. This cohort makes it possible to collect the determinants and repercussions of chronic pain and their evolutions in a real-life context, taking into account all environmental events likely to influence chronic pain. The patients were asked to complete several questionnaires, body schemes, and weekly meters, and were able to interact with a chatbot and use educational modules on chronic pain. Physicians could monitor their patients' progress in real time via an online platform. Results: The cohort study included 1427 patients and analyzed 1178 patients. The eDOL tool was able to collect various sociodemographic data; specific data for characterizing pain disorders, including body scheme; data on comorbidities related to chronic pain and its psychological and overall impact on patients' quality of life; data on drug and nondrug therapeutics and their benefit-to-risk ratio; and medical or treatment history. Among the patients completing weekly meters, 49.4\% (497/1007) continued to complete them after 3 months of follow-up, and the proportion stabilized at 39.3\% (108/275) after 12 months of follow-up. Overall, despite a fairly high attrition rate over the follow-up period, the eDOL tool collected extensive data. This amount of data will increase over time and provide a significant volume of health data of interest for future research involving the epidemiology, care pathways, trajectories, medical management, sociodemographic characteristics, and other aspects of patients with chronic pain. Conclusions: This work demonstrates that the mHealth tool eDOL is able to generate a considerable volume of data concerning the determinants and repercussions of chronic pain and their evolutions in a real-life context. The eDOL tool can incorporate numerous parameters to ensure the detailed characterization of patients with chronic pain for future research and pain management. Trial Registration: ClinicalTrials.gov NCT04880096; https://clinicaltrials.gov/ct2/show/NCT04880096 ",
doi="10.2196/54579",
url="https://mhealth.jmir.org/2024/1/e54579",
url="http://www.ncbi.nlm.nih.gov/pubmed/38865173"
}


@Article{info:doi/10.2196/52341,
author="Hou, Ling Qiao
and Liu, Yang Le
and Wu, Ying",
title="The Effects of mHealth Interventions on Quality of Life, Anxiety, and Depression in Patients With Coronary Heart Disease: Meta-Analysis of Randomized Controlled Trials",
journal="J Med Internet Res",
year="2024",
month="Jun",
day="11",
volume="26",
pages="e52341",
keywords="mobile health",
keywords="coronary heart disease",
keywords="quality of life",
keywords="anxiety",
keywords="depression",
keywords="meta-analysis",
keywords="mobile phone",
abstract="Background: Coronary heart disease (CHD) is the leading cause of death globally. In addition, 20\% to 40\% of the patients with CHD have comorbid mental health issues such as anxiety or depression, affecting the prognosis and quality of life (QoL). Mobile health (mHealth) interventions have been developed and are widely used; however, the evidence for the effects of mHealth interventions on QoL, anxiety, and depression in patients with CHD is currently ambiguous. Objective: In this study, we aimed to assess the effects of mHealth interventions on QoL, anxiety, and depression in patients with CHD. Methods: We searched the Cochrane Library, PubMed, Embase, CINAHL, Web of Science, China National Knowledge Infrastructure, and Wanfang databases from inception to August 12, 2023. Eligible studies were randomized controlled trials that involved patients with CHD who received mHealth interventions and that reported on QoL, anxiety, or depression outcomes. We used the Cochrane risk-of-bias tool for randomized trials to evaluate the risk of bias in the studies, ensuring a rigorous and methodologically sound analysis. Review Manager (desktop version 5.4; The Cochrane Collaboration) and Stata MP (version 17.0; StataCorp LLC) were used to conduct the meta-analysis. The effect size was calculated using the standardized mean difference (SMD) and its 95\% CI. Results: The meta-analysis included 23 studies (5406 participants in total) and showed that mHealth interventions significantly improved QoL in patients with CHD (SMD 0.49, 95\% CI 0.25-0.72; Z=4.07; P<.001) as well as relieved their anxiety (SMD ?0.46, 95\% CI ?0.83 to ?0.08; Z=2.38; P=.02) and depression (SMD ?0.34, 95\% CI ?0.56 to ?0.12; Z=3.00; P=.003) compared to usual care. The subgroup analyses indicated a significant effect favoring the mHealth intervention on reducing anxiety and depressive symptoms compared to usual care, especially when (1) the intervention duration was ?6 months (P=.04 and P=.001), (2) the mHealth intervention was a simple one (only 1 mHealth intervention was used) (P=.01 and P<.001), (3) it was implemented during the COVID-19 pandemic (P=.04 and P=.01), (4) it was implemented in low- or middle-income countries (P=.01 and P=.02), (5) the intervention focused on mental health (P=.01 and P=.007), and (6) adherence rates were high (?90\%; P=.03 and P=.002). In addition, comparing mHealth interventions to usual care, there was an improvement in QoL when (1) the mHealth intervention was a simple one (P<.001), (2) it was implemented in low- or middle-income countries (P<.001), and (3) the intervention focused on mental health (P<.001). Conclusions: On the basis of the existing evidence, mHealth interventions might be effective in improving QoL and reducing anxiety and depression in patients with CHD. However, large sample, high-quality, and rigorously designed randomized controlled trials are needed to provide further evidence. Trial Registration: PROSPERO CRD42022383858; https://tinyurl.com/3ea2npxf ",
doi="10.2196/52341",
url="https://www.jmir.org/2024/1/e52341",
url="http://www.ncbi.nlm.nih.gov/pubmed/38861710"
}


@Article{info:doi/10.2196/54642,
author="Wang, Panzhang
and Yu, Lei
and Li, Tao
and Zhou, Liang
and Ma, Xin",
title="Use of Mobile Technologies to Streamline Pretriage Patient Flow in the Emergency Department: Observational Usability Study",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jun",
day="7",
volume="12",
pages="e54642",
keywords="overcrowding",
keywords="overcrowded",
keywords="crowding",
keywords="smartphone",
keywords="queueing",
keywords="pretriage",
keywords="self-service",
keywords="triage",
keywords="emergency",
keywords="urgent",
keywords="ambulatory",
keywords="mHealth",
keywords="mobile health",
keywords="workflow",
keywords="health care management",
keywords="hospital",
abstract="Background: In emergency departments (EDs), triage nurses are under tremendous daily pressure to rapidly assess the acuity level of patients and log the collected information into computers. With self-service technologies, patients could complete data entry on their own, allowing nurses to focus on higher-order tasks. Kiosks are a popular working example of such self-service technologies; however, placing a sufficient number of unwieldy and fixed machines demands a spatial change in the greeting area and affects pretriage flow. Mobile technologies could offer a solution to these issues. Objective: The aim of this study was to investigate the use of mobile technologies to improve pretriage flow in EDs. Methods: The proposed stack of mobile technologies includes patient-carried smartphones and QR technology. The web address of the self-registration app is encoded into a QR code, which was posted directly outside the walk-in entrance to be seen by every ambulatory arrival. Registration is initiated immediately after patients or their proxies scan the code using their smartphones. Patients could complete data entry at any site on the way to the triage area. Upon completion, the result is saved locally on smartphones. At the triage area, the result is automatically decoded by a portable code reader and then loaded into the triage computer. This system was implemented in three busy metropolitan EDs in Shanghai, China. Both kiosks and smartphones were evaluated randomly while being used to direct pretriage patient flow. Data were collected during a 20-day period in each center. Timeliness and usability of medical students simulating ED arrivals were assessed with the After-Scenario Questionnaire. Usability was assessed by triage nurses with the Net Promoter Score (NPS). Observations made during system implementation were subject to qualitative thematic analysis. Results: Overall, 5928 of 8575 patients performed self-registration on kiosks, and 7330 of 8532 patients checked in on their smartphones. Referring effort was significantly reduced (43.7\% vs 8.8\%; P<.001) and mean pretriage waiting times were significantly reduced (4.4, SD 1.7 vs 2.9, SD 1.0 minutes; P<.001) with the use of smartphones compared to kiosks. There was a significant difference in mean usability scores for ``ease of task completion'' (4.4, SD 1.5 vs 6.7, SD 0.7; P<.001), ``satisfaction with completion time'' (4.5, SD 1.4 vs 6.8, SD 0.6; P<.001), and ``satisfaction with support'' (4.9, SD 1.9 vs 6.6, SD 1.2; P<.001). Triage nurses provided a higher NPS after implementation of mobile self-registration compared to the use of kiosks (13.3\% vs 93.3\%; P<.001). A modified queueing model was identified and qualitative findings were grouped by sequential steps. Conclusions: This study suggests patient-carried smartphones as a useful tool for ED self-registration. With increased usability and a tailored queueing model, the proposed system is expected to minimize pretriage waiting for patients in the ED. ",
doi="10.2196/54642",
url="https://mhealth.jmir.org/2024/1/e54642",
url="http://www.ncbi.nlm.nih.gov/pubmed/38848554"
}


@Article{info:doi/10.2196/50107,
author="Goerss, Doreen
and K{\"o}hler, Stefanie
and Rong, Eleonora
and Temp, Gesine Anna
and Kilimann, Ingo
and Bieber, Gerald
and Teipel, Stefan",
title="Smartwatch-Based Interventions for People With Dementia: User-Centered Design Approach",
journal="JMIR Aging",
year="2024",
month="Jun",
day="7",
volume="7",
pages="e50107",
keywords="assistive technology",
keywords="user-centered design",
keywords="usability",
keywords="dementia",
keywords="smartwatch",
keywords="mobile phone",
abstract="Background: Assistive technologies can help people living with dementia maintain their everyday activities. Nevertheless, there is a gap between the potential and use of these materials. Involving future users may help close this gap, but the impact on people with dementia is unclear. Objective: We aimed to determine if user-centered development of smartwatch-based interventions together with people with dementia is feasible. In addition, we evaluated the extent to which user feedback is plausible and therefore helpful for technological improvements. Methods: We examined the interactions between smartwatches and people with dementia or people with mild cognitive impairment. All participants were prompted to complete 2 tasks (drinking water and a specific cognitive task). Prompts were triggered using a smartphone as a remote control and were repeated up to 3 times if participants failed to complete a task. Overall, 50\% (20/40) of the participants received regular prompts, and 50\% (20/40) received intensive audiovisual prompts to perform everyday tasks. Participants' reactions were observed remotely via cameras. User feedback was captured via questionnaires, which included topics like usability, design, usefulness, and concerns. The internal consistency of the subscales was calculated. Plausibility was also checked using qualitative approaches. Results: Participants noted their preferences for particular functions and improvements. Patients struggled with rating using the Likert scale; therefore, we assisted them with completing the questionnaire. Usability (mean 78 out of 100, SD 15.22) and usefulness (mean 9 out of 12) were rated high. The smartwatch design was appealing to most participants (31/40, 76\%). Only a few participants (6/40, 15\%) were concerned about using the watch. Better usability was associated with better cognition. The observed success and self-rated task comprehension were in agreement for most participants (32/40, 80\%). In different qualitative analyses, participants' responses were, in most cases, plausible. Only 8\% (3/40) of the participants were completely unaware of their irregular task performance. Conclusions: People with dementia can have positive experiences with smartwatches. Most people with dementia provided valuable information. Developing assistive technologies together with people with dementia can help to prioritize the future development of functional and nonfunctional features. ",
doi="10.2196/50107",
url="https://aging.jmir.org/2024/1/e50107",
url="http://www.ncbi.nlm.nih.gov/pubmed/38848116"
}


@Article{info:doi/10.2196/53784,
author="Klein, R. Morgan
and Darnall, D. Beth
and You, S. Dokyoung",
title="Feasibility of Web-Based Single-Session Empowered Relief in Patients With Chronic Pain Taking Methadone or Buprenorphine: Protocol for a Single-Arm Trial",
journal="JMIR Res Protoc",
year="2024",
month="Jun",
day="6",
volume="13",
pages="e53784",
keywords="chronic pain",
keywords="opioid use disorder",
keywords="methadone",
keywords="buprenorphine",
keywords="behavioral medicine",
keywords="telehealth",
keywords="psychology",
abstract="Background: Chronic pain affects tens of millions of US adults and continues to rise in prevalence. Nonpharmacologic behavioral pain treatments are greatly needed and yet are often inaccessible, particularly in settings where medication prescribing is prioritized. Objective: This study aims to test the feasibility of a live-instructor, web-based 1-session pain relief skills class in an underserved and potentially at-risk population: people with chronic pain prescribed methadone or buprenorphine either solely for pain or for comorbid opioid use disorder (OUD). Methods: This is a national, prospective, single-arm, uncontrolled feasibility trial. The trial is untethered from medical care; to enhance participants' willingness to join the study, no medical records or drug-monitoring records are accessed. At least 45 participants will be recruited from outpatient pain clinics and from an existing research database of individuals who have chronic pain and are taking methadone or buprenorphine. Patient-reported measures will be collected at 6 time points (baseline, immediately post treatment, 2 weeks, and months 1-3) via a web-based platform, paper, or phone formats to include individuals with limited internet or computer access and low literacy skills. At baseline, participants complete demographic questions and 13 study measures (Treatment Expectations, Body Pain Map, Medication Use, Pain Catastrophizing Scale [PCS], Patient-Reported Outcomes Measurement Information System [PROMIS] Measures, and Opioid Craving Scale). Immediately post treatment, a treatment satisfaction and acceptability measure is administered on a 0 (very dissatisfied) to 10 (completely satisfied) scale, with 3 of these items being the primary outcome (perceived usefulness, participant satisfaction, and likelihood of using the skills). At each remaining time point, the participants complete all study measures minus treatment expectations and satisfaction. Participants who do not have current OUD will be assessed for historical OUD, with presence of OUD (yes or no), and history of OUD (yes or no) reported separately. Feasibility threshold is set as an overall group treatment satisfaction rating of 8 of 10. In-depth qualitative interviews will be conducted with about 10 participants to obtain additional data on patient perceptions, satisfactions, needs, and wants. To assess preliminary efficacy, we will examine changes in pain catastrophizing, pain intensity, pain bothersomeness, sleep disturbance, pain interference, depression, anxiety, physical function, global impression of change, and opioid craving at 1 month post treatment. Results: This project opened to enrollment in September 2021 and completed the recruitment in October 2023. The data collection was completed in February 2024. Results are expected to be published in late 2024. Conclusions: Results from this trial will inform the feasibility and preliminary efficacy of Empowered Relief in this population and will inform the design of a future randomized controlled trial testing web-based Empowered Relief in chronic pain and comorbid OUD. Trial Registration: ClinicalTrials.gov NCT05057988; https://clinicaltrials.gov/study/NCT05057988 International Registered Report Identifier (IRRID): DERR1-10.2196/53784 ",
doi="10.2196/53784",
url="https://www.researchprotocols.org/2024/1/e53784",
url="http://www.ncbi.nlm.nih.gov/pubmed/38843513"
}


@Article{info:doi/10.2196/48092,
author="Rzewuska D{\'i}az, Magdalena
and Locock, Louise
and Keen, Andrew
and Melvin, Mike
and Myhill, Anthony
and Ramsay, Craig",
title="Implementation of a Web-Based Outpatient Asynchronous Consultation Service: Mixed Methods Study",
journal="J Med Internet Res",
year="2024",
month="Jun",
day="4",
volume="26",
pages="e48092",
keywords="outpatient care",
keywords="teleconsultation",
keywords="asynchronous communication",
keywords="implementation",
keywords="mixed methods research",
keywords="qualitative research",
keywords="hospital data",
abstract="Background: Asynchronous outpatient patient-to-provider communication is expanding in UK health care, requiring evaluation. During the pandemic, Aberdeen Royal Infirmary in Scotland expanded its outpatient asynchronous consultation service from dermatology (deployed in May 2020) to gastroenterology and pain management clinics. Objective: We conducted a mixed methods study using staff, patient, and public perspectives and National Health Service (NHS) numerical data to obtain a rounded picture of innovation as it happened. Methods: Focus groups (3 web-based and 1 face-to-face; n=22) assessed public readiness for this service, and 14 interviews with staff focused on service design and delivery. The service's effects were examined using NHS Grampian service use data, a patient satisfaction survey (n=66), and 6 follow-up patient interviews. Survey responses were descriptively analyzed. Demographics, acceptability, nonattendance rates, and appointment outcomes of users were compared across levels of area deprivation in which they live and medical specialties. Interviews and focus groups underwent theory-informed thematic analysis. Results: Staff anticipated a simple technical system transfer from dermatology to other receptive medical specialties, but despite a favorable setting and organizational assistance, it was complicated. Key implementation difficulties included pandemic-induced technical integration delays, misalignment with existing administrative processes, and discontinuity in project management. The pain management clinic began asynchronous consultations (digital appointments) in December 2021, followed by the gastroenterology clinic in February 2022. Staff quickly learned how to explain and use this service. It was thought to function better for pain management as it fitted preexisting practices. From May to September 2022, the dermatology (adult and pediatric), gastroenterology, and pain management clinics offered 1709 appointments to a range of patients (n=1417). Digital appointments reduced travel by an estimated 44,712 miles ({\textasciitilde}71,956.81 km) compared to the face-to-face mode. The deprivation profile of people who chose to use this service closely mirrored that of NHS Grampian's population overall. There was no evidence that deprivation impacted whether digital appointment users subsequently received treatment. Only 18\% (12/66) of survey respondents were unhappy or very unhappy with being offered a digital appointment. The benefits mentioned included better access, convenience, decreased travel and waiting time, information sharing, and clinical flexibility. Overall, patients, the public, and staff recognized its potential as an NHS service but highlighted informed choice and flexibility. Better communication---including the use of the term assessment instead of appointment---may increase patient acceptance. Conclusions: Asynchronous pain management and gastroenterology consultations are viable and acceptable. Implementing this service is easiest when existing administrative processes face minimal disruption, although continuous support is needed. This study can inform practical strategies for supporting staff in adopting asynchronous consultations (eg, preparing for nonlinearity and addressing task issues). Patients need clear explanations and access to technical support, along with varied consultation options, to ensure digital inclusion. ",
doi="10.2196/48092",
url="https://www.jmir.org/2024/1/e48092",
url="http://www.ncbi.nlm.nih.gov/pubmed/38833695"
}


@Article{info:doi/10.2196/53964,
author="Eerdekens, Rob
and Zelis, Jo
and ter Horst, Herman
and Crooijmans, Caia
and van 't Veer, Marcel
and Keulards, Danielle
and Kelm, Marcus
and Archer, Gareth
and Kuehne, Titus
and Brueren, Guus
and Wijnbergen, Inge
and Johnson, Nils
and Tonino, Pim",
title="Cardiac Health Assessment Using a Wearable Device Before and After Transcatheter Aortic Valve Implantation: Prospective Study",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jun",
day="3",
volume="12",
pages="e53964",
keywords="aortic valve stenosis",
keywords="health watch",
keywords="quality of life",
keywords="heart",
keywords="cardiology",
keywords="cardiac",
keywords="aortic",
keywords="valve",
keywords="stenosis",
keywords="watch",
keywords="smartwatch",
keywords="wearables",
keywords="6MWT",
keywords="walking",
keywords="test",
keywords="QoL",
keywords="WHOQOL-BREF",
keywords="6-minute walking test",
abstract="Background: Due to aging of the population, the prevalence of aortic valve stenosis will increase drastically in upcoming years. Consequently, transcatheter aortic valve implantation (TAVI) procedures will also expand worldwide. Optimal selection of patients who benefit with improved symptoms and prognoses is key, since TAVI is not without its risks. Currently, we are not able to adequately predict functional outcomes after TAVI. Quality of life measurement tools and traditional functional assessment tests do not always agree and can depend on factors unrelated to heart disease. Activity tracking using wearable devices might provide a more comprehensive assessment. Objective: This study aimed to identify objective parameters (eg, change in heart rate) associated with improvement after TAVI for severe aortic stenosis from a wearable device. Methods: In total, 100 patients undergoing routine TAVI wore a Philips Health Watch device for 1 week before and after the procedure. Watch data were analyzed offline---before TAVI for 97 patients and after TAVI for 75 patients. Results: Parameters such as the total number of steps and activity time did not change, in contrast to improvements in the 6-minute walking test (6MWT) and physical limitation domain of the transformed WHOQOL-BREF questionnaire. Conclusions: These findings, in an older TAVI population, show that watch-based parameters, such as the number of steps, do not change after TAVI, unlike traditional 6MWT and QoL assessments. Basic wearable device parameters might be less appropriate for measuring treatment effects from TAVI. ",
doi="10.2196/53964",
url="https://mhealth.jmir.org/2024/1/e53964"
}


@Article{info:doi/10.2196/49617,
author="Cheng, Hui
and Jia, Zhihui
and Li, Ting Yu
and Yu, Xiao
and Wang, Ji Jia
and Xie, Jie Yao
and Hernandez, Jose
and Wang, X. Harry H.",
title="Metabolic Score for Insulin Resistance and New-Onset Type 2 Diabetes in a Middle-Aged and Older Adult Population: Nationwide Prospective Cohort Study and Implications for Primary Care",
journal="JMIR Public Health Surveill",
year="2024",
month="Jun",
day="3",
volume="10",
pages="e49617",
keywords="metabolic score for insulin resistance",
keywords="type 2 diabetes mellitus",
keywords="blood pressure",
keywords="longitudinal study",
keywords="primary care",
abstract="Background: The metabolic score for insulin resistance (METS-IR) has emerged as a noninsulin-based index for the approximation of insulin resistance (IR), yet longitudinal evidence supporting the utility of METS-IR in the primary prevention of type 2 diabetes mellitus (T2DM) remains limited. Objective: We aimed to investigate the longitudinal association between METS-IR, which combines fasting plasma glucose (FPG), lipid profiles, and anthropometrics that can be routinely obtained in resource-limited primary care settings, and the incidence of new-onset T2DM. Methods: We conducted a closed-cohort analysis of a nationwide, prospective cohort of 7583 Chinese middle-aged and older adults who were free of T2DM at baseline, sampled from 28 out of 31 provinces in China. We examined the characteristics of participants stratified by elevated blood pressure (BP) at baseline and new-onset T2DM at follow-up. We performed Cox proportional hazard regression analysis to explore associations of baseline METS-IR with incident T2DM in participants overall and in participants stratified by baseline BP. We also applied net reclassification improvement and integrated discrimination improvement to examine the incremental value of METS-IR. Results: During a mean follow-up period of 6.3 years, T2DM occurred in 527 participants, among which two-thirds (332/527, 62.9\%; 95\% CI 58.7\%-67.1\%) had baseline FPG<110 mg/dL. A SD unit increase in baseline METS-IR was associated with the first incidence of T2DM (adjusted hazard ratio [aHR] 1.33, 95\% CI 1.22-1.45; P<.001) in all participants. We obtained similar results in participants with normal baseline BP (aHR 1.41, 95\% CI 1.22-1.62; P<.001) and elevated baseline BP (aHR 1.29, 95\% CI 1.16-1.44; P<.001). The predictive capability for incident T2DM was improved by adding METS-IR to FPG. In study participants with new-onset T2DM whose baseline FPG was <126 mg/dL and <110 mg/dL, 62.9\% (332/527; 95\% CI 60\%-65.9\%) and 58.1\% (193/332; 95\% CI 54.3\%-61.9\%) of participants had baseline METS-IR above the cutoff values, respectively. Conclusions: METS-IR was significantly associated with new-onset T2DM, regardless of baseline BP level. Regular monitoring of METS-IR on top of routine blood glucose in clinical practice may add to the ability to enhance the early identification of primary care populations at risk for T2DM. ",
doi="10.2196/49617",
url="https://publichealth.jmir.org/2024/1/e49617",
url="http://www.ncbi.nlm.nih.gov/pubmed/38569189"
}


@Article{info:doi/10.2196/53411,
author="Kumwichar, Ponlagrit
and Prappre, Tagoon
and Chongsuvivatwong, Virasakdi",
title="Tuberculosis Treatment Compliance Under Smartphone-Based Video-Observed Therapy Versus Community-Based Directly Observed Therapy: Cluster Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jun",
day="3",
volume="12",
pages="e53411",
keywords="video-enhanced therapy",
keywords="tuberculosis",
keywords="health care system",
keywords="observed therapy",
keywords="treatment compliance",
keywords="lung disease",
keywords="randomized trial",
keywords="digital health",
keywords="telehealth",
keywords="telemedicine",
keywords="mobile phone",
abstract="Background: There are no recent studies comparing the compliance rates of both patients and observers in tuberculosis treatment between the video-observed therapy (VOT) and directly observed therapy (DOT) programs. Objective: This study aims to compare the average number of days that patients with pulmonary tuberculosis and their observers were compliant under VOT and DOT. In addition, this study aims to compare the sputum conversion rate of patients under VOT with that of patients under DOT. Methods: Patient and observer compliance with tuberculosis treatment between the VOT and DOT programs were compared based on the average number of VOT and DOT compliance days and sputum conversion rates in a 60-day cluster randomized controlled trial with patients with pulmonary tuberculosis (VOT: n=63 and DOT: n=65) with positive sputum acid-fast bacilli smears and 38 observers equally randomized into the VOT and DOT groups (19 observers per group and n=1-5 patients per observer). The VOT group submitted videos to observers via smartphones; the DOT group followed standard procedures. An intention-to-treat analysis assessed the compliance of both the patients and the observers. Results: The VOT group had higher average compliance than the DOT group (patients: mean difference 15.2 days, 95\% CI 4.8-25.6; P=.005 and observers: mean difference 21.2 days, 95\% CI 13.5-28.9; P<.001). The sputum conversion rates in the VOT and DOT groups were 73\% and 61.5\%, respectively (P=.17). Conclusions: Smartphone-based VOT significantly outperformed community-based DOT in ensuring compliance with tuberculosis treatment among observers. However, the study was underpowered to confirm improved compliance among patients with pulmonary tuberculosis and to detect differences in sputum conversion rates. Trial Registration: Thai Clinical Trials Registry (TCTR) TCTR20210624002; https://tinyurl.com/3bc2ycrh International Registered Report Identifier (IRRID): RR2-10.2196/38796 ",
doi="10.2196/53411",
url="https://mhealth.jmir.org/2024/1/e53411",
url="http://www.ncbi.nlm.nih.gov/pubmed/38830205"
}


@Article{info:doi/10.2196/50025,
author="MacNeill, Luke A.
and Doucet, Shelley
and Luke, Alison",
title="Effectiveness of a Mental Health Chatbot for People With Chronic Diseases: Randomized Controlled Trial",
journal="JMIR Form Res",
year="2024",
month="May",
day="30",
volume="8",
pages="e50025",
keywords="chatbot",
keywords="chronic disease",
keywords="arthritis",
keywords="diabetes",
keywords="mental health",
keywords="depression",
keywords="anxiety",
keywords="stress",
keywords="effectiveness",
keywords="application",
abstract="Background: People with chronic diseases tend to experience more mental health issues than their peers without these health conditions. Mental health chatbots offer a potential source of mental health support for people with chronic diseases. Objective: The aim of this study was to determine whether a mental health chatbot can improve mental health in people with chronic diseases. We focused on 2 chronic diseases in particular: arthritis and diabetes. Methods: Individuals with arthritis or diabetes were recruited using various web-based methods. Participants were randomly assigned to 1 of 2 groups. Those in the treatment group used a mental health chatbot app (Wysa [Wysa Inc]) over a period of 4 weeks. Those in the control group received no intervention. Participants completed measures of depression (Patient Health Questionnaire--9), anxiety (Generalized Anxiety Disorder Scale--7), and stress (Perceived Stress Scale--10) at baseline, with follow-up testing 2 and 4 weeks later. Participants in the treatment group completed feedback questions on their experiences with the app at the final assessment point. Results: A total of 68 participants (n=47, 69\% women; mean age 42.87, SD 11.27 years) were included in the analysis. Participants were divided evenly between the treatment and control groups. Those in the treatment group reported decreases in depression (P<.001) and anxiety (P<.001) severity over the study period. No such changes were found among participants in the control group. No changes in stress were reported by participants in either group. Participants with arthritis reported higher levels of depression (P=.004) and anxiety (P=.004) severity than participants with diabetes over the course of the study, as well as higher levels of stress (P=.01); otherwise, patterns of results were similar across these health conditions. In response to the feedback questions, participants in the treatment group said that they liked many of the functions and features of the app, the general design of the app, and the user experience. They also disliked some aspects of the app, with most of these reports focusing on the chatbot's conversational abilities. Conclusions: The results of this study suggest that mental health chatbots can be an effective source of mental health support for people with chronic diseases such as arthritis and diabetes. Although cost-effective and accessible, these programs have limitations and may not be well suited for all individuals. Trial Registration: ClinicalTrials.gov NCT04620668; https://www.clinicaltrials.gov/study/NCT04620668 ",
doi="10.2196/50025",
url="https://formative.jmir.org/2024/1/e50025",
url="http://www.ncbi.nlm.nih.gov/pubmed/38814681"
}


@Article{info:doi/10.2196/57668,
author="Shiyab, Wa'ed
and Rolls, Kaye
and Ferguson, Caleb
and Halcomb, Elizabeth",
title="Nurses' Use of mHealth Apps for Chronic Conditions: Cross-Sectional Survey",
journal="JMIR Nursing",
year="2024",
month="May",
day="29",
volume="7",
pages="e57668",
keywords="mHealth apps",
keywords="adoption",
keywords="smartphone",
keywords="chronic conditions",
keywords="nursing",
keywords="technology",
keywords="chronic",
keywords="nurse",
keywords="nurses",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="use",
keywords="cross-sectional",
keywords="survey",
keywords="surveys",
keywords="questionnaire",
keywords="questionnaires",
keywords="mobile phone",
abstract="Background: Mobile health (mHealth) is increasingly used to support public health practice, as it has positive benefits such as enhancing self-efficacy and facilitating chronic disease management. Yet, relatively few studies have explored the use of mHealth apps among nurses, despite their important role in caring for patients with and at risk of chronic conditions. Objective: The aim of the study is to explore nurses' use of mHealth apps to support adults with or at risk of chronic conditions and understand the factors that influence technology adoption. Methods: A web-based cross-sectional survey was conducted between September 2022 and January 2023. The survey was shared via social media and professional nursing organizations to Australian nurses caring for adults with or at risk of chronic conditions. Results: A total of 158 responses were included in the analysis. More than two-thirds (n=108, 68.4\%) of respondents reported that they personally used at least 1 mHealth app. Over half (n=83, 52.5\% to n=108, 68.4\%) reported they use mHealth apps at least a few times a month for clinical purposes. Logistic regression demonstrated that performance expectancy (P=.04), facilitating condition (P=.05), and personal use of mHealth apps (P=.05) were significantly associated with mHealth app recommendation. In contrast, effort expectancy (P=.09) and social influence (P=.46) did not have a significant influence on whether respondents recommended mHealth apps to patients. The inability to identify the quality of mHealth apps and the lack of access to mobile devices or internet were the most common barriers to mHealth app recommendation. Conclusions: While nurses use mHealth apps personally, there is potential to increase their clinical application. Given the challenges reported in appraising and assessing mHealth apps, app regulation and upskilling nurses will help to integrate mHealth apps into usual patient care. ",
doi="10.2196/57668",
url="https://nursing.jmir.org/2024/1/e57668",
url="http://www.ncbi.nlm.nih.gov/pubmed/38809593"
}


@Article{info:doi/10.2196/56919,
author="Ma, Yanan
and Law, Kate
and Hassan, Lamiece
and Nenadic, Goran
and van der Veer, N. Sabine",
title="Experiences and Views of Young People and Health Care Professionals of Using Social Media to Self-Manage Type 1 Diabetes Mellitus: Thematic Synthesis of Qualitative Studies",
journal="JMIR Pediatr Parent",
year="2024",
month="May",
day="29",
volume="7",
pages="e56919",
keywords="adolescents",
keywords="health care professionals",
keywords="social media",
keywords="thematic synthesis",
keywords="type 1 diabetes",
keywords="type 1 diabetes mellitus",
keywords="T1DM",
keywords="young people",
abstract="Background: Social media have shown the potential to support type 1 diabetes self-management by providing informational, emotional, and peer-to-peer support. However, the perceptions of young people and health care professionals' (HCPs) toward the use of social media for type 1 diabetes self-management have not been systematically reviewed. Objective: The aim of this study is to explore and summarize the experiences and views of young people with type 1 diabetes and their HCPs on using social media for self-management across qualitative findings. Methods: We searched MEDLINE, Embase, PsycINFO, and CINAHL from 2012 to 2023 using Medical Subject Heading terms and text words related to type 1 diabetes and social media. We screened and selected the studies according to the inclusion and exclusion criteria. We quality appraised and characterized the included studies and conducted a thematic synthesis. Results: We included 11 studies in our synthesis. A total of 9 of them were qualitative and 2 were mixed methods studies. Ten focused on young people with type 1 diabetes and 1 on HCPs. All used content analysis and were of moderate to high quality. Thirteen descriptive themes were yielded by our thematic synthesis, contributing to five analytic themes: (1) differences in how young people interact with social media, (2) characteristics of social media platforms that influence their use and uptake for type 1 diabetes self-management, (3) social media as a source of information, (4) impact on young people's coping and emotional well-being, and (5) impact on support from and relationships with HCPs and services. Conclusions: The synthesis suggests that we should consider leveraging social media's peer support capabilities to augment the traditional services for young people with type 1 diabetes. However, the patients may have privacy concerns about HCPs' involvement in their online activities. This warrants an update of existing guidelines to help young people use social media safely for self-managing their diabetes. ",
doi="10.2196/56919",
url="https://pediatrics.jmir.org/2024/1/e56919",
url="http://www.ncbi.nlm.nih.gov/pubmed/38809591"
}


@Article{info:doi/10.2196/51916,
author="Leitner, Jared
and Chiang, Po-Han
and Agnihotri, Parag
and Dey, Sujit",
title="The Effect of an AI-Based, Autonomous, Digital Health Intervention Using Precise Lifestyle Guidance on Blood Pressure in Adults With Hypertension: Single-Arm Nonrandomized Trial",
journal="JMIR Cardio",
year="2024",
month="May",
day="28",
volume="8",
pages="e51916",
keywords="blood pressure",
keywords="hypertension",
keywords="digital health",
keywords="lifestyle change",
keywords="lifestyle medicine",
keywords="wearables",
keywords="remote patient monitoring",
keywords="artificial intelligence",
keywords="AI",
keywords="mobile phone",
abstract="Background: Home blood pressure (BP) monitoring with lifestyle coaching is effective in managing hypertension and reducing cardiovascular risk. However, traditional manual lifestyle coaching models significantly limit availability due to high operating costs and personnel requirements. Furthermore, the lack of patient lifestyle monitoring and clinician time constraints can prevent personalized coaching on lifestyle modifications. Objective: This study assesses the effectiveness of a fully digital, autonomous, and artificial intelligence (AI)--based lifestyle coaching program on achieving BP control among adults with hypertension. Methods: Participants were enrolled in a single-arm nonrandomized trial in which they received a BP monitor and wearable activity tracker. Data were collected from these devices and a questionnaire mobile app, which were used to train personalized machine learning models that enabled precision lifestyle coaching delivered to participants via SMS text messaging and a mobile app. The primary outcomes included (1) the changes in systolic and diastolic BP from baseline to 12 and 24 weeks and (2) the percentage change of participants in the controlled, stage-1, and stage-2 hypertension categories from baseline to 12 and 24 weeks. Secondary outcomes included (1) the participant engagement rate as measured by data collection consistency and (2) the number of manual clinician outreaches. Results: In total, 141 participants were monitored over 24 weeks. At 12 weeks, systolic and diastolic BP decreased by 5.6 mm Hg (95\% CI ?7.1 to ?4.2; P<.001) and 3.8 mm Hg (95\% CI ?4.7 to ?2.8; P<.001), respectively. Particularly, for participants starting with stage-2 hypertension, systolic and diastolic BP decreased by 9.6 mm Hg (95\% CI ?12.2 to ?6.9; P<.001) and 5.7 mm Hg (95\% CI ?7.6 to ?3.9; P<.001), respectively. At 24 weeks, systolic and diastolic BP decreased by 8.1 mm Hg (95\% CI ?10.1 to ?6.1; P<.001) and 5.1 mm Hg (95\% CI ?6.2 to ?3.9; P<.001), respectively. For participants starting with stage-2 hypertension, systolic and diastolic BP decreased by 14.2 mm Hg (95\% CI ?17.7 to ?10.7; P<.001) and 8.1 mm Hg (95\% CI ?10.4 to ?5.7; P<.001), respectively, at 24 weeks. The percentage of participants with controlled BP increased by 17.2\% (22/128; P<.001) and 26.5\% (27/102; P<.001) from baseline to 12 and 24 weeks, respectively. The percentage of participants with stage-2 hypertension decreased by 25\% (32/128; P<.001) and 26.5\% (27/102; P<.001) from baseline to 12 and 24 weeks, respectively. The average weekly participant engagement rate was 92\% (SD 3.9\%), and only 5.9\% (6/102) of the participants required manual outreach over 24 weeks. Conclusions: The study demonstrates the potential of fully digital, autonomous, and AI-based lifestyle coaching to achieve meaningful BP improvements and high engagement for patients with hypertension while substantially reducing clinician workloads. Trial Registration: ClinicalTrials.gov NCT06337734; https://clinicaltrials.gov/study/NCT06337734 ",
doi="10.2196/51916",
url="https://cardio.jmir.org/2024/1/e51916",
url="http://www.ncbi.nlm.nih.gov/pubmed/38805253"
}


@Article{info:doi/10.2196/52647,
author="Mittal, Ajay
and Elkaldi, Yasmine
and Shih, Susana
and Nathu, Riken
and Segal, Mark",
title="Mobile Electrocardiograms in the Detection of Subclinical Atrial Fibrillation in High-Risk Outpatient Populations: Protocol for an Observational Study",
journal="JMIR Res Protoc",
year="2024",
month="May",
day="27",
volume="13",
pages="e52647",
keywords="mobile ECG",
keywords="digital health",
keywords="cardiology",
keywords="ECG",
keywords="electrocardiogram",
keywords="atrial fibrillation",
keywords="outpatient",
keywords="randomized",
keywords="controlled trial",
keywords="controlled trials",
keywords="smartphone",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="feasibility",
keywords="effectiveness",
keywords="KardiaMobile single-lead ECGs",
keywords="mobile phone",
abstract="Background: Single-lead, smartphone-based mobile electrocardiograms (ECGs) have the potential to provide a noninvasive, rapid, and cost-effective means of screening for atrial fibrillation (AFib) in outpatient settings. AFib has been associated with various comorbid diseases that prompt further investigation and screening methodologies for at-risk populations. A simple 30-second sinus rhythm strip from the KardiaMobile ECG (AliveCor) can provide an effective screen for cardiac rhythm abnormalities. Objective: The aim of this study is to demonstrate the feasibility of performing Kardia-enabled ECG recordings routinely in outpatient settings in high-risk populations and its potential use in uncovering previous undiagnosed cases of AFib. Specific aim 1 is to determine the feasibility and accuracy of performing routine cardiac rhythm sampling in patients deemed at high risk for AFib. Specific aim 2 is to determine whether routine rhythm sampling in outpatient clinics with high-risk patients can be used cost-effectively in an outpatient clinic without increasing the time it takes for the patient to be seen by a physician. Methods: Participants were recruited across 6 clinic sites across the University of Florida Health Network: University of Florida Health Nephrology, Sleep Center, Ophthalmology, Urology, Neurology, and Pre-Surgical. Participants, aged 18-99 years, who agreed to partake in the study were given a consent form and completed a questionnaire regarding their past medical history and risk factors for cardiovascular disease. Single-lead, 30-second ECGs were taken by the KardiaMobile ECG device. If patients are found to have newly diagnosed AFib, the attending physician is notified, and a 12-lead ECG or standard ECG equivalent will be ordered. Results: As of March 1, 2024, a total of 2339 participants have been enrolled. Of the data collected thus far, the KardiaMobile rhythm strip reported 381 abnormal readings, which are pending analysis from a cardiologist. A total of 78 readings were labeled as possible AFib, 159 readings were labeled unclassified, and 49 were unreadable. Of note, the average age of participants was 61 (SD 10.25) years, and the average self-reported weight was 194 (SD 14.26) pounds. Additionally, 1572 (67.25\%) participants report not regularly seeing a cardiologist. Regarding feasibility, the average length of enrolling a patient into the study was 3:30 (SD 0.5) minutes after informed consent was completed, and medical staff across clinic sites (n=25) reported 9 of 10 level of satisfaction with the impact of the screening on clinic flow. Conclusions: Preliminary data show promise regarding the feasibility of using KardiaMobile ECGs for the screening of AFib and prevention of cardiological disease in vulnerable outpatient populations. The use of a single-lead mobile ECG strip can serve as a low-cost, effective AFib screen for implementation across free clinics attempting to provide increased health care accessibility. International Registered Report Identifier (IRRID): DERR1-10.2196/52647 ",
doi="10.2196/52647",
url="https://www.researchprotocols.org/2024/1/e52647",
url="http://www.ncbi.nlm.nih.gov/pubmed/38801762"
}


@Article{info:doi/10.2196/54145,
author="Bridges, Bronwyn
and Taylor, Jake
and Weber, Thomas John",
title="Evaluation of the Parkinson's Remote Interactive Monitoring System in a Clinical Setting: Usability Study",
journal="JMIR Hum Factors",
year="2024",
month="May",
day="24",
volume="11",
pages="e54145",
keywords="Parkinson disease",
keywords="usability",
keywords="remote monitoring",
keywords="motor examination",
keywords="movement disorders",
keywords="thematic analysis",
keywords="System Usability Scale",
keywords="mobile phone",
abstract="Background: The fastest-growing neurological disorder is Parkinson disease (PD), a progressive neurodegenerative disease that affects 10 million people worldwide. PD is typically treated with levodopa, an oral pill taken to increase dopamine levels, and other dopaminergic agonists. As the disease advances, the efficacy of the drug diminishes, necessitating adjustments in treatment dosage according to the patient's symptoms and disease progression. Therefore, remote monitoring systems that can provide more detailed and accurate information on a patient's condition regularly are a valuable tool for clinicians and patients to manage their medication. The Parkinson's Remote Interactive Monitoring System (PRIMS), developed by PragmaClin Research Inc, was designed on the premise that it will be an easy-to-use digital system that can accurately capture motor and nonmotor symptoms of PD remotely. Objective: We performed a usability evaluation in a simulated clinical environment to assess the ease of use of the PRIMS and determine whether the product offers suitable functionality for users in a clinical setting. Methods: Participants were recruited from a user sign-up web-based database owned by PragmaClin Research Inc. A total of 11 participants were included in the study based on the following criteria: (1) being diagnosed with PD and (2) not being diagnosed with dementia or any other comorbidities that would make it difficult to complete the PRIMS assessment safely and independently. Patient users completed a questionnaire that is based on the Movement Disorder Society--sponsored revision of the Unified Parkinson's Disease Rating Scale. Interviews and field notes were analyzed for underlying themes and topics. Results: In total, 11 people with PD participated in the study (female individuals: n=5, 45\%; male individuals: n=6, 55\%; age: mean 66.7, SD 7.77 years). Thematic analysis of the observer's notes revealed 6 central usability issues associated with the PRIMS. These were the following: (1) the automated voice prompts are confusing, (2) the small camera is problematic, (3) the motor test exhibits excessive sensitivity to the participant's orientation and position in relation to the cameras, (4) the system poses mobility challenges, (5) navigating the system is difficult, and (6) the motor test exhibits inconsistencies and technical issues. Thematic analysis of qualitative interview responses revealed four central themes associated with participants' perspectives and opinions on the PRIMS, which were (1) admiration of purpose, (2) excessive system sensitivity, (3) video instructions preferred, and (4) written instructions disliked. The average system usability score was calculated to be 69.2 (SD 4.92), which failed to meet the acceptable system usability score of 70. Conclusions: Although multiple areas of improvement were identified, most of the participants showed an affinity for the overarching objective of the PRIMS. This feedback is being used to upgrade the current PRIMS so that it aligns more with patients' needs. ",
doi="10.2196/54145",
url="https://humanfactors.jmir.org/2024/1/e54145",
url="http://www.ncbi.nlm.nih.gov/pubmed/38787603"
}


@Article{info:doi/10.2196/56889,
author="Yanez Touzet, Alvaro
and Houhou, Tatiana
and Rahic, Zerina
and Kolias, Angelos
and Yordanov, Stefan
and Anderson, B. David
and Laufer, Ilya
and Li, Maggie
and Grahovac, Gordan
and Kotter, RN Mark
and Davies, M. Benjamin
and ",
title="Reliability of a Smartphone App to Objectively Monitor Performance Outcomes in Degenerative Cervical Myelopathy: Observational Study",
journal="JMIR Form Res",
year="2024",
month="May",
day="24",
volume="8",
pages="e56889",
keywords="reproducibility of results",
keywords="patient outcome assessment",
keywords="smartphone",
keywords="neurology",
keywords="psychometrics",
keywords="spinal cord compression",
keywords="mobile phone",
abstract="Background: Developing new clinical measures for degenerative cervical myelopathy (DCM) is an AO Spine RECODE-DCM Research, an international and multi-stakeholder partnership, priority. Difficulties in detecting DCM and its changes cause diagnostic and treatment delays in clinical settings and heightened costs in clinical trials due to elevated recruitment targets. Digital outcome measures can tackle these challenges due to their ability to measure disease remotely, repeatedly, and more economically. Objective: The aim of this study is to assess the reliability of the MoveMed battery of performance outcome measures. Methods: A prospective observational study in decentralized secondary care was performed in England, United Kingdom. The primary outcome was to determine the test-retest reliability of the MoveMed performance outcomes using the intraclass correlation (ICC) of agreement . The secondary outcome was to determine the measurement error of the MoveMed performance outcomes using both the SE of the mean (SEM) of agreement and the smallest detectable change (SDC) of agreement . Criteria from the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) manual were used to determine adequate reliability (ie, ICC of agreement ?0.7) and risk of bias. Disease stability was controlled using 2 minimum clinically important difference (MCID) thresholds obtained from the literature on the patient-derived modified Japanese Orthopaedic Association (p-mJOA) score, namely, MCID ?1 point and MCID ?2 points. Results: In total, 7 adults aged 59.5 (SD 12.4) years who live with DCM and possess an approved smartphone participated in the study. All tests demonstrated moderate to excellent test-retest coefficients and low measurement errors. In the MCID ?1 group, ICC of agreement values were 0.84-0.94 in the fast tap test, 0.89-0.95 in the hold test, 0.95 in the typing test, and 0.98 in the stand and walk test. SEM of agreement values were {\textpm}1 tap, {\textpm}1\%-3\% stability score points, {\textpm}0.06 keys per second, and {\textpm}10 steps per minute, respectively. SDC of agreement values were {\textpm}3 taps, {\textpm}4\%-7\% stability score points, {\textpm}0.2 keys per second, and {\textpm}27 steps per minute, respectively. In the MCID ?2 group, ICC of agreement values were 0.61-0.91, 0.75-0.77, 0.98, and 0.62, respectively; SEM of agreement values were {\textpm}1 tap, {\textpm}2\%-4\% stability score points, {\textpm}0.06 keys per second, and {\textpm}10 steps per minute, respectively; and SDC of agreement values were {\textpm}3-7 taps, {\textpm}7\%-10\% stability score points, {\textpm}0.2 keys per second, and {\textpm}27 steps per minute, respectively. Furthermore, the fast tap, hold, and typing tests obtained sufficient ratings (ICC of agreement ?0.7) in both MCID ?1 and MCID ?2 groups. No risk of bias factors from the COSMIN Risk of Bias checklist were recorded. Conclusions: The criteria from COSMIN provide ``very good'' quality evidence of the reliability of the MoveMed tests in an adult population living with DCM. ",
doi="10.2196/56889",
url="https://formative.jmir.org/2024/1/e56889",
url="http://www.ncbi.nlm.nih.gov/pubmed/38787602"
}


@Article{info:doi/10.2196/56607,
author="Flores, Ericka Joan
and Trambas, Christina
and Jovanovic, Natasha
and Thompson, J. Alexander
and Howell, Jessica",
title="Impact of an Automated Population-Level Cirrhosis Screening Program Using Common Pathology Tests on Rates of Cirrhosis Diagnosis and Linkage to Specialist Care (CAPRISE): Protocol for a Pilot Prospective Single-Arm Intervention Study",
journal="JMIR Res Protoc",
year="2024",
month="May",
day="22",
volume="13",
pages="e56607",
keywords="noninvasive tests",
keywords="cirrhosis",
keywords="population health",
keywords="screening",
keywords="liver cirrhosis",
keywords="liver",
keywords="compensated",
keywords="risk factor",
keywords="pathology",
keywords="population based",
keywords="liver screening",
keywords="prevalence",
keywords="hepatocellular carcinoma",
keywords="transient elastography",
keywords="FibroScan",
abstract="Background: People with compensated cirrhosis receive the greatest benefit from risk factor modification and prevention programs to reduce liver decompensation and improve early liver cancer detection. Blood-based liver fibrosis algorithms such as the Aspartate Transaminase--to-Platelet Ratio Index (APRI) and Fibrosis-4 (FIB-4) index are calculated using routinely ordered blood tests and are effective screening tests to exclude cirrhosis in people with chronic liver disease, triaging the need for further investigations to confirm cirrhosis and linkage to specialist care. Objective: This pilot study aims to evaluate the impact of a population screening program for liver cirrhosis (CAPRISE [Cirrhosis Automated APRI and FIB-4 Screening Evaluation]), which uses automated APRI and FIB-4 calculation and reporting on routinely ordered blood tests, on monthly rates of referral for transient elastography, cirrhosis diagnosis, and linkage to specialist care. Methods: We have partnered with a large pathology service in Victoria, Australia, to pilot a population-level liver cirrhosis screening package, which comprises (1) automated calculation and reporting of APRI and FIB-4 on routinely ordered blood tests; (2) provision of brief information about liver cirrhosis; and (3) a web link for transient elastography referral. APRI and FIB-4 will be prospectively calculated on all community-ordered pathology results in adults attending a single pathology service. This single-center, prospective, single-arm, pre-post study will compare the monthly rates of transient elastography (FibroScan) referral, liver cirrhosis diagnosis, and the proportion linked to specialist care in the 6 months after intervention to the 6 months prior to the intervention. Results: As of January 2024, in the preintervention phase of this study, a total of 120,972 tests were performed by the laboratory. Of these tests, 78,947 (65.3\%) tests were excluded, with the remaining 42,025 (34.7\%) tests on 37,872 individuals meeting inclusion criteria with APRI and FIB-4 being able to be calculated. Of these 42,025 tests, 1.3\% (n=531) had elevated APRI>1 occurring in 446 individuals, and 2.3\% (n=985) had elevated FIB-4>2.67 occurring in 816 individuals. Linking these data with FibroScan referral and appointment attendance is ongoing and will continue during the intervention phase, which is expected to commence on February 1, 2024. Conclusions: We will determine the feasibility and effectiveness of automated APRI and FIB-4 reporting on the monthly rate of transient elastography referrals, liver cirrhosis diagnosis, and linkage to specialist care. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12623000295640; https://tinyurl.com/58dv9ypp International Registered Report Identifier (IRRID): DERR1-10.2196/56607 ",
doi="10.2196/56607",
url="https://www.researchprotocols.org/2024/1/e56607",
url="http://www.ncbi.nlm.nih.gov/pubmed/38776541"
}


@Article{info:doi/10.2196/46067,
author="Evans, Stuart",
title="Sacroiliac Joint Dysfunction in Endurance Runners Using Wearable Technology as a Clinical Monitoring Tool: Systematic Review",
journal="JMIR Biomed Eng",
year="2024",
month="May",
day="20",
volume="9",
pages="e46067",
keywords="sacroiliac",
keywords="sacroiliac dysfunction",
keywords="sacroiliac wearables",
keywords="sensors",
keywords="injury management",
abstract="Background: In recent years, researchers have delved into the relationship between the anatomy and biomechanics of sacroiliac joint (SIJ) pain and dysfunction in endurance runners to elucidate the connection between lower back pain and the SIJ. However, the majority of SIJ pain and dysfunction cases are diagnosed and managed through a traditional athlete-clinician arrangement, where the athlete must attend regular in-person clinical appointments with various allied health professionals. Wearable sensors (wearables) are increasingly serving as a clinical diagnostic tool to monitor an athlete's day-to-day activities remotely, thus eliminating the necessity for in-person appointments. Nevertheless, the extent to which wearables are used in a remote setting to manage SIJ dysfunction in endurance runners remains uncertain. Objective: This study aims to conduct a systematic review of the literature to enhance our understanding regarding the use of wearables in both in-person and remote settings for biomechanical-based rehabilitation in SIJ dysfunction among endurance runners. In addressing this issue, the overarching goal was to explore how wearables can contribute to the clinical diagnosis (before, during, and after) of SIJ dysfunction. Methods: Three online databases, including PubMed, Scopus, and Google Scholar, were searched using various combinations of keywords. Initially, a total of 4097 articles were identified. After removing duplicates and screening articles based on inclusion and exclusion criteria, 45 articles were analyzed. Subsequently, 21 articles were included in this study. The quality of the investigation was assessed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) evidence-based minimum set of items for reporting in systematic reviews. Results: Among the 21 studies included in this review, more than half of the investigations were literature reviews focusing on wearable sensors in the diagnosis and treatment of SIJ pain, wearable movement sensors for rehabilitation, or a combination of both for SIJ gait analysis in an intelligent health care setting. As many as 4 (19\%) studies were case reports, and only 1 study could be classified as fully experimental. One paper was classified as being at the ``pre'' stage of SIJ dysfunction, while 6 (29\%) were identified as being at the ``at'' stage of classification. Significantly fewer studies attempted to capture or classify actual SIJ injuries, and no study directly addressed the injury recovery stage. Conclusions: SIJ dysfunction remains underdiagnosed and undertreated in endurance runners. Moreover, there is a lack of clear diagnostic or treatment pathways using wearables remotely, despite the availability of validated technology. Further research of higher quality is recommended to investigate SIJ dysfunction in endurance runners and explore the use of wearables for rehabilitation in remote settings. ",
doi="10.2196/46067",
url="https://biomedeng.jmir.org/2024/1/e46067",
url="http://www.ncbi.nlm.nih.gov/pubmed/38875697"
}


@Article{info:doi/10.2196/52577,
author="Scott, E. Suzanne
and Thompson, J. Matthew",
title="``Notification! You May Have Cancer.'' Could Smartphones and Wearables Help Detect Cancer Early?",
journal="JMIR Cancer",
year="2024",
month="May",
day="20",
volume="10",
pages="e52577",
keywords="wearables",
keywords="early diagnosis",
keywords="cancer",
keywords="challenges",
keywords="diagnosis",
keywords="wearable",
keywords="detect",
keywords="detection",
keywords="smartphone",
keywords="cancer diagnosis",
keywords="symptoms",
keywords="monitoring",
keywords="monitor",
keywords="implementation",
keywords="anxiety",
keywords="health care service",
keywords="mobile phone",
doi="10.2196/52577",
url="https://cancer.jmir.org/2024/1/e52577",
url="http://www.ncbi.nlm.nih.gov/pubmed/38767941"
}


@Article{info:doi/10.2196/55483,
author="Varela-Moreno, Esperanza
and Anarte-Ortiz, Teresa Maria
and Jodar-Sanchez, Francisco
and Garcia-Palacios, Azucena
and Monreal-Bartolom{\'e}, Alicia
and Gili, Margalida
and Garc{\'i}a-Campayo, Javier
and Mayoral-Cleries, Fermin",
title="Economic Evaluation of a Web Application Implemented in Primary Care for the Treatment of Depression in Patients With Type 2 Diabetes Mellitus: Multicenter Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="May",
day="16",
volume="12",
pages="e55483",
keywords="depression",
keywords="depressive",
keywords="type 2",
keywords="diabetes",
keywords="diabetic",
keywords="type 2 diabetes mellitus",
keywords="eHealth",
keywords="web-based intervention",
keywords="efficacy",
keywords="economic evaluation",
keywords="cost-effectiveness",
keywords="cost-utility",
keywords="randomized controlled trial",
keywords="RCT",
keywords="randomized",
keywords="controlled trial",
keywords="controlled trials",
keywords="cost",
keywords="costs",
keywords="economic",
keywords="economics",
keywords="web based",
keywords="internet based",
keywords="CBT",
keywords="psychotherapy",
keywords="cognitive behavioral therapy",
keywords="mental health",
abstract="Background: Depressive disorder and type 2 diabetes mellitus (T2DM) are prevalent in primary care (PC). Pharmacological treatment, despite controversy, is commonly chosen due to resource limitations and difficulties in accessing face-to-face interventions. Depression significantly impacts various aspects of a person's life, affecting adherence to medical prescriptions and glycemic control and leading to future complications and increased health care costs. To address these challenges, information and communication technologies (eg, eHealth) have been introduced, showing promise in improving treatment continuity and accessibility. However, while eHealth programs have demonstrated effectiveness in alleviating depressive symptoms, evidence regarding glycemic control remains inconclusive. This randomized controlled trial aimed to test the efficacy of a low-intensity psychological intervention via a web app for mild-moderate depressive symptoms in individuals with T2DM compared with treatment as usual (TAU) in PC. Objective: This study aimed to analyze the cost-effectiveness and cost-utility of a web-based psychological intervention to treat depressive symptomatology in people with T2DM compared with TAU in a PC setting. Methods: A multicenter randomized controlled trial was conducted with 49 patients with T2DM, depressive symptoms of moderate severity, and glycosylated hemoglobin (HbA1c) of 7.47\% in PC settings. Patients were randomized to TAU (n=27) or a web-based psychological treatment group (n=22). This web-based treatment consisted of cognitive behavioral therapy, improvement of diabetes self-care behaviors, and mindfulness. Cost-effectiveness analysis for the improvement of depressive symptomatology was conducted based on reductions in 3, 5, or 50 points on the Patient Health Questionnaire--9 (PHQ-9). The efficacy of diabetes control was estimated based on a 0.5\% reduction in HbA1c levels. Follow-up was performed at 3 and 6 months. The cost-utility analysis was performed based on quality-adjusted life years. Results: Efficacy analysis showed that the web-based treatment program was more effective in improving depressive symptoms than TAU but showed only a slight improvement in HbA1c. Incremental cost-effectiveness ratios of 186.76 for a 3-point reduction in PHQ-9 and 206.31 for reductions of 5 and 50 percentage points were obtained. In contrast, the incremental cost-effectiveness ratio for improving HbA1c levels amounted to {\texteuro}1510.90 ({\texteuro}1=US \$1.18 in 2018) per participant. The incremental cost-utility ratio resulted in {\texteuro}4119.33 per quality-adjusted life year gained. Conclusions: The intervention, using web-based modules incorporating cognitive behavioral therapy tools, diabetes self-care promotion, and mindfulness, effectively reduced depressive symptoms and enhanced glycemic control in patients with T2DM. Notably, it demonstrated clinical efficacy and economic efficiency. This supports the idea that eHealth interventions not only benefit patients clinically but also offer cost-effectiveness for health care systems. The study emphasizes the importance of including specific modules to enhance diabetes self-care behaviors in future web-based psychological interventions, emphasizing personalization and adaptation for this population. Trial Registration: ClinicalTrials.gov NCT03426709; https://clinicaltrials.gov/study/NCT03426709 International Registered Report Identifier (IRRID): RR2-10.1186/S12888-019-2037-3 ",
doi="10.2196/55483",
url="https://mhealth.jmir.org/2024/1/e55483",
url="http://www.ncbi.nlm.nih.gov/pubmed/38754101"
}


@Article{info:doi/10.2196/50679,
author="Gandrup, Julie
and Selby, A. David
and Dixon, G. William",
title="Classifying Self-Reported Rheumatoid Arthritis Flares Using Daily Patient-Generated Data From a Smartphone App: Exploratory Analysis Applying Machine Learning Approaches",
journal="JMIR Form Res",
year="2024",
month="May",
day="14",
volume="8",
pages="e50679",
keywords="rheumatoid arthritis",
keywords="flare",
keywords="patient-generated health data",
keywords="smartphone",
keywords="mobile health",
keywords="machine learning",
keywords="arthritis",
keywords="rheumatic",
keywords="rheumatism",
keywords="joint",
keywords="joints",
keywords="arthritic",
keywords="musculoskeletal",
keywords="flares",
keywords="classify",
keywords="classification",
keywords="symptom",
keywords="symptoms",
keywords="mobile phone",
abstract="Background: The ability to predict rheumatoid arthritis (RA) flares between clinic visits based on real-time, longitudinal patient-generated data could potentially allow for timely interventions to avoid disease worsening. Objective: This exploratory study aims to investigate the feasibility of using machine learning methods to classify self-reported RA flares based on a small data set of daily symptom data collected on a smartphone app. Methods: Daily symptoms and weekly flares reported on the Remote Monitoring of Rheumatoid Arthritis (REMORA) smartphone app from 20 patients with RA over 3 months were used. Predictors were several summary features of the daily symptom scores (eg, pain and fatigue) collected in the week leading up to the flare question. We fitted 3 binary classifiers: logistic regression with and without elastic net regularization, a random forest, and naive Bayes. Performance was evaluated according to the area under the curve (AUC) of the receiver operating characteristic curve. For the best-performing model, we considered sensitivity and specificity for different thresholds in order to illustrate different ways in which the predictive model could behave in a clinical setting. Results: The data comprised an average of 60.6 daily reports and 10.5 weekly reports per participant. Participants reported a median of 2 (IQR 0.75-4.25) flares each over a median follow-up time of 81 (IQR 79-82) days. AUCs were broadly similar between models, but logistic regression with elastic net regularization had the highest AUC of 0.82. At a cutoff requiring specificity to be 0.80, the corresponding sensitivity to detect flares was 0.60 for this model. The positive predictive value (PPV) in this population was 53\%, and the negative predictive value (NPV) was 85\%. Given the prevalence of flares, the best PPV achieved meant only around 2 of every 3 positive predictions were correct (PPV 0.65). By prioritizing a higher NPV, the model correctly predicted over 9 in every 10 non-flare weeks, but the accuracy of predicted flares fell to only 1 in 2 being correct (NPV and PPV of 0.92 and 0.51, respectively). Conclusions: Predicting self-reported flares based on daily symptom scorings in the preceding week using machine learning methods was feasible. The observed predictive accuracy might improve as we obtain more data, and these exploratory results need to be validated in an external cohort. In the future, analysis of frequently collected patient-generated data may allow us to predict flares before they unfold, opening opportunities for just-in-time adaptative interventions. Depending on the nature and implication of an intervention, different cutoff values for an intervention decision need to be considered, as well as the level of predictive certainty required. ",
doi="10.2196/50679",
url="https://formative.jmir.org/2024/1/e50679",
url="http://www.ncbi.nlm.nih.gov/pubmed/38743480"
}


@Article{info:doi/10.2196/42547,
author="M{\"u}ller-Bardorff, Miriam
and Schulz, Ava
and Paersch, Christina
and Recher, Dominique
and Schlup, Barbara
and Seifritz, Erich
and Kolassa, Tatjana Iris
and Kowatsch, Tobias
and Fisher, Aaron
and Galatzer-Levy, Isaac
and Kleim, Birgit",
title="Optimizing Outcomes in Psychotherapy for Anxiety Disorders Using Smartphone-Based and Passive Sensing Features: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="May",
day="14",
volume="13",
pages="e42547",
keywords="cognitive behavioral therapy",
keywords="CBT",
keywords="transdiagnostic",
keywords="anxiety",
keywords="digital",
keywords="ecological momentary assessment",
keywords="EMA",
keywords="passive sensing",
abstract="Background: Psychotherapies, such as cognitive behavioral therapy (CBT), currently have the strongest evidence of durable symptom changes for most psychological disorders, such as anxiety disorders. Nevertheless, only about half of individuals treated with CBT benefit from it. Predictive algorithms, including digital assessments and passive sensing features, could better identify patients who would benefit from CBT, and thus, improve treatment choices. Objective: This study aims to establish predictive features that forecast responses to transdiagnostic CBT in anxiety disorders and to investigate key mechanisms underlying treatment responses. Methods: This study is a 2-armed randomized controlled clinical trial. We include patients with anxiety disorders who are randomized to either a transdiagnostic CBT group or a waitlist (referred to as WAIT). We index key features to predict responses prior to starting treatment using subjective self-report questionnaires, experimental tasks, biological samples, ecological momentary assessments, activity tracking, and smartphone-based passive sensing to derive a multimodal feature set for predictive modeling. Additional assessments take place weekly at mid- and posttreatment and at 6- and 12-month follow-ups to index anxiety and depression symptom severity. We aim to include 150 patients, randomized to CBT versus WAIT at a 3:1 ratio. The data set will be subject to full feature and important features selected by minimal redundancy and maximal relevance feature selection and then fed into machine leaning models, including eXtreme gradient boosting, pattern recognition network, and k-nearest neighbors to forecast treatment response. The performance of the developed models will be evaluated. In addition to predictive modeling, we will test specific mechanistic hypotheses (eg, association between self-efficacy, daily symptoms obtained using ecological momentary assessments, and treatment response) to elucidate mechanisms underlying treatment response. Results: The trial is now completed. It was approved by the Cantonal Ethics Committee, Zurich. The results will be disseminated through publications in scientific peer-reviewed journals and conference presentations. Conclusions: The aim of this trial is to improve current CBT treatment by precise forecasting of treatment response and by understanding and potentially augmenting underpinning mechanisms and personalizing treatment. Trial Registration: ClinicalTrials.gov NCT03945617; https://clinicaltrials.gov/ct2/show/results/NCT03945617 International Registered Report Identifier (IRRID): DERR1-10.2196/42547 ",
doi="10.2196/42547",
url="https://www.researchprotocols.org/2024/1/e42547",
url="http://www.ncbi.nlm.nih.gov/pubmed/38743473"
}


@Article{info:doi/10.2196/54007,
author="Higashi, T. Robin
and Etingen, Bella
and Richardson, Eric
and Palmer, Jennifer
and Zocchi, S. Mark
and Bixler, R. Felicia
and Smith, Bridget
and McMahon, Nicholas
and Frisbee, L. Kathleen
and Fortney, C. John
and Turvey, Carolyn
and Evans, Jennifer
and Hogan, P. Timothy",
title="Veteran Experiences With an mHealth App to Support Measurement-Based Mental Health Care: Results From a Mixed Methods Evaluation",
journal="JMIR Ment Health",
year="2024",
month="May",
day="10",
volume="11",
pages="e54007",
keywords="measurement-based care",
keywords="mobile health app",
keywords="mental health",
keywords="veteran",
keywords="mHealth",
keywords="support",
keywords="mixed-methods evaluation",
keywords="digital health",
abstract="Background: Mental health conditions are highly prevalent among US veterans. The Veterans Health Administration (VHA) is committed to enhancing mental health care through the integration of measurement-based care (MBC) practices, guided by its Collect-Share-Act model. Incorporating the use of remote mobile apps may further support the implementation of MBC for mental health care. Objective: This study aims to evaluate veteran experiences with Mental Health Checkup (MHC), a VHA mobile app to support remote MBC for mental health. Methods: Our mixed methods sequential explanatory evaluation encompassed mailed surveys with veterans who used MHC and follow-up semistructured interviews with a subset of survey respondents. We analyzed survey data using descriptive statistics. We then compared responses between veterans who indicated having used MHC for ?3 versus <3 months using $\chi$2 tests. We analyzed interview data using thematic analysis. Results: We received 533 surveys (533/2631, for a 20\% response rate) and completed 20 interviews. Findings from these data supported one another and highlighted 4 key themes. (1) The MHC app had positive impacts on care processes for veterans: a majority of MHC users overall, and a greater proportion who had used MHC for ?3 months (versus <3 months), agreed or strongly agreed that using MHC helped them be more engaged in their health and health care (169/262, 65\%), make decisions about their treatment (157/262, 60\%), and set goals related to their health and health care (156/262, 60\%). Similarly, interviewees described that visualizing progress through graphs of their assessment data over time motivated them to continue therapy and increased self-awareness. (2) A majority of respondents overall, and a greater proportion who had used MHC for ?3 months (versus <3 months), agreed/strongly agreed that using MHC enhanced their communication (112/164, 68\% versus 51/98, 52\%; P=.009) and rapport (95/164, 58\% versus 42/98, 43\%; P=.02) with their VHA providers. Likewise, interviewees described how MHC helped focus therapy time and facilitated trust. (3) However, veterans also endorsed some challenges using MHC. Among respondents overall, these included difficulty understanding graphs of their assessment data (102/245, 42\%), not receiving enough training on the app (73/259, 28\%), and not being able to change responses to assessment questions (72/256, 28\%). (4) Interviewees offered suggestions for improving the app (eg, facilitating ease of log-in, offering additional reminder features) and for increasing adoption (eg, marketing the app and its potential advantages for veterans receiving mental health care). Conclusions: Although experiences with the MHC app varied, veterans were positive overall about its use. Veterans described associations between the use of MHC and engagement in their own care, self-management, and interactions with their VHA mental health providers. Findings support the potential of MHC as a technology capable of supporting the VHA's Collect-Share-Act model of MBC. ",
doi="10.2196/54007",
url="https://mental.jmir.org/2024/1/e54007",
url="http://www.ncbi.nlm.nih.gov/pubmed/38728684"
}


@Article{info:doi/10.2196/53163,
author="Sien, Sang-Wha
and Kobekyaa, Kyerepagr Francis
and Puts, Martine
and Currie, Leanne
and Tompson, Margaret
and Hedges, Penelope
and McGrenere, Joanna
and Mariano, Caroline
and Haase, R. Kristen",
title="Tailored Self-Management App to Support Older Adults With Cancer and Multimorbidity: Development and Usability Testing",
journal="JMIR Aging",
year="2024",
month="May",
day="8",
volume="7",
pages="e53163",
keywords="cancer",
keywords="aging",
keywords="self-management",
keywords="usability testing",
keywords="design thinking",
keywords="design",
keywords="oncology",
keywords="develop",
keywords="development",
keywords="usability",
keywords="gerontology",
keywords="geriatric",
keywords="geriatrics",
keywords="older adult",
keywords="older adults",
keywords="elder",
keywords="elderly",
keywords="older person",
keywords="older people",
keywords="ageing",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="application",
keywords="applications",
keywords="symptom",
keywords="symptoms",
keywords="comorbidity",
keywords="comorbidities",
keywords="comorbid",
keywords="multimorbidity",
keywords="multimorbidities",
keywords="co-design",
abstract="Background: Globally, cancer predominates in adults aged older than 60 years, and 70\% of older adults have ?1 chronic condition. Cancer self-management interventions can improve symptom management and confidence, but few interventions target the complex needs of older adults with cancer and multimorbidity. Despite growing evidence of digital health tools in cancer care, there is a paucity of theoretically grounded digital self-management supports for older adults. Many apps for older adults have not been co-designed with older adults to ensure that they are tailored to their specific needs, which would increase usability and uptake. Objective: We aim to report on the user evaluations of a self- and symptom-management app to support older adults living with cancer and multimorbidity. Methods: This study used Grey's self-management framework, a design thinking approach, and involved older adults with lived experiences of cancer to design a medium-fidelity app prototype. Older adults with cancer or caregivers were recruited through community organizations or support groups to participate in co-designing or evaluations of the app. Data from interviews were iteratively integrated into the design process and analyzed using descriptive statistics and thematic analyses. Results: In total, 15 older adults and 3 caregivers (n=18) participated in this study: 10 participated (8 older adults and 2 caregivers) in the design of the low-fidelity prototype, and 10 evaluated (9 older adults and 1 caregiver) the medium-fidelity prototype (2 older adults participated in both phases). Participants emphasized the importance of tracking functions to make sense of information across physical symptoms and psychosocial aspects; a clear display; and the organization of notes and reminders to communicate with care providers. Participants also emphasized the importance of medication initiation or cessation reminders to mitigate concerns related to polypharmacy. Conclusions: This app has the potential to support the complex health care needs of older adults with cancer, creating a ``home base'' for symptom management and support. The findings from this study will position the researchers to conduct feasibility testing and real-world implementation. ",
doi="10.2196/53163",
url="https://aging.jmir.org/2024/1/e53163",
url="http://www.ncbi.nlm.nih.gov/pubmed/38717806"
}


@Article{info:doi/10.2196/55452,
author="de Graaf, Debbie
and de Vries, M. Nienke
and van de Zande, Tessa
and Schimmel, P. Janneke J.
and Shin, Sooyoon
and Kowahl, Nathan
and Barman, Poulami
and Kapur, Ritu
and Marks Jr, J. William
and van 't Hul, Alex
and Bloem, R. Bastiaan",
title="Measuring Physical Functioning Using Wearable Sensors in Parkinson Disease and Chronic Obstructive Pulmonary Disease (the Accuracy of Digital Assessment of Performance Trial Study): Protocol for a Prospective Observational Study",
journal="JMIR Res Protoc",
year="2024",
month="May",
day="7",
volume="13",
pages="e55452",
keywords="Parkinson disease",
keywords="COPD",
keywords="chronic obstructive pulmonary disease",
keywords="physical activity",
keywords="physical capacity",
keywords="wearable devices",
keywords="walking",
keywords="exercise",
keywords="locomotion",
keywords="home-based",
keywords="wearable",
keywords="wearables",
keywords="wearable sensor",
keywords="dementia",
keywords="smartwatch",
keywords="StepWatch",
keywords="treatment",
abstract="Background: Physical capacity and physical activity are important aspects of physical functioning and quality of life in people with a chronic disease such as Parkinson disease (PD) or chronic obstructive pulmonary disease (COPD). Both physical capacity and physical activity are currently measured in the clinic using standardized questionnaires and tests, such as the 6-minute walk test (6MWT) and the Timed Up and Go test (TUG). However, relying only on in-clinic tests is suboptimal since they offer limited information on how a person functions in daily life and how functioning fluctuates throughout the day. Wearable sensor technology may offer a solution that enables us to better understand true physical functioning in daily life. Objective: We aim to study whether device-assisted versions of 6MWT and TUG, such that the tests can be performed independently at home using a smartwatch, is a valid and reliable way to measure the performance compared to a supervised, in-clinic test. Methods: This is a decentralized, prospective, observational study including 100 people with PD and 100 with COPD. The inclusion criteria are broad: age ?18 years, able to walk independently, and no co-occurrence of PD and COPD. Participants are followed for 15 weeks with 4 in-clinic visits, once every 5 weeks. Outcomes include several walking tests, cognitive tests, and disease-specific questionnaires accompanied by data collection using wearable devices (the Verily Study Watch and Modus StepWatch). Additionally, during the last 10 weeks of this study, participants will follow an aerobic exercise training program aiming to increase physical capacity, creating the opportunity to study the responsiveness of the remote 6MWT. Results: In total, 89 people with PD and 65 people with COPD were included in this study. Data analysis will start in April 2024. Conclusions: The results of this study will provide information on the measurement properties of the device-assisted 6MWT and TUG in the clinic and at home. When reliable and valid, this can contribute to a better understanding of a person's physical capacity in real life, which makes it possible to personalize treatment options. Trial Registration: ClinicalTrials.gov NCT05756075; https://clinicaltrials.gov/study/NCT05756075 International Registered Report Identifier (IRRID): DERR1-10.2196/55452 ",
doi="10.2196/55452",
url="https://www.researchprotocols.org/2024/1/e55452",
url="http://www.ncbi.nlm.nih.gov/pubmed/38713508"
}


@Article{info:doi/10.2196/53186,
author="Ren, Sicong
and McDonald, C. Catherine
and Corwin, J. Daniel
and Wiebe, J. Douglas
and Master, L. Christina
and Arbogast, B. Kristy",
title="Response Rate Patterns in Adolescents With Concussion Using Mobile Health and Remote Patient Monitoring: Observational Study",
journal="JMIR Pediatr Parent",
year="2024",
month="May",
day="6",
volume="7",
pages="e53186",
keywords="concussion",
keywords="mHealth",
keywords="response rate",
keywords="adolescents",
keywords="reporting behavior",
keywords="remote monitoring",
keywords="engagement",
keywords="monitoring",
keywords="adolescent",
keywords="teen",
keywords="youth",
keywords="remote patient monitoring",
keywords="mobile health",
keywords="injury",
keywords="neurobiological",
keywords="neurobiological development",
keywords="quality of life",
keywords="academic",
keywords="academic performance",
keywords="mHealth engagement",
keywords="tertiary care",
abstract="Background: A concussion is a common adolescent injury that can result in a constellation of symptoms, negatively affecting academic performance, neurobiological development, and quality of life. Mobile health (mHealth) technologies, such as apps for patients to report symptoms or wearables to measure physiological metrics like heart rate, have been shown to be promising in health maintenance. However, there is limited evidence about mHealth engagement in adolescents with a concussion during their recovery course. Objective: This study aims to determine the response rate and response rate patterns in concussed adolescents reporting their daily symptoms through mHealth technology. It will also examine the effect of time-, demographic-, and injury-related characteristics on response rate patterns. Methods: Participants aged between 11-18 years (median days since injury at enrollment: 11 days) were recruited from the concussion program of a tertiary care academic medical center and a suburban school's athletic teams. They were asked to report their daily symptoms using a mobile app. Participants were prompted to complete the Post-Concussion Symptom Inventory (PCSI) 3 times (ie, morning, afternoon, and evening) per day for 4 weeks following enrollment. The primary outcome was the response rate pattern over time (by day since initial app use and the day since injury). Time-, demographic-, and injury-related differences in reporting behaviors were compared using Mann Whitney U tests. Results: A total of 56 participants were enrolled (mean age 15.3, SD 1.9 years; n=32, 57\% female). The median response rate across all days of app use in the evening was 37.0\% (IQR 27.2\%-46.4\%), which was significantly higher than the morning (21.2\%, IQR 15.6\%-30.5\%) or afternoon (26.4\%, IQR 21.1\%-31.5\%; P<.001). The median daily response was significantly different by sex (female: 53.8\%, IQR 46.2\%-64.2\% vs male: 42.0\%, IQR 28.6\%-51.1\%; P=.003), days since injury to app use (participants starting to use the app >7 days since injury: 54.1\%, IQR 47.4\%-62.2\% vs starting to use the app ?7 days since injury: 38.0\%, IQR 26.0\%-53.3\%; P=.002), and concussion history (participants with a history of at least one prior concussion: 57.4\%, IQR 44.5\%-70.5\% vs participants without concussion history: 42.3\%, IQR 36.8\%-53.5\%; P=.03). There were no significant differences by age. Differences by injury mechanism (sports- and recreation-related injury: 39.6\%, IQR 36.1\%-50.4\% vs non--sports- or recreation-related injury: 30.6\%, IQR 20.0\%-42.9\%; P=.04) and initial symptom burden (PCSI scores greater than the median score of 47: 40.9\%, IQR 35.2\%-53.8\% vs PCSI scores less than or equal to the median score: 31.9\%, IQR 24.6\%-40.6\%; P=.04) were evident in the evening response rates; however, daily rates were not statistically different. Conclusions: Evening may be the optimal time to prompt for daily concussion symptom assessment among concussed adolescents compared with morning or afternoon. Multiple demographic- and injury-related characteristics were associated with higher daily response rates, including for female participants, those with more than 1 week from injury to beginning mHealth monitoring, and those with a history of at least one previous concussion. Future studies may consider incentive strategies or adaptive digital concussion assessments to increase response rates in populations with low engagement. ",
doi="10.2196/53186",
url="https://pediatrics.jmir.org/2024/1/e53186"
}


@Article{info:doi/10.2196/53550,
author="Chappell, Delaney Kaitlyn
and Meakins, Diana
and Marsh-Joyal, Melanie
and Bihari, Allison
and Goodman, J. Karen
and Le Melledo, Jean-Michel
and Lim, Allen
and Peerani, Farhad
and Kroeker, Ivy Karen",
title="Integrating Virtual Mindfulness-Based Stress Reduction Into Inflammatory Bowel Disease Care: Mixed Methods Feasibility Trial",
journal="JMIR Form Res",
year="2024",
month="May",
day="6",
volume="8",
pages="e53550",
keywords="inflammatory bowel disease",
keywords="psychosocial care",
keywords="multidisciplinary care",
keywords="quality of care",
keywords="quality of life",
keywords="mental health",
keywords="adult",
keywords="adults",
keywords="anxiety",
keywords="depression",
keywords="IBD",
keywords="virtual mindfulness",
keywords="feasibility trial",
keywords="clinic",
keywords="health facility",
keywords="Canada",
keywords="semistructured interview",
keywords="psychiatrist",
keywords="psychiatrists",
keywords="videoconferencing",
keywords="effectiveness",
keywords="v-MBSR",
keywords="coping",
keywords="coping strategy",
abstract="Background: Individuals with inflammatory bowel disease (IBD) experience cycles of aggressive physical symptoms including abdominal pain, diarrhea, and fatigue. These acute symptoms regress and return, and chronic symptoms and complications often linger. The nature of the disease can also cause individuals to experience psychological distress including symptoms of anxiety and depression; however, unlike the physical symptoms of IBD, these psychological symptoms often remain untreated. Objective: This study aims to evaluate the feasibility, acceptability, and effectiveness of virtual mindfulness-based stress reduction (v-MBSR) for adults with IBD. Methods: IBD patients with self-reported anxiety or depression were recruited from clinics in Alberta, Canada to participate in an 8-week v-MSBR intervention. Eligible patients participated in v-MBSR delivered by psychiatrists using a videoconferencing platform. Primary feasibility outcomes included trial uptake, adherence, attendance, and attrition rates. Secondary effectiveness outcomes included measures of anxiety, depression, quality of life (QoL), and mindfulness. Effectiveness data were collected at 3 time points: baseline, at intervention completion, and 6 months after completion. To further assess feasibility and acceptability, participants were invited to participate in a semistructured interview after completing v-MBSR. Results: A total of 16 of the 64 (25\%) referred patients agreed to participate in v-MBSR with the most common reason for decline being a lack of time while 7 of the 16 (43.8\%) participants completed the program and experienced encouraging effects including decreased anxiety and depression symptoms and increased health-related QoL with both improvements persisting at 6-month follow-up. Participants described improved coping strategies and disease management techniques as benefits of v-MBSR. Conclusions: Patients with IBD were interested in a psychiatrist-led virtual anxiety management intervention, but results demonstrate v-MBSR may be too time intensive for some patients with IBD patients. v-MBSR was acceptable to those who completed the intervention, and improvements to anxiety, depression, and QoL were promising and sustainable. Future studies should attempt to characterize the patients with IBD who may benefit most from interventions like v-MBSR. ",
doi="10.2196/53550",
url="https://formative.jmir.org/2024/1/e53550",
url="http://www.ncbi.nlm.nih.gov/pubmed/38709548"
}


@Article{info:doi/10.2196/50747,
author="Marier-Deschenes, Pascale
and Pinard, Marie Anne
and Jalbert, Laura
and LeBlanc, Annie",
title="Assessing the Feasibility and Preliminary Effects of a Web-Based Self-Management Program for Chronic Noncancer Pain: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2024",
month="May",
day="3",
volume="11",
pages="e50747",
keywords="persistent pain",
keywords="eHealth",
keywords="self-paced intervention",
keywords="web-based program",
keywords="evidence based",
keywords="web based",
keywords="self-management",
keywords="pain",
keywords="chronic pain",
keywords="mixed methods study",
keywords="pain treatment",
keywords="pain education",
abstract="Background: In Canada, adults with chronic noncancer pain face a persistent insufficiency of publicly funded resources, with the gold standard multidisciplinary pain treatment facilities unable to meet the high clinical demand. Web-based self-management programs cost-effectively increase access to pain management and can improve several aspects of physical and emotional functioning. Aiming to meet the demand for accessible, fully automated resources for individuals with chronic noncancer pain, we developed a French web- and evidence-based self-management program, Agir pour moi (APM). This program includes pain education and strategies to reduce stress, practice mindfulness, apply pacing, engage in physical activity, identify and manage thinking traps, sleep better, adapt diet, and sustain behavior change. Objective: This study aims to assess the APM self-management program's feasibility, acceptability, and preliminary effects in adults awaiting specialized services from a center of expertise in chronic pain management. Methods: We conducted a mixed methods study with an explanatory sequential design, including a web-based 1-arm trial and qualitative semistructured interviews. We present the results from both phases through integrative tables called joint displays. Results: Response rates were 70\% (44/63) at postintervention and 56\% (35/63) at 3-month follow-up among the 63 consenting participants who provided self-assessed information at baseline. In total, 46\% (29/63) of the participants completed the program. We interviewed 24\% (15/63) of the participants. The interview's first theme revolved around the overall acceptance, user-friendliness, and engaging nature of the program. The second theme emphasized the differentiation between microlevel and macrolevel engagements. The third theme delved into the diverse effects observed, potentially influenced by the macrolevel engagements. Participants highlighted the features that impacted their self-efficacy and the adoption of self-management strategies. We observed indications of improvement in self-efficacy, pain intensity, pain interference, depression, and catastrophizing. Interviewees described these and various other effects as potentially influenced by macrolevel engagement through behavioral change. Conclusions: These ?ndings provided preliminary evidence that the APM self-management program and research methods are feasible. However, some participants expressed the need for at least phone reminders and minimal support from a professional available to answer questions over the first few weeks of the program to engage. Recruitment strategies of a future randomized controlled trial should focus on attracting a broader representation of individuals with chronic pain in terms of gender and ethnicity. Trial Registration: ClinicalTrials.gov NCT05319652; https://clinicaltrials.gov/study/NCT05319652 ",
doi="10.2196/50747",
url="https://humanfactors.jmir.org/2024/1/e50747",
url="http://www.ncbi.nlm.nih.gov/pubmed/38701440"
}


@Article{info:doi/10.2196/50164,
author="Chedid, Maroun
and Chebib, T. Fouad
and Dahlen, Erin
and Mueller, Theodore
and Schnell, Theresa
and Gay, Melissa
and Hommos, Musab
and Swaminathan, Sundararaman
and Garg, Arvind
and Mao, Michael
and Amberg, Brigid
and Balderes, Kirk
and Johnson, F. Karen
and Bishop, Alyssa
and Vaughn, Kay Jackqueline
and Hogan, Marie
and Torres, Vicente
and Chaudhry, Rajeev
and Zoghby, Ziad",
title="An Electronic Health Record--Integrated Application for Standardizing Care and Monitoring Patients With Autosomal Dominant Polycystic Kidney Disease Enrolled in a Tolvaptan Clinic: Design and Implementation Study",
journal="JMIR Med Inform",
year="2024",
month="May",
day="1",
volume="12",
pages="e50164",
keywords="ADPKD",
keywords="autosomal dominant polycystic kidney disease",
keywords="polycystic kidney disease",
keywords="tolvaptan",
keywords="EHR",
keywords="electronic health record",
keywords="digital health solutions",
keywords="monitoring",
keywords="kidney disease",
keywords="drug-related toxicity",
keywords="digital application",
keywords="management",
keywords="chronic disease",
abstract="Background: Tolvaptan is the only US Food and Drug Administration--approved drug to slow the progression of autosomal dominant polycystic kidney disease (ADPKD), but it requires strict clinical monitoring due to potential serious adverse events. Objective: We aimed to share our experience in developing and implementing an electronic health record (EHR)--based application to monitor patients with ADPKD who were initiated on tolvaptan. Methods: The application was developed in collaboration with clinical informatics professionals based on our clinical protocol with frequent laboratory test monitoring to detect early drug-related toxicity. The application streamlined the clinical workflow and enabled our nursing team to take appropriate actions in real time to prevent drug-related serious adverse events. We retrospectively analyzed the characteristics of the enrolled patients. Results: As of September 2022, a total of 214 patients were enrolled in the tolvaptan program across all Mayo Clinic sites. Of these, 126 were enrolled in the Tolvaptan Monitoring Registry application and 88 in the Past Tolvaptan Patients application. The mean age at enrollment was 43.1 (SD 9.9) years. A total of 20 (9.3\%) patients developed liver toxicity, but only 5 (2.3\%) had to discontinue the drug. The 2 EHR-based applications allowed consolidation of all necessary patient information and real-time data management at the individual or population level. This approach facilitated efficient staff workflow, monitoring of drug-related adverse events, and timely prescription renewal. Conclusions: Our study highlights the feasibility of integrating digital applications into the EHR workflow to facilitate efficient and safe care delivery for patients enrolled in a tolvaptan program. This workflow needs further validation but could be extended to other health care systems managing chronic diseases requiring drug monitoring. ",
doi="10.2196/50164",
url="https://medinform.jmir.org/2024/1/e50164"
}


@Article{info:doi/10.2196/49024,
author="Eaton, K. Cyd
and McWilliams, Emma
and Yablon, Dana
and Kesim, Irem
and Ge, Renee
and Mirus, Karissa
and Sconiers, Takeera
and Donkoh, Alfred
and Lawrence, Melanie
and George, Cynthia
and Morrison, Leigh Mary
and Muther, Emily
and Oates, R. Gabriela
and Sathe, Meghana
and Sawicki, S. Gregory
and Snell, Carolyn
and Riekert, Kristin",
title="Cross-Cutting mHealth Behavior Change Techniques to Support Treatment Adherence and Self-Management of Complex Medical Conditions: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2024",
month="May",
day="1",
volume="12",
pages="e49024",
keywords="cystic fibrosis",
keywords="mobile health",
keywords="technology",
keywords="self-management",
keywords="patient adherence",
keywords="behavior intervention",
keywords="mHealth intervention",
keywords="systematic review",
keywords="evaluation of mHealth",
keywords="treatment adherence",
keywords="mHealth",
abstract="Background: Mobile health (mHealth) interventions have immense potential to support disease self-management for people with complex medical conditions following treatment regimens that involve taking medicine and other self-management activities. However, there is no consensus on what discrete behavior change techniques (BCTs) should be used in an effective adherence and self-management--promoting mHealth solution for any chronic illness. Reviewing the extant literature to identify effective, cross-cutting BCTs in mHealth interventions for adherence and self-management promotion could help accelerate the development, evaluation, and dissemination of behavior change interventions with potential generalizability across complex medical conditions. Objective: This study aimed to identify cross-cutting, mHealth-based BCTs to incorporate into effective mHealth adherence and self-management interventions for people with complex medical conditions, by systematically reviewing the literature across chronic medical conditions with similar adherence and self-management demands. Methods: A registered systematic review was conducted to identify published evaluations of mHealth adherence and self-management interventions for chronic medical conditions with complex adherence and self-management demands. The methodological characteristics and BCTs in each study were extracted using a standard data collection form. Results: A total of 122 studies were reviewed; the majority involved people with type 2 diabetes (28/122, 23\%), asthma (27/122, 22\%), and type 1 diabetes (19/122, 16\%). mHealth interventions rated as having a positive outcome on adherence and self-management used more BCTs (mean 4.95, SD 2.56) than interventions with no impact on outcomes (mean 3.57, SD 1.95) or those that used >1 outcome measure or analytic approach (mean 3.90, SD 1.93; P=.02). The following BCTs were associated with positive outcomes: self-monitoring outcomes of behavior (39/59, 66\%), feedback on outcomes of behavior (34/59, 58\%), self-monitoring of behavior (34/59, 58\%), feedback on behavior (29/59, 49\%), credible source (24/59, 41\%), and goal setting (behavior; 14/59, 24\%). In adult-only samples, prompts and cues were associated with positive outcomes (34/45, 76\%). In adolescent and young adult samples, information about health consequences (1/4, 25\%), problem-solving (1/4, 25\%), and material reward (behavior; 2/4, 50\%) were associated with positive outcomes. In interventions explicitly targeting medicine taking, prompts and cues (25/33, 76\%) and credible source (13/33, 39\%) were associated with positive outcomes. In interventions focused on self-management and other adherence targets, instruction on how to perform the behavior (8/26, 31\%), goal setting (behavior; 8/26, 31\%), and action planning (5/26, 19\%) were associated with positive outcomes. Conclusions: To support adherence and self-management in people with complex medical conditions, mHealth tools should purposefully incorporate effective and developmentally appropriate BCTs. A cross-cutting approach to BCT selection could accelerate the development of much-needed mHealth interventions for target populations, although mHealth intervention developers should continue to consider the unique needs of the target population when designing these tools. Trial Registration: PROSPERO CRD42021224407; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=224407 ",
doi="10.2196/49024",
url="https://mhealth.jmir.org/2024/1/e49024"
}


@Article{info:doi/10.2196/50620,
author="Steen-Olsen, Balch Emma
and Pappot, Helle
and Hjerming, Maiken
and Hanghoej, Signe
and Holl{\"a}nder-Mieritz, Cecilie",
title="Monitoring Adolescent and Young Adult Patients With Cancer via a Smart T-Shirt: Prospective, Single-Cohort, Mixed Methods Feasibility Study (OncoSmartShirt Study)",
journal="JMIR Mhealth Uhealth",
year="2024",
month="May",
day="1",
volume="12",
pages="e50620",
keywords="smart T-shirt",
keywords="AYA",
keywords="oncology",
keywords="home monitoring",
keywords="patients' perspective",
keywords="perspective",
keywords="perspectives",
keywords="experiences",
keywords="experience",
keywords="youth",
keywords="adolescent",
keywords="adolescents",
keywords="smart",
keywords="monitoring",
keywords="biometric",
keywords="sensor",
keywords="sensors",
keywords="young adult",
keywords="young adults",
keywords="feasibility",
keywords="cancer",
keywords="cancers",
keywords="electrode",
keywords="electrodes",
keywords="adherence",
keywords="mobile phone",
abstract="Background: Wearables that measure vital parameters can be potential tools for monitoring patients at home during cancer treatment. One type of wearable is a smart T-shirt with embedded sensors. Initially, smart T-shirts were designed to aid athletes in their performance analyses. Recently however, researchers have been investigating the use of smart T-shirts as supportive tools in health care. In general, the knowledge on the use of wearables for symptom monitoring during cancer treatment is limited, and consensus and awareness about compliance or adherence are lacking. Objectives: The aim of this study was to evaluate adherence to and experiences with using a smart T-shirt for the home monitoring of biometric sensor data among adolescent and young adult patients undergoing cancer treatment during a 2-week period. Methods: This study was a prospective, single-cohort, mixed methods feasibility study. The inclusion criteria were patients aged 18 to 39 years and those who were receiving treatment at Copenhagen University Hospital - Rigshospitalet, Denmark. Consenting patients were asked to wear the Chronolife smart T-shirt for a period of 2 weeks. The smart T-shirt had multiple sensors and electrodes, which engendered the following six measurements: electrocardiogram (ECG) measurements, thoracic respiration, abdominal respiration, thoracic impedance, physical activity (steps), and skin temperature. The primary end point was adherence, which was defined as a wear time of >8 hours per day. The patient experience was investigated via individual, semistructured telephone interviews and a paper questionnaire. Results: A total of 10 patients were included. The number of days with wear times of >8 hours during the study period (14 d) varied from 0 to 6 (mean 2 d). Further, 3 patients had a mean wear time of >8 hours during each of their days with data registration. The number of days with any data registration ranged from 0 to 10 (mean 6.4 d). The thematic analysis of interviews pointed to the following three main themes: (1) the smart T-shirt is cool but does not fit patients with cancer, (2) the technology limits the use of the smart T-shirt, and (3) the monitoring of data increases the feeling of safety. Results from the questionnaire showed that the patients generally had confidence in the device. Conclusions: Although the primary end point was not reached, the patients' experiences with using the smart T-shirt resulted in the knowledge that patients acknowledged the need for new technologies that improve supportive cancer care. The patients were positive when asked to wear the smart T-shirt. However, technical and practical challenges in using the device resulted in low adherence. Although wearables might have potential for home monitoring, the present technology is immature for clinical use. Trial Registration: ClinicalTrials.gov NCT05235594; https://clinicaltrials.gov/study/NCT05235594 International Registered Report Identifier (IRRID): RR2-10.2196/37626 ",
doi="10.2196/50620",
url="https://mhealth.jmir.org/2024/1/e50620"
}


@Article{info:doi/10.2196/53500,
author="Zakiyah, Neily
and Marulin, Dita
and Alfaqeeh, Mohammed
and Puspitasari, Melyani Irma
and Lestari, Keri
and Lim, Keat Ka
and Fox-Rushby, Julia",
title="Economic Evaluations of Digital Health Interventions for Patients With Heart Failure: Systematic Review",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="30",
volume="26",
pages="e53500",
keywords="digital health",
keywords="telemonitoring",
keywords="telehealth",
keywords="heart failure",
keywords="cost-effectiveness",
keywords="systematic review",
keywords="mobile phone",
abstract="Background: Digital health interventions (DHIs) have shown promising results in enhancing the management of heart failure (HF). Although health care interventions are increasingly being delivered digitally, with growing evidence on the potential cost-effectiveness of adopting them, there has been little effort to collate and synthesize the findings. Objective: This study's objective was to systematically review the economic evaluations that assess the adoption of DHIs in the management and treatment of HF. Methods: A systematic review was conducted using 3 electronic databases: PubMed, EBSCOhost, and Scopus. Articles reporting full economic evaluations of DHIs for patients with HF published up to July 2023 were eligible for inclusion. Study characteristics, design (both trial based and model based), input parameters, and main results were extracted from full-text articles. Data synthesis was conducted based on the technologies used for delivering DHIs in the management of patients with HF, and the findings were analyzed narratively. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed for this systematic review. The reporting quality of the included studies was evaluated using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) guidelines. Results: Overall, 27 economic evaluations were included in the review. The economic evaluations were based on models (13/27, 48\%), trials (13/27, 48\%), or a combination approach (1/27, 4\%). The devices evaluated included noninvasive remote monitoring devices (eg, home telemonitoring using digital tablets or specific medical devices that enable transmission of physiological data), telephone support, mobile apps and wearables, remote monitoring follow-up in patients with implantable medical devices, and videoconferencing systems. Most of the studies (24/27, 89\%) used cost-utility analysis. The majority of the studies (25/27, 93\%) were conducted in high-income countries, particularly European countries (16/27, 59\%) such as the United Kingdom and the Netherlands. Mobile apps and wearables, remote monitoring follow-up in patients with implantable medical devices, and videoconferencing systems yielded cost-effective results or even emerged as dominant strategies. However, conflicting results were observed, particularly in noninvasive remote monitoring devices and telephone support. In 15\% (4/27) of the studies, these DHIs were found to be less costly and more effective than the comparators (ie, dominant), while 33\% (9/27) reported them to be more costly but more effective with incremental cost-effectiveness ratios below the respective willingness-to-pay thresholds (ie, cost-effective). Furthermore, in 11\% (3/27) of the studies, noninvasive remote monitoring devices and telephone support were either above the willingness-to-pay thresholds or more costly than, yet as effective as, the comparators (ie, not cost-effective). In terms of reporting quality, the studies were classified as good (20/27, 74\%), moderate (6/27, 22\%), or excellent (1/27, 4\%). Conclusions: Despite the conflicting results, the main findings indicated that, overall, DHIs were more cost-effective than non-DHI alternatives. Trial Registration: PROSPERO CRD42023388241; https://tinyurl.com/2p9axpmc ",
doi="10.2196/53500",
url="https://www.jmir.org/2024/1/e53500",
url="http://www.ncbi.nlm.nih.gov/pubmed/38687991"
}


@Article{info:doi/10.2196/54706,
author="He, Wenjie
and Zhang, Wenyan
and Jin, Ya
and Zhou, Qiang
and Zhang, Huadan
and Xia, Qing",
title="Physician Versus Large Language Model Chatbot Responses to Web-Based Questions From Autistic Patients in Chinese: Cross-Sectional Comparative Analysis",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="30",
volume="26",
pages="e54706",
keywords="artificial intelligence",
keywords="chatbot",
keywords="ChatGPT",
keywords="ERNIE Bot",
keywords="autism",
abstract="Background: There is a dearth of feasibility assessments regarding using large language models (LLMs) for responding to inquiries from autistic patients within a Chinese-language context. Despite Chinese being one of the most widely spoken languages globally, the predominant research focus on applying these models in the medical field has been on English-speaking populations. Objective: This study aims to assess the effectiveness of LLM chatbots, specifically ChatGPT-4 (OpenAI) and ERNIE Bot (version 2.2.3; Baidu, Inc), one of the most advanced LLMs in China, in addressing inquiries from autistic individuals in a Chinese setting. Methods: For this study, we gathered data from DXY---a widely acknowledged, web-based, medical consultation platform in China with a user base of over 100 million individuals. A total of 100 patient consultation samples were rigorously selected from January 2018 to August 2023, amounting to 239 questions extracted from publicly available autism-related documents on the platform. To maintain objectivity, both the original questions and responses were anonymized and randomized. An evaluation team of 3 chief physicians assessed the responses across 4 dimensions: relevance, accuracy, usefulness, and empathy. The team completed 717 evaluations. The team initially identified the best response and then used a Likert scale with 5 response categories to gauge the responses, each representing a distinct level of quality. Finally, we compared the responses collected from different sources. Results: Among the 717 evaluations conducted, 46.86\% (95\% CI 43.21\%-50.51\%) of assessors displayed varying preferences for responses from physicians, with 34.87\% (95\% CI 31.38\%-38.36\%) of assessors favoring ChatGPT and 18.27\% (95\% CI 15.44\%-21.10\%) of assessors favoring ERNIE Bot. The average relevance scores for physicians, ChatGPT, and ERNIE Bot were 3.75 (95\% CI 3.69-3.82), 3.69 (95\% CI 3.63-3.74), and 3.41 (95\% CI 3.35-3.46), respectively. Physicians (3.66, 95\% CI 3.60-3.73) and ChatGPT (3.73, 95\% CI 3.69-3.77) demonstrated higher accuracy ratings compared to ERNIE Bot (3.52, 95\% CI 3.47-3.57). In terms of usefulness scores, physicians (3.54, 95\% CI 3.47-3.62) received higher ratings than ChatGPT (3.40, 95\% CI 3.34-3.47) and ERNIE Bot (3.05, 95\% CI 2.99-3.12). Finally, concerning the empathy dimension, ChatGPT (3.64, 95\% CI 3.57-3.71) outperformed physicians (3.13, 95\% CI 3.04-3.21) and ERNIE Bot (3.11, 95\% CI 3.04-3.18). Conclusions: In this cross-sectional study, physicians' responses exhibited superiority in the present Chinese-language context. Nonetheless, LLMs can provide valuable medical guidance to autistic patients and may even surpass physicians in demonstrating empathy. However, it is crucial to acknowledge that further optimization and research are imperative prerequisites before the effective integration of LLMs in clinical settings across diverse linguistic environments can be realized. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300074655; https://www.chictr.org.cn/bin/project/edit?pid=199432 ",
doi="10.2196/54706",
url="https://www.jmir.org/2024/1/e54706",
url="http://www.ncbi.nlm.nih.gov/pubmed/38687566"
}


@Article{info:doi/10.2196/50855,
author="Kandola, Aaron
and Edwards, Kyra
and Straatman, Joris
and D{\"u}hrkoop, Bettina
and Hein, Bettina
and Hayes, Joseph",
title="Digital Self-Management Platform for Adult Asthma: Randomized Attention-Placebo Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="29",
volume="26",
pages="e50855",
keywords="asthma",
keywords="mobile health",
keywords="self-management",
keywords="randomized controlled trial",
keywords="randomized",
keywords="controlled trial",
keywords="controlled trials",
keywords="RCT",
keywords="RCTs",
keywords="respiratory",
keywords="pulmonary",
keywords="smartphone",
keywords="platform",
keywords="digital health",
keywords="chronic",
keywords="breathing",
keywords="disease management",
keywords="mHealth",
keywords="app",
keywords="apps",
keywords="application",
keywords="applications",
keywords="mobile phone",
abstract="Background: Asthma is one of the most common chronic conditions worldwide, with a substantial individual and health care burden. Digital apps hold promise as a highly accessible, low-cost method of enhancing self-management in asthma, which is critical to effective asthma control. Objective: We conducted a fully remote randomized controlled trial (RCT) to assess the efficacy of juli, a commercially available smartphone self-management platform for asthma. Methods: We conducted a pragmatic single-blind, RCT of juli for asthma management. Our study included participants aged 18 years and older who self-identified as having asthma and had an Asthma Control Test (ACT) score of 19 or lower (indicating uncontrolled asthma) at the beginning of the trial. Participants were randomized (1:1 ratio) to receive juli for 8 weeks or a limited attention-placebo control version of the app. The primary outcome measure was the difference in ACT scores after 8 weeks. Secondary outcomes included remission (ACT score greater than 19), minimal clinically important difference (an improvement of 3 or more points on the ACT), worsening of asthma, and health-related quality of life. The primary analysis included participants using the app for 8 weeks (per-protocol analysis), and the secondary analysis used a modified intention-to-treat (ITT) analysis. Results: We randomized 411 participants between May 2021 and April 2023: a total of 152 (37\%) participants engaged with the app for 8 weeks and were included in the per-protocol analysis, and 262 (63.7\%) participants completed the week-2 outcome assessment and were included in the modified ITT analysis. Total attrition between baseline and week 8 was 259 (63\%) individuals. In the per-protocol analysis, the intervention group had a higher mean ACT score (17.93, SD 4.72) than the control group (16.24, SD 5.78) by week 8 (baseline adjusted coefficient 1.91, 95\% CI 0.31-3.51; P=.02). Participants using juli had greater odds of achieving or exceeding the minimal clinically important difference at 8 weeks (adjusted odds ratio 2.38, 95\% CI 1.20-4.70; P=.01). There were no between group differences in the other secondary outcomes at 8 weeks. The results from the modified ITT analyses were similar. Conclusions: Users of juli had improved asthma symptom control over 8 weeks compared with users of a version of the app with limited functionality. These findings suggest that juli is an effective digital self-management platform that could augment existing care pathways for asthma. The retention of patients in RCTs and real-world use of digital health care apps is a major challenge. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) registry  ISRCTN87679686; https://www.isrctn.com/ISRCTN87679686 ",
doi="10.2196/50855",
url="https://www.jmir.org/2024/1/e50855",
url="http://www.ncbi.nlm.nih.gov/pubmed/38684084"
}


@Article{info:doi/10.2196/52075,
author="Yoon, Minjae
and Lee, Seonhwa
and Choi, Yeon Jah
and Jung, Mi-Hyang
and Youn, Jong-Chan
and Shim, Young Chi
and Choi, Jin-Oh
and Kim, Ju Eung
and Kim, Hyungseop
and Yoo, Byung-Su
and Son, Joo Yeon
and Choi, Dong-Ju",
title="Effectiveness of a Smartphone App--Based Intervention With Bluetooth-Connected Monitoring Devices and a Feedback System in Heart Failure (SMART-HF Trial): Randomized Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="29",
volume="26",
pages="e52075",
keywords="heart failure",
keywords="mobile applications",
keywords="mobile health",
keywords="self-care",
keywords="vital sign monitoring",
keywords="mobile phone",
abstract="Background: Current heart failure (HF) guidelines recommend a multidisciplinary approach, discharge education, and self-management for HF. However, the recommendations are challenging to implement in real-world clinical settings. Objective: We developed a mobile health (mHealth) platform for HF self-care to evaluate whether a smartphone app--based intervention with Bluetooth-connected monitoring devices and a feedback system can help improve HF symptoms. Methods: In this prospective, randomized, multicenter study, we enrolled patients 20 years of age and older, hospitalized for acute HF, and who could use a smartphone from 7 tertiary hospitals in South Korea. In the intervention group (n=39), the apps were automatically paired with Bluetooth-connected monitoring devices. The patients could enter information on vital signs, HF symptoms, diet, medications, and exercise regimen into the app daily and receive feedback or alerts on their input. In the control group (n=38), patients could only enter their blood pressure, heart rate, and weight using conventional, non-Bluetooth devices and could not receive any feedback or alerts from the app. The primary end point was the change in dyspnea symptom scores from baseline to 4 weeks, assessed using a questionnaire. Results: At 4 weeks, the change in dyspnea symptom score from baseline was significantly greater in the intervention group than in the control group (mean --1.3, SD 2.1 vs mean --0.3, SD 2.3; P=.048). A significant reduction was found in body water composition from baseline to the final measurement in the intervention group (baseline level mean 7.4, SD 2.5 vs final level mean 6.6, SD 2.5; P=.003). App adherence, which was assessed based on log-in or the percentage of days when symptoms were first observed, was higher in the intervention group than in the control group. Composite end points, including death, rehospitalization, and urgent HF visits, were not significantly different between the 2 groups. Conclusions: The mobile-based health platform with Bluetooth-connected monitoring devices and a feedback system demonstrated improvement in dyspnea symptoms in patients with HF. This study provides evidence and rationale for implementing mobile app--based self-care strategies and feedback for patients with HF. Trial Registration: ClinicalTrials.gov NCT05668000; https://clinicaltrials.gov/study/NCT05668000 ",
doi="10.2196/52075",
url="https://www.jmir.org/2024/1/e52075",
url="http://www.ncbi.nlm.nih.gov/pubmed/38683665"
}


@Article{info:doi/10.2196/56417,
author="Kim, Yuyoung
and Kim, Minjung
and Kim, Jinwoo
and Song, Tae-Jin",
title="Smartphone-Based Speech Therapy for Poststroke Dysarthria: Pilot Randomized Controlled Trial Evaluating Efficacy and Feasibility",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="25",
volume="26",
pages="e56417",
keywords="dysarthria",
keywords="stroke",
keywords="smartphone",
keywords="speech therapy",
keywords="app",
keywords="acute and early subacute",
keywords="feasibility",
keywords="mobile phone",
abstract="Background: Dysarthria is a common poststroke speech disorder affecting communication and psychological well-being. Traditional speech therapy is effective but often poses challenges in terms of accessibility and patient adherence. Emerging smartphone-based therapies may offer promising alternatives for the treatment of poststroke dysarthria. Objective: This study aimed to assess the efficacy and feasibility of smartphone-based speech therapy for improving speech intelligibility in patients with acute and early subacute poststroke dysarthria. This study also explored the impact of the intervention on psychological well-being, user experience, and overall feasibility in a clinical setting. Methods: Participants were divided into 2 groups for this randomized, evaluator-blinded trial. The intervention group used a smartphone-based speech therapy app for 1 hour per day, 5 days per week, for 4 weeks, with guideline-based standard stroke care. The control group received standard guideline-based stroke care and rehabilitation. Speech intelligibility, psychological well-being, quality of life, and user acceptance were assessed using repeated measures ANOVA. Results: In this study, 40 patients with poststroke dysarthria were enrolled, 32 of whom completed the trial (16 in each group). The intervention group showed significant improvements in speech intelligibility compared with the control group. This was evidenced by improvements from baseline (F1,30=34.35; P<.001), between-group differences (F1,30=6.18; P=.02), and notable time-by-group interactions (F1,30=6.91; P=.01). Regarding secondary outcomes, the intervention led to improvements in the percentage of correct consonants over time (F1,30=5.57; P=.03). In addition, significant reductions were noted in the severity of dysarthria in the intervention group over time (F1,30=21.18; P<.001), with a pronounced group effect (F1,30=5.52; P=.03) and time-by-group interaction (F1,30=5.29; P=.03). Regarding quality of life, significant improvements were observed as measured by the EQ-5D-3L questionnaire (F1,30=13.25; P<.001) and EQ-VAS (F1,30=7.74; P=.009) over time. The adherence rate to the smartphone-based app was 64\%, with over half of the participants completing all the sessions. The usability of the app was rated high (system usability score 80.78). In addition, the intervention group reported increased self-efficacy in using the app compared with the control group (F1,30=10.81; P=.003). Conclusions: The smartphone-based speech therapy app significantly improved speech intelligibility, articulation, and quality of life in patients with poststroke dysarthria. These findings indicate that smartphone-based speech therapy can be a useful assistant device in the management of poststroke dysarthria, particularly in the acute and early subacute stroke stages. Trial Registration: ClinicalTrials.gov NCT05146765; https://clinicaltrials.gov/ct2/show/NCT05146765 ",
doi="10.2196/56417",
url="https://www.jmir.org/2024/1/e56417",
url="http://www.ncbi.nlm.nih.gov/pubmed/38509662"
}


@Article{info:doi/10.2196/53668,
author="Shalaby, Reham
and Vuong, Wesley
and Agyapong, Belinda
and Gusnowski, April
and Surood, Shireen
and Agyapong, Vincent",
title="Cancer Care Supportive Text Messaging Program (Text4Hope) for People Living With Cancer and Their Caregivers During the COVID-19 Pandemic: Longitudinal Observational Study",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="24",
volume="8",
pages="e53668",
keywords="Text4Hope Cancer Care",
keywords="COVID-19",
keywords="cancer",
keywords="caregivers",
keywords="mental health",
keywords="anxiety",
keywords="depression",
keywords="cancer care",
keywords="Canada",
keywords="Canadian",
keywords="treatment",
keywords="stress",
abstract="Background: Cancer is the leading cause of death in Canada, and living with cancer generates psychological demands, including depression and anxiety among cancer survivors and caregivers. Text4Hope-Cancer Care SMS text messaging--based service was provided to people with cancer and caregivers during the COVID-19 pandemic to support their mental health. Objective: The aim of this study is to examine the clinical effectiveness of and satisfaction with Text4Hope-Cancer Care in addressing mental health conditions among people living with cancer and caregivers. Methods: The study was conducted in Alberta, Canada. People who were diagnosed or receiving cancer treatment and caregivers self-subscribed to receive 3-months daily supportive cognitive behavioral therapy--based SMS text messages and a web-based survey was sent at designated time points to collect clinical and nonclinical data. The Hospital Anxiety and Depression scale (HADS) was used to examine changes in anxiety and depression symptoms after receiving the service. Satisfaction with the service was assessed using a survey with a Likert scale. Descriptive and inferential statistics were used, and test significance was considered with P?.05. Results: Overall, 107 individuals subscribed to the service, and 93 completed the program (completion rate 93/107, 86.9\%). A significant improvement in the anxiety symptoms (HADS-Anxiety [HADS-A] subscale) was reported after 3 months of Text4Hope-Cancer Care (t11=2.62; P=.02), with medium effect size (Hedges g=0.7), but not depression symptoms (HADS-Depression [HADS-D] subscale). Subscribers expressed high satisfaction and agreed that the service has helped them to cope with mental health symptoms and improve their quality of life. Most subscribers read the SMS text messages more than once (30/30, 100\%); took time to reflect or took a beneficial action after reading the messages (27/30, 90\%); and highly agreed (27/30, >80\%) with the value of the received supportive SMS text messages as being relevant, succinct, affirmative, and positive. All subscribers recommended SMS text messaging for stress, anxiety, and depression and for cancer care support (30/30, 100\%). Conclusions: Text4Hope-Cancer Care was well-perceived and effectively addressed anxiety symptoms among people living with cancer and caregivers during the peak of the COVID-19 pandemic. This study provides evidence-based support and insight for policy and stakeholders to implement similar convenient, economic, and accessible mental health services that support vulnerable populations during crises. International Registered Report Identifier (IRRID): RR2-10.2196/20240 ",
doi="10.2196/53668",
url="https://formative.jmir.org/2024/1/e53668",
url="http://www.ncbi.nlm.nih.gov/pubmed/38657234"
}


@Article{info:doi/10.2196/52317,
author="Haimi, Motti
and Sergienko, Ruslan",
title="Adoption and Use of Telemedicine and Digital Health Services Among Older Adults in Light of the COVID-19 Pandemic: Repeated Cross-Sectional Analysis",
journal="JMIR Aging",
year="2024",
month="Apr",
day="24",
volume="7",
pages="e52317",
keywords="telemedicine",
keywords="digital health",
keywords="older adults",
keywords="COVID-19",
keywords="use",
keywords="digital divide",
keywords="usability",
keywords="pandemic",
keywords="telehealth",
keywords="Israel",
keywords="working-hours telehealth visits",
keywords="after-hours consultation",
keywords="teleconsultation",
keywords="eHealth",
keywords="mobile health",
keywords="mHealth",
keywords="wearables",
keywords="mobile phone",
abstract="Background: As the population ages and the prevalence of long-term diseases rises, the use of telecare is becoming increasingly frequent to aid older people. Objective: This study aims to explore the use and adoption of 3 types of telehealth services among the older population in Israel before, during, and after the COVID-19 pandemic. Methods: We explored the use characteristics of older adults (aged ?65 years) belonging to Clalit Health Services in several aspects in the use of 3 types of telehealth services: the use of digital services for administrative tasks; the use of synchronous working-hours telehealth visits with the patient's personal physician during clinic business hours; and the use of after-hours consultations during evenings, nights, and weekends when the clinics are closed. The data were collected and analyzed throughout 3 distinct periods in Israel: before the COVID-19 pandemic, during the onset of the COVID-19 pandemic, and following the COVID-19 peak. Results: Data of 618,850 patients who met the inclusion criteria were extracted. Telehealth services used for administrative purposes were the most popular. The most intriguing finding was that the older population significantly increased their use of all types of telehealth services during the COVID-19 pandemic, and in most types, this use decreased after the COVID-19 peak, but to a level that was higher than the baseline level before the COVID-19 pandemic. Before the COVID-19 pandemic, 23.1\% (142,936/618,850) of the study population used working-hours telehealth visits, and 2.2\% (13,837/618,850) used after-hours consultations at least once. The percentage of use for these services increased during the COVID-19 pandemic to 59.2\% (366,566/618,850) and 5\% (30,777/618,850) and then decreased during the third period to 39.5\% (244,572/618,850) and 2.4\% (14,584/618,850), respectively (P<.001). Multiple patient variables have been found to be associated with the use of the different telehealth services in each period. Conclusions: Despite the limitations and obstacles, the older population uses telehealth services and can increase their use when they are needed. These people can learn how to use digital health services effectively, and they should be given the opportunity to do so by creating suitable and straightforward telehealth solutions tailored to this population and enhancing their usability. ",
doi="10.2196/52317",
url="https://aging.jmir.org/2024/1/e52317",
url="http://www.ncbi.nlm.nih.gov/pubmed/38656768"
}


@Article{info:doi/10.2196/48173,
author="Grove, Engelst Birgith
and de Thurah, Annette
and Ivarsen, Per
and Kvisgaard, Katrine Ann
and Hjollund, Henrik Niels
and Grytnes, Regine
and Schougaard, Valen Liv Marit",
title="Remote Symptom Monitoring Using Patient-Reported Outcomes in Patients With Chronic Kidney Disease: Process Evaluation of a Randomized Controlled Trial",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="24",
volume="8",
pages="e48173",
keywords="chronic kidney disease",
keywords="pragmatic randomized controlled trial",
keywords="process evaluation",
keywords="patient-reported outcome measures",
keywords="remote monitoring",
keywords="monitoring",
keywords="patient-reported outcome",
keywords="chronic kidney",
keywords="intervention",
abstract="Background: In Denmark, outpatient follow-up for patients with chronic kidney disease (CKD) is changing from in-hospital visits toward more remote health care delivery. The nonuse of remote patient-reported outcomes (PROs) is a well-known challenge, and it can be difficult to explain which mechanisms of interventions influence the outcome. Process evaluation may, therefore, be used to answer important questions on how and why interventions work, aiming to enhance the implications for clinical practice. Objective: This study aimed to provide insight into the intervention process by evaluating (1) the representativity of the study population, (2) patient and physician use patterns, (3) patient adherence to the intervention, and (4) clinical engagement. Methods: A process evaluation determining the reach, dose, fidelity, and clinical engagement was carried out, alongside a multicenter randomized controlled trial (RCT). We developed and implemented an intervention using PRO measures to monitor outpatients remotely. Data were collected for the PRO intervention arms in the RCT from 4 sources: (1) PRO data from the participants to determine personal factors, (2) the web-based PRO system to identify key usage intervention patterns, (3) medical records to identify clinical factors relating to the use of the intervention, and (4) semistructured interviews conducted with involved physicians. Results: Of the 320 patients invited, 152 (47.5\%) accepted to participate. The study population reflected the target population. The mean adherence rate to the PRO intervention arms was 82\% (95\% CI 76-87). The questionnaire response rate was 539/544 (99.1\%). A minority of 13 (12.9\%) of 101 patients needed assistance to complete study procedures. Physicians assessed 477/539 (88.5\%) of the questionnaires. Contact was established in 417/539 (77.4\%) of the cases, and 122/539 (22.6\%) of the patients did not have contact. Physicians initiated 288/417 (69.1\%) and patients requested 129/417 (30.9\%) of all the contacts. The primary causes of contact were clinical data (242/417, 58\%), PRO data (92/417, 22.1\%), and medication concerns and precautionary reasons (83/417, 19.9\%). Physicians found the use of PRO measures in remote follow-up beneficial for assessing the patient's health. The inclusion of self-reported clinical data in the questionnaire motivated physicians to assess patient responses. However, some barriers were emphasized, such as loss of a personal relationship with the patient and the risk of missing important symptoms in the absence of a face-to-face assessment. Conclusions: This study demonstrates the importance and practical use of remote monitoring among patients with CKD. Overall, the intervention was implemented as intended. We observed high patient adherence rates, and the physicians managed most questionnaires. Some physicians worried that distance from the patients made it unfeasible to use their ``clinical glance,'' posing a potential risk of overlooking crucial patients` symptoms. These findings underscore key considerations for the implementation of remote follow-up. Introducing a hybrid approach combining remote and face-to-face consultations may address these concerns. Trial Registration: ClinicalTrials.gov NCT03847766; https://clinicaltrials.gov/study/NCT03847766 ",
doi="10.2196/48173",
url="https://formative.jmir.org/2024/1/e48173",
url="http://www.ncbi.nlm.nih.gov/pubmed/38656781"
}


@Article{info:doi/10.2196/54852,
author="Andrikopoulou, Elisavet
and Chatzistergos, Panagiotis
and Chockalingam, Nachiappan",
title="Exploring the Pathways of Diabetes Foot Complications Treatment and Investigating Experiences From Frontline Health Care Professionals: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="24",
volume="13",
pages="e54852",
keywords="diabetic foot",
keywords="first-ever diabetic foot ulcer",
keywords="qualitative research",
keywords="quantitative evaluation",
keywords="surveys and questionnaires",
keywords="telephone interviews",
keywords="primary care",
keywords="community care",
keywords="acute care",
keywords="education of patients",
keywords="foot ulcer",
keywords="exploration",
keywords="diabetes",
keywords="foot ulceration",
keywords="United Kingdom",
keywords="diabetic foot ulceration",
keywords="DFU",
keywords="amputation",
keywords="complication",
keywords="perspectives",
keywords="experiences",
keywords="health care professionals",
keywords="barrier",
keywords="barriers",
keywords="effective care",
keywords="foot care",
keywords="primary ulcers",
keywords="quality of life",
abstract="Background: Diabetes affects more than 4.3 million individuals in the United Kingdom, with 19\% to 34\% developing diabetes-related foot ulceration (DFU) during their lifespan, which can lead to an amputation. In the United Kingdom, every week, approximately 169 people have an amputation due to diabetes. Preventing first-ever ulcers is the most effective strategy to reduce the occurrence of diabetes-related amputations, but research in this space is lacking. Objective: This protocol seeks to document the experiences and perspectives of frontline health care professionals who work with people who have diabetes and diabetes-related foot problems. Special attention is given to their perceptions of barriers to effective care, their views about barriers to effective and inclusive engagement with people with diabetes, and their experience with the first-ever DFU. Another aspect of the study is the focus on whether clinical management is affected by data sharing, data availability, and interoperability issues. Methods: This is a mixed methods explanatory protocol, which is sequential, and its purpose is to use the qualitative data to explain the initial quantitative data collected through a survey of frontline health care professionals. Data analysis of quantitative data will be completed first and then synthesized with the qualitative data analysis. Qualitative data will be analyzed using the framework method. This study will use joint displays to integrate the data. Ethical approval has been granted by the ethics committee of Staffordshire University. Results: The quantitative data collection started in March 2023 and will close in May 2024. The qualitative interviews commenced in November 2023 with volunteer participants who initially completed the survey. Conclusions: This study's survey focuses on data interoperability and the interviews focus more on the perspectives and experiences of clinicians and their perceived barriers for the effective management of diabetes foot ulcers. Including a geographically relevant and diverse cohort of health care professionals that spans a wide range of roles and care settings involved in diabetes-related foot care is very important for the successful application of this protocol. Special care is given to advertise and promote participation as widely as possible. The qualitative part of this protocol is also limited to 30-40 interview participants, as it is not realistic to interview higher numbers, due to time and resource constraints. International Registered Report Identifier (IRRID): DERR1-10.2196/54852 ",
doi="10.2196/54852",
url="https://www.researchprotocols.org/2024/1/e54852",
url="http://www.ncbi.nlm.nih.gov/pubmed/38656782"
}


@Article{info:doi/10.2196/54388,
author="Isangula, Ganka Kahabi
and Haule, John Rogers",
title="Leveraging AI and Machine Learning to Develop and Evaluate a Contextualized User-Friendly Cough Audio Classifier for Detecting Respiratory Diseases: Protocol for a Diagnostic Study in Rural Tanzania",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="23",
volume="13",
pages="e54388",
keywords="artificial intelligence",
keywords="machine learning",
keywords="respiratory diseases",
keywords="cough classifiers",
keywords="Tanzania",
keywords="Africa",
keywords="mobile phone",
keywords="user-friendly",
keywords="cough",
keywords="detecting respiratory disease",
keywords="diagnostic study",
keywords="tuberculosis",
keywords="asthma",
keywords="chronic obstructive pulmonary disease",
keywords="treatment",
keywords="management",
keywords="noninvasive",
keywords="rural",
keywords="cross-sectional research",
keywords="analysis",
keywords="cough sound",
abstract="Background: Respiratory diseases, including active tuberculosis (TB), asthma, and chronic obstructive pulmonary disease (COPD), constitute substantial global health challenges, necessitating timely and accurate diagnosis for effective treatment and management. Objective: This research seeks to develop and evaluate a noninvasive user-friendly artificial intelligence (AI)--powered cough audio classifier for detecting these respiratory conditions in rural Tanzania. Methods: This is a nonexperimental cross-sectional research with the primary objective of collection and analysis of cough sounds from patients with active TB, asthma, and COPD in outpatient clinics to generate and evaluate a noninvasive cough audio classifier. Specialized cough sound recording devices, designed to be nonintrusive and user-friendly, will facilitate the collection of diverse cough sound samples from patients attending outpatient clinics in 20 health care facilities in the Shinyanga region. The collected cough sound data will undergo rigorous analysis, using advanced AI signal processing and machine learning techniques. By comparing acoustic features and patterns associated with TB, asthma, and COPD, a robust algorithm capable of automated disease discrimination will be generated facilitating the development of a smartphone-based cough sound classifier. The classifier will be evaluated against the calculated reference standards including clinical assessments, sputum smear, GeneXpert, chest x-ray, culture and sensitivity, spirometry and peak expiratory flow, and sensitivity and predictive values. Results: This research represents a vital step toward enhancing the diagnostic capabilities available in outpatient clinics, with the potential to revolutionize the field of respiratory disease diagnosis. Findings from the 4 phases of the study will be presented as descriptions supported by relevant images, tables, and figures. The anticipated outcome of this research is the creation of a reliable, noninvasive diagnostic cough classifier that empowers health care professionals and patients themselves to identify and differentiate these respiratory diseases based on cough sound patterns. Conclusions: Cough sound classifiers use advanced technology for early detection and management of respiratory conditions, offering a less invasive and more efficient alternative to traditional diagnostics. This technology promises to ease public health burdens, improve patient outcomes, and enhance health care access in under-resourced areas, potentially transforming respiratory disease management globally. International Registered Report Identifier (IRRID): PRR1-10.2196/54388 ",
doi="10.2196/54388",
url="https://www.researchprotocols.org/2024/1/e54388",
url="http://www.ncbi.nlm.nih.gov/pubmed/38652526"
}


@Article{info:doi/10.2196/54833,
author="Polus, Manria
and Keikhosrokiani, Pantea
and Korhonen, Olli
and Behutiye, Woubshet
and Isomursu, Minna",
title="Impact of Digital Interventions on the Treatment Burden of Patients With Chronic Conditions: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="23",
volume="13",
pages="e54833",
keywords="chronic illness",
keywords="treatment burden",
keywords="eHealth",
keywords="mHealth",
keywords="digital health",
keywords="mobile health",
abstract="Background: There is great potential for delivering cost-effective, quality health care for patients with chronic conditions through digital interventions. Managing chronic conditions often includes a substantial workload required for adhering to the treatment regimen and negative consequences on the patient's function and well-being. This treatment burden affects adherence to treatment and disease outcomes. Digital interventions can potentially exacerbate the burden but also alleviate it. Objective: The objective of this review is to identify, summarize, and synthesize the evidence of how digital interventions impact the treatment burden of people with chronic conditions. Methods: The search, selection, and data synthesis processes were designed according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) 2015. A systematic search was conducted on October 16, 2023, from databases PubMed, Scopus, Web of Science, ACM, PubMed Central, and CINAHL. Results: Preliminary searches have been conducted, and screening has been started. The review is expected to be completed in October 2024. Conclusions: As the number of patients with chronic conditions is increasing, it is essential to design new digital interventions for managing chronic conditions in a way that supports patients with their treatment burden. To the best of our knowledge, the proposed systematic review will be the first review that investigates the impact of digital interventions on the treatment burden of patients. The results of this review will contribute to the field of health informatics regarding knowledge of the treatment burden associated with digital interventions and practical implications for developing better digital health care for patients with chronic conditions. Trial Registration: PROSPERO CRD42023477605; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=477605 International Registered Report Identifier (IRRID): DERR1-10.2196/54833 ",
doi="10.2196/54833",
url="https://www.researchprotocols.org/2024/1/e54833",
url="http://www.ncbi.nlm.nih.gov/pubmed/38652531"
}


@Article{info:doi/10.2196/48463,
author="Pannunzio, Valeria
and Morales Ornelas, Cristina Hosana
and Gurung, Pema
and van Kooten, Robert
and Snelders, Dirk
and van Os, Hendrikus
and Wouters, Michel
and Tollenaar, Rob
and Atsma, Douwe
and Kleinsmann, Maaike",
title="Patient and Staff Experience of Remote Patient Monitoring---What to Measure and How: Systematic Review",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="22",
volume="26",
pages="e48463",
keywords="remote patient monitoring",
keywords="telemonitoring",
keywords="patient experience",
keywords="staff experience",
keywords="monitoring",
keywords="intervention",
keywords="health outcome",
keywords="adherence",
keywords="patient monitoring",
abstract="Background: Patient and staff experience is a vital factor to consider in the evaluation of remote patient monitoring (RPM) interventions. However, no comprehensive overview of available RPM patient and staff experience--measuring methods and tools exists. Objective: This review aimed at obtaining a comprehensive set of experience constructs and corresponding measuring instruments used in contemporary RPM research and at proposing an initial set of guidelines for improving methodological standardization in this domain. Methods: Full-text papers reporting on instances of patient or staff experience measuring in RPM interventions, written in English, and published after January 1, 2011, were considered for eligibility. By ``RPM interventions,'' we referred to interventions including sensor-based patient monitoring used for clinical decision-making; papers reporting on other kinds of interventions were therefore excluded. Papers describing primary care interventions, involving participants under 18 years of age, or focusing on attitudes or technologies rather than specific interventions were also excluded. We searched 2 electronic databases, Medline (PubMed) and EMBASE, on February 12, 2021.We explored and structured the obtained corpus of data through correspondence analysis, a multivariate statistical technique. Results: In total, 158 papers were included, covering RPM interventions in a variety of domains. From these studies, we reported 546 experience-measuring instances in RPM, covering the use of 160 unique experience-measuring instruments to measure 120 unique experience constructs. We found that the research landscape has seen a sizeable growth in the past decade, that it is affected by a relative lack of focus on the experience of staff, and that the overall corpus of collected experience measures can be organized in 4 main categories (service system related, care related, usage and adherence related, and health outcome related). In the light of the collected findings, we provided a set of 6 actionable recommendations to RPM patient and staff experience evaluators, in terms of both what to measure and how to measure it. Overall, we suggested that RPM researchers and practitioners include experience measuring as part of integrated, interdisciplinary data strategies for continuous RPM evaluation. Conclusions: At present, there is a lack of consensus and standardization in the methods used to measure patient and staff experience in RPM, leading to a critical knowledge gap in our understanding of the impact of RPM interventions. This review offers targeted support for RPM experience evaluators by providing a structured, comprehensive overview of contemporary patient and staff experience measures and a set of practical guidelines for improving research quality and standardization in this domain. ",
doi="10.2196/48463",
url="https://www.jmir.org/2024/1/e48463",
url="http://www.ncbi.nlm.nih.gov/pubmed/38648090"
}


@Article{info:doi/10.2196/48756,
author="Bernal-Jim{\'e}nez, {\'A}ngeles Mar{\'i}a
and Calle, German
and Guti{\'e}rrez Barrios, Alejandro
and Gheorghe, Luciana Livia
and Cruz-Cobo, Celia
and Trujillo-Garrido, Nuria
and Rodr{\'i}guez-Mart{\'i}n, Amelia
and Tur, A. Josep
and V{\'a}zquez-Garc{\'i}a, Rafael
and Santi-Cano, Jos{\'e} Mar{\'i}a",
title="Effectiveness of an Interactive mHealth App (EVITE) in Improving Lifestyle After a Coronary Event: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Apr",
day="22",
volume="12",
pages="e48756",
keywords="coronary artery disease",
keywords="healthy lifestyle",
keywords="mHealth",
keywords="mobile health",
keywords="percutaneous coronary intervention",
keywords="randomized controlled trial",
keywords="secondary prevention",
keywords="therapeutic adherence",
abstract="Background: Coronary heart disease is one of the leading causes of mortality worldwide. Secondary prevention is essential, as it reduces the risk of further coronary events. Mobile health (mHealth) technology could become a useful tool to improve lifestyles. Objective: This study aimed to evaluate the effect of an mHealth intervention on people with coronary heart disease who received percutaneous coronary intervention. Improvements in lifestyle regarding diet, physical activity, and smoking; level of knowledge of a healthy lifestyle and the control of cardiovascular risk factors (CVRFs); and therapeutic adherence and quality of life were analyzed. Methods: This was a randomized controlled trial with a parallel group design assigned 1:1 to either an intervention involving a smartphone app (mHealth group) or to standard health care (control group). The app was used for setting aims, the self-monitoring of lifestyle and CVRFs using measurements and records, educating people with access to information on their screens about healthy lifestyles and adhering to treatment, and giving motivation through feedback about achievements and aspects to improve. Both groups were assessed after 9 months. The primary outcome variables were adherence to the Mediterranean diet, frequency of food consumed, patient-reported physical activity, smoking, knowledge of healthy lifestyles and the control of CVRFs, adherence to treatment, quality of life, well-being, and satisfaction. Results: The study analyzed 128 patients, 67 in the mHealth group and 61 in the control group; most were male (92/128, 71.9\%), with a mean age of 59.49 (SD 8.97) years. Significant improvements were observed in the mHealth group compared with the control group regarding adherence to the Mediterranean diet (mean 11.83, SD 1.74 points vs mean 10.14, SD 2.02 points; P<.001), frequency of food consumption, patient-reported physical activity (mean 619.14, SD 318.21 min/week vs mean 471.70, SD 261.43 min/week; P=.007), giving up smoking (25/67, 75\% vs 11/61, 42\%; P=.01), level of knowledge of healthy lifestyles and the control of CVRFs (mean 118.70, SD 2.65 points vs mean 111.25, SD 9.05 points; P<.001), and the physical component of the quality of life 12-item Short Form survey (SF-12; mean 45.80, SD 10.79 points vs mean 41.40, SD 10.78 points; P=.02). Overall satisfaction was higher in the mHealth group (mean 48.22, SD 3.89 vs mean 46.00, SD 4.82 points; P=.002) and app satisfaction and usability were high (mean 44.38, SD 6.18 out of 50 points and mean 95.22, SD 7.37 out of 100). Conclusions: The EVITE app was effective in improving the lifestyle of patients in terms of adherence to the Mediterranean diet, frequency of healthy food consumption, physical activity, giving up smoking, knowledge of healthy lifestyles and controlling CVRFs, quality of life, and overall satisfaction. The app satisfaction and usability were excellent. Trial Registration: Clinicaltrials.gov NCT04118504; https://clinicaltrials.gov/study/NCT04118504 ",
doi="10.2196/48756",
url="https://mhealth.jmir.org/2024/1/e48756",
url="http://www.ncbi.nlm.nih.gov/pubmed/38648103"
}


@Article{info:doi/10.2196/55829,
author="Novella-Navarro, Marta
and Iniesta-Chamorro, M. Jose
and Benavent, Diego
and Bachiller-Corral, Javier
and Calvo-Aranda, Enrique
and Borrell, Helena
and Berbel-Arcob{\'e}, Laura
and Navarro-Compan, Victoria
and Michelena, Xabier
and Lojo-Oliveira, Leticia
and Arroyo-Palomo, Jaime
and Diaz-Almiron, Mariana
and Garc{\'i}a Garc{\'i}a, Ver{\'o}nica
and Monjo-Henry, Irene
and G{\'o}mez Gonz{\'a}lez, Mar{\'i}a Claudia
and Gomez, J. Enrique
and Balsa, Alejandro
and Plasencia-Rodr{\'i}guez, Chamaida",
title="Toward Telemonitoring in Immune-Mediated Inflammatory Diseases: Protocol for a Mixed Attention Model Study",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="22",
volume="13",
pages="e55829",
keywords="digital health",
keywords="mHealth, telemonitoring, rheumatic musculoskeletal diseases",
keywords="digital resources, mixed attention model",
keywords="rheumatic disease",
keywords="musculoskeletal diseases",
keywords="chronic diseases",
keywords="pain",
keywords="inflammation",
keywords="antirheumatic drugs",
keywords="telemonitoring",
keywords="rheumatology",
keywords="hybrid care model",
keywords="care model",
keywords="MAM",
keywords="implementation",
keywords="clinical outcome",
abstract="Background: Rheumatic and musculoskeletal diseases (RMDs) are chronic diseases that may alternate between asymptomatic periods and flares. These conditions require complex treatments and close monitoring by rheumatologists to mitigate their effects and improve the patient's quality of life. Often, delays in outpatient consultations or the patient's difficulties in keeping appointments make such close follow-up challenging. For this reason, it is very important to have open communication between patients and health professionals. In this context, implementing telemonitoring in the field of rheumatology has great potential, as it can facilitate the close monitoring of patients with RMDs. The use of these tools helps patients self-manage certain aspects of their disease. This could result in fewer visits to emergency departments and consultations, as well as enable better therapeutic compliance and identification of issues that would otherwise go unnoticed. Objective: The main objective of this study is to evaluate the implementation of a hybrid care model called the mixed attention model (MAM) in clinical practice and determine whether its implementation improves clinical outcomes compared to conventional follow-up. Methods: This is a multicenter prospective observational study involving 360 patients with rheumatoid arthritis (RA) and spondylarthritis (SpA) from 5 Spanish hospitals. The patients will be followed up by the MAM protocol, which is a care model that incorporates a digital tool consisting of a mobile app that patients can use at home and professionals can review asynchronously to detect incidents and follow patients' clinical evolution between face-to-face visits. Another group of patients, whose follow-up will be conducted in accordance with a traditional face-to-face care model, will be assessed as the control group. Sociodemographic characteristics, treatments, laboratory parameters, assessment of tender and swollen joints, visual analog scale for pain, and electronic patient-reported outcome (ePRO) reports will be collected for all participants. In the MAM group, these items will be self-assessed via both the mobile app and during face-to-face visits with the rheumatologist, who will do the same for patients included in the traditional care model. The patients will be able to report any incidence related to their disease or treatment through the mobile app. Results: Participant recruitment began in March 2024 and will continue until December 2024. The follow-up period will be extended by 12 months for all patients. Data collection and analysis are scheduled for completion in December 2025. Conclusions: This paper aims to provide a detailed description of the development and implementation of a digital solution, specifically an MAM. The goal is to achieve significant economic and psychosocial impact within our health care system by enhancing control over RMDs. Trial Registration: ClinicalTrials.gov NCT06273306; https://clinicaltrials.gov/ct2/show/NCT06273306 International Registered Report Identifier (IRRID): PRR1-10.2196/55829 ",
doi="10.2196/55829",
url="https://www.researchprotocols.org/2024/1/e55829",
url="http://www.ncbi.nlm.nih.gov/pubmed/38501508"
}


@Article{info:doi/10.2196/52344,
author="Alvarez-Romero, Celia
and Polo-Molina, Alejandro
and S{\'a}nchez-{\'U}beda, Francisco Eugenio
and Jimenez-De-Juan, Carlos
and Cuadri-Benitez, Pastora Maria
and Rivas-Gonzalez, Antonio Jose
and Portela, Jose
and Palacios, Rafael
and Rodriguez-Morcillo, Carlos
and Mu{\~n}oz, Antonio
and Parra-Calderon, Luis Carlos
and Nieto-Martin, Dolores Maria
and Ollero-Baturone, Manuel
and Hern{\'a}ndez-Quiles, Carlos",
title="Machine Learning--Based Prediction of Changes in the Clinical Condition of Patients With Complex Chronic Diseases: 2-Phase Pilot Prospective Single-Center Observational Study",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="19",
volume="8",
pages="e52344",
keywords="patients with complex chronic diseases",
keywords="functional impairment",
keywords="Barthel Index",
keywords="artificial intelligence",
keywords="machine learning",
keywords="prediction model",
keywords="pilot study",
keywords="chronic patients",
keywords="chronic",
keywords="development study",
keywords="prognostic",
keywords="diagnostic",
keywords="therapeutic",
keywords="wearable",
keywords="wearables",
keywords="wearable activity tracker",
keywords="mobility device",
keywords="device",
keywords="physical activity",
keywords="caregiver",
abstract="Background: Functional impairment is one of the most decisive prognostic factors in patients with complex chronic diseases. A more significant functional impairment indicates that the disease is progressing, which requires implementing diagnostic and therapeutic actions that stop the exacerbation of the disease. Objective: This study aimed to predict alterations in the clinical condition of patients with complex chronic diseases by predicting the Barthel Index (BI), to assess their clinical and functional status using an artificial intelligence model and data collected through an internet of things mobility device. Methods: A 2-phase pilot prospective single-center observational study was designed. During both phases, patients were recruited, and a wearable activity tracker was allocated to gather physical activity data. Patients were categorized into class A (BI?20; total dependence), class B (20<BI?60; severe dependence), and class C (BI>60; moderate or mild dependence, or independent). Data preprocessing and machine learning techniques were used to analyze mobility data. A decision tree was used to achieve a robust and interpretable model. To assess the quality of the predictions, several metrics including the mean absolute error, median absolute error, and root mean squared error were considered. Statistical analysis was performed using SPSS and Python for the machine learning modeling. Results: Overall, 90 patients with complex chronic diseases were included: 50 during phase 1 (class A: n=10; class B: n=20; and class C: n=20) and 40 during phase 2 (class B: n=20 and class C: n=20). Most patients (n=85, 94\%) had a caregiver. The mean value of the BI was 58.31 (SD 24.5). Concerning mobility aids, 60\% (n=52) of patients required no aids, whereas the others required walkers (n=18, 20\%), wheelchairs (n=15, 17\%), canes (n=4, 7\%), and crutches (n=1, 1\%). Regarding clinical complexity, 85\% (n=76) met patient with polypathology criteria with a mean of 2.7 (SD 1.25) categories, 69\% (n=61) met the frailty criteria, and 21\% (n=19) met the patients with complex chronic diseases criteria. The most characteristic symptoms were dyspnea (n=73, 82\%), chronic pain (n=63, 70\%), asthenia (n=62, 68\%), and anxiety (n=41, 46\%). Polypharmacy was presented in 87\% (n=78) of patients. The most important variables for predicting the BI were identified as the maximum step count during evening and morning periods and the absence of a mobility device. The model exhibited consistency in the median prediction error with a median absolute error close to 5 in the training, validation, and production-like test sets. The model accuracy for identifying the BI class was 91\%, 88\%, and 90\% in the training, validation, and test sets, respectively. Conclusions: Using commercially available mobility recording devices makes it possible to identify different mobility patterns and relate them to functional capacity in patients with polypathology according to the BI without using clinical parameters. ",
doi="10.2196/52344",
url="https://formative.jmir.org/2024/1/e52344",
url="http://www.ncbi.nlm.nih.gov/pubmed/38640473"
}


@Article{info:doi/10.2196/50832,
author="Blanchard, Marc
and Koller, Nadana Cinja
and Azevedo, Ming Pedro
and Pr{\'e}tat, Tiffany
and H{\"u}gle, Thomas",
title="Development of a Management App for Postviral Fibromyalgia-Like Symptoms: Patient Preference-Guided Approach",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="19",
volume="8",
pages="e50832",
keywords="digital health",
keywords="patient preference",
keywords="user experience",
keywords="patient-centricity",
keywords="platform",
keywords="development",
keywords="fibromyalgia",
keywords="self-management",
keywords="quality of life",
keywords="patient outcome",
keywords="musculoskeletal",
keywords="usability testing",
keywords="digital health solution",
abstract="Background: Persistent fibromyalgia-like symptoms have been increasingly reported following viral infections, including SARS-CoV-2. About 30\% of patients with post--COVID-19 syndrome fulfill the fibromyalgia criteria. This complex condition presents significant challenges in terms of self-management. Digital health interventions offer a viable means to assist patients in managing their health conditions. However, the challenge of ensuring their widespread adoption and adherence persists. This study responds to this need by developing a patient-centered digital health management app, incorporating patient preferences to enhance usability and effectiveness, ultimately aiming to improve patient outcomes and quality of life. Objective: This research aims to develop a digital health self-management app specifically for patients experiencing postviral fibromyalgia-like symptoms. By prioritizing patient preferences and engagement through the app's design and functionality, the study intends to facilitate better self-management practices and improve adherence. Methods: Using an exploratory study design, the research used patient preference surveys and usability testing as primary tools to inform the development process of the digital health solution. We gathered and analyzed patients' expectations regarding design features, content, and usability to steer the iterative app development. Results: The study uncovered crucial insights from patient surveys and usability testing, which influenced the app's design and functionality. Key findings included a preference for a symptom list over an automated chatbot, a desire to report on a moderate range of symptoms and activities, and the importance of an intuitive onboarding process. While usability testing identified some challenges in the onboarding process, it also confirmed the importance of aligning the app with patient needs to enhance engagement and satisfaction. Conclusions: Incorporating patient feedback has been a significant factor in the development of the digital health app. Challenges encountered with user onboarding during usability testing have highlighted the importance of this process for user adoption. The study acknowledges the role of patient input in developing digital health technologies and suggests further research to improve onboarding procedures, aiming to enhance patient engagement and their ability to manage digital health resources effectively. International Registered Report Identifier (IRRID): RR2-10.2196/32193 ",
doi="10.2196/50832",
url="https://formative.jmir.org/2024/1/e50832",
url="http://www.ncbi.nlm.nih.gov/pubmed/38639986"
}


@Article{info:doi/10.2196/54172,
author="McCallum, Claire
and Campbell, Miglena
and Vines, John
and Rapley, Tim
and Ellis, Jason
and Deary, Vincent
and Hackett, Katie",
title="A Smartphone App to Support Self-Management for People Living With Sj{\"o}gren's Syndrome: Qualitative Co-Design Workshops",
journal="JMIR Hum Factors",
year="2024",
month="Apr",
day="17",
volume="11",
pages="e54172",
keywords="self-management",
keywords="mobile health",
keywords="mHealth",
keywords="eHealth",
keywords="Sj{\"o}gren's syndrome",
keywords="patient participation",
keywords="patient involvement",
keywords="fatigue",
keywords="chronic disease",
keywords="focus groups",
keywords="complex intervention development",
keywords="mobile phone",
abstract="Background: Sj{\"o}gren's syndrome (SS) is the second most common autoimmune rheumatic disease, and the range of symptoms includes fatigue, dryness, sleep disturbances, and pain. Smartphone apps may help deliver a variety of cognitive and behavioral techniques to support self-management in SS. However, app-based interventions must be carefully designed to promote engagement and motivate behavior change. Objective: We aimed to explore self-management approaches and challenges experienced by people living with SS and produce a corresponding set of design recommendations that inform the design of an engaging, motivating, and evidence-based self-management app for those living with SS. Methods: We conducted a series of 8 co-design workshops and an additional 3 interviews with participants who were unable to attend a workshop. These were audio recorded, transcribed, and initially thematically analyzed using an inductive approach. Then, the themes were mapped to the Self-Determination Theory domains of competency, autonomy, and relatedness. Results: Participants experienced a considerable demand in the daily work required in self-managing their SS. The condition demanded unrelenting, fluctuating, and unpredictable mental, physical, and social efforts. Participants used a wide variety of techniques to self-manage their symptoms; however, their sense of competency was undermined by the complexity and interconnected nature of their symptoms and affected by interactions with others. The daily contexts in which this labor was occurring revealed ample opportunities to use digital health aids. The lived experience of participants showed that the constructs of competency, autonomy, and relatedness existed in a complex equilibrium with each other. Sometimes, they were disrupted by tensions, whereas on other occasions, they worked together harmoniously. Conclusions: An SS self-management app needs to recognize the complexity and overlap of symptoms and the complexities of managing the condition in daily life. Identifying techniques that target several symptoms simultaneously may prevent users from becoming overwhelmed. Including techniques that support assertiveness and communication with others about the condition, its symptoms, and users' limitations may support users in their interactions with others and improve engagement in symptom management strategies.?For digital health aids (such as self-management apps) to provide meaningful support, they should be designed according to human needs such as competence, autonomy, and relatedness. However, the complexities among the 3 Self-Determination Theory constructs should be carefully considered, as they present both design difficulties and opportunities. ",
doi="10.2196/54172",
url="https://humanfactors.jmir.org/2024/1/e54172",
url="http://www.ncbi.nlm.nih.gov/pubmed/38630530"
}


@Article{info:doi/10.2196/48767,
author="Nwosu, Chinonyelum
and Khan, Hamda
and Masese, Rita
and Nocek, M. Judith
and Gollan, Siera
and Varughese, Taniya
and Bourne, Sarah
and Clesca, Cindy
and Jacobs, R. Sara
and Baumann, Ana
and Klesges, M. Lisa
and Shah, Nirmish
and Hankins, S. Jane
and Smeltzer, P. Matthew",
title="Recruitment Strategies in the Integration of Mobile Health Into Sickle Cell Disease Care to Increase Hydroxyurea Utilization Study (meSH): Multicenter Survey Study",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="16",
volume="8",
pages="e48767",
keywords="sickle cell",
keywords="recruitment",
keywords="eHealth",
keywords="multicenter",
keywords="utilization",
keywords="strategy",
keywords="hydroxyurea",
keywords="mobile health",
keywords="mhealth",
keywords="intervention",
abstract="Background: Hydroxyurea is an evidence-based disease-modifying therapy for sickle cell disease (SCD) but is underutilized. The Integration of Mobile Health into Sickle Cell Disease Care to Increase Hydroxyurea Utilization (meSH) multicenter study leveraged mHealth to deliver targeted interventions to patients and providers. SCD studies often underenroll; and recruitment strategies in the SCD population are not widely studied. Unanticipated events can negatively impact enrollment, making it important to study strategies that ensure adequate study accrual. Objective: The goal of this study was to evaluate enrollment barriers and the impact of modified recruitment strategies among patients and providers in the meSH study in response to a global emergency. Methods: Recruitment was anticipated to last 2 months for providers and 6 months for patients. The recruitment strategies used with patients and providers, new recruitment strategies, and recruitment rates were captured and compared. To document recruitment adaptations and their reasons, study staff responsible for recruitment completed an open-ended 9-item questionnaire eliciting challenges to recruitment and strategies used. Themes were extrapolated using thematic content analysis. Results: Total enrollment across the 7 sites included 89 providers and 293 patients. The study acceptance rate was 85.5\% (382/447) for both patients and providers. The reasons patients declined participation were most frequently a lack of time and interest in research, while providers mostly declined because of self-perceived high levels of SCD expertise, believing they did not need the intervention. Initially, recruitment involved an in-person invitation to participate during clinic visits (patients), staff meetings (providers), or within the office (providers). We identified several important recruitment challenges, including (1) lack of interest in research, (2) lack of human resources, (3) unavailable physical space for recruitment activities, and (4) lack of documentation to verify eligibility. Adaptive strategies were crucial to alleviate enrollment disruptions due to the COVID-19 pandemic. These included remote approaching and consenting (eg, telehealth, email, and telephone) for patients and providers. Additionally, for patients, recruitment was enriched by simplification of enrollment procedures (eg, directly approaching patients without a referral from the provider) and a multitouch method (ie, warm introductions with flyers, texts, and patient portal messages). We found that patient recruitment rates were similar between in-person and adapted (virtual with multitouch) approaches (167/200, 83.5\% and 126/143, 88.1\%, respectively; P=.23). However, for providers, recruitment was significantly higher for in-person vs remote recruitment (48/50, 96\% and 41/54, 76\%, respectively, P<.001). Conclusions: We found that timely adaptation in recruitment strategies secured high recruitment rates using an assortment of enriched remote recruitment strategies. Flexibility in approach and reducing the burden of enrollment procedures for participants aided enrollment. It is important to continue identifying effective recruitment strategies in studies involving patients with SCD and their providers and the impact and navigation of recruitment challenges. Trial Registration: ClinicalTrials.Gov NCT03380351; https://clinicaltrials.gov/study/NCT03380351 International Registered Report Identifier (IRRID): RR2-10.2196/16319 ",
doi="10.2196/48767",
url="https://formative.jmir.org/2024/1/e48767",
url="http://www.ncbi.nlm.nih.gov/pubmed/38625729"
}


@Article{info:doi/10.2196/51901,
author="Roberge, Patrice
and Ruel, Jean
and B{\'e}gin-Drolet, Andr{\'e}
and Lemay, Jean
and Gakwaya, Simon
and Masse, Jean-Fran{\c{c}}ois
and S{\'e}ri{\`e}s, Fr{\'e}d{\'e}ric",
title="Preliminary Assessment of an Ambulatory Device Dedicated to Upper Airway Muscle Training in Patients With Sleep Apnea: Proof-of-Concept Study",
journal="JMIR Biomed Eng",
year="2024",
month="Apr",
day="15",
volume="9",
pages="e51901",
keywords="obstructive sleep apnea/hypopnea syndrome",
keywords="OSAHS",
keywords="myofunctional therapy",
keywords="myotherapy",
keywords="oral",
keywords="orofacial",
keywords="myology",
keywords="musculature",
keywords="labial",
keywords="buccal",
keywords="lingual",
keywords="speech therapy",
keywords="physiotherapy",
keywords="physical therapy",
keywords="oropharyngeal exercises",
keywords="oropharyngeal",
keywords="pharyngeal",
keywords="pharynx",
keywords="hypopnea",
keywords="lip",
keywords="home-based",
keywords="portable device",
keywords="devices",
keywords="ambulatory",
keywords="portable",
keywords="monitoring",
keywords="apnea",
keywords="mouth",
keywords="lips",
keywords="tongue",
keywords="facial",
keywords="exercise",
keywords="exercises",
keywords="myofunctional",
keywords="continuous monitoring",
keywords="sleep-disordered breathing",
keywords="sleep",
keywords="breathing",
keywords="tongue exercise",
keywords="lip exercise",
keywords="mHealth",
keywords="muscle",
keywords="muscles",
keywords="muscular",
keywords="airway",
keywords="sleep apnea",
abstract="Background: Obstructive sleep apnea/hypopnea syndrome (OSAHS) is a prevalent condition affecting a substantial portion of the global population, with its prevalence increasing over the past 2 decades. OSAHS is characterized by recurrent upper airway (UA) closure during sleep, leading to significant impacts on quality of life and heightened cardiovascular and metabolic morbidity. Despite continuous positive airway pressure (CPAP) being the gold standard treatment, patient adherence remains suboptimal due to various factors, such as discomfort, side effects, and treatment unacceptability. Objective: Considering the challenges associated with CPAP adherence, an alternative approach targeting the UA muscles through myofunctional therapy was explored. This noninvasive intervention involves exercises of the lips, tongue, or both to improve oropharyngeal functions and mitigate the severity of OSAHS. With the goal of developing a portable device for home-based myofunctional therapy with continuous monitoring of exercise performance and adherence, the primary outcome of this study was the degree of completion and adherence to a 4-week training session. Methods: This proof-of-concept study focused on a portable device that was designed to facilitate tongue and lip myofunctional therapy and enable precise monitoring of exercise performance and adherence. A clinical study was conducted to assess the effectiveness of this program in improving sleep-disordered breathing. Participants were instructed to perform tongue protrusion, lip pressure, and controlled breathing as part of various tasks 6 times a week for 4 weeks, with each session lasting approximately 35 minutes. Results: Ten participants were enrolled in the study (n=8 male; mean age 48, SD 22 years; mean BMI 29.3, SD 3.5 kg/m2; mean apnea-hypopnea index [AHI] 20.7, SD 17.8/hour). Among the 8 participants who completed the 4-week program, the overall compliance rate was 91\% (175/192 sessions). For the tongue exercise, the success rate increased from 66\% (211/320 exercises; SD 18\%) on the first day to 85\% (272/320 exercises; SD 17\%) on the last day (P=.05). AHI did not change significantly after completion of training but a noteworthy correlation between successful lip exercise improvement and AHI reduction in the supine position was observed (Rs=--0.76; P=.03). These findings demonstrate the potential of the device for accurately monitoring participants' performance in lip and tongue pressure exercises during myofunctional therapy. The diversity of the training program (it mixed exercises mixed training games), its ability to provide direct feedback for each exercise to the participants, and the easy measurement of treatment adherence are major strengths of our training program. Conclusions: The study's portable device for home-based myofunctional therapy shows promise as a noninvasive alternative for reducing the severity of OSAHS, with a notable correlation between successful lip exercise improvement and AHI reduction, warranting further development and investigation. ",
doi="10.2196/51901",
url="https://biomedeng.jmir.org/2024/1/e51901",
url="http://www.ncbi.nlm.nih.gov/pubmed/38875673"
}


@Article{info:doi/10.2196/51428,
author="Kim, KunJung
and Hwang, Hyunchan
and Bae, Sujin
and Kim, Mi Sun
and Han, Hyun Doug",
title="The Effectiveness of a Digital App for Reduction of Clinical Symptoms in Individuals With Panic Disorder: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="12",
volume="26",
pages="e51428",
keywords="digital app",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="application",
keywords="applications",
keywords="functional near-infrared spectroscopy",
keywords="hemodynamic",
keywords="hemodynamics",
keywords="panic disorder",
keywords="anxiety",
keywords="panic",
keywords="mental",
keywords="fear",
keywords="spectroscopy",
keywords="digital therapy",
keywords="fNIRS",
keywords="brain",
keywords="imaging",
keywords="neurology",
keywords="neuroscience",
keywords="cortex",
keywords="cortices",
abstract="Background: Panic disorder is a common and important disease in clinical practice that decreases individual productivity and increases health care use. Treatments comprise medication and cognitive behavioral therapy. However, adverse medication effects and poor treatment compliance mean new therapeutic models are needed. Objective: We hypothesized that digital therapy for panic disorder may improve panic disorder symptoms and that treatment response would be associated with brain activity changes assessed with functional near-infrared spectroscopy (fNIRS). Methods: Individuals (n=50) with a history of panic attacks were recruited. Symptoms were assessed before and after the use of an app for panic disorder, which in this study was a smartphone-based app for treating the clinical symptoms of panic disorder, panic symptoms, depressive symptoms, and anxiety. The hemodynamics in the frontal cortex during the resting state were measured via fNIRS. The app had 4 parts: diary, education, quest, and serious games. The study trial was approved by the institutional review board of Chung-Ang University Hospital (1041078-202112-HR-349-01) and written informed consent was obtained from all participants. Results: The number of participants with improved panic symptoms in the app use group (20/25, 80\%) was greater than that in the control group (6/21, 29\%; $\chi$21=12.3; P=.005). During treatment, the improvement in the Panic Disorder Severity Scale (PDSS) score in the app use group was greater than that in the control group (F1,44=7.03; P=.01). In the app use group, the total PDSS score declined by 42.5\% (mean score 14.3, SD 6.5 at baseline and mean score 7.2, SD 3.6 after the intervention), whereas the PDSS score declined by 14.6\% in the control group (mean score 12.4, SD 5.2 at baseline and mean score 9.8, SD 7.9 after the intervention). There were no significant differences in accumulated oxygenated hemoglobin (accHbO2) at baseline between the app use and control groups. During treatment, the reduction in accHbO2 in the right ventrolateral prefrontal cortex (VLPFC; F1,44=8.22; P=.006) and the right orbitofrontal cortex (OFC; F1,44=8.88; P=.005) was greater in the app use than the control group. Conclusions: Apps for panic disorder should effectively reduce symptoms and VLPFC and OFC brain activity in patients with panic disorder. The improvement of panic disorder symptoms was positively correlated with decreased VLPFC and OFC brain activity in the resting state. Trial Registration: Clinical Research Information Service KCT0007280; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=21448 ",
doi="10.2196/51428",
url="https://www.jmir.org/2024/1/e51428",
url="http://www.ncbi.nlm.nih.gov/pubmed/38608270"
}


@Article{info:doi/10.2196/55080,
author="Walkner, Tammy
and Karr, W. Daniel
and Murray, Sarah
and Heeren, Amanda
and Berry-Stoelzle, Maresi",
title="Participation in Advance Care Planning Among Medically At-Risk Rural Veterans: Protocol for a Personalized Engagement Model",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="12",
volume="13",
pages="e55080",
keywords="advance care planning",
keywords="chronic disease",
keywords="end-of-life care",
keywords="health care decision",
keywords="medical decision-making",
keywords="recruiting",
keywords="shared medical decision-making",
abstract="Background: Many of the challenges in advanced care planning (ACP) conversations are linked to the waxing and waning progress of serious illnesses. Conversations with patients about future medical care decisions by a surrogate decision maker have historically been left until late in the patient's disease trajectory. These conversations often happen at a time when the patient is already very ill. The challenge in effective early ACP and serious illness conversations is to create a situation where patients appreciate the link between current and future medical care. Setting the stage to make these conversations more accessible includes using telehealth to have conversations at the patient's place of choice. The personalization used includes addressing the current medical and social needs of the patient and ensuring that expressed needs are addressed as much as possible. Engaging patients in these conversations allows the documentation of patient preferences in the electronic health record (EHR), providing guidelines for future medical care. Objective: The objective of our telehealth serious illness care conversations program was to successfully recruit patients who lacked up-to-date documentation of ACP in their EHR. Once these patients were identified, we engaged in meaningful, structured conversations to address the veterans' current needs and concerns. We developed a recruitment protocol that increased the uptake of rural veterans' participation in serious illness care conversations and subsequent EHR documentation. Methods: The recruitment protocol outlined herein used administrative data to determine those patients who have not completed or updated formal ACP documentation in the EHR and who are at above-average risk for death in the next 3-5 years. The key features of the telehealth serious illness care conversations recruitment protocol involve tailoring the recruitment approach to address current patient concerns while emphasizing future medical decision-making. Results: As of September 2022, 196 veterans had completed this intervention. The recruitment method ensures that the timing of the intervention is patient driven, allowing for veterans to engage in ACP at a time and place convenient for them and their identified support persons. Conclusions: The recruitment protocol has been successful in actively involving patients in ACP conversations, leading to an uptick in completed formal documentation of ACP preferences within the EHR for this specific population. This documentation is then available to the medical team to guide future medical care. International Registered Report Identifier (IRRID): RR1-10.2196/55080 ",
doi="10.2196/55080",
url="https://www.researchprotocols.org/2024/1/e55080",
url="http://www.ncbi.nlm.nih.gov/pubmed/38608267"
}


@Article{info:doi/10.2196/50157,
author="Dorronzoro-Zubiete, Enrique
and Castro-Marrero, Jes{\'u}s
and Ropero, Jorge
and Sevillano-Ramos, Luis Jos{\'e}
and Dolores Hern{\'a}ndez, Mar{\'i}a
and Sanmartin Senta{\~n}es, Ramon
and Alegre-Martin, Jose
and Launois-Obreg{\'o}n, Patricia
and Martin-Garrido, Isabel
and Luque Budia, Asuncion
and Lacalle-Remigio, R. Juan
and B{\'e}jar Prado, Luis
and Rivera Romero, Octavio",
title="Personalized Management of Fatigue in Individuals With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Long COVID Using a Smart Digital mHealth Solution: Protocol for a Participatory Design Approach",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="12",
volume="13",
pages="e50157",
keywords="acceptability",
keywords="myalgic encephalomyelitis/chronic fatigue syndrome",
keywords="long COVID",
keywords="mHealth",
keywords="fatigue",
keywords="physical activity",
keywords="lifestyle health",
keywords="personalized self-management",
keywords="user-centered design",
abstract="Background: Fatigue is the most common symptom in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and long COVID, impacting patients' quality of life; however, there is currently a lack of evidence-based context-aware tools for fatigue self-management in these populations. Objective: This study aimed to (1) address fatigue in ME/CFS and long COVID through the development of digital mobile health solutions for self-management, (2) predict perceived fatigue severity using real-time data, and (3) assess the feasibility and potential benefits of personalized digital mobile health solutions. Methods: The MyFatigue project adopts a patient-centered approach within the participatory health informatics domain. Patient representatives will be actively involved in decision-making processes. This study combines inductive and deductive research approaches, using qualitative studies to generate new knowledge and quantitative methods to test hypotheses regarding the relationship between factors like physical activity, sleep behaviors, and perceived fatigue in ME/CFS and long COVID. Co-design methods will be used to develop a personalized digital solution for fatigue self-management based on the generated knowledge. Finally, a pilot study will evaluate the feasibility, acceptance, and potential benefits of the digital health solution. Results: The MyFatigue project opened to enrollment in November 2023. Initial results are expected to be published by the end of 2024. Conclusions: This study protocol holds the potential to expand understanding, create personalized self-management approaches, engage stakeholders, and ultimately improve the well-being of individuals with ME/CFS and long COVID. International Registered Report Identifier (IRRID): PRR1-10.2196/50157 ",
doi="10.2196/50157",
url="https://www.researchprotocols.org/2024/1/e50157",
url="http://www.ncbi.nlm.nih.gov/pubmed/38608263"
}


@Article{info:doi/10.2196/53726,
author="Louch, Gemma
and Berzins, Kathryn
and Walker, Lauren
and Wormald, Gemma
and Blackwell, Kirstin
and Stephens, Michael
and Brown, Mark
and Baker, John",
title="Promoting a Patient-Centered Understanding of Safety in Acute Mental Health Wards: A User-Centered Design Approach to Develop a Real-Time Digital Monitoring Tool",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="12",
volume="8",
pages="e53726",
keywords="patient safety",
keywords="mental health",
keywords="patient involvement",
keywords="qualitative",
keywords="digital innovation",
keywords="real time",
keywords="monitoring",
keywords="safety",
keywords="develop",
keywords="development",
keywords="design",
keywords="perception",
keywords="perceptions",
keywords="prototype",
keywords="evidence scan",
keywords="interview",
keywords="interviews",
keywords="logic model",
keywords="programme theory",
keywords="dashboard",
keywords="dashboards",
keywords="interface",
abstract="Background: Acute mental health services report high levels of safety incidents that involve both patients and staff. The potential for patients to be involved in interventions to improve safety within a mental health setting is acknowledged, and there is a need for interventions that proactively seek the patient perspective of safety. Digital technologies may offer opportunities to address this need. Objective: This research sought to design and develop a digital real-time monitoring tool (WardSonar) to collect and collate daily information from patients in acute mental health wards about their perceptions of safety. We present the design and development process and underpinning logic model and programme theory. Methods: The first stage involved a synthesis of the findings from a systematic review and evidence scan, interviews with patients (n=8) and health professionals (n=17), and stakeholder engagement. Cycles of design activities and discussion followed with patients, staff, and stakeholder groups, to design and develop the prototype tool. Results: We drew on patient safety theory and the concepts of contagion and milieu. The data synthesis, design, and development process resulted in three prototype components of the digital monitoring tool (WardSonar): (1) a patient recording interface that asks patients to input their perceptions into a tablet computer, to assess how the ward feels and whether the direction is changing, that is, ``getting worse'' or ``getting better''; (2) a staff dashboard and functionality to interrogate the data at different levels; and (3) a public-facing ward interface. The technology is available as open-source code. Conclusions: Recent patient safety policy and research priorities encourage innovative approaches to measuring and monitoring safety. We developed a digital real-time monitoring tool to collect information from patients in acute mental health wards about perceived safety, to support staff to respond and intervene to changes in the clinical environment more proactively. ",
doi="10.2196/53726",
url="https://formative.jmir.org/2024/1/e53726",
url="http://www.ncbi.nlm.nih.gov/pubmed/38607663"
}


@Article{info:doi/10.2196/47012,
author="Wang, Ying
and Chen, Yanling
and Song, Yuqing
and Chen, Hong
and Guo, Xin
and Ma, Ling
and Liu, Huan",
title="The Impact of mHealth-Based Continuous Care on Disease Knowledge, Treatment Compliance, and Serum Uric Acid Levels in Chinese Patients With Gout: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Apr",
day="11",
volume="12",
pages="e47012",
keywords="mHealth",
keywords="continuous care",
keywords="gout",
keywords="treat-to-target",
keywords="uric acid",
keywords="Chinese",
keywords="awareness",
keywords="management",
keywords="intervention",
keywords="disease management",
keywords="compliance",
keywords="mobile health",
abstract="Background: In patients with gout, suboptimal management refers to a lack of disease knowledge, low treatment compliance, and inadequate control of serum uric acid (SUA) levels. Several studies have shown that continuous care is recommended for disease management in patients with gout. However, in China, the continuous care model commonly used for patients with gout requires significant labor and time costs, and its efficiency and coverage remain low. Mobile health (mHealth) may be able to address these issues. Objective: This study aimed to explore the impact of mHealth-based continuous care on improving gout knowledge and treatment compliance and reducing SUA levels. Methods: This study was a single-center, single-blind, and parallel-group randomized controlled trial. Participants were recruited at the West China Hospital of Sichuan University in Chengdu, China, between February 2021 and July 2021 and were randomly assigned to the intervention and control groups. The intervention group received continuous care via an mHealth app, which includes modules for health records, 24 weeks of gout-related health education materials, and interactive support. The control group received routine continuous care, including face-to-face health education, paper-based health education materials consistent with the content for the intervention group, and telephone consultations initiated by the patient. Follow-up was conducted at 6 months. Participants' gout knowledge levels and treatment compliance were measured at baseline and the 12th and 24th weeks, and participants' SUA levels were measured at baseline and the 24th week. The intention-to-treat principle and a generalized estimating equation model were used to test the effect of the intervention. Results: Overall, 258 potential participants underwent eligibility assessments, and 120 were recruited and randomized into the intervention (n=60, 50\%) and control (n=60, 50\%) groups. Of the 120 participants, 93 (77.5\%) completed the 24-week study. The 2 groups had no significant differences in sociodemographic or clinical characteristics, and the baseline measurements were comparable (all P>.05). Compared with the control group, the intervention group exhibited a significant improvement in gout knowledge levels over time ($\beta$=0.617, 95\% CI 0.104-1.129; P=.02 and $\beta$=1.300, 95\% CI 0.669-1.931; P<.001 at the 12th and 24th weeks, respectively). There was no significant difference in treatment adherence between the 2 groups at the 12th week ($\beta$=1.667, 95\% CI ?3.283 to 6.617; P=.51), while a statistical difference was observed at the 24th week ($\beta$=6.287, 95\% CI 1.357-11.216; P=.01). At the 24th week, SUA levels in both the intervention and control groups were below baseline, but there was no significant difference in SUA changes between the 2 groups (P=.43). Conclusions: Continuous care based on the mHealth app improved knowledge levels and treatment compliance among patients with gout. We suggest incorporating this intervention modality into standard continuous care for patients with gout. Trial Registration: Chinese Clinical Trials Registry ChiCTR2100042712; https://www.chictr.org.cn/showproj.html?proj=121002 ",
doi="10.2196/47012",
url="https://mhealth.jmir.org/2024/1/e47012"
}


@Article{info:doi/10.2196/46736,
author="Kummer, R. Benjamin
and Busis, A. Neil",
title="Beyond Audio-Video Telehealth: Perspective on the Current State and Future Directions of Digital Neurological Care in the United States",
journal="JMIR Neurotech",
year="2024",
month="Apr",
day="11",
volume="3",
pages="e46736",
keywords="asynchronous telehealth",
keywords="chronic condition management",
keywords="COVID-19",
keywords="digital health",
keywords="digital neurology",
keywords="eConsult",
keywords="endemic",
keywords="interprofessional consultation",
keywords="neurological apps",
keywords="neurological care",
keywords="neurology",
keywords="principal care management",
keywords="remote patient monitoring",
keywords="technology",
keywords="telehealth legislation",
keywords="telehealth",
keywords="teleneurology",
abstract="Background: The COVID-19 pandemic transformed neurological care by both requiring digital health modalities to reach patients and profoundly lowering barriers to digital health adoption. This combination of factors has given rise to a distinctive, emerging care model in neurology characterized by new technologies, care arrangements, and uncertainties. As the pandemic transitions to an endemic, there is a need to characterize the current and future states of this unique period in neurology. Objective: We sought to describe the current state of the pandemic- and postpandemic-related changes in neurological care and offer a view of the possible future directions of the field. Methods: We reviewed several themes across the ``new digital normal'' in neurology, including trends in technology adoption, barriers to technology access, newly available telehealth services, unresolved questions, and an outlook on the future of digital neurology. Results: In this new era of neurological care, we emphasize that synchronous audio-video telehealth remains the predominant form of digital interaction between neurologists and patients, mainly due to pandemic-related regulatory changes and the preexisting, steady adoption of video platforms in the prepandemic era. We also identify a persistent digital divide, with audio-only telehealth remaining a necessity for preserving care access. Asynchronous telehealth methods and services, including care coordination, interprofessional consultations, remote patient monitoring, and teletreatment are becoming increasingly important for neurological care. Finally, we identify several unanswered questions regarding the future of this ``new normal,'' including the lasting effects of emergency regulatory changes, the value proposition of telehealth, the future of telehealth reimbursement in neurology, as well as privacy considerations and trade-offs in asynchronous neurological care models. Conclusions: The COVID-19 pandemic has ushered in an era of digital adoption and innovation in neurological care, characterized by novel care models, services, and technologies, as well as numerous unresolved questions regarding the future. ",
doi="10.2196/46736",
url="https://neuro.jmir.org/2024/1/e46736"
}


@Article{info:doi/10.2196/49163,
author="Bene, Ayaka Benard
and Ibeneme, Sunny
and Fadahunsi, Philip Kayode
and Harri, Isa Bala
and Ukor, Nkiruka
and Mastellos, Nikolaos
and Majeed, Azeem
and Car, Josip",
title="Regulatory Standards and Guidance for the Use of Health Apps for Self-Management in Sub-Saharan Africa: Scoping Review",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="11",
volume="26",
pages="e49163",
keywords="regulation",
keywords="standard",
keywords="framework",
keywords="guidance",
keywords="guideline",
keywords="health app",
keywords="self-management",
keywords="World Health Organization",
keywords="WHO African Region",
keywords="sub-Saharan Africa",
abstract="Background: Health apps are increasingly recognized as crucial tools for enhancing health care delivery. Many countries, particularly those in sub-Saharan Africa, can substantially benefit from using health apps to support self-management and thus help to achieve universal health coverage and the third sustainable development goal. However, most health apps published in app stores are of unknown or poor quality, which poses a risk to patient safety. Regulatory standards and guidance can help address this risk and promote patient safety. Objective: This review aims to assess the regulatory standards and guidance for health apps supporting evidence-based best practices in sub-Saharan Africa with a focus on self-management. Methods: A methodological framework for scoping reviews was applied. A search strategy was built and applied across the following databases, gray literature sources, and institutional websites: PubMed, Scopus, World Health Organization (WHO) African Index Medicus, OpenGrey, WHO Regional Office for Africa Library, ICTworks, WHO Directory of eHealth policies, HIS Strengthening Resource Center, International Telecommunication Union, Ministry of Health websites, and Google. The search covered the period between January 2005 and January 2024. The findings were analyzed using a deductive descriptive content analysis. The policy analysis framework was adapted and used to organize the findings. The Reporting Items for Stakeholder Analysis tool guided the identification and mapping of key stakeholders based on their roles in regulating health apps for self-management. Results: The study included 49 documents from 31 sub-Saharan African countries. While all the documents were relevant for stakeholder identification and mapping, only 3 regulatory standards and guidance contained relevant information on regulation of health apps. These standards and guidance primarily aimed to build mutual trust; promote integration, inclusion, and equitable access to services; and address implementation issues and poor coordination. They provided guidance on systems quality, software acquisition and maintenance, security measures, data exchange, interoperability and integration, involvement of relevant stakeholders, and equitable access to services. To enhance implementation, the standards highlight that legal authority, coordination of activities, building capacity, and monitoring and evaluation are required. A number of stakeholders, including governments, regulatory bodies, funders, intergovernmental and nongovernmental organizations, academia, and the health care community, were identified to play key roles in regulating health apps. Conclusions: Health apps have huge potential to support self-management in sub-Saharan Africa, but the lack of regulatory standards and guidance constitutes a major barrier. Hence, for these apps to be safely and effectively integrated into health care, more attention should be given to regulation. Learning from countries with effective regulations can help sub-Saharan Africa build a more robust and responsive regulatory system, ensuring the safe and beneficial use of health apps across the region. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-025714 ",
doi="10.2196/49163",
url="https://www.jmir.org/2024/1/e49163",
url="http://www.ncbi.nlm.nih.gov/pubmed/38602718"
}


@Article{info:doi/10.2196/51849,
author="Morrow, M. Melissa
and Hughes, C. Lynne
and Collins, M. Diane
and Vos-Draper, L. Tamara",
title="Clinical Remote Monitoring of Individuals With Spinal Cord Injury at Risk for Pressure Injury Recurrence Using mHealth: Protocol for a Pilot, Pragmatic, Hybrid Implementation Trial",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="10",
volume="13",
pages="e51849",
keywords="wheelchair user",
keywords="seating and mobility",
keywords="weight shift behavior",
keywords="pressure injury",
keywords="mobile phone",
abstract="Background: Pressure injuries are one of the most challenging secondary conditions for individuals with spinal cord injuries and related disorders (SCI/D) owing to inherent, lifelong risk factors that include a lack of sensory and motor function below the level of injury and reliance on a wheelchair for daily mobility, resulting in prolonged periods of sitting. Although many factors contribute to the development of pressure injuries, the pressure between the skin and a surface is always a factor and the development of injury is dependent on the magnitude and duration of the pressure. Clinically, broad recommendations for relieving pressure are used because we know very little about the unique day-to-day life patterns of the individual wheelchair user. Typically, it is after the occurrence of a pressure injury that the therapist will check equipment fit and the effectiveness of pressure offloading and ask about other surfaces they sit on in their home and community. This time-lapsed, largely self-reported data are fraught with recall bias and inaccuracies that the therapist incorporates into a plan of care. Objective: This study's objective is to pilot-test the implementation and clinical effectiveness of a telehealth model of care combined with our mobile health (mHealth) Assisted Weight-Shift device for remote monitoring of factors related to maintaining skin health and wheelchair setup. Our overall hypothesis is that this study will result in an effective implementation plan, and the enhanced connected model of care using remote monitoring of pressure management will result in pilot-level, improved clinical outcomes for adults with spinal cord injury at high risk for pressure injury recurrence. Methods: For all aims, we will use a mixed methods design using an exploratory, sequential approach to include the strengths of both qualitative and quantitative data. For aims 1 and 2, we will iteratively collect qualitative data from therapists, patients with SCI/D, and other stakeholders. For aim 3, we will perform a hybrid effectiveness-implementation randomized controlled trial to pilot-test the intervention. The projected results include an iteratively developed and tested implementation plan that meets moderate to high levels of acceptability, feasibility, and appropriateness. Additionally, the pilot trial results are expected to show positive trends in relevant clinical outcomes related to reduced pressure injury incidence, recurrence, and improved healing when compared with the standard of care. Results: Currently, 6 participants have been recruited for our aim-1 qualitative study. Conclusions: This study will expand upon our previous study to move the Assisted Weight-Shift system into routine clinical care, which was a strong desire of adults with SCI/D for improved individualized care plans to prevent pressure injuries. The results of this study will guide the next steps in a full, hybrid effectiveness-implementation trial with the goal of improving care to prevent pressure injuries. International Registered Report Identifier (IRRID): DERR1-10.2196/51849 ",
doi="10.2196/51849",
url="https://www.researchprotocols.org/2024/1/e51849",
url="http://www.ncbi.nlm.nih.gov/pubmed/38598267"
}


@Article{info:doi/10.2196/55165,
author="Ellis, Deborah
and Carcone, Idalski April
and Templin, Thomas
and Evans, Meredyth
and Weissberg-Benchell, Jill
and Buggs-Saxton, Colleen
and Boucher-Berry, Claudia
and Miller, L. Jennifer
and Drossos, Tina
and Dekelbab, Bassem M.",
title="Moderating Effect of Depression on Glycemic Control in an eHealth Intervention Among Black Youth With Type 1 Diabetes: Findings From a Multicenter Randomized Controlled Trial",
journal="JMIR Diabetes",
year="2024",
month="Apr",
day="9",
volume="9",
pages="e55165",
keywords="adolescents",
keywords="black",
keywords="depression",
keywords="eHealth",
keywords="family intervention",
keywords="randomized clinical trial",
keywords="randomized controlled trial",
keywords="T1D",
keywords="type 1 diabetes",
abstract="Background: Black adolescents with type 1 diabetes (T1D) are at increased risk for suboptimal diabetes health outcomes; however, evidence-based interventions for this population are lacking. Depression affects a high percentage of youth with T1D and increases the likelihood of health problems associated with diabetes. Objective: Our aim was to test whether baseline levels of depression moderate the effects of a brief eHealth parenting intervention delivered to caregivers of young Black adolescents with T1D on youths' glycemic control. Methods: We conducted a multicenter randomized controlled trial at 7 pediatric diabetes clinics located in 2 large US cities. Participants (N=149) were allocated to either the intervention group or a standard medical care control group. Up to 3 intervention sessions were delivered on a tablet computer during diabetes clinic visits over a 12-month period. Results: In a linear mixed effects regression model, planned contrasts did not show significant reductions in hemoglobin A1c (HbA1c) for intervention adolescents compared to controls. However, adolescents with higher baseline levels of depressive symptoms who received the intervention had significantly greater improvements in HbA1c levels at 6-month follow-up (0.94\%; P=.01) and 18-month follow-up (1.42\%; P=.002) than those with lower levels of depression. Within the intervention group, adolescents had a statistically significant reduction in HbA1c levels from baseline at 6-month and 18-month follow-up. Conclusions: A brief, culturally tailored eHealth parenting intervention improved health outcomes among Black adolescents with T1D and depressive symptoms. Trial Registration: ClinicalTrials.gov NCT03168867; https://clinicaltrials.gov/study/NCT03168867 ",
doi="10.2196/55165",
url="https://diabetes.jmir.org/2024/1/e55165",
url="http://www.ncbi.nlm.nih.gov/pubmed/38593428"
}


@Article{info:doi/10.2196/53006,
author="Sun, Ting
and Xu, Xuejie
and Ding, Zenghui
and Xie, Hui
and Ma, Linlin
and Zhang, Jing
and Xia, Yuxin
and Zhang, Guoli
and Ma, Zuchang",
title="Development of a Health Behavioral Digital Intervention for Patients With Hypertension Based on an Intelligent Health Promotion System and WeChat: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Apr",
day="5",
volume="12",
pages="e53006",
keywords="adherence",
keywords="hypertension",
keywords="health behavior",
keywords="mHealth",
keywords="digital health",
abstract="Background: The effectiveness of timely medication, physical activity (PA), a healthy diet, and blood pressure (BP) monitoring for promoting health outcomes and behavioral changes among patients with hypertension is supported by a substantial amount of literature, with ``adherence'' playing a pivotal role. Nevertheless, there is a lack of consistent evidence regarding whether digital interventions can improve adherence to healthy behaviors among individuals with hypertension. Objective: The aim was to develop a health behavioral digital intervention for hypertensive patients (HBDIHP) based on an intelligent health promotion system and WeChat following the behavior change wheel (BCW) theory and digital micro-intervention care (DMIC) model and assess its efficacy in controlling BP and improving healthy behavior adherence. Methods: A 2-arm, randomized trial design was used. We randomly assigned 68 individuals aged >60 years with hypertension in a 1:1 ratio to either the control or experimental group. The digital intervention was established through the following steps: (1) developing digital health education materials focused on adherence to exercise prescriptions, Dietary Approaches to Stop Hypertension (DASH), prescribed medication, and monitoring of BP; (2) using the BCW theory to select behavior change techniques; (3) constructing the intervention's logic following the guidelines of the DMIC model; (4) creating an intervention manual including the aforementioned elements. Prior to the experiment, participants underwent physical examinations at the community health service center's intelligent health cabin and received intelligent personalized health recommendations. The experimental group underwent a 12-week behavior intervention via WeChat, while the control group received routine health education and a self-management manual. The primary outcomes included BP and adherence indicators. Data analysis was performed using SPSS, with independent sample t tests, chi-square tests, paired t tests, and McNemar tests. A P value <.05 was considered statistically significant. Results: The final analysis included 54 participants with a mean age of 67.24 (SD 4.19) years (n=23 experimental group, n=31 control group). The experimental group had improvements in systolic BP (--7.36 mm Hg, P=.002), exercise time (856.35 metabolic equivalent [MET]-min/week, P<.001), medication adherence (0.56, P=.001), BP monitoring frequency (P=.02), and learning performance (3.23, P<.001). Both groups experienced weight reduction (experimental: 1.2 kg, P=.002; control: 1.11 kg, P=.009) after the intervention. The diet types and quantities for both groups (P<.001) as well as the subendocardial viability ratio (0.16, P=.01) showed significant improvement. However, there were no statistically significant changes in other health outcomes. Conclusions: The observations suggest our program may have enhanced specific health outcomes and adherence to health behaviors in older adults with hypertension. However, a longer-term, larger-scale trial is necessary to validate the effectiveness. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200062643; https://www.chictr.org.cn/showprojEN.html?proj=172782 International Registered Report Identifier (IRRID): RR2-10.2196/46883 ",
doi="10.2196/53006",
url="https://mhealth.jmir.org/2024/1/e53006",
url="http://www.ncbi.nlm.nih.gov/pubmed/38578692"
}


@Article{info:doi/10.2196/50241,
author="Barnett, P. Nancy
and Sokolovsky, W. Alexander
and Meisel, K. Matthew
and Forkus, R. Shannon
and Jackson, M. Kristina",
title="A Bluetooth-Based Smartphone App for Detecting Peer Proximity: Protocol for Evaluating Functionality and Validity",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="5",
volume="13",
pages="e50241",
keywords="Bluetooth technology",
keywords="passive sensing",
keywords="proximity detection",
keywords="ecological momentary assessment",
keywords="social influence",
keywords="alcohol use",
keywords="mobile phone",
abstract="Background: While ecological momentary assessment (EMA) is commonly used to study social contexts and social influence in the real world, EMA almost exclusively relies on participant self-report of present circumstances, including the proximity to influential peers. There is the potential for developing a proximity sensing approach that uses small Bluetooth beacons and smartphone-based detection and data collection to collect information about interactions between individuals passively in real time. Objective: This paper aims to describe the methods for evaluating the functionality and validity of a Bluetooth-based beacon and a smartphone app to identify when ?2 individuals are physically proximal. Methods: We will recruit 20 participants aged 18 to 29 years with Android smartphones to complete a 3-week study during which beacon detection and self-report data will be collected using a smartphone app (MEI Research). Using an interviewer-administered social network interview, participants will identify up to 3 peers of the same age who are influential on health behavior (alcohol use in this study). These peers will be asked to carry a Bluetooth beacon (Kontakt asset tag) for the duration of the study; each beacon has a unique ID that, when detected, will be recorded by the app on the participant's phone. Participants will be prompted to respond to EMA surveys (signal-contingent reports) when a peer beacon encounter meets our criteria and randomly 3 times daily (random reports) and every morning (morning reports) to collect information about the presence of peers. In all reports, the individualized list of peers will be presented to participants, followed by questions about peer and participant behavior, including alcohol use. Data from multiple app data sets, including beacon encounter specifications, notification, and app logs, participant EMA self-reports and postparticipation interviews, and peer surveys, will be used to evaluate project goals. We will examine the functionality of the technology, including the stability of the app (eg, app crashes and issues opening the app), beacon-to-app detection (ie, does the app detect proximal beacons?), and beacon encounter notification when encounter criteria are met. The validity of the technology will be defined as the concordance between passive detection of peers via beacon-to-app communication and the participant's EMA report of peer presence. Disagreement between the beacon and self-report data (ie, false negatives and false positives) will be investigated in multiple ways (ie, to determine if the reason was technology-related or participant compliance-related) using encounter data and information collected from participants and peers. Results: Participant recruitment began in February 2023, and enrollment was completed in December 2023. Results will be reported in 2025. Conclusions: This Bluetooth-based technology has important applications and clinical implications for various health behaviors, including the potential for just-in-time adaptive interventions that target high-risk behavior in real time. International Registered Report Identifier (IRRID): DERR1-10.2196/50241 ",
doi="10.2196/50241",
url="https://www.researchprotocols.org/2024/1/e50241",
url="http://www.ncbi.nlm.nih.gov/pubmed/38578672"
}


@Article{info:doi/10.2196/54386,
author="van den Berg, N. Liselot
and Hallensleben, Cynthia
and Vlug, AE Lisa
and Chavannes, H. Niels
and Versluis, Anke",
title="The Asthma App as a New Way to Promote Responsible Short-Acting Beta2-Agonist Use in People With Asthma: Results of a Mixed Methods Pilot Study",
journal="JMIR Hum Factors",
year="2024",
month="Apr",
day="4",
volume="11",
pages="e54386",
keywords="asthma",
keywords="short-acting beta2-agonist",
keywords="SABA overuse",
keywords="app",
keywords="eHealth",
keywords="feasibility",
keywords="usability",
keywords="mobile phone",
abstract="Background: Approximately 262 million people worldwide are affected by asthma, and the overuse of reliever medication---specifically, short-acting beta2-agonist (SABA) overuse---is common. This can lead to adverse health effects. A smartphone app, the Asthma app, was developed via a participatory design to help patients gain more insight into their SABA use through monitoring and psychoeducation. Objective: This pilot study aims to evaluate the feasibility and usability of the app. The preliminary effects of using the app after 3 months on decreasing asthma symptoms and improving quality of life were examined. Methods: A mixed methods study design was used. Quantitative data were collected using the app. Asthma symptoms (measured using the Control of Allergic Rhinitis and Asthma Test) and the triggers of these symptoms were collected weekly. Quality of life (36-Item Short-Form Health Survey) was assessed at baseline and after 3, 6, and 12 months. User experience (System Usability Scale) was measured at all time points, except for baseline. Furthermore, objective user data were collected, and qualitative interviews, focusing on feasibility and usability, were organized. The interview protocol was based on the Unified Theory of Acceptance and Use of Technology framework. Qualitative data were analyzed using the Framework Method. Results: The baseline questionnaire was completed by 373 participants. The majority were female (309/373, 82.8\%), with a mean age of 46 (SD 15) years, and used, on average, 10 SABA inhalations per week. App usability was rated as good: 82.3 (SD 13.2; N=44) at 3 months. The Control of Allergic Rhinitis and Asthma Test score significantly improved at 3 months (18.5) compared with baseline (14.8; $\beta$=.189; SE 0.048; P<.001); however, the obtained score still indicated uncontrolled asthma. At 3 months, there was no significant difference in the quality of life. Owing to the high dropout rate, insufficient data were collected at 6 and 12 months and were, therefore, not further examined. User data showed that 335 users opened the app (250/335, 74.6\%, were returning visitors), with an average session time of 1 minute, and SABA registration was most often used (7506/13,081, 57.38\%). Qualitative data (from a total of 4 participants; n=2, 50\% female) showed that the participants found the app acceptable and clear. Three participants stated that gaining insight into asthma and its triggers was helpful. Two participants no longer used the app because they perceived their asthma as controlled and, therefore, did not use SABA often or only used it regularly based on the advice of the pulmonologist. Conclusions: The initial findings regarding the app's feasibility and usability are encouraging. However, the notable dropout rate underscores the need for a cautious interpretation of the results. Subsequent studies, particularly those focusing on implementation, should explore the potential integration of the app into standard treatment practices. ",
doi="10.2196/54386",
url="https://humanfactors.jmir.org/2024/1/e54386",
url="http://www.ncbi.nlm.nih.gov/pubmed/38574348"
}


@Article{info:doi/10.2196/54178,
author="Trojan, Andreas
and Roth, Sven
and Atassi, Ziad
and Kiessling, Michael
and Zenhaeusern, Reinhard
and Kadvany, Yannick
and Schumacher, Johannes
and Kullak-Ublick, A. Gerd
and Aapro, Matti
and Eniu, Alexandru",
title="Comparison of the Real-World Reporting of Symptoms and Well-Being for the HER2-Directed Trastuzumab Biosimilar Ogivri With Registry Data for Herceptin in the Treatment of Breast Cancer: Prospective Observational Study (OGIPRO) of Electronic Patient-Reported Outcomes",
journal="JMIR Cancer",
year="2024",
month="Apr",
day="4",
volume="10",
pages="e54178",
keywords="breast cancer",
keywords="biosimilar",
keywords="trastuzumab",
keywords="electronic patient-reported outcome",
keywords="ePRO",
keywords="medidux",
keywords="app",
abstract="Background: Trastuzumab has had a major impact on the treatment of human epidermal growth factor receptor 2 (HER2)-positive breast cancer (BC). Anti-HER2 biosimilars such as Ogivri have demonstrated safety and clinical equivalence to trastuzumab (using Herceptin as the reference product) in clinical trials. To our knowledge, there has been no real-world report of the side effects and quality of life (QoL) in patients treated with biosimilars using electronic patient-reported outcomes (ePROs). Objective: The primary objective of this prospective observational study (OGIPRO study) was to compare the ePRO data related to treatment side effects collected with the medidux app in patients with HER2-positive BC treated with the trastuzumab biosimilar Ogivri (prospective cohort) to those obtained from historical cohorts treated with Herceptin alone or combined with pertuzumab and/or chemotherapy (ClinicalTrials.gov NCT02004496 and NCT03578731). Methods: Patients were treated with Ogivri alone or combined with pertuzumab and/or chemotherapy and hormone therapy in (neo)adjuvant and palliative settings. Patients used the medidux app to dynamically record symptoms (according to the Common Terminology Criteria for Adverse Events [CTCAE]), well-being (according to the Eastern Cooperative Oncology Group Performance Status scale), QoL (using the EQ-5D-5L questionnaire), cognitive capabilities, and vital parameters over 6 weeks. The primary endpoint was the mean CTCAE score. Key secondary endpoints included the mean well-being score. Data of this prospective cohort were compared with those of the historical cohorts (n=38 patients; median age 51, range 31-78 years). Results: Overall, 53 female patients with a median age of 54 years (range 31-87 years) were enrolled in the OGIPRO study. The mean CTCAE score was analyzed in 50 patients with available data on symptoms, while the mean well-being score was evaluated in 52 patients with available data. The most common symptoms reported in both cohorts included fatigue, taste disorder, nausea, diarrhea, dry mucosa, joint discomfort, tingling, sleep disorder, headache, and appetite loss. Most patients experienced minimal (grade 0) or mild (grade 1) toxicities in both cohorts. The mean CTCAE score was comparable between the prospective and historical cohorts (29.0 and 30.3, respectively; mean difference --1.27, 95\% CI --7.24 to 4.70; P=.68). Similarly, no significant difference was found for the mean well-being score between the groups treated with the trastuzumab biosimilar Ogivri and Herceptin (74.3 and 69.8, respectively; mean difference 4.45, 95\% CI --3.53 to 12.44; P=.28). Conclusions: Treatment of patients with HER2-positive BC with the trastuzumab biosimilar Ogivri resulted in equivalent symptoms, adverse events, and well-being as found for patients treated with Herceptin as determined by ePRO data. Hence, integration of an ePRO system into research and clinical practice can provide reliable information when investigating the real-world tolerability and outcomes of similar therapeutic compounds. Trial Registration: ClinicalTrials.gov NCT05234021; https://clinicaltrials.gov/study/NCT05234021 ",
doi="10.2196/54178",
url="https://cancer.jmir.org/2024/1/e54178",
url="http://www.ncbi.nlm.nih.gov/pubmed/38573759"
}


@Article{info:doi/10.2196/52923,
author="Embaye, Jiska
and de Wit, Maartje
and Snoek, Frank",
title="A Self-Guided Web-Based App (MyDiaMate) for Enhancing Mental Health in Adults With Type 1 Diabetes: Insights From a Real-World Study in the Netherlands",
journal="JMIR Diabetes",
year="2024",
month="Apr",
day="3",
volume="9",
pages="e52923",
keywords="type 1 diabetes",
keywords="e-mental health",
keywords="web based",
keywords="self-help",
keywords="real world",
keywords="naturalistic",
keywords="uptake",
keywords="adoption",
keywords="usage",
keywords="mental health",
keywords="distress",
keywords="emotional well-being",
keywords="cognitive behavioral therapy",
keywords="internet-based cognitive behavioral therapy",
keywords="Europe",
keywords="Netherlands",
keywords="Dutch",
abstract="Background: MyDiaMate is a web-based intervention specifically designed for adults with type 1 diabetes (T1D) that aims to help them improve and maintain their mental health. Prior pilot-testing of MyDiaMate verified its acceptability, feasibility, and usability. Objective: This study aimed to investigate the real-world uptake and usage of MyDiaMate in the Netherlands. Methods: Between March 2021 and December 2022, MyDiaMate was made freely available to Dutch adults with T1D. Usage (participation and completion rates of the modules) was tracked using log data. Users could volunteer to participate in the user profile study, which required filling out a set of baseline questionnaires. The usage of study participants was examined separately for participants scoring above and below the cutoffs of the ``Problem Areas in Diabetes'' (PAID-11) questionnaire (diabetes distress), the ``World Health Organization Well-being Index'' (WHO-5) questionnaire (emotional well-being), and the fatigue severity subscale of the ``Checklist Individual Strength'' (CIS) questionnaire (fatigue). Two months after creating an account, study participants received an evaluation questionnaire to provide us with feedback. Results: In total, 1008 adults created a MyDiaMate account, of whom 343 (34\%) participated in the user profile study. The mean age was 43 (SD 14.9; 18-76) years. Most participants were female (n=217, 63.3\%) and higher educated (n=198, 57.6\%). The majority had been living with T1D for over 5 years (n=241, 73.5\%). Of the study participants, 59.1\% (n=199) of them reported low emotional well-being (WHO-5 score?50), 70.9\% (n=239) of them reported elevated diabetes distress (PAID-11 score?18), and 52.4\% (n=178) of them reported severe fatigue (CIS score?35). Participation rates varied between 9.5\% (n=19) for social environment to 100\% (n=726) for diabetes in balance, which opened by default. Completion rates ranged from 4.3\% (n=1) for energy, an extensive cognitive behavioral therapy module, to 68.6\% (n=24) for the shorter module on hypos. There were no differences in terms of participation and completion rates of the modules between study participants with a more severe profile, that is, lower emotional well-being, greater diabetes distress, or more fatigue symptoms, and those with a less severe profile. Further, no technical problems were reported, and various suggestions were made by study participants to improve the application, suggesting a need for more personalization. Conclusions: Data from this naturalistic study demonstrated the potential of MyDiaMate as a self-help tool for adults with T1D, supplementary to ongoing diabetes care, to improve healthy coping with diabetes and mental health. Future research is needed to explore engagement strategies and test the efficacy of MyDiaMate in a randomized controlled trial. ",
doi="10.2196/52923",
url="https://diabetes.jmir.org/2024/1/e52923",
url="http://www.ncbi.nlm.nih.gov/pubmed/38568733"
}


@Article{info:doi/10.2196/54940,
author="Fundoiano-Hershcovitz, ?Yifat
and Ritholz, D. Marilyn
and Horwitz, L. David
and Behar, Ephraim
and Manejwala, Omar
and Goldstein, Pavel",
title="The Impact of Digital Self-Monitoring of Weight on Improving Diabetes Clinical Outcomes: Quasi-Randomized Study",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="2",
volume="26",
pages="e54940",
keywords="obesity",
keywords="diabetes management",
keywords="weight monitoring",
keywords="digital health platform",
keywords="self-monitoring",
keywords="clinical outcome",
keywords="type 2 diabetes",
keywords="weight changes",
keywords="blood glucose",
keywords="patient empowerment",
abstract="Background: The management of type 2 diabetes (T2D) and obesity, particularly in the context of self-monitoring, remains a critical challenge in health care. As nearly 80\% to 90\% of patients with T2D have overweight or obesity, there is a compelling need for interventions that can effectively manage both conditions simultaneously. One of the goals in managing chronic conditions is to increase awareness and generate behavioral change to improve outcomes in diabetes and related comorbidities, such as overweight or obesity. There is a lack of real-life evidence to test the impact of self-monitoring of weight on glycemic outcomes and its underlying mechanisms. Objective: This study aims to assess the efficacy of digital self-monitoring of weight on blood glucose (BG) levels during diabetes management, investigating whether the weight changes may drive glucose fluctuations. Methods: In this retrospective, real-world quasi-randomized study, 50\% of the individuals who regularly used the weight monitoring (WM) feature were propensity score matched with 50\% of the users who did not use the weight monitoring feature (NWM) based on demographic and clinical characteristics. All the patients were diagnosed with T2D and tracked their BG levels. We analyzed monthly aggregated data 6 months before and after starting their weight monitoring. A piecewise mixed model was used for analyzing the time trajectories of BG and weight as well as exploring the disaggregation effect of between- and within-patient lagged effects of weight on BG. Results: The WM group exhibited a significant reduction in BG levels post intervention (P<.001), whereas the nonmonitoring group showed no significant changes (P=.59), and both groups showed no differences in BG pattern before the intervention (P=.59). Furthermore, the WM group achieved a meaningful decrease in BMI (P<.001). Finally, both within-patient (P<.001) and between-patient (P=.008) weight variability was positively associated with BG levels. However, 1-month lagged back BMI was not associated with BG levels (P=.36). Conclusions: This study highlights the substantial benefits of self-monitoring of weight in managing BG levels in patients with diabetes, facilitated by a digital health platform, and advocates for the integration of digital self-monitoring tools in chronic disease management. We also provide initial evidence of testing the underlying mechanisms associated with BG management, underscoring the potential role of patient empowerment. ",
doi="10.2196/54940",
url="https://www.jmir.org/2024/1/e54940",
url="http://www.ncbi.nlm.nih.gov/pubmed/38564266"
}


@Article{info:doi/10.2196/58631,
author="de Azevedo Cardoso, Taiane
and Kochhar, Shruti
and Torous, John
and Morton, Emma",
title="Digital Tools to Facilitate the Detection and Treatment of Bipolar Disorder: Key Developments and Future Directions",
journal="JMIR Ment Health",
year="2024",
month="Apr",
day="1",
volume="11",
pages="e58631",
keywords="bipolar disorder",
keywords="digital phenotyping",
keywords="machine learning",
keywords="mobile health interventions",
keywords="mobile health",
keywords="mHealth",
keywords="apps",
doi="10.2196/58631",
url="https://mental.jmir.org/2024/1/e58631",
url="http://www.ncbi.nlm.nih.gov/pubmed/38557724"
}


@Article{info:doi/10.2196/53995,
author="Bendtsen, Gr{\o}nlund Magnus
and Sch{\"o}nwandt, Thuesen Bodil Marie
and Rub{\ae}k, Mette
and Hitz, Friberg Mette",
title="Evaluation of an mHealth App on Self-Management of Osteoporosis: Prospective Survey Study",
journal="Interact J Med Res",
year="2024",
month="Apr",
day="1",
volume="13",
pages="e53995",
keywords="eHealth literacy",
keywords="health literacy",
keywords="mHealth",
keywords="mobile health",
keywords="eHealth",
keywords="mobile health apps",
keywords="self-management",
keywords="osteoporosis",
keywords="usability",
keywords="acceptability",
abstract="Background: Mobile health (mHealth) technologies can be used for disease-specific self-management, and these technologies are experiencing rapid growth in the health care industry. They use mobile devices, specifically smartphone apps, to enhance and support medical and public health practices. In chronic disease management, the use of apps in the realm of mHealth holds the potential to improve health outcomes. This is also true for mHealth apps on osteoporosis, but the usage and patients' experiences with these apps are underexplored. Objective: This prospective survey study aimed to investigate the eHealth literacy of Danish patients with osteoporosis, as well as the usability and acceptability of the app ``My Bones.'' Methods: Data on patient characteristics, disease knowledge, eHealth literacy, usability, and acceptability were collected using self-administered questionnaires at baseline, 2 months, and 6 months. The following validated questionnaires were used: eHealth Literacy Questionnaire, System Usability Scale, and Service User Technology Acceptability Questionnaire. Results: Mean scores for eHealth literacy ranged from 2.6 to 3.1, with SD ranging from 0.5 to 0.6 across the 7 domains. The mean (SD) System Usability Scale score was 74.7 (14.4), and the mean (SD) scores for domains 1, 2, and 6 of the Service User Technology Acceptability Questionnaire were 3.4 (1.2), 4.5 (1.1), 4.1 (1.2), respectively. Conclusions: Danish patients with osteoporosis are both motivated and capable of using digital health services. The app's usability was acceptable, and it has the potential to reduce visits to general practitioner clinics, enhance health outcomes, and serve as a valuable addition to regular health or social care services. ",
doi="10.2196/53995",
url="https://www.i-jmr.org/2024/1/e53995",
url="http://www.ncbi.nlm.nih.gov/pubmed/38557362"
}


@Article{info:doi/10.2196/47523,
author="Zhong, Yuqiong
and Hahne, Jessica
and Wang, Xiaomin
and Wang, Xuxi
and Wu, Ying
and Zhang, Xin
and Liu, Xing",
title="Telehealth Care Through Internet Hospitals in China: Qualitative Interview Study of Physicians' Views on Access, Expectations, and Communication",
journal="J Med Internet Res",
year="2024",
month="Mar",
day="29",
volume="26",
pages="e47523",
keywords="China",
keywords="internet hospital",
keywords="health care access",
keywords="telehealth",
keywords="doctor-patient relationship",
keywords="mobile phone",
abstract="Background: Internet hospitals in China are an emerging medical service model similar to other telehealth models used worldwide. Internet hospitals are currently in a stage of rapid development, giving rise to a series of new opportunities and challenges for patient care. Little research has examined the views of chronic disease physicians regarding internet hospitals in China. Objective: We aimed to explore the experience and views of chronic disease physicians at 3 tertiary hospitals in Changsha, China, regarding opportunities and challenges in internet hospital care. Methods: We conducted semistructured qualitative interviews with physicians (n=26) who had experience working in internet hospitals affiliated with chronic disease departments in 3 tertiary hospitals in Changsha, Hunan province, south central China. Interviews were transcribed verbatim and analyzed by content analysis using NVivo software (version 11; Lumivero). Results: Physicians emphasized that internet hospitals expand opportunities to conduct follow-up care and health education for patients with chronic illnesses. However, physicians described disparities in access for particular groups of patients, such as patients who are older, patients with lower education levels, patients with limited internet or technology access, and rural patients. Physicians also perceived a gap between patients' expectations and the reality of limitations regarding both physicians' availability and the scope of services offered by internet hospitals, which raised challenges for doctor-patient boundaries and trust. Physicians noted challenges in doctor-patient communication related to comprehension and informed consent in internet hospital care. Conclusions: This study explored the experience and views of physicians in 3 tertiary hospitals in Changsha, China, regarding access to care, patients' expectations versus the reality of services, and doctor-patient communication in internet hospital care. Findings from this study highlight the need for physician training in telehealth communication skills, legislation regulating informed consent in telehealth care, public education clarifying the scope of internet hospital services, and design of internet hospitals that is informed by the needs of patient groups with barriers to access, such as older adults. ",
doi="10.2196/47523",
url="https://www.jmir.org/2024/1/e47523",
url="http://www.ncbi.nlm.nih.gov/pubmed/38551618"
}


@Article{info:doi/10.2196/55199,
author="He, Yunfan
and Zhu, Wei
and Wang, Tong
and Chen, Han
and Xin, Junyi
and Liu, Yongcheng
and Lei, Jianbo
and Liang, Jun",
title="Mining User Reviews From Hypertension Management Mobile Health Apps to Explore Factors Influencing User Satisfaction and Their Asymmetry: Comparative Study",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Mar",
day="28",
volume="12",
pages="e55199",
keywords="hypertension management",
keywords="mobile health",
keywords="topic modeling",
keywords="satisfaction",
keywords="2-factor model",
keywords="comparative study",
abstract="Background: Hypertension significantly impacts the well-being and health of individuals globally. Hypertension management apps (HMAs) have been shown to assist patients in controlling blood pressure (BP), with their efficacy validated in clinical trials. However, the utilization of HMAs continues to be suboptimal. Presently, there is a dearth of real-world research based on big data and exploratory mining that compares Chinese and American HMAs. Objective: This study aims to systematically gather HMAs and their user reviews from both China and the United States. Subsequently, using data mining techniques, the study aims to compare the user experience, satisfaction levels, influencing factors, and asymmetry between Chinese and American users of HMAs. In addition, the study seeks to assess the disparities in satisfaction and its determinants while delving into the asymmetry of these factors. Methods: The study sourced HMAs and user reviews from 10 prominent Chinese and American app stores globally. Using the latent Dirichlet allocation (LDA) topic model, the research identified various topics within user reviews. Subsequently, the Tobit model was used to investigate the impact and distinctions of each topic on user satisfaction. The Wald test was applied to analyze differences in effects across various factors. Results: We examined a total of 261 HMAs along with their associated user reviews, amounting to 116,686 reviews in total. In terms of quantity and overall satisfaction levels, Chinese HMAs (n=91) and corresponding reviews (n=16,561) were notably fewer compared with their American counterparts (n=220 HMAs and n=100,125 reviews). The overall satisfaction rate among HMA users was 75.22\% (87,773/116,686), with Chinese HMAs demonstrating a higher satisfaction rate (13,866/16,561, 83.73\%) compared with that for American HMAs (73,907/100,125, 73.81\%). Chinese users primarily focus on reliability (2165/16,561, 13.07\%) and measurement accuracy (2091/16,561, 12.63\%) when considering HMAs, whereas American users prioritize BP tracking (17,285/100,125, 17.26\%) and data synchronization (12,837/100,125, 12.82\%). Seven factors (easy to use: P<.001; measurement accuracy: P<.001; compatibility: P<.001; cost: P<.001; heart rate detection function: P=.02; blood pressure tracking function: P<.001; and interface design: P=.01) significantly influenced the positive deviation (PD) of Chinese HMA user satisfaction, while 8 factors (easy to use: P<.001; reliability: P<.001; measurement accuracy: P<.001; compatibility: P<.001; cost: P<.001; interface design: P<.001; real-time: P<.001; and data privacy: P=.001) affected the negative deviation (ND). Notably, BP tracking had the greatest effect on PD ($\beta$=.354, P<.001), while cost had the most significant impact on ND ($\beta$=3.703, P<.001). All 12 factors (easy to use: P<.001; blood pressure tracking function: P<.001; data synchronization: P<.001; blood pressure management effect: P<.001; heart rate detection function: P<.001; data sharing: P<.001; reliability: P<.001; compatibility: P<.001; interface design: P<.001; advertisement distribution: P<.001; measurement accuracy: P<.001; and cost: P<.001) significantly influenced the PD and ND of American HMA user satisfaction. Notably, BP tracking had the greatest effect on PD ($\beta$=0.312, P<.001), while data synchronization had the most significant impact on ND ($\beta$=2.662, P<.001). In addition, the influencing factors of PD and ND in user satisfaction of HMA in China and the United States are different. Conclusions: User satisfaction factors varied significantly between different countries, showing considerable asymmetry. For Chinese HMA users, ease of use and interface design emerged as motivational factors, while factors such as cost, measurement accuracy, and compatibility primarily contributed to user dissatisfaction. For American HMA users, motivational factors were ease of use, BP tracking, BP management effect, interface design, measurement accuracy, and cost. Moreover, users expect features such as data sharing, synchronization, software reliability, compatibility, heart rate detection, and nonintrusive advertisement distribution. Tailored experience plans should be devised for different user groups in various countries to address these diverse preferences and requirements. ",
doi="10.2196/55199",
url="https://mhealth.jmir.org/2024/1/e55199",
url="http://www.ncbi.nlm.nih.gov/pubmed/38547475"
}


@Article{info:doi/10.2196/55615,
author="Kargarandehkordi, Ali
and Slade, Christopher
and Washington, Peter",
title="Personalized AI-Driven Real-Time Models to Predict Stress-Induced Blood Pressure Spikes Using Wearable Devices: Proposal for a Prospective Cohort Study",
journal="JMIR Res Protoc",
year="2024",
month="Mar",
day="25",
volume="13",
pages="e55615",
keywords="stress",
keywords="hypertension",
keywords="precision health",
keywords="personalized artificial intelligence",
keywords="wearables",
keywords="ecological momentary assessments",
keywords="passive sensing",
keywords="mobile phone",
abstract="Background: Referred to as the ``silent killer,'' elevated blood pressure (BP) often goes unnoticed due to the absence of apparent symptoms, resulting in cumulative harm over time. Chronic stress has been consistently linked to increased BP. Prior studies have found that elevated BP often arises due to a stressful lifestyle, although the effect of exact stressors varies drastically between individuals. The heterogeneous nature of both the stress and BP response to a multitude of lifestyle decisions can make it difficult if not impossible to pinpoint the most deleterious behaviors using the traditional mechanism of clinical interviews. Objective: The aim of this study is to leverage machine learning (ML) algorithms for real-time predictions of stress-induced BP spikes using consumer wearable devices such as Fitbit, providing actionable insights to both patients and clinicians to improve diagnostics and enable proactive health monitoring. This study also seeks to address the significant challenges in identifying specific deleterious behaviors associated with stress-induced hypertension through the development of personalized artificial intelligence models for individual patients, departing from the conventional approach of using generalized models. Methods: The study proposes the development of ML algorithms to analyze biosignals obtained from these wearable devices, aiming to make real-time predictions about BP spikes. Given the longitudinal nature of the data set comprising time-series data from wearables (eg, Fitbit) and corresponding time-stamped labels representing stress levels from Ecological Momentary Assessment reports, the adoption of self-supervised learning for pretraining the network and using transformer models for fine-tuning the model on a personalized prediction task is proposed. Transformer models, with their self-attention mechanisms, dynamically weigh the importance of different time steps, enabling the model to focus on relevant temporal features and dependencies, facilitating accurate prediction. Results: Supported as a pilot project from the Robert C Perry Fund of the Hawaii Community Foundation, the study team has developed the core study app, CardioMate. CardioMate not only reminds participants to initiate BP readings using an Omron HeartGuide wearable monitor but also prompts them multiple times a day to report stress levels. Additionally, it collects other useful information including medications, environmental conditions, and daily interactions. Through the app's messaging system, efficient contact and interaction between users and study admins ensure smooth progress. Conclusions: Personalized ML when applied to biosignals offers the potential for real-time digital health interventions for chronic stress and its symptoms. The project's clinical use for Hawaiians with stress-induced high BP combined with its methodological innovation of personalized artificial intelligence models highlights its significance in advancing health care interventions. Through iterative refinement and optimization, the aim is to develop a personalized deep-learning framework capable of accurately predicting stress-induced BP spikes, thereby promoting individual well-being and health outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/55615 ",
doi="10.2196/55615",
url="https://www.researchprotocols.org/2024/1/e55615",
url="http://www.ncbi.nlm.nih.gov/pubmed/38526539"
}


@Article{info:doi/10.2196/53054,
author="Bonn, E. Stephanie
and Hummel, Madeleine
and Peveri, Giulia
and Eke, Hel{\'e}n
and Alexandrou, Christina
and Bellocco, Rino
and L{\"o}f, Marie
and Trolle Lagerros, Ylva",
title="Effectiveness of a Smartphone App to Promote Physical Activity Among Persons With Type 2 Diabetes: Randomized Controlled Trial",
journal="Interact J Med Res",
year="2024",
month="Mar",
day="21",
volume="13",
pages="e53054",
keywords="behavior change",
keywords="exercise",
keywords="intervention",
keywords="mHealth",
keywords="smartphone app",
keywords="self-monitoring",
abstract="Background: Physical activity is well known to have beneficial effects on glycemic control and to reduce risk factors for cardiovascular disease in persons with type 2 diabetes. Yet, successful implementation of lifestyle interventions targeting physical activity in primary care has shown to be difficult. Smartphone apps may provide useful tools to support physical activity. The DiaCert app was specifically designed for integration into primary care and is an automated mobile health (mHealth) solution promoting daily walking. Objective: This study aimed to investigate the effect of a 3-month-long intervention promoting physical activity through the use of the DiaCert app among persons with type 2 diabetes in Sweden. Our primary objective was to assess the effect on moderate to vigorous physical activity (MVPA) at 3 months of follow-up. Our secondary objective was to assess the effect on MVPA at 6 months of follow-up and on BMI, waist circumference, hemoglobin A1c, blood lipids, and blood pressure at 3 and 6 months of follow-up. Methods: We recruited men and women with type 2 diabetes from 5 primary health care centers and 1 specialized center. Participants were randomized 1:1 to the intervention or control group. The intervention group was administered standard care and access to the DiaCert app at baseline and 3 months onward. The control group received standard care only. Outcomes of objectively measured physical activity using accelerometers, BMI, waist circumference, biomarkers, and blood pressure were assessed at baseline and follow-ups. Linear mixed models were used to assess differences in outcomes between the groups. Results: A total of 181 study participants, 65.7\% (119/181) men and 34.3\% (62/181) women, were recruited into the study and randomized to the intervention (n=93) or control group (n=88). The participants' mean age and BMI were 60.0 (SD 11.4) years and 30.4 (SD 5.3) kg/m2, respectively. We found no significant effect of the intervention (group by time interaction) on MVPA at either the 3-month ($\beta$=1.51, 95\% CI --5.53 to 8.55) or the 6-month ($\beta$=--3.53, 95\% CI --10.97 to 3.92) follow-up. We found no effect on any of the secondary outcomes at follow-ups, except for a significant effect on BMI at 6 months ($\beta$=0.52, 95\% CI 0.20 to 0.84). However, mean BMI did not differ between the groups at the 6-month follow-up. Conclusions: We found no evidence that persons with type 2 diabetes being randomized to use an app promoting daily walking increased their levels of MVPA at 3 or 6 months' follow-up compared with controls receiving standard care. The effect of the app on BMI was unclear, and we found nothing to support an effect on secondary outcomes. Further research is needed to determine what type of mHealth intervention could be effective to increase physical activity among persons with type 2 diabetes. Trial Registration: ClinicalTrials.gov NCT03053336; https://clinicaltrials.gov/study/NCT03053336 ",
doi="10.2196/53054",
url="https://www.i-jmr.org/2024/1/e53054",
url="http://www.ncbi.nlm.nih.gov/pubmed/38512333"
}


@Article{info:doi/10.2196/55178,
author="Yamamoto, Akiko
and Yamada, Eriku
and Ibara, Takuya
and Nihey, Fumiyuki
and Inai, Takuma
and Tsukamoto, Kazuya
and Waki, Tomohiko
and Yoshii, Toshitaka
and Kobayashi, Yoshiyuki
and Nakahara, Kentaro
and Fujita, Koji",
title="Using In-Shoe Inertial Measurement Unit Sensors to Understand Daily-Life Gait Characteristics in Patients With Distal Radius Fractures During 6 Months of Recovery: Cross-Sectional Study",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Mar",
day="20",
volume="12",
pages="e55178",
keywords="distal radius fracture",
keywords="gait analysis",
keywords="daily life",
keywords="long-term results",
keywords="gait",
keywords="sensor",
keywords="sensors",
keywords="walk",
keywords="walking",
keywords="fracture",
keywords="fractures",
keywords="wearable",
keywords="wearables",
keywords="recover",
keywords="rehabilitation",
keywords="spatiotemporal",
keywords="inertial measurement",
keywords="fragility",
keywords="postmenopausal",
keywords="menopause",
keywords="grip",
keywords="surgery",
keywords="surgical",
keywords="orthopedic",
keywords="postoperative",
keywords="orthopedics",
keywords="fall",
keywords="falls",
keywords="bone",
keywords="bones",
keywords="wrist",
keywords="radius",
keywords="radial",
abstract="Background: A distal radius fracture (DRF) is a common initial fragility fracture among women in their early postmenopausal period, which is associated with an increased risk of subsequent fractures. Gait assessments are valuable for evaluating fracture risk; inertial measurement units (IMUs) have been widely used to assess gait under free-living conditions. However, little is known about long-term changes in patients with DRF, especially concerning daily-life gait. We hypothesized that, in the long term, the daily-life gait parameters in patients with DRF could enable us to reveal future risk factors for falls and fractures. Objective: This study assessed the spatiotemporal characteristics of patients with DRF at 4 weeks and 6 months of recovery. Methods: We recruited 16 women in their postmenopausal period with DRF as their first fragility fracture (mean age 62.3, SD 7.0 years) and 28 matched healthy controls (mean age 65.6, SD 8.0 years). Daily-life gait assessments and physical assessments, such as hand grip strength (HGS), were performed using an in-shoe IMU sensor. Participants' results were compared with those of the control group, and their recovery was assessed for 6 months after the fracture. Results: In the fracture group, at 4 weeks after DRF, lower foot height in the swing phase (P=.049) and higher variability of stride length (P=.03) were observed, which improved gradually. However, the dorsiflexion angle in the fracture group tended to be lower consistently during 6 months (at 4 weeks: P=.06; during 6 months: P=.07). As for the physical assessments, the fracture group showed lower HGS at all time points (at 4 weeks: P<.001; during 6 months: P=.04), despite significant improvement at 6 months (P<.001). Conclusions: With an in-shoe IMU sensor, we discovered the recovery of spatiotemporal gait characteristics 6 months after DRF surgery without the participants' awareness. The consistently unchanged dorsiflexion angle in the swing phase and lower HGS could be associated with fracture risk, implying the high clinical importance of appropriate interventions for patients with DRF to prevent future fractures. These results could be applied to a screening tool for evaluating the risk of falls and fractures, which may contribute to constructing a new health care system using wearable devices in the near future. ",
doi="10.2196/55178",
url="https://mhealth.jmir.org/2024/1/e55178",
url="http://www.ncbi.nlm.nih.gov/pubmed/38506913"
}


@Article{info:doi/10.2196/51236,
author="Liu, W. Andrew
and Brown, III, William
and Madu, E. Ndubuisi
and Maiorano, R. Ali
and Bigazzi, Olivia
and Medina, Eli
and Sorric, Christopher
and Hays, R. Steven
and Odisho, Y. Anobel",
title="Patient Engagement With and Perspectives on a Mobile Health Home Spirometry Intervention: Mixed Methods Study",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Mar",
day="20",
volume="12",
pages="e51236",
keywords="mobile health",
keywords="mHealth",
keywords="remote patient monitoring",
keywords="interview",
keywords="interviews",
keywords="dropout",
keywords="attrition",
keywords="eHealth",
keywords="methods",
keywords="telemedicine",
keywords="statistics",
keywords="numerical data",
keywords="patient-centered care",
keywords="spirometry",
keywords="lung transplant",
keywords="lung",
keywords="transplant",
keywords="transplants",
keywords="transplantation",
keywords="organ",
keywords="organs",
keywords="engagement",
keywords="monitor",
keywords="monitoring",
keywords="pulmonary",
keywords="respiratory",
keywords="lungs",
keywords="experience",
keywords="experiences",
keywords="device",
keywords="devices",
keywords="complication",
keywords="complications",
abstract="Background: Patient engagement attrition in mobile health (mHealth) remote patient monitoring (RPM) programs decreases program benefits. Systemic disparities lead to inequities in RPM adoption and use. There is an urgent need to understand patients' experiences with RPM in the real world, especially for patients who have stopped using the programs, as addressing issues faced by patients can increase the value of mHealth for patients and subsequently decrease attrition. Objective: This study sought to understand patient engagement and experiences in an RPM mHealth intervention in lung transplant recipients. Methods: Between May 4, 2020, and November 1, 2022, a total of 601 lung transplant recipients were enrolled in an mHealth RPM intervention to monitor lung function. The predictors of patient engagement were evaluated using multivariable logistic and linear regression. Semistructured interviews were conducted with 6 of 39 patients who had engaged in the first month but stopped using the program, and common themes were identified. Results: Patients who underwent transplant more than 1 year before enrollment in the program had 84\% lower odds of engaging (odds ratio [OR] 0.16, 95\% CI 0.07-0.35), 82\% lower odds of submitting pulmonary function measurements (OR 0.18, 95\% CI 0.09-0.33), and 78\% lower odds of completing symptom checklists (OR 0.22, 95\% CI 0.10-0.43). Patients whose primary language was not English had 78\% lower odds of engaging compared to English speakers (OR 0.22, 95\% CI 0.07-0.67). Interviews revealed 4 prominent themes: challenges with devices, communication breakdowns, a desire for more personal interactions and specific feedback with the care team about their results, understanding the purpose of the chat, and understanding how their data are used. Conclusions: Care delivery and patient experiences with RPM in lung transplant mHealth can be improved and made more equitable by tailoring outreach and enhancements toward non-English speakers and patients with a longer time between transplant and enrollment. Attention to designing programs to provide personalization through supplementary provider contact, education, and information transparency may decrease attrition rates. ",
doi="10.2196/51236",
url="https://mhealth.jmir.org/2024/1/e51236",
url="http://www.ncbi.nlm.nih.gov/pubmed/38506896"
}


@Article{info:doi/10.2196/51249,
author="van Alen, Marie Catharina
and Brenner, Alexander
and Warnecke, Tobias
and Varghese, Julian",
title="Smartwatch Versus Routine Tremor Documentation: Descriptive Comparison",
journal="JMIR Form Res",
year="2024",
month="Mar",
day="20",
volume="8",
pages="e51249",
keywords="Parkinson disease",
keywords="tremor",
keywords="smart wearables",
keywords="smartwatch",
keywords="mobile apps",
keywords="movement disorders",
keywords="tremor documentation",
keywords="tremor occurrence",
keywords="tremor score",
doi="10.2196/51249",
url="https://formative.jmir.org/2024/1/e51249",
url="http://www.ncbi.nlm.nih.gov/pubmed/38506919"
}


@Article{info:doi/10.2196/52733,
author="Sieber, Chlo{\'e}
and Haag, Christina
and Polhemus, Ashley
and Haile, R. Sarah
and Sylvester, Ramona
and Kool, Jan
and Gonzenbach, Roman
and von Wyl, Viktor",
title="Exploring the Major Barriers to Physical Activity in Persons With Multiple Sclerosis: Observational Longitudinal Study",
journal="JMIR Rehabil Assist Technol",
year="2024",
month="Mar",
day="18",
volume="11",
pages="e52733",
keywords="physical activity",
keywords="barriers to physical activity",
keywords="Barriers to Health Promoting Activities for Disabled Persons scale",
keywords="BHADP scale",
keywords="multiple sclerosis",
keywords="Fitbit",
keywords="wearable",
abstract="Background: Physical activity (PA) represents a low-cost and readily available means of mitigating multiple sclerosis (MS) symptoms and alleviating the disease course. Nevertheless, persons with MS engage in lower levels of PA than the general population. Objective: This study aims to enhance the understanding of the barriers to PA engagement in persons with MS and to evaluate the applicability of the Barriers to Health Promoting Activities for Disabled Persons (BHADP) scale for assessing barriers to PA in persons with MS, by comparing the BHADP score with self-reported outcomes of fatigue, depression, self-efficacy, and health-related quality of life, as well as sensor-measured PA. Methods: Study participants (n=45; median age 46, IQR 40-51 years; median Expanded Disability Status Scale score 4.5, IQR 3.5-6) were recruited among persons with MS attending inpatient neurorehabilitation. They wore a Fitbit Inspire HR (Fitbit Inc) throughout their stay at the rehabilitation clinic (phase 1; 2-4 wk) and for the 4 following weeks at home (phase 2; 4 wk). Sensor-based step counts and cumulative minutes in moderate to vigorous PA were computed for the last 7 days at the clinic and at home. On the basis of PA during the last 7 end-of-study days, we grouped the study participants as active (?10,000 steps/d) and less active (<10,000 steps/d) to explore PA barriers compared with PA level. PA barriers were repeatedly assessed through the BHADP scale. We described the relevance of the 18 barriers of the BHADP scale assessed at the end of the study and quantified their correlations with the Spearman correlation test. We evaluated the associations of the BHADP score with end-of-study reported outcomes of fatigue, depression, self-efficacy, and health-related quality of life with multivariable regression models. We performed separate regression analyses to examine the association of the BHADP score with different sensor-measured outcomes of PA. Results: The less active group reported higher scores for the BHADP items Feeling what I do doesn't help, No one to help me, and Lack of support from family/friends. The BHADP items Not interested in PA and Impairment were positively correlated. The BHADP score was positively associated with measures of fatigue and depression and negatively associated with self-efficacy and health-related quality of life. The BHADP score showed an inverse relationship with the level of PA measured but not when dichotomized according to the recommended PA level thresholds. Conclusions: The BHADP scale is a valid and well-adapted tool for persons with MS because it reflects common MS symptoms such as fatigue and depression, as well as self-efficacy and health-related quality of life. Moreover, decreases in PA levels are often related to increases in specific barriers in the lives of persons with MS and should hence be addressed jointly in health care management. ",
doi="10.2196/52733",
url="https://rehab.jmir.org/2024/1/e52733",
url="http://www.ncbi.nlm.nih.gov/pubmed/38498024"
}


@Article{info:doi/10.2196/46820,
author="Simmich, Joshua
and Andrews, Emma Nicole
and Claus, Andrew
and Murdoch, Megan
and Russell, Glen Trevor",
title="Assessing a GPS-Based 6-Minute Walk Test for People With Persistent Pain: Validation Study",
journal="JMIR Form Res",
year="2024",
month="Mar",
day="18",
volume="8",
pages="e46820",
keywords="GPS",
keywords="mobile apps",
keywords="exercise test",
keywords="pain",
keywords="chronic pain",
keywords="mobile phone",
abstract="Background: The 6-minute walk test (6MWT) is a commonly used method to assess the exercise capacity of people with many health conditions, including persistent pain. However, it is conventionally performed with in-person supervision in a hospital or clinic, therefore requiring staff resources. It may also be difficult when in-person supervision is unavailable, such as during the COVID-19 pandemic, or when the person is geographically remote. A potential solution to these issues could be to use GPS to measure walking distance. Objective: The primary aim of this study was to assess the validity of a GPS-based smartphone app to measure walking distance as an alternative to the conventional 6MWT in a population with persistent pain. The secondary aim of this study was to estimate the difference between the pain evoked by the 2 test methods. Methods: People with persistent pain (N=36) were recruited to complete a conventional 6MWT on a 30-m shuttle track and a 6MWT assessed by a smartphone app using GPS, performed on outdoor walking circuits. Tests were performed in random order, separated by a 15-minute rest. The 95\% limits of agreement were calculated using the Bland-Altman method, with a specified maximum allowable difference of 100 m. Pain was assessed using an 11-point numerical rating scale before and after each walk test. Results: The mean 6-minute walk distance measured by the GPS-based smartphone app was 13.2 (SD 46; 95\% CI ?2.7 to 29.1) m higher than that assessed in the conventional manner. The 95\% limits of agreement were 103.9 (95\% CI 87.4-134.1) m and ?77.6 (95\% CI ?107.7 to ?61) m, which exceeded the maximum allowable difference. Pain increased in the conventional walk test by 1.1 (SD 1.0) points, whereas pain increased in the app test by 0.8 (SD 1.4) points. Conclusions: In individuals with persistent pain, the 2 methods of assessing the 6MWT may not be interchangeable due to limited validity. Potential reasons for the differences between the 2 methods might be attributed to the variation in track layout (shuttle track vs continuous circuit); poor GPS accuracy; deviations from the 30-m shuttle track; human variability in walking speed; and the potential impact of a first test on the second test due to fatigue, pain provocation, or a learning effect. Future research is needed to improve the accuracy of the GPS-based approach. Despite its limitations, the GPS-based 6MWT may still have value as a tool for remote monitoring that could allow individuals with persistent pain to self-administer frequent assessments of their functional capacity in their home environment. ",
doi="10.2196/46820",
url="https://formative.jmir.org/2024/1/e46820",
url="http://www.ncbi.nlm.nih.gov/pubmed/38498031"
}


@Article{info:doi/10.2196/52809,
author="Henderson, Kyra
and Reihm, Jennifer
and Koshal, Kanishka
and Wijangco, Jaeleene
and Sara, Narender
and Miller, Nicolette
and Doyle, Marianne
and Mallory, Alicia
and Sheridan, Judith
and Guo, Chu-Yueh
and Oommen, Lauren
and Rankin, P. Katherine
and Sanders, Stephan
and Feinstein, Anthony
and Mangurian, Christina
and Bove, Riley",
title="A Closed-Loop Digital Health Tool to Improve Depression Care in Multiple Sclerosis: Iterative Design and Cross-Sectional Pilot Randomized Controlled Trial and its Impact on Depression Care",
journal="JMIR Form Res",
year="2024",
month="Mar",
day="15",
volume="8",
pages="e52809",
keywords="depression",
keywords="quality of life",
keywords="bring your own device",
keywords="mHealth",
keywords="closed-loop",
keywords="clinical trial",
keywords="multiple sclerosis",
abstract="Background: People living with multiple sclerosis (MS) face a higher likelihood of being diagnosed with a depressive disorder than the general population. Although many low-cost screening tools and evidence-based interventions exist, depression in people living with MS is underreported, underascertained by clinicians, and undertreated. Objective: This study aims to design a closed-loop tool to improve depression care for these patients. It would support regular depression screening, tie into the point of care, and support shared decision-making and comprehensive follow-up. After an initial development phase, this study involved a proof-of-concept pilot randomized controlled trial (RCT) validation phase and a detailed human-centered design (HCD) phase. Methods: During the initial development phase, the technological infrastructure of a clinician-facing point-of-care clinical dashboard for MS management (BRIDGE) was leveraged to incorporate features that would support depression screening and comprehensive care (Care Technology to Ascertain, Treat, and Engage the Community to Heal Depression in people living with MS [MS CATCH]). This linked a patient survey, in-basket messages, and a clinician dashboard. During the pilot RCT phase, a convenience sample of 50 adults with MS was recruited from a single MS center with 9-item Patient Health Questionnaire scores of 5-19 (mild to moderately severe depression). During the routine MS visit, their clinicians were either asked or not to use MS CATCH to review their scores and care outcomes were collected. During the HCD phase, the MS CATCH components were iteratively modified based on feedback from stakeholders: people living with MS, MS clinicians, and interprofessional experts. Results: MS CATCH links 3 features designed to support mood reporting and ascertainment, comprehensive evidence-based management, and clinician and patient self-management behaviors likely to lead to sustained depression relief. In the pilot RCT (n=50 visits), visits in which the clinician was randomized to use MS CATCH had more notes documenting a discussion of depressive symptoms than those in which MS CATCH was not used (75\% vs 34.6\%; $\chi$21=8.2; P=.004). During the HCD phase, 45 people living with MS, clinicians, and other experts participated in the design and refinement. The final testing round included 20 people living with MS and 10 clinicians including 5 not affiliated with our health system. Most scoring targets for likeability and usability, including perceived ease of use and perceived effectiveness, were met. Net Promoter Scale was 50 for patients and 40 for clinicians. Conclusions: Created with extensive stakeholder feedback, MS CATCH is a closed-loop system aimed to increase communication about depression between people living with MS and their clinicians, and ultimately improve depression care. The pilot findings showed evidence of enhanced communication. Stakeholders also advised on trial design features of a full year long Department of Defense--funded feasibility and efficacy trial, which is now underway. Trial Registration: ClinicalTrials.gov NCT05865405; http://tinyurl.com/4zkvru9x ",
doi="10.2196/52809",
url="https://formative.jmir.org/2024/1/e52809",
url="http://www.ncbi.nlm.nih.gov/pubmed/38488827"
}


@Article{info:doi/10.2196/46699,
author="Mannoubi, Choumous
and Kairy, Dahlia
and Menezes, Vanessa Karla
and Desroches, Sophie
and Layani, Geraldine
and Vachon, Brigitte",
title="The Key Digital Tool Features of Complex Telehealth Interventions Used for Type 2 Diabetes Self-Management and Monitoring With Health Professional Involvement: Scoping Review",
journal="JMIR Med Inform",
year="2024",
month="Mar",
day="13",
volume="12",
pages="e46699",
keywords="telehealth",
keywords="telemedicine",
keywords="telenutrition",
keywords="telemonitoring",
keywords="electronic coaching",
keywords="e-coaching",
keywords="scoping review",
keywords="type 2 diabetes",
keywords="prediabetes",
keywords="diabetes management",
keywords="diabetes self-management",
keywords="mobile phone",
abstract="Background: Therapeutic education and patient self-management are crucial in diabetes prevention and treatment. Improving diabetes self-management requires multidisciplinary team intervention, nutrition education that facilitates self-management, informed decision-making, and the organization and delivery of appropriate health care services. The emergence of telehealth services has provided the public with various tools for educating themselves and for evaluating, monitoring, and improving their health and nutrition-related behaviors. Combining health technologies with clinical expertise, social support, and health professional involvement could help persons living with diabetes improve their disease self-management skills and prevent its long-term consequences. Objective: This scoping review's primary objective was to identify the key digital tool features of complex telehealth interventions used for type 2 diabetes or prediabetes self-management and monitoring with health professional involvement that help improve health outcomes. A secondary objective was to identify how these key features are developed and combined. Methods: A 5-step scoping review methodology was used to map relevant literature published between January 1, 2010 and March 31, 2022. Electronic searches were performed in the MEDLINE, CINAHL, and Embase databases. The searches were limited to scientific publications in English and French that either described the conceptual development of a complex telehealth intervention that combined self-management and monitoring with health professional involvement or evaluated its effects on the therapeutic management of patients with type 2 diabetes or prediabetes. Three reviewers independently identified the articles and extracted the data. Results: The results of 42 studies on complex telehealth interventions combining diabetes self-management and monitoring with the involvement of at least 1 health professional were synthesized. The health professionals participating in these studies were physicians, dietitians, nurses, and psychologists. The digital tools involved were smartphone apps or web-based interfaces that could be used with medical devices. We classified the features of these technologies into eight categories, depending on the intervention objective: (1) monitoring of glycemia levels, (2) physical activity monitoring, (3) medication monitoring, (4) diet monitoring, (5) therapeutic education, (6) health professional support, (7) other health data monitoring, and (8) health care management. The patient-logged data revealed behavior patterns that should be modified to improve health outcomes. These technologies, used with health professional involvement, patient self-management, and therapeutic education, translate into better control of glycemia levels and the adoption of healthier lifestyles. Likewise, they seem to improve monitoring by health professionals and foster multidisciplinary collaboration through data sharing and the development of more concise automatically generated reports. Conclusions: This scoping review synthesizes multiple studies that describe the development and evaluation of complex telehealth interventions used in combination with health professional support. It suggests that combining different digital tools that incorporate diabetes self-management and monitoring features with a health professional's advice and interaction results in more effective interventions and outcomes. ",
doi="10.2196/46699",
url="https://medinform.jmir.org/2024/1/e46699",
url="http://www.ncbi.nlm.nih.gov/pubmed/38477979"
}


@Article{info:doi/10.2196/49462,
author="Chou, Ya-Hsin
and Lin, Chemin
and Lee, Shwu-Hua
and Lee, Yen-Fen
and Cheng, Li-Chen",
title="User-Friendly Chatbot to Mitigate the Psychological Stress of Older Adults During the COVID-19 Pandemic: Development and Usability Study",
journal="JMIR Form Res",
year="2024",
month="Mar",
day="13",
volume="8",
pages="e49462",
keywords="geriatric psychiatry",
keywords="mental health",
keywords="loneliness",
keywords="chatbot",
keywords="user experience",
keywords="health promotion",
keywords="older adults",
keywords="technology-assisted interventions",
keywords="pandemic",
keywords="lonely",
keywords="gerontology",
keywords="elderly",
keywords="develop",
keywords="design",
keywords="development",
keywords="conversational agent",
keywords="geriatric",
keywords="geriatrics",
keywords="psychiatry",
abstract="Background: To safeguard the most vulnerable individuals during the COVID-19 pandemic, numerous governments enforced measures such as stay-at-home orders, social distancing, and self-isolation. These social restrictions had a particularly negative effect on older adults, as they are more vulnerable and experience increased loneliness, which has various adverse effects, including increasing the risk of mental health problems and mortality. Chatbots can potentially reduce loneliness and provide companionship during a pandemic. However, existing chatbots do not cater to the specific needs of older adult populations. Objective: We aimed to develop a user-friendly chatbot tailored to the specific needs of older adults with anxiety or depressive disorders during the COVID-19 pandemic and to examine their perspectives on mental health chatbot use. The primary research objective was to investigate whether chatbots can mitigate the psychological stress of older adults during COVID-19. Methods: Participants were older adults belonging to two age groups (?65 years and <65 years) from a psychiatric outpatient department who had been diagnosed with depressive or anxiety disorders by certified psychiatrists according to the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) criteria. The participants were required to use mobile phones, have internet access, and possess literacy skills. The chatbot's content includes monitoring and tracking health data and providing health information. Participants had access to the chatbot for at least 4 weeks. Self-report questionnaires for loneliness, depression, and anxiety were administered before and after chatbot use. The participants also rated their attitudes toward the chatbot. Results: A total of 35 participants (mean age 65.21, SD 7.51 years) were enrolled in the trial, comprising 74\% (n=26) female and 26\% (n=9) male participants. The participants demonstrated a high utilization rate during the intervention, with over 82\% engaging with the chatbot daily. Loneliness significantly improved in the older group ?65 years. This group also responded positively to the chatbot, as evidenced by changes in University of California Los Angeles Loneliness Scale scores, suggesting that this demographic can derive benefits from chatbot interaction. Conversely, the younger group, <65 years, exhibited no significant changes in loneliness after the intervention. Both the older and younger age groups provided good scores in relation to chatbot design with respect to usability (mean scores of 6.33 and 6.05, respectively) and satisfaction (mean scores of 5.33 and 5.15, respectively), rated on a 7-point Likert scale. Conclusions: The chatbot interface was found to be user-friendly and demonstrated promising results among participants 65 years and older who were receiving care at psychiatric outpatient clinics and experiencing relatively stable symptoms of depression and anxiety. The chatbot not only provided caring companionship but also showed the potential to alleviate loneliness during the challenging circumstances of a pandemic. ",
doi="10.2196/49462",
url="https://formative.jmir.org/2024/1/e49462",
url="http://www.ncbi.nlm.nih.gov/pubmed/38477965"
}


@Article{info:doi/10.2196/54635,
author="Nabunya, Proscovia
and Cavazos-Rehg, Patricia
and Mugisha, James
and Kasson, Erin
and Namuyaba, Imelda Olive
and Najjuuko, Claire
and Nsubuga, Edward
and Filiatreau, M. Lindsey
and Mwebembezi, Abel
and Ssewamala, M. Fred",
title="An mHealth Intervention to Address Depression and Improve Antiretroviral Therapy Adherence Among Youths Living With HIV in Uganda: Protocol for a Pilot Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Mar",
day="8",
volume="13",
pages="e54635",
keywords="depression",
keywords="adherence",
keywords="mHealth",
keywords="cognitive behavioral therapy",
keywords="antiretroviral therapy",
keywords="youth living with HIV",
keywords="Uganda",
abstract="Background: People living with HIV often struggle with mental health comorbidities that lower their antiretroviral therapy (ART) adherence. There is growing evidence that depression treatment may improve ART adherence and result in improved HIV outcomes. Given that mental health services are severely underequipped in low-resource settings, including in Uganda, new solutions to increase access to mental health care and close the treatment gap are urgently needed. This protocol paper presents the Suubi-Mhealth study, which proposed to develop a mobile health (mHealth) intervention for use among Ugandan youths (14-17 years) with comorbid HIV and depression, taking into account their unique contextual, cultural, and developmental needs. Objective: The proposed study is guided by the following objectives: (1) to develop and iteratively refine an intervention protocol for Suubi-Mhealth based on formative work to understand the needs of youths living with HIV; (2) to explore the feasibility and acceptability of Suubi-Mhealth on a small scale to inform subsequent refinement; (3) to test the preliminary impact of Suubi-Mhealth versus a waitlist control group on youths' outcomes, including depression and treatment adherence; and (4) to examine barriers and facilitators for integrating Suubi-Mhealth into health care settings. Methods: Youths will be eligible to participate in the study if they are (1) 14-17 years of age, (2) HIV-positive and aware of their status, (3) receiving care and ART from one of the participating clinics, and (4) living within a family. The study will be conducted in 2 phases. In phase 1, we will conduct focus group discussions with youths and health care providers, for feedback on the proposed intervention content and methods, and explore the feasibility and acceptability of the intervention. In phase II, we will pilot-test the preliminary impact of the intervention on reducing depression and improving ART adherence. Assessments will be conducted at baseline, 1-, 2-, and 6-months post intervention completion. Results: Participant recruitment for phase 1 is completed. Youths and health care providers participated in focus group discussions to share their feedback on the proposed Suubi-Mhealth intervention content, methods, design, and format. Transcription and translation of focus group discussions have been completed. The team is currently developing Suubi-Mhealth content based on participants' feedback. Conclusions: This study will lay important groundwork for several initiatives at the intersection of digital therapeutics, HIV treatment, and mental health, especially among sub-Saharan African youths, as they transition through adolescence and into adult HIV care settings. Trial Registration: ClinicalTrials.gov NCT05965245; https://clinicaltrials.gov/study/NCT05965245 International Registered Report Identifier (IRRID): DERR1-10.2196/54635 ",
doi="10.2196/54635",
url="https://www.researchprotocols.org/2024/1/e54635",
url="http://www.ncbi.nlm.nih.gov/pubmed/38457202"
}


@Article{info:doi/10.2196/52469,
author="Main, Ashleigh
and McCartney, Haruno
and Ibrar, Maryam
and Rai, Kaur Harleen
and Muirhead, Fiona
and Mavroeidi, Alexandra
and Maguire, Roma",
title="Patients' Experiences of Digital Health Interventions for the Self-Management of Chronic Pain: Protocol for a Systematic Review and Thematic Synthesis",
journal="JMIR Res Protoc",
year="2024",
month="Mar",
day="7",
volume="13",
pages="e52469",
keywords="chronic pain",
keywords="digital health",
keywords="digital tool",
keywords="digital health intervention",
keywords="mHealth",
keywords="eHealth",
keywords="pain-management",
keywords="person-centered",
keywords="experience",
keywords="protocol",
keywords="patients' experiences",
keywords="patient experiences",
keywords="self-management",
keywords="systematic review",
keywords="thematic synthesis",
keywords="protocol.",
abstract="Background: Chronic pain is a highly prevalent condition that requires multidisciplinary treatment. However, in the United Kingdom, access to specialist pain clinics where patients can receive medical multidisciplinary treatment is limited, and provision varies between health boards. As such, self-management of chronic pain using digital tools has been gaining traction recently, but evidence of its effectiveness from clinical-based trials focuses mainly on quantitative outcomes. Objective: This systematic review aims to identify, appraise, and synthesize qualitative evidence on patients' experiences with digital health interventions (DHIs) for the management of chronic pain. Methods: This systematic review will consider qualitative and mixed methods studies that explore the experience of patients (aged 18 years and older) with chronic pain engaging in DHIs to manage their pain. MEDLINE Ovid, PubMed, Embase, CINAHL, PsycINFO, and Scopus databases will be searched for published studies. The systematic review will be conducted in accordance with the ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) guidelines. Following the 3-step thematic synthesis methodology of Thomas and Harden, titles and abstracts will be screened by 2 independent reviewers (AM and HM), and a third reviewer (MI or FM) will resolve any conflict that arises before the full-text screening. The Critical Appraisal Skills Programme checklist tool will be used to critically appraise the included studies. The extracted data will be imported to NVivo (QSR International), where thematic synthesis will be used to derive analytical themes from the included studies. Results: Themes that encapsulate the patient experience will be identified from qualitative evidence, and these themes will shed light on the perceived benefits and disadvantages, usability, acceptability, and the overall impact digital tools can have on the lives of those with chronic pain. Conclusions: This systematic review will identify, appraise, and synthesize the overall experience of patients engaging in DHI to manage a diverse range of chronic pain conditions. By elaborating the patient experience through qualitative analysis, the findings from this review will enhance our current understanding of the experiences of patients with chronic pain using digital tools for the self-management of their pain and highlight what person-centered elements are essential for future DHI development. Trial Registration: PROSPERO CRD42023445100; http://tinyurl.com/4z77khfs International Registered Report Identifier (IRRID): DERR1-10.2196/52469 ",
doi="10.2196/52469",
url="https://www.researchprotocols.org/2024/1/e52469",
url="http://www.ncbi.nlm.nih.gov/pubmed/38451694"
}


@Article{info:doi/10.2196/48310,
author="Yoon, Sungwon
and Tang, Haoming
and Tan, Min Chao
and Phang, Kie Jie
and Kwan, Heng Yu
and Low, Leng Lian",
title="Acceptability of Mobile App--Based Motivational Interviewing and Preferences for App Features to Support Self-Management in Patients With Type 2 Diabetes: Qualitative Study",
journal="JMIR Diabetes",
year="2024",
month="Mar",
day="6",
volume="9",
pages="e48310",
keywords="mobile health",
keywords="motivational interviewing",
keywords="diabetes",
keywords="self-management",
keywords="health coaching",
keywords="acceptability",
keywords="application",
keywords="management",
keywords="type 2 diabetes",
keywords="communication",
keywords="patient barrier",
keywords="healthy behavior",
keywords="feedback",
keywords="visualization",
keywords="hybrid model",
abstract="Background: Patients with type 2 diabetes mellitus (T2DM) experience multiple barriers to improving self-management. Evidence suggests that motivational interviewing (MI), a patient-centered communication method, can address patient barriers and promote healthy behavior. Despite the value of MI, existing MI studies predominantly used face-to-face or phone-based interventions. With the growing adoption of smartphones, automated MI techniques powered by artificial intelligence on mobile devices may offer effective motivational support to patients with T2DM. Objective: This study aimed to explore the perspectives of patients with T2DM on the acceptability of app-based MI in routine health care and collect their feedback on specific MI module features to inform our future intervention. Methods: We conducted semistructured interviews with patients with T2DM, recruited from public primary care clinics. All interviews were audio recorded and transcribed verbatim. Thematic analysis was conducted using NVivo. Results: In total, 33 patients with T2DM participated in the study. Participants saw MI as a mental reminder to increase motivation and a complementary care model conducive to self-reflection and behavior change. Yet, there was a sense of reluctance, mainly stemming from potential compromise of autonomy in self-care by the introduction of MI. Some participants felt confident in their ability to manage conditions independently, while others reported already making changes and preferred self-management at their own pace. Compared with in-person MI, app-based MI was viewed as offering a more relaxed atmosphere for open sharing without being judged by health care providers. However, participants questioned the lack of human touch, which could potentially undermine a patient-provider therapeutic relationship. To sustain motivation, participants suggested more features of an ongoing supportive nature such as the visualization of milestones, gamified challenges and incremental rewards according to achievements, tailored multimedia resources based on goals, and conversational tools that are interactive and empathic. Conclusions: Our findings suggest the need for a hybrid model of intervention involving both app-based automated MI and human coaching. Patient feedback on specific app features will be incorporated into the module development and tested in a randomized controlled trial. ",
doi="10.2196/48310",
url="https://diabetes.jmir.org/2024/1/e48310",
url="http://www.ncbi.nlm.nih.gov/pubmed/38446526"
}


@Article{info:doi/10.2196/52766,
author="Torbj{\o}rnsen, Astrid
and Spildo, Ingeborg
and Mollestad, Aadland Maria
and Jensen, Lunde Annesofie
and Singstad, Tone
and Weldingh, Mickelson Nina
and Joranger, P{\aa}l
and Ribu, Lis
and Holmen, Heidi",
title="Investigating Digital Patient-Reported Outcome Measures in Patient-Centered Diabetes Specialist Outpatient Care (DigiDiaS): Protocol for a Multimethod Prospective Observational Study",
journal="JMIR Res Protoc",
year="2024",
month="Mar",
day="5",
volume="13",
pages="e52766",
keywords="patient-reported outcome measures",
keywords="PROMs",
keywords="diabetes mellitus",
keywords="DM",
keywords="type 1",
keywords="patient acceptance of health care",
keywords="telemedicine",
keywords="mobile apps",
keywords="mobile phone",
abstract="Background: Living with type 1 diabetes is challenging, and to support self-management, repeated consultations in specialist outpatient care are often required. The emergence of new digital solutions has revolutionized how health care services can be patient centered, providing unprecedented opportunities for flexible, high-quality care. However, there is a lack of studies exploring how the use of digital patient-reported outcome measures (PROMs) for flexible specialist care affects diabetes self-management. To provide new knowledge on the relevance of using PROMs in standard care, we have designed a multimethod prospective study. Objective: The overall aim of this protocol is to describe our prospective multimethod observational study designed to investigate digital PROMs in a routine specialist outpatient setting for flexible patient-centered diabetes care (DigiDiaS). Methods: This protocol outlines the design of a multimethod prospective observational cohort study that includes data from electronic health records, self-reported questionnaires, clinical consultation field observations, and individual in-depth interviews with patients and diabetes health care personnel. All patients with type 1 diabetes at a designated outpatient clinic were invited to participate and use the digital PROM implemented in clinical care. Both users and nonusers of the digital PROM were eligible for the prospective study, allowing for a comparison of the two groups. Data were collected at baseline and after 12 months, including self-management as the primary outcome assessed using the Patient Activation Measure, along with the secondary outcomes of digital health literacy, quality of life, health economy, and clinical variables such as glycated hemoglobin. Results: The digital solution was implemented for routine clinical care in the department in November 2021, and data collection for the prospective study started in October 2022. As of September 6, 2023, 84.6\% (186/220) of patients among those in the digital PROM and 15.5\% (34/220) of patients among the nonusers have consented to participate. We expect the study to have enough participants by the autumn of 2023. With 1 year of follow-up, the results are expected by spring 2025. Conclusions: In conclusion, a multimethod prospective observational cohort study can offer valuable insights into the relevance, effectiveness, and acceptability of digital tools using PROMs in diabetes specialist care. Such knowledge is crucial for achieving broad and successful implementation and use of these tools in a large diabetes outpatient clinic. International Registered Report Identifier (IRRID): DERR1-10.2196/52766 ",
doi="10.2196/52766",
url="https://www.researchprotocols.org/2024/1/e52766",
url="http://www.ncbi.nlm.nih.gov/pubmed/38441955"
}


@Article{info:doi/10.2196/52442,
author="Keogh, Alison
and Brennan, Carol
and Johnston, William
and Dickson, Jane
and Leslie, J. Stephen
and Burke, David
and Megyesi, Peter
and Caulfield, Brian",
title="Six-Month Pilot Testing of a Digital Health Tool to Support Effective Self-Care in People With Heart Failure: Mixed Methods Study",
journal="JMIR Form Res",
year="2024",
month="Mar",
day="1",
volume="8",
pages="e52442",
keywords="digital health",
keywords="heart failure",
keywords="cardiology",
keywords="self-care",
keywords="behavior change",
keywords="eHealth",
keywords="mHealth",
keywords="mobile health",
keywords="mobile app",
keywords="mobile phone",
keywords="elderly",
keywords="self-management",
keywords="digital tools",
keywords="digital tool",
keywords="human-centered design",
keywords="app",
keywords="apps",
keywords="applications",
keywords="wearables",
keywords="wearable",
keywords="Fitbit",
keywords="usability",
keywords="adherence",
keywords="feasibility",
keywords="congestive heart failure",
keywords="cardiac failure",
keywords="myocardial failure",
keywords="heart decompensation",
abstract="Background: Digital tools may support people to self-manage their heart failure (HF). Having previously outlined the human-centered design development of a digital tool to support self-care of HF, the next step was to pilot the tool over a period of time to establish people's acceptance of it in practice. Objective: This study aims to conduct an observational pilot study to examine the usability, adherence, and feasibility of a digital health tool for HF within the Irish health care system. Methods: A total of 19 participants with HF were provided with a digital tool comprising a mobile app and the Fitbit Charge 4 and Aria Air smart scales for a period of 6 months. Changes to their self-care were assessed before and after the study with the 9-item European HF Self-care Behavior Scale (EHFScBS) and the Minnesota Living with HF Questionnaire (MLwHFQ) using a Wilcoxon signed rank test. After the study, 3 usability questionnaires were implemented and descriptively analyzed: the System Usability Scale (SUS), Wearable Technology Motivation Scale (WTMS), and Comfort Rating Scale (CRS). Participants also undertook a semistructured interview regarding their experiences with the digital tool. Interviews were analyzed deductively using the Theoretical Domains Framework. Results: Participants wore their devices for an average of 86.2\% of the days in the 6-month testing period ranging from 40.6\% to 98\%. Although improvements in the EHFScBS and MLwHFQ were seen, these changes were not significant (P=.10 and P=.70, respectively, where P>.03, after a Bonferroni correction). SUS results suggest that the usability of this system was not acceptable with a median score of 58.8 (IQR 55.0-60.0; range 45.0-67.5). Participants demonstrated a strong motivation to use the system according to the WTMS (median 6.0, IQR 5.0-7.0; range 1.0-7.0), whereas the Fitbit was considered very comfortable as demonstrated by the low CRS results (median 0.0, IQR 0.0-0.0; range 0.0-2.0). According to participant interviews, the digital tool supported self-management through increased knowledge, improved awareness, decision-making, and confidence in their own data, and improving their social support through a feeling of comfort in being watched. Conclusions: The digital health tool demonstrated high levels of adherence and acceptance among participants. Although the SUS results suggest low usability, this may be explained by participants uncertainty that they were using it fully, rather than it being unusable, especially given the experiences documented in their interviews. The digital tool targeted key self-management behaviors and feelings of social support. However, a number of changes to the tool, and the health service, are required before it can be implemented at scale. A full-scale feasibility trial conducted at a wider level is required to fully determine its potential effectiveness and wider implementation needs. ",
doi="10.2196/52442",
url="https://formative.jmir.org/2024/1/e52442",
url="http://www.ncbi.nlm.nih.gov/pubmed/38427410"
}


@Article{info:doi/10.2196/49110,
author="Milton, Alyssa
and Ozols A?M, Ingrid
and Cassidy, Tayla
and Jordan, Dana
and Brown, Ellie
and Arnautovska, Urska
and Cook, Jim
and Phung, Darren
and Lloyd-Evans, Brynmor
and Johnson, Sonia
and Hickie, Ian
and Glozier, Nick",
title="Co-Production of a Flexibly Delivered Relapse Prevention Tool to Support the Self-Management of Long-Term Mental Health Conditions: Co-Design and User Testing Study",
journal="JMIR Form Res",
year="2024",
month="Feb",
day="23",
volume="8",
pages="e49110",
keywords="self-management",
keywords="serious mental illness",
keywords="self-care",
keywords="digital health tools",
keywords="blended interventions",
keywords="peer support",
keywords="mobile phone",
abstract="Background: Supported self-management interventions, which assist individuals in actively understanding and managing their own health conditions, have a robust evidence base for chronic physical illnesses, such as diabetes, but have been underused for long-term mental health conditions. Objective: This study aims to co-design and user test a mental health supported self-management intervention, My Personal Recovery Plan (MyPREP), that could be flexibly delivered via digital and traditional paper-based mediums. Methods: This study adopted a participatory design, user testing, and rapid prototyping methodologies, guided by 2 frameworks: the 2021 Medical Research Council framework for complex interventions and an Australian co-production framework. Participants were aged ?18 years, self-identified as having a lived experience of using mental health services or working in a peer support role, and possessed English proficiency. The co-design and user testing processes involved a first round with 6 participants, focusing on adapting a self-management resource used in a large-scale randomized controlled trial in the United Kingdom, followed by a second round with 4 new participants for user testing the co-designed digital version. A final round for gathering qualitative feedback from 6 peer support workers was conducted. Data analysis involved transcription, coding, and thematic interpretation as well as the calculation of usability scores using the System Usability Scale. Results: The key themes identified during the co-design and user testing sessions were related to (1) the need for self-management tools to be flexible and well-integrated into mental health services, (2) the importance of language and how language preferences vary among individuals, (3) the need for self-management interventions to have the option of being supported when delivered in services, and (4) the potential of digitization to allow for a greater customization of self-management tools and the development of features based on individuals' unique preferences and needs. The MyPREP paper version received a total usability score of 71, indicating C+ or good usability, whereas the digital version received a total usability score of 85.63, indicating A or excellent usability. Conclusions: There are international calls for mental health services to promote a culture of self-management, with supported self-management interventions being routinely offered. The resulting co-designed prototype of the Australian version of the self-management intervention MyPREP provides an avenue for supporting self-management in practice in a flexible manner. Involving end users, such as consumers and peer workers, from the beginning is vital to address their need for personalized and customized interventions and their choice in how interventions are delivered. Further implementation-effectiveness piloting of MyPREP in real-world mental health service settings is a critical next step. ",
doi="10.2196/49110",
url="https://formative.jmir.org/2024/1/e49110",
url="http://www.ncbi.nlm.nih.gov/pubmed/38393768"
}


@Article{info:doi/10.2196/53991,
author="Schmitz, Boris
and Wirtz, Svenja
and Sestayo-Fern{\'a}ndez, Manuela
and Sch{\"a}fer, Hendrik
and Douma, R. Emma
and Alonso Vazquez, Marta
and Gonz{\'a}lez-Salvado, Violeta
and Habibovic, Mirela
and Gatsios, Dimitris
and Kop, Johan Willem
and Pe{\~n}a-Gil, Carlos
and Mooren, Frank",
title="Living Lab Data of Patient Needs and Expectations for eHealth-Based Cardiac Rehabilitation in Germany and Spain From the TIMELY Study: Cross-Sectional Analysis",
journal="J Med Internet Res",
year="2024",
month="Feb",
day="22",
volume="26",
pages="e53991",
keywords="eHealth",
keywords="coronary artery disease",
keywords="rehabilitation",
keywords="mHealth",
keywords="mobile health",
keywords="mobile phone",
keywords="app",
keywords="apps",
keywords="applications",
keywords="personalized medicine",
keywords="patient empowerment",
keywords="living lab",
keywords="coronary",
keywords="cardiac",
keywords="cardiology",
keywords="heart",
keywords="telehealth",
keywords="telemedicine",
keywords="monitoring",
keywords="survey",
keywords="surveys",
keywords="experience",
keywords="experiences",
keywords="attitude",
keywords="attitudes",
keywords="opinion",
keywords="perception",
keywords="perceptions",
keywords="perspective",
keywords="perspectives",
keywords="acceptance",
keywords="technology use",
keywords="usage",
abstract="Background: The use of eHealth technology in cardiac rehabilitation (CR) is a promising approach to enhance patient outcomes since adherence to healthy lifestyles and risk factor management during phase III CR maintenance is often poorly supported. However, patients' needs and expectations have not been extensively analyzed to inform the design of such eHealth solutions. Objective: The goal of this study was to provide a detailed patient perspective on the most important functionalities to include in an eHealth solution to assist them in phase III CR maintenance. Methods: A guided survey as part of a Living Lab approach was conducted in Germany (n=49) and Spain (n=30) involving women (16/79, 20\%) and men (63/79, 80\%) with coronary artery disease (mean age 57 years, SD 9 years) participating in a structured center-based CR program. The survey covered patients' perceived importance of different CR components in general, current usage of technology/technical devices, and helpfulness of the potential features of eHealth in CR. Questionnaires were used to identify personality traits (psychological flexibility, optimism/pessimism, positive/negative affect), potentially predisposing patients to acceptance of an app/monitoring devices. Results: All the patients in this study owned a smartphone, while 30\%-40\% used smartwatches and fitness trackers. Patients expressed the need for an eHealth platform that is user-friendly, personalized, and easily accessible, and 71\% (56/79) of the patients believed that technology could help them to maintain health goals after CR. Among the offered components, support for regular physical exercise, including updated schedules and progress documentation, was rated the highest. In addition, patients rated the availability of information on diagnosis, current medication, test results, and risk scores as (very) useful. Of note, for each item, except smoking cessation, 35\%-50\% of the patients indicated a high need for support to achieve their long-term health goals, suggesting the need for individualized care. No major differences were detected between Spanish and German patients (all P>.05) and only younger age (P=.03) but not sex, education level, or personality traits (all P>.05) were associated with the acceptance of eHealth components. Conclusions: The patient perspectives collected in this study indicate high acceptance of personalized user-friendly eHealth platforms with remote monitoring to improve adherence to healthy lifestyles among patients with coronary artery disease during phase III CR maintenance. The identified patient needs comprise support in physical exercise, including regular updates on personalized training recommendations. Availability of diagnoses, laboratory results, and medications, as part of a mobile electronic health record were also rated as very useful. Trial Registration: ClinicalTrials.gov NCT05461729; https://clinicaltrials.gov/study/NCT05461729 ",
doi="10.2196/53991",
url="https://www.jmir.org/2024/1/e53991",
url="http://www.ncbi.nlm.nih.gov/pubmed/38386376"
}


@Article{info:doi/10.2196/44406,
author="Gheisari, Mehdi
and Ghaderzadeh, Mustafa
and Li, Huxiong
and Taami, Tania
and Fern{\'a}ndez-Campusano, Christian
and Sadeghsalehi, Hamidreza
and Afzaal Abbasi, Aaqif",
title="Mobile Apps for COVID-19 Detection and Diagnosis for Future Pandemic Control: Multidimensional Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Feb",
day="22",
volume="12",
pages="e44406",
keywords="COVID-19",
keywords="detection",
keywords="diagnosis",
keywords="internet of things",
keywords="cloud computing",
keywords="mobile applications",
keywords="mobile app",
keywords="mobile apps",
keywords="artificial intelligence: AI",
keywords="mobile phone",
keywords="smartphone",
abstract="Background: In the modern world, mobile apps are essential for human advancement, and pandemic control is no exception. The use of mobile apps and technology for the detection and diagnosis of COVID-19 has been the subject of numerous investigations, although no thorough analysis of COVID-19 pandemic prevention has been conducted using mobile apps, creating a gap. Objective: With the intention of helping software companies and clinical researchers, this study provides comprehensive information regarding the different fields in which mobile apps were used to diagnose COVID-19 during the pandemic. Methods: In this systematic review, 535 studies were found after searching 5 major research databases (ScienceDirect, Scopus, PubMed, Web of Science, and IEEE). Of these, only 42 (7.9\%) studies concerned with diagnosing and detecting COVID-19 were chosen after applying inclusion and exclusion criteria using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol. Results: Mobile apps were categorized into 6 areas based on the content of these 42 studies: contact tracing, data gathering, data visualization, artificial intelligence (AI)--based diagnosis, rule- and guideline-based diagnosis, and data transformation. Patients with COVID-19 were identified via mobile apps using a variety of clinical, geographic, demographic, radiological, serological, and laboratory data. Most studies concentrated on using AI methods to identify people who might have COVID-19. Additionally, symptoms, cough sounds, and radiological images were used more frequently compared to other data types. Deep learning techniques, such as convolutional neural networks, performed comparatively better in the processing of health care data than other types of AI techniques, which improved the diagnosis of COVID-19. Conclusions: Mobile apps could soon play a significant role as a powerful tool for data collection, epidemic health data analysis, and the early identification of suspected cases. These technologies can work with the internet of things, cloud storage, 5th-generation technology, and cloud computing. Processing pipelines can be moved to mobile device processing cores using new deep learning methods, such as lightweight neural networks. In the event of future pandemics, mobile apps will play a critical role in rapid diagnosis using various image data and clinical symptoms. Consequently, the rapid diagnosis of these diseases can improve the management of their effects and obtain excellent results in treating patients. ",
doi="10.2196/44406",
url="https://mhealth.jmir.org/2024/1/e44406",
url="http://www.ncbi.nlm.nih.gov/pubmed/38231538"
}


@Article{info:doi/10.2196/50863,
author="Li, Zhaoying
and Lei, Yating
and Bui, Quoc
and DePaul, Olivia
and Nicol, E. Ginger
and Mohr, C. David
and Lee, I. Sunghoon
and Fong, M. Mandy W.
and Metts, L. Christopher
and Tomazin, E. Stephanie
and Wong, K. Alex W.",
title="A Digital Intervention to Promote Self-Management Self-Efficacy Among Community-Dwelling Individuals With Stroke: Pilot Randomized Controlled Trial",
journal="JMIR Rehabil Assist Technol",
year="2024",
month="Feb",
day="19",
volume="11",
pages="e50863",
keywords="digital intervention",
keywords="feasibility",
keywords="mobile health",
keywords="participation",
keywords="rehabilitation",
keywords="self-efficacy",
keywords="self-management",
keywords="stroke",
keywords="technology",
keywords="telehealth",
keywords="telemedicine",
keywords="text messaging",
abstract="Background: Digital interventions provided through smartphones or the internet that are guided by a coach have been proposed as promising solutions to support the self-management of chronic conditions. However, digital intervention for poststroke self-management is limited; we developed the interactive Self-Management Augmented by Rehabilitation Technologies (iSMART) intervention to address this gap. Objective: This study aimed to examine the feasibility and initial effects of the iSMART intervention to improve self-management self-efficacy in people with stroke. Methods: A parallel, 2-arm, nonblinded, randomized controlled trial of 12-week duration was conducted. A total of 24 participants with mild-to-moderate chronic stroke were randomized to receive either the iSMART intervention or a manual of stroke rehabilitation (attention control). iSMART was a coach-guided, technology-supported self-management intervention designed to support people managing chronic conditions and maintaining active participation in daily life after stroke. Feasibility measures included retention and engagement rates in the iSMART group. For both the iSMART intervention and active control groups, we used the Feasibility of Intervention Measure, Acceptability of Intervention Measure, and Intervention Appropriateness Measure to assess the feasibility, acceptability, and appropriateness, respectively. Health measures included the Participation Strategies Self-Efficacy Scale and the Patient-Reported Outcomes Measurement Information System's Self-Efficacy for Managing Chronic Conditions. Results: The retention rate was 82\% (9/11), and the engagement (SMS text message response) rate was 78\% for the iSMART group. Mean scores of the Feasibility of Intervention Measure, Acceptability of Intervention Measure, and Intervention Appropriateness Measure were 4.11 (SD 0.61), 4.44 (SD 0.73), and 4.36 (SD 0.70), respectively, which exceeded our benchmark (4 out of 5), suggesting high feasibility, acceptability, and appropriateness of iSMART. The iSMART group showed moderate-to-large effects in improving self-efficacy in managing emotions (r=0.494), symptoms (r=0.514), daily activities (r=0.593), and treatments and medications (r=0.870), but the control group showed negligible-to-small effects in decreasing self-efficacy in managing emotions (r=0.252), symptoms (r=0.262), daily activities (r=0.136), and treatments and medications (r=0.049). In addition, the iSMART group showed moderate-to-large effects of increasing the use of participation strategies for management in the home (r=0.554), work (r=0.633), community (r=0.673), and communication activities (r=0.476). In contrast, the control group showed small-to-large effects of decreasing the use of participation strategies for management in the home (r=0.567), work (r=0.342, community (r=0.215), and communication activities (r=0.379). Conclusions: Our findings support the idea that iSMART was feasible to improve poststroke self-management self-efficacy. Our results also support using a low-cost solution, such as SMS text messaging, to supplement traditional therapeutic patient education interventions. Further evaluation with a larger sample of participants is still needed. Trial Registration: ClinicalTrials.gov 202004137; https://clinicaltrials.gov/study/NCT04743037?id=202004137\&rank=1 ",
doi="10.2196/50863",
url="https://rehab.jmir.org/2024/1/e50863",
url="http://www.ncbi.nlm.nih.gov/pubmed/38373029"
}


@Article{info:doi/10.2196/53316,
author="Williams, Hants
and Steinberg, Sarah
and Leon, Kendall
and Vingum, Ryan
and Hu, Mengyao
and Berzin, Robin
and Hagg, Heather
and Hanaway, Patrick",
title="Predictive Criterion Validity of the Parsley Symptom Index Against the Patient-Reported Outcomes Measurement Information System-10 in a Chronic Disease Cohort: Retrospective Cohort Study",
journal="JMIR Form Res",
year="2024",
month="Feb",
day="16",
volume="8",
pages="e53316",
keywords="chronic disease",
keywords="eHealth",
keywords="ePROM",
keywords="mHealth",
keywords="Parsley Symptom Index",
keywords="patient-reported outcome measure",
keywords="PROM",
keywords="PSI",
keywords="telehealth",
keywords="telemedicine",
keywords="validation",
keywords="web-based",
abstract="Background: Approximately 60\% of US adults live with chronic disease, imposing a significant burden on patients and the health care system. With the rise of telehealth, patient-reported outcomes measures (PROMs) have emerged as pivotal tools for managing chronic disease. While numerous PROMs exist, few have been designed explicitly for telehealth settings. The Parsley Symptom Index (PSI) is an electronic patient-reported outcome measure (ePROM) developed specifically for telehealth environments. Objective: Our aim is to determine whether the PSI predicts changes in the established Patient-Reported Outcomes Measurement Information System-10 (PROMIS-10) Global Health, a 10-question short form. Methods: We conducted a retrospective cohort study using data from 367 unique patients, amassing 1170 observations between August 30, 2017, and January 30, 2023. Patients completed the PSI and the PROMIS-10 multiple times throughout the study period. Using univariate regression models, we assess the predictive criterion validity of the PSI against PROMIS-10 scores. Results: This study revealed significant relationships between the PSI and PROMIS-10 physical and mental health scores through comprehensive univariate analyses, thus establishing support for the criterion validity of the PSI. These analyses highlighted the PSI's potential as an insightful tool for understanding and predicting both mental and physical health dimensions. Conclusions: Our findings emphasize the importance of the PSI in capturing the nuanced interactions between symptomatology and health outcomes. These insights reinforce the value of the PSI in clinical contexts and support its potential as a versatile tool in both research and practice. ",
doi="10.2196/53316",
url="https://formative.jmir.org/2024/1/e53316",
url="http://www.ncbi.nlm.nih.gov/pubmed/38363587"
}


@Article{info:doi/10.2196/48729,
author="Ipsen, Ammundsen Jonas
and Sandal, Fleng Louise
and Chang, Siu Natalie Hong
and Schi{\o}ttz-Christensen, Berit
and S{\o}gaard, Karen
and Hansen, Anders",
title="Interest in mHealth Among Patients With Low Back Pain: Cross-Sectional Study",
journal="JMIR Hum Factors",
year="2024",
month="Feb",
day="12",
volume="11",
pages="e48729",
keywords="low back pain",
keywords="mHealth solutions",
keywords="mobile health",
keywords="characteristics",
keywords="patient interest",
keywords="transferability",
keywords="representativeness",
abstract="Background: Digitally supported self-management tailored to an individual's need, in addition to usual care, may reduce pain-related disability compared to usual care alone, and patients with low back pain (LBP) using mobile health (mHealth) solutions express positive experiences. Hence, implementing mHealth solutions designed to support self-management is desirable from a clinical and patient perspective. Easily accessible mHealth solutions that can support the self-management of patients with LBP are available, but interest may be subgroup specific. Understanding the characteristics and preferences of patients with LBP labeled as interested may help to reach relevant LBP patient groups and inform the development and implementation of effective interventions with mHealth for patients with LBP. Objective: This study aims to explore the proportion of patients with LBP labeled as interested in testing an mHealth solution designed to support self-management in addition to usual care and to assess how these patients differ from those who were labeled as not interested. Methods: This exploratory cross-sectional study analyzed demographic and patient-reported outcomes from the SpineData registry, a Danish registry of patients with LBP in an outpatient setting. Between February and December 2019, the SpineData registry was used to assess the preliminary eligibility of patients for a clinical trial (selfBACK). Patients were labeled as interested or uninterested depending on if they responded to an invitation to be tested for eligibility for the trial Outcomes were selected from the International Classification of Functioning core set of LBP using a clinical approach. Associations were assessed in a backward selection process, and the proportion of variance explained was assessed with pseudo-R2 statistic. Results: This study included 843 patients, with 181 (21\%) individuals labeled as interested in participating in the selfBACK trial. Notably, the cohort labeled as interested differed from their uninterested counterparts in two key aspects: age (36-65 years: 116/181, 64.1\% vs 347/662, 52.4\%; P=.003) and smoking status (smokers: 22/181, 12.5\% vs 174/662, 26.6\%; P<.001). Those aged 36-65 years had higher odds of being labeled as interested compared to individuals aged 18-35 years (odds ratio [OR] 0.43, 95\% CI 0.26-0.71) and those 65 years or older (OR 0.77, 95\% CI 0.53-1.15). Nevertheless, age accounted for only a modest proportion of variance (R2=0.014). Smokers demonstrated lower odds of being labeled as interested (OR 0.39, 95\% CI 0.24-0.64), with smoking status explaining a similarly small proportion of variance (R2=0.019). Collectively, age and smoking status accounted for 3.3\% of the variance. Conclusions: Our investigation revealed that 181 (21\%) individuals with LBP invited to participate in the mHealth solution trial for self-management expressed interest. Generally, the characteristics of those labeled as interested and uninterested were comparable. Of note, patients aged 36-65 years had a higher frequency of being labeled as interested compared to their younger and older counterparts. ",
doi="10.2196/48729",
url="https://humanfactors.jmir.org/2024/1/e48729",
url="http://www.ncbi.nlm.nih.gov/pubmed/38345837"
}


@Article{info:doi/10.2196/49491,
author="Semere, Wagahta
and Karter, J. Andrew
and Lyles, R. Courtney
and Reed, E. Mary
and Karliner, Leah
and Kaplan, Celia
and Liu, Y. Jennifer
and Livaudais-Toman, Jennifer
and Schillinger, Dean",
title="Care Partner Engagement in Secure Messaging Between Patients With Diabetes and Their Clinicians: Cohort Study",
journal="JMIR Diabetes",
year="2024",
month="Feb",
day="9",
volume="9",
pages="e49491",
keywords="caregivers",
keywords="diabetes",
keywords="telehealth",
keywords="secure messaging",
keywords="patient portal",
keywords="messaging",
keywords="diabetes outcomes",
keywords="family care",
keywords="clinical care",
abstract="Background: Patient engagement with secure messaging (SM) via digital patient portals has been associated with improved diabetes outcomes, including increased patient satisfaction and better glycemic control. Yet, disparities in SM uptake exist among older patients and racial and ethnic underserved groups. Care partners (family members or friends) may provide a means for mitigating these disparities; however, it remains unclear whether and to what extent care partners might enhance SM use. Objective: We aim to examine whether SM use differs among older patients with diabetes based on the involvement of care partner proxies. Methods: This is a substudy of the ECLIPPSE (Employing Computational Linguistics to Improve Patient-Provider Secure Emails) project, a cohort study taking place in a large, fully integrated health care delivery system with an established digital patient portal serving over 4 million patients. Participants included patients with type 2 diabetes aged ?50 years, newly registered on the patient portal, who sent ?1 English-language message to their clinician between July 1, 2006, and December 31, 2015. Proxy SM was identified by having a registered proxy. To identify nonregistered proxies, a computational linguistics algorithm was applied to detect words and phrases more likely to appear in proxy messages compared to patient-authored messages. The primary outcome was the annual volume of secure messages (sent or received); secondary outcomes were the length of time to the first SM sent by patient or proxy and the number of annual SM exchanges (unique message topics generating ?1 reply). Results: The mean age of the cohort (N=7659) at this study's start was 61 (SD 7.16) years; 75\% (n=5573) were married, 15\% (n=1089) identified as Black, 10\% (n=747) Chinese, 12\% (n=905) Filipino, 13\% (n=999) Latino, and 30\% (n=2225) White. Further, 49\% (n=3782) of patients used a proxy to some extent. Compared to nonproxy users, proxy users were older (P<.001), had lower educational attainment (P<.001), and had more comorbidities (P<.001). Adjusting for patient sociodemographic and clinical characteristics, proxy users had greater annual SM volume (20.7, 95\% CI 20.2-21.2 vs 10.9, 95\% CI 10.7-11.2; P<.001), shorter time to SM initiation (hazard ratio vs nonusers: 1.30, 95\% CI 1.24-1.37; P<.001), and more annual SM exchanges (6.0, 95\% CI 5.8-6.1 vs 2.9, 95\% CI 2.9-3.0, P<.001). Differences in SM engagement by proxy status were similar across patient levels of education, and racial and ethnic groups. Conclusions: Among a cohort of older patients with diabetes, proxy SM involvement was independently associated with earlier initiation and increased intensity of messaging, although it did not appear to mitigate existing disparities in SM. These findings suggest care partners can enhance patient-clinician telecommunication in diabetes care. Future studies should examine the effect of care partners' SM involvement on diabetes-related quality of care and clinical outcomes. ",
doi="10.2196/49491",
url="https://diabetes.jmir.org/2024/1/e49491",
url="http://www.ncbi.nlm.nih.gov/pubmed/38335020"
}


@Article{info:doi/10.2196/47555,
author="Pierz, A. Kerri
and Locantore, Nicholas
and McCreary, Gretchen
and Calvey, J. Robert
and Hackney, Nickole
and Doshi, Pooja
and Linnell, John
and Sundaramoorthy, Abirammy
and Reed, R. Carol
and Yates, Julie",
title="Investigation of the Impact of Wellinks on the Quality of Life and Clinical Outcomes in Patients With Chronic Obstructive Pulmonary Disease: Interventional Research Study",
journal="JMIR Form Res",
year="2024",
month="Feb",
day="9",
volume="8",
pages="e47555",
keywords="chronic obstructive pulmonary disease",
keywords="COPD",
keywords="health coaching",
keywords="pulmonary rehabilitation",
keywords="remote care",
keywords="disease management",
keywords="patient engagement",
keywords="Wellinks",
keywords="digital health",
keywords="adult",
keywords="mobile app",
keywords="remote model of care",
keywords="mobile phone",
abstract="Background: Wellinks is a remote disease management solution that provides novel chronic obstructive pulmonary disease (COPD) care delivery. Objective: This study evaluated the satisfaction, engagement, and clinical outcomes of Wellinks participants. This study also investigated the cadence of health coaching for patients with COPD. Methods: A 24-week interventional study was conducted by Wellinks and the COPD Foundation in 2022. Adults with COPD were recruited by the COPD Foundation in the United States and determined to be eligible if they had phone and internet access, owned a smartphone, and were not currently participating in pulmonary rehabilitation. All study participants provided written informed consent. The Wellinks solution included remote health coaching, pulmonary rehabilitation, and group education; participants were provided the Wellinks app and smart spirometry and pulse oximetry devices. Participants were offered 6 coaching sessions in the first 12 weeks. For the second 12-week period, participants either reduced frequency or discontinued coaching; all other components of the Wellinks solution remained unchanged. The COPD Self-Efficacy Scale, Modified Medical Research Council dyspnea scale, pulmonary function, pulse oximetry, and patient-reported healthcare resource utilization were the clinical outcome measures. Nonclinical outcomes included engagement and satisfaction with Wellinks and net promoter score. Results: In total, 141 adults consented and completed Wellinks onboarding; 84.4\% (n=119) of whom remained engaged throughout the 24-week study. Participants had a mean age of 70 (SD 7.8; range 48-88) years, and 55.7\% (n=78) were female. Most participants (n=119, 84.4\%) completed all 6 coaching sessions during the first 12-week period. Compliance with spirometer and pulse oximeter use was 82.3\% and 89.4\%, respectively, at week 1 but waned over the study period to 8.5\% and 9.2\%, respectively, at the end of the study. Participants indicated a high degree of satisfaction with Wellinks, with 95.5\% (n=85) and 91\% (n=81) of participants indicating that they agreed or strongly agreed that the educational content and health coaching, respectively, were valuable. At the end of the study, the net promoter score was +64 and +55 in the coaching continuation and discontinuation arms, respectively. A significant improvement from baseline to end of the study was observed in the COPD Self-Efficacy Scale total score (P<.001) and domain scores (P<.001 for each domain). In total, 35.1\% (n=27) of participants improved by at least 1 category of change on the 5-point Modified Medical Research Council dyspnea scale from baseline to week 24. Conclusions: This study confirmed the feasibility of using a remote model of care delivery to support people living with COPD. The insights gained in this study have allowed for further refinement and personalization of the Wellinks care model. Findings related to the combined use of technology and personal care delivery should be considered by others developing remote disease management tools. Trial Registration: ClinicalTrials.gov NCT05259280; https://clinicaltrials.gov/ct2/show/NCT05259280 ",
doi="10.2196/47555",
url="https://formative.jmir.org/2024/1/e47555",
url="http://www.ncbi.nlm.nih.gov/pubmed/38335023"
}


@Article{info:doi/10.2196/51021,
author="Masiero, Marianna
and Filipponi, Chiara
and Fragale, Elisa
and Pizzoli, Maria Silvia Francesca
and Munzone, Elisabetta
and Milani, Alessandra
and Guido, Luca
and Guardamagna, Vittorio
and Marceglia, Sara
and Prandin, Roberto
and Prenassi, Marco
and Caruso, Annamaria
and Manzelli, Vania
and Savino, Chiara
and Conti, Costanza
and Rizzi, Federica
and Casalino, Alice
and Candiani, Giulia
and Memini, Francesca
and Chiveri, Luca
and Vitali, Luigi Andrea
and Corbo, Massimo
and Grasso, Roberto
and Didier, Florence
and Ferrucci, Roberta
and Pravettoni, Gabriella",
title="Support for Chronic Pain Management for Breast Cancer Survivors Through Novel Digital Health Ecosystems: Pilot Usability Study of the PainRELife Mobile App",
journal="JMIR Form Res",
year="2024",
month="Feb",
day="2",
volume="8",
pages="e51021",
keywords="chronic pain",
keywords="eHealth",
keywords="cancer",
keywords="decision-making",
keywords="survivorship",
keywords="self-efficacy",
keywords="pain",
keywords="oncology",
keywords="health ecosystem",
keywords="health ecosystems",
keywords="breast",
keywords="survivor",
keywords="survivors",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="applications",
keywords="MARS",
abstract="Background: Chronic pain is one of the most common and critical long-term effects of breast cancer. Digital health technologies enhance the management of chronic pain by monitoring physical and psychological health status and supporting pain self-management and patient treatment decisions throughout the clinical pathway. Objective: This pilot study aims to evaluate patients' experiences, including usability, with a novel digital integrated health ecosystem for chronic pain named PainRELife. The sample included patients with breast cancer during survivorship. The PainRELife ecosystem comprises a cloud technology platform interconnected with electronic health records and patients' devices to gather integrated health care data. Methods: We enrolled 25 patients with breast cancer (mean age 47.12 years) experiencing pain. They were instructed to use the PainRELife mobile app for 3 months consecutively. The Mobile Application Rating Scale (MARS) was used to evaluate usability. Furthermore, pain self-efficacy and participation in treatment decisions were evaluated. The study received ethical approval (R1597/21-IEO 1701) from the Ethical Committee of the European Institute of Oncology. Results: The MARS subscale scores were medium to high (range: 3.31-4.18), and the total app quality score was 3.90. Patients with breast cancer reported reduced pain intensity at 3 months, from a mean of 5 at T0 to a mean of 3.72 at T2 (P=.04). The total number of times the app was accessed was positively correlated with pain intensity at 3 months (P=.03). The engagement (P=.03), information (P=.04), and subjective quality (P=.007) subscales were positively correlated with shared decision-making. Furthermore, participants with a lower pain self-efficacy at T2 (mean 40.83) used the mobile app more than participants with a higher pain self-efficacy (mean 48.46; P=.057). Conclusions: The data collected in this study highlight that digital health technologies, when developed using a patient-driven approach, might be valuable tools for increasing participation in clinical care by patients with breast cancer, permitting them to achieve a series of key clinical outcomes and improving quality of life. Digital integrated health ecosystems might be important tools for improving ongoing monitoring of physical status, psychological burden, and socioeconomic issues during the cancer survivorship trajectory. International Registered Report Identifier (IRRID): RR2-10.2196/41216 ",
doi="10.2196/51021",
url="https://formative.jmir.org/2024/1/e51021",
url="http://www.ncbi.nlm.nih.gov/pubmed/38306176"
}


@Article{info:doi/10.2196/53262,
author="Zhou, Tianyu
and Salman, David
and McGregor, Alison",
title="mHealth Apps for the Self-Management of Low Back Pain: Systematic Search in App Stores and Content Analysis",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Feb",
day="1",
volume="12",
pages="e53262",
keywords="smartphone",
keywords="mHealth",
keywords="mobile health",
keywords="low back pain",
keywords="self-management",
keywords="treatment interventions",
keywords="mobile phone",
abstract="Background: With the rapid development of mobile health (mHealth) technology, many health apps have been introduced to the commercial market for people with back pain conditions. However, little is known about their content, quality, approaches to care for low back pain (LBP), and associated risks of use. Objective: The aims of this research were to (1) identify apps for the self-management of LBP currently on the market and (2) assess their quality, intervention content, theoretical approaches, and risk-related approaches. Methods: The UK iTunes and Google Play stores were initially searched for apps related to the self-management of LBP in May 2022. A repeat search in June 2023 was conducted to ensure that any relevant new apps developed in the last year were incorporated into the review. A total of 3 keywords recommended by the Cochrane Back and Neck Group were used to search apps ``low back pain,'' ``back pain,'' and ``lumbago.'' The quality of the apps was assessed by using the 5-point Mobile App Rating Scale (MARS). Results: A total of 69 apps (25 iOS and 44 Android) met the inclusion criteria. These LBP self-management apps mainly provide recommendations on muscle stretching (n=51, 73.9\%), muscle strengthening (n=42, 60.9\%), core stability exercises (n=32, 46.4\%), yoga (n=19, 27.5\%), and information about LBP mechanisms (n=17, 24.6\%). Most interventions (n=14, 78\%) are consistent with the recommendations in the National Institute for Health and Care Excellence (NICE) guidelines. The mean (SD) MARS overall score of included apps was 2.4 (0.44) out of a possible 5 points. The functionality dimension was associated with the highest score (3.0), whereas the engagement and information dimension resulted in the lowest score (2.1). Regarding theoretical and risk-related approaches, 18 (26.1\%) of the 69 apps reported the rate of intervention progression, 11 (15.9\%) reported safety checks, only 1 (1.4\%) reported personalization of care, and none reported the theoretical care model or the age group targeted. Conclusions: mHealth apps are potentially promising alternatives to help people manage their LBP; however, most of the LBP self-management apps were of poor quality and did not report the theoretical approaches to care and their associated risks. Although nearly all apps reviewed included a component of care listed in the NICE guidelines, the model of care delivery or embracement of care principles such as the application of a biopsychosocial model was unclear. ",
doi="10.2196/53262",
url="https://mhealth.jmir.org/2024/1/e53262",
url="http://www.ncbi.nlm.nih.gov/pubmed/38300700"
}


@Article{info:doi/10.2196/47102,
author="Lee, Kyoungjin
and Park, Jeongok
and Oh, Geum Eui
and Lee, JuHee
and Park, Chang
and Choi, Deuk Young",
title="Effectiveness of a Nurse-Led Mobile-Based Health Coaching Program for Patients With Prostate Cancer at High Risk of Metabolic Syndrome: Randomized Waitlist Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Feb",
day="1",
volume="12",
pages="e47102",
keywords="nurses",
keywords="prostate neoplasms",
keywords="healthy lifestyle",
keywords="metabolic syndrome",
keywords="exercise",
keywords="diet",
keywords="mobile phone",
abstract="Background: Androgen deprivation therapy (ADT), a standard treatment for prostate cancer (PC), causes many physical side effects. In particular, it causes metabolic changes such as fasting glucose abnormalities or accumulation of body fat, and its continuation can lead to metabolic syndrome (MetS), which is closely related to diabetes and cardiovascular disease. Therefore, it is important to maintain and practice a healthy lifestyle in patients with PC. Objective: This study aims to evaluate the effectiveness of a nurse-led mobile-based program that aims to promote a healthy lifestyle in patients with PC undergoing ADT with MetS risk factors. Methods: This was a single-blind, randomized, waitlist control interventional study. A total of 48 patients were randomly assigned to the experimental and waitlist control groups at the urology cancer clinic of a tertiary general hospital in South Korea. The inclusion criteria were patients who had undergone ADT for >6 months, had at least 1 of the 5 MetS components in the abnormal range, and could access a mobile-based education program. The experimental group attended a 4-week mobile-based program on exercise and diet that included counseling and encouragement to maintain a healthy lifestyle, whereas the control group was placed on a waitlist and received usual care during the follow-up period, followed by the intervention. The primary outcome was a change in the lifestyle score. The secondary outcomes were changes in 5 MetS components, body composition, and health-related quality of life. The outcomes were measured at 6 weeks and 12 weeks after the initiation of the intervention. Each participant was assigned to each group in a sequential order of enrollment in a 4{\texttimes}4 permuted block design randomization table generated in the SAS (SAS Institute) statistical program. A linear mixed model was used for statistical analysis. Results: A total of 24 participants were randomly assigned to each group; however, 2 participants in the experimental group dropped out for personal reasons before starting the intervention. Finally, 46 participants were included in the intention-to-treat analysis. The experimental group showed more positive changes in the healthy lifestyle score ($\beta$=29.23; P?.001), level of each MetS component (fasting blood sugar: $\beta$=?12.0; P=.05 and abdominal circumference: $\beta$=?2.49; P=.049), body composition (body weight: $\beta$=?1.52; P<.001 and BMI: $\beta$=?0.55; P<.001), and the urinary irritative and obstructive domain of health-related quality of life ($\beta$=14.63; P<.001) over time than the waitlist control group. Conclusions: Lifestyle changes through nurse-led education can improve level of each MetS components, body composition, and ADT side effects. Nurses can induce positive changes in patients' lifestyles and improve the self-management of patients starting ADT through this program. Trial Registration: Clinical Research Information Service KCT0006560; http://tinyurl.com/yhvj4vwh ",
doi="10.2196/47102",
url="https://mhealth.jmir.org/2024/1/e47102",
url="http://www.ncbi.nlm.nih.gov/pubmed/38300697"
}


@Article{info:doi/10.2196/48781,
author="Rebus, David
and Iskander, Andrew
and Deonarine, Felicia
and Almas, Asad
and Rattigan, Darren
and Henn, Patrick
and Fadahunsi, Philip Kayode
and O'Donoghue, John",
title="Compliance of Type 2 Diabetes Applications to International Guidelines: Protocol for a Quantitative App Assessment",
journal="JMIR Res Protoc",
year="2024",
month="Jan",
day="31",
volume="13",
pages="e48781",
keywords="diabetes",
keywords="mobile apps",
keywords="Mobile Apps Rating Scale",
keywords="mHealth",
keywords="mobile health",
keywords="diabetes application",
keywords="application",
keywords="chronic condition",
keywords="monitoring",
keywords="accuracy",
keywords="safety",
keywords="tool",
keywords="assistance",
keywords="treatment",
keywords="management",
keywords="type 2 diabetes",
abstract="Background: Diabetes is among the most common chronic conditions people live with across the world. While it can be managed to a substantial degree, it can result in significant complications. As such, easy access to accurate tools to aid diabetes management is useful in minimizing these complications. Mobile apps are highly accessible and widely used, but there is a gap in the literature examining their compliance with medical guidelines. Objective: The aims of this study are to develop the Analysis of Diabetes Apps (ADA) checklist to evaluate apps' compliance to guidelines set by the International Diabetes Federation (IDF) on the treatment and management of type 2 diabetes; to assess type 2 diabetes apps in the Apple App Store and the Android Google Play Store, and their compliance with international guidelines using the ADA framework; and to compare the novel ADA checklist against both the Mobile App Rating Scale (MARS) tool kit and app ratings for each store. Methods: We will develop a checklist based on the ``IDF Clinical Practice Recommendations for Managing Type 2 Diabetes in Primary Care.'' Type 2 diabetes apps will be scraped from 6 countries' app stores using web scraping tools. These countries include Australia, Brazil, India, Nigeria, the United States, and the United Kingdom, which were selected based on the largest population of English-speaking people in each continent. The apps will be searched on the web-based scraper using the search terms ``blood sugar,'' ``diabetes,'' ``glucose level,'' ``insulin,'' ``sugar level,'' and ``type 2 diabetes.'' Apps will be excluded if they are paid or are not in English. The apps will be assessed using the ADA checklist to evaluate their compliance to the international diabetes guidelines. Once scored, the results will be analyzed with descriptive statistics. The most popular apps will be further analyzed using the MARS tool kit. The ADA checklist scores will then be compared to both the MARS tool kit score and app ratings for each store. Results: The ADA checklist developed based on the IDF guidelines focuses on general information, risk factors, diagnosis, pharmacology, lifestyle modification, glycemic recommendations, and medications. The initial stress testing of the protocol resulted in 173 included apps. This will vary in the final search as the app stores are constantly changing. Conclusions: The protocol presents the development of a checklist to investigate the compliance of type 2 diabetes apps with international guidelines. The checklist will hopefully form the basis of a scoring system for future research on compliance of mobile apps with international guidelines. High standardization of the ADA checklist will make it a robust tool for people with diabetes and their health care providers alike in assessing type 2 diabetes apps in the future. International Registered Report Identifier (IRRID): PRR1-10.2196/48781 ",
doi="10.2196/48781",
url="https://www.researchprotocols.org/2024/1/e48781",
url="http://www.ncbi.nlm.nih.gov/pubmed/38294861"
}


@Article{info:doi/10.2196/44422,
author="Cheng, Weibin
and Cao, Xiaowen
and Lian, Wanmin
and Tian, Junzhang",
title="An Introduction to Smart Home Ward--Based Hospital-at-Home Care in China",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jan",
day="30",
volume="12",
pages="e44422",
keywords="smart home ward",
keywords="telemonitoring",
keywords="telemedicine",
keywords="home care",
keywords="hospital at home",
keywords="healthcare delivery",
keywords="implementation",
keywords="smart ward",
keywords="medical monitoring",
keywords="medical care",
keywords="rehabilitation",
keywords="health care",
doi="10.2196/44422",
url="https://mhealth.jmir.org/2024/1/e44422"
}


@Article{info:doi/10.2196/52573,
author="Liu, Peng
and Wang, Lingmeng
and Wang, Fuzhi",
title="Evaluation of Chinese HIV Mobile Apps by Researchers and Patients With HIV: Quality Evaluation Study",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jan",
day="26",
volume="12",
pages="e52573",
keywords="HIV",
keywords="mobile app",
keywords="evaluation",
keywords="mobile phone",
abstract="Background: Against the backdrop of globalization, China remains one of the most heavily burdened countries in Asia with regard to AIDS. However, many high-risk groups and patients affected by AIDS may be less likely to actively seek care from medical institutions because of fear of experiencing shame or discrimination. Mobile apps provide a promising avenue for supporting the prevention, diagnosis, and treatment of AIDS. However, a comprehensive systematic evaluation of these mobile apps' functionality and quality has not been conducted yet. Objective: This study aims to identify the available mobile apps for AIDS in China, assess and discuss the functional features and quality of these Chinese AIDS mobile apps, and offer decision support for patients and clinical practitioners in accessing high-quality AIDS mobile apps. Furthermore, based on the evaluation results, recommendations for improvement will be provided. Methods: A systematic search was conducted on the Qimai app data platform, the Aladdin WeChat applet data platform, and WeChat to identify mobile apps related to AIDS. A snowball sampling method was used to supplement the potentially overlooked apps. The selected mobile apps underwent a rigorous screening process based on unified criteria. Subsequently, assessments were independently undertaken by 3 separate researchers and 2 patients with HIV, using both the Mobile App Rating Scale (MARS) and the User Mobile App Rating Scale (uMARS). Quantitative interpretations of the data were facilitated by the MedCalc statistical software (version 20.217, MedCalc Software). Results: A total of 2901 AIDS mobile apps were included in the study, with 2897 identified through information retrieval and an additional 4 added via snowball sampling. After a rigorous selection process, 21 apps were determined to be usable. Among them, the Hong Feng Wan app achieved the highest combined average score, calculated based on the MARS (3.96, SD 0.33) and uMARS (4.47, SD 0.26). Overall, there was no significant correlation between MARS and uMARS (rapp quality total score=0.41; P=.07; rsubjective quality=0.39; P=.08). A notable issue was the widespread lack of user privacy protection, with only 24\% (5/21) of the apps offering this feature. Conclusions: The number of available Chinese AIDS mobile apps is limited, with WeChat applets dominating the market. Nonetheless, the performance of WeChat mini-apps is generally inferior to that of independent apps, and there may be significant discrepancies between assessments conducted by researchers and those provided by genuine end users, emphasizing the necessity of involving real users in the development and evaluation of HIV mobile apps. In addition, developers of these Chinese HIV mobile apps need to devote attention to improving privacy protection mechanisms, in addition to considering the evaluations of researchers and real users. This will help attract more users and increase user loyalty. ",
doi="10.2196/52573",
url="https://mhealth.jmir.org/2024/1/e52573",
url="http://www.ncbi.nlm.nih.gov/pubmed/38277215"
}


@Article{info:doi/10.2196/52987,
author="Richards, Rebecca
and Wren, Gina
and Whitman, Michael",
title="The Potential of a Digital Weight Management Program to Support Specialist Weight Management Services in the UK National Health Service: Retrospective Analysis",
journal="JMIR Diabetes",
year="2024",
month="Jan",
day="24",
volume="9",
pages="e52987",
keywords="digital health intervention",
keywords="smartphone",
keywords="diabetes management",
keywords="obesity management",
keywords="mobile phone",
keywords="management",
keywords="obesity",
keywords="digital health",
keywords="diabetes",
keywords="weight",
keywords="manage",
keywords="support",
keywords="weight management",
keywords="retrospective analysis",
keywords="treatment",
keywords="type 2 diabetes",
keywords="effectiveness",
keywords="primary care",
keywords="weight loss",
keywords="clinical",
keywords="primary care service",
abstract="Background: Digital weight management interventions (DWMIs) have the potential to support existing specialist weight management services (SWMS) in the National Health Service (NHS) to increase access to treatment for people living with obesity and type 2 diabetes. At present, there is limited real-world evidence and long-term outcomes on the potential effectiveness of DWMIs to support such services. Objective: This study aimed to examine real-world data to evaluate the impact of Second Nature's 12-month DWMI for patients living with obesity with or without type 2 diabetes, referred from NHS primary care services, on sustained weight loss over a 2-year period. Methods: Retrospective data were extracted in August 2023 for participants who participated in the program between January 1, 2017, and January 8, 2021. Eligible participants were adults with a BMI ?35 kg/m2, with or without type 2 diabetes. The primary outcomes were weight change in kilograms and percentage weight change at 2 years. Secondary outcomes were weight loss at 1 year, program engagement, and the proportion of participants who achieved ?5\% and ?10\% weight loss. Differences in weight loss between baseline and the 1- and 2-year follow-up points were compared using paired 2-tailed t tests. Linear regression models were used to examine whether participants' ethnicity, indices of multiple deprivation, presence of type 2 diabetes, or program engagement were associated with weight loss at 1 year or 2 years. Results: A total of 1130 participants with a mean baseline BMI of 46.3 (SD 31.6) kg/m2 were included in the analysis. Of these participants, 65\% (740/1130) were female (mean age 49.9, SD 12.0 years), 18.1\% (205/339) were from Black, Asian, mixed, or other ethnicities, and 78.2\% (884/1130) had type 2 diabetes. A total of 281 (24.9\%) participants recorded weight readings at 2 years from baseline, with a mean weight loss of 13.8 kg (SD 14.2 kg; P<.001) or 11.8\% (SD 10.9\%; P<.001). A total of 204 (18.1\%) participants achieved ?5\% weight loss, and 130 (11.5\%) participants reached ?10\% weight loss. Weight loss did not significantly differ by ethnicity, indices of multiple deprivation, presence of type 2 diabetes, or engagement in the program. Conclusions: The findings suggested that Second Nature's DWMI has the potential to support people living with obesity and type 2 diabetes remotely to achieve clinically significant and sustained weight loss at 2 years from baseline. Further research is needed to compare the intervention to standard care and assess integration with multidisciplinary clinical teams and pharmacotherapy in order to support this study's findings. ",
doi="10.2196/52987",
url="https://diabetes.jmir.org/2024/1/e52987",
url="http://www.ncbi.nlm.nih.gov/pubmed/38265852"
}


@Article{info:doi/10.2196/50616,
author="Nagel, Johanna
and Wegener, Florian
and Grim, Casper
and Hoppe, Wilhelm Matthias",
title="Effects of Digital Physical Health Exercises on Musculoskeletal Diseases: Systematic Review With Best-Evidence Synthesis",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jan",
day="23",
volume="12",
pages="e50616",
keywords="mobile health",
keywords="mHealth",
keywords="electronic health",
keywords="eHealth",
keywords="digital health applications",
keywords="DiGA",
keywords="musculoskeletal",
keywords="MSK",
keywords="home-based",
keywords="PROM",
keywords="disorder",
keywords="mobile phone",
abstract="Background: Musculoskeletal diseases affect 1.71 billion people worldwide, impose a high biopsychosocial burden on patients, and are associated with high economic costs. The use of digital health interventions is a promising cost-saving approach for the treatment of musculoskeletal diseases. As physical exercise is the best clinical practice in the treatment of musculoskeletal diseases, digital health interventions that provide physical exercises could have a highly positive impact on musculoskeletal diseases, but evidence is lacking. Objective: This systematic review aims to evaluate the impact of digital physical health exercises on patients with musculoskeletal diseases concerning the localization of the musculoskeletal disease, patient-reported outcomes, and medical treatment types. Methods: We performed systematic literature research using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search was conducted using the PubMed, BISp, Cochrane Library, and Web of Science databases. The Scottish Intercollegiate Guidelines Network checklist was used to assess the quality of the included original studies. To determine the evidence and direction of the impact of digital physical health exercises, a best-evidence synthesis was conducted, whereby only studies with at least acceptable methodological quality were included for validity purposes. Results: A total of 8988 studies were screened, of which 30 (0.33\%) randomized controlled trials met the inclusion criteria. Of these, 16 studies (53\%) were of acceptable or high quality; they included 1840 patients (1008/1643, 61.35\% female; 3 studies including 197 patients did not report gender distribution) with various musculoskeletal diseases. A total of 3 different intervention types (app-based interventions, internet-based exercises, and telerehabilitation) were used to deliver digital physical health exercises. Strong evidence was found for the positive impact of digital physical health exercises on musculoskeletal diseases located in the back. Moderate evidence was found for diseases located in the shoulder and hip, whereas evidence for the entire body was limited. Conflicting evidence was found for diseases located in the knee and hand. For patient-reported outcomes, strong evidence was found for impairment and quality of life. Conflicting evidence was found for pain and function. Regarding the medical treatment type, conflicting evidence was found for operative and conservative therapies. Conclusions: Strong to moderate evidence was found for a positive impact on musculoskeletal diseases located in the back, shoulder, and hip and on the patient-reported outcomes of impairment and quality of life. Thus, digital physical health exercises could have a positive effect on a variety of symptoms of musculoskeletal diseases. ",
doi="10.2196/50616",
url="https://mhealth.jmir.org/2024/1/e50616",
url="http://www.ncbi.nlm.nih.gov/pubmed/38261356"
}


@Article{info:doi/10.2196/38064,
author="Morsa, Maxime
and Perrin, Am{\'e}lie
and David, Val{\'e}rie
and Rault, Gilles
and Le Roux, Enora
and Alberti, Corinne
and Gagnayre, R{\'e}mi
and Pougheon Bertrand, Dominique",
title="Experiences Among Patients With Cystic Fibrosis in the MucoExocet Study of Using Connected Devices for the Management of Pulmonary Exacerbations: Grounded Theory Qualitative Research",
journal="JMIR Form Res",
year="2024",
month="Jan",
day="23",
volume="8",
pages="e38064",
keywords="cystic fibrosis",
keywords="mobile health",
keywords="mHealth",
keywords="patient education",
keywords="chronic disease",
keywords="empowerment",
keywords="devices",
keywords="patients",
keywords="detection",
keywords="treatment",
keywords="respiratory",
keywords="education",
keywords="monitoring",
keywords="care",
abstract="Background: Early detection of pulmonary exacerbations (PEx) in patients with cystic fibrosis is important to quickly trigger treatment and reduce respiratory damage. An intervention was designed in the frame of the MucoExocet research study providing patients with cystic fibrosis with connected devices and educating them to detect and react to their early signs of PEx. Objective: This study aims to identify the contributions and conditions of home monitoring in relation to their care teams from the users' point of view to detect PEx early and treat it. This study focused on the patients' experiences as the first and main users of home monitoring. Methods: A qualitative study was conducted to explore patients' and professionals' experiences with the intervention. We interviewed patients who completed the 2-year study using semistructured guides and conducted focus groups with the care teams. All the interviews were recorded and transcribed verbatim. Their educational material was collected. A grounded analysis was conducted by 2 researchers. Results: A total of 20 patients completed the study. Three main categories emerged from the patients' verbatim transcripts and were also found in those of the professionals: (1) task technology fit, reflecting reliability, ease of use, accuracy of data, and support of the technology; (2) patient empowerment through technology, grouping patients' learnings, validation of their perception of exacerbation, assessment of treatment efficacy, awareness of healthy behaviors, and ability to react to PEx signs in relation to their care team; (3) use, reflecting a continuous or intermittent use, the perceived usefulness balanced with cumbersome measurements, routinization and personalization of the measurement process, and the way data are shared with the care team. Furthermore, 3 relationships were highlighted between the categories that reflect the necessary conditions for patient empowerment through the use of technology. Conclusions: We discuss a theorization of the process of patient empowerment through the use of connected devices and call for further research to verify or amend it in the context of other technologies, illnesses, and care organizations. Trial Registration: ClinicalTrials.gov NCT03304028; https://clinicaltrials.gov/ct2/show/results/NCT03304028 ",
doi="10.2196/38064",
url="https://formative.jmir.org/2024/1/e38064",
url="http://www.ncbi.nlm.nih.gov/pubmed/38261372"
}


@Article{info:doi/10.2196/44214,
author="White, M. Katie
and Carr, Ewan
and Leightley, Daniel
and Matcham, Faith
and Conde, Pauline
and Ranjan, Yatharth
and Simblett, Sara
and Dawe-Lane, Erin
and Williams, Laura
and Henderson, Claire
and Hotopf, Matthew",
title="Engagement With a Remote Symptom-Tracking Platform Among Participants With Major Depressive Disorder: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jan",
day="19",
volume="12",
pages="e44214",
keywords="remote measurement",
keywords="technology",
keywords="engagement",
keywords="app",
keywords="depression",
keywords="smartphones",
keywords="wearable devices",
keywords="symptom tracking",
keywords="self-awareness",
keywords="community",
keywords="mobile phone",
abstract="Background: Multiparametric remote measurement technologies (RMTs), which comprise smartphones and wearable devices, have the potential to revolutionize understanding of the etiology and trajectory of major depressive disorder (MDD). Engagement with RMTs in MDD research is of the utmost importance for the validity of predictive analytical methods and long-term use and can be conceptualized as both objective engagement (data availability) and subjective engagement (system usability and experiential factors). Positioning the design of user interfaces within the theoretical framework of the Behavior Change Wheel can help maximize effectiveness. In-app components containing information from credible sources, visual feedback, and access to support provide an opportunity to promote engagement with RMTs while minimizing team resources. Randomized controlled trials are the gold standard in quantifying the effects of in-app components on engagement with RMTs in patients with MDD. Objective: This study aims to evaluate whether a multiparametric RMT system with theoretically informed notifications, visual progress tracking, and access to research team contact details could promote engagement with remote symptom tracking over and above the system as usual. We hypothesized that participants using the adapted app (intervention group) would have higher engagement in symptom monitoring, as measured by objective and subjective engagement. Methods: A 2-arm, parallel-group randomized controlled trial (participant-blinded) with 1:1 randomization was conducted with 100 participants with MDD over 12 weeks. Participants in both arms used the RADAR-base system, comprising a smartphone app for weekly symptom assessments and a wearable Fitbit device for continuous passive tracking. Participants in the intervention arm (n=50, 50\%) also had access to additional in-app components. The primary outcome was objective engagement, measured as the percentage of weekly questionnaires completed during follow-up. The secondary outcomes measured subjective engagement (system engagement, system usability, and emotional self-awareness). Results: The levels of completion of the Patient Health Questionnaire-8 (PHQ-8) were similar between the control (67/97, 69\%) and intervention (66/97, 68\%) arms (P value for the difference between the arms=.83, 95\% CI ?9.32 to 11.65). The intervention group participants reported slightly higher user engagement (1.93, 95\% CI ?1.91 to 5.78), emotional self-awareness (1.13, 95\% CI ?2.93 to 5.19), and system usability (2.29, 95\% CI ?5.93 to 10.52) scores than the control group participants at follow-up; however, all CIs were wide and included 0. Process evaluation suggested that participants saw the in-app components as helpful in increasing task completion. Conclusions: The adapted system did not increase objective or subjective engagement in remote symptom tracking in our research cohort. This study provides an important foundation for understanding engagement with RMTs for research and the methodologies by which this work can be replicated in both community and clinical settings. Trial Registration: ClinicalTrials.gov NCT04972474; https://clinicaltrials.gov/ct2/show/NCT04972474 International Registered Report Identifier (IRRID): RR2-10.2196/32653 ",
doi="10.2196/44214",
url="https://mhealth.jmir.org/2024/1/e44214",
url="http://www.ncbi.nlm.nih.gov/pubmed/38241070"
}


@Article{info:doi/10.2196/48019,
author="Handa, Tomoko
and Onoue, Takeshi
and Kobayashi, Tomoko
and Maeda, Ryutaro
and Mizutani, Keigo
and Yamagami, Ayana
and Kinoshita, Tamaki
and Yasuda, Yoshinori
and Iwama, Shintaro
and Miyata, Takashi
and Sugiyama, Mariko
and Takagi, Hiroshi
and Hagiwara, Daisuke
and Suga, Hidetaka
and Banno, Ryoichi
and Azuma, Yoshinori
and Kasai, Takatoshi
and Yoshioka, Shuko
and Kuwatsuka, Yachiyo
and Arima, Hiroshi",
title="Effects of Digitization of Self-Monitoring of Blood Glucose Records Using a Mobile App and the Cloud System on Outpatient Management of Diabetes: Single-Armed Prospective Study",
journal="JMIR Diabetes",
year="2024",
month="Jan",
day="19",
volume="9",
pages="e48019",
keywords="app",
keywords="diabetes care",
keywords="diabetes",
keywords="digital intervention",
keywords="digital therapeutics",
keywords="glycemic control",
keywords="mobile app",
keywords="mHealth",
abstract="Background: In recent years, technologies promoting the digitization of self-monitoring of blood glucose (SMBG) records including app-cloud cooperation systems have emerged. Studies combining these technological interventions with support from remote health care professionals have reported improvements in glycemic control. Objective: To assess the use of an app-cloud cooperation system linked with SMBG devices in clinical settings, we evaluated its effects on outpatient management of diabetes without remote health care professional support. Methods: In this multicenter, open-label, and single-armed prospective study, 48 patients with diabetes (including type 1 and type 2) at 3 hospitals in Japan treated with insulin or glucagon-like peptide 1 receptor agonists and performing SMBG used the app-cloud cooperation system for 24 weeks. The SMBG data were automatically uploaded to the cloud via the app. The patients could check their data, and their attending physicians reviewed the data through the cloud prior to the patients' regular visits. The primary outcome was changes in glycated hemoglobin (HbA1c) levels. Results: Although HbA1c levels did not significantly change in all patients, the frequency of daily SMBG following applying the system was significantly increased before induction at 12 (0.60 per day, 95\% CI 0.19-1.00; P=.002) and 24 weeks (0.43 per day, 95\% CI 0.02-0.84; P=.04). In the subset of 21 patients whose antidiabetic medication had not been adjusted during the intervention period, a decrease in HbA1c level was observed at 12?weeks (P=.02); however, this significant change disappeared at 24 weeks (P=.49). The Diabetes Treatment Satisfaction Questionnaire total score and ``Q4: convenience'' and ``Q5: flexibility'' scores significantly improved after using the system (all P<.05), and 72\% (33/46) patients and 76\% (35/46) physicians reported that the app-cloud cooperation system helped them adjust insulin doses. Conclusions: The digitization of SMBG records and sharing of the data by patients and attending physicians during face-to-face visits improved self-management in patients with diabetes. Trial Registration: Japan Registry of Clinical Trials (jRCT) jRCTs042190057; https://jrct.niph.go.jp/en-latest-detail/jRCTs042190057 ",
doi="10.2196/48019",
url="https://diabetes.jmir.org/2024/1/e48019",
url="http://www.ncbi.nlm.nih.gov/pubmed/38241065"
}


@Article{info:doi/10.2196/48345,
author="Schroeder, Tanja
and Haug, Maximilian
and Georgiou, Andrew
and Seaman, Karla
and Gewald, Heiko",
title="Evidence of How Physicians and Their Patients Adopt mHealth Apps in Germany: Exploratory Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jan",
day="17",
volume="12",
pages="e48345",
keywords="mobile health apps",
keywords="DiGA",
keywords="adoption",
keywords="prescription",
keywords="mHealth",
keywords="aging and individual differences",
abstract="Background: The enactment of the ``Act to Improve Healthcare Provision through Digitalisation and Innovation '' (Digital Healthcare Act; Digitale-Versorgung-Gesetz [DVG]) in Germany has introduced a paradigm shift in medical practice, allowing physicians to prescribe mobile health (mHealth) apps alongside traditional medications. This transformation imposes a dual responsibility on physicians to acquaint themselves with qualifying apps and align them with patient diagnoses, while requiring patients to adhere to the prescribed app use, similar to pharmaceutical adherence. This transition, particularly challenging for older generations who are less skilled with technology, underscores a significant evolution in Germany's medical landscape. Objective: This study aims to investigate physicians' responses to this novel treatment option, their strategies for adapting to this form of prescription, and the willingness of patients to adhere to prescribed mHealth apps. Methods: Using an exploratory qualitative study design, we conducted semistructured interviews with 28 physicians and 30 potential patients aged 50 years and older from August 2020 to June 2021. Results: The findings reveal several factors influencing the adoption of mHealth apps, prompting a nuanced understanding of adoption research. Notably, both physicians and patients demonstrated a lack of information regarding mHealth apps and their positive health impacts, contributing to a deficiency in trust. Physicians' self-perceived digital competence and their evaluation of patients' digital proficiency emerge as pivotal factors influencing the prescription of mHealth apps. Conclusions: Our study provides comprehensive insights into the prescription process and the fundamental factors shaping the adoption of mHealth apps in Germany. The identified information gaps on both the physicians' and patients' sides contribute to a trust deficit and hindered digital competence. This research advances the understanding of adoption dynamics regarding digital health technologies and highlights crucial considerations for the successful integration of digital health apps into medical practice. ",
doi="10.2196/48345",
url="https://mhealth.jmir.org/2024/1/e48345",
url="http://www.ncbi.nlm.nih.gov/pubmed/38231550"
}


@Article{info:doi/10.2196/49373,
author="He, Yirong
and Huang, Chuanya
and He, Qiuyang
and Liao, Shujuan
and Luo, Biru",
title="Effects of mHealth-Based Lifestyle Interventions on Gestational Diabetes Mellitus in Pregnant Women With Overweight and Obesity: Systematic Review and Meta-Analysis",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jan",
day="17",
volume="12",
pages="e49373",
keywords="mobile health",
keywords="mHealth",
keywords="lifestyle intervention",
keywords="gestational diabetes mellitus",
keywords="meta-analysis",
keywords="mobile phone",
abstract="Background: The increasing incidence of gestational diabetes mellitus (GDM) is a global health problem that is more likely to occur in pregnant women with overweight or obesity. Adhering to a healthy lifestyle is associated with a reduced risk of GDM. With the development of IT, mobile health (mHealth) interventions have become widely available in health care. However, there are no definitive conclusions on the effectiveness of mHealth-based lifestyle interventions in preventing GDM. Objective: This study aims to evaluate the impact of mHealth-based lifestyle interventions on GDM and other pregnancy outcomes in pregnant women with overweight or obesity. Methods: A systematic literature search was conducted in 5 English databases (MEDLINE, Embase, Web of Science, CENTRAL, and CINAHL) and 4 Chinese databases (CBM, CNKI, Vip, and Wanfang) to identify randomized controlled trials (RCTs) on the effectiveness of mHealth-based interventions for GDM from inception to January 10, 2023. In total, 2 authors independently screened the studies and extracted the data. The quality of the included studies was examined using the Cochrane risk-of-bias tool. Data synthesis was conducted using Review Manager (version 5.4; The Cochrane Collaboration). Results: A total of 16 RCTs with 7351 participants were included in this study. The included studies were published between 2014 and 2021 and were conducted in China, the United States, Australia, New Zealand, the United Kingdom, Ireland, and Norway. The sample sizes of the studies ranged from 75 to 2202, and the duration of the mHealth-based lifestyle interventions ranged from 4 to 28 weeks. Compared with usual care, mHealth-based lifestyle interventions significantly reduced the incidence of GDM (odds ratio [OR] 0.74, 95\% CI 0.56-0.96; P=.03; I2=65\%), preterm birth (OR 0.65, 95\% CI 0.48-0.87; P=.004; I2=25\%), macrosomia (OR 0.59, 95\% CI 0.40-0.87; P=.008; I2=59\%), and gestational weight gain (mean difference=?1.12 kg, 95\% CI ?1.44 to ?0.80; P<.001; I2=43\%). The subgroup analysis showed that interventions delivered via apps (OR 0.55, 95\% CI 0.37-0.83; P=.004; I2=44\%), provided by obstetricians (OR 0.69, 95\% CI 0.51-0.93; P=.02; I2=60\%), and targeted at Asian populations (OR 0.44, 95\% CI 0.34-0.58; P<.001; I2=0\%) and that used the International Association of Diabetes and Pregnancy Study Groups diagnostic criteria (OR 0.58, 95\% CI 0.39-0.86; P=.007; I2=69\%) showed a statistically significant reduction in the risk of GDM. Conclusions: mHealth-based lifestyle interventions had a favorable impact on the prevention of GDM in pregnant women with overweight and obesity. Future studies need to further explore the potential of mHealth-based interventions for GDM through better design and more rigorous large-scale RCTs. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021286995; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=286995 ",
doi="10.2196/49373",
url="https://mhealth.jmir.org/2024/1/e49373",
url="http://www.ncbi.nlm.nih.gov/pubmed/38231555"
}


@Article{info:doi/10.2196/47295,
author="Robinson, Billy
and Proimos, Eleni
and Zou, Daniel
and Gong, Enying
and Oldenburg, Brian
and See, Katharine",
title="Functionality and Quality of Asthma mHealth Apps and Their Consistency With International Guidelines: Structured Search and Evaluation",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jan",
day="10",
volume="12",
pages="e47295",
keywords="asthma",
keywords="mobile health",
keywords="mHealth",
keywords="app",
keywords="mobile",
keywords="chronic disease",
keywords="systematic review",
keywords="smartphone",
keywords="review methodology",
keywords="respiratory",
keywords="compliance",
keywords="guideline",
keywords="guidelines",
keywords="review of apps",
keywords="evaluation",
keywords="quality",
keywords="best practices",
keywords="apps",
keywords="mobile phone",
abstract="Background: Asthma is a chronic respiratory disorder requiring long-term pharmacotherapy and judicious patient self-management. Few studies have systematically evaluated asthma mobile health (mHealth) apps for quality and functionality; however, none have systematically assessed these apps for their content alignment with international best practice guidelines. Objective: This review aims to conduct a systematic search and evaluation of current mHealth apps in the Australian marketplace for their functionality, quality, and consistency with best practice guidelines. Methods: The most recent Global Initiative for Asthma (GINA) guidelines were reviewed to identify key recommendations that could be feasibly incorporated into an mHealth app. We developed a checklist based on these recommendations and a modified version of a previously developed framework. App stores were reviewed to identify potential mHealth apps based on predefined criteria. Evaluation of suitable apps included the assessment of technical information, an app quality assessment using the validated Mobile App Rating Scale (MARS) framework, and an app functionality assessment using the Intercontinental Medical Statistics Institute for Health Informatics (IMS) Functionality Scoring System. Finally, the mHealth apps were assessed for their content alignment with the GINA guidelines using the checklist we developed. Results: Of the 422 apps initially identified, 53 were suitable for further analysis based on inclusion and exclusion criteria. The mean number of behavioral change techniques for a single app was 3.26 (SD 2.27). The mean MARS score for all the reviewed apps was 3.05 (SD 0.54). Of 53 apps, 27 (51\%) achieved a total MARS score of ?3. On average, the reviewed apps achieved 5.1 (SD 2.79) functionalities on the 11-point IMS functionality scale. The median number of functionalities identified was 5 (IQR 2-7). Overall, 10 (22\%) of the 45 apps with reviewer consensus in this domain provided general knowledge regarding asthma. Of 53 apps, skill training in peak flow meters, inhaler devices, recognizing or responding to exacerbations, and nonpharmacological asthma management were identified in 8 (17\%), 12 (25\%), 11 (28\%), and 14 (31\%) apps, respectively; 19 (37\%) apps could track or record ``asthma symptoms,'' which was the most commonly recorded metric. The most frequently identified prompt was for taking preventive medications, available in 9 (20\%) apps. Five (10\%) apps provided an area for patients to store or enter their asthma action plan. Conclusions: This study used a unique checklist developed based on the GINA guidelines to evaluate the content alignment of asthma apps. Good-quality asthma apps aligned with international best practice asthma guidelines are lacking. Future app development should target the currently lacking key features identified in this study, including the use of asthma action plans and the deployment of behavioral change techniques to engage and re-engage with users. This study has implications for clinicians navigating the ever-expanding mHealth app market for chronic diseases. Trial Registration: PROSPERO CRD42021269894; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=269894 International Registered Report Identifier (IRRID): RR2-10.2196/33103 ",
doi="10.2196/47295",
url="https://mhealth.jmir.org/2024/1/e47295",
url="http://www.ncbi.nlm.nih.gov/pubmed/38198204"
}


@Article{info:doi/10.2196/46222,
author="Josefsson, Cecilia
and Liljeroos, Thea
and Hellgren, Margareta
and P{\"o}der, Ulrika
and Hedstr{\"o}m, Mariann
and Olsson, G. Erik M.",
title="The Sukaribit Smartphone App for Better Self-Management of Type 2 Diabetes: Randomized Controlled Feasibility Study",
journal="JMIR Form Res",
year="2024",
month="Jan",
day="10",
volume="8",
pages="e46222",
keywords="diabetes mellitus",
keywords="type 2",
keywords="health behavior",
keywords="mobile health",
keywords="mobile application",
keywords="pilot study",
keywords="mobile app",
keywords="mHealth",
keywords="diabetes",
keywords="diabetic",
keywords="RCT",
keywords="randomized",
keywords="glycemic",
keywords="self care",
keywords="self management",
keywords="blood sugar",
keywords="T2D",
keywords="diabetes type 2",
keywords="home-testing",
keywords="digital health",
abstract="Background: A new app, Sukaribit, was designed to enable contact between the caregiver and the patient with the intent to improve self-care and glycemic control (hemoglobin A1c [HbA1c]). Objective: This study investigated the feasibility of the study methodology and the intervention in preparation for a larger effectiveness study. Methods: Adults with type 2 diabetes were recruited in this randomized controlled feasibility study with a mixed methods design. The intervention group (n=28) tried Sukaribit for 2 months. They were encouraged to report blood glucose levels and medications, and they received feedback from a physician. The control group (n=31) received standard care. Both groups were evaluated with pre and postmeasurements of glycemic control (HbA1c), diabetes distress, physical activity, and self-care. Feasibility was evaluated against 5 progression criteria regarding recruitment, study methods, and active participation. Results: Of the 5 progression criteria, only 2 were met or partially met. The recruitment process exceeded expectations, and data collection worked well for self-reported data but not for HbA1c measured with a home testing kit. The participants were less active than anticipated, and the effect sizes were small. Only the number of blood glucose tests per day was positively affected by the intervention, with 0.6 more tests per day in the intervention group. Conclusions: Recruitment of participants to a future fully powered study may work with minor adjustments. The collection of HbA1c using home testing constituted a major problem, and an alternative strategy is warranted. Finally, the app was not used as intended. In order to proceed with a larger study, the app and study procedures need improvement. ",
doi="10.2196/46222",
url="https://formative.jmir.org/2024/1/e46222",
url="http://www.ncbi.nlm.nih.gov/pubmed/38198200"
}


@Article{info:doi/10.2196/50293,
author="Moungui, Claude Henri
and Nana-Djeunga, Clotaire Hugues
and Anyiang, Frankline Che
and Cano, Mireia
and Ruiz Postigo, Antonio Jose
and Carrion, Carme",
title="Dissemination Strategies for mHealth Apps: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jan",
day="5",
volume="12",
pages="e50293",
keywords="mobile health",
keywords="mHealth",
keywords="mobile health apps",
keywords="mHealth apps",
keywords="dissemination",
keywords="marketing strategies",
keywords="digital marketing",
keywords="engagement",
keywords="onboarding",
keywords="systematic review",
keywords="systematic",
keywords="market",
keywords="marketing",
keywords="app",
keywords="apps",
keywords="adoption",
keywords="consumer",
keywords="mobile phone",
abstract="Background: Among the millions of mobile apps in existence, thousands fall under the category of mobile health (mHealth). Although the utility of mHealth apps has been demonstrated for disease diagnosis, treatment data management, and health promotion strategies, to be effective they must reach and be used by their target audience. An appropriate marketing strategy can ensure that apps reach potential users and potentially convert them to actual users. Such a strategy requires definitions of target end users, communication channels, and advertising content, as well as a timeline for effectively reaching and motivating end users to adopt and maintain engagement with the mHealth app. Objective: The aim of this study was to identify strategies and elements that ensure that end users adopt and remain engaged with mHealth apps. Methods: A systematic search of the PubMed, PsycINFO, Scopus, and CINAHL databases was conducted for suitable studies published between January 1, 2018, and September 30, 2022. Two researchers independently screened studies for inclusion, extracted data, and assessed the risk of bias. The main outcome was dissemination strategies for mHealth apps. Results: Of the 648 papers retrieved from the selected databases, only 10 (1.5\%) met the inclusion criteria. The marketing strategies used in these studies to inform potential users of the existence of mHealth apps and motivate download included both paid and unpaid strategies and used various channels, including social media, emails, printed posters, and face-to-face communication. Most of the studies reported a combination of marketing concepts used to advertise their mHealth apps. Advertising messages included instructions on where and how to download and install the apps. In most of the studies (6/10, 60\%), instructions were oriented toward how to use the apps and maintain engagement with a health intervention. The most frequently used paid marketing platform was Facebook Ads Manager (2/10, 20\%). Advertising performance was influenced by many factors, including but not limited to advertising content. In 1 (10\%) of the 10 studies, animated graphics generated the greatest number of clicks compared with other image types. The metrics used to assess marketing strategy effectiveness were number of downloads; nonuse rate; dropout rate; adherence rate; duration of app use; and app usability over days, weeks, or months. Additional indicators such as cost per click, cost per install, and clickthrough rate were mainly used to assess the cost-effectiveness of paid marketing campaigns. Conclusions: mHealth apps can be disseminated via paid and unpaid marketing strategies using various communication channels. The effects of these strategies are reflected in download numbers and user engagement with mHealth apps. Further research could provide guidance on a framework for disseminating mHealth apps and encouraging their routine use. ",
doi="10.2196/50293",
url="https://mhealth.jmir.org/2024/1/e50293",
url="http://www.ncbi.nlm.nih.gov/pubmed/38180796"
}


@Article{info:doi/10.2196/48716,
author="Wu, Ying
and Wang, Xiaohui
and Zhou, Mengyao
and Huang, Zhuoer
and Liu, Lijuan
and Cong, Li",
title="Application of eHealth Tools in Anticoagulation Management After Cardiac Valve Replacement: Scoping Review Coupled With Bibliometric Analysis",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jan",
day="5",
volume="12",
pages="e48716",
keywords="eHealth tool",
keywords="cardiac valve replacement",
keywords="anticoagulation management",
keywords="scoping review",
keywords="bibliometrics analysis",
keywords="rehabilitation",
abstract="Background: Anticoagulation management can effectively prevent complications in patients undergoing cardiac valve replacement (CVR). The emergence of eHealth tools provides new prospects for the management of long-term anticoagulants. However, there is no comprehensive summary of the application of eHealth tools in anticoagulation management after CVR. Objective: Our objective is to clarify the current state, trends, benefits, and challenges of using eHealth tools in the anticoagulation management of patients after CVR and provide future directions and recommendations for development in this field. Methods: This scoping review follows the 5-step framework developed by Arksey and O'Malley. We searched 5 databases such as PubMed, MEDLINE, Web of Science, CINAHL, and Embase using keywords such as ``eHealth,'' ``anticoagulation,'' and ``valve replacement.'' We included papers on the practical application of eHealth tools and excluded papers describing the underlying mechanisms for developing eHealth tools. The search time ranged from the database inception to March 1, 2023. The study findings were reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Additionally, VOSviewer (version 1.6.18) was used to construct visualization maps of countries, institutions, authors, and keywords to investigate the internal relations of included literature and to explore research hotspots and frontiers. Results: This study included 25 studies that fulfilled the criteria. There were 27,050 participants in total, with the sample size of the included studies ranging from 49 to 13,219. The eHealth tools mainly include computer-based support systems, electronic health records, telemedicine platforms, and mobile apps. Compared to traditional anticoagulation management, eHealth tools can improve time in therapeutic range and life satisfaction. However, there is no significant impact observed in terms of economic benefits and anticoagulation-related complications. Bibliometric analysis suggests the potential for increased collaboration and opportunities among countries and academic institutions. Italy had the widest cooperative relationships. Machine learning and artificial intelligence are the popular research directions in anticoagulation management. Conclusions: eHealth tools exhibit promise for clinical applications in anticoagulation management after CVR, with the potential to enhance postoperative rehabilitation. Further high-quality research is needed to explore the economic benefits of eHealth tools in long-term anticoagulant therapy and the potential to reduce the occurrence of adverse events. ",
doi="10.2196/48716",
url="https://mhealth.jmir.org/2024/1/e48716",
url="http://www.ncbi.nlm.nih.gov/pubmed/38180783"
}


@Article{info:doi/10.2196/44619,
author="Luu, Phuoc An
and Nguyen, Thanh Truong
and Cao, Cam Van Thi
and Ha, Diem Trinh Hoang
and Chung, Thu Lien Thi
and Truong, Ngoc Trung
and Nguyen Le Nhu, Tung
and Dao, Bach Khoa
and Nguyen, Van Hao
and Khanh, Quoc Phan Nguyen
and Le, Thuy Khanh Thuy
and Tran, Bao Luu Hoai
and Nhat, Huy Phung Tran
and Tran, Minh Duc
and Lam, Minh Yen
and Thwaites, Louise Catherine
and Mcknight, Jacob
and Vinh Chau, Van Nguyen
and Van Nuil, Ilo Jennifer
and ",
title="Acceptance and User Experiences of a Wearable Device for the Management of Hospitalized Patients in COVID-19--Designated Wards in Ho Chi Minh City, Vietnam: Action Learning Project",
journal="JMIR Hum Factors",
year="2024",
month="Jan",
day="5",
volume="11",
pages="e44619",
keywords="vital signs",
keywords="wearable devices",
keywords="action learning",
keywords="technology acceptance model",
keywords="TAM",
keywords="COVID-19",
keywords="user-centered design",
keywords="wearables",
keywords="remote monitoring",
keywords="technology acceptance",
keywords="oximeter",
abstract="Background: Wearable devices have been used extensively both inside and outside of the hospital setting. During the COVID-19 pandemic, in some contexts, there was an increased need to remotely monitor pulse and saturated oxygen for patients due to the lack of staff and bedside monitors. Objective: A prototype of a remote monitoring system using wearable pulse oximeter devices was implemented at the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam, from August to December 2021. The aim of this work was to support the ongoing implementation of the remote monitoring system. Methods: We used an action learning approach with rapid pragmatic methods, including informal discussions and observations as well as a feedback survey form designed based on the technology acceptance model to assess the use and acceptability of the system. Based on these results, we facilitated a meeting using user-centered design principles to explore user needs and ideas about its development in more detail. Results: In total, 21 users filled in the feedback form. The mean technology acceptance model scores ranged from 3.5 (for perceived ease of use) to 4.4 (for attitude) with behavioral intention (3.8) and perceived usefulness (4.2) scoring in between. Those working as nurses scored higher on perceived usefulness, attitude, and behavioral intention than did physicians. Based on informal discussions, we realized there was a mismatch between how we (ie, the research team) and the ward teams perceived the use and wider purpose of the technology. Conclusions: Designing and implementing the devices to be more nurse-centric from their introduction could have helped to increase their efficiency and use during the complex pandemic period. ",
doi="10.2196/44619",
url="https://humanfactors.jmir.org/2024/1/e44619",
url="http://www.ncbi.nlm.nih.gov/pubmed/38180799"
}


@Article{info:doi/10.2196/52035,
author="Schulze Lammers, Sophia
and Lawrenz, Thorsten
and Lawin, Dennis
and Hoyer, Annika
and Stellbrink, Christoph
and Albrecht, Urs-Vito",
title="Prolonged mHealth-Based Arrhythmia Monitoring in Patients With Hypertrophic Cardiomyopathy (HCM-PATCH): Protocol for a Single-Center Cohort Study",
journal="JMIR Res Protoc",
year="2023",
month="Dec",
day="29",
volume="12",
pages="e52035",
keywords="hypertrophic cardiomyopathy",
keywords="nonsustained ventricular arrhythmia",
keywords="sudden cardiac death",
keywords="implantable cardioverter-defibrillator",
keywords="long-term ECG",
keywords="digital medicine",
keywords="long-term electrocardiography",
abstract="Background: Patients with hypertrophic cardiomyopathy (HCM) are at increased risk of sudden cardiac death (SCD) due to ventricular arrhythmias and other arrhythmias. Screening for arrhythmias is mandatory to assess the individual SCD risk, but long-term electrocardiography (ECG) is rarely performed in routine clinical practice. Intensified monitoring may increase the detection rate of ventricular arrhythmias and identify more patients with an increased SCD risk who are potential candidates for the primary prophylactic implantation of an implantable cardioverter-defibrillator. To date, reliable data on the clinical benefit of prolonged arrhythmia monitoring in patients with HCM are rare. Objective: This prospective study aims to measure the prevalence of ventricular arrhythmias in patients with HCM observed by mobile health (mHealth)--based continuous rhythm monitoring over 14 days compared to standard practice (a 24- and 48-h long-term ECG). The frequency of ventricular arrhythmias in this 14-day period is compared with the frequency in the first 24 or 48 hours for the same patient (intraindividual comparison). Methods: Following the sample size calculation, 34 patients with a low or intermediate risk for SCD, assessed by the HCM Risk--SCD calculator, will need to be recruited in this single-center cohort study between June 2023 and February 2024. All patients will receive an ECG patch that records their heart activity over 14 days. In addition, cardiac magnetic resonance imaging and genetic testing data will be integrated into risk stratification. All patients will be asked to complete questionnaires about their symptoms; previous therapy; family history; and, at the end of the study, their experience with the ECG patch-based monitoring. Results: The Hypertrophic Cardiomyopathy: Clinical Impact of a Prolonged mHealth-Based Arrhythmia Monitoring by Single-Channel ECG (HCM-PATCH) study investigates the prevalence of nonsustained ventricular tachycardia (ie, ?3 consecutive ventricular beats at a rate of 120 beats per minute, lasting for <30 seconds) in low- to intermediate-risk patients with HCM (according to the HCM Risk--SCD calculator) with additional mHealth-based prolonged rhythm monitoring. The study was funded by third-party funding from the Department of Cardiology and Intensive Care Medicine, University Hospital Ostwestfalen-Lippe of Bielefeld University in June 2023 and approved by the institutional review board in May 2023. Data collection began in June 2023, and we plan to end the study in February 2024. Of the 34 patients, 26 have been recruited. Data analysis has not yet taken place. Publication of the results is planned for the fall of 2024. Conclusions: Prolonged mHealth-based rhythm monitoring could lead to differences in the prevalence of arrhythmias compared to 24- and 48-hour long-term ECGs. This may lead to improved identification of patients at high risk and trigger therapeutic interventions that may provide better protection from SCD or atrial fibrillation--related complications such as embolic stroke. Trial Registration: Deutsches Register Klinischer Studien DRKS00032144; https://tinyurl.com/498bkrx8 International Registered Report Identifier (IRRID): DERR1-10.2196/52035 ",
doi="10.2196/52035",
url="https://www.researchprotocols.org/2023/1/e52035",
url="http://www.ncbi.nlm.nih.gov/pubmed/38157231"
}


@Article{info:doi/10.2196/47224,
author="Abdelhameed, Farah
and Pearson, Eilish
and Parsons, Nick
and Barber, M. Thomas
and Panesar, Arjun
and Summers, Charlotte
and de la Fosse, Michaela
and Hanson, Petra",
title="Health Outcomes Following Engagement With a Digital Health Tool Among People With Prediabetes and Type 2 Diabetes: Prospective Evaluation Study",
journal="JMIR Diabetes",
year="2023",
month="Dec",
day="28",
volume="8",
pages="e47224",
keywords="application",
keywords="diabetes",
keywords="digital health tool",
keywords="digital health",
keywords="eHealth",
keywords="mHealth",
keywords="mobile app",
keywords="mobile health",
keywords="prediabetes",
keywords="quality of life",
keywords="type 2 diabetes",
abstract="Background: Diabetes is a worldwide chronic condition causing morbidity and mortality, with a growing economic burden on health care systems. Complications from poorly controlled diabetes are associated with increased socioeconomic costs and reduced quality of life. Smartphones have become an influential platform, providing feasible tools such as health apps to deliver tailored support to enhance the ability of patients with diabetes for self-management. Gro Health is a National Health Service division X--certified digital health tool used to deliver educational and monitoring support to facilitate the development of skills and practices for maintaining good health. Objective: This study aims to assess self-reported outcomes of the Gro Health app among users with diabetes and prediabetes and identify the factors that determine engagement with the digital health tool. Methods: This was a service evaluation of self-reported data collected prospectively by the developers of the Gro Health app. The EQ-5D questionnaire is a standardized tool used to measure health status for clinical and economic appraisal. Gro Health users completed the EQ-5D at baseline and 6 months after using the app. Users provided informed consent for the use of their anonymized data for research purposes. EQ-5D index scores and visual analogue scale (VAS) scores were calculated at baseline and 6 months for individuals with prediabetes and type 2 diabetes. Descriptive statistics and multiple-regression models were used to assess changes in the outcome measures and determine factors that affected engagement with the digital tool. Results: A total of 84\% (1767/2114) of Gro Health participants completed EQ-5D at baseline and 6 months. EQ-5D index scores are average values that reflect people's preferences about their health state (1=full health and 0=moribund). There was a significant and clinically meaningful increase in mean EQ-5D index scores among app users between baseline (0.746, SD 0.23) and follow-up (0.792, SD 0.22; P<.001). The greatest change was observed in the mean VAS score, with a percentage change of 18.3\% improvement (61.7, SD 18.1 at baseline;?73.0, SD 18.8 at follow-up; P<.001). Baseline EQ-5D index scores, age, and completion of educational modules were associated with significant changes in the follow-up EQ-5D index scores, with baseline EQ-5D index scores, race and ethnicity, and completion of educational modules being significantly associated with app engagement (P<.001). Conclusions: This study provides evidence of a significant positive effect on self-reported quality of life among people living with type 2 diabetes engaging with a digital health intervention. The improvements, as demonstrated by the EQ-5D questionnaire, are facilitated through access to education and monitoring support tools within the app. This provides an opportunity for health care professionals to incorporate National Health Service--certified digital tools, such as Gro Health, as part of the holistic management of people living with diabetes. ",
doi="10.2196/47224",
url="https://diabetes.jmir.org/2023/1/e47224",
url="http://www.ncbi.nlm.nih.gov/pubmed/38016426"
}


@Article{info:doi/10.2196/52872,
author="Berg, Jorid Inger
and Tveter, Therese Anne
and Bakland, Gunnstein
and Hakim, Sarah
and Kristianslund, K. Eirik
and Lillegraven, Siri
and Macfarlane, J. Gary
and Moholt, Ellen
and Provan, A. Sella
and Sexton, Joseph
and Thomassen, EK Emil
and De Thurah, Annette
and Gossec, Laure
and Haavardsholm, A. Espen
and {\O}ster{\aa}s, Nina",
title="Follow-Up of Patients With Axial Spondyloarthritis in Specialist Health Care With Remote Monitoring and Self-Monitoring Compared With Regular Face-to-Face Follow-Up Visits (the ReMonit Study): Protocol for a Randomized, Controlled Open-Label Noninferiority Trial",
journal="JMIR Res Protoc",
year="2023",
month="Dec",
day="27",
volume="12",
pages="e52872",
keywords="spondyloarthritis",
keywords="inflammatory joint disease",
keywords="telemedicine",
keywords="remote monitoring",
keywords="remote care",
keywords="self-management",
keywords="randomized controlled trial",
keywords="cost-effectiveness",
abstract="Background: Patients with chronic inflammatory joint diseases such as axial spondyloarthritis have traditionally received regular follow-up in specialist health care to maintain low disease activity. The follow-up has been organized as prescheduled face-to-face visits, which are time-consuming for both patients and health care professionals. Technology has enabled the remote monitoring of disease activity, allowing patients to self-monitor their disease and contact health care professionals when needed. Remote monitoring or self-monitoring may provide a more personalized follow-up, but there is limited research on how these follow-up strategies perform in maintaining low disease activity, patient satisfaction, safety, and cost-effectiveness. Objective: The Remote Monitoring in Axial Spondyloarthritis (ReMonit) study aimed to assess the effectiveness of digital remote monitoring and self-monitoring in maintaining low disease activity in patients with axial spondyloarthritis. Methods: The ReMonit study is a 3-armed, single-site, randomized, controlled, open-label noninferiority trial including patients with axial spondyloarthritis with low disease activity (Ankylosing Spondylitis Disease Activity Score <2.1) and on stable treatment with a tumor necrosis factor inhibitor. Participants were randomized 1:1:1 to arm A (usual care, face-to-face visits every sixth month), arm B (remote monitoring, monthly digital registration of patient-reported outcomes), or arm C (patient-initiated care, self-monitoring, no planned visits during the study period). The primary end point was disease activity measured with the Ankylosing Spondylitis Disease Activity Score, evaluated at 6, 12, and 18 months. We aimed to include 240 patients, 80 in each arm. Secondary end points included other measures of disease activity, patient satisfaction, safety, and cost-effectiveness. Results: The project is funded by the South-Eastern Norway Regional Health Authority and Centre for the treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Norway. Enrollment started in September 2021 and was completed with 242 patients by June 2022. The data collection will be completed in December 2023. Conclusions: To our knowledge, this trial will be among the first to evaluate the effectiveness, safety, and cost-effectiveness of remote digital monitoring and self-monitoring of patients with axial spondyloarthritis compared with usual care. Hence, the ReMonit study will contribute important knowledge to personalized follow-up strategies for patients with axial spondyloarthritis. These results may also be relevant for other patient groups with inflammatory joint diseases. Trial Registration: ClinicalTrials.gov NCT05031767; hpps://www.clinicaltrials.gov/study/NCT05031767 International Registered Report Identifier (IRRID): DERR1-10.2196/52872 ",
doi="10.2196/52872",
url="https://www.researchprotocols.org/2023/1/e52872",
url="http://www.ncbi.nlm.nih.gov/pubmed/38150310"
}


@Article{info:doi/10.2196/39019,
author="Huang, Xiting
and Xiang, Xinyue
and Liu, Yang
and Wang, Zhiqian
and Jiang, Zhili
and Huang, Lihua",
title="The Use of Gamification in the Self-Management of Patients With Chronic Diseases: Scoping Review",
journal="JMIR Serious Games",
year="2023",
month="Dec",
day="22",
volume="11",
pages="e39019",
keywords="gamification",
keywords="chronic diseases",
keywords="self-management",
keywords="scoping review",
keywords="mobile phone",
abstract="Background: Chronic disease self-management is a public health issue of worldwide concern, and gamification is an emerging strategy to improve patients' participation in chronic disease self-management. Some studies have summarized designs for the gamification of chronic disease self-management from the perspective of eHealth technology, but they have not mentioned differences in design methods, functions, and evaluation methods of gamified designs for self-management in different chronic diseases. Objective: This scoping review aims to synthesize the characteristics of realization forms, functions, and evaluation methods in chronic disease self-management gamification to improve self-management among the chronic disease population. Methods: We applied a methodological framework for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. As of January 7, 2023, we systematically searched 9 databases for relevant studies from January 2012 to December 2022. Related data were extracted based on the research questions. We calculated the frequencies, charted the quantitative data, and coded the extracted material for qualitative content analysis. Results: We retrieved 16,221 records, of which 70 (0.43\%) met the eligibility criteria. In the included research, the target populations for gamified designs for self-management of chronic diseases included patients with stroke, cancer, diabetes, chronic obstructive pulmonary disease, coronary heart disease, obesity, and hypertension. Almost all studies mentioned technical support for gamification (68/70, 97\%), mainly in the form of active video games (58/70, 83\%); however, less than half of the studies mentioned the theoretical basis for gamification (31/70, 44\%). There were 37 concepts or theories relevant to gamification design, most of which were in the field of psychology or were cross-disciplinary (n=33, 89\%). Gamification for the self-management of chronic diseases has been widely recognized, including for promoting physical exercise and rehabilitation training (48/99, 48\%), increasing initiative for symptom management (18/99, 18\%), providing psychological support (14/99, 14\%), improving cognitive function (12/99, 12\%), and improving medication adherence (7/99, 7\%). A total of 39 studies mentioned the gamification effect; however, we did not find a unified evaluation standard. Conclusions: This scoping review focuses on gamification designs for chronic disease self-management and summarizes the realization forms and functions of gamification in self-management for different patient populations. With practice in a gamified internet-based environment, patients can not only master the knowledge and skills of self-management in fascinating scenarios but also benefit from gaming experience and make better health-related decisions in real life. It is worth noting that a comprehensive evaluation of the users as well as a personalized and targeted intervention should be developed before gamification. ",
doi="10.2196/39019",
url="https://games.jmir.org/2023/1/e39019",
url="http://www.ncbi.nlm.nih.gov/pubmed/38133907"
}


@Article{info:doi/10.2196/43809,
author="Liu, Fang
and Song, Ting
and Yu, Ping
and Deng, Ning
and Guan, Yingping
and Yang, Yang
and Ma, Yuanji",
title="Efficacy of an mHealth App to Support Patients' Self-Management of Hypertension: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2023",
month="Dec",
day="19",
volume="25",
pages="e43809",
keywords="mobile app",
keywords="mHealth",
keywords="mobile health",
keywords="smartphone",
keywords="high blood pressure",
keywords="medication adherence",
keywords="reminder",
keywords="health education",
keywords="motivation",
keywords="hypertension control",
keywords="hypertension",
keywords="blood pressure",
keywords="self-management",
abstract="Background: Hypertension is a significant global disease burden. Mobile health (mHealth) offers a promising means to provide patients with hypertension with easy access to health care services. Yet, its efficacy needs to be validated, especially in lower-income areas with a high-salt diet. Objective: This study aims to assess the efficacy of an mHealth app--based intervention in supporting patients' self-management of hypertension. Methods: A 2-arm randomized controlled trial was conducted among 297 patients with hypertension at the General Hospital of Ningxia Medical University, Ningxia Hui Autonomous Region, China. Participants selected via convenience sampling were randomly allocated into intervention and control groups. Intervention group participants were trained and asked to use an mHealth app named Blood Pressure Assistant for 6 months. They could use the app to record and upload vital signs, access educational materials, and receive self-management reminders and feedback from health care providers based on the analysis of the uploaded data. Control group participants received usual care. Blood pressure (BP) and 2 questionnaire surveys about hypertension knowledge and lifestyle behavior were used to assess all participants at baseline and 6 months. Data analysis was performed with SPSS software using 2-tailed t tests and a chi-square test. Results: There were no significant differences in baseline characteristics and medication use between the 2 groups (all P>.05). After 6 months, although both groups show a significant pre-post improvement (P<.001 each), the BP control rate (ie, the proportion of patients with a systolic BP of <140 mm Hg and diastolic BP of <90 mm Hg) in the intervention group was better than that in the control group (100/111, 90.1\% vs 75/115, 65.2\%; P<.001). The mean systolic and diastolic BP were significantly reduced by 25.83 (SD 8.99) and 14.28 (SD 3.74) mm Hg in the intervention group (P<.001) and by 21.83 (SD 6.86) and 8.87 (SD 4.22) mm Hg in the control group (P<.001), respectively. The differences in systolic and diastolic BP between the 2 groups were significant (P<.001 and P=.01, respectively). Hypertension knowledge significantly improved only in the intervention group in both pre-post and intergroup comparisons (both P<.001). However, only intragroup improvement was observed for lifestyle behaviors in the intervention group (P<.001), including medication adherence (P<.001), healthy diet (P=.02), low salt intake (P<.001), and physical exercises (P=.02), and no significant difference was observed in the control group or on intergroup comparisons. Conclusions: This research shows that the mHealth app--based intervention has the potential to improve patient health knowledge and support self-management among them toward a healthier lifestyle, including medication adherence, low-salt diets, and physical exercises, thereby achieving optimal BP control. Further research is still needed to verify the specific effects of these interventions. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900026437; https://www.chictr.org.cn/showproj.html?proj=38801 ",
doi="10.2196/43809",
url="https://www.jmir.org/2023/1/e43809",
url="http://www.ncbi.nlm.nih.gov/pubmed/38113071"
}


@Article{info:doi/10.2196/52697,
author="Bhagavathula, Srikanth Akshaya
and Aldhaleei, Ali Wafa
and Atey, Mehari Tesfay
and Assefa, Solomon
and Tesfaye, Wubshet",
title="Efficacy of eHealth Technologies on Medication Adherence in Patients With Acute Coronary Syndrome: Systematic Review and Meta-Analysis",
journal="JMIR Cardio",
year="2023",
month="Dec",
day="19",
volume="7",
pages="e52697",
keywords="medication adherence",
keywords="eHealth",
keywords="secondary prevention",
keywords="acute coronary syndrome",
keywords="heart disease",
keywords="text messaging",
keywords="mobile app",
keywords="cardiology",
keywords="cardioprotective",
keywords="prevention",
keywords="efficacy",
keywords="statins",
abstract="Background: Suboptimal adherence to cardiac pharmacotherapy, recommended by the guidelines after acute coronary syndrome (ACS) has been recognized and is associated with adverse outcomes. Several randomized controlled trials (RCTs) have shown that eHealth technologies are useful in reducing cardiovascular risk factors. However, little is known about the effect of eHealth interventions on medication adherence in patients following ACS. Objective: The aim of this study is to examine the efficacy of the eHealth interventions on medication adherence to selected 5 cardioprotective medication classes in patients with ACS. Methods: A systematic literature search of PubMed, Embase, Scopus, and Web of Science was conducted between May and October 2022, with an update in October 2023 to identify RCTs that evaluated the effectiveness of eHealth technologies, including texting, smartphone apps, or web-based apps, to improve medication adherence in patients after ACS. The risk of bias was evaluated using the modified Cochrane risk-of-bias tool for RCTs. A pooled meta-analysis was performed using a fixed-effect Mantel-Haenszel model and assessed the medication adherence to the medications of statins, aspirin, P2Y12 inhibitors, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and $\beta$-blockers. Results: We identified 5 RCTs, applicable to 4100 participants (2093 intervention vs 2007 control), for inclusion in the meta-analysis. In patients who recently had an ACS, compared to the control group, the use of eHealth intervention was not associated with improved adherence to statins at different time points (risk difference [RD] --0.01, 95\% CI --0.03 to 0.03 at 6 months and RD --0.02, 95\% CI --0.05 to 0.02 at 12 months), P2Y12 inhibitors (RD --0.01, 95\% CI --0.04 to 0.02 and RD --0.01, 95\% CI --0.03 to 0.02), aspirin (RD 0.00, 95\% CI --0.06 to 0.07 and RD --0.00, 95\% CI --0.07 to 0.06), angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (RD --0.01, 95\% CI --0.04 to 0.02 and RD 0.01, 95\% CI --0.04 to 0.05), and $\beta$-blockers (RD 0.00, 95\% CI --0.03 to 0.03 and RD --0.01, 95\% CI --0.05 to 0.03). The intervention was also not associated with improved adherence irrespective of the adherence assessment method used (self-report or objective). Conclusions: This review identified limited evidence on the effectiveness of eHealth interventions on adherence to guideline-recommended medications after ACS. While the pooled analyses suggested a lack of effectiveness of such interventions on adherence improvement, further studies are warranted to better understand the role of different eHealth approaches in the post-ACS context. ",
doi="10.2196/52697",
url="https://cardio.jmir.org/2023/1/e52697",
url="http://www.ncbi.nlm.nih.gov/pubmed/38113072"
}


@Article{info:doi/10.2196/49097,
author="Montilva-Monsalve, Jonas
and Dimantas, Bruna
and Perski, Olga
and Gutman, Morrison Leslie",
title="Barriers and Enablers to the Adoption of a Healthier Diet Using an App: Qualitative Interview Study With Patients With Type 2 Diabetes Mellitus",
journal="JMIR Diabetes",
year="2023",
month="Dec",
day="19",
volume="8",
pages="e49097",
keywords="behavior change techniques",
keywords="diabetes",
keywords="apps",
keywords="smartphone",
keywords="enablers",
keywords="barriers",
keywords="mobile phone",
abstract="Background: Adopting a healthy diet is one of the cornerstones of type 2 diabetes (T2D) management. Apps are increasingly used in diabetes self-management, but most studies to date have focused on assessing their impact in terms of weight loss or glycemic control, with limited evidence on the behavioral factors that influence app use to change dietary habits. Objective: The main objectives of this study were to assess the enablers and barriers to adopting a healthier diet using the Gro Health app in 2 patient groups with T2D (patients with recently diagnosed and long-standing T2D) and to identify behavior change techniques (BCTs) to enhance enablers and overcome barriers. Methods: Two semistructured qualitative interview studies were conducted; the first study took place between June and July 2021, with a sample of 8 patients with recently diagnosed (<12 mo) T2D, whereas the second study was conducted between May and June 2022 and included 15 patients with long-standing (>18 mo) T2D. In both studies, topic guides were informed by the Capability, Opportunity, Motivation, and Behavior model and the Theoretical Domains Framework. Transcripts were analyzed using a combined deductive framework and inductive thematic analysis approach. The Behavior Change Wheel framework was applied to identify appropriate BCTs that could be used in future iterations of apps for patients with diabetes. Themes were compared between the patient groups. Results: This study identified similarities and differences between patient groups in terms of enablers and barriers to adopting a healthier diet using the app. The main enablers for recently diagnosed patients included the acquired knowledge about T2D diets and skills to implement these, whereas the main barriers were the difficulty in deciding which app features to use and limited cooking skills. By contrast, for patients with long-standing T2D, the main enablers included knowledge validation provided by the app, along with app elements to help self-regulate food intake; the main barriers were the limited interest paid to the content provided or limited skills engaging with apps in general. Both groups reported more enablers than barriers to performing the target behavior when using the app. Consequently, BCTs were selected to address key barriers in both groups, such as simplifying the information hierarchy in the app interface, including tutorials demonstrating how to use the app features, and redesigning the landing page of the app to guide users toward these tutorials. Conclusions: Patients with recently diagnosed and long-standing T2D encountered similar enablers but slightly different barriers when using an app to adopting a healthier diet. Consequently, the development of app-based approaches to adopt a healthier diet should account for these similarities and differences within patient segments to reduce barriers to performing the target behavior. ",
doi="10.2196/49097",
url="https://diabetes.jmir.org/2023/1/e49097",
url="http://www.ncbi.nlm.nih.gov/pubmed/38113087"
}


@Article{info:doi/10.2196/44762,
author="Yamashiki, Noriyo
and Kawabata, Kyoko
and Murata, Miki
and Ikeda, Shunichiro
and Fujimaki, Takako
and Suwa, Kanehiko
and Seki, Toshihito
and Aramaki, Eiji
and Naganuma, Makoto",
title="Narrowing the Patient--Physician Gap Based on Self-Reporting and Monthly Hepatologist Feedback for Patients With Alcohol-Related Liver Disease: Interventional Pilot Study Using a Journaling Smartphone App",
journal="JMIR Form Res",
year="2023",
month="Dec",
day="19",
volume="7",
pages="e44762",
keywords="alcohol-related liver disease",
keywords="alcohol use disorder",
keywords="alcoholism",
keywords="smartphone",
keywords="mobile health",
abstract="Background: Screening and intervention for alcohol use disorders (AUDs) are recommended to improve the prognosis of patients with alcohol-related liver disease (ALD). Most patients' smartphone app diaries record drinking behavior for self-monitoring. A smartphone app can be expected to also be helpful for physicians because it can provide rich patient information to hepatologists, leading to suitable feedback. We conducted this prospective pilot study to assess the use of a smartphone app as a journaling tool and as a self-report--based feedback source for patients with ALD. Objective: The aims of this study were assessment of whether journaling (self-report) and self-report--based feedback can help patients maintain abstinence and improve liver function data. Methods: This pilot study used a newly developed smartphone journaling app for patients, with input data that physicians can review. After patients with ALD were screened for harmful alcohol use, some were invited to use the smartphone journaling app for 8 weeks. Their self-reported alcohol intake, symptoms, and laboratory data were recorded at entry, week 4, and week 8. Biomarkers for alcohol use included gamma glutamyl transferase (GGT), percentage of carbohydrate-deficient transferrin to transferrin (\%CDT), and GGT-CDT (GGT-CDT= 0.8 {\texttimes} ln[GGT] + 1.3 {\texttimes} ln[\%CDT]). At each visit, their recorded data were reviewed by a hepatologist to evaluate changes in alcohol consumption and laboratory data. The relation between those outcomes and app usage was also investigated. Results: Of 14 patients agreeing to participate, 10 completed an 8-week follow-up, with diary input rates between 44\% and 100\% of the expected days. Of the 14 patients, 2 withdrew from clinical follow-up, and 2 additional patients never used the smartphone journaling app. Using the physician's view, a treating hepatologist gave feedback via comments to patients at each visit. Mean self-reported alcohol consumption dropped from baseline (100, SD 70 g) to week 4 (13, SD 25 g; P=.002) and remained lower at week 8 (13, SD 23 g; P=.007). During the study, 5 patients reported complete abstinence. No significant changes were found in mean GGT and mean \%CDT alone, but the mean GGT-CDT combination dropped significantly from entry (5.2, SD 1.2) to the week 4 visit (4.8, SD 1.1; P=.02) and at week 8 (4.8, SD 1.0; P=.01). During the study period, decreases in mean total bilirubin (3.0, SD 2.4 mg/dL to 2.4, SD 1.9 mg/dL; P=.01) and increases in mean serum albumin (3.0, SD 0.9 g/dL to 3.3, SD 0.8 g/dL; P=.009) were recorded. Conclusions: These pilot study findings revealed that a short-term intervention with a smartphone journaling app used by both patients and treatment-administering hepatologists was associated with reduced drinking and improved liver function. Trial Registration: UMIN CTR UMIN000045285; http://tinyurl.com/yvvk38tj ",
doi="10.2196/44762",
url="https://formative.jmir.org/2023/1/e44762/"
}


@Article{info:doi/10.2196/43105,
author="Singh, Akanksha
and Schooley, Benjamin
and Patel, Nitin",
title="Effects of User-Reported Risk Factors and Follow-Up Care Activities on Satisfaction With a COVID-19 Chatbot: Cross-Sectional Study",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Dec",
day="14",
volume="11",
pages="e43105",
keywords="patient engagement",
keywords="chatbot",
keywords="population health",
keywords="health recommender systems",
keywords="conversational recommender systems",
keywords="design factors",
keywords="COVID-19",
abstract="Background: The COVID-19 pandemic influenced many to consider methods to reduce human contact and ease the burden placed on health care workers. Conversational agents or chatbots are a set of technologies that may aid with these challenges. They may provide useful interactions for users, potentially reducing the health care worker burden while increasing user satisfaction. Research aims to understand these potential impacts of chatbots and conversational recommender systems and their associated design features. Objective: The objective of this study was to evaluate user perceptions of the helpfulness of an artificial intelligence chatbot that was offered free to the public in response to COVID-19. The chatbot engaged patients and provided educational information and the opportunity to report symptoms, understand personal risks, and receive referrals for care. Methods: A cross-sectional study design was used to analyze 82,222 chats collected from patients in South Carolina seeking services from the Prisma Health system. Chi-square tests and multinomial logistic regression analyses were conducted to assess the relationship between reported risk factors and perceived chat helpfulness using chats started between April 24, 2020, and April 21, 2022. Results: A total of 82,222 chat series were started with at least one question or response on record; 53,805 symptom checker questions with at least one COVID-19--related activity series were completed, with 5191 individuals clicking further to receive a virtual video visit and 2215 clicking further to make an appointment with a local physician. Patients who were aged >65 years (P<.001), reported comorbidities (P<.001), had been in contact with a person with COVID-19 in the last 14 days (P<.001), and responded to symptom checker questions that placed them at a higher risk of COVID-19 (P<.001) were 1.8 times more likely to report the chat as helpful than those who reported lower risk factors. Users who engaged with the chatbot to conduct a series of activities were more likely to find the chat helpful (P<.001), including seeking COVID-19 information (3.97-4.07 times), in-person appointments (2.46-1.99 times), telehealth appointments with a nearby provider (2.48-1.9 times), or vaccination (2.9-3.85 times) compared with those who did not perform any of these activities. Conclusions: Chatbots that are designed to target high-risk user groups and provide relevant actionable items may be perceived as a helpful approach to early contact with the health system for assessing communicable disease symptoms and follow-up care options at home before virtual or in-person contact with health care providers. The results identified and validated significant design factors for conversational recommender systems, including triangulating a high-risk target user population and providing relevant actionable items for users to choose from as part of user engagement. ",
doi="10.2196/43105",
url="https://mhealth.jmir.org/2023/1/e43105",
url="http://www.ncbi.nlm.nih.gov/pubmed/38096007"
}


@Article{info:doi/10.2196/49278,
author="Zvulunov, Alex
and Lenevich, Stepan
and Migacheva, Natalia",
title="A Mobile Health App for Facilitating Disease Management in Children With Atopic Dermatitis: Feasibility and Impact Study",
journal="JMIR Dermatol",
year="2023",
month="Dec",
day="13",
volume="6",
pages="e49278",
keywords="atopic dermatitis",
keywords="eczema",
keywords="Atopic App mobile health application",
keywords="artificial intelligence",
keywords="dermatitis",
keywords="dermatology",
keywords="skin",
keywords="disease management",
keywords="child",
keywords="children",
keywords="pediatric",
keywords="pediatrics",
keywords="feasibility",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="applications",
abstract="Background: Inadequate control of atopic dermatitis (AD) increases the frequency of exacerbations and reduces the quality of life. Mobile health apps provide information and communication technology and may increase treatment adherence and facilitate disease management at home. The mobile health app, Atopic App, designed for patients and their caregivers, and the associated web-based patient education program, Atopic School, provide an opportunity for improving patients' and caregivers' engagement and adherence to the management of AD. Objective: This noninterventional, observational study aimed to explore the feasibility and potential impact on the management of AD in children by caregivers using the Atopic App mobile health app. Methods: The patient-oriented eczema measure (POEM) and numerical rating scale for the grading of pruritus were used as severity scores (scale range: 0-28). The artificial intelligence model of the app was used to assess the severity of AD based on the eczema area and severity index approach. The deidentified data enabled the analysis of the severity of AD, treatment plan history, potential triggers of flare-ups, usage of available features of the app, and the impact of patient education. Results: During a 12-month period, of the 1223 users who installed the app, 910 (74.4\%) registered users were caregivers of children with AD. The web-based Atopic School course was accessed by 266 (29.2\%) caregivers of children with AD, 134 (50.4\%) of whom completed the course. Usage of the app was significantly more frequent among those who completed the Atopic School program than among those who did not access or did not complete the course (P<.001). Users who completed a second POEM 21 to 27 days apart exhibited a significant improvement of AD severity based on the POEM score (P<.001), with an average improvement of 3.86 (SD 6.85) points. The artificial intelligence severity score and itching score were highly correlated with the POEM score (r=0.35 and r=0.52, respectively). Conclusions: The Atopic App provides valuable real-world data on the epidemiology, severity dynamics, treatment patterns, and exacerbation-trigger correlations in patients with AD. The significant reduction in the POEM score among users of the Atopic App indicates a potential impact of this tool on health care engagement by caregivers of children with AD. ",
doi="10.2196/49278",
url="https://derma.jmir.org/2023/1/e49278",
url="http://www.ncbi.nlm.nih.gov/pubmed/38090787"
}


@Article{info:doi/10.2196/46481,
author="Gregory, E. Megan
and Cao, Weidan
and Rahurkar, Saurabh
and Jonnalagadda, Pallavi
and Stock, C. James
and Ghazi, M. Sanam
and Reid, Endia
and Berk, L. Abigail
and Hebert, Courtney
and Li, Lang
and Addison, Daniel",
title="Exploring the Incorporation of a Novel Cardiotoxicity Mobile Health App Into Care of Patients With Cancer: Qualitative Study of Patient and Provider Perspectives",
journal="JMIR Cancer",
year="2023",
month="Dec",
day="12",
volume="9",
pages="e46481",
keywords="cancer, cardiology, implementation science, mobile app, oncology",
keywords="mobile phone",
keywords="cancer patient",
keywords="patient care",
keywords="mobile health application",
keywords="application",
keywords="implementation",
keywords="design",
keywords="development",
keywords="symptom tracking",
keywords="cardiotoxicity",
keywords="cancer therapy",
keywords="symptom",
keywords="primary care",
abstract="Background: Cardiotoxicity is a limitation of several cancer therapies and early recognition improves outcomes. Symptom-tracking mobile health (mHealth) apps are feasible and beneficial, but key elements for mHealth symptom-tracking to indicate early signs of cardiotoxicity are unknown. Objective: We explored considerations for the design of, and implementation into a large academic medical center, an mHealth symptom-tracking tool for early recognition of cardiotoxicity in patients with cancer after cancer therapy initiation. Methods: We conducted semistructured interviews of >50\% of the providers (oncologists, cardio-oncologists, and radiation oncologists) who manage cancer treatment-related cardiotoxicity in the participating institution (n=11), and either interviews or co-design or both with 6 patients. Data were coded and analyzed using thematic analysis. Results: Providers indicated that there was no existing process to enable early recognition of cardiotoxicity and felt the app could reduce delays in diagnosis and lead to better patient outcomes. Signs and symptoms providers recommended for tracking included chest pain or tightness, shortness of breath, heart racing or palpitations, syncope, lightheadedness, edema, and excessive fatigue. Implementation barriers included determining who would receive symptom reports, ensuring all members of the patient's care team (eg, oncologist, cardiologist, and primary care) were informed of the symptom reports and could collaborate on care plans, and how to best integrate the app data into the electronic health record. Patients (n=6, 100\%) agreed that the app would be useful for enhanced symptom capture and education and indicated willingness to use it. Conclusions: Providers and patients agree that a patient-facing, cancer treatment-related cardiotoxicity symptom-tracking mHealth app would be beneficial. Additional studies evaluating the role of mHealth as a potential strategy for targeted early cardioprotective therapy initiation are needed. ",
doi="10.2196/46481",
url="https://cancer.jmir.org/2023/1/e46481",
url="http://www.ncbi.nlm.nih.gov/pubmed/38085565"
}


@Article{info:doi/10.2196/47426,
author="Nitschke, Marlies
and Nwosu, Bertrand Obioma
and Grube, Lara
and Knitza, Johannes
and Seifer, Ann-Kristin
and Eskofier, M. Bjoern
and Schett, Georg
and Morf, Harriet",
title="Refinement and Usability Analysis of an eHealth App for Ankylosing Spondylitis as a Complementary Treatment to Physical Therapy: Development and Usability Study",
journal="JMIR Form Res",
year="2023",
month="Dec",
day="12",
volume="7",
pages="e47426",
keywords="ankylosing spondylitis",
keywords="axial spondylarthritis",
keywords="DHA",
keywords="digital health application",
keywords="eHealth",
keywords="self-assessment",
keywords="Usability",
keywords="Yoga",
keywords="YogiTherapy",
abstract="Background: Mobile eHealth apps have been used as a complementary treatment to increase the quality of life of patients and provide new opportunities for the management of rheumatic diseases. Telemedicine, particularly in the areas of prevention, diagnostics, and therapy, has become an essential cornerstone in the care of patients with rheumatic diseases. Objective: This study aims to improve the design and technology of YogiTherapy and evaluate its usability and quality. Methods: We newly implemented the mobile eHealth app YogiTherapy with a modern design, the option to change language, and easy navigation to improve the app's usability and quality for patients. After refinement, we evaluated the app by conducting a study with 16 patients with AS (4 female and 12 male; mean age 48.1,?SD?16.8 y). We assessed the usability of YogiTherapy with a task performance test (TPT) with a think-aloud protocol and the quality with the German version of the Mobile App Rating Scale (MARS). Results: In the TPT, the participants had to solve 6 tasks that should be performed on the app. The overall task completion rate in the TPT was high (84/96, 88\% completed tasks). Filtering for videos and navigating to perform an assessment test caused the largest issues during the TPT, while registering in the app and watching a yoga video were highly intuitive. Additionally, 12 (75\%) of the 16 participants completed the German version of MARS. The quality of YogiTherapy was rated with an average MARS score of 3.79?(SD?0.51) from a maximum score of 5. Furthermore, results from the MARS questionnaire demonstrated a positive evaluation regarding functionality and aesthetics. Conclusions: The refined and tested YogiTherapy app showed promising results among most participants. In the future, the app could serve its function as a complementary treatment for patients with AS. For this purpose, surveys with a larger number of patients should still be conducted. As a substantial advancement, we made the app free and openly available on the iOS App and Google Play stores. ",
doi="10.2196/47426",
url="https://formative.jmir.org/2023/1/e47426",
url="http://www.ncbi.nlm.nih.gov/pubmed/38085558"
}


@Article{info:doi/10.2196/51515,
author="Colonna, Giulia
and Hoye, Jocelyn
and de Laat, Bart
and Stanley, Gelsina
and Ibrahimy, Alaaddin
and Tinaz, Sule
and Morris, D. Evan",
title="Measuring Heart Rate Accurately in Patients With Parkinson Disease During Intense Exercise: Usability Study of Fitbit Charge 4",
journal="JMIR Biomed Eng",
year="2023",
month="Dec",
day="8",
volume="8",
pages="e51515",
keywords="Fitbit",
keywords="heart rate measurements",
keywords="Parkinson disease",
keywords="exercise",
keywords="accuracy",
keywords="intensity",
keywords="heart rate",
keywords="wearable",
keywords="neurodegenerative disease",
keywords="aerobic exercise",
keywords="physical exercise",
keywords="program",
keywords="device",
abstract="Background: Parkinson disease (PD) is the second most common neurodegenerative disease, affecting approximately 1\% of the world's population.Increasing evidence suggests that aerobic physical exercise can be beneficial in mitigating both motor and nonmotor symptoms of the disease.In a recent pilot study of the role of exercise on PD, we sought to confirm exercise intensity by monitoring heart rate (HR). For this purpose, we asked participants to wear a chest strap HR monitor (Polar Electro Oy) and the Fitbit Charge 4 (Fitbit Inc) wrist-worn HR monitor as a potential proxy due to its convenience.Polar H10 has been shown to provide highly accurate R-R interval measurements. Therefore, we treated it as the gold standard in this study. It has been shown that Fitbit Charge 4 has comparable accuracy to Polar H10 in healthy participants. It has yet to be determined if the Fitbit is as accurate as Polar H10 in patients with PD during rest and exercise. Objective: This study aimed to compare Fitbit Charge 4 to Polar H10 for monitoring HR in patients with PD at rest and during an intensive exercise program. Methods: A total of 596 exercise sessions from 11 (6 male and 5 female) participants were collected simultaneously with both devices. Patients with early-stage PD (Hoehn and Yahr ?2) were enrolled in a 6-month exercise program designed for patients with PD. They participated in 3 one-hour exercise sessions per week. They wore both Fitbit and Polar H10 during each session. Sessions included rest, warm-up, intense exercise, and cool-down periods.We calculated the bias in the HR of the Fitbit Charge 4 at rest (5 min) and during intense exercise (20 min) by comparing the mean HR during each of the periods to the respective means measured by Polar H10 (HRFitbit -- HRPolar). We also measured the sensitivity and specificity of Fitbit Charge 4 to detect average HRs that exceed the threshold for intensive exercise, defined as 70\% of an individual's theoretical maximum HR. Different types of correlations between the 2 devices were investigated. Results: The mean bias was 1.68 beats per minute (bpm) at rest and 6.29 bpm during high-intensity exercise, with an overestimation by Fitbit Charge 4 in both conditions. The mean bias of the Fitbit across both rest and intensive exercise periods was 3.98 bpm. The device's sensitivity in identifying high-intensity exercise sessions was 97.14\%. The correlation between the 2 devices was nonlinear, suggesting Fitbit's tendency to saturate at high values of HR. Conclusions: The performance of Fitbit Charge 4 is comparable to Polar H10 for assessing exercise intensity in a cohort of patients with PD (mean bias 3.98 bpm). The device could be considered a reasonable surrogate for more cumbersome chest-worn devices in future studies of clinical cohorts. ",
doi="10.2196/51515",
url="https://biomedeng.jmir.org/2023/1/e51515",
url="http://www.ncbi.nlm.nih.gov/pubmed/38875680"
}


@Article{info:doi/10.2196/42497,
author="Guo, Huey-Ming Sophie
and Lin, Jiun-Lu
and Hsing, Hung-Chun
and Lee, Chun-Chuan
and Chuang, Shih-Ming",
title="The Effect of Mobile eHealth Education to Improve Knowledge, Skills, Self-Care, and Mobile eHealth Literacies Among Patients With Diabetes: Development and Evaluation Study",
journal="J Med Internet Res",
year="2023",
month="Dec",
day="6",
volume="25",
pages="e42497",
keywords="mobile eHealth technology",
keywords="mHealth literacy",
keywords="eHealth literacy",
keywords="diabetes",
keywords="HbA1c",
keywords="self-care behavior",
abstract="Background: The promotion of mobile health (mHealth) and eHealth technologies as tools for managing chronic diseases, particularly diabetes mellitus, is on the rise. Nevertheless, individuals with diabetes frequently face a literacy gap that hinders their ability to fully leverage the benefits offered by these resources. Enhancing technology literacy to facilitate the adoption of mobile eHealth services poses a significant challenge in numerous countries. Objective: This study aims to develop an educational mobile eHealth literacy (eHL) program for patients with diabetes and to evaluate its effect on patients' outcomes. Methods: This study designed a mobile eHL education program comprising 2 modules specifically tailored for individuals with type 2 diabetes (T2D). These modules focused on guiding participants through the process of effectively navigating reliable health websites and utilizing diabetes-related apps. Using a pre- and posttest experimental design, the study featured an intervention group and a control group. Participants were recruited from 3 outpatient departments in hospitals, and assessments were conducted both before and after the intervention, along with a follow-up measure at the 3-month mark. The evaluation encompassed sociodemographic characteristics, computer and internet proficiency, mobile app usage, mobile eHL, and patient outcomes such as self-care behaviors and glycated hemoglobin (HbA1c) levels. Results: The analysis included a total of 132 eligible participants. Significant differences were observed in the mean scores of knowledge (P<.001) and skills (P<.001) related to computers, the web, and mobile devices at the initiation of the study and after the intervention. During the 3-month follow-up, the findings indicated a significant improvement in mobile eHL (t114=3.391, P=.001) and mHealth literacy (mHL, a subconcept of mobile eHL; t114=3.801, P<.001) within the intervention group, whereas no such improvement was observed in the control group. The chi-square values from the McNemar test underscored that individuals with uncontrolled diabetes (HbA1c?7\%) in the intervention group exhibited more improvement compared with the control group. The generalized estimating equations model unveiled a significant difference in the change of general mHL in the intervention group ($\beta$=1.91, P=.047) and self-care behavior in the control group from T0 to T2 ($\beta$=--8.21, P=.015). Despite being small, the effect sizes for mobile eHL (d=0.49) and HbA1c (d=0.33) in the intervention group were greater than those in the control group (d=0.14 and d=0.16, respectively). Conclusions: The implementation of a mobile eHL education intervention demonstrates a positive influence on the familiarity of patients with T2D regarding health technology, leading to favorable glycemic outcomes. While additional studies are warranted for a more comprehensive understanding, this program emerges as a promising solution for enhancing patients' uptake of digital health technology. ",
doi="10.2196/42497",
url="https://www.jmir.org/2023/1/e42497",
url="http://www.ncbi.nlm.nih.gov/pubmed/38055321"
}


@Article{info:doi/10.2196/46558,
author="Thompson, N. Alexandra
and Dawson, R. Deirdre
and Legasto-Mulvale, Michelle Jean
and Chandran, Nivetha
and Tanchip, Chelsea
and Niemczyk, Veronika
and Rashkovan, Jillian
and Jeyakumar, Saisa
and Wang, H. Rosalie
and Cameron, I. Jill
and Nalder, Emily",
title="Mobile Technology--Based Interventions for Stroke Self-Management Support: Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Dec",
day="6",
volume="11",
pages="e46558",
keywords="stroke",
keywords="chronic disease",
keywords="self-management",
keywords="rehabilitation",
keywords="mobile health",
keywords="mHealth",
keywords="eHealth",
keywords="telehealth",
keywords="telemedicine",
keywords="digital health",
keywords="mobile phone",
abstract="Background: There is growing interest in enhancing stroke self-management support using mobile health (mHealth) technology (eg, smartphones and apps). Despite this growing interest, ``self-management support'' is inconsistently defined and applied in the poststroke mHealth intervention literature, which limits efforts to synthesize and compare evidence. To address this gap in conceptual clarity, a scoping review was conducted. Objective: The objectives were to (1) identify and describe the types of poststroke mHealth interventions evaluated using a randomized controlled trial design, (2) determine whether (and how) such interventions align with well-accepted conceptualizations of self-management support (the theory by Lorig and Holman and the Practical Reviews in Self-Management Support [PRISMS] taxonomy by Pearce and colleagues), and (3) identify the mHealth functions that facilitate self-management. Methods: A scoping review was conducted according to the methodology by Arksey and O'Malley and Levac et al. In total, 7 databases were searched. Article screening and data extraction were performed by 2 reviewers. The data were analyzed using descriptive statistics and content analysis. Results: A total of 29 studies (26 interventions) were included. The interventions addressed 7 focal areas (physical exercise, risk factor management, linguistic exercise, activities of daily living training, medication adherence, stroke education, and weight management), 5 types of mobile devices (mobile phones or smartphones, tablets, wearable sensors, wireless monitoring devices, and laptops), and 7 mHealth functions (educating, communicating, goal setting, monitoring, providing feedback, reminding, and motivating). Collectively, the interventions aligned well with the concept of self-management support. However, on an individual basis (per intervention), the alignment was less strong. Conclusions: On the basis of the results, it is recommended that future research on poststroke mHealth interventions be more theoretically driven, more multidisciplinary, and larger in scale. ",
doi="10.2196/46558",
url="https://mhealth.jmir.org/2023/1/e46558",
url="http://www.ncbi.nlm.nih.gov/pubmed/38055318"
}


@Article{info:doi/10.2196/46718,
author="Peven, Kimberly
and Wickham, P. Aidan
and Wilks, Octavia
and Kaplan, C. Yusuf
and Marhol, Andrei
and Ahmed, Saddif
and Bamford, Ryan
and Cunningham, C. Adam
and Prentice, Carley
and Meczner, Andr{\'a}s
and Fenech, Matthew
and Gilbert, Stephen
and Klepchukova, Anna
and Ponzo, Sonia
and Zhaunova, Liudmila",
title="Assessment of a Digital Symptom Checker Tool's Accuracy in Suggesting Reproductive Health Conditions: Clinical Vignettes Study",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Dec",
day="5",
volume="11",
pages="e46718",
keywords="women's health",
keywords="symptom checkers",
keywords="symptom checker",
keywords="digital health",
keywords="chatbot",
keywords="accuracy",
keywords="eHealth apps",
keywords="mobile phone",
keywords="mobile health",
keywords="mHealth",
keywords="mobile health app",
keywords="polycystic ovary syndrome",
keywords="gynecology",
keywords="digital health tool",
keywords="endometriosis",
keywords="uterus",
keywords="uterine",
keywords="uterine fibroids",
keywords="vignettes",
keywords="clinical vignettes",
abstract="Background: Reproductive health conditions such as endometriosis, uterine fibroids, and polycystic ovary syndrome (PCOS) affect a large proportion of women and people who menstruate worldwide. Prevalence estimates for these conditions range from 5\% to 40\% of women of reproductive age. Long diagnostic delays, up to 12 years, are common and contribute to health complications and increased health care costs. Symptom checker apps provide users with information and tools to better understand their symptoms and thus have the potential to reduce the time to diagnosis for reproductive health conditions. Objective: This study aimed to evaluate the agreement between clinicians and 3 symptom checkers (developed by Flo Health UK Limited) in assessing symptoms of endometriosis, uterine fibroids, and PCOS using vignettes. We also aimed to present a robust example of vignette case creation, review, and classification in the context of predeployment testing and validation of digital health symptom checker tools. Methods: Independent general practitioners were recruited to create clinical case vignettes of simulated users for the purpose of testing each condition symptom checker; vignettes created for each condition contained a mixture of condition-positive and condition-negative outcomes. A second panel of general practitioners then reviewed, approved, and modified (if necessary) each vignette. A third group of general practitioners reviewed each vignette case and designated a final classification. Vignettes were then entered into the symptom checkers by a fourth, different group of general practitioners. The outcomes of each symptom checker were then compared with the final classification of each vignette to produce accuracy metrics including percent agreement, sensitivity, specificity, positive predictive value, and negative predictive value. Results: A total of 24 cases were created per condition. Overall, exact matches between the vignette general practitioner classification and the symptom checker outcome were 83\% (n=20) for endometriosis, 83\% (n=20) for uterine fibroids, and 88\% (n=21) for PCOS. For each symptom checker, sensitivity was reported as 81.8\% for endometriosis, 84.6\% for uterine fibroids, and 100\% for PCOS; specificity was reported as 84.6\% for endometriosis, 81.8\% for uterine fibroids, and 75\% for PCOS; positive predictive value was reported as 81.8\% for endometriosis, 84.6\% for uterine fibroids, 80\% for PCOS; and negative predictive value was reported as 84.6\% for endometriosis, 81.8\% for uterine fibroids, and 100\% for PCOS. Conclusions: The single-condition symptom checkers have high levels of agreement with general practitioner classification for endometriosis, uterine fibroids, and PCOS. Given long delays in diagnosis for many reproductive health conditions, which lead to increased medical costs and potential health complications for individuals and health care providers, innovative health apps and symptom checkers hold the potential to improve care pathways. ",
doi="10.2196/46718",
url="https://mhealth.jmir.org/2023/1/e46718",
url="http://www.ncbi.nlm.nih.gov/pubmed/38051574"
}


@Article{info:doi/10.2196/52464,
author="Wang, Yijun
and Guo, Fuding
and Wang, Jun
and Li, Zeyan
and Tan, Wuping
and Xie, Mengjie
and Yang, Xiaomeng
and Duan, Shoupeng
and Song, Lingpeng
and Cheng, Siyi
and Liu, Zhihao
and Liu, Hengyang
and Qiao, Jiaming
and Wang, Yueyi
and Zhou, Liping
and Zhou, Xiaoya
and Jiang, Hong
and Yu, Lilei",
title="Efficacy of a WeChat-Based Multimodal Digital Transformation Management Model in New-Onset Mild to Moderate Hypertension: Randomized Clinical Trial",
journal="J Med Internet Res",
year="2023",
month="Dec",
day="4",
volume="25",
pages="e52464",
keywords="digital health care",
keywords="mHealth",
keywords="mobile health",
keywords="apps",
keywords="applications",
keywords="controlled trials",
keywords="digital transformation",
keywords="precision",
keywords="multimodal",
keywords="precision medicine",
keywords="hypertension",
keywords="blood pressure",
keywords="WeChat",
keywords="social media",
keywords="self-management",
keywords="mobile phone",
abstract="Background: The advantages of multimodal digitally transformed mobile health management for patients diagnosed with mild to moderate hypertension are not yet established. Objective: We aim to evaluate the therapeutic benefits of a novel WeChat-based multimodal digital transforming management model in mobile health blood pressure (BP) management. Methods: This randomized controlled clinical trial included 175 individuals with new-onset mild to moderate hypertension who were admitted to our center between September and October 2022. The patients were randomly assigned to either the multimodal intervention group (n=88) or the usual care group (n=87). The primary composite outcome was home and office BP differences after 6 months. The major secondary outcomes were 6-month quality-of-life scores, including the self-rating anxiety scale, self-rating depression scale, and Pittsburgh Sleep Quality Index. Results: The mean home BP decreased from 151.74 (SD 8.02)/94.22 (SD 9.32) to 126.19 (SD 8.45)/82.28 (SD 9.26) mm Hg in the multimodal intervention group and from 150.78 (SD 7.87)/91.53 (SD 9.78) to 133.48 (SD 10.86)/84.45 (SD 9.19) mm Hg in the usual care group, with a mean difference in systolic blood pressure and diastolic blood pressure of --8.25 mm Hg (95\% CI --11.71 to --4.78 mm Hg; P<.001) and --4.85 mm Hg (95\% CI --8.41 to --1.30 mm Hg; P=.008), respectively. The mean office BP decreased from 153.64 (SD 8.39)/93.56 (SD 8.45) to 127.81 (SD 8.04)/ 82.16 (SD 8.06) mm Hg in the multimodal intervention group and from 151.48 (SD 7.14)/(91.31 (SD 9.61) to 134.92 (SD 10.11)/85.09 (SD 8.26) mm Hg in the usual care group, with a mean difference in systolic blood pressure and diastolic blood pressure of --9.27 mm Hg (95\% CI --12.62 to --5.91 mm Hg; P<.001) and --5.18 mm Hg (95\% CI --8.47 to --1.89 mm Hg; P=.002), respectively. From baseline to 6 months, home BP control <140/90 mm Hg was achieved in 64 (72.7\%) patients in the multimodal intervention group and 46 (52.9\%) patients in the usual care group (P=.007). Meanwhile, home BP control <130/80 mm Hg was achieved in 32 (36.4\%) patients in the multimodal intervention group and 16 (18.4\%) patients in the usual care group (P=.008). After 6 months, there were significant differences in the quality-of-life total and graded scores, including self-rating anxiety scale scores (P=.04), self-rating depression scale scores (P=.03), and Pittsburgh Sleep Quality Index scores (P<.001), in the multimodal intervention group compared with the usual care group. Conclusions: The WeChat-based multimodal intervention model improved the BP control rates and lowered the BP levels more than the usual care approach. The multimodal digital transforming management model for hypertension represents an emerging medical practice that utilizes the individual's various risk factor profiles for primary care and personalized therapy decision-making in patients with hypertension. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200063550; https://www.chictr.org.cn/showproj.html?proj=175816 ",
doi="10.2196/52464",
url="https://www.jmir.org/2023/1/e52464",
url="http://www.ncbi.nlm.nih.gov/pubmed/38048156"
}


@Article{info:doi/10.2196/49735,
author="Bentsen, Line
and Hangh{\o}j, Signe
and Hjerming, Maiken
and Bergmann, Buur Mette
and Thycosen, Marianne
and Borup, Anette
and Larsen, Camilla
and Pappot, Helle",
title="Development of Quality of Life in Adolescents and Young Adults With Cancer Using a Patient Support Smartphone App: Prepost Interventional Study",
journal="JMIR Cancer",
year="2023",
month="Dec",
day="4",
volume="9",
pages="e49735",
keywords="adolescent",
keywords="young adult",
keywords="cancer",
keywords="quality of life",
keywords="eHealth",
keywords="smartphone application",
keywords="application",
keywords="development",
keywords="interventional study",
keywords="youth",
keywords="grief",
keywords="symptom tracker",
keywords="social community",
keywords="Denmark",
keywords="physical functioning",
keywords="treatment",
keywords="mobile phone",
abstract="Background: Adolescents and young adults often experience existential concerns in addition to side effects during a cancer trajectory, which they often carry alone. Thus, cohesion with other adolescents and young adults with cancer is essential but difficult due to the relatively small, widely dispersed nationwide population. In cocreation, a smartphone app has been developed and includes an information bank, a symptom tracker, and a social community platform, aiming to improve the quality of life (QoL) in this patient group. Objective: This nationwide, multicenter study aimed to investigate the QoL in adolescents and young adults undergoing a cancer trajectory as they used the app for 6 weeks. Methods: Via youth support initiatives, participants were recruited from hospitals in all regions of Denmark. Inclusion criteria were patients with cancer aged 15-29 years who either initiated any cancer treatment or started follow-up after cancer treatment within 30 days. Participants used the adolescents and young adults cancer app for 6 weeks. Before and after the 6 weeks of app use, they completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). The participants were divided into a treatment and a follow-up group for analysis. A high score for a functional scale or the global health or overall QoL represents a high or healthy level of functioning or high QoL, respectively; however, a high score for a symptom scale or item represents a high level of symptomatology. Results: Overall, 81 participants were recruited. However, 4 participants did not answer the questionnaire and 6 participants did not use the app. In the treatment group (n=36), significant improvement was found in 2 domains: ``Role functioning'' (baseline median 33.33, IQR 16.67-83.33 vs 6 weeks median 66.67, IQR 33.33-83.33;?P=.04) and ``Pain'' (baseline median 33.33, IQR 16.67-50.00 vs 6 weeks median 16.67, IQR 0.00-33.33;?P=.04). The ``Global health/Overall QoL'' scale remained stable (baseline median 58.33, IQR 45.83-77.08 vs 6 weeks median 62.50, IQR 41.67-75.00;?P=.25). In the follow-up group (n=35), significant improvement was found in 3 domains: ``Physical functioning'' (baseline median 79.23, IQR 73.33-93.33 vs 6 weeks median 82.86, IQR 73.33-100.00;?P=.03), ``Cognitive functioning'' (baseline median 62.38, IQR 50.00-83.33 vs 6 weeks median 69.52, IQR 50.00-100.00;?P=.02), and ``Social functioning'' (baseline median 76.19, IQR 50.00-100.00 vs 6 weeks median 85.71, IQR 83.33-100.00;?P=.05), as well as in the ``Global health/Overall QoL'' scale (baseline median 57.14, IQR 83.33-100.00 vs 6 weeks median 75.0, IQR 62.91-85.73;?P<.001). Conclusions: In this study, we found an improvement in specific QoL scales for both participants in treatment and follow-up when using the app for 6 weeks. The global health or overall QoL score improved significantly in the follow-up group. In the treatment group, it remained stable. International Registered Report Identifier (IRRID): RR2-10.2196/10098 ",
doi="10.2196/49735",
url="https://cancer.jmir.org/2023/1/e49735",
url="http://www.ncbi.nlm.nih.gov/pubmed/38048144"
}


@Article{info:doi/10.2196/51316,
author="Einhorn, Julian
and Murphy, R. Andrew
and Rogal, S. Shari
and Suffoletto, Brian
and Irizarry, Taya
and Rollman, L. Bruce
and Forman, E. Daniel
and Muldoon, F. Matthew",
title="Automated Messaging Program to Facilitate Systematic Home Blood Pressure Monitoring: Qualitative Analysis of Provider Interviews",
journal="JMIR Cardio",
year="2023",
month="Dec",
day="4",
volume="7",
pages="e51316",
keywords="mHealth",
keywords="digital intervention",
keywords="qualitative research",
keywords="provider stakeholders",
keywords="hypertension",
keywords="home blood pressure monitoring",
keywords="implementation research",
keywords="short-messaging system",
keywords="remote monitoring",
keywords="qualitative analysis",
keywords="messaging program",
keywords="blood pressure",
keywords="monitoring",
keywords="cardiovascular",
keywords="disease",
keywords="text messaging",
keywords="text mining",
keywords="self-management",
keywords="mobile phone",
abstract="Background: Hypertension is a leading cause of cardiovascular and kidney disease in the United States, yet blood pressure (BP) control at a population level is poor and worsening. Systematic home BP monitoring (HBPM) programs can lower BP, but programs supporting HBPM are not routinely used. The MyBP program deploys automated bidirectional text messaging for HBPM and disease self-management support. Objective: We aim to produce a qualitative analysis of input from providers and staff regarding implementation of an innovative HBPM program in primary care practices. Methods: Semistructured interviews (average length 31 minutes) were conducted with physicians (n=11), nurses, and medical assistants (n=6) from primary care settings. The interview assessed multiple constructs in the Consolidated Framework for Implementation Research domains of intervention characteristics, outer setting, inner setting, and characteristics of individuals. Interviews were transcribed verbatim and analyzed using inductive coding to organize meaningful excerpts and identify salient themes, followed by mapping to the updated Consolidated Framework for Implementation Research constructs. Results: Health care providers reported that MyBP has good ease of use and was likely to engage patients in managing their high BP. They also felt that it would directly support systematic BP monitoring and habit formation in the convenience of the patient's home. This could increase health literacy and generate concrete feedback to raise the day-to-day salience of BP control. Providers expressed concern that the cost of BP devices remains an encumbrance. Some patients were felt to have overriding social or emotional barriers, or lack the needed technical skills to interact with the program, use good measurement technique, and input readings accurately. With respect to effects on their medical practice, providers felt MyBP would improve the accuracy and frequency of HBPM data, and thereby improve diagnosis and treatment management. The program may positively affect the patient-provider relationship by increasing rapport and bidirectional accountability. Providers appreciated receiving aggregated HBPM data to increase their own efficiency but also expressed concern about timely routing of incoming HBPM reports, lack of true integration with the electronic health record, and the need for a dedicated and trained staff member. Conclusions: In this qualitative analysis, health care providers perceived strong relative advantages of using MyBP to support patients. The identified barriers suggest the need for corrective implementation strategies to support providers in adopting the program into routine primary care practice, such as integration into the workflow and provider education. Trial Registration: ClinicalTrials.gov NCT03650166; https://tinyurl.com/bduwn6r4 ",
doi="10.2196/51316",
url="https://cardio.jmir.org/2023/1/e51316",
url="http://www.ncbi.nlm.nih.gov/pubmed/38048147"
}


@Article{info:doi/10.2196/46430,
author="Esmaeilzadeh, Pouyan",
title="Older Adults' Perceptions About Using Intelligent Toilet Seats Beyond Traditional Care: Web-Based Interview Survey",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Dec",
day="1",
volume="11",
pages="e46430",
keywords="older adults",
keywords="age tech",
keywords="intelligent toilet seat",
keywords="survey interview",
keywords="qualitative study",
keywords="mobile phone",
abstract="Background: In contemporary society, age tech (age technology) represents a significant advancement in health care aimed at enhancing patient engagement, ensuring sustained independence, and promoting quality of life for older people. One innovative form of age tech is the intelligent toilet seat, which is designed to collect, analyze, and provide insights based on toileting logs and excreta data. Understanding how older people perceive and interact with such technology can offer invaluable insights to researchers, technology developers, and vendors. Objective: This study examined older adults' perspectives regarding the use of intelligent toilet seats. Through a qualitative methodology, this research aims to unearth the nuances of older people's opinions, shedding light on their preferences, concerns, and potential barriers to adoption. Methods: Data were collected using a web-based interview survey distributed on Amazon Mechanical Turk. The analyzed data set comprised 174 US-based individuals aged ?65 years who voluntarily participated in this study. The qualitative data were carefully analyzed using NVivo (Lumivero) based on detailed content analysis, ensuring that emerging themes were coded and classified based on the conceptual similarities in the respondents' narratives. Results: The analysis revealed 5 dominant themes encompassing the opinions of aging adults. The perceived benefits and advantages of using the intelligent toilet seat were grouped into 3 primary themes: health-related benefits including the potential for early disease detection, continuous health monitoring, and seamless connection to health care insights. Technology-related advantages include the noninvasive nature of smart toilet seats and leveraging unique and innovative data collection and analysis technology. Use-related benefits include ease of use, potential for multiple users, and cost reduction owing to the reduced need for frequent clinical visits. Conversely, the concerns and perceived risks were classified into 2 significant themes: psychological concerns, which included concerns about embarrassment and aging-related stereotypes, and the potential emotional impact of constant health monitoring. Technical performance risks include concerns centered on privacy and security, device reliability, data accuracy, potential malfunctions, and the implications of false positives or negatives. Conclusions: The decision of older adults to incorporate intelligent toilet seats into their daily lives depends on myriad factors. Although the potential health and technological benefits are evident, valid concerns that need to be addressed remain. To foster widespread adoption, it is imperative to enhance the advantages while simultaneously addressing and mitigating the identified risks. This balanced approach will pave the way for a more holistic integration of smart health care devices into the routines of the older population, ensuring that they reap the full benefits of age tech advancements. ",
doi="10.2196/46430",
url="https://mhealth.jmir.org/2023/1/e46430",
url="http://www.ncbi.nlm.nih.gov/pubmed/38039065"
}


@Article{info:doi/10.2196/48483,
author="Govindaraj, Ramkumar
and Agar, Meera
and Currow, David
and Luckett, Tim",
title="Assessing Patient-Reported Outcomes in Routine Cancer Clinical Care Using Electronic Administration and Telehealth Technologies: Realist Synthesis of Potential Mechanisms for Improving Health Outcomes",
journal="J Med Internet Res",
year="2023",
month="Nov",
day="28",
volume="25",
pages="e48483",
keywords="patient-reported outcome measure",
keywords="PROM",
keywords="PROMs",
keywords="realist synthesis",
keywords="oncology",
keywords="eHealth",
keywords="patient reported",
keywords="outcome measure",
keywords="outcome measures",
keywords="realist",
keywords="literature review",
keywords="narrative review",
keywords="search strategy",
keywords="review methods",
keywords="review methodology",
keywords="electronic patient-reported outcome measure",
keywords="ePROM",
keywords="cancer",
keywords="self-reporting",
keywords="mobile phone",
abstract="Background: The routine measurement of patient-reported outcomes in cancer clinical care using electronic patient-reported outcome measures (ePROMs) is gaining momentum worldwide. However, a deep understanding of the mechanisms underpinning ePROM interventions that could inform their optimal design to improve health outcomes is needed. Objective: This study aims to identify the implicit mechanisms that underpin the effectiveness of ePROM interventions and develop program theories about how and when ePROM interventions improve health outcomes. Methods: A realist synthesis of the literature about ePROM interventions in cancer clinical care was performed. A conceptual framework of ePROM interventions was constructed to define the scope of the review and frame the initial program theories. Literature searches of Ovid MEDLINE, Ovid Embase, Scopus, and CINAHL, supplemented by citation tracking, were performed to identify relevant literature to develop, refine, and test program theories. Quality appraisal of relevant studies was performed using the Mixed Methods Appraisal Tool. Results: Overall, 61 studies were included in the realist synthesis: 15 (25\%) mixed methods studies, 9 (15\%) qualitative studies, 13 (21\%) descriptive studies, 21 (34\%) randomized controlled trials, and 3 (5\%) quasi-experimental studies. In total, 3 initial program theories were developed regarding the salient components of ePROM interventions---remote self-reporting, real-time feedback to clinicians, and clinician-patient telecommunication. The refined theories posit that remote self-reporting enables patients to recognize and report symptoms accurately and empowers them to communicate these to clinicians, real-time feedback prompts clinicians to manage symptoms proactively, and clinician-patient telephone interactions and e-interactions between clinic encounters improve symptom management by reshaping how clinicians and patients communicate. However, the intervention may not achieve the intended benefit if ePROMs become a reminder to patients of their illness and are not meaningful to them and when real-time feedback to clinicians lacks relevance and increases the workload. Conclusions: The key to improving health outcomes through ePROM interventions is enabling better symptom reporting and communication through remote symptom self-reporting, promoting proactive management of symptoms through real-time clinician feedback, and facilitating clinician-patient interactions. Patient engagement with self-reporting and clinician engagement in responding to feedback are vital and may reinforce each other in improving outcomes. Effective ePROM interventions might fundamentally alter how clinicians and patients interact between clinic encounters. ",
doi="10.2196/48483",
url="https://www.jmir.org/2023/1/e48483",
url="http://www.ncbi.nlm.nih.gov/pubmed/38015606"
}


@Article{info:doi/10.2196/51507,
author="Althobiani, A. Malik
and Ranjan, Yatharth
and Jacob, Joseph
and Orini, Michele
and Dobson, Butler Richard James
and Porter, C. Joanna
and Hurst, R. John
and Folarin, A. Amos",
title="Evaluating a Remote Monitoring Program for Respiratory Diseases: Prospective Observational Study",
journal="JMIR Form Res",
year="2023",
month="Nov",
day="24",
volume="7",
pages="e51507",
keywords="remote monitoring",
keywords="home health care",
keywords="mHealth",
keywords="mobile health",
keywords="apps",
keywords="applications",
keywords="wearables",
keywords="passive data collection",
keywords="data collection",
keywords="retention",
keywords="engagement",
keywords="attrition",
keywords="dropout",
keywords="spirometry",
keywords="oximetry",
keywords="home based",
keywords="machine learning",
keywords="artificial intelligence",
keywords="chronic obstructive pulmonary disease",
keywords="COPD",
keywords="pulmonary",
keywords="lungs",
keywords="respiratory",
keywords="interstitial lung disease",
keywords="ILD",
keywords="COVID-19",
keywords="respiratory diseases",
keywords="lung",
keywords="chronic",
keywords="SARS-CoV-2",
keywords="monitoring",
keywords="observational",
keywords="cohort",
keywords="feasibility",
keywords="usability",
keywords="acceptability",
keywords="community based",
keywords="self-management",
abstract="Background: Patients with chronic respiratory diseases and those in the postdischarge period following hospitalization because of COVID-19 are particularly vulnerable, and little is known about the changes in their symptoms and physiological parameters. Continuous remote monitoring of physiological parameters and symptom changes offers the potential for timely intervention, improved patient outcomes, and reduced health care costs. Objective: This study investigated whether a real-time multimodal program using commercially available wearable technology, home-based Bluetooth-enabled spirometers, finger pulse oximeters, and smartphone apps is feasible and acceptable for patients with chronic respiratory diseases, as well as the value of low-burden, long-term passive data collection. Methods: In a 3-arm prospective observational cohort feasibility study, we recruited 60 patients from the Royal Free Hospital and University College Hospital. These patients had been diagnosed with interstitial lung disease, chronic obstructive pulmonary disease, or post--COVID-19 condition (n=20 per group) and were followed for 180 days. This study used a comprehensive remote monitoring system designed to provide real-time and relevant data for both patients and clinicians. Data were collected using REDCap (Research Electronic Data Capture; Vanderbilt University) periodic surveys, Remote Assessment of Disease and Relapses--base active app questionnaires, wearables, finger pulse oximeters, smartphone apps, and Bluetooth home-based spirometry. The feasibility of remote monitoring was measured through adherence to the protocol, engagement during the follow-up period, retention rate, acceptability, and data integrity. Results: Lowest-burden passive data collection methods, via wearables, demonstrated superior adherence, engagement, and retention compared with active data collection methods, with an average wearable use of 18.66 (SD 4.69) hours daily (77.8\% of the day), 123.91 (SD 33.73) hours weekly (72.6\% of the week), and 463.82 (SD 156.70) hours monthly (64.4\% of the month). Highest-burden spirometry tasks and high-burden active app tasks had the lowest adherence, engagement, and retention, followed by low-burden questionnaires. Spirometry and active questionnaires had the lowest retention at 0.5 survival probability, indicating that they were the most burdensome. Adherence to and quality of home spirometry were analyzed; of the 7200 sessions requested, 4248 (59\%) were performed. Of these, 90.3\% (3836/4248) were of acceptable quality according to American Thoracic Society grading. Inclusion of protocol holidays improved retention measures. The technologies used were generally well received. Conclusions: Our findings provide evidence supporting the feasibility and acceptability of remote monitoring for capturing both subjective and objective data from various sources for respiratory diseases. The high engagement level observed with passively collected data suggests the potential of wearables for long-term, user-friendly remote monitoring in respiratory disease management. The unique piloting of certain features such as protocol holidays, alert notifications for missing data, and flexible support from the study team provides a reference for future studies in this field. International Registered Report Identifier (IRRID): RR2-10.2196/28873 ",
doi="10.2196/51507",
url="https://formative.jmir.org/2023/1/e51507",
url="http://www.ncbi.nlm.nih.gov/pubmed/37999935"
}


@Article{info:doi/10.2196/33147,
author="Reston, Elizabeth Riley
and Caskey, J. Fergus
and Hole, Barnaby
and Udayaraj, Udaya
and Weinman, John",
title="CareKnowDo---A Multichannel Digital and Telephone Support Program for People With Chronic Kidney Disease: Feasibility Randomized Controlled Trial",
journal="JMIR Form Res",
year="2023",
month="Nov",
day="23",
volume="7",
pages="e33147",
keywords="kidney disease",
keywords="chronic",
keywords="blood pressure",
keywords="randomized controlled trial",
keywords="telemedicine",
keywords="mobile health",
keywords="mHealth",
keywords="self-management",
keywords="guideline adherence",
keywords="medication adherence",
keywords="illness beliefs",
keywords="medication beliefs",
keywords="health psychology",
keywords="preventative medicine",
keywords="qualitative research",
abstract="Background: Chronic kidney disease (CKD) is a common, progressive condition. Lifestyle changes and antihypertensive medication can slow the progression to end-stage kidney disease, which requires renal replacement therapy. However, adherence to these recommendations is often low. Objective: The aim of CareKnowDo was to assess the feasibility of rolling out a digital self-management support and adherence program integrated with a patient-facing electronic health record, Patient View (PV). Methods: A 2-arm, parallel, individual-level pragmatic feasibility pilot randomized controlled trial was conducted at 2 National Health Service (NHS) sites in the United Kingdom. A total of 61 patients with CKD were randomized 1:1 into 2 groups and provided with either a new, tailored digital and telephone support program (CareKnowDo: 31/61, 51\%) integrated with PV or standard care (PV alone: 30/61, 49\%). Quantitative measures included clinical and psychosocial measures. The primary outcomes were feasibility based: recruitment rate, dropout, and the exploration of associations. Results: Of the 1392 patients screened in local kidney clinics, 269 (19.32\%) met the basic inclusion criteria; the first 22.7\% (61/269) who met the eligibility criteria were recruited to participate in the study. Of the 69 patients, 23 (38\%) patients completed the final 6-month follow-up web-based survey. Reasons for the attrition were explored. A higher belief in the ability of the treatment to control CKD was associated with lower blood pressure at baseline (r=0.52; P=.005), and a higher perceived understanding of CKD at baseline was associated with lower blood pressure at follow-up (r=0.66; P<.001). Beliefs about medicines at baseline were associated with blood pressure at baseline but not at follow-up. This was true for both concerns about medicines (r=0.58; P=.001) and perceived necessity of medicines (r=0.42; P=.03). Conclusions: A tailored digital and nurse call--based program to enhance support for patients with CKD was piloted in 2 NHS sites and found to be feasible and acceptable. However, to maximize the effectiveness of the intervention (and of future trials), consideration should be given to the target audience most likely to benefit, as well as how to help them access the program as quickly and easily as possible. Trial Registration: NHS Health Research Authority, IRAS ID 184206; https://www.hra.nhs.uk/planning-and-improving -research/application-summaries/research-summaries/careknowdo-pilot-version-1/ ",
doi="10.2196/33147",
url="https://formative.jmir.org/2023/1/e33147",
url="http://www.ncbi.nlm.nih.gov/pubmed/37995117"
}


@Article{info:doi/10.2196/45145,
author="Lim, Chun Dwight Su
and Kwok, Benedict
and Williams, Patricia
and Koczwara, Bogda",
title="The Impact of Digital Technology on Self-Management in Cancer: Systematic Review",
journal="JMIR Cancer",
year="2023",
month="Nov",
day="22",
volume="9",
pages="e45145",
keywords="self-management",
keywords="self-management support",
keywords="self-management core skills",
keywords="digital technology",
keywords="digital health",
keywords="mHealth",
keywords="mobile health",
keywords="eHealth",
keywords="cancer",
keywords="theoretical frameworks",
keywords="predictors of effect",
keywords="chronic disease",
keywords="skills",
keywords="decision-making",
keywords="cancer treatment",
abstract="Background: Self-management (SM) plays an important role in supporting patients' adaptation to and management of the symptoms of chronic diseases. Cancer is a chronic disease that requires patients to have responsibility in management. Digital technology has the potential to enhance SM support, but there is little data on what SM skills are most commonly supported by digital technology. Objective: This review aimed to examine the SM core skills that were enabled and supported by digital interventions in people with cancer and identify any predictors of the effect of digital health intervention on SM core skills. Methods: Three electronic databases (MEDLINE, Scopus, and CINAHL) were searched for papers, published from January 2010 to February 2022, that reported randomized controlled trials (RCTs) involving patients with cancer or survivors of cancer where a digital technology intervention was evaluated and change in 1 or more SM core skills was a measured outcome. Results: This systematic review resulted in 12 studies that were eligible to identify which SM core skills were enabled and supported by digital intervention. The total number of participants in the 12 studies was 2627. The most common SM core skills targeted by interventions were decision-making, goal setting, and partnering with health professionals. A total of 8 (67\%) out of 12 RCTs demonstrated statistically significant improvement in outcomes including self-efficacy, survivorship care knowledge and attitude, quality of life, increased knowledge of treatment, and emotional and social functioning. A total of 5 (62\%) out of 8 positive RCTs used theoretical considerations in their study design; whereas in 1 (25\%) out of 4 negative RCTs, theoretical considerations were used. In 3 studies, some factors were identified that were associated with the development of SM core skills, which included younger age (regression coefficient [RC]=--0.06, 95\% CI --0.10 to --0.02; P=.002), computer literacy (RC=--0.20, 95\% CI --0.37 to --0.03; P=.02), completing cancer treatment (Cohen d=0.31), male sex (SD 0.34 in social functioning; P=.009), higher education (SD 0.19 in social functioning; P=.04), and being a recipient of chemotherapy (SD 0.36 in depression; P=.008). In all 3 studies, there were no shared identical factors that supported the development of SM core skills, whereby each study had a unique set of factors that supported the development of SM core skills. Conclusions: Digital technology for patients with cancer appears to improve SM core skills including decision-making, goal setting, and partnering with health care partners. This effect is greater in people who are younger, male, educated, highly computer literate, completing cancer treatment, or a recipient of chemotherapy. Future research should focus on targeting multiple SM core skills and identifying predictors of the effect of digital technology intervention. Trial Registration: PROSPERO CRD42021221922; https://tinyurl.com/mrx3pfax ",
doi="10.2196/45145",
url="https://cancer.jmir.org/2023/1/e45145",
url="http://www.ncbi.nlm.nih.gov/pubmed/37991831"
}


@Article{info:doi/10.2196/47103,
author="Alluhaidan, Saleh Ala
and Chatterjee, Samir
and Drew, E. David
and Ractham, Peter
and Kaewkitipong, Laddawan",
title="Empowerment Enabled by Information and Communications Technology and Intention to Sustain a Healthy Behavior: Survey of General Users",
journal="JMIR Hum Factors",
year="2023",
month="Nov",
day="22",
volume="10",
pages="e47103",
keywords="empowerment",
keywords="behavior change",
keywords="information and communications technology",
keywords="ICT",
keywords="sustaining health behavior",
keywords="long-term health behavior",
keywords="mobile phone",
abstract="Background: Most people with chronic conditions fail to adhere to self-management behavioral guidelines. In the last 2 decades, several mobile health apps and IT-based systems have been designed and developed to help patients change and sustain their healthy behaviors. However, these systems often lead to short-term behavior change or adherence while the goal is to engage the population toward long-term behavior change. Objective: This study aims to contribute to the development of long-term health behavior changes or to help people sustain their healthy behavior. For this purpose, we built and tested a theoretical model that includes enablers of empowerment and an intention to sustain a healthy behavior when patients are assisted by information and communications technology. Methods: Structural equation modeling was used to analyze 427 survey returns collected from a diverse population of participants and patients. Notably, the model testing was performed for physical activity as a generally desirable healthy goal. Results: Message aligned with personal goals, familiarity with technology tools, high self-efficacy, social connection, and community support played a significant role (P<.001) in empowering individuals to maintain a healthy behavior. The feeling of being empowered exhibited a strong influence, with a path coefficient of 0.681 on an intention to sustain healthy behavior. Conclusions: The uniqueness of this model is its recognition of needs (ie, social connection, community support, and self-efficacy) to sustain a healthy behavior. Individuals are empowered when they are assisted by family and community, specifically when they possess the knowledge, skills, and self-awareness to ascertain and achieve their goals. This nascent theory explains what might lead to more sustainable behavior change and is meant to help designers build better apps that enable people to conduct self-care routines and sustain their behavior. ",
doi="10.2196/47103",
url="https://humanfactors.jmir.org/2023/1/e47103",
url="http://www.ncbi.nlm.nih.gov/pubmed/37991814"
}


@Article{info:doi/10.2196/49144,
author="Jang, Hyunchul
and Lee, Siwoo
and Son, Yunhee
and Seo, Sumin
and Baek, Younghwa
and Mun, Sujeong
and Kim, Hoseok
and Kim, Icktae
and Kim, Junho",
title="Exploring Variations in Sleep Perception: Comparative Study of Chatbot Sleep Logs and Fitbit Sleep Data",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Nov",
day="21",
volume="11",
pages="e49144",
keywords="sleep",
keywords="sleep time",
keywords="chat",
keywords="self-report",
keywords="sleep log",
keywords="sleep diary",
keywords="wearables",
keywords="Fitbit",
keywords="patient-generated health data",
keywords="PGHD",
abstract="Background: Patient-generated health data are important in the management of several diseases. Although there are limitations, information can be obtained using a wearable device and time-related information such as exercise time or sleep time can also be obtained. Fitbits can be used to acquire sleep onset, sleep offset, total sleep time (TST), and wakefulness after sleep onset (WASO) data, although there are limitations regarding the depth of sleep and satisfaction; therefore, the patient's subjective response is still important information that cannot be replaced by wearable devices. Objective: To effectively use patient-generated health data related to time such as sleep, it is first necessary to understand the characteristics of the time response recorded by the user. Therefore, the aim of this study was to analyze the characteristics of individuals' time perception in comparison with wearable data. Methods: Sleep data were acquired for 2 weeks using a Fitbit. Participants' sleep records were collected daily through chatbot conversations while wearing the Fitbit, and the two sets of data were statistically compared. Results: In total, 736 people aged 30-59 years were recruited for this study, and the sleep data of 543 people who wore a Fitbit and responded to the chatbot for more than 7 days on the same day were analyzed. Research participants tended to respond to sleep-related times on the hour or in 30-minute increments, and each participant responded within the range of 60-90 minutes from the value measured by the Fitbit. On average for all participants, the chat responses and the Fitbit data were similar within a difference of approximately 15 minutes. Regarding sleep onset, the participant response was 8 minutes and 39 seconds (SD 58 minutes) later than that of the Fitbit data, whereas with respect to sleep offset, the response was 5 minutes and 38 seconds (SD 57 minutes) earlier. The participants' actual sleep time (AST) indicated in the chat was similar to that obtained by subtracting the WASO from the TST measured by the Fitbit. The AST was 13 minutes and 39 seconds (SD 87 minutes) longer than the time WASO was subtracted from the Fitbit TST. On days when the participants reported good sleep, they responded 19 (SD 90) minutes longer on the AST than the Fitbit data. However, for each sleep event, the probability that the participant's AST was within {\textpm}30 and {\textpm}60 minutes of the Fitbit TST-WASO was 50.7\% and 74.3\%, respectively. Conclusions: The chatbot sleep response and Fitbit measured time were similar on average and the study participants had a slight tendency to perceive a relatively long sleep time if the quality of sleep was self-reported as good. However, on a participant-by-participant basis, it was difficult to predict participants' sleep duration responses with Fitbit data. Individual variations in sleep time perception significantly affect patient responses related to sleep, revealing the limitations of objective measures obtained through wearable devices. ",
doi="10.2196/49144",
url="https://mhealth.jmir.org/2023/1/e49144",
url="http://www.ncbi.nlm.nih.gov/pubmed/37988148"
}


@Article{info:doi/10.2196/52036,
author="Liew, Huiling
and Pienkowska, Anita
and Ang, Chin-Siang
and Mahadzir, Azlan Muhammad Daniel
and Goh, Ing Kelley Fann
and Lodh, Nandika
and Bojic, Iva
and Lawate, Ashwini
and Ong, Chwen Qi
and Venkataraman, Kavita
and Car, Josip
and Ho, Yan Andy Hau",
title="Empowering Foot Care Literacy Among People Living With Diabetes and Their Carers With an mHealth App: Protocol for a Feasibility Study",
journal="JMIR Res Protoc",
year="2023",
month="Nov",
day="21",
volume="12",
pages="e52036",
keywords="digital therapeutics",
keywords="mHealth",
keywords="diabetes mellitus",
keywords="diabetes foot ulcer",
keywords="feasibility study",
keywords="mobile phone",
abstract="Background: Diabetic foot ulcers (DFUs) cause significant morbidity affecting 19\% to 34\% of people living with diabetes mellitus. DFUs not only impair quality of life but may also result in limb loss and mortality. Patient education has been advocated to raise awareness of proper foot self-care and the necessity of seeking assistance when a foot wound occurs. Modern technologies, including mobile health (mHealth) interventions such as health apps, bring the potential for more cost-effective and scalable interventions. Objective: This study aims to examine the feasibility and usability of a newly developed mHealth app called Well Feet, which is a diabetes and foot care education app for individuals at risk of developing DFU. Methods: Well Feet was developed using an evidence-based and expert panel cocreation approach to deliver educational content available in 3 languages (ie, English, Chinese, and Malay) via animation videos and a range of additional features, including adaptive learning. A nonrandomized, single-arm feasibility study using a mixed methods approach with a series of validated questionnaires and focus group discussions will be conducted. In total, 40 patients and carers will be recruited from a tertiary hospital diabetes clinic to receive a 1-month mHealth intervention. The primary outcomes are the usability of the app and a qualitative perspective on user experience. Secondary outcomes include changes in foot care knowledge, self-management behaviors, and quality of life. Results: Patient recruitment began in July 2023, and the intervention and data collection will be completed by the end of September 2023. This study has been approved by National Healthcare Group Domain Specific Review Board (2022/00614) on February 10, 2023. The expected results will be published in spring 2024. Conclusions: Through this feasibility study, the Well Feet DFU education app will undergo a comprehensive quantitative and qualitative evaluation of its usability and acceptance for future improvement in its design. With local contextualization, cultural adaptation, and its multilingual functionality, the app addresses a critical aspect of DFU health education and self-management in a multiethnic population. Findings from this study will refine and enhance the features of the app based on user feedback and shape the procedural framework for a subsequent randomized controlled trial to assess the effectiveness of Well Feet. Trial Registration: ClinicalTrials.gov NCT05564728; https://clinicaltrials.gov/study/NCT05564728 International Registered Report Identifier (IRRID): DERR1-10.2196/52036 ",
doi="10.2196/52036",
url="https://www.researchprotocols.org/2023/1/e52036",
url="http://www.ncbi.nlm.nih.gov/pubmed/37988150"
}


@Article{info:doi/10.2196/53874,
author="Wooldridge, S. Jennalee
and Morse, L. Jessica
and Delgado, Jorge
and Afari, Niloofar",
title="Daily Functioning of Veterans With Type 2 Diabetes: Protocol for an Ambulatory Assessment Study",
journal="JMIR Res Protoc",
year="2023",
month="Nov",
day="20",
volume="12",
pages="e53874",
keywords="type 2 diabetes mellitus",
keywords="ecological momentary assessment",
keywords="ambulatory assessment",
keywords="intensive longitudinal assessment",
keywords="physical activity",
keywords="self-management  behavior",
keywords="functioning",
keywords="social support",
abstract="Background: Diabetes impacts nearly 25\% of veterans. Many veterans do not engage in recommended physical activity and other diabetes self-management behaviors. Type 2 diabetes is generally asymptomatic; as such, the long-term consequences of inadequate self-management and benefits of consistent self-management are not salient in the short term. Furthermore, self-management behaviors typically take place outside of medical visits; however, self-management--related factors are only assessed during medical visits, likely missing large amounts of variability. Thus, ambulatory assessment methods such as ecological momentary assessment (EMA), accelerometry, and continuous glucose monitoring are needed to understand the dynamics of daily self-management and identify potential intervention targets. Objective: The overarching goal of this study is to understand daily, time-varying factors (comorbid affective symptoms and social context) that influence physical activity, diabetes self-management, glycemic management, daily functioning, and quality of life in participants' natural environments. Methods: We are recruiting veterans with type 2 diabetes (target N=100). Participants are required to complete a battery of baseline assessments related to mental health, psychosocial factors, and self-management behaviors. Participants then receive 5 momentary EMA surveys and 1 daily EMA survey per day, in which veterans report comorbid affective symptoms (mood, stress, and pain), social support, social interactions, physical activity, and other self-management behaviors. Momentary surveys are delivered randomly during daily preprogrammed intervals over a 14-day sampling period. Accelerometry and continuous glucose monitoring are also used to assess physical activity and blood glucose, respectively. The first 6 participants also completed interviews assessing their experience in the study and barriers to participation. These test participants informed modifications to the protocol for the remaining participants. Results: The project received funding in April of 2023. Enrollment began in March of 2023 and is planned to be completed in April 2025. Among the 6 test participants, the overall EMA response rate was 87\% (range 74\%-95\%). The response rate for the EMA survey including daily items (67\%, range 21\%-93\%) was lower than the earlier shorter EMA surveys (89\%, range 81\%-96\%). The mean rate of valid accelerometer wear of at least 20 hours per day was 93\% (SD 11\%), and continuous glucose monitoring data were available for 91\% (SD 17\%) of days on average. Participants reported few barriers to completing EMA surveys but noted the random timing of questions made it difficult to plan around, and the end-of-day survey was long. Two participants reported survey items reminded or motivated them to engage in diabetes self-management behaviors. Conclusions: Assessment tools developed from this study can inform clinical decision-making by considering barriers to self-management that occur in daily life. Clinical applications include tailored, adaptive technology--supported interventions to improve self-management that provide the right type and amount of support at the right time by adapting to an individual's changing internal and contextual state. International Registered Report Identifier (IRRID): DERR1-10.2196/53874 ",
doi="10.2196/53874",
url="https://www.researchprotocols.org/2023/1/e53874",
url="http://www.ncbi.nlm.nih.gov/pubmed/37983070"
}


@Article{info:doi/10.2196/50334,
author="Mora, Nallely
and Arvanitakis, Zoe
and Thomas, Merly
and Kramer, Holly
and Morrato, H. Elaine
and Markossian, W. Talar",
title="Applying Customer Discovery Method to a Chronic Disease Self-Management Mobile App: Qualitative Study",
journal="JMIR Form Res",
year="2023",
month="Nov",
day="13",
volume="7",
pages="e50334",
keywords="mobile app",
keywords="disease management",
keywords="customer discovery",
keywords="customer segment",
keywords="value proposition",
keywords="chronic disease management",
keywords="self-management",
keywords="chronic disease",
keywords="digital health",
keywords="ehealth",
keywords="mobile application",
keywords="mhealth",
keywords="customer delivery",
abstract="Background: A significant health challenge is evident in the United States, with 6 in 10 adults having a chronic disease and 4 in 10 adults having 2 or more. Chronic disease self-management aims to prevent or delay disease progression and disability and reduce mortality risk. The evidence to support the use of information technology tools, including mobile apps, web-based portals, and web-based educational interventions, that support disease self-management and improve clinical outcomes is growing. Customer discovery and value proposition design methodology is a form of stakeholder engagement and is based on marketing and lean start-up business methods. As applied in health care, customer discovery and value proposition methodology can be used to understand the clinical problem and articulate the product's hypothesized unique value proposition relative to alternative options that are available to end users. Objective: This study aims to describe the experience and findings of academic researchers applying the customer discovery and value proposition methodology to identify stakeholders, needs, adaptability, and sustainability of a chronic disease self-management mobile app (CDapp). The motivation of the work is to make mobile health app interventions accessible and acceptable for all segments of patients' chronic diseases. Methods: Data were obtained through key informant interviews and analyzed using rapid qualitative analysis techniques. The value proposition framework was used to build the interview guide. The aim was to identify the needs, challenges (pains), and potential benefits (gains) of the CDapp for our stakeholders. Results: Our results showed that the primary consumers (end users) of a CDapp were the patients. The app adopters (decision makers) can be medical center leaders including population health department managers or insurance providers, while the consumer adoption influencers (influencers or saboteurs) are clinicians and patient caregivers. We developed an ecosystem map to visualize the clinical practice workflow and how an app for chronic disease management might integrate within an academic health care center or system. A value proposition for the identified customer segments was generated. Each stakeholder segment was working within a different framework to improve patient self-management. Patients needed help to adhere to self-care activities and they needed tailored health education. Health care leaders aim to improve the quality of care while reducing costs and workload. Clinicians wanted to improve patient education and care while reducing the time burden. Our results also showed that within academic medical centers, there were variations regarding patients' self-reported abilities to manage their diseases. Conclusions: Customer discovery is a useful form of stakeholder engagement when designing studies that seek to implement, adapt, and sustain an intervention. The customer discovery and value proposition methodology can be used as an alternative or complementary approach to formative research to generate valuable information in a brief period. ",
doi="10.2196/50334",
url="https://formative.jmir.org/2023/1/e50334",
url="http://www.ncbi.nlm.nih.gov/pubmed/37955947"
}


@Article{info:doi/10.2196/48754,
author="Abd-alrazaq, Alaa
and AlSaad, Rawan
and Harfouche, Manale
and Aziz, Sarah
and Ahmed, Arfan
and Damseh, Rafat
and Sheikh, Javaid",
title="Wearable Artificial Intelligence for Detecting Anxiety: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2023",
month="Nov",
day="8",
volume="25",
pages="e48754",
keywords="anxiety",
keywords="artificial intelligence",
keywords="wearable devices",
keywords="machine learning",
keywords="systematic review",
keywords="mobile phone",
abstract="Background: Anxiety disorders rank among the most prevalent mental disorders worldwide. Anxiety symptoms are typically evaluated using self-assessment surveys or interview-based assessment methods conducted by clinicians, which can be subjective, time-consuming, and challenging to repeat. Therefore, there is an increasing demand for using technologies capable of providing objective and early detection of anxiety. Wearable artificial intelligence (AI), the combination of AI technology and wearable devices, has been widely used to detect and predict anxiety disorders automatically, objectively, and more efficiently. Objective: This systematic review and meta-analysis aims to assess the performance of wearable AI in detecting and predicting anxiety. Methods: Relevant studies were retrieved by searching 8 electronic databases and backward and forward reference list checking. In total, 2 reviewers independently carried out study selection, data extraction, and risk-of-bias assessment. The included studies were assessed for risk of bias using a modified version of the Quality Assessment of Diagnostic Accuracy Studies--Revised. Evidence was synthesized using a narrative (ie, text and tables) and statistical (ie, meta-analysis) approach as appropriate. Results: Of the 918 records identified, 21 (2.3\%) were included in this review. A meta-analysis of results from 81\% (17/21) of the studies revealed a pooled mean accuracy of 0.82 (95\% CI 0.71-0.89). Meta-analyses of results from 48\% (10/21) of the studies showed a pooled mean sensitivity of 0.79 (95\% CI 0.57-0.91) and a pooled mean specificity of 0.92 (95\% CI 0.68-0.98). Subgroup analyses demonstrated that the performance of wearable AI was not moderated by algorithms, aims of AI, wearable devices used, status of wearable devices, data types, data sources, reference standards, and validation methods. Conclusions: Although wearable AI has the potential to detect anxiety, it is not yet advanced enough for clinical use. Until further evidence shows an ideal performance of wearable AI, it should be used along with other clinical assessments. Wearable device companies need to develop devices that can promptly detect anxiety and identify specific time points during the day when anxiety levels are high. Further research is needed to differentiate types of anxiety, compare the performance of different wearable devices, and investigate the impact of the combination of wearable device data and neuroimaging data on the performance of wearable AI. Trial Registration: PROSPERO CRD42023387560; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=387560 ",
doi="10.2196/48754",
url="https://www.jmir.org/2023/1/e48754",
url="http://www.ncbi.nlm.nih.gov/pubmed/37938883"
}


@Article{info:doi/10.2196/42604,
author="Zaki, Sasha",
title="Tailoring Educational Materials to Cultural Context Matters",
journal="J Med Internet Res",
year="2023",
month="Nov",
day="6",
volume="25",
pages="e42604",
keywords="Bangladesh",
keywords="health education",
keywords="health knowledge",
keywords="quality of life",
keywords="motivation",
keywords="randomized controlled trial",
keywords="RCT",
keywords="campaign",
keywords="chronic kidney disease",
keywords="knowledge",
keywords="mobile health",
keywords="mHealth",
keywords="kidney",
keywords="chronic disease",
keywords="chronic condition",
keywords="patient education",
keywords="patient knowledge",
keywords="low- and middle-income countries",
keywords="LMIC",
doi="10.2196/42604",
url="https://www.jmir.org/2023/1/e42604",
url="http://www.ncbi.nlm.nih.gov/pubmed/37930771"
}


@Article{info:doi/10.2196/50983,
author="Lee, Taeyoung
and Cho, Younghoon
and Cha, Su Kwang
and Jung, Jinhwan
and Cho, Jungim
and Kim, Hyunggug
and Kim, Daewoo
and Hong, Joonki
and Lee, Dongheon
and Keum, Moonsik
and Kushida, A. Clete
and Yoon, In-Young
and Kim, Jeong-Whun",
title="Accuracy of 11 Wearable, Nearable, and Airable Consumer Sleep Trackers: Prospective Multicenter Validation Study",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Nov",
day="2",
volume="11",
pages="e50983",
keywords="consumer sleep trackers",
keywords="wearables",
keywords="nearables",
keywords="airables",
keywords="sleep monitoring",
keywords="sleep stage",
keywords="comparative study",
keywords="polysomnography",
keywords="multicenter study",
keywords="deep learning",
keywords="artificial intelligence",
keywords="Fitbit Sense 2, Amazon Halo Rise, SleepRoutine",
abstract="Background: Consumer sleep trackers (CSTs) have gained significant popularity because they enable individuals to conveniently monitor and analyze their sleep. However, limited studies have comprehensively validated the performance of widely used CSTs. Our study therefore investigated popular CSTs based on various biosignals and algorithms by assessing the agreement with polysomnography. Objective: This study aimed to validate the accuracy of various types of CSTs through a comparison with in-lab polysomnography. Additionally, by including widely used CSTs and conducting a multicenter study with a large sample size, this study seeks to provide comprehensive insights into the performance and applicability of these CSTs for sleep monitoring in a hospital environment. Methods: The study analyzed 11 commercially available CSTs, including 5 wearables (Google Pixel Watch, Galaxy Watch 5, Fitbit Sense 2, Apple Watch 8, and Oura Ring 3), 3 nearables (Withings Sleep Tracking Mat, Google Nest Hub 2, and Amazon Halo Rise), and 3 airables (SleepRoutine, SleepScore, and Pillow). The 11 CSTs were divided into 2 groups, ensuring maximum inclusion while avoiding interference between the CSTs within each group. Each group (comprising 8 CSTs) was also compared via polysomnography. Results: The study enrolled 75 participants from a tertiary hospital and a primary sleep-specialized clinic in Korea. Across the 2 centers, we collected a total of 3890 hours of sleep sessions based on 11 CSTs, along with 543 hours of polysomnography recordings. Each CST sleep recording covered an average of 353 hours. We analyzed a total of 349,114 epochs from the 11 CSTs compared with polysomnography, where epoch-by-epoch agreement in sleep stage classification showed substantial performance variation. More specifically, the highest macro F1 score was 0.69, while the lowest macro F1 score was 0.26. Various sleep trackers exhibited diverse performances across sleep stages, with SleepRoutine excelling in the wake and rapid eye movement stages, and wearables like Google Pixel Watch and Fitbit Sense 2 showing superiority in the deep stage. There was a distinct trend in sleep measure estimation according to the type of device. Wearables showed high proportional bias in sleep efficiency, while nearables exhibited high proportional bias in sleep latency. Subgroup analyses of sleep trackers revealed variations in macro F1 scores based on factors, such as BMI, sleep efficiency, and apnea-hypopnea index, while the differences between male and female subgroups were minimal. Conclusions: Our study showed that among the 11 CSTs examined, specific CSTs showed substantial agreement with polysomnography, indicating their potential application in sleep monitoring, while other CSTs were partially consistent with polysomnography. This study offers insights into the strengths of CSTs within the 3 different classes for individuals interested in wellness who wish to understand and proactively manage their own sleep. ",
doi="10.2196/50983",
url="https://mhealth.jmir.org/2023/1/e50983",
url="http://www.ncbi.nlm.nih.gov/pubmed/37917155"
}


@Article{info:doi/10.2196/43979,
author="Kyt{\"o}, Mikko
and Koivusalo, Saila
and Tuomonen, Heli
and Str{\"o}mberg, Lisbeth
and Ruonala, Antti
and Marttinen, Pekka
and Heinonen, Seppo
and Jacucci, Giulio",
title="Supporting the Management of Gestational Diabetes Mellitus With Comprehensive Self-Tracking: Mixed Methods Study of Wearable Sensors",
journal="JMIR Diabetes",
year="2023",
month="Oct",
day="31",
volume="8",
pages="e43979",
keywords="gestational diabetes",
keywords="self-management",
keywords="self-tracking",
keywords="wearable sensor",
keywords="mobile application",
keywords="self-discovery",
keywords="behavior change",
keywords="user experience",
abstract="Background: Gestational diabetes mellitus (GDM) is an increasing health risk for pregnant women as well as their children. Telehealth interventions targeted at the management of GDM have been shown to be effective, but they still require health care professionals for providing guidance and feedback. Feedback from wearable sensors has been suggested to support the self-management of GDM, but it is unknown how self-tracking should be designed in clinical care. Objective: This study aimed to investigate how to support the self-management of GDM with self-tracking of continuous blood glucose and lifestyle factors without help from health care personnel. We examined comprehensive self-tracking from self-discovery (ie, learning associations between glucose levels and lifestyle) and user experience perspectives. Methods: We conducted a mixed methods study where women with GDM (N=10) used a continuous glucose monitor (CGM; Medtronic Guardian) and 3 physical activity sensors: activity bracelet (Garmin Vivosmart 3), hip-worn sensor (UKK Exsed), and electrocardiography sensor (Firstbeat 2) for a week. We collected data from the sensors, and after use, participants took part in semistructured interviews about the wearable sensors. Acceptability of the wearable sensors was evaluated with the Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire. Moreover, maternal nutrition data were collected with a 3-day food diary, and self-reported physical activity data were collected with a logbook. Results: We found that the CGM was the most useful sensor for the self-discovery process, especially when learning associations between glucose and nutrition intake. We identified new challenges for using data from the CGM and physical activity sensors in supporting self-discovery in GDM. These challenges included (1) dispersion of glucose and physical activity data in separate applications, (2) absence of important trackable features like amount of light physical activity and physical activities other than walking, (3) discrepancy in the data between different wearable physical activity sensors and between CGMs and capillary glucose meters, and (4) discrepancy in perceived and measured quantification of physical activity. We found the body placement of sensors to be a key factor in measurement quality and preference, and ultimately a challenge for collecting data. For example, a wrist-worn sensor was used for longer compared with a hip-worn sensor. In general, there was a high acceptance for wearable sensors. Conclusions: A mobile app that combines glucose, nutrition, and physical activity data in a single view is needed to support self-discovery. The design should support tracking features that are important for women with GDM (such as light physical activity), and data for each feature should originate from a single sensor to avoid discrepancy and redundancy. Future work with a larger sample should involve evaluation of the effects of such a mobile app on clinical outcomes. Trial Registration: Clinicaltrials.gov NCT03941652; https://clinicaltrials.gov/study/NCT03941652 ",
doi="10.2196/43979",
url="https://diabetes.jmir.org/2023/1/e43979",
url="http://www.ncbi.nlm.nih.gov/pubmed/37906216"
}


@Article{info:doi/10.2196/48912,
author="Kim, Du-Ri
and Moon, EunSoo
and Shin, Myung-Jun
and Yang, Yeong-Ae
and Park, Jong-Hwan",
title="Effect of Individual Virtual Reality Cognitive Training Programs on Cognitive Function and Depression in Middle-Aged Women: Randomized Controlled Trial",
journal="JMIR Ment Health",
year="2023",
month="Oct",
day="25",
volume="10",
pages="e48912",
keywords="cognitive function",
keywords="depression",
keywords="middle aged",
keywords="virtual reality",
keywords="women",
abstract="Background: Given the increasing incidence of early-onset Alzheimer disease, strategies for early diagnosis and swift treatment interventions are crucial for mitigating cognitive problems in women and middle-aged individuals who face a high risk of cognitive impairment. Objective: This study aimed to assess the effectiveness of individual cognitive training programs based on virtual reality (VR), a nonpharmacological intervention, on cognitive function and depression in middle-aged women at risk of cognitive impairment. It used VR technology, which has recently been recognized as a promising tool. Methods: We administered a VR-based cognitive training program for 30 minutes daily, twice a week, for 12 weeks (24 sessions). This study included middle-aged women residing in older adults' welfare facilities in G-gu, Busan, from May to August 2021. A total of 60 participants were randomly divided into the training (n=30) and control (n=30) groups. Cognitive and depressive functions were assessed using the Korean versions of the Montreal Cognitive Assessment (K-MoCA), Digit Span Test (DST), Korean-Color Word Stroop Test (K-CWST), and Short Form of the Geriatric Depression Scale (SGDS-K) before the intervention. The training group underwent a VR-based cognitive training program, whereas the control group was educated to maintain regular daily activities. The same assessments were performed 12 weeks after treatment. Results: A comparison of the mean scores before and after K-MoCA in the training group revealed a significant increase from 24.87 (SD 2.62) to 27.50 (SD 1.70; P<.01), indicating substantial cognitive improvement. Similarly, the mean DST forward scores increased significantly from 6.97 (SD 1.10) to 7.90 (SD 1.18; P<.01), suggesting enhanced short-term auditory memory and attention. The mean DST backward scores also showed a significant improvement from 4.10 (SD 0.71) to 4.77 (SD 1.2; P=.01). Notably, the mean SGDS-K scores decreased significantly from 3.97 (SD 2.51) to 2.13 (SD 1.87; P<.01), indicating a reduction in depression within the training group. Conclusions: The VR-based cognitive training programs significantly enhanced cognitive function and reduced depression in middle-aged women. Consequently, these programs are considered beneficial nonpharmacological cognitive training interventions for middle-aged women at high risk of cognitive impairment. Trial Registration: UMIN Clinical Trials Registry UMIN000049752; https://tinyurl.com/z5du989z ",
doi="10.2196/48912",
url="https://mental.jmir.org/2023/1/e48912",
url="http://www.ncbi.nlm.nih.gov/pubmed/37878378"
}


@Article{info:doi/10.2196/46651,
author="Beintner, Ina
and Kerber, Andr{\'e}
and Dominke, Clara
and Voderholzer, Ulrich",
title="Improving Mild to Moderate Depression With an App-Based Self-Guided Intervention: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="Oct",
day="25",
volume="12",
pages="e46651",
keywords="depression",
keywords="mobile app",
keywords="intervention",
keywords="unguided",
keywords="transdiagnostic",
keywords="randomized controlled trial",
keywords="e-mental health",
keywords="digital app",
keywords="self-management",
keywords="mental health",
keywords="mHealth",
keywords="mobile health",
keywords="unguided digital intervention",
keywords="public health",
keywords="digital intervention",
keywords="mobile phone",
abstract="Background: Depression is one of the most prevalent mental disorders and frequently co-occurs with other mental disorders. Despite the high direct and indirect costs to both individuals and society, more than 80\% of those diagnosed with depression remain with their primary care physician and do not receive specialized treatment. Self-guided digital interventions have been shown to improve depression and, due to their scalability, have a large potential public health impact. Current digital interventions often focus on specific disorders, while recent research suggests that transdiagnostic approaches are more suitable. Objective: This paper presents the protocol for a study that aims to assess the efficacy of a self-guided transdiagnostic app-based self-management intervention in patients with mild or moderate depression with and without comorbid mental disorders. Specifically, we are investigating the impact of the intervention on symptoms of depression, quality of life, anxiety symptoms, and mental health--related patient empowerment and self-management skills. Methods: The intervention under investigation, MindDoc with Prescription, is a self-guided digital intervention aimed at supporting individuals with mild to moderate mental disorders from the internalizing spectrum, including depression. The app can be used as a low-threshold psychosocial intervention. Up to 570 adult patients will be randomized to either receive the intervention in addition to care as usual or only care as usual. We are including adults with a permanent residency in Germany and mild or moderate depression according to International Classification of Diseases, 10th Revision, criteria (F32.0, F32.1, F33.0, and F33.1). Clinical interviews will be conducted to confirm the diagnosis. Data will be collected at baseline as well as 8 weeks and 6 months after randomization. The primary outcome will be depression symptom severity after 8 weeks. Secondary outcomes will be quality of life, anxiety symptom severity, and patient empowerment and self-management behaviors. Data will be analyzed using multiple imputations, using the intention-to-treat principle, while sensitivity analyses will be based on additional imputation strategies and a per-protocol analysis. Results: Recruitment for the trial started on February 7, 2023, and the first participant was randomized on February 14, 2023. As of September 5, 2023, 275 participants have been included in the trial and 176 have provided the primary outcome. The rate of missing values in the primary outcome is approximately 20\%. Conclusions: Data from this efficacy trial will be used to establish whether access to the intervention is associated with an improvement in depression symptoms in individuals diagnosed with mild or moderate depression. The study will contribute to expanding the evidence base on transdiagnostic digital interventions. Trial Registration: German Registry of Clinical Trials DRKS00030852; https://drks.de/search/de/trial/DRKS00030852 International Registered Report Identifier (IRRID): DERR1-10.2196/46651 ",
doi="10.2196/46651",
url="https://www.researchprotocols.org/2023/1/e46651",
url="http://www.ncbi.nlm.nih.gov/pubmed/37878374"
}


@Article{info:doi/10.2196/49051,
author="Li, Yufei
and Chen, Weihong
and Liang, Yanjing
and Yang, Ling
and Hou, Lili",
title="Evaluation of Mobile Health Technology Interventions for the Postdischarge Management of Patients With Head and Neck Cancer: Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Oct",
day="23",
volume="11",
pages="e49051",
keywords="head and neck cancer",
keywords="mobile health technology",
keywords="postdischarge",
keywords="self-management",
keywords="rehabilitation",
abstract="Background: Patients with head and neck cancer (HNC) often experience various types and degrees of complications and functional impairment following surgery or radiotherapy. Consequently, these patients require extensive postdischarge rehabilitation, either at home or in the community. Numerous studies have shown the advantages of mobile Health (mHealth) technology in assisting patients with cancer with self-management and rehabilitation during the postdischarge period. However, few reviews have focused on the intervention, management, and evaluation of mHealth technology in postdischarge patients with HNC. Objective: This study aimed to conduct a scoping review of mHealth technology apps and interventions currently available to patients discharged from hospitals after receiving treatment for HNC. This study sought to identify and summarize the types and effectiveness of existing mHealth interventions as well as the differences in their outcome assessments. Methods: The PubMed, Embase, Web of Science, and CINAHL databases were used to identify studies with no publication time limits. The keywords ``mobile health technology'' and ``head and neck cancer'' were combined to address the main concepts of the research questions. Results: Of the 1625 papers identified, 13 (0.8\%) met the inclusion and exclusion criteria. Most studies (n=8, 61.5\%) were randomized controlled trials (RCTs) and cohort studies. These studies were conducted in 6 countries. The main aims of the mHealth interventions in these studies are as follows: (1) symptom monitoring and assessment, (2) rehabilitation training, (3) access to medical health information, (4) telehealth advisers, (5) peer communication and support, and (6) follow-up/review reminders. The outcome evaluations of the 13 included studies were grouped into 4 categories: (1) technology usability and patient satisfaction, (2) self-management of symptoms and patient-reported outcome--related indicators, (3) adherence, and (4) health-related quality of life. Conclusions: A limited number of studies have investigated the use of mHealth technology in the postdischarge self-management of patients with HNC. The existing literature suggests that mHealth technology can effectively assist patients with HNC in self-management and postdischarge interventions. It plays an important role in addressing patients' health information needs, reducing both their somatic and psychological burdens, and improving their overall quality of life. Future research should prioritize conducting additional high-quality RCTs to evaluate the usability and analyze the cost-effectiveness of mHealth technology. ",
doi="10.2196/49051",
url="https://mhealth.jmir.org/2023/1/e49051",
url="http://www.ncbi.nlm.nih.gov/pubmed/37870887"
}


@Article{info:doi/10.2196/40968,
author="Sze, Thing Wei
and Kow, Guan Suk",
title="Perspectives and Needs of Malaysian Patients With Diabetes for a Mobile Health App Support on Self-Management of Diabetes: Qualitative Study",
journal="JMIR Diabetes",
year="2023",
month="Oct",
day="23",
volume="8",
pages="e40968",
keywords="mHealth",
keywords="self-management",
keywords="diabetes",
keywords="remote monitoring",
keywords="telehealth",
keywords="telemedicine",
abstract="Background: Effective self-management of diabetes is crucial for improving clinical outcomes by maintaining glucose levels and preventing the exacerbation of the condition. Mobile health (mHealth) has demonstrated its significance in enhancing self-management practices. However, only 20\% of Malaysians are familiar with mHealth technologies and use them for health management. Objective: This study aims to explore the perceived benefits and challenges, needs and preferences, and willingness of patients with diabetes to use mHealth apps for self-management of diabetes. Methods: The study involved one-on-one semistructured online interviews with a total of 15 participants, all of whom were aged 18 years or older and had been diagnosed with diabetes for more than 6 months. An interview guide was developed based on the constructs of the Technology Acceptance Model (TAM), the Health Information Technology Acceptance Model (HITAM), and the aesthetics factor derived from the Mobile Application Rating Scale. All interviews were recorded in audio format and transcribed verbatim. The interview content was then organized and coded using ATLAS.ti version 8. Thematic analysis was conducted in accordance with the recommended guidelines for analyzing the data. Results: From the interviews with participants, 3 key themes emerged regarding the perceived benefits of using mHealth app support in diabetes self-management. These themes were the ability to track and monitor diabetes control, assistance in making lifestyle modifications, and the facilitation of more informed treatment decision-making for health care professionals. The interviews with participants revealed 4 prominent themes regarding the perceived barriers to using mHealth app support for diabetes self-management. These themes were a lack of awareness about the availability of mHealth support, insufficient support in using mHealth apps, the perception that current mHealth apps do not align with users' specific needs, and limited digital literacy among users. The interviews with participants unveiled 4 key themes related to their needs and preferences concerning mHealth app support for diabetes self-management. These themes were the desire for educational information, user-friendly design features, carbohydrate-counting functionality, and the ability to engage socially with both peers and health care professionals. The majority of participants expressed their willingness to use mHealth apps if they received recommendations and guidance from health care professionals. Conclusions: Patients generally perceive mHealth app support as beneficial for diabetes self-management and are willing to use these apps, particularly if recommended by health care professionals. However, several barriers may hinder the utilization of mHealth apps, including a lack of awareness and recommendations regarding these apps from health care professionals. To ensure the effective development of mHealth app support systems for diabetes self-management, it is crucial to implement user-centered design processes that consider the specific needs and preferences of patients. This approach will help create apps that are tailored to the requirements of individuals managing diabetes. ",
doi="10.2196/40968",
url="https://diabetes.jmir.org/2023/1/e40968",
url="http://www.ncbi.nlm.nih.gov/pubmed/37870903"
}


@Article{info:doi/10.2196/49677,
author="Tokede, Bunmi
and Yansane, Alfa
and Ibarra-Noriega, Ana
and Mullins, Joanna
and Simmons, Kristen
and Skourtes, Nicholas
and Mehta, Urvi
and Tungare, Sayali
and Holmes, David
and White, Joel
and Walji, Muhammad
and Kalenderian, Elsbeth",
title="Evaluating the Impact of an mHealth Platform for Managing Acute Postoperative Dental Pain: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Oct",
day="20",
volume="11",
pages="e49677",
keywords="mobile health",
keywords="patient-reported outcomes",
keywords="acute pain",
keywords="dentistry",
keywords="dental",
keywords="dentist",
keywords="pain",
keywords="mHealth",
keywords="patient-reported outcome",
keywords="PRO",
keywords="patient-reported outcome measures",
keywords="PROs",
keywords="PROM",
keywords="randomized controlled trial",
keywords="RCT",
abstract="Background: Postoperative dental pain is pervasive and can affect a patient's quality of life. Adopting a patient-centric approach to pain management involves having contemporaneous information about the patient's experience of pain and using it to personalize care. Objective: In this study, we evaluated the use of a mobile health (mHealth) platform to collect pain-related patient-reported outcomes over 7 days after the patients underwent pain-inducing dental procedures; we then relayed the information to the dentist and determined its impact on the patient's pain experience. Methods: The study used a cluster-randomized experimental study design with an intervention arm where patients were prompted to complete a series of questions relating to their pain experience after receiving automated text notifications on their smartphone on days 1, 3, 5, and 7, with the resulting information fed back to dentists, and a control arm where patients received usual care. Providers were randomized, and patients subsequently assumed the enrollment status of their providers. Providers or their staff identified eligible patients and invited them to participate in the study. Provider interviews and surveys were conducted to evaluate acceptance of the mHealth platform. Results: A total of 42 providers and 1525 patients participated. For the primary outcome (pain intensity on a 1 to 10 scale, with 10 being the most painful), intervention group patients reported an average pain intensity of 4.8 (SD 2.6), while those in the control group reported an average pain intensity of 4.7 (SD 2.8). These differences were not significant. There were also no significant differences in secondary outcomes, including pain interference with activity or sleep, patient satisfaction with pain management, or opioid prescribing. Patient surveys revealed reluctance to use the app was mostly due to technological challenges, data privacy concerns, and a preference for phone calls over texting. Providers had high satisfaction with the app and suggested integrating additional features, such as an in-system camera for patients to upload pictures and videos of the procedural site, and integration with the electronic health record system. Conclusions: While the mHealth platform did not have a significant impact on acute postoperative pain experience, patients and providers indicated improvement in patient-provider communication, patient-provider relationship, postoperative complication management, and ability to manage pain medication prescribing. Expanded collaboration between mHealth developers and frontline health care providers can facilitate the applicability of these platforms, further help improve its integration with the normal clinic workflow, and assist in moving toward a more patient-centric approach to pain management. Trial Registration: ClinicalTrials.gov NCT03881891; https://www.clinicaltrials.gov/study/NCT03881891 ",
doi="10.2196/49677",
url="https://mhealth.jmir.org/2023/1/e49677"
}


@Article{info:doi/10.2196/48970,
author="Chen, Bi-Lian
and Lien, Han-Chung
and Yang, Shyh-Sheng
and Wu, Shiao-Chi
and Chiang, Hsien-Hsien
and Lin, Li-Chan",
title="Impact of Mobile Apps in Conjunction With Percutaneous Endoscopic Gastrostomy on Patients' Complications, Quality of Life, and Health-Related Self-Care Behaviors: Randomized Clinical Trial",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Oct",
day="20",
volume="11",
pages="e48970",
keywords="percutaneous endoscopic gastrostomy",
keywords="mobile applications tracking system",
keywords="self-care",
keywords="complications",
keywords="quality of life",
keywords="mobile application",
keywords="mHealth app",
keywords="mHealth intervention",
keywords="health promotion",
keywords="health education",
keywords="endoscopy",
keywords="application",
keywords="education",
keywords="gastrostomy",
keywords="care",
keywords="prevention",
keywords="behavior",
keywords="tracking",
keywords="utilization",
abstract="Background: Percutaneous endoscopic gastrostomy (PEG) is commonly chosen for long-term enteral nutrition support. However, common complications of PEG include wound infection, leakage, obstruction, bleeding, dislodgement, pneumonia, peritonitis, and more. The anticipation of these complications by both patients and their family caregivers underscores the essential requirement of ongoing technical guidance for the daily care of PEG and the adoption of preventative strategies. Objective: This study aimed to establish and compare a health education program utilizing a tracking system for PEG using a mobile app (PEG app) and instant messaging software versus a paper-based health education program with instant messaging software. Their effectiveness to prevent complications, avoid hospital readmissions, improve self-care practices, and enhance quality of life outcomes was assessed. Methods: A randomized controlled trial design was used, and the study sample consisted of patients from a medical center in central Taiwan who underwent thoracic surgery or gastroenterology procedures. Inclusion criteria were being a new case undergoing his or her first gastric tube insertion and having the ability to operate a smartphone. Exclusion criteria were cases requiring tube replacement or nasogastric tubes. A total of 74 participants were enrolled, with 37 participants in the experimental group and 37 participants in the control group. Data collection took place from hospitalization until 1 month after discharge. The experimental group received care utilizing the gastric tube tracking system (PEG app) and the Line app that included phone, text, and photo capture capabilities, while the control group received routine nursing care and used the Line app. Results: The experimental group demonstrated a significant reduction in the occurrence of complications compared with the control group ($\chi$21=12.087, P=.001). Specifically, the occurrence of leakage events was significantly lower in the experimental group than in the control group ($\chi$21=12.906, P=.001). However, the experimental group exhibited superior self-care ability compared with the control group (t72=2.203, P=.03). There was no significant difference in overall quality of life scores between the experimental and control groups (t72=1.603, P=.11). However, the experimental group showed better social aspects of quality of life than the control group (t72=2.164, P=.03). Conclusions: Integration of the PEG app with instant messaging can enhance self-care ability, improve social aspects of quality of life, and reduce complications. The study results suggest that the PEG app could be used as an adjunct tool to promote patients' self-directed management of their gastric tube at home, particularly for patients who have undergone their first PEG placement and are being discharged from the hospital. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300071271; https://tinyurl.com/4vvy584e ",
doi="10.2196/48970",
url="https://mhealth.jmir.org/2023/1/e48970/"
}


@Article{info:doi/10.2196/46189,
author="Sprave, Tanja
and Pfaffenlehner, Michelle
and Stoian, Raluca
and Christofi, Eleni
and R{\"u}hle, Alexander
and Z{\"o}ller, Daniela
and Fabian, Alexander
and Fahrner, Harald
and Binder, Harald
and Sch{\"a}fer, Henning
and Gkika, Eleni
and Grosu, Anca-Ligia
and Heinemann, Felix
and Nicolay, Henrik Nils",
title="App-Controlled Treatment Monitoring and Support for Patients With Head and Neck Cancer Undergoing Radiotherapy: Results From a Prospective Randomized Controlled Trial",
journal="J Med Internet Res",
year="2023",
month="Oct",
day="19",
volume="25",
pages="e46189",
keywords="mHealth",
keywords="head and neck cancer",
keywords="head and neck squamous cell carcinoma",
keywords="HNSCC",
keywords="radiotherapy",
keywords="mobile app",
keywords="quality of life",
keywords="patient-reported outcome measure",
keywords="PROM",
keywords="mobile health",
keywords="head",
keywords="neck",
keywords="cancer",
keywords="oncology",
keywords="radiation",
keywords="randomized controlled trial",
keywords="RCT",
keywords="satisfaction",
keywords="treatment surveillance",
keywords="patient surveillance",
keywords="feasibility",
keywords="patient reported",
keywords="outcome measure",
keywords="app-based",
abstract="Background: Head and neck cancers (HNCs) are very common malignancies, and treatment often requires multimodal approaches, including radiotherapy and chemotherapy. Patients with HNC often display a high symptom burden, both due to the disease itself and the adverse effects of the multimodal therapy. Close telemonitoring of symptoms and quality of life during the course of treatment may help to identify those patients requiring early medical support. Objective: The App-Controlled Treatment Monitoring and Support for Patients With Head and Neck Cancer (APCOT) trial aimed to investigate the feasibility of integrating electronic patient-reported outcomes (ePROs) in the treatment surveillance pathway of patients with HNC during the course of their radiotherapy. Additionally, the influence of app-based ePRO monitoring on global and disease-specific quality of life and patient satisfaction with treatment was assessed. Methods: Patients undergoing radiotherapy for histologically proven HNCs at the Department of Radiation Oncology, University Medical Center Freiburg, Germany, were enrolled in this trial and monitored by weekly physician appointments. Patients were randomized between additional ePRO monitoring on each treatment day or standard-of-care monitoring. Feasibility of ePRO monitoring was defined as ?80\% of enrolled patients answering ?80\% of their daily app-based questions. Quality of life and patient satisfaction were assessed by the European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (QLQ-C30), the head and neck cancer module (H\&N35), and the validated Patient Satisfaction Questionnaire Short Form (PSQ-18) at the completion of treatment and compared between trial arms. Results: A total of 100 patients were enrolled in this trial, and 93 patients were evaluable. All patients (100\%) in the experimental arm answered ?80\% of the ePRO questions during treatment, reaching the predefined threshold for the feasibility of ePRO monitoring (P<.001 in the binomial test). No clinical or patient-specific factor was found to influence feasibility. Global health and most domains of the general quality of life were comparable between trial arms, but an increased HNC-specific symptom burden was reported by patients undergoing ePRO surveillance. ePRO monitoring resulted in improved patient satisfaction regarding interpersonal manners (P=.01), financial aspects (P=.01), and time spent with a doctor (P=.01). Conclusions: This trial demonstrated the feasibility of incorporating daily app-based ePRO surveillance for patients with HNC undergoing radiotherapy. Our data, for the first time, demonstrate that telemonitoring in this setting led to increased reporting of HNC-specific symptom burden and significantly improved several domains of patient satisfaction. Further analyses are needed to assess whether our findings hold true outside the context of a clinical trial. Trial Registration: German Clinical Trials Register DRKS00020491; https://drks.de/search/en/trial/DRKS00020491 ",
doi="10.2196/46189",
url="https://www.jmir.org/2023/1/e46189",
url="http://www.ncbi.nlm.nih.gov/pubmed/37856185"
}


@Article{info:doi/10.2196/47374,
author="H{\ae}germark, Aale Emil
and Kongshaug, Nina
and Raj, Xavier Sunil
and Hofsli, Eva
and Faxvaag, Arild",
title="Design, Development, and Evaluation of an mHealth App for Reporting of Side Effects During Cytostatic Treatment: Usability Test and Interview Study",
journal="JMIR Form Res",
year="2023",
month="Oct",
day="19",
volume="7",
pages="e47374",
keywords="mobile health",
keywords="mHealth",
keywords="user-centered design",
keywords="usability testing",
keywords="cancer",
keywords="side effects",
keywords="cytostatic treatment",
keywords="intervention",
keywords="mobile app",
keywords="usability",
keywords="user interface",
keywords="user",
keywords="smartphone",
keywords="mobile phone",
abstract="Background: Using mobile health (mHealth) interventions such as smartphone apps to deliver health services is an opportunity to engage patients more actively in their own treatment. Usability tests allow for the evaluation of a service by testing it out on the relevant users before implementation in clinical practice. Objective: The objective of this study was to design, develop, and evaluate the user interface of an app that would aid patients with cancer in reporting a more comprehensive summary of their side effects. Methods: The usability test was conducted by exposing patients with cancer to a prototype of an mHealth app that allowed for reporting of side effects from a chemotherapy regimen. After solving a set of 13 tasks, the test participants completed a system usability scale questionnaire and were interviewed using a semistructured interview guide. The interviews were later transcribed and analyzed. Results: The 10 test participants had a mean age of 56.5 (SD 7.11) years. The mean total task completion time for the task-solving session was 240.15 (SD 166.78) seconds. The calculated system usability scale score was 92.5. Most participants solved most of the tasks without any major issues. A minority reported having difficulties using apps on smartphones in general. One patient never achieved a meaningful interaction with our app prototype. Most of those who engaged with the app approved of features that calmed them down, made them more empowered, and put them in control. They preferred to report on side effects in a detailed and concise manner. App features that provided specific advice could provoke both fear and rational action. Conclusions: The user tests uncovered design flaws that allowed for subsequent refining of an app that has the potential to enhance the safety of patients undergoing home-based chemotherapy. However, a refined version of the app is unlikely to be of value to all patients. Some might not be able to use apps on smartphones in general, or their ability to use apps is impaired because of their disease. This finding should have implications for health care providers' overall design of their follow-up service as the service must allow for all the patients to receive safe treatment whether they can use an mHealth app or not. ",
doi="10.2196/47374",
url="https://formative.jmir.org/2023/1/e47374",
url="http://www.ncbi.nlm.nih.gov/pubmed/37856183"
}


@Article{info:doi/10.2196/48454,
author="Nakrys, Marius
and Valinskas, Sarunas
and Aleknavicius, Kasparas
and Jonusas, Justinas",
title="Pilot Investigation of Blood Pressure Control Using a Mobile App (Cardi.Health): Retrospective Chart Review Study",
journal="JMIR Cardio",
year="2023",
month="Oct",
day="17",
volume="7",
pages="e48454",
keywords="mobile app",
keywords="Cardi.Health",
keywords="blood pressure",
keywords="engagement",
keywords="app",
keywords="pilot study",
keywords="hypertension",
keywords="effective",
keywords="blood pressure control",
keywords="self-monitoring",
keywords="medication",
keywords="management",
keywords="users",
keywords="use",
abstract="Background: The high prevalence of hypertension necessitates effective, scalable interventions for blood pressure (BP) control. Self-monitoring has shown improved adherence to medication and better BP management. Mobile apps offer a promising approach with their increasing popularity and potential for large-scale implementation. Studies have demonstrated associations between mobile app interventions and lowered BP, yet real-world data on app effectiveness and engagement remain limited. Objective: In this study, we analyzed real-world user data from the Cardi.Health mobile app, which is aimed at helping its users monitor and control their BP. Our goal was to find out whether there is an association between the use of the mobile app and a decrease in BP. Additionally, the study explored how engagement with the app may influence this outcome. Methods: This was a retrospective chart review study. The initial study population comprised 4407 Cardi.Health users who began using the app between January 2022 and April 2022. After applying inclusion criteria, the final study cohort comprised 339 users with elevated BP at the baseline. The sample consisted of 108 (31.9\%) men and 231 (68.1\%) women (P=.04). This retrospective chart review study obtained permission from the Biomedical Research Alliance of New York Institutional Review Board (June 2022, registration ID 22-08-503-939). Results: The study's main findings were that there is a possible relationship between use of the Cardi.Health mobile app and a decrease in systolic BP. Additionally, there was a significant association between active use of the app and systolic BP decrease ($\chi$21=5.311; P=.02). Finally, active users had an almost 2 times greater chance of reducing systolic BP by 5 mm Hg or more over 4 weeks (odds ratio 1.932, 95\% CI 1.074-3.528; P=.03). Conclusions: This study shows a possible relationship between Cardi.Health mobile app use and decreased BP. Additionally, engagement with the app may be related to better results---active use was associated with an almost 2-fold increase in the odds of reducing BP by 5 or more mm Hg. ",
doi="10.2196/48454",
url="https://cardio.jmir.org/2023/1/e48454",
url="http://www.ncbi.nlm.nih.gov/pubmed/37847544"
}


@Article{info:doi/10.2196/51019,
author="Bladt, Lola
and Kashtiara, Ardavan
and Platteau, Wouter
and De Wachter, Stefan
and De Win, Gunter",
title="First-Year Experience of Managing Urology Patients With Home Uroflowmetry: Descriptive Retrospective Analysis",
journal="JMIR Form Res",
year="2023",
month="Oct",
day="17",
volume="7",
pages="e51019",
keywords="lower urinary tract symptoms",
keywords="home uroflowmetry",
keywords="automated bladder diary",
keywords="homeflow",
keywords="hospiflow",
keywords="mobile phone",
abstract="Background: Lower urinary tract symptoms affect a large number of people of all ages and sexes. The clinical assessment typically involves a bladder diary and uroflowmetry test. Conventional paper-based diaries are affected by low patient compliance, whereas in-clinic uroflowmetry measurement face challenges such as patient stress and inconvenience factors. Home uroflowmetry and automated bladder diaries are believed to overcome these limitations. Objective: In this study, we present our first-year experience of managing urological patients using Minze homeflow, which combines home uroflowmetry and automated bladder diaries. Our objective was 2-fold: first, to provide a description of the reasons for using homeflow and second, to compare the data obtained from homeflow with the data obtained from in-clinic uroflowmetry (hospiflow). Methods: A descriptive retrospective analysis was conducted using Minze homeflow between July 2019 and July 2020 at a tertiary university hospital. The device comprises a Bluetooth-connected gravimetric uroflowmeter, a patient smartphone app, and a cloud-based clinician portal. Descriptive statistics, Bland-Altman plots, the McNemar test, and the Wilcoxon signed rank test were used for data analysis. Results: The device was offered to 166 patients, including 91 pediatric and 75 adult patients. In total, 3214 homeflows and 129 hospiflows were recorded. Homeflow proved valuable for diagnosis, particularly in cases where hospiflow was unreliable or unsuccessful, especially in young children. It confirmed or excluded abnormal hospiflow results and provided comprehensive data with multiple measurements taken at various bladder volumes, urge levels, and times of the day. As a result, we found that approximately one-fourth of the patients with abnormal flow curves in the clinic had normal bell-shaped flow curves at home. Furthermore, homeflow offers the advantage of providing an individual's plot of maximum flow rate (Q-max) versus voided volume as well as an average or median result. Our findings revealed that a considerable percentage of patients (22/76, 29\% for pediatric patients and 24/50, 48\% for adult patients) had a Q-max measurement from hospiflow falling outside the range of homeflow measurements. This discrepancy may be attributed to the unnatural nature of the hospiflow test, resulting in nonrepresentative uroflow curves and an underestimation of Q-max, as confirmed by the Bland-Altman plot analysis. The mean difference for Q-max was ?3.1 mL/s (with an upper limit of agreement of 13 mL/s and a lower limit of agreement of ?19.2 mL/s), which was statistically significant (Wilcoxon signed rank test: V=2019.5; P<.001). Given its enhanced reliability, homeflow serves as a valuable tool not only for diagnosis but also for follow-up, allowing for the evaluation of treatment effectiveness and home monitoring of postoperative and recurrent interventions. Conclusions: Our first-year experience with Minze homeflow demonstrated its feasibility and usefulness in the diagnosis and follow-up of various patient categories. Homeflow provided more reliable and comprehensive voiding data compared with hospiflow. ",
doi="10.2196/51019",
url="https://formative.jmir.org/2023/1/e51019",
url="http://www.ncbi.nlm.nih.gov/pubmed/37847531"
}


@Article{info:doi/10.2196/50108,
author="Woodworth, C. Emily
and Briskin, A. Ellie
and Plys, Evan
and Macklin, Eric
and Tatar, G. Raquel
and Huberty, Jennifer
and Vranceanu, Ana-Maria",
title="Mindfulness-Based App to Reduce Stress in Caregivers of Persons With Alzheimer Disease and Related Dementias: Protocol for a Single-Blind Feasibility Proof-of-Concept Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="Oct",
day="13",
volume="12",
pages="e50108",
keywords="caregiver",
keywords="dementia",
keywords="mindfulness",
keywords="mobile app",
keywords="protocol",
keywords="randomized controlled trial",
abstract="Background: Informal caregivers (ie, individuals who provide assistance to a known person with health or functional needs, often unpaid) experience high levels of stress. Caregiver stress is associated with negative outcomes for both caregivers and care recipients. Mindfulness-based interventions (MBIs) show promise for improving stress, emotional distress, and sleep disturbance in caregivers of persons with Alzheimer disease and related dementias (ADRD). Commercially available mobile mindfulness apps can deliver MBIs to caregivers of persons with ADRD in a feasible and cost-effective manner. Objective: We are conducting a single-blind feasibility proof-of-concept randomized controlled trial (RCT; National Institutes of Health [NIH] stage 1B) comparing 2 free mobile apps: the active intervention Healthy Minds Program (HMP) with within-app text tailored for addressing stress among caregivers of persons with ADRD, versus Wellness App (WA), a time- and dose-matched educational control also tailored for caregivers of persons with ADRD. Methods: We aim to recruit 80 geographically diverse and stressed caregivers of persons with ADRD. Interested caregivers use a link or QR code on a recruitment flyer to complete a web-based eligibility screener. Research assistants conduct enrollment phone calls, during which participants provide informed consent digitally. After participants complete baseline surveys, we randomize them to the mindfulness-based intervention (HMP) or educational control podcast app (WA) and instruct them to listen to prescribed content for 10 minutes per day (70 minutes per week) for 12 weeks. Caregivers are blinded to intervention versus control. The study team checks adherence weekly and contacts participants to promote adherence as needed. Participants complete web-based self-report measures at baseline, posttest, and follow-up; weekly process measures are also completed. Primary outcomes are a priori set feasibility benchmarks. Secondary outcomes are stress, emotional distress, sleep disturbance, caregiver burden, mindfulness, awareness, connection, insight, and purpose. We will calculate 1-sided 95\% CI to assess feasibility benchmarks. Effect sizes of change in outcomes will be used to examine the proof of concept. Results: Recruitment started on February 20, 2023. We have enrolled 27 caregivers (HMP: n=14; WA: n=13) as of June 2023. Funding began in August 2022, and we plan to finish enrollment by December 2023. Data analysis is expected to begin in May 2024 when all follow-ups are complete; publication of findings will follow. Conclusions: Through this trial, we aim to establish feasibility benchmarks for HMP and WA, as well as establish a proof of concept that HMP improves stress (primary quantitative outcome), emotional distress, sleep, and mindfulness more than WA. Results will inform a future efficacy trial (NIH stage II). HMP has the potential to be a cost-effective solution to reduce stress in caregivers of persons with ADRD, benefiting caregiver health and quality of care as well as patient care. Trial Registration: ClinicalTrials.gov NCT05732038; https://clinicaltrials.gov/study/NCT05732038 International Registered Report Identifier (IRRID): DERR1-10.2196/50108 ",
doi="10.2196/50108",
url="https://www.researchprotocols.org/2023/1/e50108",
url="http://www.ncbi.nlm.nih.gov/pubmed/37831492"
}


@Article{info:doi/10.2196/49252,
author="Fraterman, Itske
and Wollersheim, M. Barbara
and Tibollo, Valentina
and Glaser, Catherina Savannah Lucia
and Medlock, Stephanie
and Cornet, Ronald
and Gabetta, Matteo
and Gisko, Vitali
and Barkan, Ella
and di Flora, Nicola
and Glasspool, David
and Kogan, Alexandra
and Lanzola, Giordano
and Leizer, Roy
and Mallo, Henk
and Ottaviano, Manuel
and Peleg, Mor
and van de Poll-Franse, V. Lonneke
and Veggiotti, Nicole
and ?niata?a, Konrad
and Wilk, Szymon
and Parimbelli, Enea
and Quaglini, Silvana
and Rizzo, Mimma
and Locati, Deborah Laura
and Boekhout, Annelies
and Sacchi, Lucia
and Wilgenhof, Sofie",
title="An eHealth App (CAPABLE) Providing Symptom Monitoring, Well-Being Interventions, and Educational Material for Patients With Melanoma Treated With Immune Checkpoint Inhibitors: Protocol for an Exploratory Intervention Trial",
journal="JMIR Res Protoc",
year="2023",
month="Oct",
day="11",
volume="12",
pages="e49252",
keywords="eHealth",
keywords="melanoma",
keywords="fatigue",
keywords="quality of life",
keywords="intervention",
keywords="pilot study",
keywords="QoL",
keywords="cancer",
keywords="oncology",
keywords="HRQoL",
keywords="symptom",
keywords="symptoms",
keywords="monitoring",
keywords="adoption",
keywords="acceptance",
keywords="patient education",
keywords="digital health",
keywords="immune checkpoint inhibitors",
keywords="immunotherapy",
abstract="Background: Since treatment with immune checkpoint inhibitors (ICIs) is becoming standard therapy for patients with high-risk and advanced melanoma, an increasing number of patients experience treatment-related adverse events such as fatigue. Until now, studies have demonstrated the benefits of using eHealth tools to provide either symptom monitoring or interventions to reduce treatment-related symptoms such as fatigue. However, an eHealth tool that facilitates the combination of both symptom monitoring and symptom management in patients with melanoma treated with ICIs is still needed. Objective: In this pilot study, we will explore the use of the CAPABLE (Cancer Patients Better Life Experience) app in providing symptom monitoring, education, and well-being interventions on health-related quality of life (HRQoL) outcomes such as fatigue and physical functioning, as well as patients' acceptance and usability of using CAPABLE. Methods: This prospective, exploratory pilot study will examine changes in fatigue over time in 36 patients with stage III or IV melanoma during treatment with ICI using CAPABLE (a smartphone app and multisensory smartwatch). This cohort will be compared to a prospectively collected cohort of patients with melanoma treated with standard ICI therapy. CAPABLE will be used for a minimum of 3 and a maximum of 6 months. The primary endpoint in this study is the change in fatigue between baseline and 3 and 6 months after the start of treatment. Secondary end points include HRQoL outcomes, usability, and feasibility parameters. Results: Study inclusion started in April 2023 and is currently ongoing. Conclusions: This pilot study will explore the effect, usability, and feasibility of CAPABLE in patients with melanoma during treatment with ICI. Adding the CAPABLE system to active treatment is hypothesized to decrease fatigue in patients with high-risk and advanced melanoma during treatment with ICIs compared to a control group receiving standard care. The Medical Ethics Committee NedMec (Amsterdam, The Netherlands) granted ethical approval for this study (reference number 22-981/NL81970.000.22). Trial Registration: ClinicalTrials.gov NCT05827289; https://clinicaltrials.gov/study/NCT05827289 International Registered Report Identifier (IRRID): DERR1-10.2196/49252 ",
doi="10.2196/49252",
url="https://www.researchprotocols.org/2023/1/e49252",
url="http://www.ncbi.nlm.nih.gov/pubmed/37819691"
}


@Article{info:doi/10.2196/47608,
author="Sadler, Sean
and Gerrard, James
and Searle, Angela
and Lanting, Sean
and West, Matthew
and Wilson, Rhonda
and Ginige, Athula
and Fang, Y. Kerry
and Chuter, Vivienne",
title="The Use of mHealth Apps for the Assessment and Management of Diabetes-Related Foot Health Outcomes: Systematic Review",
journal="J Med Internet Res",
year="2023",
month="Oct",
day="4",
volume="25",
pages="e47608",
keywords="First Nations",
keywords="Aboriginal",
keywords="Torres Strait Islander",
keywords="mobile health",
keywords="mHealth",
keywords="diabetes",
keywords="diabetic",
keywords="foot",
keywords="systematic review",
keywords="review methodology",
keywords="mobile app",
keywords="mobile apps",
keywords="mobile phone",
abstract="Background: Globally, diabetes affects approximately 500 million people and is predicted to affect up to 700 million people by 2045. In Australia, the ongoing impact of colonization produces inequity in health care delivery and inequality in health care outcomes for First Nations Peoples, with diabetes rates 4 times those of non-Indigenous Australians. Evidence-based clinical practice has been shown to reduce complications of diabetes-related foot disease, including ulceration and amputation, by 50\%. However, factors such as a lack of access to culturally safe care, geographical remoteness, and high costs associated with in-person care are key barriers for First Nations Peoples in accessing evidence-based care, leading to the development of innovative mobile health (mHealth) apps as a way to increase access to health services and improve knowledge and self-care management for people with diabetes. Objective: This study aims to evaluate studies investigating the use of mHealth apps for the assessment and management of diabetes-related foot health in First Nations Peoples in Australia and non-Indigenous populations globally. Methods: PubMed, Informit's Indigenous Collection database, Ovid MEDLINE, Embase, CINAHL Complete, and Scopus were searched from inception to September 8, 2022. Hand searches of gray literature and reference lists of included studies were conducted. Studies describing mHealth apps developed for the assessment and management of diabetes-related foot health were eligible. Studies must include an evaluation (qualitative or quantitative) of the mHealth app. No language, publication date, or publication status restrictions were used. Quality appraisal was performed using the revised Cochrane risk-of-bias tool for randomized trials and the Health Evidence Bulletins Wales checklists for observational, cohort, and qualitative studies. Results: No studies specifically including First Nations Peoples in Australia were identified. Six studies in non-Indigenous populations with 361 participants were included. Foot care education was the main component of all mHealth apps. Of the 6 mHealth apps, 2 (33\%) provided functionality for participants to enter health-related data; 1 (17\%) included a messaging interface. The length of follow-up ranged from 1-6 months. Of the 6 studies, 1 (17\%) reported high levels of acceptability of the mHealth app content for self-care by people with diabetes and diabetes specialists; the remaining 5 (83\%) reported that participants had improved diabetes-related knowledge and self-management skills after using their mHealth app. Conclusions: The findings from this systematic review provide an overview of the features deployed in mHealth apps and indicate that this type of intervention can improve knowledge and self-care management skills in non-Indigenous people with diabetes. Future research needs to focus on mHealth apps for populations where there is inadequate or ineffective service delivery, including for First Nations Peoples and those living in geographically remote areas, as well as evaluate direct effects on diabetes-related foot disease outcomes. Trial Registration: PROSPERO CRD42022349087; https://tinyurl.com/35u6mmzd ",
doi="10.2196/47608",
url="https://www.jmir.org/2023/1/e47608",
url="http://www.ncbi.nlm.nih.gov/pubmed/37792467"
}


@Article{info:doi/10.2196/50374,
author="Lin, Kuei Yu
and Aikens, E. James
and de Zoysa, Nicole
and Hall, Diana
and Funnell, Martha
and Nwankwo, Robin
and Kloss, Kate
and DeJonckheere, J. Melissa
and Pop-Busui, Rodica
and Piatt, A. Gretchen
and Amiel, A. Stephanie
and Piette, D. John",
title="An mHealth Text Messaging Program Providing Symptom Detection Training and Psychoeducation to Improve Hypoglycemia Self-Management: Intervention Development Study",
journal="JMIR Form Res",
year="2023",
month="Oct",
day="3",
volume="7",
pages="e50374",
keywords="behavioral intervention",
keywords="CGM",
keywords="continuous glucose monitor",
keywords="design",
keywords="develop",
keywords="development",
keywords="diabetes",
keywords="diabetic",
keywords="glucose",
keywords="hypoglycemia",
keywords="hypoglycemic",
keywords="messaging",
keywords="mHealth",
keywords="mobile health",
keywords="self-management",
keywords="SMS text message",
keywords="text message",
keywords="type 1 diabetes",
keywords="type 1",
keywords="user-centered",
abstract="Background: Hypoglycemia remains a challenge for roughly 25\% of people with type 1 diabetes (T1D) despite using advanced technologies such as continuous glucose monitors (CGMs) or automated insulin delivery systems. Factors impacting hypoglycemia self-management behaviors (including reduced ability to detect hypoglycemia symptoms and unhelpful hypoglycemia beliefs) can lead to hypoglycemia development in people with T1D who use advanced diabetes technology. Objective: This study aims to develop a scalable, personalized mobile health (mHealth) behavioral intervention program to improve hypoglycemia self-management and ultimately reduce hypoglycemia in people with T1D who use advanced diabetes technology. Methods: We (a multidisciplinary team, including clinical and health psychologists, diabetes care and education specialists, endocrinologists, mHealth interventionists and computer engineers, qualitative researchers, and patient partners) jointly developed an mHealth text messaging hypoglycemia behavioral intervention program based on user-centered design principles. The following five iterative steps were taken: (1) conceptualization of hypoglycemia self-management processes and relevant interventions; (2) identification of text message themes and message content development; (3) message revision; (4) patient partner assessments for message readability, language acceptability, and trustworthiness; and (5) message finalization and integration with a CGM data--connected mHealth SMS text message delivery platform. An mHealth web-based SMS text message delivery platform that communicates with a CGM glucose information-sharing platform was also developed. Results: The mHealth SMS text messaging hypoglycemia behavioral intervention program HypoPals, directed by patients' own CGM data, delivers personalized intervention messages to (1) improve hypoglycemia symptom detection and (2) elicit self-reflection, provide fact-based education, and suggest practical health behaviors to address unhelpful hypoglycemia beliefs and promote hypoglycemia self-management. The program is designed to message patients up to 4 times per day over a 10-week period. Conclusions: A rigorous conceptual framework, a multidisciplinary team (including patient partners), and behavior change techniques were incorporated to create a scalable, personalized mHealth SMS text messaging behavioral intervention. This program was systematically developed to improve hypoglycemia self-management in advanced diabetes technology users with T1D. A clinical trial is needed to evaluate the program's efficacy for future clinical implementation. ",
doi="10.2196/50374",
url="https://formative.jmir.org/2023/1/e50374",
url="http://www.ncbi.nlm.nih.gov/pubmed/37788058"
}


@Article{info:doi/10.2196/42100,
author="S{\o}holm, Uffe
and Zaremba, Natalie
and Broadley, Melanie
and Axelsen, Lundager Johanne
and Divilly, Patrick
and Martine-Edith, Gilberte
and Amiel, A. Stephanie
and Mader, K. Julia
and Pedersen-Bjergaard, Ulrik
and McCrimmon, J. Rory
and Renard, Eric
and Evans, Mark
and de Galan, Bastiaan
and Heller, Simon
and Hendrieckx, Christel
and Choudhary, Pratik
and Speight, Jane
and Pouwer, Frans
and ",
title="Assessing the Content Validity, Acceptability, and Feasibility of the Hypo-METRICS App: Survey and Interview Study",
journal="JMIR Diabetes",
year="2023",
month="Sep",
day="29",
volume="8",
pages="e42100",
keywords="hypoglycemia",
keywords="diabetes",
keywords="ecological momentary assessment",
keywords="smartphone app",
keywords="content validity",
keywords="mobile phone",
abstract="Background: The Hypoglycaemia -- MEasurement, ThResholds and ImpaCtS (Hypo-METRICS) smartphone app was developed to investigate the impact of hypoglycemia on daily functioning in adults with type 1 diabetes mellitus or insulin-treated type 2 diabetes mellitus. The app uses ecological momentary assessments, thereby minimizing recall bias and maximizing ecological validity. It was used in the Hypo-METRICS study, a European multicenter observational study wherein participants wore a blinded continuous glucose monitoring device and completed the app assessments 3 times daily for 70 days. Objective: The 3 aims of the study were to explore the content validity of the app, the acceptability and feasibility of using the app for the duration of the Hypo-METRICS study, and suggestions for future versions of the app. Methods: Participants who had completed the 70-day Hypo-METRICS study in the United Kingdom were invited to participate in a brief web-based survey and an interview (approximately 1h) to explore their experiences with the app during the Hypo-METRICS study. Thematic analysis of the qualitative data was conducted using both deductive and inductive methods. Results: A total of 18 adults with diabetes (type 1 diabetes: n=10, 56\%; 5/10, 50\% female; mean age 47, SD 16 years; type 2 diabetes: n=8, 44\%; 2/8, 25\% female; mean age 61, SD 9 years) filled out the survey and were interviewed. In exploring content validity, participants overall described the Hypo-METRICS app as relevant, understandable, and comprehensive. In total, 3 themes were derived: hypoglycemia symptoms and experiences are idiosyncratic; it was easy to select ratings on the app, but day-to-day changes were perceived as minimal; and instructions could be improved. Participants offered suggestions for changes or additional questions and functions that could increase engagement and improve content (such as providing more examples with the questions). In exploring acceptability and feasibility, 5 themes were derived: helping science and people with diabetes; easy to fit in, but more flexibility wanted; hypoglycemia delaying responses and increasing completion time; design, functionality, and customizability of the app; and limited change in awareness of symptoms and impact. Participants described using the app as a positive experience overall and as having a possible, although limited, intervention effect in terms of both hypoglycemia awareness and personal impact. Conclusions: The Hypo-METRICS app shows promise as a new research tool to assess the impact of hypoglycemia on an individual's daily functioning. Despite suggested improvements, participants' responses indicated that the app has satisfactory content validity, overall fits in with everyday life, and is suitable for a 10-week research study. Although developed for research purposes, real-time assessments may have clinical value for monitoring and reviewing hypoglycemia symptom awareness and personal impact. ",
doi="10.2196/42100",
url="https://diabetes.jmir.org/2023/1/e42100",
url="http://www.ncbi.nlm.nih.gov/pubmed/37773626"
}


@Article{info:doi/10.2196/48585,
author="Nguyen, Anna
and Nagykaldi, Zsolt
and Bui, Thanh
and Chen, Sixia
and Businelle, Michael
and Eschiti, Valerie
and Dwyer, Kathleen",
title="mHealth Intervention for Vietnamese Living With Diabetes: Protocol for a Stepped Wedge Pilot Study",
journal="JMIR Res Protoc",
year="2023",
month="Sep",
day="28",
volume="12",
pages="e48585",
keywords="Vietnamese",
keywords="type 2 diabetes",
keywords="diabetes self-management",
keywords="mobile health technology",
keywords="intervention study",
keywords="stepped wedge design",
keywords="mobile health",
keywords="intervention",
keywords="mobile app",
keywords="digital health",
keywords="diabetes",
keywords="self-management",
keywords="awareness",
keywords="mhealth",
keywords="implementation",
abstract="Background: Evidence indicates participation in a diabetes self-management education and support program improves self-care behaviors and hemoglobin A1c. Language and cultural differences may be barriers to program participation resulting in ineffective self-management, but these factors can be addressed with appropriate interventions. Given the high health care costs associated with diabetes complications, we developed a multicomponent, culturally tailored Self-Management Mobile Health Intervention for US Vietnamese With Diabetes (SMart-D). Objective: This study aims to evaluate the SMart-D intervention's feasibility, acceptability, and effectiveness with intentions to scale up the intervention in the future. This mixed methods study incorporates the Reach, Effectiveness, Adoption, Implementation, Maintenance framework to evaluate the intervention. Methods: This stepped wedge randomized controlled pilot study will be conducted over 2 years in collaboration with primary care clinics. Eligible participants are patients with type 2 diabetes who are receiving health care from participating clinics. Clinics will be randomly assigned to an implementation date and will begin with patients enrolling in the control period while receiving standard care, then cross over to the intervention period where patients receive standard care plus the SMart-D intervention for over 12 weeks. Focus groups or interviews will be conducted with clinicians and patients after study completion. Qualitative data will be analyzed using NVivo. Outcomes on self-care behavior changes will be measured with the Summary of Diabetes Self-Care Activities scale and clinical changes will be measured using laboratory tests. A generalized linear mixed-effect model will be used to compute time effect, clustering effect, and the interaction of the control and intervention periods using SAS (version 9.4; SAS Institute). Results: We hypothesize that (1) at least 50\% (n=5) of eligible clinics and 50\% (n=40) of eligible patients who are invited will participate, and at least 70\% (n=56) of patients will complete the program, and (2) patients who receive the intervention will have improved self-care behaviors and clinical test results with at least 75\% (n=60) of the patients maintaining improved outcomes at follow-up visits compared with baseline, and participants will verbalize that the intervention is feasible and acceptable. As of August 2023, we enrolled 10 clinics and 60 patients. Baseline data results will be available by the end of 2023 and outcome data will be published in 2025. Conclusions: This is the first Vietnamese diabetes self-management education and support intervention that leverages mobile health technology to address the barriers of language and culture differences through collaboration with primary care clinics. This study will provide a better understanding of the implementation process, demonstrate the potential effectiveness of the intervention, accelerate the pace of moving evidence-based interventions to practice among the US Vietnamese population, and potentially provide a replicable implementation model that can be culturally adapted to other non-English speaking ethnic minorities. International Registered Report Identifier (IRRID): DERR1-10.2196/48585 ",
doi="10.2196/48585",
url="https://www.researchprotocols.org/2023/1/e48585",
url="http://www.ncbi.nlm.nih.gov/pubmed/37768716"
}


@Article{info:doi/10.2196/44985,
author="Beutter, L. Chantal N.
and Zeller, Katharina
and Martens, M. Uwe
and Pfleiderer, Bettina
and Fegeler, Christian",
title="User-Centered Development of a Mobile App to Assess the Quality of Life of Patients With Cancer: Iterative Investigation and Usability Testing",
journal="JMIR Cancer",
year="2023",
month="Sep",
day="26",
volume="9",
pages="e44985",
keywords="quality of life",
keywords="cancer",
keywords="mHealth",
keywords="mobile health",
keywords="patient empowerment",
keywords="user-centered design",
keywords="user",
keywords="user centered",
keywords="design",
keywords="physical well-being",
keywords="well-being",
keywords="mental health",
keywords="monitoring",
keywords="development",
keywords="usability",
abstract="Background: The treatment for cancer can have a negative impact not only on physical well-being but also on mental health and the quality of life (QoL). Health apps enable the monitoring of different parameters, but to date, there are only few that support patients with cancer and none that focuses on the assessment of QoL. Furthermore, patients as stakeholders are often only integrated at the late stage of the development process, if at all. Objective: The aim of this research was to develop and evaluate a smartphone app (Lion-App) to enable patients with cancer to autonomously measure the QoL with an iterative, user-centered approach. Methods: Patients with cancer were involved in a 3-stage process from conceptualization to the point when the app was available on the tester's private device. First, focus groups with members (N=21) of cancer support groups were conducted to understand their expectations and needs. Thereafter, individual tests were performed. After developing a prototype that incorporated findings from the focus groups, a second test cycle was conducted, followed by a beta test lasting 2 months. In our app, the QoL can be assessed via a patient diary and an integrated questionnaire. Through all stages, usability was evaluated using the modular extended version of the User Experience Questionnaire (UEQ+), including the calculation of a key performance indicator (KPI). If possible, the impact of sex on the results was evaluated. As part of the beta test, usage rates as well as age-dependent differences were also assessed. Results: A total of 21 participants took part in the initial 3 focus groups. In the subsequent usability testing (N=18), 17 (94\%) participants rated their impression through the UEQ+, with a mean KPI of 2.12 (SD 0.64, range: --3 to 3). In the second usability test (N=14), the mean KPI increased to 2.28 (SD=0.49). In the beta test, the usage rate of 19 participants was evaluated, of whom 14 (74\%) also answered the UEQ+ (mean KPI 1.78, SD 0.84). An influence of age on the number of questionnaire responses in Lion-App was observed, with a decrease in responses with increasing age (P=.02). Sex-dependent analyses were only possible for the first usability test and the beta test. The main adjustments based on user feedback were a restructuring of the diary as well as integration of a shorter questionnaire to assess the QoL. Conclusions: The iterative, user-centered approach for development and usability testing resulted in positive evaluations of Lion-App. Our app was rated as suitable for everyday use to monitor the QoL of patients with cancer. Initial results indicated that the sex and age of participants seem to play only a minor role. ",
doi="10.2196/44985",
url="https://cancer.jmir.org/2023/1/e44985",
url="http://www.ncbi.nlm.nih.gov/pubmed/37751285"
}


@Article{info:doi/10.2196/51852,
author="Chung, Hsueh-Wen
and Tai, Chen-Jei
and Chang, Polun
and Su, Wen-Lin
and Chien, Li-Yin",
title="Authors' Reply: Concerns on Generalizability",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Sep",
day="21",
volume="11",
pages="e51852",
keywords="mHealth app",
keywords="mobile health",
keywords="mHealth",
keywords="app",
keywords="prediabetes",
keywords="traditional Chinese medicine",
keywords="TCM",
keywords="health-related quality of life",
keywords="body constitution",
keywords="meridian energy",
doi="10.2196/51852",
url="https://mhealth.jmir.org/2023/1/e51852",
url="http://www.ncbi.nlm.nih.gov/pubmed/37733412"
}


@Article{info:doi/10.2196/50280,
author="Lin, Yongjian",
title="Concerns on Generalizability",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Sep",
day="21",
volume="11",
pages="e50280",
keywords="mHealth app",
keywords="mobile health",
keywords="mHealth",
keywords="app",
keywords="prediabetes",
keywords="traditional Chinese medicine",
keywords="TCM",
keywords="health-related quality of life",
keywords="body constitution",
keywords="meridian energy",
doi="10.2196/50280",
url="https://mhealth.jmir.org/2023/1/e50280",
url="http://www.ncbi.nlm.nih.gov/pubmed/37733387"
}


@Article{info:doi/10.2196/43376,
author="Ader, Leonie
and Schick, Anita
and L{\"o}ffler, Martin
and L{\"o}ffler, Annette
and Beiner, Eva
and Eich, Wolfgang
and Vock, Stephanie
and Sirazitdinov, Andrei
and Malone, Christopher
and Hesser, J{\"u}rgen
and Hopp, Michael
and Ruckes, Christian
and Flor, Herta
and Tesarz, Jonas
and Reininghaus, Ulrich",
title="Refocusing of Attention on Positive Events Using Monitoring-Based Feedback and Microinterventions for Patients With Chronic Musculoskeletal Pain in the PerPAIN Randomized Controlled Trial: Protocol for a Microrandomized Trial",
journal="JMIR Res Protoc",
year="2023",
month="Sep",
day="20",
volume="12",
pages="e43376",
keywords="experience sampling method",
keywords="ESM",
keywords="ecological momentary intervention",
keywords="EMI",
keywords="microrandomized trial",
keywords="mobile health",
keywords="mHealth",
keywords="positive intervention",
keywords="complex intervention",
keywords="mobile phone",
abstract="Background: Chronic musculoskeletal pain (CMSP) affects between 13\% and 47\% of the population, with a global growth rate of 20.3\% within the last 15 years, suggesting that there is a high need for effective treatments. Pain diaries have long been a common tool in nonpharmacological pain treatment for monitoring and providing feedback on patients' symptoms in daily life. More recently, positive refocusing techniques have come to be used, promoting pain-free episodes and positive outcomes rather than focusing on managing the pain. Objective: This study aims to evaluate the feasibility (ie, acceptability, intervention adherence, and fidelity) and initial signals of efficacy of the PerPAIN app, an ecological momentary intervention for patients with CMSP. The app comprises digitalized monitoring using the experience sampling method (ESM) and feedback. In addition, the patients receive 3 microinterventions targeted at refocusing of attention on positive events. Methods: In a microrandomized trial, we will recruit 35 patients with CMSP who will be offered the app for 12 weeks. Participants will be prompted to fill out 4 ESM monitoring questionnaires a day assessing information on their current context and the proximal outcome variables: absence of pain, positive mood, and subjective activity. Participants will be randomized daily and weekly to receive no feedback, verbal feedback, or visual feedback on proximal outcomes assessed by the ESM. In addition, the app will encourage participants to complete 3 microinterventions based on positive psychology and cognitive behavioral therapy techniques. These microinterventions are prompts to report joyful moments and everyday successes or to plan pleasant activities. After familiarizing themselves with each microintervention individually, participants will be randomized daily to receive 1 of the 3 exercises or none. We will assess whether the 2 feedback types and the 3 microinterventions increase proximal outcomes at the following time point. The microrandomized trial is part of the PerPAIN randomized controlled trial (German Clinical Trials Register DRKS00022792) investigating a personalized treatment approach to enhance treatment outcomes in CMSP. Results: Approval was granted by the Ethics Committee II of the University of Heidelberg on August 4, 2020. Recruitment for the microrandomized trial began in May 2021 and is ongoing at the time of submission. By October 10, 2022, a total of 24 participants had been enrolled in the microrandomized trial. Conclusions: This trial will provide evidence on the feasibility of the PerPAIN app and the initial signals of efficacy of the different intervention components. In the next step, the intervention would need to be further refined and investigated in a definitive trial. This ecological momentary intervention presents a potential method for offering low-level accessible treatment to a wide range of people, which could have substantial implications for public health by reducing disease burden of chronic pain in the population. International Registered Report Identifier (IRRID): DERR1-10.2196/43376 ",
doi="10.2196/43376",
url="https://www.researchprotocols.org/2023/1/e43376",
url="http://www.ncbi.nlm.nih.gov/pubmed/37728983"
}


@Article{info:doi/10.2196/47811,
author="Marini, Christina
and Cruz, Jocelyn
and Payano, Leydi
and Flores, Patino Ronaldo
and Arena, Gina-Maria
and Mandal, Soumik
and Leven, Eric
and Mann, Devin
and Schoenthaler, Antoinette",
title="Opening the Black Box of an mHealth Patient-Reported Outcome Tool for Diabetes Self-Management: Interview Study Among Patients With Type 2 Diabetes",
journal="JMIR Form Res",
year="2023",
month="Sep",
day="19",
volume="7",
pages="e47811",
keywords="mobile health",
keywords="mHealth",
keywords="patient-reported outcomes",
keywords="diabetes",
keywords="qualitative",
keywords="patient engagement",
abstract="Background: Mobile health (mHealth) tools are used to collect data on patient-reported outcomes (PROs) and facilitate the assessment of patients' self-management behaviors outside the clinic environment. Despite the high availability of mHealth diabetes tools, there is a lack of understanding regarding the underlying reasons why these mHealth PRO tools succeed or fail in terms of changing patients' self-management behaviors. Objective: This study aims to identify the factors that drive engagement with an mHealth PRO tool and facilitate patients' adoption of self-management behaviors, as well as elicit suggestions for improvement. Methods: This qualitative study was conducted within the context of a randomized controlled trial designed to evaluate the efficacy of an mHealth PRO tool (known as i-Matter) versus usual care regarding reduction in glycated hemoglobin (HbA1c) levels and adherence to self-management behaviors at 12 months among patients with uncontrolled type 2 diabetes. Patients randomized to i-Matter participated in semistructured interviews about their experiences at the 3-, 6-, 9-, and 12-month study visits. A qualitative analysis of the interviews was conducted by 2 experienced qualitative researchers using conventional qualitative content analysis. Results: The sample comprised 71 patients, of whom 67 (94\%) completed at least one interview (n=48, 72\% female patients; n=25, 37\% identified as African American or Black; mean age 56.65 [SD 9.79] years). We identified 4 overarching themes and 6 subthemes. Theme 1 showed that the patients' reasons for engagement with i-Matter were multifactorial. Patients were driven by internal motivating factors that bolstered their engagement and helped them feel accountable for their diabetes (subtheme 1) and external motivating factors that helped to serve as reminders to be consistent with their self-management behaviors (subtheme 2). Theme 2 revealed that the use of i-Matter changed patients' attitudes toward their disease and their health behaviors in 2 ways: patients developed more positive attitudes about their condition and their ability to effectively self-manage it (subtheme 3), and they also developed a better awareness of their current behaviors, which motivated them to adopt healthier lifestyle behaviors (subtheme 4). Theme 3 showed that patients felt more committed to their health as a result of using i-Matter. Theme 4 highlighted the limitations of i-Matter, which included its technical design (subtheme 5) and the need for more resources to support the PRO data collected and shared through the tool (subtheme 6). Conclusions: This study isolated internal and external factors that prompted patients to change their views about their diabetes, become more engaged with the intervention and their health, and adopt healthy behaviors. These behavioral mechanisms provide important insights to drive future development of mHealth interventions that could lead to sustained behavior change. ",
doi="10.2196/47811",
url="https://formative.jmir.org/2023/1/e47811",
url="http://www.ncbi.nlm.nih.gov/pubmed/37725427"
}


@Article{info:doi/10.2196/45484,
author="Chen, Nai-Jung
and Huang, Chiu-Mieh
and Fan, Ching-Chih
and Lu, Li-Ting
and Lin, Fen-He
and Liao, Jung-Yu
and Guo, Jong-Long",
title="User Evaluation of a Chat-Based Instant Messaging Support Health Education Program for Patients With Chronic Kidney Disease: Preliminary Findings of a Formative Study",
journal="JMIR Form Res",
year="2023",
month="Sep",
day="19",
volume="7",
pages="e45484",
keywords="chronic kidney disease",
keywords="chatbot",
keywords="health education",
keywords="push notification",
keywords="users' evaluation",
abstract="Background: Artificial intelligence--driven chatbots are increasingly being used in health care, but few chat-based instant messaging support health education programs are designed for patients with chronic kidney disease (CKD) to evaluate their effectiveness. In addition, limited research exists on the usage of chat-based programs among patients with CKD, particularly those that integrate a chatbot aimed at enhancing the communication ability and disease-specific knowledge of patients. Objective: The objective of this formative study is to gather the data necessary to develop an intervention program of chat-based instant messaging support health education for patients with CKD. Participants' user experiences will form the basis for program design improvements. Methods: Data were collected from April to November 2020 using a structured questionnaire. A pre-post design was used, and a total of 60 patients consented to join the 3-month program. Among them, 55 successfully completed the study measurements. The System Usability Scale was used for participant evaluations of the usability of the chat-based program. Results: Paired t tests revealed significant differences before and after intervention for communicative literacy (t54=3.99; P<.001) and CKD-specific disease knowledge (t54=7.54; P<.001). Within disease knowledge, significant differences were observed in the aspects of CKD basic knowledge (t54=3.46; P=.001), lifestyle (t54=3.83; P=.001), dietary intake (t54=5.51; P<.001), and medication (t54=4.17; P=.001). However, no significant difference was found in the aspect of disease prevention. Subgroup analysis revealed that while the findings among male participants were similar to those of the main sample, this was not the case among female participants. Conclusions: The findings reveal that a chat-based instant messaging support health education program may be effective for middle-aged and older patients with CKD. The use of a chat-based program with multiple promoting approaches is promising, and users' evaluation is satisfactory. Trial Registration: ClinicalTrials.gov NCT05665517; https://clinicaltrials.gov/study/NCT05665517 ",
doi="10.2196/45484",
url="https://formative.jmir.org/2023/1/e45484",
url="http://www.ncbi.nlm.nih.gov/pubmed/37725429"
}


@Article{info:doi/10.2196/45760,
author="Kwun, Ju-Seung
and Lee, Hoon Jang
and Park, Eun Bo
and Park, Sung Jong
and Kim, Jeong Hyeon
and Kim, Sun-Hwa
and Jeon, Ki-Hyun
and Cho, Hyoung-won
and Kang, Si-Hyuck
and Lee, Wonjae
and Youn, Tae-Jin
and Chae, In-Ho
and Yoon, Chang-Hwan",
title="Diagnostic Value of a Wearable Continuous Electrocardiogram Monitoring Device (AT-Patch) for New-Onset Atrial Fibrillation in High-Risk Patients: Prospective Cohort Study",
journal="J Med Internet Res",
year="2023",
month="Sep",
day="18",
volume="25",
pages="e45760",
keywords="arrhythmias",
keywords="atrial fibrillation",
keywords="wearable electronic device",
keywords="patch electrocardiogram monitor",
keywords="electrocardiogram",
keywords="adult",
keywords="AT-Patch",
keywords="heart failure",
keywords="mobile phone",
abstract="Background: While conventional electrocardiogram monitoring devices are useful for detecting atrial fibrillation, they have considerable drawbacks, including a short monitoring duration and invasive device implantation. The use of patch-type devices circumvents these drawbacks and has shown comparable diagnostic capability for the early detection of atrial fibrillation. Objective: We aimed to determine whether a patch-type device (AT-Patch) applied to patients with a high risk of new-onset atrial fibrillation defined by the congestive heart failure, hypertension, age ?75 years, diabetes mellitus, stroke, vascular disease, age 65-74 years, sex scale (CHA2DS2-VASc) score had increased detection rates. Methods: In this nonrandomized multicenter prospective cohort study, we enrolled 320 adults aged ?19 years who had never experienced atrial fibrillation and whose CHA2DS2-VASc score was ?2. The AT-Patch was attached to each individual for 11 days, and the data were analyzed for arrhythmic events by 2 independent cardiologists. Results: Atrial fibrillation was detected by the AT-Patch in 3.4\% (11/320) of patients, as diagnosed by both cardiologists. Interestingly, when participants with or without atrial fibrillation were compared, a previous history of heart failure was significantly more common in the atrial fibrillation group (n=4/11, 36.4\% vs n=16/309, 5.2\%, respectively; P=.003). When a CHA2DS2-VASc score ?4 was combined with previous heart failure, the detection rate was significantly increased to 24.4\%. Comparison of the recorded electrocardiogram data revealed that supraventricular and ventricular ectopic rhythms were significantly more frequent in the new-onset atrial fibrillation group compared with nonatrial fibrillation group (3.4\% vs 0.4\%; P=.001 and 5.2\% vs 1.2\%; P<.001), respectively. Conclusions: This study detected a moderate number of new-onset atrial fibrillations in high-risk patients using the AT-Patch device. Further studies will aim to investigate the value of early detection of atrial fibrillation, particularly in patients with heart failure as a means of reducing adverse clinical outcomes of atrial fibrillation. Trial Registration: ClinicalTrials.gov NCT04857268; https://classic.clinicaltrials.gov/ct2/show/NCT04857268 ",
doi="10.2196/45760",
url="https://www.jmir.org/2023/1/e45760",
url="http://www.ncbi.nlm.nih.gov/pubmed/37721791"
}


@Article{info:doi/10.2196/52204,
author="Feng, Yuheng
and Li, Xiaohong",
title="Authors' Reply: Methodological Considerations for a Diabetes Family-Based eHealth Intervention",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Sep",
day="18",
volume="11",
pages="e52204",
keywords="public health",
keywords="type 2 diabetes mellitus",
keywords="intervention",
keywords="randomized controlled trial",
keywords="community health center",
doi="10.2196/52204",
url="https://mhealth.jmir.org/2023/1/e52204",
url="http://www.ncbi.nlm.nih.gov/pubmed/37721796"
}


@Article{info:doi/10.2196/48652,
author="Bro?, Jan
and Campbell, D. Matthew
and Krollov{\'a}, Pavl{\'i}na
and Michalec, Juraj",
title="Methodological Considerations for a Diabetes Family-Based eHealth Intervention",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Sep",
day="18",
volume="11",
pages="e48652",
keywords="public health",
keywords="type 2 diabetes mellitus",
keywords="intervention",
keywords="randomized controlled trial",
keywords="community health center",
doi="10.2196/48652",
url="https://mhealth.jmir.org/2023/1/e48652",
url="http://www.ncbi.nlm.nih.gov/pubmed/37721787"
}


@Article{info:doi/10.2196/44016,
author="Finlay-Jones, Louise Amy
and Parkinson, Asha
and Sirois, Fuschia
and Perry, Yael
and Boyes, Mark
and Rees, S. Clare",
title="Web-Based Self-Compassion Training to Improve the Well-Being of Youth With Chronic Medical Conditions: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2023",
month="Sep",
day="13",
volume="25",
pages="e44016",
keywords="self-compassion",
keywords="chronic illness",
keywords="adolescent psychology",
keywords="mental health",
keywords="digital interventions",
keywords="internet",
keywords="well-being",
keywords="mobile phone",
abstract="Background: Up to one-third of young people live with chronic physical conditions (eg, diabetes, asthma, and autoimmune disease) that frequently involve recurrent pain, fatigue, activity limitations, stigma, and isolation. These issues may be exacerbated as young people transition through adolescence. Accordingly, young people with chronic illness are at a high risk of psychological distress. Accessible, evidence-based interventions for young people with chronic illnesses are urgently needed to improve well-being, support adaptation, and enhance daily functioning. Self-compassion, which is an adaptive means of relating to oneself during times of difficulty, is a promising intervention target for this population. Objective: This study aims to test the efficacy of a 4-week, self-guided, web-based self-compassion training program for improving well-being among young Australians (aged 16-25 years) living with a chronic medical condition. The primary outcomes were self-compassion, emotion regulation difficulties, and coping; the secondary outcomes were well-being, distress, and quality of life. We also sought to test whether changes in primary outcomes mediated changes in secondary outcomes and gather feedback about the strengths and limitations of the program. Methods: We conducted a single-blind, parallel-group, randomized controlled trial comparing a 4-week, fully automated, web-based self-compassion training program with a waitlist control. Participants were recruited via the internet, and outcomes were self-assessed at 4 (T1) and 12 weeks (T2) after the baseline time point via a web-based survey. A mixed methods approach was used to evaluate the program feedback. Results: Overall, 151 patients (age: mean 21.15, SD 2.77 years; female patients: n=132, 87.4\%) were randomized to the intervention (n=76, 50.3\%) and control (n=75, 49.7\%) groups. The loss--to--follow-up rate was 47.4\%, and program use statistics indicated that only 29\% (22/76) of young people in the experimental group completed 100\% of the program. The main reported barrier to completion was a lack of time. As anticipated, treatment effects were observed for self-compassion (P=.01; partial $\eta$2=0.05; small effect); well-being (P?.001; partial $\eta$2=0.07; medium effect); and distress (P=.003; partial $\eta$2=0.054; small-medium effect) at the posttest time point and maintained at follow-up. Contrary to our hypotheses, no intervention effects were observed for emotion regulation difficulties or maladaptive coping strategies. Improvements in adaptive coping were observed at the posttest time point but were not maintained at follow-up. Self-compassion, but not emotion regulation difficulties or coping, mediated the improvements in well-being. Conclusions: Minimal-contact, web-based self-compassion training can confer mental health benefits on young people with chronic conditions. This group experiences substantial challenges to participation in mental health supports, and program engagement and retention in this trial were suboptimal. Future work should focus on refining the program content, engagement, and delivery to optimize engagement and treatment outcomes for the target group. Trial Registration: Australian New Zealand Clinical Trials Registry 12619000572167; https://tinyurl.com/5n6hevt International Registered Report Identifier (IRRID): RR2-10.1186/s12889-020-8226-7 ",
doi="10.2196/44016",
url="https://www.jmir.org/2023/1/e44016",
url="http://www.ncbi.nlm.nih.gov/pubmed/37703081"
}


@Article{info:doi/10.2196/45437,
author="Gu, Yu
and Guan, Yushan
and Meng, Zhaolin",
title="Health Providers' Perceptions and Experiences of Using mHealth for Chronic Noncommunicable Diseases: Qualitative Systematic Review and Meta-Synthesis",
journal="J Med Internet Res",
year="2023",
month="Sep",
day="12",
volume="25",
pages="e45437",
keywords="mHealth",
keywords="mobile health",
keywords="health providers",
keywords="adoption",
keywords="chronic noncommunicable diseases",
keywords="systematic review",
keywords="meta-synthesis",
keywords="mobile phone",
abstract="Background: Mobile health (mHealth) technology has great potential for addressing the epidemic of chronic noncommunicable diseases (CNCDs) by assisting health providers (HPs) with managing these diseases. However, there is currently limited evidence regarding the acceptance of mHealth among HPs, which is a key prerequisite for harnessing this potential. Objective: This review aimed to investigate the perceptions and experiences of HPs regarding the barriers to and facilitators of mHealth use for CNCDs. Methods: A systematic search was conducted in MEDLINE (via Ovid), Embase, Web of Science, Google Scholar, and Cochrane Library (via Ovid) for studies that assessed the perceptions and experiences of HPs regarding the barriers to and facilitators of mHealth use for CNCDs. Qualitative studies and mixed methods studies involving qualitative methods published in English were included. Data synthesis and interpretation were performed using a thematic synthesis approach. Results: A total of 18,242 studies were identified, of which 24 (0.13\%) met the inclusion criteria. Overall, 6 themes related to facilitators were identified, namely empowering patient self-management, increasing efficiency, improving access to care, increasing the quality of care, improving satisfaction, and improving the usability of the internet and mobile software. Furthermore, 8 themes related to barriers were identified, namely limitation due to digital literacy, personal habits, or health problems; concern about additional burden; uncertainty around the value of mHealth technology; fear of medicolegal risks; lack of comfortable design and experience; lack of resources and incentives; lack of policy guidance and regulation; and worrisome side effects resulting from the use of mHealth. Conclusions: This study contributes to the understanding of the beneficial factors of and obstacles to mHealth adoption by HPs for CNCDs. The findings of this study may provide significant insights for health care workers and policy makers who seek ways to improve the adoption of mHealth by HPs for CNCDs. ",
doi="10.2196/45437",
url="https://www.jmir.org/2023/1/e45437",
url="http://www.ncbi.nlm.nih.gov/pubmed/37698902"
}


@Article{info:doi/10.2196/38481,
author="Inomata, Takenori
and Sung, Jaemyoung
and Nakamura, Masahiro
and Iwagami, Masao
and Akasaki, Yasutsugu
and Fujio, Kenta
and Ebihara, Nobuyuki
and Ide, Takuma
and Nagao, Masashi
and Okumura, Yuichi
and Nagino, Ken
and Fujimoto, Keiichi
and Eguchi, Atsuko
and Hirosawa, Kunihiko
and Midorikawa-Inomata, Akie
and Muto, Kaori
and Fujisawa, Kumiko
and Kikuchi, Yota
and Nojiri, Shuko
and Murakami, Akira",
title="Using the AllerSearch Smartphone App to Assess the Association Between Dry Eye and Hay Fever: mHealth-Based Cross-Sectional Study",
journal="J Med Internet Res",
year="2023",
month="Sep",
day="12",
volume="25",
pages="e38481",
keywords="dry eye",
keywords="hay fever",
keywords="mobile health",
keywords="personalized medicine",
keywords="smartphone",
keywords="pollinosis",
keywords="rhinitis",
keywords="allergic conjunctivitis",
keywords="nasal symptom score",
keywords="nonnasal symptom score",
keywords="Ocular Surface Disease Index",
keywords="Japanese Allergic Conjunctival Disease Standard Quality of Life Questionnaire",
keywords="mobile phone",
abstract="Background: Dry eye (DE) and hay fever (HF) show synergistic exacerbation of each other's pathology through inflammatory pathways. Objective: This study aimed to investigate the association between DE and HF comorbidity and the related risk factors. Methods: A cross-sectional observational study was conducted using crowdsourced multidimensional data from individuals who downloaded the AllerSearch smartphone app in Japan between February 2018 and May 2020. AllerSearch collected the demographics, medical history, lifestyle and residential information, HF status, DE symptoms, and HF-related quality of life. HF symptoms were evaluated using the nasal symptom score (0-15 points) and nonnasal symptom score (0-12 points). HF was defined by the participants' responses to the questionnaire as HF, non-HF, or unknown. Symptomatic DE was defined as an Ocular Surface Disease Index total score (0-100 points), with a threshold score of 13 points. HF-related quality of life was assessed using the Japanese Allergic Conjunctival Disease Standard Quality of Life Questionnaire (0-68 points). We conducted a multivariable linear regression analysis to examine the association between the severity of DE and HF symptoms. We subsequently conducted a multivariable logistic regression analysis to identify the factors associated with symptomatic DE (vs nonsymptomatic DE) among individuals with HF. Dimension reduction via Uniform Manifold Approximation and Projection stratified the comorbid DE and HF symptoms. The symptom profiles in each cluster were identified using hierarchical heat maps. Results: This study included 11,284 participants, classified into experiencing HF (9041 participants), non-HF (720 participants), and unknown (1523 participants) groups. The prevalence of symptomatic DE among individuals with HF was 49.99\% (4429/9041). Severe DE symptoms were significantly associated with severe HF symptoms: coefficient 1.33 (95\% CI 1.10-1.57; P<.001) for mild DE, coefficient 2.16 (95\% CI 1.84-2.48; P<.001) for moderate DE, and coefficient 3.80 (95\% CI 3.50-4.11; P<.001) for severe DE. The risk factors for comorbid symptomatic DE among individuals with HF were identified as female sex; lower BMI; medicated hypertension; history of hematologic, collagen, heart, liver, respiratory, or atopic disease; tomato allergy; current and previous mental illness; pet ownership; living room and bedrooms furnished with materials other than hardwood, carpet, tatami, and vinyl; discontinuation of contact lens use during the HF season; current contact lens use; smoking habits; and sleep duration of <6 hours per day. Uniform Manifold Approximation and Projection stratified the heterogeneous comorbid DE and HF symptoms into 14 clusters. In the hierarchical heat map, cluster 9 was comorbid with the most severe HF and DE symptoms, and cluster 1 showed severe HF symptoms with minimal DE-related symptoms. Conclusions: This crowdsourced study suggested a significant association between severe DE and HF symptoms. Detecting DE among individuals with HF could allow effective prevention and interventions through concurrent treatment for ocular surface management along with HF treatment. ",
doi="10.2196/38481",
url="https://www.jmir.org/2023/1/e38481",
url="http://www.ncbi.nlm.nih.gov/pubmed/37698897"
}


@Article{info:doi/10.2196/48638,
author="Noda, Masao
and Kuroda, Tatsuaki
and Nomura, Akihiro
and Ito, Makoto
and Yoshizaki, Tomokazu
and Fushiki, Hiroaki",
title="Smartphone-Assisted Medical Care for Vestibular Dysfunction as a Telehealth Strategy for Digital Therapy Beyond COVID-19: Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Sep",
day="11",
volume="11",
pages="e48638",
keywords="dizziness",
keywords="vertigo",
keywords="telemedicine",
keywords="smartphone",
keywords="digital therapy",
keywords="telehealth",
keywords="COVID-19",
keywords="information technology",
keywords="scoping review",
keywords="health device",
keywords="remote diagnosis",
keywords="medical care",
abstract="Background: Dizziness and vertigo can be caused by various factors, such as peripheral vestibular and central disorders. Although consultations with specialists are advisable when necessary, patients with severe vertigo symptoms may have limited mobility, which may interfere with hospital visits. The spread of COVID-19 has further limited the number of hospital visits for patients with dizziness; therefore, a method of medical care that enables more accurate treatment under time and geographical constraints is needed. Telemedicine has become widespread, owing to the popularity of smartphone and tablet devices in recent years, and the use of devices and systems has made it possible to provide efficient medical care. However, no previous scoping review has mapped existing studies on telemedicine for vertigo and dizziness, and no recommendations have been made regarding which devices and systems should be used for specific diseases. Objective: The aim of this review was to map and assess previous studies on the use of information communications technology, smartphones, and apps for treating patients with vertigo and discuss the added value of introducing telemedicine to improve the quality of medical care and create an environment that builds security and trust among patients. Methods: A scoping review was conducted with the methodological framework of Arksey and O'Malley and in accordance with the of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews) guidelines. The PubMed, MEDLINE, and Cochrane Library databases were searched to retrieve previous reports on smartphone-assisted telemedicine treatment for vertigo published between January 2000 and May 2023. Two authors independently assessed eligibility and extracted data. Results: This review included 20 papers that reported devices or systems for telemedicine for vestibular dysfunction. Among studies that reported the use of a device or app, 2 were related to anamnesis and subjective symptoms, 12 were related to objective examination, 7 were related to remote diagnosis, and 7 were related to treatment and rehabilitation. Conclusions: With the advancement of technology, the use of telemedicine in patients with dizziness may be feasible. In the future, it will be necessary to consider how telemedicine can be used in dizziness treatment and develop an effective treatment system combining in-person medical care and the effective use of devices for the management of severe vertigo and related diseases. The smooth introduction of telemedicine in vertigo treatment is expected to improve the quality of treatment, increase opportunities for patients to receive medical care, and reduce time and travel costs, leading to a sense of security and trust among patients. ",
doi="10.2196/48638",
url="https://mhealth.jmir.org/2023/1/e48638",
url="http://www.ncbi.nlm.nih.gov/pubmed/37695671"
}


@Article{info:doi/10.2196/47638,
author="Kumbara, B. Abhimanyu
and Iyer, K. Anand
and Green, R. Courtney
and Jepson, H. Lauren
and Leone, Keri
and Layne, E. Jennifer
and Shomali, Mansur",
title="Impact of a Combined Continuous Glucose Monitoring--Digital Health Solution on Glucose Metrics and Self-Management Behavior for Adults With Type 2 Diabetes: Real-World, Observational Study",
journal="JMIR Diabetes",
year="2023",
month="Sep",
day="11",
volume="8",
pages="e47638",
keywords="type 2 diabetes",
keywords="digital health",
keywords="continuous glucose monitoring",
keywords="artificial intelligence",
keywords="glycemic outcomes",
keywords="engagement",
keywords="digital health intervention",
keywords="mHealth",
keywords="diabetes management",
abstract="Background: The BlueStar (Welldoc) digital health solution for people with diabetes incorporates data from multiple devices and generates coaching messages using artificial intelligence. The BlueStar app syncs glucose data from the G6 (Dexcom) real-time continuous glucose monitoring (RT-CGM) system, which provides a glucose measurement every 5 minutes. Objective: The objective of this real-world study of people with type 2 diabetes (T2D) using the digital health solution and RT-CGM was to evaluate change in glycemic control and engagement with the program over 3 months. Methods: Participants were current or former enrollees in an employer-sponsored health plan, were aged 18 years or older, had a T2D diagnosis, and were not using prandial insulin. Outcomes included CGM-based glycemic metrics and engagement with the BlueStar app, including logging medications taken, exercise, food details, blood pressure, weight, and hours of sleep. Results: Participants in the program that met our analysis criteria (n=52) were aged a mean of 53 (SD 9) years; 37\% (19/52) were female and approximately 50\% (25/52) were taking diabetes medications. The RT-CGM system was worn 90\% (SD 8\%) of the time over 3 months. Among individuals with suboptimal glycemic control at baseline, defined as mean glucose >180 mg/dL, clinically meaningful improvements in glycemic control were observed, including reductions in a glucose management indicator (--0.8 percentage points), time above range 181-250 mg/dL (--4.4 percentage points) and time above range >250 mg/dL (--14 percentage points; all P<.05). Time in range 70-180 mg/dL also increased by 15 percentage points (P=.016) in this population, which corresponds to an increase of approximately 3.5 hours per day in the target range. Over the 3-month study, 29\% (15/52) of participants completed at least one engagement activity per week. Medication logging was completed most often by participants (23/52, 44\%) at a rate of 12.1 (SD 0.8) events/week, and this was closely followed by exercise and food logging. Conclusions: The combination of an artificial intelligence--powered digital health solution and RT-CGM helped people with T2D improve their glycemic outcomes and diabetes self-management behaviors. ",
doi="10.2196/47638",
url="https://diabetes.jmir.org/2023/1/e47638",
url="http://www.ncbi.nlm.nih.gov/pubmed/37590491"
}


@Article{info:doi/10.2196/44147,
author="Yoon, Yong-Hoon
and Kim, Jongin
and Lee, Jin Kwang
and Cho, Dongrae
and Oh, Kyung Jin
and Kim, Minsu
and Roh, Jae-Hyung
and Park, Woong Hyun
and Lee, Jae-Hwan",
title="Blood Pressure Measurement Based on the Camera and Inertial Measurement Unit of a Smartphone: Instrument Validation Study",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Sep",
day="8",
volume="11",
pages="e44147",
keywords="blood pressure",
keywords="camera",
keywords="cuffless",
keywords="inertial measurement unit",
keywords="smartphone software",
keywords="cardiovascular",
keywords="hypertension",
keywords="smartphone",
keywords="measure",
keywords="accuracy",
keywords="accurate",
keywords="software",
keywords="mHealth",
keywords="mobile health",
abstract="Background: Even though several mobile apps that can measure blood pressure have been developed, the data about the accuracy of these apps are limited. Objective: We assessed the accuracy of AlwaysBP (test) in blood pressure measurement compared with the standard, cuff-based, manual method of brachial blood pressure measurement (reference). Methods: AlwaysBP is a smartphone software that estimates systolic blood pressure (SBP) and diastolic blood pressure (DBP) based on pulse transit time (PTT). PTT was calculated with a finger photoplethysmogram and seismocardiogram using, respectively, the camera and inertial measurement unit sensor of a commercially available smartphone. After calculating PTT, SBP and DBP were estimated via the Bramwell-Hill and Moens-Korteweg equations. A calibration process was carried out 3 times for each participant to determine the input parameters of the equations. This study was conducted from March to August 2021 at Chungnam National University Sejong Hospital with 87 participants aged between 19 and 70 years who met specific conditions. The primary analysis aimed to evaluate the accuracy of the test method compared with the reference method for the entire study population. The secondary analysis was performed to confirm the stability of the test method for up to 4 weeks in 15 participants. At enrollment, gender, arm circumference, and blood pressure distribution were considered according to current guidelines. Results: Among the 87 study participants, 45 (52\%) individuals were male, and the average age was 35.6 (SD 10.4) years. Hypertension was diagnosed in 14 (16\%) participants before this study. The mean test and reference SBPs were 120.0 (SD 18.8) and 118.7 (SD 20.2) mm Hg, respectively (difference: mean 1.2, SD 7.1 mm Hg). The absolute differences between the test and reference SBPs were <5, <10, and <15 mm Hg in 57.5\% (150/261), 84.3\% (220/261 ), and 94.6\% (247/261) of measurements. The mean test and reference DBPs were 80.1 (SD 12.6) and 81.1 (SD 14.4) mm Hg, respectively (difference: mean ?1.0, SD 6.0 mm Hg). The absolute differences between the test and reference DBPs were <5, <10, and <15 mm Hg in 75.5\% (197/261), 93.9\% (245/261), and 97.3\% (254/261) of measurements, respectively. The secondary analysis showed that after 4 weeks, the differences between SBP and DBP were 0.1 (SD 8.8) and ?2.4 (SD 7.6) mm Hg, respectively. Conclusions: AlwaysBP exhibited acceptable accuracy in SBP and DBP measurement compared with the standard measurement method, according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization protocol criteria. However, further validation studies with a specific validation protocol designed for cuffless blood pressure measuring devices are required to assess clinical accuracy. This technology can be easily applied in everyday life and may improve the general population's awareness of hypertension, thus helping to control it. ",
doi="10.2196/44147",
url="https://mhealth.jmir.org/2023/1/e44147"
}


@Article{info:doi/10.2196/49020,
author="Strout, Kelley
and Schwartz-Mette, Rebecca
and McNamara, Jade
and Parsons, Kayla
and Walsh, Dyan
and Bonnet, Jen
and O'Brien, M. Liam
and Robinson, Kathryn
and Sibley, Sean
and Smith, Annie
and Sapp, Maile
and Sprague, Lydia
and Sabegh, Sajedi Nima
and Robinson, Kaitlin
and Henderson, Amanda",
title="Wellness in Nursing Education to Promote Resilience and Reduce Burnout: Protocol for a Holistic Multidimensional Wellness Intervention and Longitudinal Research Study Design in Nursing Education",
journal="JMIR Res Protoc",
year="2023",
month="Sep",
day="8",
volume="12",
pages="e49020",
keywords="nursing workforce",
keywords="academic performance",
keywords="burnout",
keywords="resilience",
keywords="wellness",
keywords="nursing",
keywords="education",
keywords="nursing education",
keywords="protocol",
keywords="nursing students",
keywords="students",
keywords="holistic",
keywords="implementation",
keywords="workforce",
abstract="Background: The United States faces a nursing shortage driven by a burnout epidemic among nurses and nursing students. Nursing students are an integral population to fuel the nursing workforce at high risk of burnout and increased rates of perceived stress. Objective: The aim of this paper is to describe WellNurse, a holistic, interdisciplinary, multidimensional longitudinal research study that examines evidence-based interventions intended to reduce burnout and increase resilience among graduate and undergraduate nursing students. Methods: Graduate and undergraduate nursing students matriculated at a large public university in the northeastern United States are eligible to enroll in this ongoing, longitudinal cohort study beginning in March 2021. Participants complete a battery of health measurements twice each semester during the fourth week and the week before final examinations. The measures include the Perceived Stress Scale, the Satisfaction with Life Scale, the Oldenburg Burnout Inventory, the Brief Resilience Scale, and the Pittsburgh Sleep Quality Index. Participants are eligible to enroll in a variety of interventions, including mindfulness-based stress reduction, mindful eating, fitness training, and massage therapy. Those who enroll in specific, targeted interventions complete additional measures designed to target the aim of the intervention. All participants receive a free Fitbit device. Additional environmental changes are being implemented to further promote a culture that supports academic well-being, including recruiting a diverse student population through evidence-based holistic admissions, inclusive teaching design, targeted resilience and stress reduction workshops, and cultural shifts within classrooms and curricula. The study design protocol is registered at Open Science Framework DOI 10.17605/OSF.IO/NCBPE. Results: The project was funded on January 1, 2022. Data collection started in March 2022. A total of 267 participants have been recruited. Results will be published after each semester starting in December 2023. WellNurse evaluation follows the Rapid Cycle Quality Improvement framework to continuously monitor ongoing project processes, activity outcomes, and progress toward reducing burnout and increasing resilience. Rapid Cycle Quality Improvement promotes the ability to alter WellNurse interventions, examine multiple interventions, and test their effectiveness among the nursing education population to identify the most effective interventions. Conclusions: Academic nursing organizations must address student burnout risk and increase resilience to produce a future workforce that provides high-quality patient care to a diverse population. Findings from WellNurse will support evidence-based implementations for public baccalaureate and master's nursing programs in the United States. International Registered Report Identifier (IRRID): DERR1-10.2196/49020 ",
doi="10.2196/49020",
url="https://www.researchprotocols.org/2023/1/e49020/"
}


@Article{info:doi/10.2196/40422,
author="Nordstoga, Lovise Anne
and Aasdahl, Lene
and Sandal, Fleng Louise
and Dalager, Tina
and Kongsvold, Atle
and Mork, Jarle Paul
and Nilsen, Lund Tom Ivar",
title="The Role of Pain Duration and Pain Intensity on the Effectiveness of App-Delivered Self-Management for Low Back Pain (selfBACK): Secondary Analysis of a Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Aug",
day="31",
volume="11",
pages="e40422",
keywords="low back pain",
keywords="self-management",
keywords="mHealth",
keywords="mobile app",
keywords="health app",
keywords="mobile health",
keywords="back",
keywords="pain",
keywords="randomized controlled trial",
keywords="RCT",
keywords="secondary analysis",
keywords="secondary analyses",
keywords="spine",
keywords="effectiveness",
keywords="digital intervention",
abstract="Background: Clinical guidelines for nonspecific low back pain (LBP) recommend self-management tailored to individual needs and capabilities as a first-line treatment. Mobile health solutions are a promising method for delivering tailored self-management interventions to patients with nonspecific LBP. However, it is not clear if the effectiveness of such self-management interventions depends on patients' initial pain characteristics. High pain intensity and long-term symptoms of LBP have been associated with an unfavorable prognosis, and current best evidence indicates that long-term LBP (lasting more than 3 months) requires a more extensive treatment approach compared to more acute LBP. The artificial intelligence--based selfBACK app supports tailored and evidence-based self-management of nonspecific LBP. In a recent randomized controlled trial, we showed that individuals who received the selfBACK app in addition to usual care had lower LBP-related disability at the 3-month follow-up compared to those who received usual care only. This effect was sustained at 6 and 9 months. Objective: This study aims to explore if the baseline duration and intensity of LBP influence the effectiveness of the selfBACK intervention in a secondary analysis of the selfBACK randomized controlled trial. Methods: In the selfBACK trial, 461 adults (18 years or older) who sought care for nonspecific LBP in primary care or at an outpatient spine clinic were randomized to receive the selfBACK intervention adjunct to usual care (n=232) or usual care alone (n=229). In this secondary analysis, the participants were stratified according to the duration of the current LBP episode at baseline (?12 weeks vs >12 weeks) or baseline LBP intensity (?5 points vs >5 points) measured by a 0-10 numeric rating scale. The outcomes were LBP-related disability measured by the Roland-Morris Disability Questionnaire (0- to 24-point scale), average LBP intensity, pain self-efficacy, and global perceived effect. To assess whether the duration and intensity of LBP influenced the effect of selfBACK, we estimated the difference in treatment effect between the strata at the 3- and 9-month follow-ups with a 95\% CI. Results: Overall, there was no difference in effect for patients with different durations or intensities of LBP at either the 3- or 9-month follow-ups. However, there was suggestive evidence that the effect of the selfBACK intervention on LBP-related disability at the 3-month follow-up was largely confined to people with the highest versus the lowest LBP intensity (mean difference between the intervention and control group ?1.8, 95\% CI ?3.0 to ?0.7 vs 0.2, 95\% CI ?1.1 to 0.7), but this was not sustained at the 9-month follow-up. Conclusions: The results suggest that the intensity and duration of LBP have negligible influence on the effectiveness of the selfBACK intervention on LBP-related disability, average LBP intensity, pain self-efficacy, and global perceived effect. Trial Registration: ClinicalTrials.gov NTC03798288; https://clinicaltrials.gov/study/NCT03798288 International Registered Report Identifier (IRRID): RR2-10.2196/14720 ",
doi="10.2196/40422",
url="https://mhealth.jmir.org/2023/1/e40422"
}


@Article{info:doi/10.2196/49806,
author="Caparso, Cinzia
and Ozkan, Gwynne
and Kluge, Maxwell
and Salim, Humza
and Khaghany, Aidan
and Blok, Amanda
and Choi, Won Sung",
title="Mobile Technology to Monitor and Support Health and Well-Being: Qualitative Study of Perspectives and Design Suggestions From Patients Undergoing Hematopoietic Cell Transplantation",
journal="JMIR Form Res",
year="2023",
month="Aug",
day="31",
volume="7",
pages="e49806",
keywords="hematopoietic stem cell transplantation",
keywords="bone marrow",
keywords="surgery",
keywords="surgical",
keywords="recovery",
keywords="mobile apps",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="qualitative research",
keywords="qualitative",
keywords="experience",
keywords="experiences",
keywords="perception",
keywords="perceptions",
keywords="stem cell",
keywords="stem cells",
keywords="transplant",
keywords="transplantation",
keywords="transplants",
keywords="hematopoietic",
keywords="positive psychology",
keywords="psychology",
abstract="Background: In the United States, hematopoietic stem cell transplant (HCT) surpasses 22,000 procedures annually. Due to the demanding and time-intensive process of an HCT, patients and family care partners face unique challenges involving their health and well-being. Positive psychology interventions (PPIs) may offer potential solutions to help boost health and well-being. Objective: This study aimed to explore and understand patients' experiences and perceptions about the use of the Roadmap 2.0 app, specifically its PPI features, during the acute phase of HCT. Methods: From an ongoing randomized controlled trial, HCT patients (n=17) were recruited to participate in semistructured qualitative interviews between October 2022 and January 2023 within a large academic medical center in the Midwestern states. Using a qualitative descriptive approach, interviews were conducted in person or via Zoom. The data were analyzed through constant comparative analysis. The Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines were followed. Results: The majority of the participants reported Roadmap 2.0 as easy to use and enjoyed the ability to track their health data (eg, steps, mood, sleep; 9/17). Regarding the use of PPIs during the acute phase of treatment, 88\% of the participants reported interest in participating in PPIs, specifically the Pleasant Activity Scheduling (11/17) followed by Gratitude Journaling (7/17) activities. Additionally, participants provided recommendations on adapting Roadmap 2.0. The major recommendations were (1) ``Working Together: Need for Dyadic Involvement,'' (2) ``Connectivity with Other Patients,'' and (3) ``Gap in Nutritional Support.'' Participants (10/17) expressed the importance of caregiver involvement in activities beyond treatment-related management for maintaining healthy patient-caregiver dyadic relationships. They also expressed their desire for connectivity with other patients undergoing HCT, primarily for comparing experiences and discussing topics such as symptom management (8/17). Lastly, participants identified a gap in nutritional support during the HCT process and expressed interest in an intervention that could promote healthy eating through education and notification reminders (9/17). Conclusions: Participants openly expressed their eagerness to participate in research studies that foster connection and positive relationships with their caregivers as well as with other HCT patients. They emphasized the significance of having access to nutritional support or guidance and highlighted the potential benefits of using mobile technology to enhance these collective efforts. Trial Registration: ClinicalTrials.gov NCT04094844; https://clinicaltrials.gov/study/NCT04094844 International Registered Report Identifier (IRRID): RR2-10.2196/19288 ",
doi="10.2196/49806",
url="https://formative.jmir.org/2023/1/e49806",
url="http://www.ncbi.nlm.nih.gov/pubmed/37651172"
}


@Article{info:doi/10.2196/42415,
author="Paganini, Sarah
and Meier, Evelyn
and Terhorst, Yannik
and Wurst, Ramona
and Hohberg, Vivien
and Schultchen, Dana
and Strahler, Jana
and Wursthorn, Max
and Baumeister, Harald
and Messner, Eva-Maria",
title="Stress Management Apps: Systematic Search and Multidimensional Assessment of Quality and Characteristics",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Aug",
day="29",
volume="11",
pages="e42415",
keywords="stress management",
keywords="mobile app",
keywords="mHealth",
keywords="mobile health",
keywords="quality assessment",
keywords="review",
keywords="evidence base",
keywords="availability",
abstract="Background: Chronic stress poses risks for physical and mental well-being. Stress management interventions have been shown to be effective, and stress management apps (SMAs) might help to transfer strategies into everyday life. Objective: This review aims to provide a comprehensive overview of the quality and characteristics of SMAs to give potential users or health professionals a guideline when searching for SMAs in common app stores. Methods: SMAs were identified with a systematic search in the European Google Play Store and Apple App Store. SMAs were screened and checked according to the inclusion criteria. General characteristics and quality were assessed by 2 independent raters using the German Mobile Application Rating Scale (MARS-G). The MARS-G assesses quality (range 1 to 5) on the following four dimensions: (1) engagement, (2) functionality, (3) esthetics, and (4) information. In addition, the theory-based stress management strategies, evidence base, long-term availability, and common characteristics of the 5 top-rated SMAs were assessed and derived. Results: Of 2044 identified apps, 121 SMAs were included. Frequently implemented strategies (also in the 5 top-rated SMAs) were psychoeducation, breathing, and mindfulness, as well as the use of monitoring and reminder functions. Of the 121 SMAs, 111 (91.7\%) provided a privacy policy, but only 44 (36.4\%) required an active confirmation of informed consent. Data sharing with third parties was disclosed in only 14.0\% (17/121) of the SMAs. The average quality of the included apps was above the cutoff score of 3.5 (mean 3.59, SD 0.50). The MARS-G dimensions yielded values above this cutoff score (functionality: mean 4.14, SD 0.47; esthetics: mean 3.76, SD 0.73) and below this score (information: mean 3.42, SD 0.46; engagement: mean 3.05, SD 0.78). Most theory-based stress management strategies were regenerative stress management strategies. The evidence base for 9.1\% (11/121) of the SMAs could be identified, indicating significant group differences in several variables (eg, stress or depressive symptoms) in favor of SMAs. Moreover, 38.0\% (46/121) of the SMAs were no longer available after a 2-year period. Conclusions: The moderate information quality, scarce evidence base, constraints in data privacy and security features, and high volatility of SMAs pose challenges for users, health professionals, and researchers. However, owing to the scalability of SMAs and the few but promising results regarding their effectiveness, they have a high potential to reach and help a broad audience. For a holistic stress management approach, SMAs could benefit from a broader repertoire of strategies, such as more instrumental and mental stress management strategies. The common characteristics of SMAs with top-rated quality can be used as guidance for potential users and health professionals, but owing to the high volatility of SMAs, enhanced evaluation frameworks are needed. ",
doi="10.2196/42415",
url="https://mhealth.jmir.org/2023/1/e42415",
url="http://www.ncbi.nlm.nih.gov/pubmed/37642999"
}


@Article{info:doi/10.2196/49738,
author="Persson, Roland Dan
and Zhukouskaya, Katiarina
and Wegener, Karin Anne-Marie
and J{\o}rgensen, K{\o}lle Lene
and Bardram, Eyvind Jakob
and B{\ae}kgaard, Per",
title="Exploring Patient Needs and Designing Concepts for Digitally Supported Health Solutions in Managing Type 2 Diabetes: Cocreation Study",
journal="JMIR Form Res",
year="2023",
month="Aug",
day="25",
volume="7",
pages="e49738",
keywords="cocreation",
keywords="co-creation",
keywords="participatory design",
keywords="diabetes",
keywords="type 2 diabetes mellitus",
keywords="T2DM",
keywords="chronic illness",
keywords="personalized self-care",
keywords="mobile health",
keywords="mHealth",
keywords="eHealth",
abstract="Background: Self-management of the progressive disease type 2 diabetes mellitus (T2DM) becomes part of the daily life of patients starting from the time of diagnosis. However, despite the availability of technical innovations, the uptake of digital solutions remains low. One reason that has been reported is that digital solutions often focus purely on clinical factors that may not align with the patient's perspective. Objective: The aim of this study was to develop digital solutions that address the needs of patients with T2DM, designed from the user's perspective. The goal was to address the patients' expressed real-world needs by having the users themselves choose the scope and format of the solutions. Methods: Using participatory methods, we conducted 3 cocreation workshops in collaboration with the Danish Diabetes Association, with 20 persons with T2DM and 11 stakeholders across workshops: user experience designers, researchers, and diabetes experts including a diabetes nurse. The overall structure of the 3 workshops was aligned with the 4 phases of the double diamond: initially discovering and mapping out key experienced issues, followed by a workshop on thematic mapping and definition of key concepts, and succeeded by an exploration and development of 2 prototypes. Subsequently, high-fidelity interactive prototypes were refined as part of the delivery phase, in which 7 formative usability tests were conducted. Results: The workshops mapped experiential topics over time from prediagnosis to the current state, resulting in a detailed exploration and understanding of 6 themes related to and based on the experiences of patients with T2DM: diabetes care, diabetes knowledge, glucose monitoring, diet, physical activity, and social aspects of diabetes. Two prototypes were developed by the participants to address some of their expressed needs over time related to the 6 themes: an activity-based continuous glucose monitoring app and a web-based guide to diabetes. Both prototypes emphasize periods of structured self-measurements of blood glucose to support evolving needs for self-exploration through distinct phases of learning, active use, and supporting use. Periods of low or intermittent use may thus not reflect a failure of design in a traditional sense but rather be a sign of evolving needs over time. Conclusions: Our results indicate that the needs of patients with T2DM differ between individuals and change over time. As a result, the suggested digitally supported empowering health prototypes can be personalized to support self-exploration, individual preference in long-term management, and changing needs over time. Despite individuals experiencing different journeys with diabetes, users perceive the self-measurement of blood glucose as a universally useful tool to empower everyday decision-making. ",
doi="10.2196/49738",
url="https://formative.jmir.org/2023/1/e49738",
url="http://www.ncbi.nlm.nih.gov/pubmed/37624633"
}


@Article{info:doi/10.2196/47553,
author="Hu, Yuanjia
and Lu, Yang
and Tian, Chenghua
and He, Yunfan
and Rong, Kaiyi
and Pan, Sijia
and Lei, Jianbo",
title="Current Status and Trends in mHealth-Based Research for Treatment and Intervention in Tinnitus: Bibliometric and Comparative Product Analysis",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Aug",
day="24",
volume="11",
pages="e47553",
keywords="tinnitus",
keywords="mobile health",
keywords="mHealth",
keywords="internet",
keywords="application",
keywords="software",
keywords="bibliometrics",
keywords="mobile phone",
abstract="Background: As a global medical problem, tinnitus can seriously harm human health and is difficult to alleviate, ranking among the top 3 complex diseases in the otolaryngology field. Traditional cognitive behavioral therapy and sound therapy require offline face-to-face treatment with medical staff and have limited effectiveness. Mobile health (mHealth), which, in recent decades, has been greatly applied in the field of rehabilitation health care, improving access to health care resources and the quality of services, has potential research value in the adjunctive treatment of tinnitus. Objective: This study aimed to understand the research trends, product characteristics, problems, and research transformation of tinnitus treatment software by analyzing the research progress of mHealth for tinnitus treatment based on the literature and related marketed apps. Methods: Bibliometric methods were used to describe the characteristics of the relevant literature in terms of the number and topics of publications, authors, and institutions. We further compared the features and limitations of the currently available tinnitus treatment software. Results: Data published until February 28, 2022, were collected. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standardized screening process, 75 papers were included. The country with the highest number of publications was Germany, followed by the United Kingdom and the United States, whereas China had only a single relevant study. The most frequently found journals were the American Journal of Audiology and the Journal of the American Academy of Audiology (18/75, 24\%). With regard to publication topics, cognitive behavioral therapy started to become a hot topic in 2017, and research on mHealth apps has increased. In this study, 28 tinnitus treatment apps were obtained (n=24, 86\% from product data and n=4, 14\% from literature data); these apps were developed mainly in the United States (10/28, 36\%) or China (9/28, 32\%). The main treatment methods were sound therapy (10/28, 36\%) and cognitive behavioral therapy (2/28, 7\%). Of the 75 publications, 7 (9\%) described apps in the market stage. Of the 28 apps, 22 (79\%) lacked literature studies or evidence from professional bodies. Conclusions: We found that, as a whole, the use of mHealth for treatment and intervention in tinnitus was showing a rapid development, in which good progress had been made in studies around sound therapy and cognitive behavioral therapy, although most of the studies (50/75, 67\%) focused on treatment effects. However, the field is poorly accepted in top medical journals, and the majority are in the research design phase, with a lack of translation of the literature results and clinical validation of the marketed apps. Furthermore, in the future, novel artificial intelligence techniques should be used to address the issue of staged monitoring of tinnitus. ",
doi="10.2196/47553",
url="https://mhealth.jmir.org/2023/1/e47553",
url="http://www.ncbi.nlm.nih.gov/pubmed/37616044"
}


@Article{info:doi/10.2196/46880,
author="O'Meara, Miguel
and Mateus Acu{\~n}a, Camilo Juan
and Uribe, Andrea",
title="Long-Term Benefits of an Integrated Continuous Glucose Monitoring and Insulin Pump System for Emergency Admissions, Hospitalization, and Metabolic Control in a Cohort of People With Diabetes: Retrospective Cohort Study",
journal="JMIR Diabetes",
year="2023",
month="Aug",
day="23",
volume="8",
pages="e46880",
keywords="automated insulin delivery",
keywords="continuous glucose monitoring",
keywords="CGM",
keywords="glycemic control",
keywords="hypoglycemia",
keywords="sensor-augmented insulin pump",
keywords="type 1 diabetes",
abstract="Background: There is evidence in the literature that the use of sensor-augmented insulin pumps in patients with high-complexity diabetes improves metabolic control. However, there is no long-term information on clinical outcomes such as hospitalization or admission to the emergency room. This study describes outcomes for metabolic control, incidence of hospitalizations, and emergency room visits in a specific population using this technology. Objective: We aimed to assess long-term glycemic and clinical outcomes after the use of continuous subcutaneous insulin infusion and continuous glucose monitoring in people with diabetes. Methods: A retrospective cohort study was carried out in patients with diabetes previously treated with an intensive insulin regimen at a specialized diabetes treatment center who required a sensor-augmented insulin pump due to nonoptimal glycemic control. Glycated hemoglobin, severe hypoglycemic episodes, nonsevere hypoglycemic episodes, perception of hypoglycemia, and the incidence of emergency room visits and hospitalizations before and after treatment were evaluated. Results: Between January 2013 and August 2020, 74 patients with a median age of 36 (IQR 27-46) years were included in the study with a median 4 (IQR 2-7) years of follow-up. We found a statistically significant reduction in glycated hemoglobin (8.35\% vs 7\%; P<.001), nonsevere hypoglycemic episodes (71/74, 96\% vs 62/74, 84\%; P=.01), emergency room visits (42/73, 58\% vs 4/62, 6\%; P<.001), and hospitalizations (36/72, 50\% vs 10/72, 14\%; P<.001) after use of continuous subcutaneous insulin infusion. Conclusions: The use of a sensor-augmented insulin pump associated with a strict follow-up program for patients with high-complexity diabetes led to a significant and sustained reduction in glycated hemoglobin and hypoglycemic episodes, as well as in the rate of emergency room visits and hospitalizations. These results encourage the adoption of this technology in patients who do not achieve metabolic control with optimal management of diabetes. ",
doi="10.2196/46880",
url="https://diabetes.jmir.org/2023/1/e46880",
url="http://www.ncbi.nlm.nih.gov/pubmed/37610810"
}


@Article{info:doi/10.2196/46043,
author="Frisby, Caitlin
and Eikelboom, H. Robert
and Mahomed-Asmail, Faheema
and Kuper, Hannah
and Moore, R. David
and de Kock, Tersia
and Manchaiah, Vinaya
and Swanepoel, Wet De",
title="Mobile Health Hearing Aid Acclimatization and Support Program in Low-Income Communities: Feasibility Study",
journal="JMIR Form Res",
year="2023",
month="Aug",
day="23",
volume="7",
pages="e46043",
keywords="community-based rehabilitation",
keywords="community health care worker",
keywords="text message",
keywords="messaging",
keywords="motivational",
keywords="reminder",
keywords="acclimatization",
keywords="technology use",
keywords="hearing aid acclimatization",
keywords="hearing aid",
keywords="hearing loss",
keywords="low- and middle-income countries",
keywords="LMIC",
keywords="low income",
keywords="developing country",
keywords="low resource",
keywords="hearing",
keywords="audiology",
keywords="mobile health",
keywords="mHealth",
keywords="health care workers",
keywords="usability",
abstract="Background: The most common management option for hearing loss is hearing aids. In addition to devices, patients require information and support, including maintenance and troubleshooting. Mobile health (mHealth) technologies can support hearing aid management, acclimatization, and use. This study developed an mHealth acclimatization and support program for first-time hearing aid users and subsequently implemented and pilot-tested the feasibility of the program. The program was facilitated by community health workers (CHWs) in low-income communities in South Africa. Objective: This study aimed to evaluate the feasibility of an mHealth acclimatization and support program supported by CHWs in low-income communities. Methods: An application-based acclimatization and support was adapted and translated for use in low- and middle-income countries. This program was delivered in the form of 20 different voice notes accompanied by graphical illustrations via WhatsApp or 20 different SMS text messages. The program was provided to first-time hearing aid users immediately after a community-based hearing aid fitting in March 2021 in 2 low-income communities in the Western Cape, South Africa. The 20 messages were sent over a period of 45 days. Participants were contacted telephonically on days 8, 20, and 43 of the program and via open-ended paper-based questionnaires translated to isiXhosa 45 days and 6 months after the program started to obtain information on their experiences, perceptions, and accessibility of the program. Their responses were analyzed using inductive thematic analysis. Results: A total of 19 participants fitted with hearing aids received the mHealth acclimatization and support program. Most participants (15/19, 79\%) received the program via WhatsApp, with 21\% (4/19) of them receiving it via SMS text message. Participants described the program as helpful, supportive, informative, sufficient, and clear at both follow-ups. A total of 14 participants reported that they were still using their hearing aids at the 6-month follow-up. Three participants indicated that not all their questions about hearing aids were answered, and 5 others had minor hearing aid issues. This included feedback (n=1), battery performance (n=1), physical fit (n=2), and issues with hearing aid accessories (n=1). However, CHWs successfully addressed all these issues. There were no notable differences in responses between the participants who received the program via WhatsApp compared with those who received it through SMS text message. Most participants receiving WhatsApp messages reported that the voice notes were easier to understand, but the graphical illustrations supplemented the voice notes well. Conclusions: An mHealth acclimatization and support program is feasible and potentially assists hearing aid acclimatization and use for first-time users in low-income communities. Scalable mHealth support options can facilitate increased access and improve outcomes of hearing care. ",
doi="10.2196/46043",
url="https://formative.jmir.org/2023/1/e46043",
url="http://www.ncbi.nlm.nih.gov/pubmed/37610802"
}


@Article{info:doi/10.2196/45986,
author="Edwards, Colin
and Borton, Rebecca
and Ross, Anita
and Molloy, Fiona",
title="A Bespoke Electronic Health Journal for Monitoring Response to Botulinum Toxin in Treatment of Cervical Dystonia: Open-Label Observational Study of User Experience",
journal="JMIR Form Res",
year="2023",
month="Aug",
day="23",
volume="7",
pages="e45986",
keywords="cervical dystonia",
keywords="electronic health journal",
keywords="user experience",
keywords="user acceptance testing",
keywords="botulinum toxin",
keywords="diary",
keywords="acceptability",
keywords="user testing",
keywords="symptom control",
keywords="spasm",
keywords="muscle pain",
keywords="spasmodic torticollis",
abstract="Background: The mainstay of treatment for cervical dystonia (CD) is regular botulinum toxin injections every 3-4 months. Clinical evaluation of response is dependent on the patient's recall of how well symptoms responded to the previous injection. A mobile health app could assist both patients and health care professionals to monitor treatment benefits and side effects to assist with the selection of muscle and toxin dose to be injected at the next visit. The DystoniaDiary is a bespoke electronic health journal for monitoring symptoms of CD and response to treatment. Objective: The objective of this study was to assess the acceptability and utility of the DystoniaDiary in patients with CD treated with botulinum toxins as part of their usual care. Methods: In this open-label, single-center, single-arm observational study, patients attending a botulinum toxin injection clinic were invited to download the DystoniaDiary app. Patients selected up to 3 of their most troublesome CD symptoms (from a predefined list) and were prompted every 3 days to rate the control of these symptoms on a scale from 0 (very badly) to 100 (very well). Dates of onset and wearing off of response to injected botulinum toxin and responses to the Cervical Dystonia Impact Profile (CDIP-58) questionnaire at baseline and week 6 were also recorded in the app. Results: A total of 34 patients installed DystoniaDiary. Twenty-five patients (25/34, 74\%) recorded data for ?12 weeks and 21 patients (21/34, 62\%) for ?16 weeks. Median time between the first and last data input was 140 days with a median of 13 recordings per patient. User experience questionnaires at weeks 4 and 12 (20 respondents) indicated that the majority of respondents found the DystoniaDiary app easy to install and use, liked using it, would recommend it to others (19/20), and wished to continue using it (16/20). A smaller proportion indicated that the DystoniaDiary gave a greater sense of control in managing their CD (13/20). There was interindividual variation in patients' perceptions of control of their symptoms after botulinum toxin injection. Response to treatment was apparent in the symptom control scores for some patients, whereas the severity of other patients' symptoms did not appear to change after treatment. Conclusions: This observational study demonstrated that the DystoniaDiary app was perceived as useful and acceptable for a large proportion of this sample of patients with CD attending a botulinum toxin clinic. Patients with CD appear to be willing to regularly record symptom severity for at least the duration of a botulinum injection treatment cycle (12-16 weeks). This app may be useful in monitoring and optimizing individual patient responses to botulinum toxin injection. ",
doi="10.2196/45986",
url="https://formative.jmir.org/2023/1/e45986",
url="http://www.ncbi.nlm.nih.gov/pubmed/37610807"
}


@Article{info:doi/10.2196/47142,
author="Costa, Lemos Wilbert Dener
and de Oliveira, Maicon Alan
and Aguilar, Jos{\'e} Guilherme
and dos Santos, Costa Luana Michelly Aparecida
and dos Santos, Albano Luiz Ricardo
and Donato, Barros Dantony de Castro
and Foresto, Felipe
and Frade, Cipriani Marco Andrey",
title="A Review of Software and Mobile Apps to Support the Clinical Diagnosis of Hansen Disease",
journal="JMIR Dermatol",
year="2023",
month="Aug",
day="18",
volume="6",
pages="e47142",
keywords="software",
keywords="mobile apps",
keywords="leprosy",
keywords="medical informatics",
keywords="Mycobacterium leprae",
keywords="clinical diagnosis",
keywords="Hansen disease",
keywords="mHealth",
keywords="mobile health",
keywords="mobile app",
keywords="Hansen",
keywords="dermatology",
keywords="scoping review",
keywords="skin",
keywords="diagnosis",
keywords="diagnostic",
doi="10.2196/47142",
url="https://derma.jmir.org/2023/1/e47142",
url="http://www.ncbi.nlm.nih.gov/pubmed/37594779"
}


@Article{info:doi/10.2196/48308,
author="Xu, Huan Richard
and Shi, Lushaobo
and Shi, Zengping
and Li, Ting
and Wang, Dong",
title="Investigating Individuals' Preferences in Determining the Functions of Smartphone Apps for Fighting Pandemics: Best-Worst Scaling Survey Study",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="15",
volume="25",
pages="e48308",
keywords="best-worst scaling",
keywords="BWS",
keywords="smartphone app",
keywords="app",
keywords="pandemic",
keywords="preference",
keywords="health care",
keywords="survey",
abstract="Background: Smartphone apps have been beneficial in controlling and preventing the COVID-19 pandemic. However, there is a gap in research surrounding the importance of smartphone app functions from a user's perspective. Although the insights and opinions of different stakeholders, such as policymakers and medical professionals, can influence the success of a public health policy, any strategy will face difficulty in achieving the expected effect if it is not based on a method that users can accept. Objective: This study aimed to assess the importance of a hypothetical smartphone app's functions for managing health during a pandemic based on the perspective of user preferences. Methods: A cross-sectional and web-based survey using the best-worst scaling (BWS) method was used to investigate the general population's preferences for important smartphone app functions. Participants were recruited from a professional surveying company's web-based surveying panel. The attributes of the BWS questionnaire were developed based on a robust process, including literature review, interviews, and expert discussion. A balanced incomplete block design was used to construct the choice task to ensure the effectiveness of the research design. Count analysis, conditional logit model analysis, and mixed logit analysis were used to estimate preference heterogeneity among respondents. Results: The responses of 2153 participants were eligible for analysis. Nearly 55\% (1192/2153) were female, and the mean age was 31.4 years. Most participants (1765/2153, 81.9\%) had completed tertiary or higher education, and approximately 70\% (1523/2153) were urban residents. The 3 most vital functions according to their selection were ``surveillance and monitoring of infected cases,'' ``quick self-screening,'' and ``early detection of infected cases.'' The mixed logit regression model identified significant heterogeneity in preferences among respondents, and stratified analysis showed that some heterogeneities varied in respondents by demographics and COVID-19--related characteristics. Participants who preferred to use the app were more likely to assign a high weight to the preventive functions than those who did not prefer to use it. Conversely, participants who showed lower willingness to use the app tended to indicate a higher preference for supportive functions than those who preferred to use it. Conclusions: This study ranks the importance of smartphone app features that provide health care services during a pandemic based on the general population's preferences in China. It provides empirical evidence for decision-makers to develop eHealth policies and strategies that address future public health crises from a person-centered care perspective. Continued use of apps and smart investment in digital health can help improve health outcomes and reduce the burden of disease on individuals and communities. ",
doi="10.2196/48308",
url="https://www.jmir.org/2023/1/e48308",
url="http://www.ncbi.nlm.nih.gov/pubmed/37581916"
}


@Article{info:doi/10.2196/39525,
author="Madujibeya, Ifeanyi
and Lennie, A. Terry
and Pelzel, Jamie
and Moser, K. Debra",
title="Patients' Experiences Using a Mobile Health App for Self-Care of Heart Failure in a Real-World Setting: Qualitative Analysis",
journal="JMIR Form Res",
year="2023",
month="Aug",
day="15",
volume="7",
pages="e39525",
keywords="heart failure",
keywords="patients' experiences",
keywords="experience",
keywords="satisfaction",
keywords="facilitator",
keywords="mobile health apps",
keywords="mobile app",
keywords="health app",
keywords="app feature",
keywords="mobile health",
keywords="cardiology",
keywords="cardiovascular",
keywords="patient care",
keywords="self-management",
keywords="patient",
keywords="heart",
keywords="mHealth",
keywords="self-care",
keywords="medication",
keywords="performance",
keywords="feedback",
keywords="personalized",
abstract="Background: Publicly available patient-focused mobile health (mHealth) apps are being increasingly integrated into routine heart failure (HF)--related self-care. However, there is a dearth of research on patients' experiences using mHealth apps for self-care in real-world settings. Objective: The purpose of this study was to explore patients' experiences using a commercially available mHealth app, OnTrack to Health, for HF self-care in a real-world setting. Methods: Patient satisfaction, measured with a 5-point Likert scale, and an open-ended survey were used to gather data from 23 patients with HF who were provided the OnTrack to Health app as a part of routine HF management. A content analysis of patients' responses was conducted with the qualitative software Atlas.ti (version 8; ATLAS.ti Scientific Software Development GmbH). Results: Patients (median age 64, IQR 57-71 years; 17/23, 74\% male) used OnTrack to Health for a median 164 (IQR 51-640) days before the survey. All patients reported excellent experiences related to app use and would recommend the app to other patients with HF. Five themes emerged from the responses to the open-ended questions: (1) features that enhanced self-care of HF (medication tracker, graphic performance feedback and automated alerts, secured messaging features, and HF self-care education); (2) perceived benefits (provided assurance of safety, improved HF self-care, and decreased hospitalization rates); (3) challenges with using apps for self-care (giving up previous self-care strategies); (4) facilitators (perceived ease of use and availability of technical support); and (5) suggested improvements (streamlining data entry, integration of apps with an electronic medical record, and personalization of app features). Conclusions: Patients were satisfied with using OnTrack to Health for self-care. They perceived the features of the app as valuable tools for improving self-care ability and decreasing hospitalization rates. The development of apps in collaboration with end users is essential to ensure high-quality patient experiences related to app use for self-care. ",
doi="10.2196/39525",
url="https://formative.jmir.org/2023/1/e39525",
url="http://www.ncbi.nlm.nih.gov/pubmed/37581912"
}


@Article{info:doi/10.2196/44297,
author="Rai, Amneet
and Riddle, Mark
and Mishra, Rajendra
and Nguyen, Nhien
and Valine, Kelly
and Fenney, Megan",
title="Use of a Smartphone-Based Medication Adherence Platform to Improve Outcomes in Uncontrolled Type 2 Diabetes Among Veterans: Prospective Case-Crossover Study",
journal="JMIR Diabetes",
year="2023",
month="Aug",
day="10",
volume="8",
pages="e44297",
keywords="application",
keywords="biguanide",
keywords="blood glucose",
keywords="case-crossover",
keywords="diabetes management",
keywords="diabetes",
keywords="diabetic",
keywords="digital health intervention",
keywords="epidemiology",
keywords="glucose monitoring",
keywords="glucose",
keywords="HbgA1c",
keywords="hemoglobin A1c",
keywords="hemoglobin",
keywords="hyperlipidemia",
keywords="hypertension",
keywords="interquartile range",
keywords="IQR",
keywords="MAS",
keywords="Medication Adherence Scores",
keywords="medication adherence",
keywords="mobile health intervention",
keywords="mobile phone",
keywords="odds ratio",
keywords="paired t test",
keywords="quasi experimental",
keywords="SEAMS",
keywords="Self-Efficacy for Appropriate Medication Use Scale",
keywords="smartphone",
keywords="sulfonylurea",
keywords="T2DM",
keywords="Type 2 Diabetes Mellitus",
keywords="veteran",
abstract="Background: Medication nonadherence is a problem that impacts both the patient and the health system. Objective: The objective of this study was to evaluate the impact of a novel smartphone app with patient-response-directed clinical intervention on medication adherence and blood glucose control in noninsulin-dependent patients with type 2 diabetes mellitus (T2DM). Methods: We enrolled 50 participants with T2DM not on insulin with smartphones from a rural health care center in Northern Nevada for participation in this case-crossover study. Participants underwent a standard of care arm and an intervention arm. Each study arm was 3 months long, for a total of 6 months of follow-up. Participants had a hemoglobin A1c (HbA1c) lab draw at enrollment, 3 months, and 6 months. Participants had monthly ``medication adherence scores'' (MAS) and ``Self-Efficacy for Appropriate Medication Use Scale'' (SEAMS) questionnaires completed at baseline and monthly for the duration of the study. Our primary outcomes of interest were the changes in HbA1c between study arms. Secondary outcomes included the evaluation of the difference in the proportion of participants achieving a clinically meaningful reduction in HbA1c and the difference in the number of participants requiring diabetes therapy escalation between study arms. Exploratory outcomes included the analysis of the variation in medication possession ratio (MPR), MAS, and SEAMS during each study arm. Results: A total of 30 participants completed both study arms and were included in the analysis. Dropouts were higher in participants enrolled in the standard of care arm first (9/25, 36\% vs 4/25, 16\%). Participants had a median HbA1c of 9.1\%, had been living with T2DM for 6 years, had a median age of 66 years, and had a median of 8.5 medications. HbA1c reduction was 0.69\% in the intervention arm versus 0.35\% in the standard of care arm (P=.30). A total of 70\% (21/30) of participants achieved a clinically meaningful reduction in HbA1c of 0.5\% in the app intervention arm versus 40\% (12/30) in the standard of care arm (odds ratio 2.29, 95\% CI 0.94-5.6; P=.09). Participants had higher odds of a therapy escalation while in the standard of care arm (18/30, 60\% vs 5/30, 16.7\%, odds ratio 4.3, 95\% CI 1.2-15.2; P=.02). The median MPR prior to enrollment was 109\%, 112\% during the study's intervention arm, and 102\% during the standard of care arm. The median real-time MAS was 93.2\%. The change in MAS (1 vs --0.1; P=.02) and SEAMS (1.9 vs --0.2; P<.001) from baseline to month 3 was higher in the intervention arm compared to standard of care. Conclusions: A novel smartphone app with patient-response-directed provider intervention holds promise in the ability to improve blood glucose control in complex non--insulin-dependent T2DM and is worthy of additional study. ",
doi="10.2196/44297",
url="https://diabetes.jmir.org/2023/1/e44297",
url="http://www.ncbi.nlm.nih.gov/pubmed/37561555"
}


@Article{info:doi/10.2196/44528,
author="Haddad, C. Tufia
and Maita, C. Karla
and Inselman, W. Jonathan
and Avila, R. Francisco
and Torres-Guzman, A. Ricardo
and Coffey, D. Jordan
and Christopherson, A. Laura
and Leuenberger, M. Angela
and Bell, J. Sarah
and Pahl, F. Dominick
and Garcia, P. John
and Manka, Lukas
and Forte, J. Antonio
and Maniaci, J. Michael",
title="Patient Satisfaction With a Multisite, Multiregional Remote Patient Monitoring Program for Acute and Chronic Condition Management: Survey-Based Analysis",
journal="J Med Internet Res",
year="2023",
month="Jul",
day="27",
volume="25",
pages="e44528",
keywords="remote patient monitoring",
keywords="patient satisfaction",
keywords="postacute care",
keywords="chronic conditions",
keywords="acute conditions mobile phone",
abstract="Background: Remote patient monitoring (RPM) is an option for continuously managing the care of patients in the comfort of their homes or locations outside hospitals and clinics. Patient engagement with RPM programs is essential for achieving successful outcomes and high quality of care. When relying on technology to facilitate monitoring and shifting disease management to the home environment, it is important to understand the patients' experiences to enable quality improvement. Objective: This study aimed to describe patients' experiences and overall satisfaction with an RPM program for acute and chronic conditions in a multisite, multiregional health care system. Methods: Between January 1, 2021, and August 31, 2022, a patient experience survey was delivered via email to all patients enrolled in the RPM program. The survey encompassed 19 questions across 4 categories regarding comfort, equipment, communication, and overall experience, as well as 2 open-ended questions. Descriptive analysis of the survey response data was performed using frequency distribution and percentages. Results: Surveys were sent to 8535 patients. The survey response rate was 37.16\% (3172/8535) and the completion rate was 95.23\% (3172/3331). Survey results indicated that 88.97\% (2783/3128) of participants agreed or strongly agreed that the program helped them feel comfortable managing their health from home. Furthermore, 93.58\% (2873/3070) were satisfied with the RPM program and ready to graduate when meeting the program goals. In addition, patient confidence in this model of care was confirmed by 92.76\% (2846/3068) of the participants who would recommend RPM to people with similar conditions. There were no differences in ease of technology use according to age. Those with high school or less education were more likely to agree that the equipment and educational materials helped them feel more informed about their care plans than those with higher education levels. Conclusions: This multisite, multiregional RPM program has become a reliable health care delivery model for the management of acute and chronic conditions outside hospitals and clinics. Program participants reported an excellent overall experience and a high level of satisfaction in managing their health from the comfort of their home environment. ",
doi="10.2196/44528",
url="https://www.jmir.org/2023/1/e44528",
url="http://www.ncbi.nlm.nih.gov/pubmed/37343182"
}


@Article{info:doi/10.2196/44428,
author="Woelfle, Tim
and Bourguignon, Lucie
and Lorscheider, Johannes
and Kappos, Ludwig
and Naegelin, Yvonne
and Jutzeler, Ruth Catherine",
title="Wearable Sensor Technologies to Assess Motor Functions in People With Multiple Sclerosis: Systematic Scoping Review and Perspective",
journal="J Med Internet Res",
year="2023",
month="Jul",
day="27",
volume="25",
pages="e44428",
keywords="multiple sclerosis",
keywords="digital biomarkers",
keywords="digital health technologies",
keywords="digital mobility outcomes",
keywords="wearables",
keywords="sensors",
keywords="inertial motion unit",
keywords="accelerometry",
keywords="actigraphy",
keywords="review",
abstract="Background: Wearable sensor technologies have the potential to improve monitoring in people with multiple sclerosis (MS) and inform timely disease management decisions. Evidence of the utility of wearable sensor technologies in people with MS is accumulating but is generally limited to specific subgroups of patients, clinical or laboratory settings, and functional domains. Objective: This review aims to provide a comprehensive overview of all studies that have used wearable sensors to assess, monitor, and quantify motor function in people with MS during daily activities or in a controlled laboratory setting and to shed light on the technological advances over the past decades. Methods: We systematically reviewed studies on wearable sensors to assess the motor performance of people with MS. We scanned PubMed, Scopus, Embase, and Web of Science databases until December 31, 2022, considering search terms ``multiple sclerosis'' and those associated with wearable technologies and included all studies assessing motor functions. The types of results from relevant studies were systematically mapped into 9 predefined categories (association with clinical scores or other measures; test-retest reliability; group differences, 3 types; responsiveness to change or intervention; and acceptability to study participants), and the reporting quality was determined through 9 questions. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. Results: Of the 1251 identified publications, 308 were included: 176 (57.1\%) in a real-world context, 107 (34.7\%) in a laboratory context, and 25 (8.1\%) in a mixed context. Most publications studied physical activity (196/308, 63.6\%), followed by gait (81/308, 26.3\%), dexterity or tremor (38/308, 12.3\%), and balance (34/308, 11\%). In the laboratory setting, outcome measures included (in addition to clinical severity scores) 2- and 6-minute walking tests, timed 25-foot walking test, timed up and go, stair climbing, balance tests, and finger-to-nose test, among others. The most popular anatomical landmarks for wearable placement were the waist, wrist, and lower back. Triaxial accelerometers were most commonly used (229/308, 74.4\%). A surge in the number of sensors embedded in smartphones and smartwatches has been observed. Overall, the reporting quality was good. Conclusions: Continuous monitoring with wearable sensors could optimize the management of people with MS, but some hurdles still exist to full clinical adoption of digital monitoring. Despite a possible publication bias and vast heterogeneity in the outcomes reported, our review provides an overview of the current literature on wearable sensor technologies used for people with MS and highlights shortcomings, such as the lack of harmonization, transparency in reporting methods and results, and limited data availability for the research community. These limitations need to be addressed for the growing implementation of wearable sensor technologies in clinical routine and clinical trials, which is of utmost importance for further progress in clinical research and daily management of people with MS. Trial Registration: PROSPERO CRD42021243249; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=243249 ",
doi="10.2196/44428",
url="https://www.jmir.org/2023/1/e44428",
url="http://www.ncbi.nlm.nih.gov/pubmed/37498655"
}


@Article{info:doi/10.2196/42852,
author="Saevarsdottir, Rut Saeunn
and Gudmundsdottir, Lara Sigridur",
title="Mobile Apps and Quality of Life in Patients With Breast Cancer and Survivors: Systematic Literature Review",
journal="J Med Internet Res",
year="2023",
month="Jul",
day="26",
volume="25",
pages="e42852",
keywords="mobile health",
keywords="mHealth",
keywords="breast cancer",
keywords="quality of life",
keywords="review",
keywords="systematic review",
keywords="cancer treatment",
keywords="mobile app",
keywords="patient care",
keywords="survivorship",
keywords="digital health intervention",
keywords="lifestyle intervention",
keywords="mobile phone",
abstract="Background: Side effects of breast cancer treatment may persist long into survivorship, reducing quality of life (QOL) in patients with breast cancer and survivors. There is growing evidence for the use of digital health technologies, such as mobile apps, to support self-management, decrease symptom burden, and improve QOL in patients with cancer. However, an updated overview of the effects of mobile apps on QOL and well-being in patients with breast cancer and survivors is needed. Objective: The aim of this review was to provide an overview of breast cancer--specific, mobile app--driven lifestyle or behavioral interventions in patient care through to survivorship and their impact on QOL and mental well-being. Methods: A systematic search of PubMed, Scopus, and Web of Science was conducted to identify relevant studies. The inclusion criteria were limited to original studies involving a trial of a mobile app--driven lifestyle or behavioral intervention for patients with breast cancer or survivors and using QOL or well-being measures. The results of the studies that met the inclusion criterion were then synthesized in text and table format. The quality of the evidence was assessed with the Cochrane risk-of-bias tool. Results: A total of 17 studies with the number of participants ranging from 23 to 356 met the inclusion criterion. Of the 17 reviewed studies, 7 (41\%) delivered an app-only intervention, and 10 (59\%) combined an app with additional supporting materials, such as SMS text messaging, telecoaching, wearables, or printed materials. Among the 17 reviewed studies, 6 (35\%) focused on aiding patients with breast cancer during the active treatment phase (excluding ongoing hormone therapy), whereas the remaining 11 (65\%) focused on survivorship. The majority of the studies (14/17, 82\%) observed some positive effects on QOL or well-being measures. Conclusions: The results of the review indicate that mobile apps are a promising avenue for improving QOL and well-being in breast cancer care. Positive effects were observed in patients undergoing active treatment in all reviewed studies, but effects were less clear after chemotherapy and in long-term survivors. Although lifestyle and behavioral digital interventions are still being developed, and further research should still be pursued, the available data suggest that current mobile health apps aid patients with breast cancer and survivors. ",
doi="10.2196/42852",
url="https://www.jmir.org/2023/1/e42852",
url="http://www.ncbi.nlm.nih.gov/pubmed/37494111"
}


@Article{info:doi/10.2196/42768,
author="McCue, Maggie
and Khatib, Rasha
and Kabir, Christopher
and Blair, Chris
and Fehnert, Ben
and King, James
and Spalding, Alexander
and Zaki, Lara
and Chrones, Lambros
and Roy, Anit
and Kemp, E. David",
title="User-Centered Design of a Digitally Enabled Care Pathway in a Large Health System: Qualitative Interview Study",
journal="JMIR Hum Factors",
year="2023",
month="Jul",
day="26",
volume="10",
pages="e42768",
keywords="depression",
keywords="major depressive disorder",
keywords="depression management",
keywords="patient engagement",
keywords="user-centered design",
keywords="mobile app",
keywords="digital platform",
keywords="qualitative research",
keywords="shared decision-making",
keywords="measurement-based care",
keywords="mobile phone",
abstract="Background: Major depressive disorder (MDD) is a leading cause of disability worldwide. Management of chronic conditions such as MDD can be improved by enhanced patient engagement, measurement-based care (MBC), and shared decision-making (SDM). A user-centered design approach can improve the understanding of the patient journey and care team workflows and thus aid the development of digital health care innovations optimized for the needs of patients living with MDD and their primary care teams. Objective: This study aims to use qualitative research methods for the user-centered design of a digitally enabled MDD care platform, PathwayPlatform, intended to enhance patient engagement, MBC, and SDM. Methods: Insights were gathered through 2 stages of qualitative interviews by a study team with expertise in qualitative research and user-centered design methods. Thematic analysis was used to generate an overarching understanding of a set of shared experiences, thoughts, or behaviors across a broad qualitative data set, including transcripts of interviews, to allow both inductive and deductive insights to emerge. Thematic analysis of interviews was supported by Dedoose (SocioCultural Research Consultants, LLC), a qualitative data analysis software tool that enables systematized coding. Findings and insights were presented based on code frequency, salience, and relevance to the research project. Results: In stage 1, interviews were conducted with 20 patients living with MDD and 15 health care providers from September 2018 to January 2019 to understand the experiences with and perceptions about the initial functionality of the Pathway app while also exploring the perceptions about potential additional features and functionality. Feedback about care team workflows and treatment approaches was collected in stage-2 interviews with 36 health care providers at 8 primary care sites. Inductive and deductive thematic analyses revealed several themes related to app functionality, patient-provider engagement, workflow integration, and patient education. Both patients and their care teams perceived the remote tracking of patient-reported outcomes via digital tools to be clinically useful and reliable and to promote MBC and SDM. However, there was emphasis on the need to enhance the flow of real-time data shared with the care team, improve trend visualizations, and integrate the data within the existing clinical workflow and educational programs for patients and their care teams. User feedback was incorporated into the iterative development of the Pathway app. Conclusions: Ongoing communication with patients living with MDD and their care teams provided an opportunity for user-centric developmental iterations of the Pathway Platform. Key insights led to further development of the patient-facing and care team--facing visit preparation features, collaborative goal-setting and goal-tracking features, patient-reported outcome summaries, and trend visualizations. The result is an enhanced digital platform with the potential to improve treatment outcomes and provide patients living with MDD additional support throughout their treatment journey. ",
doi="10.2196/42768",
url="https://humanfactors.jmir.org/2023/1/e42768",
url="http://www.ncbi.nlm.nih.gov/pubmed/37494099"
}


@Article{info:doi/10.2196/46627,
author="Bristol, A. Alycia
and Litchman, Michelle
and Berg, Cynthia
and Grigorian, Ernest
and Small, Denise
and Glazener, Ashley
and Jones, Christopher
and Allen, A. Nancy",
title="Using Continuous Glucose Monitoring and Data Sharing to Encourage Collaboration Among Older Adults With Type 1 Diabetes and Their Care Partners: Qualitative Descriptive Study",
journal="JMIR Nursing",
year="2023",
month="Jul",
day="26",
volume="6",
pages="e46627",
keywords="type 1 diabetes",
keywords="continuous glucose monitoring",
keywords="care partner",
keywords="communication",
keywords="data sharing",
keywords="caregiver",
keywords="caregiving",
keywords="diabetes",
keywords="diabetic",
keywords="type 1",
keywords="glucose",
keywords="dyad",
keywords="older adult",
keywords="elder",
keywords="telehealth",
keywords="collaboration",
keywords="insulin",
keywords="endocrinology",
keywords="endocrine",
keywords="self-efficacy",
keywords="health education",
keywords="insulin pump",
keywords="tele",
keywords="hypoglycemia",
keywords="hyperglycemia",
abstract="Background: Persons with diabetes use continuous glucose monitoring (CGM) to self-manage their diabetes. Care partners (CPs) frequently become involved in supporting persons with diabetes in the management of their diabetes. However, persons with diabetes and CP dyads may require more communication and problem-solving skills regarding how to share and respond to CGM data. Objective: The purpose of this study was to describe the experiences of persons with diabetes and CPs who participated in the Share ``plus'' intervention, which addresses dyadic communication strategies, problem-solving, and action planning to promote sharing of CGM data among the dyad. Methods: Ten dyads participated in the Share ``plus'' telehealth intervention. Participants were interviewed during and after the Share ``plus'' intervention. Thematic analysis was used to analyze interview data. Results: During postsession interviews, dyads described feeling a sense of shared responsibility yet viewed the persons with diabetes as ultimately responsible for the disease. Additionally, dyads shared that communication patterns improved and were able to recognize the negative aspects of previously established communication patterns. Dyads reported communication focused on hypoglycemia episodes while also differing in the frequency they reviewed CGM data and set alerts. Overall, dyads expressed positive reactions to the Share ``plus'' intervention. Conclusions: Share ``plus'' was helpful in promoting positive CGM-related communication among dyads and encouraged more CP support. CPs play an important role in supporting older adults with type 1 diabetes. Communication strategies help support dyad involvement in CGM data sharing and self-management among persons with diabetes. ",
doi="10.2196/46627",
url="https://nursing.jmir.org/2023/1/e46627",
url="http://www.ncbi.nlm.nih.gov/pubmed/37494110"
}


@Article{info:doi/10.2196/46313,
author="Poblete, Yareli Jacqueline
and Vawter, Lauren Natalie
and Lewis, Virginia Sydney
and Felisme, Marc Earl
and Mohn, Adriana Paloma
and Shea, Jennifer
and Northrup, William Adam
and Liu, Jie
and Al-Rousan, Tala
and Godino, Gideon Job",
title="Digitally Based Blood Pressure Self-Monitoring Program That Promotes Hypertension Self-Management and Health Education Among Patients With Low-Income: Usability Study",
journal="JMIR Hum Factors",
year="2023",
month="Jul",
day="24",
volume="10",
pages="e46313",
keywords="hypertension",
keywords="blood pressure",
keywords="digital health",
keywords="health education",
keywords="self-measured blood pressure monitoring",
keywords="remote patient monitoring",
abstract="Background: According to evidence-based clinical guidelines, adults with hypertension are advised to self-monitor their blood pressure (BP) twice daily. Self-measured BP monitoring is a recommended strategy for improving hypertension management. Objective: We aimed to determine the feasibility and acceptability of a digitally based BP self-monitoring program that promotes hypertension self-management and health education among low-income patients. We hypothesized that the program would be highly feasible and acceptable and that at least 50\% of the patients would use the monitor at the rate required for the reimbursement of the device's cost (16 days of measurements in any 30-day period). Methods: Withings BPM Connect was deployed to patients at Family Health Centers of San Diego. Program elements included training, SMS text message reminders, and physician communication. Compliance, use, mean BP, and BP control status were calculated. A Kaplan-Meier time-to-event analysis was conducted to compare time to compliance between a strict definition (?16 days in any rolling 30-day window) and a lenient definition (?1 day per week for 4 consecutive weeks). A log-rank test was performed to determine whether the difference in time to compliance between the definitions was statistically significant. Mean systolic BP (SBP) and diastolic BP (DBP) before the intervention and after the intervention and mean change in SBP and DBP across patients were calculated. Paired sample t tests (2-tailed) were performed to assess the changes in SBP and DBP from before to after the intervention. Results: A total of 179 patients received the monitors. The mean changes in SBP and DBP from before to after the intervention were +2.62 (SE 1.26) mm?Hg and +3.31 (SE 0.71) mm?Hg, respectively. There was a statistically significant increase in both SBP and DBP after the intervention compared with before the intervention (P=.04 and P<.001). At the first and last measurements, 37.5\% (63/168) and 48.8\% (82/168) of the patients had controlled BP, respectively. During the observation period, 83.3\% (140/168) of the patients had at least 1 controlled BP measurement. Use decreased over time, with 53.6\% (90/168) of the patients using their monitor at week 2 and only 25\% (42/168) at week 11. Although only 25.6\% (43/168) achieved the strict definition of compliance, 42.3\% (71/168) achieved the lenient definition of compliance. The median time to compliance was 130 days for the strict definition and 95 days for the lenient definition. The log-rank test showed a statistically significant difference in time to compliance between the compliance definitions (P<.001). Only 26.8\% (45/168) complied with the measurement rate that would result in device cost reimbursement. Conclusions: Few patients used the monitors at a rate that would result in reimbursement, raising financial feasibility concerns. Plans for sustaining costs among low-income patients need to be further evaluated. ",
doi="10.2196/46313",
url="https://humanfactors.jmir.org/2023/1/e46313",
url="http://www.ncbi.nlm.nih.gov/pubmed/37486745"
}


@Article{info:doi/10.2196/45099,
author="Wong, K. Alex W.
and Fong, M. Mandy W.
and Munsell, S. Elizabeth G.
and Metts, L. Christopher
and Lee, I. Sunghoon
and Nicol, E. Ginger
and DePaul, Olivia
and Tomazin, E. Stephanie
and Kaufman, J. Katherine
and Mohr, C. David",
title="Using Intervention Mapping and Behavior Change Techniques to Develop a Digital Intervention for Self-Management in Stroke: Development Study",
journal="JMIR Hum Factors",
year="2023",
month="Jul",
day="24",
volume="10",
pages="e45099",
keywords="mobile health",
keywords="digital intervention",
keywords="technology",
keywords="SMS text messaging",
keywords="intervention mapping",
keywords="behavior change",
keywords="self-management",
keywords="stroke",
keywords="rehabilitation",
keywords="mobile phone",
abstract="Background: Digital therapeutics, such as interventions provided via smartphones or the internet, have been proposed as promising solutions to support self-management in persons with chronic conditions. However, the evidence supporting self-management interventions through technology in stroke is scarce, and the intervention development processes are often not well described, creating challenges in explaining why and how the intervention would work. Objective: This study describes a specific use case of using intervention mapping (IM) and the taxonomy of behavior change techniques (BCTs) in designing a digital intervention to manage chronic symptoms and support daily life participation in people after stroke. IM is an implementation science framework used to bridge the gap between theories and practice to ensure that the intervention can be implemented in real-world settings. The taxonomy of BCTs consists of a set of active ingredients designed to change self-management behaviors. Methods: We used the first 4 steps of the IM process to develop a technology-supported self-management intervention, interactive Self-Management Augmented by Rehabilitation Technologies (iSMART), adapted from a face-to-face stroke-focused psychoeducation program. Planning group members were involved in adapting the intervention. They also completed 3 implementation measures to assess the acceptability, appropriateness, and feasibility of iSMART. Results: In step 1, we completed a needs assessment consisting of assembling a planning group to codevelop the intervention, conducting telephone surveys of people after stroke (n=125) to identify service needs, and performing a systematic review of randomized controlled trials to examine evidence of the effectiveness of digital self-management interventions to improve patient outcomes. We identified activity scheduling, symptom management, stroke prevention, access to care resources, and cognitive enhancement training as key service needs after a stroke. The review suggested that digital self-management interventions, especially those using cognitive behavioral theory, effectively reduce depression, anxiety, and fatigue and enhance self-efficacy in neurological disorders. Step 2 identified key determinants, objectives, and strategies for self-management in iSMART, including knowledge, behavioral regulation, skills, self-efficacy, motivation, negative and positive affect, and social and environmental support. In step 3, we generated the intervention components underpinned by appropriate BCTs. In step 4, we developed iSMART with the planning group members. Especially, iSMART simplified the original psychoeducation program and added 2 new components: SMS text messaging and behavioral coaching, intending to increase the uptake by people after stroke. iSMART was found to be acceptable (mean score 4.63, SD 0.38 out of 5), appropriate (mean score 4.63, SD 0.38 out of 5), and feasible (mean score 4.58, SD 0.34 out of 5). Conclusions: We describe a detailed example of using IM and the taxonomy of BCTs for designing and developing a digital intervention to support people after stroke in managing chronic symptoms and maintaining active participation in daily life. ",
doi="10.2196/45099",
url="https://humanfactors.jmir.org/2023/1/e45099",
url="http://www.ncbi.nlm.nih.gov/pubmed/37486748"
}


@Article{info:doi/10.2196/45896,
author="van der Kamp, R. Matti{\`e}nne
and Hengeveld, S. Vera
and Brusse-Keizer, J. Marjolein G.
and Thio, J. Boony
and Tabak, Monique",
title="eHealth Technologies for Monitoring Pediatric Asthma at Home: Scoping Review",
journal="J Med Internet Res",
year="2023",
month="Jul",
day="21",
volume="25",
pages="e45896",
keywords="telemedicine",
keywords="wearable electronic devices",
keywords="asthma",
keywords="child",
keywords="pediatrics",
keywords="internet-based interventions",
keywords="monitoring",
keywords="computers",
keywords="hand-held device",
keywords="medication",
keywords="spirometry",
abstract="Background: eHealth monitoring technologies offer opportunities to more objectively assess symptoms when they appear in daily life. Asthma is the most common chronic disease in childhood with an episodic course, requiring close follow-up of pediatric asthma control to identify disease deterioration, prevent exacerbations, and enhance quality of life. eHealth technologies in pediatric asthma care show promising results regarding feasibility, acceptability, and asthma-related health outcomes. However, broad systematic evaluations of eHealth technologies in pediatric asthma are lacking. Objective: The objective of this scoping review was to identify the types and applications of eHealth technologies for monitoring and treatment in pediatric asthma and explore which monitoring domains show the most relevance or potential for future research. Methods: A scoping review was conducted using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A systematic and comprehensive search was performed on English papers that investigated the development, validation, or application of eHealth technologies for home monitoring or treatment of pediatric asthma in the following databases: PubMed, Cochrane Library, IEEE, Scopus, CINAHL, PsycINFO, and ACM Digital Library. Two authors independently assessed eligibility and extracted data. Data were presented by a descriptive analysis of characteristics and a narrative report for each eHealth domain. Results: The review included 370 manuscripts. The following 10 monitoring domains were identified: air quality, airway inflammation markers, lung function, physical activity, sleep, audiovisual, other physiological measurements, questionnaires, medication monitoring, and digital environment (ie, digital platforms, applications, websites, and software tools to monitor or support monitoring). Rising numbers of studies were seen, and the numbers accelerated in the last few years throughout most domains, especially medication monitoring and digital environment. Limited studies (35/370, 9.5\%) of multiparameter monitoring strategies, using three or more domains, were found. The number of monitoring validation studies remained stable, while development and intervention studies increased. Intervention outcomes seemed to indicate the noninferiority and potential superiority of eHealth monitoring in pediatric asthma. Conclusions: This systematic scoping review provides a unique overview of eHealth pediatric asthma monitoring studies, and it revealed that eHealth research takes place throughout different monitoring domains using different approaches. The outcomes of the review showed the potency for efficacy of most monitoring domains (especially the domains of medication monitoring, lung function, and digital environment). Future studies could focus on modifying potentially relevant hospital-based diagnostics for the home setting to investigate potential beneficial effects and focus on combining home-monitoring domains to facilitate multiparameter decision-making and personalized clinical decision support. ",
doi="10.2196/45896",
url="https://www.jmir.org/2023/1/e45896",
url="http://www.ncbi.nlm.nih.gov/pubmed/37477966"
}


@Article{info:doi/10.2196/45572,
author="Frank, C. Adam
and Li, Ruibei
and Peterson, S. Bradley
and Narayanan, S. Shrikanth",
title="Wearable and Mobile Technologies for the Evaluation and Treatment of Obsessive-Compulsive Disorder: Scoping Review",
journal="JMIR Ment Health",
year="2023",
month="Jul",
day="18",
volume="10",
pages="e45572",
keywords="wearable",
keywords="smartphone",
keywords="obsessive-compulsive disorder",
keywords="OCD",
keywords="digital",
keywords="phenotype",
keywords="biomarker",
keywords="mobile phone",
abstract="Background: Smartphones and wearable biosensors can continuously and passively measure aspects of behavior and physiology while also collecting data that require user input. These devices can potentially be used to monitor symptom burden; estimate diagnosis and risk for relapse; predict treatment response; and deliver digital interventions in patients with obsessive-compulsive disorder (OCD), a prevalent and disabling psychiatric condition that often follows a chronic and fluctuating course and may uniquely benefit from these technologies. Objective: Given the speed at which mobile and wearable technologies are being developed and implemented in clinical settings, a continual reappraisal of this field is needed. In this scoping review, we map the literature on the use of wearable devices and smartphone-based devices or apps in the assessment, monitoring, or treatment of OCD. Methods: In July 2022 and April 2023, we conducted an initial search and an updated search, respectively, of multiple databases, including PubMed, Embase, APA PsycINFO, and Web of Science, with no restriction on publication period, using the following search strategy: (``OCD'' OR ``obsessive'' OR ``obsessive-compulsive'') AND (``smartphone'' OR ``phone'' OR ``wearable'' OR ``sensing'' OR ``biofeedback'' OR ``neurofeedback'' OR ``neuro feedback'' OR ``digital'' OR ``phenotyping'' OR ``mobile'' OR ``heart rate variability'' OR ``actigraphy'' OR ``actimetry'' OR ``biosignals'' OR ``biomarker'' OR ``signals'' OR ``mobile health''). Results: We analyzed 2748 articles, reviewed the full text of 77 articles, and extracted data from the 25 articles included in this review. We divided our review into the following three parts: studies without digital or mobile intervention and with passive data collection, studies without digital or mobile intervention and with active or mixed data collection, and studies with a digital or mobile intervention. Conclusions: Use of mobile and wearable technologies for OCD has developed primarily in the past 15 years, with an increasing pace of related publications. Passive measures from actigraphy generally match subjective reports. Ecological momentary assessment is well tolerated for the naturalistic assessment of symptoms, may capture novel OCD symptoms, and may also document lower symptom burden than retrospective recall. Digital or mobile treatments are diverse; however, they generally provide some improvement in OCD symptom burden. Finally, ongoing work is needed for a safe and trusted uptake of technology by patients and providers. ",
doi="10.2196/45572",
url="https://mental.jmir.org/2023/1/e45572",
url="http://www.ncbi.nlm.nih.gov/pubmed/37463010"
}


@Article{info:doi/10.2196/46432,
author="Abdulhussein, S. Fatema
and Pinkney, Susan
and G{\"o}rges, Matthias
and van Rooij, Tibor
and Amed, Shazhan",
title="Designing a Collaborative Patient-Centered Digital Health Platform for Pediatric Diabetes Care in British Columbia: Formative Needs Assessment by Caregivers of Children and Youths Living With Type 1 Diabetes and Health Care Providers",
journal="JMIR Pediatr Parent",
year="2023",
month="Jul",
day="13",
volume="6",
pages="e46432",
keywords="application design",
keywords="challenge",
keywords="child",
keywords="design",
keywords="development",
keywords="diabetes",
keywords="diabetic",
keywords="digital health",
keywords="digital solution",
keywords="engagement",
keywords="feature",
keywords="needs assessment",
keywords="patient engagement",
keywords="patient need",
keywords="pediatric",
keywords="perception",
keywords="privacy",
keywords="secure",
keywords="security",
keywords="trust",
keywords="Type 1 diabetes",
keywords="Type 1",
keywords="usage",
keywords="user centered",
keywords="user need",
keywords="youth",
abstract="Background: Digital health apps are becoming increasingly available for people living with diabetes, yet data silos continue to exist. This requires health care providers (HCPs) and patients to use multiple digital platforms to access health data. Objective: In this study, we gathered the perspectives of caregivers of children and youths living with type 1 diabetes (T1D) and pediatric diabetes HCPs in the user-centered design of TrustSphere, a secure, single-point-of-access, integrative digital health platform. Methods: We distributed web-based surveys to caregivers of children and youths living with T1D and pediatric diabetes HCPs in British Columbia, Canada. Surveys were designed using ordinal scales and had free-text questions. Survey items assessed key challenges, perceptions about digital trust and security, and potential desirable features for a digital diabetes platform. Results: Similar challenges were identified between caregivers of children and youths living with T1D (n=99) and HCPs (n=49), including access to mental health support, integration of diabetes technology and device data, and the ability to collaborate on care plans with their diabetes team. Caregivers and HCPs identified potential features that directly addressed their challenges, such as more accessible diabetes data and diabetes care plans. Caregivers had more trust in sharing their child's data digitally than HCPs. Most caregivers and HCPs stated that an integrative platform for T1D would support collaborative patient care. Conclusions: Caregiver and HCP perspectives gathered in this study will inform the early prototype of an integrative digital health platform. This prototype will be presented and iterated upon through a series of usability testing sessions with caregivers and HCPs to ensure the platform meets end users' needs. ",
doi="10.2196/46432",
url="https://pediatrics.jmir.org/2023/1/e46432",
url="http://www.ncbi.nlm.nih.gov/pubmed/37440296"
}


@Article{info:doi/10.2196/46649,
author="Holmen, Heidi
and Holm, Martin Are
and Kilv{\ae}r, Karsten Thomas
and Ljos{\aa}, Marte Tone
and Granan, Lars-Petter
and Ekholdt, Christopher
and Larsen, Sandberg Lotte
and Fosse, Erik",
title="Digital Outpatient Services for Adults: Development of an Intervention and Protocol for a Multicenter Non--Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="Jul",
day="10",
volume="12",
pages="e46649",
keywords="cancer",
keywords="complex pain",
keywords="digital solution",
keywords="epilepsy",
keywords="health literacy",
keywords="interstitial lung disease",
keywords="mHealth",
keywords="outpatient",
keywords="patient-reported outcome measures",
keywords="remote monitoring",
keywords="self-monitoring",
abstract="Background: Health care services are being challenged by an increasing number of patients and limited resources. Hence, research investigating options to reduce costs and increase effectiveness is warranted. Digital outpatient services can provide flexible and tailored follow-up, improve patients' health literacy, and facilitate the identification of adverse courses of disease. However, previous research largely focused on disease-specific contexts and outcomes. Therefore, research on digital services investigating generic outcomes such as health literacy is warranted. Objective: This article aims to describe the ``digital outpatient service'' intervention and present the protocol for an ongoing multicenter, nonrandomized trial evaluating this intervention. Methods: Based on previous experiences and evidence-based knowledge, we developed this intervention through patient-journey maps in collaboration with each clinical specialty. The patients gain access to a mobile app for self-monitoring and patient-reported outcomes and a chat for contact between the patients and health care workers. The health care workers' dashboard includes a traffic light system to draw attention to the most urgent patient reports. In this multicenter, non--randomized controlled trial, patients are allocated to the control group receiving standard care or the 6-month intervention. Eligible patients are aged 18 years or older who receive outpatient care at the neurology, lung, pain, or cancer departments at 2 university hospitals in Norway. Our evaluation will include patient-reported outcomes, qualitative interviews, and clinical measures. The primary outcome will be health literacy using the Health Literacy Questionnaire. A sample size of 165 participants is split into a 1:2 ratio in favor of the intervention. We will analyze quantitative data in SPSS (IBM Corp) using descriptive statistics and logistic regression, and qualitative data using thematic analysis. Results: This trial started in September 2021, and the intervention started in January 2022. Recruitment has ended, with 55 patients in the control group and 107 patients in the intervention group. Follow-up is expected to end in July 2023, with results expected to be obtained in December 2023. Conclusions: This study will evaluate an intervention facilitated by an already certified digital multicomponent solution, with intervention content based on patient-reported outcomes, health literacy, and self-monitoring. The intervention is specifically tailored to each participating center and the needs of their patients using patient journey maps. The comprehensive and generic evaluation of this digital outpatient service intervention is a strength as it targets a heterogeneous sample of patients. Thus, this study will provide important knowledge about the applicability and effects of digital health care services. As a result, patients and health care workers will gain a new, evidence-based understanding of whether and how digital tools may be used in clinical care. Trial Registration: ClinicalTrials.gov NCT05068869; https://clinicaltrials.gov/ct2/show/NCT05068869 International Registered Report Identifier (IRRID): DERR1-10.2196/46649 ",
doi="10.2196/46649",
url="https://www.researchprotocols.org/2023/1/e46649",
url="http://www.ncbi.nlm.nih.gov/pubmed/37428533"
}


@Article{info:doi/10.2196/44533,
author="LeBlanc, R. Matthew
and LeBlanc, W. Thomas
and Yang, Qing
and McLaughlin, Jennifer
and Irish, Kerry
and Smith, K. Sophia",
title="A Mobile App to Support Self-Management in Patients with Multiple Myeloma or Chronic Lymphocytic Leukemia: Pilot Randomized Controlled Trial",
journal="JMIR Cancer",
year="2023",
month="Jul",
day="6",
volume="9",
pages="e44533",
keywords="chronic lymphocytic leukemia",
keywords="distress",
keywords="intervention",
keywords="leukemia",
keywords="mHealth",
keywords="mobile application",
keywords="multiple myeloma",
keywords="post-traumatic stress",
keywords="self-management",
keywords="symptoms",
keywords="treatment",
abstract="Background: Patients with blood cancer experience serious physical and emotional symptoms throughout their cancer journey. Objective: Building on previous work, we aimed to develop an app designed to help patients with multiple myeloma and chronic lymphocytic leukemia self-manage symptoms and test it for acceptability and preliminary efficacy. Methods: We developed our Blood Cancer Coach app with input from clinicians and patients. Our 2-armed randomized controlled pilot trial recruited participants from Duke Health and nationally in partnerships with the Association of Oncology Social Work, Leukemia and Lymphoma Society, and other patient groups. Participants were randomized to the attention control (Springboard Beyond Cancer website) arm or the Blood Cancer Coach app intervention arm. The fully automated Blood Cancer Coach app included symptom and distress tracking with tailored feedback, medication reminders and adherence tracking, multiple myeloma and chronic lymphocytic leukemia education resources, and mindfulness activities. Patient-reported data were collected at baseline, 4 weeks, and 8 weeks for both arms through the Blood Cancer Coach app. Outcomes of interest were global health (Patient Reported Outcomes Measurement Information System Global Health), posttraumatic stress (Posttraumatic Stress Disorder Checklist for DSM-5), and cancer symptoms (Edmonton Symptom Assessment System Revised). Among participants in the intervention arm, satisfaction surveys and usage data were used to evaluate acceptability. Results: Among 180 patients who downloaded the app, 49\% (89) of them consented to participate and 40\% (72) of them completed baseline surveys. Of those who completed baseline surveys, 53\% (38) of them completed week 4 surveys (16 intervention and 22 control) and 39\% (28) of them completed week 8 surveys (13 intervention and 15 control). Most participants found the app at least moderately effective at helping manage symptoms (87\%), feeling more comfortable seeking help (87\%), increasing awareness of resources (73\%), and reported being satisfied with the app overall (73\%). Participants completed an average of 248.5 app tasks over the 8-week study period. The most used functions within the app were medication log, distress tracking, guided meditations, and symptom tracking. There were no significant differences between the control and intervention arms at week 4 or 8 on any outcomes. We also saw no significant improvement over time within the intervention arm. Conclusions: The results of our feasibility pilot were promising in which most participants found the app to be helpful in managing their symptoms, reported satisfaction with the app, and that it was helpful in several important areas. We did not, however, find significantly reduced symptoms or improved global mental and physical health over 2 months. Recruitment and retention were challenging for this app-based study, an experience echoed by others. Limitations included a predominantly White and college educated sample. Future studies would do well to include self-efficacy outcomes, target those with more symptoms, and emphasize diversity in recruitment and retention. Trial Registration: ClinicalTrials.gov NCT05928156; https://clinicaltrials.gov/study/NCT05928156 ",
doi="10.2196/44533",
url="https://cancer.jmir.org/2023/1/e44533",
url="http://www.ncbi.nlm.nih.gov/pubmed/37410541"
}


@Article{info:doi/10.2196/41490,
author="Beydon, Nicole
and Taill{\'e}, Camille
and Corvol, Harriet
and Valcke, Judith
and Portal, Jean-Jacques
and Plantier, Laurent
and Mangiapan, Gilles
and Perisson, Caroline
and Aubertin, Guillaume
and Hadchouel, Alice
and Briend, Guillaume
and Guilleminault, Laurent
and Neukirch, Catherine
and Cros, Pierrick
and Appere de Vecchi, Corinne
and Mahut, Bruno
and Vicaut, Eric
and Delclaux, Christophe",
title="Digital Action Plan (Web App) for Managing Asthma Exacerbations: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2023",
month="Jun",
day="29",
volume="25",
pages="e41490",
keywords="asthma exacerbation",
keywords="action plan",
keywords="web application",
keywords="mobile phone",
abstract="Background: A written action plan (WAP) for managing asthma exacerbations is recommended. Objective: We aimed to compare the effect on unscheduled medical contacts (UMCs) of a digital action plan (DAP) accessed via a smartphone web app combined with a WAP on paper versus that of the same WAP alone. Methods: This randomized, unblinded, multicenter (offline recruitment in private offices and public hospitals), and parallel-group trial included children (aged 6-12 years) or adults (aged 18-60 years) with asthma who had experienced at least 1 severe exacerbation in the previous year. They were randomized to a WAP or DAP+WAP group in a 1:1 ratio. The DAP (fully automated) provided treatment advice according to the severity and previous pharmacotherapy of the exacerbation. The DAP was an algorithm that recorded 3 to 9 clinical descriptors. In the app, the participant first assessed the severity of their current symptoms on a 10-point scale and then entered the symptom descriptors. Before the trial, the wordings and ordering of these descriptors were validated by 50 parents of children with asthma and 50 adults with asthma; the app was not modified during the trial. Participants were interviewed at 3, 6, 9, and 12 months to record exacerbations, UMCs, and WAP and DAP use, including the subjective evaluation (availability and usefulness) of the action plans, by a research nurse. Results: Overall, 280 participants were randomized, of whom 33 (11.8\%) were excluded because of the absence of follow-up data after randomization, leaving 247 (88.2\%) participants (children: n=93, 37.7\%; adults: n=154, 62.3\%). The WAP group had 49.8\% (123/247) of participants (children: n=45, 36.6\%; mean age 8.3, SD 2.0 years; adults: n=78, 63.4\%; mean age 36.3, SD 12.7 years), and the DAP+WAP group had 50.2\% (124/247) of participants (children: n=48, 38.7\%; mean age 9.0, SD 1.9 years; adults: n=76, 61.3\%; mean age 34.5, SD 11.3 years). Overall, the annual severe exacerbation rate was 0.53 and not different between the 2 groups of participants. The mean number of UMCs per year was 0.31 (SD 0.62) in the WAP group and 0.37 (SD 0.82) in the DAP+WAP group (mean difference 0.06, 95\% CI ?0.12 to 0.24; P=.82). Use per patient with at least 1 moderate or severe exacerbation was higher for the WAP (33/65, 51\% vs 15/63, 24\% for the DAP; P=.002). Thus, participants were more likely to use the WAP than the DAP despite the nonsignificant difference between the action plans in the subjective evaluation. Median symptom severity of the self-evaluated exacerbation was 4 out of 10 and not significantly different from the symptom severity assessed by the app. Conclusions: The DAP was used less often than the WAP and did not decrease the number of UMCs compared with the WAP alone. Trial Registration: ClinicalTrials.gov NCT02869958; https://clinicaltrials.gov/ct2/show/NCT02869958 ",
doi="10.2196/41490",
url="https://www.jmir.org/2023/1/e41490",
url="http://www.ncbi.nlm.nih.gov/pubmed/37255277"
}


@Article{info:doi/10.2196/44585,
author="Lewkowicz, Daniel
and Bottinger, Erwin
and Siegel, Martin",
title="Economic Evaluation of Digital Therapeutic Care Apps for Unsupervised Treatment of Low Back Pain: Monte Carlo Simulation",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Jun",
day="29",
volume="11",
pages="e44585",
keywords="cost-utility analysis",
keywords="cost",
keywords="probabilistic sensitivity analysis",
keywords="Monte Carlo simulation",
keywords="low back pain",
keywords="pain",
keywords="economic",
keywords="cost-effectiveness",
keywords="Markov model",
keywords="digital therapy",
keywords="digital health app",
keywords="mHealth, mobile health",
keywords="health app",
keywords="mobile app",
keywords="orthopedic",
keywords="QUALY",
keywords="DALY",
keywords="quality-adjusted life years",
keywords="disability-adjusted life years",
keywords="time horizon",
keywords="veteran",
keywords="statistics",
abstract="Background: Digital therapeutic care (DTC) programs are unsupervised app-based treatments that provide video exercises and educational material to patients with nonspecific low back pain during episodes of pain and functional disability. German statutory health insurance can reimburse DTC programs since 2019, but evidence on efficacy and reasonable pricing remains scarce. This paper presents a probabilistic sensitivity analysis (PSA) to evaluate the efficacy and cost-utility of a DTC app against treatment as usual (TAU) in Germany. Objective: The aim of this study was to perform a PSA in the form of a Monte Carlo simulation based on the deterministic base case analysis to account for model assumptions and parameter uncertainty. We also intend to explore to what extent the results in this probabilistic analysis differ from the results in the base case analysis and to what extent a shortage of outcome data concerning quality-of-life (QoL) metrics impacts the overall results. Methods: The PSA builds upon a state-transition Markov chain with a 4-week cycle length over a model time horizon of 3 years from a recently published deterministic cost-utility analysis. A Monte Carlo simulation with 10,000 iterations and a cohort size of 10,000 was employed to evaluate the cost-utility from a societal perspective. Quality-adjusted life years (QALYs) were derived from Veterans RAND 6-Dimension (VR-6D) and Short-Form 6-Dimension (SF-6D) single utility scores. Finally, we also simulated reducing the price for a 3-month app prescription to analyze at which price threshold DTC would result in being the dominant strategy over TAU in Germany. Results: The Monte Carlo simulation yielded on average a {\texteuro}135.97 (a currency exchange rate of EUR {\texteuro}1=US \$1.069 is applicable) incremental cost and 0.004 incremental QALYs per person and year for the unsupervised DTC app strategy compared to in-person physiotherapy in Germany. The corresponding incremental cost-utility ratio (ICUR) amounts to an additional {\texteuro}34,315.19 per additional QALY. DTC yielded more QALYs in 54.96\% of the iterations. DTC dominates TAU in 24.04\% of the iterations for QALYs. Reducing the app price in the simulation from currently {\texteuro}239.96 to {\texteuro}164.61 for a 3-month prescription could yield a negative ICUR and thus make DTC the dominant strategy, even though the estimated probability of DTC being more effective than TAU is only 54.96\%. Conclusions: Decision-makers should be cautious when considering the reimbursement of DTC apps since no significant treatment effect was found, and the probability of cost-effectiveness remains below 60\% even for an infinite willingness-to-pay threshold. More app-based studies involving the utilization of QoL outcome parameters are urgently needed to account for the low and limited precision of the available QoL input parameters, which are crucial to making profound recommendations concerning the cost-utility of novel apps. ",
doi="10.2196/44585",
url="https://mhealth.jmir.org/2023/1/e44585",
url="http://www.ncbi.nlm.nih.gov/pubmed/37384379"
}


@Article{info:doi/10.2196/45162,
author="Goodman, Andrew
and Mahoney, Ray
and Spurling, Geoffrey
and Lawler, Sheleigh",
title="Influencing Factors to mHealth Uptake With Indigenous Populations: Qualitative Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Jun",
day="23",
volume="11",
pages="e45162",
keywords="mHealth",
keywords="Indigenous",
keywords="Canada",
keywords="Australia",
keywords="New Zealand",
keywords="United States",
keywords="Papua New Guinea",
keywords="Samoa",
keywords="qualitative",
keywords="systematic review",
keywords="feasibility",
keywords="acceptability",
keywords="users",
keywords="design",
keywords="workflow",
abstract="Background: The advancements and abundance of mobile phones and portable health devices have created an opportunity to use mobile health (mHealth) for population health systems. There is increasing evidence for the feasibility and acceptance of mHealth with Indigenous populations. Providing a synthesis of qualitative findings of mHealth with Indigenous populations will gain insights into the strengths and challenges to mHealth use in Indigenous populations. Objective: This review aimed to identify and synthesize qualitative data pertaining to the experiences and perceptions of mHealth from the perspectives of end users (patients and service providers) living in the colonial settler democracies of Canada, Australia, New Zealand, the United States, the Pacific Islands, and the S{\'a}pmi region of northern Europe. Methods: In May 2021, systematic searches of peer-reviewed, scientific papers were conducted across the 5 databases of PubMed, CINAHL, Embase, PsycINFO, and Web of Science. Qualitative or mixed method studies were included where a mHealth intervention was the primary focus for responding to health challenges with Indigenous populations. Two authors independently screened papers for eligibility and assessed the risk of bias using a modified version of the Critical Appraisal Skills Programme. A meta-aggregative approach was used to analyze the findings of included studies. Results: Seventeen papers met the eligibility criteria, 8 studies with patients, 7 studies with service providers, and 2 studies that included both patients and service providers. Studies were conducted in Australia (n=10), Canada (n=2), New Zealand (n=2), Papua New Guinea (n=1), the United States (n=1), and Samoa (n=1). Our interpretation of these qualitative findings shows commonalities between Indigenous patients' and service providers' perceptions of mHealth. We summarize our findings in six themes: (1) mHealth literacy, (2) mHealth as a facilitator for connection and support, (3) mHealth content needed to be culturally relevant, (4) mHealth security and confidentiality, (5) mHealth supporting rather than replacing service providers, and (6) workplace and organizational capacity. Conclusions: This research suggests that mHealth can meet the needs of both patients and service providers when the mHealth intervention is culturally relevant, accounts for digital and health literacy, incorporates interactive components, is supported by workplaces, fits into health provider workflows, and meets security and confidentiality standards. Future mHealth research with Indigenous populations should partner with key representatives (eg, patients, service providers, and executive leaders) in the mHealth design appropriate to the purpose, people, setting, and delivery. ",
doi="10.2196/45162",
url="https://mhealth.jmir.org/2023/1/e45162",
url="http://www.ncbi.nlm.nih.gov/pubmed/37351947"
}


@Article{info:doi/10.2196/43788,
author="Khatib, Rasha
and McCue, Maggie
and Blair, Chris
and Roy, Anit
and Franco, John
and Fehnert, Ben
and King, James
and Sarkey, Sara
and Chrones, Lambros
and Martin, Michael
and Kabir, Christopher
and Kemp, E. David",
title="Design and Implementation of a Digitally Enabled Care Pathway to Improve Management of Depression in a Large Health Care System: Protocol for the Implementation of a Patient Care Platform",
journal="JMIR Res Protoc",
year="2023",
month="Jun",
day="23",
volume="12",
pages="e43788",
keywords="mental health",
keywords="depression",
keywords="depressive",
keywords="major depressive disorder",
keywords="depression management",
keywords="primary care",
keywords="patient engagement",
keywords="measurement-based care",
keywords="shared decision-making",
keywords="user-centered design",
keywords="mobile app",
keywords="digital platform",
keywords="mobile phone",
keywords="mobile health",
keywords="adherence",
abstract="Background: Major depressive disorder (MDD) is a serious public health concern worldwide. A treatment approach that incorporates measurement-based care (MBC) and shared decision-making between patients with MDD and their providers may foster patient engagement and improve clinical outcomes. While digital tools such as mobile apps show promise for expanding health interventions, these apps are rarely integrated into clinical practice. Objective: The primary objective of this ongoing study is to determine whether implementation of a digital tool---the Pathway Platform---in primary care improves adherence to MBC practices; here, we present the study methods. Methods: This large-scale, real-world implementation study is based on a pilot study of an earlier iteration of a mobile app (the Pathway app) that confirmed the feasibility of using the app in patients with MDD and showed a positive trend in patient engagement in the app arm. In addition, a user-centered design approach that included qualitative assessments from patients and providers was used to improve understanding of the patient journey and care team workflows. User feedback highlighted the need for enhanced features, education modules, and real-time data sharing via integration with the electronic health record. The current iteration of the Platform includes the newest version of the Pathway app, education modules for both patients and providers, and real-time patient-level data sharing with the electronic health record. The study takes place in primary care sites within the Advocate Aurora Health system in Illinois and includes adult patients with MDD who were recently prescribed monotherapy antidepressant medication (defined as a new start, medication switch, or dose change in the past 3 months). Clinical performance and selected patient outcomes will be compared before and after the implementation of the Platform. Results: Patient recruitment was completed in July 2022, with initial results expected in mid-2023. Conclusions: This study will provide useful insights into real-world integration of a digital platform within a large health system. The methods presented here highlight the unique user-centric development of the Pathway Platform, which has resulted in an enhanced digital tool with the potential to foster MBC and shared decision-making, improve patient-provider communication, and ultimately lead to optimized treatment outcomes for patients with MDD. Trial Registration: ClinicalTrials.gov NCT04891224; https://clinicaltrials.gov/ct2/show/NCT04891224 International Registered Report Identifier (IRRID): DERR1-10.2196/43788 ",
doi="10.2196/43788",
url="https://www.researchprotocols.org/2023/1/e43788",
url="http://www.ncbi.nlm.nih.gov/pubmed/37351941"
}


@Article{info:doi/10.2196/41099,
author="Chung, Hsueh-Wen
and Tai, Chen-Jei
and Chang, Polun
and Su, Wen-Lin
and Chien, Li-Yin",
title="The Effectiveness of a Traditional Chinese Medicine--Based Mobile Health App for Individuals With Prediabetes: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Jun",
day="20",
volume="11",
pages="e41099",
keywords="mHealth app",
keywords="prediabetes",
keywords="traditional Chinese medicine",
keywords="health-related quality of life",
keywords="body constitution",
keywords="meridian energy",
abstract="Background: Traditional Chinese medicine (TCM) theories assert that body constitution and meridian energy lay the foundation for disease prevention. TCM-based health concepts have not yet been incorporated into mobile health (mHealth) apps for individuals with prediabetes. Objective: The aim of this study was to examine the effectiveness of a TCM mHealth app for individuals with prediabetes. Methods: This randomized controlled trial recruited 121 individuals with prediabetes at a teaching hospital in New Taipei City between February 2020 and May 2021. The participants were randomly assigned to?the TCM mHealth app group (n=42), ordinary mHealth app group (n=41), or control group (n=38). All participants received the usual care that included 15-20 minutes of health education about the disease, along with healthy diet and exercise encouragement. The ordinary mHealth app included physical activity (PA), diet, and disease education, along with individual records. The TCM mHealth app additionally included qi and body constitution information, along with constitution-based PA and diet advice. The control group received the usual care alone and did not have access to any app. Data were collected at baseline, at the end of the 12-week intervention, and 1 month after the intervention. Body constitution, including yang-deficiency, yin-deficiency, and phlegm-stasis, was measured according to the Body Constitution Questionnaire, with higher scores indicating a greater deficiency. Body energy was examined using the Meridian Energy Analysis Device. The Short-Form 36 questionnaire was used to evaluate health-related quality of life (HRQOL), which yielded physical component scores and mental component scores, with higher scores indicating better physical and mental aspects of HRQOL, respectively. Results: Compared to the control group, the TCM mHealth app group showed greater improvement in hemoglobin A1c (HbA1c), yang-deficiency and phlegm-stasis body constitution, and BMI; however, no significant differences were found in these outcomes between the TCM mHealth app and ordinary mHealth app groups. The TCM mHealth app group showed better improvement in body energy and mental component scores than the ordinary mHealth app group. There were no significant differences in fasting plasma glucose, yin-deficiency body constitution, Dietary Approaches to Stop Hypertension dietary behavior, and total PA among the three groups after the intervention. Conclusions: Use of either the ordinary or TCM mHealth app improved HRQOL among individuals with prediabetes. Compared to the outcomes of controls not using any app, use of the TCM mHealth app was effective at improving HbA1c, BMI, yang-deficiency and phlegm-stasis body constitution, and HRQOL. Moreover, using the TCM mHealth app seemed to improve the body energy and HRQOL more than when using the ordinary mHealth app. Further studies with a larger sample size and longer follow-up period may be necessary to determine whether the differences favoring the TCM app are clinically meaningful. Trial Registration: ClinicalTrials.gov NCT04096989; https://clinicaltrials.gov/ct2/show/NCT04096989 ",
doi="10.2196/41099",
url="https://mhealth.jmir.org/2023/1/e41099",
url="http://www.ncbi.nlm.nih.gov/pubmed/37338977"
}


@Article{info:doi/10.2196/38275,
author="Cheung, Wah Ngai
and Redfern, Julie
and Thiagalingam, Aravinda
and Hng, Tien-Ming
and Marschner, Simone
and Haider, Rabbia
and Faruquie, Sonia
and Von Huben, Amy
and She, Shelley
and McIntyre, Daniel
and Cho, Jin-Gun
and Chow, K. Clara
and ",
title="Effect of Mobile Phone Text Messaging Self-Management Support for Patients With Diabetes or Coronary Heart Disease in a Chronic Disease Management Program (SupportMe) on Blood Pressure: Pragmatic Randomized Controlled Trial",
journal="J Med Internet Res",
year="2023",
month="Jun",
day="16",
volume="25",
pages="e38275",
keywords="diabetes mellitus",
keywords="type 2",
keywords="coronary disease",
keywords="chronic disease",
keywords="SMS text messaging",
keywords="delivery of health care",
keywords="integrated",
keywords="self-management",
abstract="Background: Maintaining engagement and support for patients with chronic diseases is challenging. SMS text messaging programs have complemented patient care in a variety of situations. However, such programs have not been widely translated into routine care. Objective: We aimed to examine the implementation and utility of a customized SMS text message--based support program for patients with type 2 diabetes (T2D), coronary heart disease, or both within a chronic disease integrated care program. Methods: We conducted a 6-month pragmatic parallel-group, single-blind randomized controlled trial that recruited people with T2D or coronary heart disease. Intervention participants received 4 semipersonalized SMS text messages per week providing self-management support to supplement standard care. Preprogrammed algorithms customized content based on participant characteristics, and the messages were sent at random times of the day and in random order by a fully automated SMS text messaging engine. Control participants received standard care and only administrative SMS text messages. The primary outcome was systolic blood pressure. Evaluations were conducted face to face whenever possible by researchers blinded to randomization. Participants with T2D were evaluated for glycated hemoglobin level. Participant-reported experience measures were evaluated using questionnaires and focus groups and summarized using proportions and thematic analysis. Results: A total of 902 participants were randomized (n=448, 49.7\% to the intervention group and n=454, 50.3\% to the control group). Primary outcome data were available for 89.5\% (807/902) of the participants. At 6 months, there was no difference in systolic blood pressure between the intervention and control arms (adjusted mean difference=0.9 mm?Hg, 95\% CI ?1.1 to 2.1; P=.38). Of 642 participants with T2D, there was no difference in glycated hemoglobin (adjusted mean difference=0.1\%, 95\% CI ?0.1\% to 0.3\%; P=.35). Self-reported medication adherence was better in the intervention group (relative risk=0.82, 95\% CI 0.68-1.00; P=.045). Participants reported that the SMS text messages were useful (298/344, 86.6\%) and easily understood (336/344, 97.7\%) and motivated change (217/344, 63.1\%). The lack of bidirectional messaging was identified as a barrier. Conclusions: The intervention did not improve blood pressure in this cohort, possibly because of high clinician commitment to improved routine patient care as part of the chronic disease management program as well as favorable baseline metrics. There was high program engagement, acceptability, and perceived value. Feasibility as part of an integrated care program was demonstrated. SMS text messaging programs may supplement chronic disease management and support self-care. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616001689460; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371769\&isReview=true International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-025923 ",
doi="10.2196/38275",
url="https://www.jmir.org/2023/1/e38275",
url="http://www.ncbi.nlm.nih.gov/pubmed/37327024"
}


@Article{info:doi/10.2196/41227,
author="Gudmundsd{\'o}ttir, L{\'a}ra Sigr{\'i}dur
and Ballarini, Tommaso
and {\'A}mundad{\'o}ttir, L. Mar{\'i}a
and M{\'e}sz{\'a}ros, Judit
and Eysteinsdottir, Huld Jenna
and Thorleifsdottir, H. Ragna
and Hrafnkelsd{\'o}ttir, K. Sigr{\'i}dur
and Helgadottir, Halla
and Oddsson, Saemundur
and Silverberg, I. Jonathan",
title="Engagement, Retention, and Acceptability in a Digital Health Program for Atopic Dermatitis: Prospective Interventional Study",
journal="JMIR Form Res",
year="2023",
month="Jun",
day="14",
volume="7",
pages="e41227",
keywords="digital therapeutics",
keywords="DTX",
keywords="eHealth",
keywords="engagement",
keywords="retention",
keywords="atopic dermatitis",
keywords="eczema",
keywords="medication reminder",
keywords="symptom tracking",
keywords="patient-reported outcomes",
keywords="quality of life",
keywords="dermatology",
keywords="feasibility",
keywords="mobile phone",
abstract="Background: Patients with atopic dermatitis can experience chronic eczema with pruritus, skin pain, sleep problems, anxiety, and other problems that reduce their quality of life (QoL). Current treatments aim to improve these symptoms and reduce inflammation, but poor treatment adherence and disease understanding are key concerns in the long-term management of atopic dermatitis. Digital therapeutics can help with these and support patients toward a healthier lifestyle to improve their overall QoL. Objective: The aim of the study is to test the feasibility of a digital health program tailored for atopic dermatitis through program engagement, retention, and acceptability. Methods: Adults with atopic dermatitis were recruited in Iceland for a 6-week digital health program delivered through a smartphone app. Key components of the digital program were disease and trigger education; medication reminders; patient-reported outcomes (PROs) on energy levels, stress levels, and quality of sleep (referred to as QoL PROs); atopic dermatitis symptom PROs; guided meditation; and healthy lifestyle coaching. The primary outcome was program feasibility, as assessed by in-app retention and engagement. User satisfaction was assessed by the mHealth (ie, mobile health) App Usability Questionnaire (MAUQ). Results: A total of 21 patients were recruited (17 female, mean age 31 years), 20 (95\%) completed the program. On average, users were active in the app 6.5 days per week and completed 8.2 missions per day. The education content, medication reminders, and PROs had high user engagement and retention; all users who were exposed to the QoL PROs (n=17) interacted with these, and 20/21 (95\%) users were continuously engaged with the education missions, medication missions, and symptom PROs. Continued engagement with the step counter and mind missions among exposed users was lower (17/21 and 13/20 participants, respectively). Medication reminder and education task completion remained high over time (at least 18/20, 90\%), but weekly interactions declined. All assigned users completed atopic dermatitis symptom PROs on weeks 1-5 and only one did not do so on week 6; the reported number and total severity of atopic dermatitis symptoms reduced during the program. Regarding the QoL PROs, 16/17 (94\%) and 14/17 (82\%) users interacted with these at least 3 times in the first and last week of the program, respectively, and all reported improvements over time. User satisfaction was high with a total score of 6.2/7. Conclusions: We found high overall engagement and retention in a targeted digital health program among patients with atopic dermatitis, as well as high compliance with missions relating to medication reminders, patient education, and PROs. Symptom number and severity were reduced, and QoL PROs improved over time. We conclude that a digital health program is feasible and may provide added benefits for patients with atopic dermatitis, including the tracking and improvement of atopic dermatitis symptoms. ",
doi="10.2196/41227",
url="https://formative.jmir.org/2023/1/e41227",
url="http://www.ncbi.nlm.nih.gov/pubmed/36975050"
}


@Article{info:doi/10.2196/41890,
author="Norman-Nott, Nell
and Hesam-Shariati, Negin
and Wilks, R. Chelsey
and Schroeder, Jessica
and Suh, Jina
and Briggs, E. Nancy
and McAuley, H. James
and Quid{\'e}, Yann
and Gustin, M. Sylvia",
title="Internet-Delivered Dialectical Behavioral Therapy Skills Training for Chronic Pain: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="Jun",
day="7",
volume="12",
pages="e41890",
keywords="internet-delivered",
keywords="dialectical behavioral therapy",
keywords="chronic pain",
keywords="emotion dysregulation",
keywords="emotion-centric intervention",
keywords="mobile phone",
abstract="Background: Emotion dysregulation is key to the development and maintenance of chronic pain, feeding into a cycle of worsening pain and disability. Dialectical behavioral therapy (DBT), an evidence-based treatment for complex transdiagnostic conditions presenting with high emotion dysregulation, may be beneficial to manage and mitigate the emotional and sensory aspects of chronic pain. Increasingly, DBT skills training as a key component of standard DBT is being delivered as a stand-alone intervention without concurrent therapy to help develop skills for effective emotion regulation. A previous repeated-measure single-case trial investigating a novel technologically driven DBT skills training, internet-delivered DBT skills training for chronic pain (iDBT-Pain), revealed promising findings to improve both emotion dysregulation and pain intensity. Objective: This randomized controlled trial aims to examine the efficacy of iDBT-Pain in comparison with treatment as usual to reduce emotion dysregulation (primary outcome) for individuals with chronic pain after 9 weeks and at the 21-week follow-up. The secondary outcomes include pain intensity, pain interference, anxiety symptoms, depressive symptoms, perceived stress, posttraumatic stress, harm avoidance, social cognition, sleep quality, life satisfaction, and well-being. The trial also examines the acceptability of the iDBT-Pain intervention for future development and testing. Methods: A total of 48 people with chronic pain will be randomly assigned to 1 of 2 conditions: treatment and treatment as usual. Participants in the treatment condition will receive iDBT-Pain, consisting of 6 live web-based group sessions led by a DBT skills trainer and supervised by a registered psychologist and the iDBT-Pain app. Participants in the treatment-as-usual condition will not receive iDBT-Pain but will still access their usual medication and health interventions. We predict that iDBT-Pain will improve the primary outcome of emotion dysregulation and the secondary outcomes of pain intensity, pain interference, anxiety symptoms, depressive symptoms, perceived stress, harm avoidance, social cognition, sleep quality, life satisfaction, and well-being. A linear mixed model with random effects of individuals will be conducted to investigate the differences between the baseline, 9-week (primary end point), and 21-week (follow-up) assessments as a function of experimental condition. Results: Recruitment started in February 2023, and the clinical trial started in March 2023. Data collection for the final assessment is planned to be completed by July 2024. Conclusions: If our hypothesis is confirmed, our findings will contribute to the evidence for the efficacy and acceptability of a viable intervention that may be used by health care professionals for people with chronic pain. The results will add to the chronic pain literature to inform about the potential benefits of DBT skills training for chronic pain and will contribute evidence about technologically driven interventions. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12622000113752; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=383208\&isReview=true International Registered Report Identifier (IRRID): PRR1-10.2196/41890 ",
doi="10.2196/41890",
url="https://www.researchprotocols.org/2023/1/e41890",
url="http://www.ncbi.nlm.nih.gov/pubmed/37285187"
}


@Article{info:doi/10.2196/44630,
author="Auton, Alice
and Zaman, Sameer
and Padayachee, Yorissa
and Samways, W. Jack
and Quaife, M. Nicholas
and Sweeney, Mark
and Tenorio, Indira
and Linton, F. Nick W.
and Cole, D. Graham
and Peters, S. Nicholas
and Mayet, Jamil
and Barton, Carys
and Plymen, Carla",
title="Smartphone-Based Remote Monitoring for Chronic Heart Failure: Mixed Methods Analysis of User Experience From Patient and Nurse Perspectives",
journal="JMIR Nursing",
year="2023",
month="Jun",
day="6",
volume="6",
pages="e44630",
keywords="heart failure",
keywords="health-related quality of life",
keywords="mHealth",
keywords="nurse specialist",
keywords="patient engagement",
keywords="self-management",
keywords="self-care",
abstract="Background: Community-based management by heart failure specialist nurses (HFSNs) is key to improving self-care in heart failure with reduced ejection fraction. Remote monitoring (RM) can aid nurse-led management, but in the literature, user feedback evaluation is skewed in favor of the patient rather than nursing user experience. Furthermore, the ways in which different groups use the same RM platform at the same time are rarely directly compared in the literature. We present a balanced semantic analysis of user feedback from patient and nurse perspectives of Luscii, a smartphone-based RM strategy combining self-measurement of vital signs, instant messaging, and e-learning. Objective: This study aims to (1) evaluate how patients and nurses use this type of RM (usage type), (2) evaluate patients' and nurses' user feedback on this type of RM (user experience), and (3) directly compare the usage type and user experience of patients and nurses using the same type of RM platform at the same time. Methods: We performed a retrospective usage type and user experience evaluation of the RM platform from the perspective of both patients with heart failure with reduced ejection fraction and the HFSNs using the platform to manage them. We conducted semantic analysis of written patient feedback provided via the platform and a focus group of 6 HFSNs. Additionally, as an indirect measure of tablet adherence, self-measured vital signs (blood pressure, heart rate, and body mass) were extracted from the RM platform at onboarding and 3 months later. Paired 2-tailed t tests were used to evaluate differences between mean scores across the 2 timepoints. Results: A total of 79 patients (mean age 62 years; 35\%, 28/79 female) were included. Semantic analysis of usage type revealed extensive, bidirectional information exchange between patients and HFSNs using the platform. Semantic analysis of user experience demonstrates a range of positive and negative perspectives. Positive impacts included increased patient engagement, convenience for both user groups, and continuity of care. Negative impacts included information overload for patients and increased workload for nurses. After the patients used the platform for 3 months, they showed significant reductions in heart rate (P=.004) and blood pressure (P=.008) but not body mass (P=.97) compared with onboarding. Conclusions: Smartphone-based RM with messaging and e-learning facilitates bilateral information sharing between patients and nurses on a range of topics. Patient and nurse user experience is largely positive and symmetrical, but there are possible negative impacts on patient attention and nurse workload. We recommend RM providers involve patient and nurse users in platform development, including recognition of RM usage in nursing job plans. ",
doi="10.2196/44630",
url="https://nursing.jmir.org/2023/1/e44630",
url="http://www.ncbi.nlm.nih.gov/pubmed/37279054"
}


@Article{info:doi/10.2196/43803,
author="Riboli-Sasco, Eva
and El-Osta, Austen
and Alaa, Aos
and Webber, Iman
and Karki, Manisha
and El Asmar, Line Marie
and Purohit, Katie
and Painter, Annabelle
and Hayhoe, Benedict",
title="Triage and Diagnostic Accuracy of Online Symptom Checkers: Systematic Review",
journal="J Med Internet Res",
year="2023",
month="Jun",
day="2",
volume="25",
pages="e43803",
keywords="systematic review",
keywords="digital triage",
keywords="diagnosis",
keywords="online symptom checker",
keywords="safety",
keywords="accuracy",
keywords="mobile phone",
abstract="Background: In the context of a deepening global shortage of health workers and, in particular, the COVID-19 pandemic, there is growing international interest in, and use of, online symptom checkers (OSCs). However, the evidence surrounding the triage and diagnostic accuracy of these tools remains inconclusive. Objective: This systematic review aimed to summarize the existing peer-reviewed literature evaluating the triage accuracy (directing users to appropriate services based on their presenting symptoms) and diagnostic accuracy of OSCs aimed at lay users for general health concerns. Methods: Searches were conducted in MEDLINE, Embase, CINAHL, Health Management Information Consortium (HMIC), and Web of Science, as well as the citations of the studies selected for full-text screening. We included peer-reviewed studies published in English between January 1, 2010, and February 16, 2022, with a controlled and quantitative assessment of either or both triage and diagnostic accuracy of OSCs directed at lay users. We excluded tools supporting health care professionals, as well as disease- or specialty-specific OSCs. Screening and data extraction were carried out independently by 2 reviewers for each study. We performed a descriptive narrative synthesis. Results: A total of 21,296 studies were identified, of which 14 (0.07\%) were included. The included studies used clinical vignettes, medical records, or direct input by patients. Of the 14 studies, 6 (43\%) reported on triage and diagnostic accuracy, 7 (50\%) focused on triage accuracy, and 1 (7\%) focused on diagnostic accuracy. These outcomes were assessed based on the diagnostic and triage recommendations attached to the vignette in the case of vignette studies or on those provided by nurses or general practitioners, including through face-to-face and telephone consultations. Both diagnostic accuracy and triage accuracy varied greatly among OSCs. Overall diagnostic accuracy was deemed to be low and was almost always lower than that of the comparator. Similarly, most of the studies (9/13, 69 \%) showed suboptimal triage accuracy overall, with a few exceptions (4/13, 31\%). The main variables affecting the levels of diagnostic and triage accuracy were the severity and urgency of the condition, the use of artificial intelligence algorithms, and demographic questions. However, the impact of each variable differed across tools and studies, making it difficult to draw any solid conclusions. All included studies had at least one area with unclear risk of bias according to the revised Quality Assessment of Diagnostic Accuracy Studies-2 tool. Conclusions: Although OSCs have potential to provide accessible and accurate health advice and triage recommendations to users, more research is needed to validate their triage and diagnostic accuracy before widescale adoption in community and health care settings. Future studies should aim to use a common methodology and agreed standard for evaluation to facilitate objective benchmarking and validation. Trial Registration: PROSPERO CRD42020215210; https://tinyurl.com/3949zw83 ",
doi="10.2196/43803",
url="https://www.jmir.org/2023/1/e43803",
url="http://www.ncbi.nlm.nih.gov/pubmed/37266983"
}


@Article{info:doi/10.2196/45531,
author="Liu, Wei
and Yu, Xiaojuan
and Wang, Jiangyuan
and Zhou, Tianmeng
and Yu, Ting
and Chen, Xuyong
and Xie, Shasha
and Han, Fuman
and Wang, Zi",
title="Improving Kidney Outcomes in Patients With Nondiabetic Chronic Kidney Disease Through an Artificial Intelligence--Based Health Coaching Mobile App: Retrospective Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Jun",
day="1",
volume="11",
pages="e45531",
keywords="chronic kidney disease",
keywords="self-management",
keywords="mobile apps",
keywords="end-stage kidney disease",
keywords="eHealth intervention",
keywords="kidney",
keywords="efficacy",
keywords="eHealth care",
keywords="dialysis",
keywords="deep-learning",
keywords="artificial intelligence",
keywords="patient care",
abstract="Background: Chronic kidney disease (CKD) is a global health burden. However, the efficacy of different modes of eHealth care in facilitating self-management for patients with CKD is unclear. Objective: The aim of this study was to evaluate the effectiveness of a mobile app--based intelligent care system in improving the kidney outcomes of patients with CKD. Methods: Our study was a retrospective analysis based on the KidneyOnline intelligent system developed in China. Patients with CKD but not dependent on dialysis who registered on the KidneyOnline app between January 2017 and January 2021 were screened. Patients in the the KidneyOnline intelligent system group and those in the conventional care group were 1:1 matched according to their baseline characteristics. The intervention group received center-based follow-up combined with the KidneyOnline intelligent patient care system, which was a nurse-led, patient-oriented collaborative management system. Health-related data uploaded by the patients were integrated using deep learning optical character recognition (OCR). Artificial intelligence (AI)--generated personalized recipes, lifestyle intervention suggestions, early warnings, real-time questions and answers, and personalized follow-up plans were also provided. Patients in the conventional group could get professional suggestions from the nephrologists through regular clinical visits, but they did not have access to the service provided by AI and the health coach team. Patients were followed for at least 3 months after recruitment or until death or start of renal replacement therapy. Results: A total of 2060 eligible patients who registered on the KidneyOnline app from 2017 to 2021 were enrolled for the analysis. Of those, 902 (43.8\%) patients were assessed for survival analysis after propensity score matching, with 451(50\%) patients in the KidneyOnline intelligent patient care system group and 451(50\%) patients in the conventional care group. After a mean follow-up period of 15.8 (SD 9.5) months, the primary composite kidney outcome occurred in 28 (6\%) participants in the KidneyOnline intelligent patient care system group and 32 (7\%) in the conventional care group, with a hazard ratio of 0.391 (95\% CI 0.231-0.660; P<.001). Subgroup survival analysis demonstrated that the KidneyOnline care system significantly reduced the risk of composite kidney outcome, irrespective of age, sex, baseline estimated glomerular filtration rate (eGFR), and proteinuria. In addition, the mean arterial pressure (MAP) significantly decreased from 88.9 (SD 10.5) mmHg at baseline to 85.6 (SD 7.9) mmHg at 6 months (P<.001) in the KidneyOnline intelligent patient care system group and from 89.3 (SD 11.1) mmHg to 87.5 (SD 8.2) mmHg (P=.002) in the conventional CKD care group. Conclusions: The utilization of the KidneyOnline intelligent care system was associated with reduced risk of unfavorable kidney outcomes in nondiabetic patients with CKD. ",
doi="10.2196/45531",
url="https://mhealth.jmir.org/2023/1/e45531",
url="http://www.ncbi.nlm.nih.gov/pubmed/37261895"
}


@Article{info:doi/10.2196/44132,
author="Ossenbrink, Linda
and Haase, Tina
and Timpel, Patrick
and Schoffer, Olaf
and Scheibe, Madlen
and Schmitt, Jochen
and Deckert, Stefanie
and Harst, Lorenz",
title="Effectiveness of Digital Health Interventions Containing Game Components for the Self-management of Type 2 Diabetes: Systematic Review",
journal="JMIR Serious Games",
year="2023",
month="Jun",
day="1",
volume="11",
pages="e44132",
keywords="diabetes",
keywords="gamification",
keywords="digital health",
keywords="diabetes self-management",
keywords="mobile phone",
abstract="Background: Games and game components have become a major trend in the realm of digital health research and practice as they are assumed to foster behavior change and thereby improve patient-reported and clinical outcomes for patients with type 2 diabetes. Objective: The aim of this systematic review was to summarize and evaluate the current evidence on the effectiveness of digital health interventions containing game components on behavioral, patient-reported, and clinical outcomes for patients with type 2 diabetes. Methods: An electronic search was conducted in MEDLINE and PsycINFO in April 2020; updated in April 2022; and supplemented by additional searches via Google Scholar, Web of Science (which was used for forward citation tracking), and within the references of the included records. Articles were identified using predefined inclusion and exclusion criteria. In total, 2 reviewers independently conducted title, abstract, and full-text screening and then individually performed a critical appraisal of all the included studies using the Cochrane risk-of-bias tool version 2. A consensus was reached through discussion. Results: Of 2325 potentially relevant titles (duplicates excluded), 10 (0.43\%) randomized controlled trials were included in this review. Quality assessment revealed a high risk of bias for all randomized controlled trials except for 10\% (1/10), with performance bias due to the lack of blinding being the major source of bias. There is evidence suggesting that digital health interventions containing game components can substantially improve motivation for physical activity (1/1, 100\% of the studies dealing with PA motivation), exercise intensity (3/5, 60\%), dietary behavior (4/4, 100\%), health literacy (1/3, 33\%), mental quality of life (2/2, 100\%), glycated hemoglobin level (2/6, 33\%), BMI (1/3, 33\%), fasting plasma glucose level (1/2, 50\%), waist circumference (1/1, 100\%), and aerobic capacity (1/1, 100\%). Conclusions: Published studies indicated that digital health interventions containing game components might improve health behavior patterns, quality of life, and clinical outcomes in patients with type 2 diabetes. However, the intervention types and outcomes studied were heterogeneous, and study quality was mostly low, which translates to ambiguous results. Future research should focus on sound methodology and reporting as well as on identifying game components that contribute to significant positive effects. Trial Registration: PROSPERO CRD42020209706; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=209706 ",
doi="10.2196/44132",
url="https://games.jmir.org/2023/1/e44132",
url="http://www.ncbi.nlm.nih.gov/pubmed/37261900"
}


@Article{info:doi/10.2196/46976,
author="Shade, Marcia
and Kovaleva, Mariya
and Harp, Kimberly
and Martin-Hammond, Aqueasha",
title="Older Adults' Pain Outcomes After mHealth Interventions: Scoping Review",
journal="JMIR Aging",
year="2023",
month="May",
day="31",
volume="6",
pages="e46976",
keywords="mHealth",
keywords="older adults",
keywords="pain",
keywords="self-management",
keywords="pain management",
keywords="mobile health",
keywords="musculoskeletal pain",
keywords="scoping review",
keywords="pain outcomes",
keywords="mobile phone",
abstract="Background: Pain is prevalent and poorly managed in older adults. Although pain self-management strategies are helpful, adoption and access are limited; thus, technology provides an opportunity for intervention delivery. Mobile health (mHealth) is feasible to use in older adults; however, we have yet to understand the effect of mHealth pain self-management interventions on pain outcomes in older adults. Objective: The purpose of this scoping review is to examine the characteristics of mHealth interventions and their efficacy on pain outcomes in older adults with musculoskeletal pain. Methods: With the assistance of a medical librarian, keywords and subject headings were generated, including but not limited to mobile health application, mHealth, digital, pain, pain management, and older. A search was conducted for papers in journal databases, including PubMed, Embase, CINAHL, Scopus, and IEEE Xplore, between 2000 and 2022. Papers were screened according to predetermined inclusion and exclusion criteria, and reference lists were reviewed for additional paper inclusion. Three authors appraised the methodology of papers independently, then collaboratively to synthesize the evidence. Results: Six publications were included in the scoping review. The design and methodology ranged widely from pilot studies to a comparative effectiveness trial. Older participants in the studies reported a variety of musculoskeletal conditions. Delivery of the mHealth pain self-management interventions incorporated mobile devices, such as a smartphone or tablet. Most mHealth-delivered interventions were multicomponent and incorporated elements of in-person and telephone access to an interventionist. The findings suggested mHealth interventions may reduce pain intensity; however, pain interference and other pain-related conditions did not have a statistically significant reduction. Conclusions: Research that has explored mHealth for pain self-management is beginning to move beyond feasibility. The few experimental studies conducted in older adults are heterogeneous, and the interventions are mostly multicomponent. It is premature to conclude the interventions' significant effect on pain or pain-related symptoms. As technology continues to integrate into health care, more experimental research is warranted to examine the efficacy of mHealth interventions on a variety of pain outcomes in older adults. ",
doi="10.2196/46976",
url="https://aging.jmir.org/2023/1/e46976",
url="http://www.ncbi.nlm.nih.gov/pubmed/37256667"
}


@Article{info:doi/10.2196/45654,
author="Castillo Padr{\'o}s, Ram{\'o}n Manuel
and Pastor, Nuria
and Altarriba Paracolls, J{\'u}lia
and Mosquera Pe{\~n}a, Marcelino
and Pergolizzi, Denise
and Salvador Verg{\`e}s, {\`A}ngels",
title="A Smart System for Remote Monitoring of Patients in Palliative Care (HumanITcare Platform): Mixed Methods Study",
journal="JMIR Form Res",
year="2023",
month="May",
day="31",
volume="7",
pages="e45654",
keywords="palliative care",
keywords="advanced illness",
keywords="remote monitoring",
keywords="eHealth",
keywords="telemedicine",
keywords="mHealth",
abstract="Background: Due to the complexities of advanced illnesses and their treatments, it can be difficult for patients in palliative care to maintain their quality of life. Telemedicine interventions in chronic disease management engage patients in their care, provide continuous follow-up by their health care providers, identify symptoms earlier, and allow a quick response to illness-related decline. Objective: We aimed to detail and reflect on the design of an app and evaluate its feasibility to monitor the clinical situation of patients with advanced illnesses. Methods: This study used a mixed methods design using qualitative methods to inform app development and design and quantitative methods for data collection and analysis of patient evaluations. Palliative care units in 2 Spanish university hospitals (Nuestra Se{\~n}ora de la Candelaria in Santa Cruz de Tenerife and University Hospital Complex of Ferrol in A Coru{\~n}a) carried out a literature review, designed the study protocol, and obtained approval from the Ethics Committee from June to December 2020. In addition, focus group meetings were held, and the design and technical development of the app were elaborated on and subsequently presented in the participating palliative care units. From January to March 2021, the app was made public on the App Store and Play Store, and a pilot study with patients was carried out in April to September 2021. Results: Six focus group meetings were held that included doctors, nurses, app developers, technology consultants, and sponsors. In addition, the technology consultants presented their results 3 times in the participating palliative care units to obtain feedback. After the app's final design, it was possible to publish it on the usual servers and begin its evaluation in patients (n=60, median age 72 years). Sixty percent (n=36) of the participants were women and 40\% (n=24) were men. The most prevalent advanced pathology was cancer (n=46, 76\%), followed by other diseases (n=7, 12\%) and amyotrophic lateral sclerosis (n=5, 8\%). Seventy percent (n=42) of the patients were already in follow-up prior to the start of the study, while 30\% (n=18) were included at the start of their follow-up. The information in the app was collected and entered by relatives or caregivers in 60\% (n=36) of the cases. The median follow-up was 52 (IQR 14-104) days. In all, 69\% (n=41) had a follow-up >30 days (10 were deceased and 9 were missing data). The use of the different sections of the app ranged from 37\% (n=22) for the glycemic record to 90\% (n=54) for the constipation scale). Patients and caregivers were delighted with its ease of use and usefulness. Conclusions: Incorporating an intelligent remote patient monitoring system in clinical practice for patients in palliative care can improve access to health services and provide more information to professionals. ",
doi="10.2196/45654",
url="https://formative.jmir.org/2023/1/e45654",
url="http://www.ncbi.nlm.nih.gov/pubmed/37256664"
}


@Article{info:doi/10.2196/43597,
author="Carswell, Claire
and Coventry, A. Peter
and Brown, E. Jennifer V.
and Alderson, L. Sarah
and Double, Keith
and Gilbody, Simon
and Holt, G. Richard I.
and Jacobs, Rowena
and Lister, Jennie
and Osborn, David
and Shiers, David
and Siddiqi, Najma
and Taylor, Johanna
and Kellar, Ian
and ",
title="Development of a Supported Self-management Intervention for People With Severe Mental Illness and Type 2 Diabetes: Theory and Evidence-Based Co-design Approach",
journal="J Med Internet Res",
year="2023",
month="May",
day="12",
volume="25",
pages="e43597",
keywords="severe mental illness",
keywords="diabetes",
keywords="intervention development",
keywords="co-design",
keywords="mental health",
keywords="comorbidity",
keywords="mobile phone",
abstract="Background: Type 2 diabetes is 2 to 3 times more common among people with severe mental illness (SMI). Self-management is crucial, with additional challenges faced by people with SMI. Therefore, it is essential that any diabetes self-management program for people with SMI addresses the unique needs of people living with both conditions and the inequalities they experience within health care services. Objective: We combined theory, empirical evidence, and co-design approaches to develop a type 2 diabetes self-management intervention for people with SMI. Methods: The development process encompassed 4 steps: step 1 involved prioritizing the mechanisms of action (MoAs) and behavior change techniques (BCTs) for the intervention. Using findings from primary qualitative research and systematic reviews, we selected candidate MoAs to target in the intervention and candidate BCTs to use. Expert stakeholders then ranked these MoAs and BCTs using a 2-phase survey. The average scores were used to generate a prioritized list of MoAs and BCTs. During step 2, we presented the survey results to an expert consensus workshop to seek expert agreement with the definitive list of MoAs and BCTs for the intervention and identify potential modes of delivery. Step 3 involved the development of trigger films using the evidence from steps 1 and 2. We used animations to present the experiences of people with SMI managing diabetes. These films were used in step 4, where we used a stakeholder co-design approach. This involved a series of structured workshops, where the co-design activities were informed by theory and evidence. Results: Upon the completion of the 4-step process, we developed the DIAMONDS (diabetes and mental illness, improving outcomes and self-management) intervention. It is a tailored self-management intervention based on the synthesis of the outputs from the co-design process. The intervention incorporates a digital app, a paper-based workbook, and one-to-one coaching designed to meet the needs of people with SMI and coexisting type 2 diabetes. Conclusions: The intervention development work was underpinned by the MoA theoretical framework and incorporated systematic reviews, primary qualitative research, expert stakeholder surveys, and evidence generated during co-design workshops. The intervention will now be tested for feasibility before undergoing a definitive evaluation in a pragmatic randomized controlled trial. ",
doi="10.2196/43597",
url="https://www.jmir.org/2023/1/e43597",
url="http://www.ncbi.nlm.nih.gov/pubmed/37171868"
}


@Article{info:doi/10.2196/41216,
author="Masiero, Marianna
and Filipponi, Chiara
and Pizzoli, Maria Silvia Francesca
and Munzone, Elisabetta
and Guido, Luca
and Guardamagna, Andrea Vittorio
and Marceglia, Sara
and Caruso, Annamaria
and Prandin, Roberto
and Prenassi, Marco
and Manzelli, Vania
and Savino, Chiara
and Conti, Costanza
and Rizzi, Federica
and Casalino, Alice
and Candiani, Giulia
and Memini, Francesca
and Chiveri, Luca
and Vitali, Luigi Andrea
and Corbo, Massimo
and Milani, Alessandra
and Grasso, Roberto
and Traversoni, Silvia
and Fragale, Elisa
and Didier, Florence
and Pravettoni, Gabriella",
title="Usability Testing of a New Digital Integrated Health Ecosystem (PainRELife) for the Clinical Management of Chronic Pain in Patients With Early Breast Cancer: Protocol for a Pilot Study",
journal="JMIR Res Protoc",
year="2023",
month="May",
day="12",
volume="12",
pages="e41216",
keywords="decision-making",
keywords="decision aid",
keywords="chronic pain",
keywords="eHealth",
keywords="patient electronic health record",
keywords="clinical",
keywords="technology",
keywords="mobile application",
keywords="pilot study",
keywords="breast cancer",
keywords="chronic",
keywords="patient",
keywords="cancer",
keywords="pain",
abstract="Background: Chronic pain (CP) and its management are critical issues in the care pathway of patients with breast cancer. Considering the complexity of CP experience in cancer, the international scientific community has advocated identifying cutting-edge approaches for CP management. Recent advances in the field of health technology enable the adoption of a novel approach to care management by developing integrated ecosystems and mobile health apps. Objective: The primary end point of this pilot study is to evaluate patients' usability experience at 3 months of a new digital and integrated technological ecosystem, PainRELife, for CP in a sample of patients with breast cancer. The PainRELife ecosystem is composed of 3 main technological assets integrated into a single digital ecosystem: Fast Healthcare Interoperability Resources--based cloud platform (Nu platform) that enables care pathway definition and data collection; a big data infrastructure connected to the Fast Healthcare Interoperability Resources server that analyzes data and implements dynamic dashboards for aggregate data visualization; and an ecosystem of personalized applications for patient-reported outcomes collection, digital delivery of interventions and tailored information, and decision support of patients and caregivers (PainRELife app). Methods: This is an observational, prospective pilot study. Twenty patients with early breast cancer and chronic pain will be enrolled at the European Institute of Oncology at the Division of Medical Senology and the Division of Pain Therapy and Palliative Care. Each patient will use the PainRELife mobile app for 3 months, during which data extracted from the questionnaires will be sent to the Nu Platform that health care professionals will manage. This pilot study is nested in a large-scale project named ``PainRELife,'' which aims to develop a cloud technology platform to interoperate with institutional systems and patients' devices to collect integrated health care data. The study received approval from the Ethical Committee of the European Cancer Institute in December 2021 (number R1597/21-IEO 1701). Results: The recruitment process started in May 2022 and ended in October 2022. Conclusions: The new integrated technological ecosystems might be considered an encouraging affordance to enhance a patient-centered approach to managing patients with cancer. This pilot study will inform about which features the health technological ecosystems should have to be used by cancer patients to manage CP. International Registered Report Identifier (IRRID): DERR1-10.2196/41216 ",
doi="10.2196/41216",
url="https://www.researchprotocols.org/2023/1/e41216",
url="http://www.ncbi.nlm.nih.gov/pubmed/37171843"
}


@Article{info:doi/10.2196/44652,
author="Racey, Megan
and Whitmore, Carly
and Alliston, Paige
and Cafazzo, A. Joseph
and Crawford, Allison
and Castle, David
and Dragonetti, Rosa
and Fitzpatrick-Lewis, Donna
and Jovkovic, Milos
and Melamed, C. Osnat
and Naeem, Farooq
and Senior, Peter
and Strudwick, Gillian
and Ramdass, Seeta
and Vien, Victor
and Selby, Peter
and Sherifali, Diana",
title="Technology-Supported Integrated Care Innovations to Support Diabetes and Mental Health Care: Scoping Review",
journal="JMIR Diabetes",
year="2023",
month="May",
day="9",
volume="8",
pages="e44652",
keywords="technology",
keywords="mental health",
keywords="type 2 diabetes",
keywords="type 1 diabetes",
keywords="virtual care",
keywords="integrated care",
keywords="scoping review",
keywords="health information technology",
keywords="digital health",
keywords="support",
keywords="psychosocial",
keywords="education",
keywords="application",
keywords="distress",
keywords="clinical integration",
keywords="intervention",
abstract="Background: For individuals living with diabetes and its psychosocial comorbidities (eg, depression, anxiety, and distress), there remains limited access to interprofessional, integrated care that includes mental health support, education, and follow-up. Health technology, broadly defined as the application of organized knowledge or skill as software, devices, and systems to solve health problems and improve quality of life, is emerging as a means of addressing these gaps. There is thus a need to understand how such technologies are being used to support, educate, and help individuals living with co-occurring diabetes and mental health distress or disorder. Objective: The purpose of this scoping review was to (1) describe the literature on technology-enabled integrated interventions for diabetes and mental health; (2) apply frameworks from the Mental Health Commission of Canada and World Health Organization to elucidate the components, type, processes, and users of technology-enabled integrated interventions for diabetes and mental health; and (3) map the level of integration of interventions for diabetes and mental health. Methods: We searched 6 databases from inception to February 2022 for English-language, peer-reviewed studies of any design or type that used technology to actively support both diabetes and any mental health distress or disorder in succession or concurrently among people with diabetes (type 1 diabetes, type 2 diabetes, and gestational diabetes). Reviewers screened citations and extracted data including study characteristics and details about the technology and integration used. Results: We included 24 studies described in 38 publications. These studies were conducted in a range of settings and sites of care including both web-based and in-person settings. Studies were mostly website-based (n=13) and used technology for wellness and prevention (n=16) and intervention and treatment (n=15). The primary users of these technologies were clients and health care providers. All the included intervention studies (n=20) used technology for clinical integration, but only 7 studies also used the technology for professional integration. Conclusions: The findings of this scoping review suggest that there is a growing body of literature on integrated care for diabetes and mental health enabled by technology. However, gaps still exist with how to best equip health care professionals with the knowledge and skills to offer integrated care. Future research is needed to continue to explore the purpose, level, and breadth of technology-enabled integration to facilitate an approach to overcome or address care fragmentation for diabetes and mental health and to understand how health technology can further drive the scale-up of innovative integrated interventions. ",
doi="10.2196/44652",
url="https://diabetes.jmir.org/2023/1/e44652",
url="http://www.ncbi.nlm.nih.gov/pubmed/37159256"
}


@Article{info:doi/10.2196/38798,
author="Kitagawa, Takashi
and Hayashi, Masateru",
title="mHealth for the Self-management of Knee Osteoarthritis: Scoping Review",
journal="J Med Internet Res",
year="2023",
month="May",
day="8",
volume="25",
pages="e38798",
keywords="knee osteoarthritis",
keywords="mobile health",
keywords="mHealth",
keywords="self-management",
keywords="knee joint",
keywords="scoping review",
keywords="pain",
keywords="physical function",
keywords="quality of life",
keywords="mobile phone app",
keywords="patient education",
abstract="Background: Educating patients on the self-management of knee osteoarthritis (OA) reportedly reduces pain, improves activities of daily living, and even reduces health care costs. Objective: This scoping review will summarize the current evidence on mobile health (mHealth) and smartphone app--based disease self-management for patients with knee OA. Methods: PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, and CINAHL were systematically searched in May 2021 using the keywords ``knee osteoarthritis,'' ``mobile health,'' and ``self-management.'' Studies that investigated patients with knee OA based on radiography or clinical diagnosis were included. The following criteria were applied to the mobile phone apps included in the search-derived studies: the ability to (1) record and manage symptoms, (2) provide patient education, and (3) guide and record activities of daily living. Studies eligible for inclusion in this scoping review were interventional trials or observational studies published in English. Results: This scoping review included 8 reports, of which 3 were randomized controlled trials and 1 was a conference abstract. Most studies provided data on the outcomes of pain, physical function, and quality of life. Conclusions: An increasing number of reports are addressing the effectiveness of mHealth in patients with knee OA, and the data suggest that mHealth efficacy is similar to conventional management of health. International Registered Report Identifier (IRRID): RR2-10.17504/protocols.io.buuxnwxn ",
doi="10.2196/38798",
url="https://www.jmir.org/2023/1/e38798",
url="http://www.ncbi.nlm.nih.gov/pubmed/37155233"
}


@Article{info:doi/10.2196/42574,
author="Plachta-Danielzik, Sandra
and Grasskemper, Lena
and Schmidt, Karen
and Schreiber, Stefan
and Bokemeyer, Bernd",
title="Health Status, Quality of Life, Psychosocial Well-being, and Wearables Data of Patients With Active Ulcerative Colitis Receiving Filgotinib Therapy (FilgoColitis Study): Protocol for a Real-world Observational Study",
journal="JMIR Res Protoc",
year="2023",
month="May",
day="8",
volume="12",
pages="e42574",
keywords="ulcerative colitis",
keywords="inflammatory bowel",
keywords="filgotinib",
keywords="wearable",
keywords="eHealth",
keywords="digital health",
keywords="quality of life",
keywords="fatigue",
keywords="patient-reported outcome",
keywords="real-world evidence",
keywords="mobile phone",
abstract="Background: Filgotinib was approved in Germany for treating patients with moderate to severe active ulcerative colitis in November 2021. It represents a preferential Janus kinase 1 inhibitor. The FilgoColitis study began recruiting immediately after approval and aims to assess filgotinib effectiveness under real-world conditions with a particular focus on patient-reported outcomes (PROs). The novelty of the study design is the optional inclusion of 2 innovative wearables, which could provide a new layer of patient-derived data. Objective: The study investigates quality of life (QoL) and psychosocial well-being of patients with active ulcerative colitis during long-term exposure to filgotinib. PROs related to QoL and psychometric profiles (fatigue and depression) are collected alongside with disease activity symptom scores. We aim to evaluate physical activity patterns collected by wearables as an addition to traditional PROs, patient-reported health status, and QoL in different phases of disease activity. Methods: This is a prospective, single-arm, multicentric, noninterventional, observational study with a sample size of 250 patients. QoL is assessed with validated questionnaires: the Short Inflammatory Bowel Disease Questionnaire (sIBDQ) for the disease-specific QoL, the EQ-5D for the general QoL, and the fatigue questionnaire (Inflammatory Bowel Disease-Fatigue [IBD-F]). Physical activity data are collected from patients using wearables (SENS motion leg sensor [accelerometry] and smartwatch, GARMIN v{\'i}vosmart 4). Results: The enrollment started in December 2021 and was still open at the date of submission. After 6 months of study initiation, 69 patients were enrolled. The study is expected to be completed in June 2026. Conclusions: Real-world data for novel drugs are important to assess effectiveness outside of highly selected populations represented by randomized controlled trials. We examine whether patients' QoL and other PROs can be supplemented with physical activity patterns measured objectively. Use of wearables with newly defined outcomes represents an additional observational tool for monitoring disease activity in patients with inflammatory bowel disease. Trial Registration: German Clinical Trials Register DRKS00027327; https://drks.de/search/en/trial/DRKS00027327 International Registered Report Identifier (IRRID): DERR1-10.2196/42574 ",
doi="10.2196/42574",
url="https://www.researchprotocols.org/2023/1/e42574",
url="http://www.ncbi.nlm.nih.gov/pubmed/37155235"
}


@Article{info:doi/10.2196/44030,
author="Deniz-Garcia, Alejandro
and Fabelo, Himar
and Rodriguez-Almeida, J. Antonio
and Zamora-Zamorano, Garlene
and Castro-Fernandez, Maria
and Alberiche Ruano, Pino Maria del
and Solvoll, Terje
and Granja, Concei{\c{c}}{\~a}o
and Schopf, Roger Thomas
and Callico, M. Gustavo
and Soguero-Ruiz, Cristina
and W{\"a}gner, M. Ana
and ",
title="Quality, Usability, and Effectiveness of mHealth Apps and the Role of Artificial Intelligence: Current Scenario and Challenges",
journal="J Med Internet Res",
year="2023",
month="May",
day="4",
volume="25",
pages="e44030",
keywords="artificial intelligence",
keywords="chronic disease prevention and management",
keywords="big data",
keywords="mobile health",
keywords="mHealth",
keywords="noncommunicable diseases",
keywords="mobile phone",
doi="10.2196/44030",
url="https://www.jmir.org/2023/1/e44030",
url="http://www.ncbi.nlm.nih.gov/pubmed/37140973"
}


@Article{info:doi/10.2196/45405,
author="Anmella, Gerard
and Corponi, Filippo
and Li, M. Bryan
and Mas, Ariadna
and Sanabra, Miriam
and Pacchiarotti, Isabella
and Valent{\'i}, Marc
and Grande, Iria
and Benabarre, Antoni
and Gim{\'e}nez-Palomo, Anna
and Garriga, Marina
and Agasi, Isabel
and Bastidas, Anna
and Cavero, Myriam
and Fern{\'a}ndez-Plaza, Tabatha
and Arbelo, N{\'e}stor
and Bioque, Miquel
and Garc{\'i}a-Rizo, Clemente
and Verdolini, Norma
and Madero, Santiago
and Murru, Andrea
and Amoretti, Silvia
and Mart{\'i}nez-Aran, Anabel
and Ruiz, Victoria
and Fico, Giovanna
and De Prisco, Michele
and Oliva, Vincenzo
and Solanes, Aleix
and Radua, Joaquim
and Samalin, Ludovic
and Young, H. Allan
and Vieta, Eduard
and Vergari, Antonio
and Hidalgo-Mazzei, Diego",
title="Exploring Digital Biomarkers of Illness Activity in Mood Episodes: Hypotheses Generating and Model Development Study",
journal="JMIR Mhealth Uhealth",
year="2023",
month="May",
day="4",
volume="11",
pages="e45405",
keywords="depression",
keywords="mania",
keywords="bipolar disorder",
keywords="major depressive disorder",
keywords="machine learning",
keywords="deep learning",
keywords="physiological data",
keywords="digital biomarker",
keywords="wearable",
keywords="Empatica E4",
abstract="Background: Depressive and manic episodes within bipolar disorder (BD) and major depressive disorder (MDD) involve altered mood, sleep, and activity, alongside physiological alterations wearables can capture. Objective: Firstly, we explored whether physiological wearable data could predict (aim 1) the severity of an acute affective episode at the intra-individual level and (aim 2) the polarity of an acute affective episode and euthymia among different individuals. Secondarily, we explored which physiological data were related to prior predictions, generalization across patients, and associations between affective symptoms and physiological data. Methods: We conducted a prospective exploratory observational study including patients with BD and MDD on acute affective episodes (manic, depressed, and mixed) whose physiological data were recorded using a research-grade wearable (Empatica E4) across 3 consecutive time points (acute, response, and remission of episode). Euthymic patients and healthy controls were recorded during a single session (approximately 48 h). Manic and depressive symptoms were assessed using standardized psychometric scales. Physiological wearable data included the following channels: acceleration (ACC), skin temperature, blood volume pulse, heart rate (HR), and electrodermal activity (EDA). Invalid physiological data were removed using a rule-based filter, and channels were time aligned at 1-second time units and segmented at window lengths of 32 seconds, as best-performing parameters. We developed deep learning predictive models, assessed the channels' individual contribution using permutation feature importance analysis, and computed physiological data to psychometric scales' items normalized mutual information (NMI). We present a novel, fully automated method for the preprocessing and analysis of physiological data from a research-grade wearable device, including a viable supervised learning pipeline for time-series analyses. Results: Overall, 35 sessions (1512 hours) from 12 patients (manic, depressed, mixed, and euthymic) and 7 healthy controls (mean age 39.7, SD 12.6 years; 6/19, 32\% female) were analyzed. The severity of mood episodes was predicted with moderate (62\%-85\%) accuracies (aim 1), and their polarity with moderate (70\%) accuracy (aim 2). The most relevant features for the former tasks were ACC, EDA, and HR. There was a fair agreement in feature importance across classification tasks (Kendall W=0.383). Generalization of the former models on unseen patients was of overall low accuracy, except for the intra-individual models. ACC was associated with ``increased motor activity'' (NMI>0.55), ``insomnia'' (NMI=0.6), and ``motor inhibition'' (NMI=0.75). EDA was associated with ``aggressive behavior'' (NMI=1.0) and ``psychic anxiety'' (NMI=0.52). Conclusions: Physiological data from wearables show potential to identify mood episodes and specific symptoms of mania and depression quantitatively, both in BD and MDD. Motor activity and stress-related physiological data (EDA and HR) stand out as potential digital biomarkers for predicting mania and depression, respectively. These findings represent a promising pathway toward personalized psychiatry, in which physiological wearable data could allow the early identification and intervention of mood episodes. ",
doi="10.2196/45405",
url="https://mhealth.jmir.org/2023/1/e45405",
url="http://www.ncbi.nlm.nih.gov/pubmed/36939345"
}


@Article{info:doi/10.2196/41501,
author="Zahed, Karim
and Mehta, Ranjana
and Erraguntla, Madhav
and Qaraqe, Khalid
and Sasangohar, Farzan",
title="Understanding Patient Beliefs in Using Technology to Manage Diabetes: Path Analysis Model From a National Web-Based Sample",
journal="JMIR Diabetes",
year="2023",
month="May",
day="3",
volume="8",
pages="e41501",
keywords="type 1 diabetes mellitus",
keywords="self-management",
keywords="intention",
keywords="psychological models",
keywords="tremor",
keywords="hypoglycemia",
keywords="mobile app",
keywords="health technology",
abstract="Background: ?With 425 million individuals globally living with diabetes, it is critical to support the self-management of this life-threatening condition. However, adherence and engagement with existing technologies are inadequate and need further research. Objective: ?The objective of our study was to develop an integrated belief model that helps identify the significant constructs in predicting intention to use a diabetes self-management device for the detection of hypoglycemia. Methods: ?Adults with type 1 diabetes living in the United States were recruited through Qualtrics to take a web-based questionnaire that assessed their preferences for a device that monitors their tremors and alerts them of the onset of hypoglycemia. As part of this questionnaire, a section focused on eliciting their response to behavioral constructs from the Health Belief Model, Technology Acceptance Model, and others. Results: ?A total of 212 eligible participants responded to the Qualtrics survey. Intention to use a device for the self-management of diabetes was well predicted (R2=0.65; F12,199=27.19; P<.001) by 4 main constructs. The most significant constructs were perceived usefulness ($\beta$=.33; P<.001) and perceived health threat ($\beta$=.55; P<.001) followed by cues to action ($\beta$=.17; P<.001) and a negative effect from resistance to change ($\beta$=?.19; P<.001). Older age ($\beta$=.025; P<.001) led to an increase in their perceived health threat. Conclusions: For individuals to use such a device, they need to perceive it as useful, perceive diabetes as life-threatening, regularly remember to perform actions to manage their condition, and exhibit less resistance to change. The model predicted the intention to use a diabetes self-management device as well, with several constructs found to be significant. This mental modeling approach can be complemented in future work by field-testing with physical prototype devices and assessing their interaction with the device longitudinally. ",
doi="10.2196/41501",
url="https://diabetes.jmir.org/2023/1/e41501",
url="http://www.ncbi.nlm.nih.gov/pubmed/37133906"
}


@Article{info:doi/10.2196/42978,
author="Yoon, Ho Chang
and Nolan, Imogen
and Humphrey, Gayl
and Duffy, J. Eamon
and Thomas, G. Mark
and Ritchie, R. Stephen",
title="Long-Term Impact of a Smartphone App on Prescriber Adherence to Antibiotic Guidelines for Adult Patients With Community-Acquired Pneumonia: Interrupted Time-Series Study",
journal="J Med Internet Res",
year="2023",
month="May",
day="2",
volume="25",
pages="e42978",
keywords="app",
keywords="antimicrobial stewardship",
keywords="antibiotic adherence",
keywords="community",
keywords="pneumonia",
keywords="smartphone",
keywords="mobile health",
keywords="mHealth",
keywords="antibiotic",
keywords="behavior",
keywords="adults",
keywords="diagnosis",
keywords="pulmonary",
keywords="patient",
abstract="Background: Mobile health platforms like smartphone apps that provide clinical guidelines are ubiquitous, yet their long-term impact on guideline adherence remains unclear. In 2016, an antibiotic guidelines app, called SCRIPT, was introduced in Auckland City Hospital, New Zealand, to provide local antibiotic guidelines to clinicians on their smartphones. Objective: We aimed to assess whether the provision of antibiotic guidelines in a smartphone app resulted in sustained changes in antibiotic guideline adherence by prescribers. Methods: We analyzed antibiotic guideline adherence rates during the first 24 hours of hospital admission in adults diagnosed with community-acquired pneumonia using an interrupted time-series study with 3 distinct periods post app implementation (ie, 3, 12, and 24 months). Results: Adherence increased from 23\% (46/200) at baseline to 31\% (73/237) at 3 months and 34\% (69/200) at 12 months, reducing to 31\% (62/200) at 24 months post app implementation (P=.07 vs baseline). However, increased adherence was sustained in patients with pulmonary consolidation on x-ray (9/63, 14\% at baseline; 23/77, 30\% after 3 months; 32/92, 35\% after 12 month; and 32/102, 31\% after 24 months; P=.04 vs baseline). Conclusions: An antibiotic guidelines app increased overall adherence, but this was not sustained. In patients with pulmonary consolidation, the increased adherence was sustained. ",
doi="10.2196/42978",
url="https://www.jmir.org/2023/1/e42978",
url="http://www.ncbi.nlm.nih.gov/pubmed/37129941"
}


@Article{info:doi/10.2196/42339,
author="Lawal, Abdul
and Menon, Devidas
and Affleck, Ewan
and Stafinski, Tania",
title="The Impact of Secure Messaging in the Treatment of Patients With Diabetes Within a Primary Care Setting: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2023",
month="May",
day="2",
volume="12",
pages="e42339",
keywords="secure messaging",
keywords="secure message",
keywords="text messaging",
keywords="security",
keywords="privacy",
keywords="chronic disease",
keywords="chronic condition",
keywords="primary care",
keywords="health outcome",
keywords="diabetic",
keywords="diabetes",
keywords="virtual care",
keywords="scoping review",
keywords="review methodology",
keywords="health care system",
abstract="Background: Diabetes---a high-burden chronic disease---requires lifetime active management involving the use of different tools and health care resources to improve patient health outcomes. Recent studies have demonstrated promising results regarding the impact of the use of virtual care technology on the treatment of chronic diseases, such as diabetes. However, it is unclear whether the use of technologies, such as secure messaging, improves the quality of care and reduces diabetes-related costs to the health care system. Objective: The purpose of our scoping review is to explore what is known about the use of secure messaging in the treatment of diabetes within the primary care setting and how its impact has been assessed from the patient and health system perspectives. Our review aims to understand to what extent secure messaging improves the quality of diabetes care. Methods: Our scoping review will follow the 6-step Arksey and O'Malley methodological framework, as well as the Joanna Briggs Institute methodology for scoping reviews and their recommended tools. The tools to guide the development and reporting of the review in a structured way will include the Population, Concept, and Context framework and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines and checklist. The search strategy was developed iteratively in collaboration with a professional information specialist. Furthermore, a peer review of electronic search strategies was also conducted by an independent, third-party, professional information specialist. A systematic literature search will be conducted against databases, including Ovid MEDLINE ALL, Embase, APA PsycINFO, Cochrane Library on Wiley, CINAHL on EBSCO, and PubMed. Grey literature sources will also be searched for relevant literature. Literature on the use of secure messaging in the treatment of diabetes (types 1 and 2) within a primary care setting will be included. Two reviewers will review the literature based on the inclusion criteria in the following two steps: (1) title and abstract review and (2) full-text review. Discrepancies will be discussed to reach consensus where possible; otherwise, a third reviewer will resolve the dispute. Results: The results and a final report are expected to be completed and submitted to a peer-reviewed journal in 6 months. Conclusions: The review will examine existing literature to identify the impact of secure messaging in diabetes treatment within primary care settings. Research gaps will also be identified to determine if there is a need for further studies. International Registered Report Identifier (IRRID): DERR1-10.2196/42339 ",
doi="10.2196/42339",
url="https://www.researchprotocols.org/2023/1/e42339",
url="http://www.ncbi.nlm.nih.gov/pubmed/37129935"
}


@Article{info:doi/10.2196/43678,
author="Wong, Ching Arkers Kwan
and Bayuo, Jonathan
and Wong, Yuet Frances Kam
and Chow, Sum Karen Kit
and Wong, Man Siu
and Lau, Ki Avis Cheuk",
title="The Synergistic Effect of Nurse Proactive Phone Calls With an mHealth App Program on Sustaining App Usage: 3-Arm Randomized Controlled Trial",
journal="J Med Internet Res",
year="2023",
month="May",
day="1",
volume="25",
pages="e43678",
keywords="adults",
keywords="application",
keywords="apps",
keywords="behavior",
keywords="community",
keywords="depression",
keywords="diabetes",
keywords="disease",
keywords="hypertension",
keywords="intervention",
keywords="mHealth",
keywords="older adults",
keywords="proactive",
keywords="program",
keywords="self-efficacy",
keywords="self-management",
keywords="technology",
keywords="usage",
abstract="Background: Although mobile health application (mHealth app) programs have effectively promoted disease self-management behaviors in the last decade, usage rates have tended to fall over time. Objective: We used a case management approach led by a nurse and supported by a health-social partnership team with the aim of sustaining app usage among community-dwelling older adults and evaluated the outcome differences (i.e, self-efficacy, levels of depression, and total health service usages) between those who continued to use the app. Methods: This was a 3-arm randomized controlled trial. A total of 221 older adults with hypertension, diabetes, or chronic pain were randomized into 3 groups: mHealth (n=71), mHealth with interactivity (mHealth+I; n=74), and the control (n=76). The mHealth application was given to the mHealth and mHealth+I groups. The mHealth+I group also received 8 proactive calls in 3 months from a nurse to encourage use of the app. The control group received no interventions. Data were collected at preintervention (T1), postintervention (T2), and at 3 months' postintervention (T3) to ascertain the sustained effect. Results: A total of 37.8\% of mHealth+I and 18.3\% of mHealth group participants continued using the mHealth app at least twice per week until the end of the sixth month. The difference in app usage across the 2 groups between T2 and T3 was significant ($\chi$21=6.81, P=.009). Improvements in self-efficacy ($\beta$=4.30, 95\% CI 0.25-8.35, P=.04) and depression levels ($\beta$=--1.98, 95\% CI --3.78 to --0.19, P=.03) from T1 to T3 were observed in the mHealth group participants who continued using the app. Although self-efficacy and depression scores improved from T1 to T2 in the mHealth+I group, the mean values decreased at T3. Health service usage decreased for all groups from T1 to T2 ($\beta$=--1.38, 95\% CI --1.98 to --0.78, P<.001), with a marginal increase at T3. Conclusions: The relatively low rates of mHealth app usage at follow-up are comparable to those reported in the literature. More work is needed to merge the technology-driven and in-person aspects of mHealth. Trial Registration: ClinicalTrials.gov NCT03878212; https://clinicaltrials.gov/ct2/show/NCT03878212 International Registered Report Identifier (IRRID): RR2-10.1159/000509129 ",
doi="10.2196/43678",
url="https://www.jmir.org/2023/1/e43678",
url="http://www.ncbi.nlm.nih.gov/pubmed/37126378"
}


@Article{info:doi/10.2196/46046,
author="Curtis, R. Jeffrey
and Willig, James",
title="Uptake of Remote Physiologic Monitoring in the US Medicare Program: A Serial Cross-sectional Analysis",
journal="JMIR Mhealth Uhealth",
year="2023",
month="May",
day="1",
volume="11",
pages="e46046",
keywords="remote patient monitoring",
keywords="remote therapeutic monitoring",
keywords="digital health",
keywords="mobile technology",
keywords="mHealth",
keywords="mobile health",
keywords="remote monitoring",
keywords="patient monitoring",
keywords="cost",
keywords="economic",
keywords="payment",
keywords="Medicare",
keywords="insurance",
keywords="health coverage",
keywords="outpatient",
doi="10.2196/46046",
url="https://mhealth.jmir.org/2023/1/e46046",
url="http://www.ncbi.nlm.nih.gov/pubmed/37040464"
}


@Article{info:doi/10.2196/35064,
author="Vlasakova, Martina
and Muzik, Jan
and Holubov{\'a}, Anna
and Fiala, Dominik
and Arsand, Eirik
and Urbanov{\'a}, Jana
and Jan{\'i}{\v c}kov{\'a} ??{\'a}rsk{\'a}, Denisa
and Brabec, Marek
and Bro?, Jan",
title="A Telemedicine System Intervention for Patients With Type 1 Diabetes: Pilot Feasibility Crossover Intervention Study",
journal="JMIR Form Res",
year="2023",
month="Apr",
day="28",
volume="7",
pages="e35064",
keywords="diabetes mellitus",
keywords="diabetes",
keywords="telemedicine",
keywords="telemedicine system",
keywords="mobile health",
keywords="mHealth",
keywords="telemonitoring",
keywords="quality of life",
keywords="telehealth",
keywords="compensation",
keywords="evaluation",
keywords="intervention",
keywords="feasibility",
abstract="Background: Today's diabetes-oriented telemedicine systems can gather and analyze many parameters like blood glucose levels, carbohydrate intake, insulin doses, and physical activity levels (steps). Information collected can be presented to patients in a variety of graphical outputs. Despite the availability of several technical means, a large percentage of patients do not reach the goals established in their diabetes treatment. Objective: The objective of the study was to evaluate the benefits of the Diani telemedicine system for the treatment of patients with type 1 diabetes mellitus. Methods: Data were collected during a 24-week feasibility study. Patients responded to the World Health Organization Quality of Life -- BREF (WHOQOL-BREF) questionnaire and a system evaluation questionnaire. The level of glycated hemoglobin (HbA1c) and the patient's body weight were measured, and the patient's use of the telemedicine system and their daily physical activity level were monitored. All data were sent from the patient's device to the Diani server using a real-time diabetes diary app. Wilcoxon and Friedman tests and the linear mixed effects method were used for data analysis. Results: This study involved 10 patients (men: n=5; women: n=5), with a mean age of 47.7 (SD 19.3) years, a mean duration of diabetes of 10.5 (SD 8.6) years, and a mean HbA1c value of 59.5 (SD 6.7) mmol/mol. The median number of days the patients used the system was 84. After the intervention, the mean HbA1c decreased by 4.35 mmol/mol (P=.01). The patients spent 18.6 (SD 6.8) minutes on average using the app daily. After the intervention, the number of patients who measured their blood glucose level at least 3 times a day increased by 30\%. The graphical visualization of the monitored parameters, automatic transmission of measured data from the glucometer, compatibility, and interconnection of individual devices when entering data were positively evaluated by patients. Conclusions: The Diani system was found to be beneficial for patients with type 1 diabetes mellitus in terms of managing their disease. Patients perceived it positively; it strengthened their knowledge of diabetes and their understanding of the influences of the measured values on the management of their disease. Its use had a positive effect on the HbA1c level. ",
doi="10.2196/35064",
url="https://formative.jmir.org/2023/1/e35064",
url="http://www.ncbi.nlm.nih.gov/pubmed/37115601"
}


@Article{info:doi/10.2196/31694,
author="Evans, Eric
and Zengul, Ayse
and Knight, Amy
and Willig, Amanda
and Cherrington, Andrea
and Mehta, Tapan
and Thirumalai, Mohanraj",
title="My Health, My Life, My Way---An Inclusive Web-Based Self-management Program for People With Disabilities Living With Chronic Conditions: Protocol for a Multiphase Optimization Strategy Study",
journal="JMIR Res Protoc",
year="2023",
month="Apr",
day="28",
volume="12",
pages="e31694",
keywords="telehealth",
keywords="health coaching",
keywords="artificial intelligence",
keywords="chronic conditions",
keywords="mobile phone",
abstract="Background: Individuals with disabilities living with chronic health conditions require self-management programs that are accessible, sustainable, inclusive, and adaptable. Health coaching is an effective approach to promoting behavior change in self-management. Health coaching combined with telehealth technology has the potential to improve the overall quality of, and access to, health services. Objective: This protocol outlines the study design for implementing the My Health, My Life, My Way intervention. The study will assess the feasibility, acceptability, and preliminary efficacy of the intervention for people with disabilities and optimize it. Methods: The My Health, My Life, My Way study is a 4-arm randomized controlled trial evaluating the delivery of a 6-month intervention involving telecoaching, inclusive educational content, and technology access for 200 individuals with chronic conditions and physical disabilities. This study uses the engineering-inspired multiphase optimization strategy (MOST) framework to evaluate intervention components and assess whether a combination or lack of individual elements influences behavior. Participants will be randomized to 1 of 4 study arms: scheduled coaching calls and gamified rewards, no scheduled coaching calls and gamified rewards, scheduled coaching calls and flat rewards, and no scheduled coaching calls and flat rewards. Results: The My Health, My Life, My Way study was approved by the institutional review board of the University of Alabama at Birmingham, and recruitment and enrollment will begin in May 2023. Data analysis is expected to be completed within 6 months of ending data collection. This clinical trial protocol was developed based on the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) 2013 statement. Conclusions: The My Health, My Life, My Way study will help to optimize and improve our understanding of the feasibility and efficacy of a web-based self-management program for people with physical disabilities and chronic conditions. More specifically, My Health, My Life, My Way will determine which combination of interventions (coaching calls and gamification) will result in increased participation in self-management programming. The My Health, My Life, My Way intervention has the potential to become a scalable and novel method to successfully manage chronic conditions in people with disabilities. Trial Registration: ClinicalTrials.gov NCT05481593; https://clinicaltrials.gov/ct2/show/NCT05481593 International Registered Report Identifier (IRRID): PRR1-10.2196/31694 ",
doi="10.2196/31694",
url="https://www.researchprotocols.org/2023/1/e31694",
url="http://www.ncbi.nlm.nih.gov/pubmed/37115620"
}


@Article{info:doi/10.2196/38474,
author="Klemme, Isabel
and Wrona, J. Kamil
and de Jong, Marije Irja
and Dockweiler, Christoph
and Aschentrup, Leona
and Albrecht, Joanna",
title="Integration of the Vision of People With Diabetes Into the Development Process to Improve Self-management via Diabetes Apps: Qualitative Interview Study",
journal="JMIR Diabetes",
year="2023",
month="Apr",
day="27",
volume="8",
pages="e38474",
keywords="people with type 1 diabetes",
keywords="self-management",
keywords="diabetes apps",
keywords="vision assessment",
keywords="anticipated stigma",
keywords="qualitative research",
keywords="Digitale Gesundheitsanwendungen",
keywords="DiGA",
keywords="mobile phone",
abstract="Background: Diabetes is a major global epidemic and serious public health problem. Diabetes self-management is a 24/7 challenge for people with type 1 diabetes that influences their quality of life (QoL). Certain apps can support the self-management of people with diabetes; however, current apps do not meet the needs of people with diabetes appropriately, and their safety is not ensured. Moreover, there are a multitude of hardware and software problems associated with diabetes apps and regulations. Clear guidelines are required to regulate medical care via apps. In Germany, apps must undergo 2 examination processes to be listed in the Digitale Gesundheitsanwendungen directory. However, neither examination process considers whether the medical use of the apps is sufficient for users' self-management. Objective: This study aims to contribute to the technology development process of diabetes apps by exploring individual perspectives on desired features and content of diabetes apps among people with diabetes. The vision assessment conducted is a first step toward creating a shared vision among all relevant stakeholders. To ensure adequate research and development processes for diabetes apps in the future, guiding visions from all relevant stakeholders are required. Methods: In a qualitative study, 24 semistructured interviews with patients with type 1 diabetes were conducted, among whom 10 (42\%) were currently using an app. To clarify the perceptions of people with diabetes regarding the functions and content of diabetes apps, a vision assessment was conducted. Results: People with diabetes have concrete ideas of features and content in apps to improve their QoL and allow them to live as comfortably as possible, such as informative predictions through artificial intelligence, improvements in signal loss and value delay through smartwatches, improved communication and information-sharing capabilities, reliable information sources, and user-friendly and discreet messaging options through smartwatches. In addition, according to people with diabetes, future apps should show improved sensors and app connectivity to avoid incorrect values being displayed. They also wish for an explicit indication that displayed values are delayed. In addition, personalized information was found to be lacking in apps. Conclusions: People with type 1 diabetes want future apps to improve their self-management and QoL and reduce stigma. Desired key features include personalized artificial intelligence predictions of blood glucose levels, improved communication and information sharing through chat and forum options, comprehensive information resources, and smartwatch alerts. A vision assessment is the first step in creating a shared vision among stakeholders to responsibly guide the development of diabetes apps. Relevant stakeholders include patient organizations, health care professionals, insurers, policy makers, device manufacturers, app developers, researchers, medical ethicists, and data security experts. After the research and development process, new apps must be launched while considering regulations regarding data security, liability, and reimbursement. ",
doi="10.2196/38474",
url="https://diabetes.jmir.org/2023/1/e38474",
url="http://www.ncbi.nlm.nih.gov/pubmed/37104003"
}


@Article{info:doi/10.2196/42679,
author="Bernard, M. Renaldo
and Seijas, Vanessa
and Davis, Micheal
and Volkova, Anel
and Diviani, Nicola
and L{\"u}scher, Janina
and Sabariego, Carla",
title="Mobile Health Self-management Support for Spinal Cord Injury: Systematic Literature Review",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Apr",
day="26",
volume="11",
pages="e42679",
keywords="mobile phone",
keywords="mobile health",
keywords="mHealth",
keywords="eHealth",
keywords="telemedicine",
keywords="telehealth",
keywords="spinal cord injury",
keywords="self-management",
keywords="internet-based intervention",
keywords="World Wide Web",
keywords="systematic review",
abstract="Background: Self-management plays a critical role in maintaining and improving the health of persons with spinal cord injury (SCI). Despite their potential, existing mobile health (mHealth) self-management support (SMS) tools for SCI have not been comprehensively described in terms of their characteristics and approaches. It is important to have an overview of these tools to know how best to select, further develop, and improve them. Objective: The objective of this systematic literature review was to identify mHealth SMS tools for SCI and summarize their characteristics and approaches to offering SMS. Methods: A systematic review of the literature published between January 2010 and March 2022 was conducted across 8 bibliographic databases. The data synthesis was guided by the self-management task taxonomy by Corbin and Strauss, the self-management skill taxonomy by Lorig and Holman, and the Practical Reviews in Self-Management Support taxonomy. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards guided the reporting. Results: A total of 24 publications reporting on 19 mHealth SMS tools for SCI were included. These tools were introduced from 2015 onward and used various mHealth technologies and multimedia formats to provide SMS using 9 methods identified by the Practical Reviews in Self-Management Support taxonomy (eg, social support and lifestyle advice and support). The identified tools focused on common SCI self-management areas (eg, bowel, bladder, and pain management) and overlooked areas such as sexual dysfunction problems and environmental problems, including barriers in the built environment. Most tools (12/19, 63\%) unexpectedly supported a single self-management task instead of all 3 tasks (ie, medical, role, and emotional management), and emotional management tasks had very little support. All self-management skills (eg, problem-solving, decision-making, and action planning) had coverage, but a single tool addressed resource use. The identified mHealth SMS tools were similar in terms of number, introduction period, geographical distribution, and technical sophistication compared with SMS tools for other chronic conditions. Conclusions: This systematic literature review provides one of the first descriptions of mHealth SMS tools for SCI in terms of their characteristics and approaches to offering SMS. This study's findings highlight a need for increased coverage of key SMS for SCI components; adopting comparable usability, user experience, and accessibility evaluation methods; and related research to provide more detailed reporting. Future research should consider other data sources such as app stores and technology-centric bibliographic databases to complement this compilation by identifying other possibly overlooked mHealth SMS tools. A consideration of this study's findings is expected to support the selection, development, and improvement of mHealth SMS tools for SCI. ",
doi="10.2196/42679",
url="https://mhealth.jmir.org/2023/1/e42679",
url="http://www.ncbi.nlm.nih.gov/pubmed/37099372"
}


@Article{info:doi/10.2196/40427,
author="Zhaunova, Liudmila
and Bamford, Ryan
and Radovic, Tara
and Wickham, Aidan
and Peven, Kimberly
and Croft, Jazz
and Klepchukova, Anna
and Ponzo, Sonia",
title="Characterization of Self-reported Improvements in Knowledge and Health Among Users of Flo Period Tracking App: Cross-sectional Survey",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Apr",
day="26",
volume="11",
pages="e40427",
keywords="health knowledge",
keywords="menstrual cycle",
keywords="pregnancy",
keywords="period-tracking app",
keywords="digital health",
keywords="women's health",
abstract="Background: Research shows that poor knowledge and awareness of menstrual and pregnancy health among women are associated with adverse reproductive health and pregnancy outcomes. Menstrual cycle-- and pregnancy-tracking mobile apps are promising tools for improving women's awareness of and attitudes toward their reproductive health; however, there is little information about subscribers' perceptions of app functionality and its impact on their knowledge and health. Objective: This study aimed to explore knowledge and health improvements related to menstrual cycle and pregnancy, as well as improvements in general health among Flo app users. We also investigated what components of the Flo app were associated with the abovementioned improvements and evaluated whether those improvements differed based on education level, country of residence (low- and middle-income vs high-income countries), free or premium subscription to the app, short- or long-term use of the app, and frequency of use. Methods: Flo subscribers who had been using the app for no less than 30 days, completed a web-based survey. A total of 2212 complete survey responses were collected. The survey included demographic questions and questions about motivations guiding the use of the Flo app and which components of the app improved their knowledge and health, as well as to what extent. Results: Most study participants reported improvements in menstrual cycle (1292/1452, 88.98\%) and pregnancy (698/824, 84.7\%) knowledge from Flo app use. Participants with higher levels of education and those from high-income countries reported using the app predominantly for getting pregnant ($\chi$21=4.2, P=.04; $\chi$21=52.3, P<.001, respectively) and pregnancy tracking ($\chi$21=19.3, P<.001; $\chi$21=20.9, P=.001, respectively). Participants with less education reported using the app to avoid pregnancy ($\chi$21=4.2; P=.04) and to learn more about their body ($\chi$21=10.8; P=.001) and sexual health ($\chi$21=6.3; P=.01), while participants from low- and middle-income countries intended to mainly learn more about their sexual health ($\chi$21=18.2; P<.001). Importantly, the intended use of the app across education levels and country income levels matched areas in which they had gained knowledge and achieved their health goals upon use of the Flo app. Period, fertile days, and ovulation predictions as well as symptom tracking were consistently the top 3 components in the app that helped users with their cycle knowledge and general health. Reading articles or watching videos helped with users' education regarding their pregnancy. Finally, the strongest improvements in knowledge and health were observed in premium, frequent, and long-term users. Conclusions: This study suggests that menstrual health apps, such as Flo, could present revolutionary tools to promote consumer health education and empowerment on a global scale. ",
doi="10.2196/40427",
url="https://mhealth.jmir.org/2023/1/e40427",
url="http://www.ncbi.nlm.nih.gov/pubmed/37099370"
}


@Article{info:doi/10.2196/42564,
author="Xie, Feng Li
and Housni, Asmaa
and Nakhla, Meranda
and Cianci, Rosemarie
and Leroux, Catherine
and Da Costa, Deborah
and Brazeau, Anne-Sophie",
title="Adaptation of an Adult Web Application for Type 1 Diabetes Self-management to Youth Using the Behavior Change Wheel to Tailor the Needs of Health Care Transition: Qualitative Interview Study",
journal="JMIR Diabetes",
year="2023",
month="Apr",
day="26",
volume="8",
pages="e42564",
keywords="type 1 diabetes",
keywords="youth",
keywords="eHealth",
keywords="self-management",
keywords="mobile phone",
keywords="peer support",
abstract="Background: Youth (aged 14-24 years) living with type 1 diabetes (T1D) encounter increased challenges in their diabetes self-management (DSM), especially during the transition to adult care. Although DSM education and support are imperative, there is insufficient information on how web-based digital tools tailored to their demands can be developed. Objective: On the basis of the Behavior Change Wheel, this study aims to identify, among youth living with T1D, the needs and factors influencing their DSM in the context of health care transition and to inform the adaptation (content and features) of an adult self-guided web application (Support). Methods: Internet-based semistructured individual interviews based on a phenomenological study design were conducted with 21 youths, and transcripts were analyzed using an inductive approach with concept mapping. Results: Factors influencing T1D self-management were categorized into barriers and facilitators and then as external or internal. Features influencing the accessibility to information, increasing the sense of support, and use of the tool were positively accepted. Features unrelated to their expectations of digital tool use or difficulty navigating were viewed negatively. Participants expressed an interest in reliable, practical, and novel educational content. Although youth considered the information provided by medical professionals to be important, peer exchange was deemed necessary to obtain a practical perspective and real-life examples. Conclusions: Compared with the adult population, in addition to tailored content and a simplified information search process, when building a DSM education and support digital tool for youth, features should be selected to encourage supervised peer exchange. ",
doi="10.2196/42564",
url="https://diabetes.jmir.org/2023/1/e42564",
url="http://www.ncbi.nlm.nih.gov/pubmed/37121571"
}


@Article{info:doi/10.2196/38545,
author="Tugault-Lafleur, N. Claire
and De-Jongh Gonz{\'a}lez, Olivia
and Macdonald, Janice
and Bradbury, Jennifer
and Warshawski, Tom
and Ball, C. Geoff D.
and Morrison, Katherine
and Ho, Josephine
and Hamilton, Jill
and Buchholz, Annick
and M{\^a}sse, Louise",
title="Efficacy of the Aim2Be Intervention in Changing Lifestyle Behaviors Among Adolescents With Overweight and Obesity: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2023",
month="Apr",
day="25",
volume="25",
pages="e38545",
keywords="mobile health",
keywords="mHealth",
keywords="childhood obesity",
keywords="lifestyle management",
keywords="adolescents",
keywords="randomized controlled trial",
keywords="RCT",
keywords="mobile phone",
abstract="Background: Aim2Be is a gamified lifestyle app designed to promote lifestyle behavior changes among Canadian adolescents and their families. Objective: The primary aim was to test the efficacy of the Aim2Be app with support from a live coach to reduce weight outcomes (BMI Z score [zBMI]) and improve lifestyle behaviors among adolescents with overweight and obesity and their parents versus a waitlist control group over 3 months. The secondary aim was to compare health trajectories among waitlist control participants over 6 months (before and after receiving access to the app), assess whether support from a live coach enhanced intervention impact, and evaluate whether the app use influenced changes among intervention participants. Methods: A 2-arm parallel randomized controlled trial was conducted from November 2018 to June 2020. Adolescents aged 10 to 17 years with overweight or obesity and their parents were randomized into an intervention group (Aim2Be with a live coach for 6 months) or a waitlist control group (Aim2Be with no live coach; accessed after 3 months). Adolescents' assessments at baseline and at 3 and 6 months included measured height and weight, 24-hour dietary recalls, and daily step counts measured with a Fitbit. Data on self-reported physical activity, screen time, fruit and vegetable intake, and sugary beverage intake of adolescents and parents were also collected. Results: A total of 214 parent-child participants were randomized. In our primary analyses, there were no significant differences in zBMI or any of the health behaviors between the intervention and control groups at 3 months. In our secondary analyses, among waitlist control participants, zBMI (P=.02), discretionary calories (P=.03), and physical activity outside of school (P=.001) declined, whereas daily screen time increased (P<.001) after receiving access to the app compared with before receiving app access. Adolescents randomized to Aim2Be with live coaching reported more time being active outside of school compared with adolescents who used Aim2Be with no coaching over 3 months (P=.001). App use did not modify any changes in outcomes among adolescents in the intervention group. Conclusions: The Aim2Be intervention did not improve zBMI and lifestyle behaviors in adolescents with overweight and obesity compared with the waitlist control group over 3 months. Future studies should explore the potential mediators of changes in zBMI and lifestyle behaviors as well as predictors of engagement. Trial Registration: ClinicalTrials.gov NCT03651284; https://clinicaltrials.gov/ct2/show/study/NCT03651284 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-4080-2 ",
doi="10.2196/38545",
url="https://www.jmir.org/2023/1/e38545",
url="http://www.ncbi.nlm.nih.gov/pubmed/37097726"
}


@Article{info:doi/10.2196/41439,
author="Andrews, A. Jacob
and Craven, P. Michael
and Guo, Boliang
and Weyer, Janice
and Lees, Simon
and Zormpas, I. Spyridon
and Thorpe, E. Sarah
and Devonshire, Julie
and San Antonio-Arce, Victoria
and Whitehouse, P. William
and Julie, Jessica
and Malins, Sam
and Hammers, Alexander
and Reif, Andreas
and Ruhe, G. Henricus
and Durbano, Federico
and Barlati, Stefano
and Sen, Arjune
and Frederiksen, L. Jette
and Martinelli, Alessandra
and Callen, Antonio
and Torras-Borrell, Joan
and Berrocal-Izquierdo, Nuria
and Zabalza, Ana
and Morriss, Richard
and Hollis, Chris
and ",
title="Clinical Perspectives on Using Remote Measurement Technology in Assessing Epilepsy, Multiple Sclerosis, and Depression: Delphi Study",
journal="JMIR Neurotech",
year="2023",
month="Apr",
day="25",
volume="2",
pages="e41439",
keywords="mobile health",
keywords="mHealth",
keywords="wearable",
keywords="wearable technology",
keywords="smartphone",
keywords="use case",
keywords="implementation",
keywords="epilepsy",
keywords="multiple sclerosis",
keywords="MS",
keywords="depression",
keywords="depressive disorder",
keywords="Delphi",
keywords="remote measurement technology",
keywords="RMT",
keywords="central nervous system",
keywords="nervous system disorder",
keywords="neurology",
keywords="neurological disorder",
keywords="expert panel",
keywords="expert opinion",
keywords="perspective",
keywords="mobile phone",
abstract="Background: Multiple sclerosis (MS), epilepsy, and depression are chronic central nervous system conditions in which remote measurement technology (RMT) may offer benefits compared with usual assessment. We previously worked with clinicians, patients, and researchers to develop 13 use cases for RMT: 5 in epilepsy (seizure alert, seizure counting, risk scoring, triage support, and trend analysis), 3 in MS (detecting silent progression, detecting depression in MS, and donating data to a biobank), and 5 in depression (detecting trends, reviewing treatment, self-management, comorbid monitoring, and carer alert). Objective: In this study, we aimed to evaluate the use cases and related implementation issues with an expert panel of clinicians external to our project consortium. Methods: We used a Delphi exercise to validate the use cases and suggest a prioritization among them and to ascertain the importance of a variety of implementation issues related to RMT. The expert panel included clinicians from across Europe who were external to the project consortium. The study had 2 survey rounds (n=23 and n=17) and a follow-up interview round (n=9). Data were analyzed for consensus between participants and for stability between survey rounds. The interviews explored the reasons for answers given in the survey. Results: The findings showed high stability between rounds on questions related to specific use cases but lower stability on questions relating to wider issues around the implementation of RMT. Overall, questions on wider issues also had less consensus. All 5 use cases for epilepsy (seizure alert, seizure counting, risk scoring, triage support, and trend analysis) were considered beneficial, with consensus among participants above the a priori threshold for most questions, although use case 3 (risk scoring) was considered less likely to facilitate or catalyze care. There was very little consensus on the benefits of the use cases in MS, although this may have resulted from a higher dropout rate of MS clinicians (50\%). Participants agreed that there would be benefits for all 5 of the depression use cases, although fewer questions on use case 4 (triage support) reached consensus agreement than for depression use cases 1 (detecting trends), 2 (reviewing treatment), 3 (self-management), and 5 (carer alert). The qualitative analysis revealed further insights into each use case and generated 8 themes on practical issues related to implementation. Conclusions: Overall, these findings inform the prioritization of use cases for RMT that could be developed in future work, which may include clinical trials, cost-effectiveness studies, and the commercial development of RMT products and services. Priorities for further development include the use of RMT to provide more accurate records of symptoms and treatment response than is currently possible and to provide data that could help inform patient triage and generate timely alerts for patients and carers. ",
doi="10.2196/41439",
url="https://neuro.jmir.org/2023/1/e41439"
}


@Article{info:doi/10.2196/40990,
author="Jahromi, Reza
and Zahed, Karim
and Sasangohar, Farzan
and Erraguntla, Madhav
and Mehta, Ranjana
and Qaraqe, Khalid",
title="Hypoglycemia Detection Using Hand Tremors: Home Study of Patients With Type 1 Diabetes",
journal="JMIR Diabetes",
year="2023",
month="Apr",
day="19",
volume="8",
pages="e40990",
keywords="acceleration",
keywords="hand tremors",
keywords="tremor",
keywords="hypoglycemia",
keywords="blood sugar",
keywords="glucose",
keywords="diabetes",
keywords="diabetic",
keywords="noninvasive",
keywords="measurement tool",
keywords="digital measurement",
keywords="monitoring",
keywords="wearable",
keywords="accelerometer",
keywords="machine learning",
keywords="wearable device",
keywords="smart watch",
keywords="detect",
keywords="time domain",
keywords="frequency domain",
keywords="model",
keywords="algorithm",
abstract="Background: Diabetes affects millions of people worldwide and is steadily increasing. A serious condition associated with diabetes is low glucose levels (hypoglycemia). Monitoring blood glucose is usually performed by invasive methods or intrusive devices, and these devices are currently not available to all patients with diabetes. Hand tremor is a significant symptom of hypoglycemia, as nerves and muscles are powered by blood sugar. However, to our knowledge, no validated tools or algorithms exist to monitor and detect hypoglycemic events via hand tremors. Objective: In this paper, we propose a noninvasive method to detect hypoglycemic events based on hand tremors using accelerometer data. Methods: We analyzed triaxial accelerometer data from a smart watch recorded from 33 patients with type 1 diabetes for 1 month. Time and frequency domain features were extracted from acceleration signals to explore different machine learning models to classify and differentiate between hypoglycemic and nonhypoglycemic states. Results: The mean duration of the hypoglycemic state was 27.31 (SD 5.15) minutes per day for each patient. On average, patients had 1.06 (SD 0.77) hypoglycemic events per day. The ensemble learning model based on random forest, support vector machines, and k-nearest neighbors had the best performance, with a precision of 81.5\% and a recall of 78.6\%. The results were validated using continuous glucose monitor readings as ground truth. Conclusions: Our results indicate that the proposed approach can be a potential tool to detect hypoglycemia and can serve as a proactive, nonintrusive alert mechanism for hypoglycemic events. ",
doi="10.2196/40990",
url="https://diabetes.jmir.org/2023/1/e40990",
url="http://www.ncbi.nlm.nih.gov/pubmed/37074783"
}


@Article{info:doi/10.2196/41321,
author="Hollier, M. John
and Strickland, A. Tiant{\'a}
and Fordis, Michael C.
and van Tilburg, AL Miranda
and Shulman, J. Robert
and Thompson, Debbe",
title="Children's and Caregivers' Review of a Guided Imagery Therapy Mobile App Designed to Treat Children With Functional Abdominal Pain Disorders: Leveraging a Mixed Methods Approach With User-Centered Design",
journal="JMIR Form Res",
year="2023",
month="Apr",
day="19",
volume="7",
pages="e41321",
keywords="guided imagery therapy",
keywords="guided imagery",
keywords="psychotherapy",
keywords="disorders of gut-brain interaction",
keywords="functional abdominal pain disorders",
keywords="pediatric",
keywords="pain",
keywords="mobile app",
keywords="mobile health",
keywords="mHealth",
keywords="mixed methods research",
keywords="usability",
keywords="gamification",
keywords="user-centered design",
keywords="guided image therapy",
keywords="app prototype",
keywords="prototype",
keywords="feedback",
keywords="children",
keywords="child",
keywords="youths",
keywords="caregiver",
keywords="mobile phone",
abstract="Background: Functional abdominal pain disorders (FAPDs) are highly prevalent and associated with substantial morbidity. Guided imagery therapy (GIT) is efficacious; however, barriers often impede patient access. Therefore, we developed a GIT mobile app as a novel delivery platform. Objective: Guided by user-centered design, this study captured the critiques of our GIT app from children with FAPDs and their caregivers. Methods: Children aged 7 to 12 years with Rome IV--defined FAPDs and their caregivers were enrolled. The participants completed a software evaluation, which assessed how well they executed specific app tasks: opening the app, logging in, initiating a session, setting the reminder notification time, and exiting the app. Difficulties in completing these tasks were tallied. After this evaluation, the participants independently completed a System Usability Scale survey. Finally, the children and caregivers were separately interviewed to capture their thoughts about the app. Using a hybrid thematic analysis approach, 2 independent coders coded the interview transcripts using a shared codebook. Data integration occurred after the qualitative and quantitative data were analyzed, and the collective results were summarized. Results: We enrolled 16 child-caregiver dyads. The average age of the children was 9.0 (SD 1.6) years, and 69\% (11/16) were female. The System Usability Scale average scores were above average at 78.2 (SD 12.6) and 78.0 (SD 13.5) for the children and caregivers, respectively. The software evaluation revealed favorable usability for most tasks, but 75\% (12/16) of children and 69\% (11/16) of caregivers had difficulty setting the reminder notification. The children's interviews confirmed the app's usability as favorable but noted difficulty in locating the reminder notification. The children recommended adding exciting scenery and animations to the session screen. Their preferred topics were animals, beaches, swimming, and forests. They also recommended adding soft sounds related to the session topic. Finally, they suggested that adding app gamification enhancements using tangible and intangible rewards for listening to the sessions would promote regular use. The caregivers also assessed the app's usability as favorable but verified the difficulty in locating the reminder notification. They preferred a beach setting, and theme-related music and nature sounds were recommended to augment the session narration. App interface suggestions included increasing the font and image sizes. They also thought that the app's ability to relieve gastrointestinal symptoms and gamification enhancements using tangible and intangible incentives would positively influence the children's motivation to use the app regularly. Data integration revealed that the GIT app had above-average usability. Usability challenges included locating the reminder notification feature and esthetics affecting navigation. Conclusions: Children and caregivers rated our GIT app's usability favorably, offered suggestions to improve its appearance and session content, and recommended rewards to promote its regular use. Their feedback will inform future app refinements. ",
doi="10.2196/41321",
url="https://formative.jmir.org/2023/1/e41321",
url="http://www.ncbi.nlm.nih.gov/pubmed/37074773"
}


@Article{info:doi/10.2196/46001,
author="Chen, Leeann
and Bartel, Christianna
and Cai, Xinlu
and Cheng, Yanghuidi
and Perer, Adam
and McClaine, Sean
and Kairis, Elizabeth
and Durica, Krina
and Huang, Weiyu
and Low, A. Carissa",
title="Patient and Provider Perspectives on Symptom Monitoring During Outpatient Chemotherapy: Interview Study",
journal="JMIR Form Res",
year="2023",
month="Apr",
day="17",
volume="7",
pages="e46001",
keywords="symptom management",
keywords="remote patient monitoring",
keywords="doctor-patient communication",
keywords="mobile technology",
keywords="cancer",
keywords="ambulatory",
keywords="chemotherapy",
keywords="oncology",
keywords="remote monitoring",
keywords="outpatient",
keywords="mobile phone",
abstract="Background: Fluctuating symptoms and side effects are common during outpatient cancer treatment, and approaches to monitoring symptoms vary widely across providers, patients, and clinical settings. To design a remote symptom monitoring system that patients and providers find to be useful, it may be helpful to understand current clinical approaches to monitoring and managing chemotherapy-related symptoms among patients and providers and assess how more frequent and systematic assessment and sharing of data could improve patient and provider experiences. Objective: The goals of this study were to learn about patient and provider perspectives on monitoring symptoms during chemotherapy, understand barriers and challenges to effective symptom monitoring at one institution, and explore the potential value of remote symptom monitoring between provider visits. Methods: A total of 15 patients who were currently undergoing or had recently completed chemotherapy and 7 oncology providers participated in semistructured interviews. Interviews were transcribed and coded using an iterative thematic analysis approach. The study was conducted at a National Cancer Institute--Designated Comprehensive Cancer Center. Results: Four main themes were discussed by patients and providers: (1) asynchronous nature of current methods for tracking and managing symptoms, (2) variability in reported symptoms due to patient factors, (3) limitations of existing communication channels, and (4) potential value of real-time remote symptom monitoring during chemotherapy. Current asynchronous methods and existing communication channels resulted in a disconnect between when symptoms are most severe and when conversations about symptoms happen, a situation further complicated by memory impairments during chemotherapy. Patients and providers both highlighted improvements in patient-provider communication as a potential benefit of remote real-time symptom monitoring. Providers also emphasized the value of temporal data regarding when symptoms first emerge and how they progress over time, as well as the potential value of concurrent activity or other data about daily activities and functioning. Patients noted that symptom monitoring could result in better preparation for subsequent treatment cycles. Conclusions: Both patients and providers highlighted significant challenges of asynchronous, patient-initiated, phone-dependent symptom monitoring and management. Oncology patients and providers reported that more routine remote monitoring of symptoms between visits could improve patient-provider communication, prepare patients for subsequent chemotherapy cycles, and facilitate provider insight and clinical decision-making with regard to symptom management. ",
doi="10.2196/46001",
url="https://formative.jmir.org/2023/1/e46001",
url="http://www.ncbi.nlm.nih.gov/pubmed/37067857"
}


@Article{info:doi/10.2196/43236,
author="Sakane, Naoki
and Suganuma, Akiko
and Domichi, Masayuki
and Sukino, Shin
and Abe, Keiko
and Fujisaki, Akiyoshi
and Kanazawa, Ai
and Sugimoto, Mamiko",
title="The Effect of a mHealth App (KENPO-app) for Specific Health Guidance on Weight Changes in Adults With Obesity and Hypertension: Pilot Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Apr",
day="12",
volume="11",
pages="e43236",
keywords="obesity",
keywords="hypertension",
keywords="mobile health care app",
keywords="specific health guidance",
keywords="obese",
keywords="weight",
keywords="mHealth",
keywords="mobile health",
keywords="mobile app",
keywords="health app",
abstract="Background: Commercial smartphone apps that promote self-monitoring of weight loss are widely available. The development of disease-specific apps has begun, but there is no app for specific health guidance (SHG) to prevent metabolic syndrome, type 2 diabetes, and cardiovascular diseases in middle-aged adults in Japan. Objective: This study aimed to determine the efficacy of an SHG mobile health app in facilitating weight loss in Japanese adults with obesity and hypertension. Methods: In a 12-week, statistician-blinded, randomized parallel controlled trial, 78 overweight and obese men aged 40-69 years were assigned in a 1:1 ratio to either the usual support plus KENPO-app group (intervention group) or the active control group. KENPO-app (release April 10, 2019; OMRON Healthcare Co., Ltd.) was developed by the study team and focus groups and uses behavior change techniques (ie, self-monitoring and goal-setting theory). This app was developed for SHG based on the four specific health checkups and guidance system in Japan: (1) focusing primarily on achieving the target (weight loss of ?2 kg); (2) assessing healthy eating, exercise habits, smoking habits, relaxation, and self-weighing; (3) providing information on the results of specific health checkups; and (4) starting an intervention period of 6 months with the interim assessment at 3 months. The initial assessment explored the following: personality traits (4 types), health checkup data concerns (10 items), symptom concerns (10 items), and the aim of the intervention (weight loss, improving fitness, symptoms, laboratory data). Chatbot-supported health information on health and health behavior was selected from 392 quizzes based on app data and was provided to participants. The KENPO-app had chatbot-supported feedback and information provision combined with a self-monitoring tool (weight, steps, and blood pressure). Data on active exercise, healthy eating, and healthy lifestyle habits were obtained using a web-based self-administered questionnaire at baseline and 12 weeks. Results: The trial's retention rate was 95\% (74/78). The adherence to daily self-weighing, wearing the pedometer, and blood pressure monitoring in the KENPO-app group was significantly higher than those in the active control group. Compared with the active control group, the median body weight and BMI of the intervention group significantly decreased at 3 months (--0.4, IQR --2.0 to 0.6 kg vs --1.1, IQR --2.7 to --0.5 kg; P=.03; --0.1, IQR --0.6 to 0.3 kg vs --0.4, IQR --0.8 to --0.2 kg; P=.02, respectively). The intervention increased the percentage of participants who self-reported taking ?8000 steps, eating vegetables before rice, eating slowly, and relaxing. Personality traits were associated with the degree of weight loss in the intervention group. Conclusions: The SHG-specific KENPO-app was feasible and induced modest but significant weight loss in adults with obesity. Trial Registration: University Hospital Medical Information Network Center UMIN000046263; https://tinyurl.com/bderys3b ",
doi="10.2196/43236",
url="https://mhealth.jmir.org/2023/1/e43236",
url="http://www.ncbi.nlm.nih.gov/pubmed/37043287"
}


@Article{info:doi/10.2196/41018,
author="Son, Changwon
and Hegde, Sudeep
and Markert, Carl
and Zahed, Karim
and Sasangohar, Farzan",
title="Use of a Mobile Biofeedback App to Provide Health Coaching for Stress Self-management: Pilot Quasi-Experiment",
journal="JMIR Form Res",
year="2023",
month="Apr",
day="12",
volume="7",
pages="e41018",
keywords="mental health",
keywords="health coaching",
keywords="stress",
keywords="biofeedback",
keywords="mHealth",
keywords="mobile apps",
keywords="breathing exercises",
keywords="students",
keywords="veterans",
keywords="COVID-19",
keywords="vulnerable population",
keywords="college student",
keywords="self-management",
keywords="mobile health app",
keywords="psychological well-being",
keywords="digital health intervention",
abstract="Background: Mental health is an increasing concern among vulnerable populations, including college students and veterans. Objective: The purpose of this study was to determine if mobile health technology combined with health coaching can better enable a user to self-manage their mental health. Methods: This study evaluated the mobile app ``Biofeedback'' that provided health coaching on stress self-management for college student veterans' mental health concerns. Twenty-four college student veterans were recruited from a large public university in Texas during the spring 2020 semester, impacted by COVID-19. Ten participants were assigned to the intervention group where they used the mobile Biofeedback app on their smartphones and smartwatches, and 14 were assigned to the control group without the app; assignment was based on mobile phone compatibility. Both groups participated in one initial lab session where they learned a deep-breathing exercise technique. The intervention group was then asked to use the mobile Biofeedback app during their daily lives and a smartwatch, and the control group was asked to perform the breathing exercises on their own. Both groups filled out Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) self-assessments at 2-week intervals. At the end of the semester, both groups were given an exit interview to provide user experience and perceived benefits of health coaching via the mobile biofeedback app. Results: The deep-breathing exercise in the initial lab session reduced stress in both groups. Over the course of the study, the app recorded 565 coached breathing exercises with a significant decrease (approximately 3 beats per minute) in participants' heart rate during the 6-minute time period immediately after conducting the breathing exercises (Spearman rank correlation coefficient --0.61, P<.001; S=9,816,176). There was no significant difference between the two groups for PHQ-9 and GAD-7 scores over the course of the semester. Exit interview responses indicated that participants perceived that the mobile Biofeedback app improved their health and helped them address stress challenges. All participants reported that the intervention helped them manage their stress better and expressed that health coaching via a mobile device would improve their overall health. Conclusions: Participants reported a positive perception of the app for their mental health self-management during a stressful semester. Future work should examine long-term effects of the app with a larger sample size balanced between male and female participants, randomized participant allocation, real-time detection of mental health symptoms, and additional features of the app. ",
doi="10.2196/41018",
url="https://formative.jmir.org/2023/1/e41018",
url="http://www.ncbi.nlm.nih.gov/pubmed/36952560"
}


@Article{info:doi/10.2196/44275,
author="Takano, Ayumi
and Ono, Koki
and Nozawa, Kyosuke
and Sato, Makito
and Onuki, Masaki
and Sese, Jun
and Yumoto, Yosuke
and Matsushita, Sachio
and Matsumoto, Toshihiko",
title="Wearable Sensor and Mobile App--Based mHealth Approach for Investigating Substance Use and Related Factors in Daily Life: Protocol for an Ecological Momentary Assessment Study",
journal="JMIR Res Protoc",
year="2023",
month="Apr",
day="11",
volume="12",
pages="e44275",
keywords="alcohol and drug use",
keywords="alcoholism",
keywords="digital health",
keywords="drug use",
keywords="ecological momentary assessment",
keywords="ecological momentary intervention",
keywords="electronic health record",
keywords="Fitbit",
keywords="machine learning",
keywords="mHealth",
keywords="mobile app",
keywords="self-monitoring",
keywords="wearables devices",
abstract="Background: Digital health technologies using mobile apps and wearable devices are a promising approach to the investigation of substance use in the real world and for the analysis of predictive factors or harms from substance use. Moreover, consecutive repeated data collection enables the development of predictive algorithms for substance use by machine learning methods. Objective: We developed a new self-monitoring mobile app to record daily substance use, triggers, and cravings. Additionally, a wearable activity tracker (Fitbit) was used to collect objective biological and behavioral data before, during, and after substance use. This study aims to describe a model using machine learning methods to determine substance use. Methods: This study is an ongoing observational study using a Fitbit and a self-monitoring app. Participants of this study were people with health risks due to alcohol or methamphetamine use. They were required to record their daily substance use and related factors on the self-monitoring app and to always wear a Fitbit for 8 weeks, which collected the following data: (1) heart rate per minute, (2) sleep duration per day, (3) sleep stages per day, (4) the number of steps per day, and (5) the amount of physical activity per day. Fitbit data will first be visualized for data analysis to confirm typical Fitbit data patterns for individual users. Next, machine learning and statistical analysis methods will be performed to create a detection model for substance use based on the combined Fitbit and self-monitoring data. The model will be tested based on 5-fold cross-validation, and further preprocessing and machine learning methods will be conducted based on the preliminary results. The usability and feasibility of this approach will also be evaluated. Results: Enrollment for the trial began in September 2020, and the data collection finished in April 2021. In total, 13 people with methamphetamine use disorder and 36 with alcohol problems participated in this study. The severity of methamphetamine or alcohol use disorder assessed by the Drug Abuse Screening Test-10 or the Alcohol Use Disorders Identification Test-10 was moderate to severe. The anticipated results of this study include understanding the physiological and behavioral data before, during, and after alcohol or methamphetamine use and identifying individual patterns of behavior. Conclusions: Real-time data on daily life among people with substance use problems were collected in this study. This new approach to data collection might be helpful because of its high confidentiality and convenience. The findings of this study will provide data to support the development of interventions to reduce alcohol and methamphetamine use and associated negative consequences. International Registered Report Identifier (IRRID): DERR1-10.2196/44275 ",
doi="10.2196/44275",
url="https://www.researchprotocols.org/2023/1/e44275",
url="http://www.ncbi.nlm.nih.gov/pubmed/37040162"
}


@Article{info:doi/10.2196/38900,
author="Hellem, Katherine Abby
and Whitfield, Candace
and Casetti, Amanda
and Robles, Cielito Maria
and Dinh, Mackenzie
and Meurer, William
and Skolarus, Lesli",
title="Engagement in Self-measured Blood Pressure Monitoring Among Medically Underresourced Participants (the Reach Out Trial): Digital Framework Qualitative Study",
journal="JMIR Cardio",
year="2023",
month="Apr",
day="7",
volume="7",
pages="e38900",
keywords="mobile health",
keywords="mHealth",
keywords="cardiovascular disease",
keywords="hypertension",
keywords="blood pressure",
keywords="semistructured interviews",
keywords="intervention engagement",
keywords="social determinants of health",
keywords="DBCI framework",
abstract="Background: Mobile health (mHealth) interventions serve as a scalable opportunity to engage people with hypertension in self-measured blood pressure (SMBP) monitoring, an evidence-based approach to lowering blood pressure (BP) and improving BP control. Reach Out is an SMS text messaging--based SMBP mHealth trial that aims to reduce BP among hypertensive patients recruited from the emergency department of a safety net hospital in a low-income, predominately Black city. Objective: As the benefits of Reach Out are predicated on participants' engagement with the intervention, we sought to understand participants' determinants of engagement via prompted SMBP with personalized feedback (SMBP+feedback). Methods: We conducted semistructured telephone interviews based on the digital behavior change interventions framework. Participants were purposively sampled from 3 engagement categories: high engagers (?80\% response to SMBP prompts), low engagers (?20\% response to BP prompts), and early enders (participants who withdrew from the trial). Results: We conducted interviews with 13 participants, of whom 7 (54\%) were Black, with a mean age of 53.6 (SD 13.25) years. Early enders were less likely to be diagnosed with hypertension prior to Reach Out, less likely to have a primary care provider, and less likely to be taking antihypertensive medications than their counterparts. Overall, participants liked the SMS text messaging design of the intervention, including the SMBP+feedback. Several participants across all levels of engagement expressed interest in and identified the benefit of enrolling in the intervention with a partner of their choice. High engagers expressed the greatest understanding of the intervention, the least number of health-related social needs, and the greatest social support to engage in SMBP. Low engagers and early enders shared a mixed understanding of the intervention and less social support compared to high engagers. Participation decreased as social needs increased, with early enders sharing the greatest amount of resource insecurity apart from a notable exception of a high engager with high health-related social needs. Conclusions: Prompted SMBP+feedback was perceived favorably by all participants. To enhance SMBP engagement, future studies could consider greater support in the initiation of SMBP, evaluating and addressing participants' unmet health-related social needs, as well as strategies to cultivate social norms. ",
doi="10.2196/38900",
url="https://cardio.jmir.org/2023/1/e38900",
url="http://www.ncbi.nlm.nih.gov/pubmed/37027200"
}


@Article{info:doi/10.2196/45920,
author="Hjorth-Johansen, Elin
and B{\o}r{\o}sund, Elin
and Martinsen {\O}sten, Ingeborg
and Holmstr{\o}m, Henrik
and Moen, Anne",
title="Acceptability and Initial Adoption of the Heart Observation App for Infants With Congenital Heart Disease: Qualitative Study",
journal="JMIR Form Res",
year="2023",
month="Apr",
day="5",
volume="7",
pages="e45920",
keywords="congenital heart disease",
keywords="readiness for discharge",
keywords="mobile app",
keywords="follow-up, health services",
keywords="mHealth",
abstract="Background: Approximately 1\% of all infants are born with a congenital heart disease (CHD). Internationally CHD remains a major cause of infant death, some of which occur unexpectedly after a gradual deterioration at home. Many parents find it difficult to recognize worsening of symptoms. Objective: This study aims to report the acceptability and initial adoption of a mobile app, the Heart Observation app (HOBS), aiming to support parents' understanding and management of their child's condition and to increase quality in follow-up from health care professionals in complex health care services in Norway. Methods: A total of 9 families were interviewed on discharge from the neonatal intensive care unit and after 1 month at home. The infant's primary nurse, community nurse, and cardiologist were also interviewed regarding their experiences about collaboration with the family. The interviews were analyzed inductively with thematic content analysis. Results: The analysis generated 4 main themes related to acceptability and adoption: (1) Individualize Initial Support, (2) Developing Confidence and Coping, (3) Normalize When Appropriate, and (4) Implementation in a Complex Service Pathway. The receptivity of parents to learn and attend in the intervention differs according to their present situation. Health care professionals emphasized the importance of adapting the introduction and guidance to parents' receptivity to ensure comprehension, self-efficacy, and thereby acceptance before discharge (Individualize Initial Support). Parents perceived that HOBS served them well and nurtured confidence by teaching them what to be aware of. Health care professionals reported most parents as confident and informed. This potential effect increased the possibility of adoption (Developing Confidence and Coping). Parents expressed that HOBS was not an ``everyday app'' and wanted to normalize everyday life when appropriate. Health care professionals suggested differentiating use according to severity and reducing assessments after recovery to adapt the burden of assessments when appropriate (Normalize When Appropriate). Health care professionals' attitude to implement HOBS in their services was positive. They perceived HOBS as useful to systemize guidance, to enhance communication regarding an infant's condition, and to increase understanding of heart defects in health care professionals with sparse experience (Implementation in a Complex Service Pathway). Conclusions: This feasibility study shows that both parents and health care professionals found HOBS as a positive addition to the health care system and follow-up. HOBS was accepted and potentially useful, but health care professionals should guide parents initially to ensure comprehension and adapt timing to parents' receptivity. By doing so, parents may be confident to know what to look for regarding their child's health and cope at home. Differentiating between various diagnoses and severity is important to support normalization when appropriate. Further controlled studies are needed to assess adoption, usefulness, and benefits in the health care system. ",
doi="10.2196/45920",
url="https://formative.jmir.org/2023/1/e45920",
url="http://www.ncbi.nlm.nih.gov/pubmed/37018028"
}


@Article{info:doi/10.2196/43823,
author="Willms, Amanda
and Rhodes, E. Ryan
and Liu, Sam",
title="The Development of a Hypertension Prevention and Financial-Incentive mHealth Program Using a ``No-Code'' Mobile App Builder: Development and Usability Study",
journal="JMIR Form Res",
year="2023",
month="Apr",
day="5",
volume="7",
pages="e43823",
keywords="mobile health",
keywords="mHealth",
keywords="usability study",
keywords="financial incentive",
keywords="physical activity",
keywords="mobile phone",
keywords="smartphone",
abstract="Background: Regular physical activity (PA) is a key lifestyle component for hypertension prevention. Previous studies have shown that mobile health (mHealth) apps can be an effective tool for improving PA behaviors. However, adherence to and poor engagement with these apps is a challenge. A potential solution to overcome this challenge may be to combine financial incentives with innovative behavior theory, such as the Multiprocess Action Control (M-PAC) framework. Currently, there is a lack of PA financial incentive--driven M-PAC mHealth programs aimed at hypertension prevention. Objective: We aimed to describe the process of developing an 8-week mHealth PA and financial-incentive hypertension education program (Healthy Hearts) and to evaluate usability of the Healthy Hearts program. Methods: The first 2 stages of the Integrate, Design, Assess, and Share framework were used to guide the development of the Healthy Hearts program. The development process consisted of 2 phases. In phase 1, the research team met to discuss implementing the M-PAC framework to adopt an existing web-based hypertension prevention program to a mobile app. The app was developed using a no-code app development platform, Pathverse (Pathverse Inc), to help decrease overall development time. In phase 2, we created a prototype and conducted usability testing to evaluate lesson 1 of the Healthy Hearts program to further enhance the user experience. We used semistructured interviews and the mHealth App Usability Questionnaire to evaluate program acceptability and usability. Results: Intervention development among the research team successfully created an 8-week financial-incentive hypertension education program for adults aged 40-65 years who did not currently meet the Canadian Physical Activity Guidelines (<150 minutes of moderate to vigorous PA per week). This program lasted 8 weeks and comprised 25 lessons guided by the M-PAC framework. The program used various behavior change techniques to further support PA adherence. Usability testing of the first lesson was successful, with 6 participants recruited for 2 rounds of testing. Feedback was gathered to enhance the content, layout, and design of the Healthy Hearts program to prepare the mHealth program for feasibility testing. Results of round 1 of usability testing suggested that the content delivered in the lessons was long. Therefore, the content was divided into multiple lessons before round 2 of usability testing, where feedback was only on design preferences. A minimum viable product was created with these results. Conclusions: The iterative development process and the usability assessments suggested by the Integrate, Design, Assess, and Share framework enabled participants to provide valuable feedback on the content, design, and layout of the program before advancing to feasibility testing. Furthermore, the use of the ``no-code'' app development tool enabled our team to rapidly make changes to the app based on user feedback during the iterative design process. ",
doi="10.2196/43823",
url="https://formative.jmir.org/2023/1/e43823",
url="http://www.ncbi.nlm.nih.gov/pubmed/37018038"
}


@Article{info:doi/10.2196/44996,
author="Mueller, Christian
and Sch{\"u}rks, Markus
and Neu{\ss}er, Thomas
and von der Osten, Uschi
and Weiherm{\"u}ller, Daniela
and von Arnim, Ira
and Martin, Stephan",
title="Identification of Patients With Elevated Urine Albumin--to-Creatinine Ratio Levels in a Type 2 Diabetes Mellitus Cohort Based on Data Submitted by Patients via a Smartphone App (SMART-Finder): Protocol for an Observational Study",
journal="JMIR Res Protoc",
year="2023",
month="Apr",
day="5",
volume="12",
pages="e44996",
keywords="app-based documentation",
keywords="chronic kidney disease",
keywords="prevalence",
keywords="MyTherapy",
keywords="type 2 diabetes mellitus",
keywords="urine albumin-to-creatinine ratio screening",
abstract="Background: Despite effective treatment options, chronic kidney disease (CKD) has become a major cause of mortality worldwide due to the ever-increasing number of patients with type 2 diabetes mellitus (T2DM). Guideline-compliant, at least, annual screening of patients with T2DM is crucial to prevent renal disease progression. However, data on the prevalence of CKD in patients with T2DM and on screening frequency are limited. SMART-Finder is the first study to exclusively use data provided directly by patients via an adherence app to collect information on the prevalence of CKD, risk factors, disease management, and quality of life of patients with T2DM in Germany. Objective: The primary objective of this study is to determine the proportion of patients with T2DM and an elevated urine albumin-to-creatinine ratio (UACR; albumin-to-creatinine ratio stage A2 and A3) at baseline and after 12 ({\textpm}3) months. Secondary objectives include the proportion of patients who remain in or switch to another albumin-to-creatinine ratio classification category after 12 months, information on quality of life, disease awareness, and adherence rates, as well as the proportion of patients without any UACR-screening data. Recruitment occurs via push notification among MyTherapy app users with T2DM. Methods: This is a single-arm, retrospective/prospective, observational, digital, patient-centered cohort study, with recruitment and data documentation via a health app. Required routine laboratory data are provided by treating physicians to their patients for data entry. The study population includes adult patients with T2DM documenting their data in the MyTherapy app using their own smartphone or tablet. Study participants are provided with a specifically developed electronic case report form containing questions on demographic and general data, quality of life, disease awareness, and laboratory values including estimated glomerular filtration rate, UACR, hemoglobin 1Ac, and blood pressure. Apart from demographic and general data, all data are collected at baseline and 12 months after the last UACR assessment. An automatically generated push notification reminds participants of the second data entry. The extracted and pseudonymized data are analyzed descriptively. Results: The enrollment period for this study started in February 2023 and shall end after 12 months or after the enrollment of 5000 patients. An interim analysis is planned 3 months after the inclusion of the first patient and the final analysis after 12 months of follow-up. Conclusions: Overall, the study will contribute to minimizing the existing data gap on the prevalence of CKD in patients with T2DM in Germany, provide important insights into the current disease management of patients with T2DM in everyday clinical practice in Germany, and support guideline-based care for the participating patients. International Registered Report Identifier (IRRID): PRR1-10.2196/44996 ",
doi="10.2196/44996",
url="https://www.researchprotocols.org/2023/1/e44996",
url="http://www.ncbi.nlm.nih.gov/pubmed/37018036"
}


@Article{info:doi/10.2196/44765,
author="Lee, Mauricette
and Bin Mahmood, Shakran Abu Bakar
and Lee, Sing Eng
and Smith, Elizabeth Helen
and Tudor Car, Lorainne",
title="Smartphone and Mobile App Use Among Physicians in Clinical Practice: Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Mar",
day="31",
volume="11",
pages="e44765",
keywords="evidence-based medicine",
keywords="specialist",
keywords="general practitioners",
keywords="GP",
keywords="primary care physicians",
keywords="mobile apps",
keywords="consultants",
keywords="surgeons",
keywords="pediatricians",
keywords="clinical care",
keywords="mobile phone",
abstract="Background: Health care professionals are increasingly using smartphones in clinical care. Smartphone use can affect patient quality of care and clinical outcomes. Objective: This scoping review aimed to describe how physicians use smartphones and mobile apps in clinical settings. Methods: We conducted a scoping review using the Joanna Briggs Institute methodology and reported the results according to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. We used the following databases in our literature search: MEDLINE, Embase, Cochrane Library, Web of Science, Google Scholar, and gray literature for studies published since 2010. An additional search was also performed by scanning the reference lists of included studies. A narrative synthesis approach was used. Results: A total of 10 studies, published between 2016 and 2021, were included in this review. Of these studies, 8 used surveys and 2 used surveys with focus group study designs to explore smartphone use, its adoption, experience of using it, and views on the use of smartphones among physicians. There were studies with only general practitioners (n=3), studies with only specialists (n=3), and studies with both general practitioners and specialists (n=4). Physicians use smartphones and mobile apps for communication (n=9), clinical decision-making (n=7), drug compendium (n=7), medical education and training (n=7), maintaining health records (n=4), managing time (n=4), and monitoring patients (n=2) in clinical practice. The Medscape medical app was frequently used for information gathering. WhatsApp, a nonmedical app, was commonly used for physician-patient communication. The commonly reported barriers were lack of regulatory oversight, privacy concerns, and limited Wi-Fi or internet access. The commonly reported facilitator was convenience and having access to evidence-based medicine, clinical decision-making support, and a wide array of apps. Conclusions: Smartphones and mobile apps were used for communication, medical education and training, clinical decision-making, and drug compendia in most studies. Although the benefits of smartphones and mobile apps for physicians at work were promising, there were concerns about patient privacy and confidentiality. Legislation is urgently needed to protect the liability of health care professionals using smartphones. ",
doi="10.2196/44765",
url="https://mhealth.jmir.org/2023/1/e44765",
url="http://www.ncbi.nlm.nih.gov/pubmed/37000498"
}


@Article{info:doi/10.2196/43867,
author="Mehdizadeh, Hamed
and Asadi, Farkhondeh
and Nazemi, Eslam
and Mehrvar, Azim
and Yazdanian, Azade
and Emami, Hassan",
title="A Mobile Self-Management App (CanSelfMan) for Children With Cancer and Their Caregivers: Usability and Compatibility Study",
journal="JMIR Pediatr Parent",
year="2023",
month="Mar",
day="30",
volume="6",
pages="e43867",
keywords="Digital health",
keywords="eHealth",
keywords="Telehealth",
keywords="mHealth",
keywords="Mobile app",
keywords="self-management",
keywords="cancer",
keywords="child",
keywords="parent",
keywords="caregiver",
keywords="usability evaluation",
abstract="Background: Despite the increasing development of different smartphone apps in the health care domain, most of these apps lack proper evaluation. In fact, with the rapid development of smartphones and wireless communication infrastructure, many health care systems around the world are using these apps to provide health services for people without sufficient scientific efforts to design, develop, and evaluate them. Objective: The objective of this study was to evaluate the usability of CanSelfMan, a self-management app that provides access to reliable information to improve communication between health care providers and children with cancer and their parents/caregivers, facilitating remote monitoring and promoting medication adherence. Methods: We performed debugging and compatibility tests in a simulated environment to identify possible errors. Then, at the end of the 3-week period of using the app, children with cancer and their parents/caregivers filled out the User Experience Questionnaire (UEQ) to evaluate the usability of the CanSelfMan app and their level of user satisfaction. Results: During the 3 weeks of CanSelfMan use, 270 cases of symptom evaluation and 194 questions were recorded in the system by children and their parents/caregivers and answered by oncologists. After the end of the 3 weeks, 44 users completed the standard UEQ user experience questionnaire. According to the children's evaluations, attractiveness (mean 1.956, SD 0.547) and efficiency (mean 1.934, SD 0.499) achieved the best mean results compared with novelty (mean 1.711, SD   0.481). Parents/caregivers rated efficiency at a mean of 1.880 (SD 0.316) and attractiveness at a mean of 1.853 (SD 0.331). The lowest mean score was reported for novelty (mean 1.670, SD 0.225). Conclusions: In this study, we describe the evaluation process of a self-management system to support children with cancer and their families. Based on the feedback and scores obtained from the usability evaluation, it seems that the children and their parents find CanSelfMan to be an interesting and practical idea to provide reliable and updated information on cancer and help them manage the complications of this disease. ",
doi="10.2196/43867",
url="https://pediatrics.jmir.org/2023/1/e43867",
url="http://www.ncbi.nlm.nih.gov/pubmed/36995746"
}


@Article{info:doi/10.2196/41082,
author="Bianchini, Edoardo
and Warmerdam, Elke
and Romijnders, Robbin
and St{\"u}rner, Hanja Klarissa
and Baron, Ralf
and Heinzel, Sebastian
and Pontieri, Ernesto Francesco
and Hansen, Clint
and Maetzler, Walter",
title="Turning When Using Smartphone in Persons With and Those Without Neurologic Conditions: Observational Study",
journal="J Med Internet Res",
year="2023",
month="Mar",
day="30",
volume="25",
pages="e41082",
keywords="turning",
keywords="turning coordination",
keywords="smartphone",
keywords="dual task",
keywords="dual task cost",
keywords="Parkinson disease",
keywords="Parkinson",
keywords="stroke",
keywords="multiple sclerosis",
keywords="low back pain",
keywords="neurology",
keywords="neurological",
keywords="movement",
keywords="biomechanics",
keywords="gait",
keywords="balance",
keywords="walk",
keywords="kinesiology",
keywords="fall",
abstract="Background: Turning during walking is a relevant and common everyday movement and it depends on a correct top-down intersegmental coordination. This could be reduced in several conditions (en bloc turning), and an altered turning kinematics has been linked to increased risk of falls. Smartphone use has been associated with poorer balance and gait; however, its effect on turning-while-walking has not been investigated yet. This study explores turning intersegmental coordination during smartphone use in different age groups and neurologic conditions. Objective: This study aims to evaluate the effect of smartphone use on turning behavior in healthy individuals of different ages and those with various neurological diseases. Methods: Younger (aged 18-60 years) and older (aged >60 years) healthy individuals and those with Parkinson disease, multiple sclerosis, subacute stroke (<4 weeks), or lower-back pain performed turning-while-walking alone (single task [ST]) and while performing 2 different cognitive tasks of increasing complexity (dual task [DT]). The mobility task consisted of walking up and down a 5-m walkway at self-selected speed, thus including 180{\textdegree} turns. Cognitive tasks consisted of a simple reaction time test (simple DT [SDT]) and a numerical Stroop test (complex DT [CDT]). General (turn duration and the number of steps while turning), segmental (peak angular velocity), and intersegmental turning parameters (intersegmental turning onset latency and maximum intersegmental angle) were extracted for head, sternum, and pelvis using a motion capture system and a turning detection algorithm. Results: In total, 121 participants were enrolled. All participants, irrespective of age and neurologic disease, showed a reduced intersegmental turning onset latency and a reduced maximum intersegmental angle of both pelvis and sternum relative to head, thus indicating an en bloc turning behavior when using a smartphone. With regard to change from the ST to turning when using a smartphone, participants with Parkinson disease reduced their peak angular velocity the most, which was significantly different from lower-back pain relative to the head (P<.01). Participants with stroke showed en bloc turning already without smartphone use. Conclusions: Smartphone use during turning-while-walking may lead to en bloc turning and thus increase fall risk across age and neurologic disease groups. This behavior is probably particularly dangerous for those groups with the most pronounced changes in turning parameters during smartphone use and the highest fall risk, such as individuals with Parkinson disease. Moreover, the experimental paradigm presented here might be useful in differentiating individuals with lower-back pain without and those with early or prodromal Parkinson disease. In individuals with subacute stroke, en bloc turning could represent a compensative strategy to overcome the newly occurring mobility deficit. Considering the ubiquitous smartphone use in daily life, this study should stimulate future studies in the area of fall risk and neurological and orthopedic diseases. Trial Registration: German Clinical Trials Register DRKS00022998; https://drks.de/search/en/trial/DRKS00022998 ",
doi="10.2196/41082",
url="https://www.jmir.org/2023/1/e41082",
url="http://www.ncbi.nlm.nih.gov/pubmed/36995756"
}


@Article{info:doi/10.2196/43507,
author="Topp, Robert
and Greenstein, Jay
and Etnoyer-Slaski, Jena",
title="The Effect of a Mobile Health App on Treatment Adherence and Revenue at Physical Health Clinics: Retrospective Record Review",
journal="JMIR Rehabil Assist Technol",
year="2023",
month="Mar",
day="28",
volume="10",
pages="e43507",
keywords="physical health",
keywords="completion of therapy",
keywords="phone app",
keywords="clinic charges and payments",
keywords="payment",
keywords="cost",
keywords="physiotherapy",
keywords="physical therapy",
keywords="adherence",
keywords="attrition",
keywords="mobile phone",
keywords="reminder",
keywords="mobile health",
keywords="mHealth",
keywords="health app",
keywords="mobile app",
abstract="Background: A significant number of patients do not adhere to their prescribed course of physical therapy or discharge themselves from care. Adhering to prescribed physical therapy, including attending physical therapy clinic appointments, contributes to patients achieving the goals of therapy including reducing pain and increasing functionality. Web-based platforms have been demonstrated to be effective means for managing clinical patients with musculoskeletal pain, similar to managing them in person. Behavior change techniques introduced through digital or web-based platforms can reduce nonadherence with prescribed physical therapy and improve patient outcomes. Literature also indicates that a phone-based app provided to patients, which includes a reward-incentive gamification to complement their care, contributed to a greater number of kept appointments in a physical therapy clinic. Objective: This study aims to compare the rate of provider discharge with self-discharge and the number of clinic visits among patients attending a physical health clinic who did and did not choose to adopt a phone-based app to complement their care. A secondary purpose was to compare the revenue generated by patients attending a physical health clinic who did and did not choose to adopt a phone-based app to complement their care. Methods: A retrospective analysis of all new outpatient medical records (N=5328) from a multisite physical health practice was conducted between January 2018 and December 2019. Patients in the sample self-selected the 2018 Usual Care, the 2019 Usual Care, or the 2019 Kanvas App groups. Kanvas is a customized private practice app, designed for patient engagement with their specific health care provider. This app included a gamification system that provided rewards to the patient for attending their scheduled clinic appointments. According to their medical record, each patient was classified as completing their prescribed therapy (provider discharged) or not completing their prescribed therapy (self-discharged). Additionally, the total number of clinic visits each patient attended, the total charges for services, and the total payments received by the clinic per patient were extracted from each patient's medical record. Results: Patients in the 2019 Kanvas App Group exhibited a higher rate of provider discharge compared to patients who did not adopt the app. This greater rate of provider discharges among the patients who adopted the Kanvas app likely contributed to this group attending more clinic visits (13.21, SD 12.09) than the other study groups who did not download the app (10.72, SD 9.80 to 11.35, SD 11.10). This greater number of clinic visits in turn contributed to the patients who adopted the app generating more clinic charges and payments. Conclusions: Future investigators need to employ more rigorous methods to confirm these findings, and clinicians need to weigh the anticipated benefits against the cost and staff involvement in managing the Kanvas app. ",
doi="10.2196/43507",
url="https://rehab.jmir.org/2023/1/e43507",
url="http://www.ncbi.nlm.nih.gov/pubmed/36889337"
}


@Article{info:doi/10.2196/43781,
author="Bente, E. Britt
and Wentzel, Jobke
and Schepers, Celina
and Breeman, D. Linda
and Janssen, R. Veronica
and Pieterse, E. Marcel
and Evers, M. Andrea W.
and van Gemert-Pijnen, Lisette",
title="Implementation and User Evaluation of an eHealth Technology Platform Supporting Patients With Cardiovascular Disease in Managing Their Health After a Cardiac Event: Mixed Methods Study",
journal="JMIR Cardio",
year="2023",
month="Mar",
day="24",
volume="7",
pages="e43781",
keywords="patient needs",
keywords="health behavior",
keywords="lifestyle support",
keywords="user-centered design",
keywords="implementation",
keywords="evaluation",
keywords="cardiovascular disease",
keywords="app",
keywords="web-based platform",
keywords="intervention",
abstract="Background: eHealth technology can help patients with cardiovascular disease adopt and maintain a healthy lifestyle by supporting self-management and offering guidance, coaching, and tailored information. However, to support patients over time, eHealth needs to blend in with their needs, treatment, and daily lives. Just as needs can differ between patients, needs can change within patients over time. To better adapt technology features to patients' needs, it is necessary to account for these changes in needs and contexts of use. Objective: This study aimed to identify and monitor patients' needs for support from a web-based health management platform and how these needs change over time. It aimed to answer the following research questions: ``How do novice and more advanced users experience an online health management platform?'' ``What user expectations support or hinder the adoption of an online health management platform, from a user perspective?'' and ``How does actual usage relate to user experiences and adoption?'' Methods: A mixed methods design was adopted. The first method involved 2 rounds of usability testing, followed by interviews, with 10 patients at 0 months (round 1) and 12 patients at 6 months (round 2). In the second method, log data were collected to describe the actual platform use. Results: After starting cardiac rehabilitation, the platform was used frequently. The patients mentioned that they need to have an incentive, set goals, self-monitor their health data, and feel empowered by the platform. However, soon after the rehabilitation program stopped, use of the platform declined or patients even quit because of the lack of continued tailored or personalized advice. The reward system motivated them to log data, but most participants indicated that being healthy should be the main focus, not receiving gifts. A web-based platform is flexible, accessible, and does not have any obligations; however, it should be implemented as an addition to regular care. Conclusions: Although use of the platform declined in the longer term, patients quitting the technology did not directly indicate that the technology was not functioning well or that patients no longer focused on achieving their values. The key to success should not be user adherence to a platform but adherence to healthy lifestyle habits. Therefore, the implementation of eHealth should include the transition to a stage where patients might no longer need support from a technology platform to be independently and sustainably adherent to their healthy lifestyle habits. This emphasizes the importance of conducting multi-iterative evaluations to continuously monitor whether and how patients' needs and contexts of use change over time. Future research should focus on how this transition can be identified and monitored and how these insights can inform the design and implementation of the technology. ",
doi="10.2196/43781",
url="https://cardio.jmir.org/2023/1/e43781",
url="http://www.ncbi.nlm.nih.gov/pubmed/36961491"
}


@Article{info:doi/10.2196/41050,
author="Hunter, Victoria
and Shapiro, Allison
and Chawla, Devika
and Drawnel, Faye
and Ramirez, Ernesto
and Phillips, Elizabeth
and Tadesse-Bell, Sara
and Foschini, Luca
and Ukachukwu, Vincent",
title="Characterization of Influenza-Like Illness Burden Using Commercial Wearable Sensor Data and Patient-Reported Outcomes: Mixed Methods Cohort Study",
journal="J Med Internet Res",
year="2023",
month="Mar",
day="23",
volume="25",
pages="e41050",
keywords="influenza",
keywords="influenza-like illness",
keywords="wearable sensor",
keywords="person-generated health care data",
abstract="Background: The burden of influenza-like illness (ILI) is typically estimated via hospitalizations and deaths. However, ILI-associated morbidity that does not require hospitalization remains poorly characterized. Objective: The main objective of this study was to characterize ILI burden using commercial wearable sensor data and investigate the extent to which these data correlate with self-reported illness severity and duration. Furthermore, we aimed to determine whether ILI-associated changes in wearable sensor data differed between care-seeking and non--care-seeking populations as well as between those with confirmed influenza infection and those with ILI symptoms only. Methods: This study comprised participants enrolled in either the FluStudy2020 or the Home Testing of Respiratory Illness (HTRI) study; both studies were similar in design and conducted between December 2019 and October 2020 in the United States. The participants self-reported ILI-related symptoms and health care--seeking behaviors via daily, biweekly, and monthly surveys. Wearable sensor data were recorded for 120 and 150 days for FluStudy2020 and HTRI, respectively. The following features were assessed: total daily steps, active time (time spent with >50 steps per minute), sleep duration, sleep efficiency, and resting heart rate. ILI-related changes in wearable sensor data were compared between the participants who sought health care and those who did not and between the participants who tested positive for influenza and those with symptoms only. Correlative analyses were performed between wearable sensor data and patient-reported outcomes. Results: After combining the FluStudy2020 and HTRI data sets, the final ILI population comprised 2435 participants. Compared with healthy days (baseline), the participants with ILI exhibited significantly reduced total daily steps, active time, and sleep efficiency as well as increased sleep duration and resting heart rate. Deviations from baseline typically began before symptom onset and were greater in the participants who sought health care than in those who did not and greater in the participants who tested positive for influenza than in those with symptoms only. During an ILI event, changes in wearable sensor data consistently varied with those in patient-reported outcomes. Conclusions: Our results underscore the potential of wearable sensors to discriminate not only between individuals with and without influenza infections but also between care-seeking and non--care-seeking populations, which may have future application in health care resource planning. Trial Registration: Clinicaltrials.gov NCT04245800; https://clinicaltrials.gov/ct2/show/NCT04245800 ",
doi="10.2196/41050",
url="https://www.jmir.org/2023/1/e41050",
url="http://www.ncbi.nlm.nih.gov/pubmed/36951890"
}


@Article{info:doi/10.2196/40272,
author="Robinson, A. Stephanie
and Zocchi, Mark
and Purington, Carolyn
and Am, Linda
and DeLaughter, Kathryn
and Vimalananda, G. Varsha
and Netherton, Dane
and Ash, S. Arlene
and Hogan, P. Timothy
and Shimada, L. Stephanie",
title="Secure Messaging for Diabetes Management: Content Analysis",
journal="JMIR Diabetes",
year="2023",
month="Mar",
day="23",
volume="8",
pages="e40272",
keywords="secure messaging",
keywords="patient-provider communication",
keywords="veterans",
keywords="message content",
keywords="diabetes",
keywords="patient portal",
keywords="T2D",
keywords="management",
keywords="support",
keywords="messaging",
keywords="glycemic control",
keywords="communication",
keywords="engagement",
keywords="health information",
keywords="diabetic control",
keywords="disease outcomes",
abstract="Background: Secure messaging use is associated with improved diabetes-related outcomes. However, it is less clear how secure messaging supports diabetes management. Objective: We examined secure message topics between patients and clinical team members in a national sample of veterans with type 2 diabetes to understand use of secure messaging for diabetes management and potential associations with glycemic control. Methods: We surveyed and analyzed the content of secure messages between 448 US Veterans Health Administration patients with type 2 diabetes and their clinical teams. We also explored the relationship between secure messaging content and glycemic control. Results: Explicit diabetes-related content was the most frequent topic (72.1\% of participants), followed by blood pressure (31.7\% of participants). Among diabetes-related conversations, 90.7\% of patients discussed medication renewals or refills. More patients with good glycemic control engaged in 1 or more threads about blood pressure compared to those with poor control (37.5\% vs 27.2\%, P=.02). More patients with good glycemic control engaged in 1 more threads intended to share information with their clinical team about an aspect of their diabetes management compared to those with poor control (23.7\% vs 12.4\%, P=.009). Conclusions: There were few differences in secure messaging topics between patients in good versus poor glycemic control. Those in good control were more likely to engage in informational messages to their team and send messages related to blood pressure. It may be that the specific topic content of the secure messages may not be that important for glycemic control. Simply making it easier for patients to communicate with their clinical teams may be the driving influence between associations previously reported in the literature between secure messaging and positive clinical outcomes in diabetes. ",
doi="10.2196/40272",
url="https://diabetes.jmir.org/2023/1/e40272",
url="http://www.ncbi.nlm.nih.gov/pubmed/36951903"
}


@Article{info:doi/10.2196/40595,
author="Seki, Tomotsugu
and Aki, Morio
and Furukawa, A. Toshi
and Kawashima, Hirotsugu
and Miki, Tomotaka
and Sawaki, Yujin
and Ando, Takaaki
and Katsuragi, Kentaro
and Kawashima, Takahiko
and Ueno, Senkei
and Miyagi, Takashi
and Noma, Shun'ichi
and Tanaka, Shiro
and Kawakami, Koji",
title="Electronic Health Record--Nested Reminders for Serum Lithium Level Monitoring in Patients With Mood Disorder: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2023",
month="Mar",
day="22",
volume="25",
pages="e40595",
keywords="electronic health record",
keywords="lithium",
keywords="mood disorders",
keywords="randomized controlled trial",
keywords="quality of health care",
abstract="Background: Clinical guidelines recommend regular serum lithium monitoring every 3 to 6 months. However, in the real world, only a minority of patients receive adequate monitoring. Objective: This study aims to examine whether the use of the electronic health record (EHR)--nested reminder system for serum lithium monitoring can help achieve serum lithium concentrations within the therapeutic range for patients on lithium maintenance therapy. Methods: We conducted an unblinded, single-center, EHR-nested, parallel-group, superiority randomized controlled trial comparing EHR-nested reminders with usual care in adult patients receiving lithium maintenance therapy for mood disorders. The primary outcome was the achievement of therapeutically appropriate serum lithium levels between 0.4 and 1.0 mEq/L at 18 months after enrollment. The key secondary outcomes are included as follows: the number of serum lithium level monitoring except for the first and final monitoring; exacerbation of the mood disorder during the study period, defined by hospitalization, increase in lithium dose, addition of antipsychotic drugs or mood stabilizers, or addition or increase of antidepressants; adherence defined by the proportion of days covered by lithium carbonate prescription during the study period. Results: A total of 111 patients were enrolled in this study. A total of 56 patients were assigned to the reminder group, and 55 patients were assigned to the usual care group. At the follow-up, 38 (69.1\%) patients in the reminder group and 33 (60.0\%) patients in the usual care group achieved the primary outcome (odds ratio 2.14, 95\% CI 0.82-5.58, P=.12). The median number of serum lithium monitoring was 2 in the reminder group and 0 in the usual care group (rate ratio 3.62; 95\% CI 2.47-5.29, P<.001). The exacerbation of mood disorders occurred in 17 (31.5\%) patients in the reminder group and in 16 (34.8\%) patients in the usual care group (odds ratio 0.97, 95\% CI 0.42-2.28, P=.95). Conclusions: We found insufficient evidence for an EHR-nested reminder to increase the achievement of therapeutic serum lithium concentrations. However, the number of monitoring increased with relatively simple and inexpensive intervention. The EHR-based reminders may be useful to improve quality of care for patients on lithium maintenance therapy, and they have potentials to be applied to other problems. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000033633; https://tinyurl.com/5n7wtyav ",
doi="10.2196/40595",
url="https://www.jmir.org/2023/1/e40595",
url="http://www.ncbi.nlm.nih.gov/pubmed/36947138"
}


@Article{info:doi/10.2196/44316,
author="Scheer, Justin
and Areias, C. Anabela
and Molinos, Maria
and Janela, Dora
and Moulder, Robert
and Lains, Jorge
and Bento, Virg{\'i}lio
and Yanamadala, Vijay
and Dias Correia, Fernando
and Costa, Fab{\'i}ola",
title="Engagement and Utilization of a Complete Remote Digital Care Program for Musculoskeletal Pain Management in Urban and Rural Areas Across the United States: Longitudinal Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Mar",
day="16",
volume="11",
pages="e44316",
keywords="physical therapy",
keywords="physiotherapy",
keywords="remote care",
keywords="telerehabilitation",
keywords="digital therapy",
keywords="eHealth",
keywords="telehealth",
keywords="telemedicine",
keywords="musculoskeletal",
keywords="musculoskeletal conditions",
keywords="urban",
keywords="rural",
keywords="pain",
keywords="health inequity",
keywords="digital care",
keywords="pain management",
keywords="clinical outcome",
keywords="health equity",
keywords="engagement",
abstract="Background: Musculoskeletal (MSK) conditions are the number one cause of disability worldwide. Digital care programs (DCPs) for MSK pain management have arisen as alternative care delivery models to circumvent challenges in accessibility of conventional therapy. Despite the potential of DCPs to reduce inequities in accessing care, the outcomes of such interventions in rural and urban populations have yet to be studied. Objective: The aim of this study was to assess the impact of urban or rural residency on engagement and clinical outcomes after a multimodal DCP for MSK pain. Methods: This study consists of an ad hoc analysis of a decentralized single-arm investigation into engagement and clinical-related outcomes after a multimodal DCP in patients with MSK conditions. Patients were coded according to their zip codes to a specific rural-urban commuting area code and grouped into rural and urban cohorts. Changes in their engagement and clinical outcomes from baseline to program end were assessed. Latent growth curve analysis was performed to estimate change trajectories adjusting for the following covariates: age, gender, BMI, employment status, and pain acuity. Outcomes included engagement, self-reported pain, and the results of the Generalized Anxiety Disorder 7-item, Patient Health Questionnaire 9-item, and Work Productivity and Activity Impairment scales. A minimum clinically important difference (MCID) of 30\% was considered for pain. Results: Patients with urban and rural residency across the United States participated in the program (n=9992). A 73.8\% (7378/9992) completion rate was observed. Both groups reported high satisfaction scores and similar engagement with exercise sessions, with rural residents showing higher engagement with educational content (P<.001) and higher program completion rates (P=.02). All groups showed a significant improvement in all clinical outcomes, including pain, mental health, and work productivity, without statistically significant intergroup differences. The percentage of patients meeting the MCID was similar in both groups (urban: 67.1\%, rural: 68.3\%; P=.30). Conclusions: This study advocates for the utility of a DCP in improving access to MSK care in urban and rural areas alike, showcasing its potential to promote health equity. High engagement, satisfaction, and completion rates were noted in both groups, as well as significant improvements in clinical outcomes. Trial Registration: ClinicalTrials.gov NCT04092946; https://clinicaltrials.gov/ct2/show/NCT04092946 ",
doi="10.2196/44316",
url="https://mhealth.jmir.org/2023/1/e44316",
url="http://www.ncbi.nlm.nih.gov/pubmed/36735933"
}


@Article{info:doi/10.2196/42389,
author="Diez Alvarez, Sergio
and Fellas, Antoni
and Santos, Derek
and Sculley, Dean
and Wynne, Katie
and Acharya, Shamasunder
and Navathe, Pooshan
and Girones, Xavier
and Coda, Andrea",
title="The Clinical Impact of Flash Glucose Monitoring---a Digital Health App and Smartwatch Technology in Patients With Type 2 Diabetes: Scoping Review",
journal="JMIR Diabetes",
year="2023",
month="Mar",
day="15",
volume="8",
pages="e42389",
keywords="type 2 diabetes",
keywords="flash glucose monitoring",
keywords="digital health",
keywords="smartwatch",
keywords="scoping review",
keywords="app",
keywords="smartphone",
keywords="mobile phone",
keywords="mHealth",
keywords="digital",
keywords="application",
keywords="technology",
keywords="effective",
keywords="management",
keywords="glucose",
keywords="monitoring",
keywords="database",
keywords="wearable",
keywords="diabetes",
keywords="diabetic",
keywords="glucose monitoring",
abstract="Background: Type 2 diabetes has a growing prevalence and confers significant cost burden to the health care system, raising the urgent need for cost-effective and easily accessible solutions. The management of type 2 diabetes requires significant commitment from the patient, caregivers, and the treating team to optimize clinical outcomes and prevent complications. Technology and its implications for the management of type 2 diabetes is a nascent area of research. The impact of some of the more recent technological innovations in this space, such as continuous glucose monitoring, flash glucose monitoring, web-based applications, as well as smartphone- and smart watch--based interactive apps has received limited attention in the research literature. Objective: This scoping review aims to explore the literature available on type 2 diabetes, flash glucose monitoring, and digital health technology to improve diabetic clinical outcomes and inform future research in this area. Methods: A scoping review was undertaken by searching Ovid MEDLINE and CINAHL databases. A second search using all identified keywords and index terms was performed on Ovid MEDLINE (January 1966 to July 2021), EMBASE (January 1980 to July 2021), Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library, latest issue), CINAHL (from 1982), IEEE Xplore, ACM Digital Libraries, and Web of Science databases. Results: There were very few studies that have explored the use of mobile health and flash glucose monitoring in type 2 diabetes. These studies have explored somewhat disparate and limited areas of research, and there is a distinct lack of methodological rigor in this area of research. The 3 studies that met the inclusion criteria have addressed aspects of the proposed research question. Conclusions: This scoping review has highlighted the lack of research in this area, raising the opportunity for further research in this area, focusing on the clinical impact and feasibility of the use of multiple technologies, including flash glucose monitoring in the management of patients with type 2 diabetes. ",
doi="10.2196/42389",
url="https://diabetes.jmir.org/2023/1/e42389",
url="http://www.ncbi.nlm.nih.gov/pubmed/36920464"
}


@Article{info:doi/10.2196/42134,
author="Khalid, Ayisha
and Dong, Quanfang
and Chuluunbaatar, Enkhzaya
and Haldane, Victoria
and Durrani, Hammad
and Wei, Xiaolin",
title="Implementation Science Perspectives on Implementing Telemedicine Interventions for Hypertension or Diabetes Management: Scoping Review",
journal="J Med Internet Res",
year="2023",
month="Mar",
day="14",
volume="25",
pages="e42134",
keywords="telemedicine",
keywords="hypertension",
keywords="diabetes",
keywords="implementation science",
keywords="mobile phone",
abstract="Background: Hypertension and diabetes are becoming increasingly prevalent worldwide. Telemedicine is an accessible and cost-effective means of supporting hypertension and diabetes management, especially as the COVID-19 pandemic has accelerated the adoption of technological solutions for care. However, to date, no review has examined the contextual factors that influence the implementation of telemedicine interventions for hypertension or diabetes worldwide. Objective: We adopted a comprehensive implementation research perspective to synthesize the barriers to and facilitators of implementing telemedicine interventions for the management of hypertension, diabetes, or both. Methods: We performed a scoping review involving searches in Ovid MEDLINE, Embase, CINAHL, Cochrane Library, Web of Science, and Google Scholar to identify studies published in English from 2017 to 2022 describing barriers and facilitators related to the implementation of telemedicine interventions for hypertension and diabetes management. The coding and synthesis of barriers and facilitators were guided by the Consolidated Framework for Implementation Research. Results: Of the 17,687 records identified, 35 (0.2\%) studies were included in our scoping review. We found that facilitators of and barriers to implementation were dispersed across the constructs of the Consolidated Framework for Implementation Research. Barriers related to cost, patient needs and resources (eg, lack of consideration of language needs, culture, and rural residency), and personal attributes of patients (eg, demographics and priorities) were the most common. Facilitators related to the design and packaging of the intervention (eg, user-friendliness), patient needs and resources (eg, personalized information that leveraged existing strengths), implementation climate (eg, intervention embedded into existing infrastructure), knowledge of and beliefs about the intervention (eg, convenience of telemedicine), and other personal attributes (eg, technical literacy) were the most common. Conclusions: Our findings suggest that the successful implementation of telemedicine interventions for hypertension and diabetes requires comprehensive efforts at the planning, execution, engagement, and reflection and evaluation stages of intervention implementation to address challenges at the individual, interpersonal, organizational, and environmental levels. ",
doi="10.2196/42134",
url="https://www.jmir.org/2023/1/e42134",
url="http://www.ncbi.nlm.nih.gov/pubmed/36917174"
}


@Article{info:doi/10.2196/45355,
author="Stojancic, Sofia Rebecca
and Subramaniam, Arvind
and Vuong, Caroline
and Utkarsh, Kumar
and Golbasi, Nuran
and Fernandez, Olivia
and Shah, Nirmish",
title="Predicting Pain in People With Sickle Cell Disease in the Day Hospital Using the Commercial Wearable Apple Watch: Feasibility Study",
journal="JMIR Form Res",
year="2023",
month="Mar",
day="14",
volume="7",
pages="e45355",
keywords="sickle cell disease",
keywords="vaso-occlusive crises",
keywords="mobile health",
keywords="consumer wearable",
keywords="Apple Watch",
keywords="machine learning",
keywords="pain",
keywords="prediction",
keywords="smartwatch",
keywords="wearable",
keywords="predict",
abstract="Background: Sickle cell disease (SCD) is a genetic red blood cell disorder associated with severe complications including chronic anemia, stroke, and vaso-occlusive crises (VOCs). VOCs are unpredictable, difficult to treat, and the leading cause of hospitalization. Recent efforts have focused on the use of mobile health technology to develop algorithms to predict pain in people with sickle cell disease. Combining the data collection abilities of a consumer wearable, such as the Apple Watch, and machine learning techniques may help us better understand the pain experience and find trends to predict pain from VOCs. Objective: The aim of this study is to (1) determine the feasibility of using the Apple Watch to predict the pain scores in people with sickle cell disease admitted to the Duke University SCD Day Hospital, referred to as the Day Hospital, and (2) build and evaluate machine learning algorithms to predict the pain scores of VOCs with the Apple Watch. Methods: Following approval of the institutional review board, patients with sickle cell disease, older than 18 years, and admitted to Day Hospital for a VOC between July 2021 and September 2021 were approached to participate in the study. Participants were provided with an Apple Watch Series 3, which is to be worn for the duration of their visit. Data collected from the Apple Watch included heart rate, heart rate variability (calculated), and calories. Pain scores and vital signs were collected from the electronic medical record. Data were analyzed using 3 different machine learning models: multinomial logistic regression, gradient boosting, and random forest, and 2 null models, to assess the accuracy of pain scores. The evaluation metrics considered were accuracy (F1-score), area under the receiving operating characteristic curve, and root-mean-square error (RMSE). Results: We enrolled 20 patients with sickle cell disease, all of whom identified as Black or African American and consisted of 12 (60\%) females and 8 (40\%) males. There were 14 individuals diagnosed with hemoglobin type SS (70\%). The median age of the population was 35.5 (IQR 30-41) years. The median time each individual spent wearing the Apple Watch was 2 hours and 17 minutes and a total of 15,683 data points were collected across the population. All models outperformed the null models, and the best-performing model was the random forest model, which was able to predict the pain scores with an accuracy of 84.5\%, and a RMSE of 0.84. Conclusions: The strong performance of the model in all metrics validates feasibility and the ability to use data collected from a noninvasive device, the Apple Watch, to predict the pain scores during VOCs. It is a novel and feasible approach and presents a low-cost method that could benefit clinicians and individuals with sickle cell disease in the treatment of VOCs. ",
doi="10.2196/45355",
url="https://formative.jmir.org/2023/1/e45355",
url="http://www.ncbi.nlm.nih.gov/pubmed/36917171"
}


@Article{info:doi/10.2196/40285,
author="Bonn, E. Stephanie
and Alexandrou, Christina
and Trolle Lagerros, Ylva",
title="A Digital Platform and Smartphone App to Increase Physical Activity in Patients With Type 2 Diabetes: Overview Of a Technical Solution",
journal="JMIR Form Res",
year="2023",
month="Mar",
day="14",
volume="7",
pages="e40285",
keywords="methods",
keywords="mHealth",
keywords="mobile app",
keywords="self-management",
keywords="smartphone",
keywords="digital",
keywords="platform",
keywords="physical activity",
keywords="diabetes",
keywords="technical",
keywords="engagement",
keywords="self-care",
keywords="development",
keywords="app",
keywords="walking",
keywords="effective",
abstract="International Registered Report Identifier (IRRID): RR2-10.1186/s12889-018-5026-4 ",
doi="10.2196/40285",
url="https://formative.jmir.org/2023/1/e40285",
url="http://www.ncbi.nlm.nih.gov/pubmed/36917156"
}


@Article{info:doi/10.2196/34331,
author="Lentferink, Aniek
and Oldenhuis, Hilbrand
and Velthuijsen, Hugo
and van Gemert-Pijnen, Lisette",
title="How Reflective Automated e-Coaching Can Help Employees Improve Their Capacity for Resilience: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2023",
month="Mar",
day="10",
volume="10",
pages="e34331",
keywords="self-reflection",
keywords="stress management",
keywords="resilience",
keywords="eHealth",
keywords="self-tracking",
keywords="e-Coaching",
keywords="mobile phone",
abstract="Background: An eHealth tool that coaches employees through the process of reflection has the potential to support employees with moderate levels of stress to increase their capacity for resilience. Most eHealth tools that include self-tracking summarize the collected data for the users. However, users need to gain a deeper understanding of the data and decide upon the next step to take through self-reflection. Objective: In this study, we aimed to examine the perceived effectiveness of the guidance offered by an automated e-Coach during employees' self-reflection process in gaining insights into their situation and on their perceived stress and resilience capacities and the usefulness of the design elements of the e-Coach during this process. Methods: Of the 28 participants, 14 (50\%) completed the 6-week BringBalance program that allowed participants to perform reflection via four phases: identification, strategy generation, experimentation, and evaluation. Data collection consisted of log data, ecological momentary assessment (EMA) questionnaires for reflection provided by the e-Coach, in-depth interviews, and a pre- and posttest survey (including the Brief Resilience Scale and the Perceived Stress Scale). The posttest survey also asked about the utility of the elements of the e-Coach for reflection. A mixed methods approach was followed. Results: Pre- and posttest scores on perceived stress and resilience were not much different among completers (no statistical test performed). The automated e-Coach did enable users to gain an understanding of factors that influenced their stress levels and capacity for resilience (identification phase) and to learn the principles of useful strategies to improve their capacity for resilience (strategy generation phase). Design elements of the e-Coach reduced the reflection process into smaller steps to re-evaluate situations and helped them to observe a trend (identification phase). However, users experienced difficulties integrating the chosen strategies into their daily life (experimentation phase). Moreover, the identified events related to stress and resilience were too specific through the guidance offered by the e-Coach (identification phase), and the events did not recur, which consequently left users unable to sufficiently practice (strategy generation phase), experiment (experimentation phase), and evaluate (evaluation phase) the techniques during meaningful events. Conclusions: Participants were able to perform self-reflection under the guidance of the automated e-Coach, which often led toward gaining new insights. To improve the reflection process, more guidance should be offered by the e-Coach that would aid employees to identify events that recur in daily life. Future research could study the effects of the suggested improvements on the quality of reflection via an automated e-Coach. ",
doi="10.2196/34331",
url="https://humanfactors.jmir.org/2023/1/e34331",
url="http://www.ncbi.nlm.nih.gov/pubmed/36897635"
}


@Article{info:doi/10.2196/44254,
author="Pelletier, Cynthia
and Chabot, Christian
and Gagnon, Marie-Pierre
and Rh{\'e}aume, Caroline",
title="Implementing an Activity Tracker to Increase Motivation for Physical Activity in Patients With Diabetes in Primary Care: Strengths, Weaknesses, Opportunities and Threats (SWOT) Analysis",
journal="JMIR Form Res",
year="2023",
month="Mar",
day="10",
volume="7",
pages="e44254",
keywords="activity tracker",
keywords="type 2 diabetes",
keywords="family medicine research",
keywords="SWOT analysis",
keywords="physical activity",
keywords="physical activity motivation",
keywords="diabetes",
keywords="implementation",
keywords="chronic disease",
keywords="intervention",
keywords="questionnaire",
keywords="tool",
abstract="Background: Many projects related to technology implementation in the context of chronic diseases have been developed over the years to better manage lifestyle medicine interventions and improve patient care. However, technology implementation in primary care settings remains challenging. Objective: The aim is to carry out a strengths, weaknesses, opportunities, and threats (SWOT) analysis (1) to assess satisfaction among patients with type 2 diabetes using an activity tracker to increase motivation for physical activity (PA) and (2) to explore the research and health care team's perceptions of this technology's implementation in a primary care setting. Methods: A 3-month hybrid type 1 study, which included 2 stages, was conducted in an academic primary health center in Quebec City, Quebec, Canada. In stage 1, a total of 30 patients with type 2 diabetes were randomized to the intervention (activity tracker) group or the control group. In stage 2, a SWOT analysis was performed on both patients and health care professionals to determine the components of successful technology implementation. Two questionnaires were used to gather feedback: a satisfaction and acceptability questionnaire concerning an activity tracker (15 patients in the intervention group) and a questionnaire based on the SWOT elements (15 patients in the intervention group and 7 health care professionals). Both questionnaires contained quantitative and qualitative questions. Qualitative variables from open questions were synthesized in a matrix and ranked according to apparition frequency and global importance. A thematic analysis was performed by the first author and validated by 2 coauthors separately. The information gathered was triangulated to propose recommendations that were then approved by the team. Both quantitative (randomized controlled trial participants) and qualitative (randomized controlled trial participants and team) results were combined for recommendations. Results: In total, 86\% (12/14) of the participants were satisfied with their activity tracker use and 75\% (9/12) felt that it incited them to stick to their PA program. The main strengths of the team members' perspectives were the project initiation and involvement of a patient partner, the study design, the team, and the device. The weaknesses were the budgetary constraints, the turnover, and the technical issues. The opportunities were the primary care setting, the loan of equipment, and common technology. The threats were recruitment issues, administrative challenges, technological difficulties, and a single research site. Conclusions: Patients with type 2 diabetes were satisfied with their activity tracker used to improve motivation for PA. Health care team members agreed that implementation can be done in primary care, but some challenges remain in using this technological tool in clinical practice regularly. Trial Registration: ClinicalTrials.gov NCT03709966; https://clinicaltrials.gov/ct2/show/NCT03709966 ",
doi="10.2196/44254",
url="https://formative.jmir.org/2023/1/e44254",
url="http://www.ncbi.nlm.nih.gov/pubmed/36897642"
}


@Article{info:doi/10.2196/43675,
author="Eyles, Helen
and Grey, Jacqueline
and Jiang, Yannan
and Umali, Elaine
and McLean, Rachael
and Te Morenga, Lisa
and Neal, Bruce
and Rodgers, Anthony
and Doughty, N. Robert
and Ni Mhurchu, Cliona",
title="Effectiveness of a Sodium-Reduction Smartphone App and Reduced-Sodium Salt to Lower Sodium Intake in Adults With Hypertension: Findings From the Salt Alternatives Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Mar",
day="9",
volume="11",
pages="e43675",
keywords="mobile health",
keywords="mHealth",
keywords="smartphone",
keywords="smartphone app",
keywords="cardiovascular disease",
keywords="sodium",
keywords="salt",
keywords="blood pressure",
keywords="technology",
keywords="reduced-sodium salt",
keywords="mobile phone",
abstract="Background: Even modest reductions in blood pressure (BP) can have an important impact on population-level morbidity and mortality from cardiovascular disease. There are 2 promising approaches: the SaltSwitch smartphone app, which enables users to scan the bar code of a packaged food using their smartphone camera and receive an immediate, interpretive traffic light nutrition label on-screen alongside a list of healthier, lower-salt options in the same food category; and reduced-sodium salts (RSSs), which are an alternative to regular table salt that are lower in sodium and higher in potassium but have a similar mouthfeel, taste, and flavor. Objective: Our aim was to determine whether a 12-week intervention with a sodium-reduction package comprising the SaltSwitch smartphone app and an RSS could reduce urinary sodium excretion in adults with high BP. Methods: A 2-arm parallel randomized controlled trial was conducted in New Zealand (target n=326). Following a 2-week baseline period, adults who owned a smartphone and had high BP (?140/85 mm Hg) were randomized in a 1:1 ratio to the intervention (SaltSwitch smartphone app + RSS) or control (generic heart-healthy eating information from The Heart Foundation of New Zealand). The primary outcome was 24-hour urinary sodium excretion at 12 weeks estimated via spot urine. Secondary outcomes were urinary potassium excretion, BP, sodium content of food purchases, and intervention use and acceptability. Intervention effects were assessed blinded using intention-to-treat analyses with generalized linear regression adjusting for baseline outcome measures, age, and ethnicity. Results: A total of 168 adults were randomized (n=84, 50\% per group) between June 2019 and February 2020. Challenges associated with the COVID-19 pandemic and smartphone technology detrimentally affected recruitment. The adjusted mean difference between groups was 547 (95\% CI ?331 to 1424) mg for estimated 24-hour urinary sodium excretion, 132 (95\% CI ?1083 to 1347) mg for urinary potassium excretion, ?0.66 (95\% CI ?3.48 to 2.16) mm Hg for systolic BP, and 73 (95\% CI ?21 to 168) mg per 100 g for the sodium content of food purchases. Most intervention participants reported using the SaltSwitch app (48/64, 75\%) and RSS (60/64, 94\%). SaltSwitch was used on 6 shopping occasions, and approximately 1/2 tsp per week of RSS was consumed per household during the intervention. Conclusions: In this randomized controlled trial of a salt-reduction package, we found no evidence that dietary sodium intake was reduced in adults with high BP. These negative findings may be owing to lower-than-anticipated engagement with the trial intervention package. However, implementation and COVID-19--related challenges meant that the trial was underpowered, and it is possible that a real effect may have been missed. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000352101; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377044 and Universal Trial U1111-1225-4471 ",
doi="10.2196/43675",
url="https://mhealth.jmir.org/2023/1/e43675",
url="http://www.ncbi.nlm.nih.gov/pubmed/36892914"
}


@Article{info:doi/10.2196/38506,
author="Weigandt, Alexander Wanja
and Schardt, Yannic
and Bruch, Aimee
and Herr, Raphael
and Goebeler, Matthias
and Benecke, Johannes
and Schmieder, Astrid",
title="Impact of an eHealth Smartphone App on Quality of Life and Clinical Outcome of Patients With Hand and Foot Eczema: Prospective Randomized Controlled Intervention Study",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Mar",
day="7",
volume="11",
pages="e38506",
keywords="hand and foot eczema",
keywords="eHealth",
keywords="mobile health",
keywords="mHealth",
keywords="telemedicine",
keywords="disease management",
keywords="smartphone app",
keywords="mobile phone",
abstract="Background: Chronic hand and foot eczema is a polyetiological dermatological condition. Patients experience pain, itching, and sleep disturbances and have a reduced quality of life. Skin care programs and patient education can improve the clinical outcome. eHealth devices offer a new opportunity to better inform and monitor patients. Objective: This study aimed to systematically analyze the effect of a monitoring smartphone app combined with patient education on the quality of life and clinical outcome of patients with hand and foot eczema. Methods: Patients in the intervention group received an educational program; attended study visits on weeks 0, 12, and 24; and had access to the study app. Patients in the control group attended the study visits only. The primary end point was a statistically significant reduction in Dermatology Life Quality Index, pruritus, and pain at weeks 12 and 24. The secondary end point was a statistically significant reduction in the modified Hand Eczema Severity Index (HECSI) score at weeks 12 and 24. This is an interim analysis at week 24 of the 60-week randomized controlled study. Results: In total, 87 patients were included in the study and randomized to the intervention group (n=43, 49\%) or control group (n=44, 51\%). Of the 87 patients, 59 (68\%) completed the study visit at week 24. There were no significant differences between the intervention and control groups regarding quality of life, pain, itch, activity, and clinical outcome at weeks 12 and 24. Subgroup analysis revealed that, compared with the control group, the intervention group with an app use frequency of fewer than once every 5 weeks had a significant improvement in the Dermatology Life Quality Index at weeks 12 (P=.001) and 24 (P=.05), in pain measured on a numeric rating scale at weeks 12 (P=.02) and 24 (P=.02), and in the HECSI score at week 12 (P=.02). In addition, the HECSI scores assessed on the basis of pictures taken by the patients of their hands and feet correlated strongly with the HECSI scores recorded by physicians during regular personal visits (r=0.898; P=.002) even when the quality of the images was not that good. Conclusions: An educational program combined with a monitoring app that connects patients with their treating dermatologists can improve quality of life if the app is not used too frequently. In addition, telemedical care can at least partially replace personal care in patients with hand and foot eczema because the analysis of the pictures taken by the patients correlates strongly with that of the in vivo images. A monitoring app such as the one presented in this study has the potential to improve patient care and should be implemented in daily practice. Trial Registration: Deutsches Register Klinischer Studien DRKS00020963; https://drks.de/search/de/trial/DRKS00020963 ",
doi="10.2196/38506",
url="https://mhealth.jmir.org/2023/1/e38506",
url="http://www.ncbi.nlm.nih.gov/pubmed/36881465"
}


@Article{info:doi/10.2196/41115,
author="Leiner, Johannes
and K{\"o}nig, Sebastian
and Mouratis, Konstantinos
and Kim, Igor
and Schmitz, Pia
and Joshi, Tanvi
and Schanner, Carolin
and Wohlrab, Lisa
and Hohenstein, Sven
and Pellissier, Vincent
and Nitsche, Anne
and Kuhlen, Ralf
and Hindricks, Gerhard
and Bollmann, Andreas",
title="A Digital Infrastructure for Cardiovascular Patient Care Based on Mobile Health Data and Patient-Reported Outcomes: Concept Details of the Helios TeleWear Project Including Preliminary Experiences",
journal="JMIR Form Res",
year="2023",
month="Mar",
day="3",
volume="7",
pages="e41115",
keywords="mHealth",
keywords="wearable",
keywords="patient-reported outcomes",
keywords="electrocardiogram",
keywords="cardiovascular disease",
keywords="atrial fibrillation",
keywords="telemedicine",
keywords="mobile health",
keywords="telehealth",
abstract="Background: Mobile health (mHealth) approaches are already having a fundamental impact on clinical practice in cardiovascular medicine. A variety of different health apps and wearable devices for capturing health data such as electrocardiograms (ECGs) exist. However, most mHealth technologies focus on distinct variables without integrating patients' quality of life, and the impact on clinical outcome measures of implementing those digital solutions into cardiovascular health care is still to be determined. Objective: Within this document, we describe the TeleWear project, which was recently initiated as an approach for contemporary patient management integrating mobile-collected health data and the standardized mHealth-guided measurement of patient-reported outcomes (PROs) in patients with cardiovascular disease. Methods: The specifically designed mobile app and clinical frontend form the central elements of our TeleWear infrastructure. Because of its flexible framework, the platform allows far-reaching customization with the possibility to add different mHealth data sources and respective questionnaires (patient-reported outcome measures). Results: With initial focus on patients with cardiac arrhythmias, a feasibility study is currently carried out to assess wearable-recorded ECG and PRO transmission and its evaluation by physicians using the TeleWear app and clinical frontend. First experiences made during the feasibility study yielded positive results and confirmed the platform's functionality and usability. Conclusions: TeleWear represents a unique mHealth approach comprising PRO and mHealth data capturing. With the currently running TeleWear feasibility study, we aim to test and further develop the platform in a real-world setting. A randomized controlled trial including patients with atrial fibrillation that investigates PRO- and ECG-based clinical management based on the established TeleWear infrastructure will evaluate its clinical benefits. Widening the spectrum of health data collection and interpretation beyond the ECG and use of the TeleWear infrastructure in different patient subcohorts with focus on cardiovascular diseases are further milestones of the project with the ultimate goal to establish a comprehensive telemedical center entrenched by mHealth. ",
doi="10.2196/41115",
url="https://formative.jmir.org/2023/1/e41115",
url="http://www.ncbi.nlm.nih.gov/pubmed/36867450"
}


@Article{info:doi/10.2196/34958,
author="O'Connor, Antonia
and Sharrad, Kelsey
and King, Charmaine
and Carson-Chahhoud, Kristin",
title="An Augmented Reality Technology to Provide Demonstrative Inhaler Technique Education for Patients With Asthma: Interview Study Among Patients, Health Professionals, and Key Community Stakeholders",
journal="JMIR Form Res",
year="2023",
month="Mar",
day="2",
volume="7",
pages="e34958",
keywords="augmented reality",
keywords="asthma",
keywords="disease management",
keywords="smartphone",
keywords="inhaler technique",
keywords="mobile phone",
abstract="Background: Many people with asthma use incorrect inhaler technique, resulting in suboptimal disease management and increased health service use. Novel ways of delivering appropriate instructions are needed. Objective: This study explored stakeholder perspectives on the potential use of augmented reality (AR) technology to improve asthma inhaler technique education. Methods: On the basis of existing evidence and resources, an information poster displaying the images of 22 asthma inhaler devices was developed. Using AR technology via a free smartphone app, the poster launched video demonstrations of correct inhaler technique for each device. In total, 21 semistructured, one?on?one interviews with health professionals, people with asthma, and key community stakeholders were conducted, and data were analyzed thematically using the Triandis model of interpersonal behavior. Results: A total of 21 participants were recruited into the study, and data saturation was achieved. People with asthma were confident with inhaler technique (mean score 9.17, SD 1.33, out of 10). However, health professionals and key community stakeholders identified that this perception was misguided (mean 7.25, SD 1.39, and mean 4.5, SD 0.71, for health professionals and key community stakeholders, respectively) and facilitates persistent incorrect inhaler use and suboptimal disease management. Delivering inhaler technique education using AR was favored by all participants (21/21, 100\%), particularly around ease of use, with the ability to visually display inhaler techniques for each device. There was a strongly held belief that the technology has the capacity for improving inhaler technique across all participant groups (mean 9.25, SD 0.89, for participants; mean 9.83, SD 0.41, for health professionals; and mean 9.5, SD 0.71, for key community stakeholders). However, all participants (21/21, 100\%) identified some barriers, particularly regarding access and appropriateness of AR for older people. Conclusions: AR technology may be a novel means to address poor inhaler technique among certain cohorts of patients with asthma and serve as a prompt for health professionals to initiate review of inhaler devices. A randomized controlled trial design is needed to evaluate the efficacy of this technology for use in the clinical care setting. ",
doi="10.2196/34958",
url="https://formative.jmir.org/2023/1/e34958",
url="http://www.ncbi.nlm.nih.gov/pubmed/36862496"
}


@Article{info:doi/10.2196/40921,
author="Ko, Siyeon
and Lee, Jisan
and An, Doyeon
and Woo, Hyekyung",
title="Menstrual Tracking Mobile App Review by Consumers and Health Care Providers: Quality Evaluations Study",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Mar",
day="1",
volume="11",
pages="e40921",
keywords="mobile app",
keywords="period",
keywords="menstrual cycle",
keywords="mHealth",
keywords="mobile health",
keywords="evaluation",
keywords="women's health",
keywords="health care provider",
keywords="consumer",
keywords="menstrual app",
keywords="digital health app",
keywords="health screening",
keywords="consumer satisfaction",
abstract="Background: Women's menstrual cycle is an important component of their overall health. Physiological cycles and associated symptoms can be monitored continuously and used as indicators in various fields. Menstrual apps are accessible and can be used to promote overall female health. However, no study has evaluated these apps' functionality from both consumers' and health care providers' perspectives. As such, the evidence indicating whether the menstrual apps available on the market provide user satisfaction is insufficient. Objective: This study was performed to investigate the key content and quality of menstrual apps from the perspectives of health care providers and consumers. We also analyzed the correlations between health care provider and consumer evaluation scores. On the basis of this analysis, we offer technical and policy recommendations that could increase the usability and convenience of future app. Methods: We searched the Google Play Store and iOS App Store using the keywords ``period'' and ``menstrual cycle'' in English and Korean and identified relevant apps. An app that met the following inclusion criteria was selected as a research app: nonduplicate; with >10,000 reviews; last updated ?180 days ago; relevant to this topic; written in Korean or English; available free of charge; and currently operational. App quality was evaluated by 6 consumers and 4 health care providers using Mobile Application Rating Scale (MARS) and user version of the Mobile Application Rating Scale (uMARS). We then analyzed the correlations among MARS scores, uMARS scores, star ratings, and the number of reviews. Results: Of the 34 apps, 31 (91\%) apps could be used to predict the menstrual cycle, and 2 (6\%) apps provided information pertinent to health screening. All apps that scored highly in the MARS evaluation offer a symptom logging function and provide the user with personalized notifications. The ``Bom Calendar'' app had the highest MARS (4.51) and uMARS (4.23) scores. The MARS (2.22) and uMARS (4.15) scores for the ``Menstrual calendar---ovulation \& pregnancy calendar'' app were different. In addition, there was no relationship between MARS and uMARS scores (r=0.32; P=.06). Conclusions: We compared consumer and health care provider ratings for menstrual apps. Continuous monitoring of app quality from consumer and health care provider perspectives is necessary to guide their development and update content. ",
doi="10.2196/40921",
url="https://mhealth.jmir.org/2023/1/e40921",
url="http://www.ncbi.nlm.nih.gov/pubmed/36857125"
}


@Article{info:doi/10.2196/44277,
author="Nevoret, Camille
and Gervaise, Nathalie
and Delemer, Brigitte
and Bekka, Said
and Detournay, Bruno
and Benkhelil, Amine
and Bahloul, Amar
and d'Orsay, Genevi{\`e}ve
and Penfornis, Alfred",
title="The Effectiveness of an App (Insulia) in Recommending Basal Insulin Doses for French Patients With Type 2 Diabetes Mellitus: Longitudinal Observational Study",
journal="JMIR Diabetes",
year="2023",
month="Mar",
day="1",
volume="8",
pages="e44277",
keywords="diabetes mellitus",
keywords="insulin",
keywords="medical informatics apps",
keywords="telemedicine",
keywords="mobile health",
keywords="mobile health intervention",
keywords="health app",
keywords="digital monitoring",
keywords="remote monitoring",
keywords="virtual care",
keywords="clinical algorithm",
abstract="Background: For patients with type 2 diabetes (T2D), calculating the daily dose of basal insulin may be challenging. Insulia is a digital remote monitoring solution that uses clinical algorithms to recommend basal insulin doses. A predecessor device was evaluated in the TeleDiab-2 randomized controlled trial, showing that a higher percentage of patients using the app achieved their target fasting blood glucose (FBG) level compared to the control group, and insulin doses were adjusted to higher levels without hypoglycemia. Objective: This study aims to analyze how the glycemic control of Insulia users has evolved when using the app in a real-life setting in France. Methods: A retrospective observational analysis of data collected through the device in adult French patients with T2D treated with basal insulin and oral antihyperglycemic agents using the system for ?6 months was conducted. Analyses were descriptive and distinguished the results in a subpopulation of regular and compliant users of the app. Glycemic outcomes were estimated considering the percentage of patients who achieved their individualized FBG target between 5.5 and 6 months following the initiation of device use, the frequency of hypoglycemia resulting in a treatment change over the 6-month period of exposure, and the evolution of the average hemoglobin A1c (HbA1c) level over the same period. Results: Of the 484 users, 373 (77.1\%) performed at least one dose calculation. A total of 221 (59.2\%) users were men. When app use started, the mean age, BMI, HbA1c, and basal insulin dose were 55.8 (SD 11.9) years, 30.6 (SD 5.9) kg/m2, 10.1\% (SD 2.0\%), and 25.5 (SD 15.8) IU/day, respectively. Over a median use duration of 5.0 (95\% CI 3.8-5.7) months, patients used the system 5.8 (SD 1.6) times per week on average, and 73.4\% of their injected doses were consistent with the app's suggested doses. Among regular and compliant user patients (n=91, ?5 measurements/week and ?80\% adherence to calculated doses), 60\% (55/91) achieved the FBG target ({\textpm}5\%) at 6 months (5.5-6 months) versus 51.5\% (145/282) of the other patients (P=.15). There was an increase in the proportion of patients achieving their target FBG for regular and compliant users (+1.86\% every 2 weeks) without clear improvement in other patients. A logistic model did not identify the variables that were significantly associated with this outcome among regular and compliant users. In the overall population, the incidence of reported hypoglycemia decreased simultaneously (--0.16\%/month). Among 82 patients, the mean HbA1c decreased from 9.9\% to 7.2\% at 6 months. Conclusions: An improvement in glycemic control as measured by the percentage of patients reaching their FBG individualized target range without increasing hypoglycemic risk was observed in patients using the Insulia app, especially among regular users following the dose recommendations of the algorithm. ",
doi="10.2196/44277",
url="https://diabetes.jmir.org/2023/1/e44277",
url="http://www.ncbi.nlm.nih.gov/pubmed/36749650"
}


@Article{info:doi/10.2196/39389,
author="Guardado Medina, Sharon
and Isomursu, Minna",
title="The Use of Patient-Generated Health Data From Consumer-Grade Mobile Devices in Clinical Workflows: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2023",
month="Feb",
day="27",
volume="12",
pages="e39389",
keywords="patient-generated health data",
keywords="mobile health",
keywords="mHealth",
keywords="health care professional",
keywords="mobile technology",
keywords="health self-management",
keywords="smartphone",
keywords="mobile phone",
keywords="condition",
keywords="care",
keywords="intervention",
keywords="support",
keywords="control",
keywords="clinical",
keywords="literature",
keywords="data",
keywords="devices",
keywords="review",
keywords="meta-analysis",
keywords="PubMed",
keywords="Scopus",
keywords="integration",
keywords="electronic",
keywords="treatment",
abstract="Background: With the rapid advancement of mobile technology, the scope of mobile health (mHealth) has expanded to include consumer-grade devices such as smartphones and wearable sensors. These solutions have typically been used for fitness purposes; however, due to their ubiquitous capabilities for data collection, they have the potential to bridge information gaps and supplement data from clinical visits. Patient-generated health data (PGHD) can be derived from mHealth solutions and be used by health care professionals (HCPs) as complementary tools in the care process, yet their integration into clinical workflows presents a myriad of challenges. PGHD might be a new and unfamiliar source of information for most HCPs, and the majority of mHealth solutions have not been designed to be used by HCPs as active reviewers. As mHealth solutions become more available and attractive to patients, HCPs may see an increase in the influx of data and related inquiries from their patients. This mismatch in expectations can result in disruptions to clinical workflows and negatively impact patient-clinician relationships. For PGHD to be integrated into clinical workflows, its use should be proven beneficial for both patients and HCPs. However, so far, only limited research has been done on the concrete experiences of HCPs as active reviewers of PGHD from consumer-grade mobile devices. Objective: We aimed to systematically guide the review of existing literature to identify what types of PGHD from consumer-grade mobile devices are currently being used by HCPs as complementary tools in the care process. Methods: The PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) 2015 was followed for the design of the search, selection, and data synthesis processes. Electronic searches will be done on PubMed, ACM Digital Library, IEEE Xplore, and Scopus. Results: Preliminary searches have been conducted, and previous related systematic and scoping reviews have been found and evaluated. The review is expected to be completed in February 2023. Conclusions: This protocol will guide the review of existing literature on the use of PGHD produced by consumer-grade mobile devices. Although there have been previous reviews related to this topic, our proposed approach seeks to understand the specific opinions and experiences of different types of HCPs who are already using PGHD in their clinical practice and the motives for deeming these data useful and worth reviewing. Depending on the studies that will be included, there may be an opportunity to provide a wider understanding of what types of HCPs trust PGHD, despite the possible challenges that its use might convey, potentially contributing with the knowledge to support the design strategies of mHealth tools that could be integrated into clinical workflows. International Registered Report Identifier (IRRID): PRR1-10.2196/39389 ",
doi="10.2196/39389",
url="https://www.researchprotocols.org/2023/1/e39389",
url="http://www.ncbi.nlm.nih.gov/pubmed/36848208"
}


@Article{info:doi/10.2196/35917,
author="Abdolkhani, Robab
and Gray, Kathleen
and Borda, Ann
and DeSouza, Ruth",
title="Recommendations for the Quality Management of Patient-Generated Health Data in Remote Patient Monitoring: Mixed Methods Study",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Feb",
day="24",
volume="11",
pages="e35917",
keywords="data quality management",
keywords="patient-generated health data",
keywords="remote patient monitoring",
keywords="wearable electronic devices",
keywords="remote sensing technology",
keywords="telemedicine",
keywords="big data",
abstract="Background: Patient-generated health data (PGHD) collected from innovative wearables are enabling health care to shift to outside clinical settings through remote patient monitoring (RPM) initiatives. However, PGHD are collected continuously under the patient's responsibility in rapidly changing circumstances during the patient's daily life. This poses risks to the quality of PGHD and, in turn, reduces their trustworthiness and fitness for use in clinical practice. Objective: Using a sociotechnical health informatics lens, we developed a data quality management (DQM) guideline for PGHD captured from wearable devices used in RPM with the objective of investigating how DQM principles can be applied to ensure that PGHD can reliably inform clinical decision-making in RPM. Methods: First, clinicians, health information specialists, and MedTech industry representatives with experience in RPM were interviewed to identify DQM challenges. Second, these stakeholder groups were joined by patient representatives in a workshop to co-design potential solutions to meet the expectations of all the stakeholders. Third, the findings, along with the literature and policy review results, were interpreted to construct a guideline. Finally, we validated the guideline through a Delphi survey of international health informatics and health information management experts. Results: The guideline constructed in this study comprised 19 recommendations across 7 aspects of DQM. It explicitly addressed the needs of patients and clinicians but implied that there must be collaboration among all stakeholders to meet these needs. Conclusions: The increasing proliferation of PGHD from wearables in RPM requires a systematic approach to DQM so that these data can be reliably used in clinical care. The developed guideline is an important next step toward safe RPM. ",
doi="10.2196/35917",
url="https://mhealth.jmir.org/2023/1/e35917",
url="http://www.ncbi.nlm.nih.gov/pubmed/36826986"
}


@Article{info:doi/10.2196/38592,
author="Fu, C. Helen N.
and Wyman, F. Jean
and Peden-McAlpine, J. Cynthia
and Draucker, Burke Claire
and Schleyer, Titus
and Adam, J. Terrence",
title="App Design Features Important for Diabetes Self-management as Determined by the Self-Determination Theory on Motivation: Content Analysis of Survey Responses From Adults Requiring Insulin Therapy",
journal="JMIR Diabetes",
year="2023",
month="Feb",
day="24",
volume="8",
pages="e38592",
keywords="diabetes app",
keywords="mobile health",
keywords="mHealth",
keywords="diabetes",
keywords="diabetic",
keywords="health app",
keywords="self-management",
keywords="motivation",
keywords="competence",
keywords="autonomy",
keywords="connectivity",
keywords="self-determination theory",
keywords="insulin",
keywords="glycemic control",
keywords="glucose",
keywords="blood sugar",
keywords="design",
keywords="user need",
keywords="qualitative",
keywords="randomized trial",
abstract="Background: Using a diabetes app can improve glycemic control; however, the use of diabetes apps is low, possibly due to design issues that affect patient motivation. Objective: This study aimed to describes how adults with diabetes requiring insulin perceive diabetes apps based on 3 key psychological needs (competence, autonomy, and connectivity) described by the Self-Determination Theory (SDT) on motivation. Methods: This was a qualitative analysis of data collected during a crossover randomized laboratory trial (N=92) testing 2 diabetes apps. Data sources included (1) observations during app testing and (2) survey responses on desired app features. Guided by the SDT, coding categories included app functions that could address psychological needs for motivation in self-management: competence, autonomy, and connectivity. Results: Patients described design features that addressed needs for competence, autonomy, and connectivity. To promote competence, electronic data recording and analysis should help patients track and understand blood glucose (BG) results necessary for planning behavior changes. To promote autonomy, BG trend analysis should empower patients to set safe and practical personalized behavioral goals based on time and the day of the week. To promote connectivity, app email or messaging function could share data reports and communicate with others on self-management advice. Additional themes that emerged are the top general app designs to promote positive user experience: patient-friendly; automatic features of data upload; voice recognition to eliminate typing data; alert or reminder on self-management activities; and app interactivity of a sound, message, or emoji change in response to keeping or not keeping BG in the target range. Conclusions: The application of the SDT was useful in identifying motivational app designs that address the psychological needs of competence, autonomy, and connectivity. User-centered design concepts, such as being patient-friendly, differ from the SDT because patients need a positive user experience (ie, a technology need). Patients want engaging diabetes apps that go beyond data input and output. Apps should be easy to use, provide personalized analysis reports, be interactive to affirm positive behaviors, facilitate data sharing, and support patient-clinician communication. ",
doi="10.2196/38592",
url="https://diabetes.jmir.org/2023/1/e38592",
url="http://www.ncbi.nlm.nih.gov/pubmed/36826987"
}


@Article{info:doi/10.2196/43522,
author="Yang, Seongwoo
and Bui, Nhung Cam
and Park, Kyounghoon",
title="Mobile Health Apps for Breast Cancer: Content Analysis and Quality Assessment",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Feb",
day="23",
volume="11",
pages="e43522",
keywords="app",
keywords="breast cancer",
keywords="quality assessment",
keywords="mobile health",
keywords="mHealth",
keywords="digital health",
keywords="digital health intervention",
keywords="cancer management",
keywords="tablet",
keywords="prevention",
keywords="survivor",
keywords="peer-support",
abstract="Background: The number of mobile health apps is rapidly increasing. This means that consumers are faced with a bewildering array of choices, and finding the benefit of such apps may be challenging. The significant international burden of breast cancer (BC) and the potential of mobile health apps to improve medical and public health practices mean that such apps will likely be important because of their functionalities in daily life. As the app market has grown exponentially, several review studies have scrutinized cancer- or BC-related apps. However, those reviews concentrated on the availability of the apps and relied on user ratings to decide on app quality. To minimize subjectivity in quality assessment, quantitative methods to assess BC-related apps are required. Objective: The purpose of this study is to analyze the content and quality of BC-related apps to provide useful information for end users and clinicians. Methods: Based on a stepwise systematic approach, we analyzed apps related to BC, including those related to prevention, detection, treatment, and survivor support. We used the keywords ``breast cancer'' in English and Korean to identify commercially available apps in the Google Play and App Store. The apps were then independently evaluated by 2 investigators to determine their eligibility for inclusion. The content and quality of the apps were analyzed using objective frameworks and the Mobile App Rating Scale (MARS), respectively. Results: The initial search identified 1148 apps, 69 (6\%) of which were included. Most BC-related apps provided information, and some recorded patient-generated health data, provided psychological support, and assisted with medication management. The Kendall coefficient of concordance between the raters was 0.91 (P<.001). The mean MARS score (range: 1-5) of the apps was 3.31 (SD 0.67; range: 1.94-4.53). Among the 5 individual dimensions, functionality had the highest mean score (4.37, SD 0.42) followed by aesthetics (3.74, SD 1.14). Apps that only provided information on BC prevention or management of its risk factors had lower MARS scores than those that recorded medical data or patient-generated health data. Apps that were developed >2 years ago, or by individuals, had significantly lower MARS scores compared to other apps (P<.001). Conclusions: The quality of BC-related apps was generally acceptable according to the MARS, but the gaps between the highest- and lowest-rated apps were large. In addition, apps using personalized data were of higher quality than those merely giving related information, especially after treatment in the cancer care continuum. We also found that apps that had been updated within 1 year and developed by private companies had higher MARS scores. This may imply that there are criteria for end users and clinicians to help choose the right apps for better clinical outcomes. ",
doi="10.2196/43522",
url="https://mhealth.jmir.org/2023/1/e43522",
url="http://www.ncbi.nlm.nih.gov/pubmed/36821352"
}


@Article{info:doi/10.2196/37987,
author="Tesema, Naomi
and Guillaume, Dominique
and Francis, Sherilyn
and Paul, Sudeshna
and Chandler, Rasheeta",
title="Mobile Phone Apps for HIV Prevention Among College-Aged Black Women in Atlanta: Mixed Methods Study and User-Centered Prototype",
journal="JMIR Form Res",
year="2023",
month="Feb",
day="23",
volume="7",
pages="e37987",
keywords="Black women",
keywords="HIV prevention",
keywords="mobile health",
keywords="mHealth app",
keywords="mobile technology",
keywords="reproductive health",
keywords="women's health",
abstract="Background: Black women in college are disproportionately affected by HIV diagnoses. Mobile apps can facilitate the innovative delivery of accurate HIV and sexual and reproductive health information. However, mobile health interventions are severely underused in this population. Objective: We aimed to quantitatively and qualitatively explore the perspectives of college-aged Black women on using a mobile health app for HIV prevention and sexual and reproductive health. The data obtained from Black women were used to design preliminary mobile app wireframes and features. Methods: This explanatory, sequential mixed methods study took place from 2019 to 2020 and targeted Black women who were enrolled in college or who had recently graduated from college. Convenience sampling was used during the quantitative phase, followed by purposive sampling in the qualitative phase. A cross-sectional web-based survey evaluating the willingness to use a mobile app for HIV prevention was conducted in the quantitative phase. Descriptive statistics were used for all variables. A separate focus group discussion was conducted with Black women in college to expand on the quantitative results. Focus group discussions explored their perceptions on HIV and health content delivered through a mobile app along with potential features that participants desired within the app. Using the data obtained, we selected the primary features for the app prototype. Results: In total, we enrolled 34 participants in the survey, with 6 participating in focus group discussions. Over half of the respondents reported a willingness to use an app that contained pre-exposure prophylaxis content. Women who claimed recent sexual activity reported being more likely to use an app feature that would allow them to order an at-home HIV testing kit than their non--sexually active counterparts. The emerging themes from the focus group session were Black women's health concerns, HIV risk, sources of health information, and preferred app features. The content in our prototype included speaking with a specialist, HIV and pre-exposure prophylaxis information, holistic wellness, and features promoting engagement and retention. Conclusions: The results of our study guided the design of wireframes for an app prototype targeting HIV prevention in college-aged Black women. The rapid growth of mobile devices in Black communities, coupled with high rates of smartphone ownership among Black youth, makes mobile health interventions a promising strategy for addressing sexual and reproductive health disparities. Participants in our sample were willing to use a culturally appropriate and gender-considerate app for their sexual health needs. Our findings indicate that Black women in college may be excellent candidates for mobile app--based interventions. ",
doi="10.2196/37987",
url="https://formative.jmir.org/2023/1/e37987",
url="http://www.ncbi.nlm.nih.gov/pubmed/36821362"
}


@Article{info:doi/10.2196/39093,
author="Yang, Lin
and Kuang, Angela
and Xu, Claire
and Shewchuk, Brittany
and Singh, Shaminder
and Quan, Hude
and Zeng, Yong",
title="Design Principles in mHealth Interventions for Sustainable Health Behavior Changes: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2023",
month="Feb",
day="22",
volume="12",
pages="e39093",
keywords="behavior change",
keywords="intervention",
keywords="mHealth",
keywords="personalization",
keywords="dialogue",
keywords="mobile health",
keywords="mobile app",
keywords="self-management",
abstract="Background: In recent years, mHealth has increasingly been used to deliver behavioral interventions for disease prevention and self-management. Computing power in mHealth tools can provide unique functions beyond conventional interventions in provisioning personalized behavior change recommendations and delivering them in real time, supported by dialogue systems. However, design principles to incorporate these features in mHealth interventions have not been systematically evaluated. Objective: The goal of this review is to identify best practices for the design of mHealth interventions targeting diet, physical activity, and sedentary behavior. We aim to identify and summarize the design characteristics of current mHealth tools with a focus on the following features: (1) personalization, (2) real-time functions, and (3) deliverable resources. Methods: We will conduct a systematic search of electronic databases, including MEDLINE, CINAHL, Embase, PsycINFO, and Web of Science for studies published since 2010. First, we will use keywords that combine mHealth, interventions, chronic disease prevention, and self-management. Second, we will use keywords that cover diet, physical activity, and sedentary behavior. Literature found in the first and second steps will be combined. Finally, we will use keywords for personalization and real-time functions to limit the results to interventions that have reported these design features. We expect to perform narrative syntheses for each of the 3 target design features. Study quality will be evaluated using the Risk of Bias 2 assessment tool. Results: We have conducted a preliminary search of existing systematic reviews and review protocols on mHealth-supported behavior change interventions. We have identified several reviews that aimed to evaluate the efficacy of mHealth behavior change interventions in a range of populations, evaluate methodologies for assessing mHealth behavior change randomized trials, and assess the diversity of behavior change techniques and theories in mHealth interventions. However, syntheses on the unique features of mHealth intervention design are absent in the literature. Conclusions: Our findings will provide a basis for developing best practices for designing mHealth tools for sustainable behavior change. Trial Registration: PROSPERO CRD42021261078; https://tinyurl.com/m454r65t International Registered Report Identifier (IRRID): PRR1-10.2196/39093 ",
doi="10.2196/39093",
url="https://www.researchprotocols.org/2023/1/e39093",
url="http://www.ncbi.nlm.nih.gov/pubmed/36811938"
}


@Article{info:doi/10.2196/40389,
author="Oteo, Alberto
and Daneshvar, Hadi
and Baldacchino, Alexander
and Matheson, Catriona",
title="Overdose Alert and Response Technologies: State-of-the-art Review",
journal="J Med Internet Res",
year="2023",
month="Feb",
day="15",
volume="25",
pages="e40389",
keywords="drug overdose",
keywords="technology",
keywords="opioids",
keywords="telemedicine",
keywords="mobile health",
keywords="mHealth",
keywords="apnea",
keywords="sensor",
keywords="naloxone",
keywords="mobile phone",
abstract="Background: Drug overdose deaths, particularly from opioids, are a major global burden, with 128,000 deaths estimated in 2019. Opioid overdoses can be reversed through the timely administration of naloxone but only if responders are able to administer it. There is an emerging body of research and development in technologies that can detect the early signs of an overdose and facilitate timely responses. Objective: Our aim was to identify and classify overdose-specific digital technologies being developed, implemented, and evaluated. Methods: We conducted a ``state-of-the-art review.'' A systematic search was conducted in MEDLINE, Embase, Web of Science, Scopus, ACM, IEEE Xplore, and SciELO. We also searched references from articles and scanned the gray literature. The search included terms related to telehealth and digital technologies, drugs, and overdose and papers published since 2010. We classified our findings by type of technology and its function, year of publication, country of study, study design, and theme. We performed a thematic analysis to classify the papers according to the main subject. Results: Included in the selection were 17 original research papers, 2 proof-of-concept studies, 4 reviews, 3 US government grant registries, and 6 commercial devices that had not been named in peer-reviewed literature. All articles were published between 2017 and 2022, with a marked increase since 2019. All were based in or referred to the United States or Canada and concerned opioid overdose. In total, 39\% (9/23) of the papers either evaluated or described devices designed to monitor vital signs and prompt an alert once a certain threshold indicating a potential overdose has been reached. A total of 43\% (10/23) of the papers focused on technologies to alert potential responders to overdoses and facilitate response. In total, 48\% (11/23) of the papers and 67\% (4/6) of the commercial devices described combined alert and response devices. Sensors monitor a range of vital signs, such as oxygen saturation level, respiratory rate, or movement. Response devices are mostly smartphone apps enabling responders to arrive earlier to an overdose site. Closed-loop devices that can detect an overdose through a sensor and automatically administer naloxone without any external intervention are still in the experimental or proof-of-concept phase. The studies were grouped into 4 themes: acceptability (7/23, 30\%), efficacy or effectiveness (5/23, 22\%), device use and decision-making (3/23, 13\%), and description of devices (6/23, 26\%). Conclusions: There has been increasing interest in the research and application of these technologies in recent years. Literature suggests willingness to use these devices by people who use drugs and affected communities. More real-life studies are needed to test the effectiveness of these technologies to adapt them to the different settings and populations that might benefit from them. ",
doi="10.2196/40389",
url="https://www.jmir.org/2023/1/e40389",
url="http://www.ncbi.nlm.nih.gov/pubmed/36790860"
}


@Article{info:doi/10.2196/40504,
author="van Eijck, C. Sander
and Janssen, M. Daan
and van der Steen, C. Maria
and Delvaux, G. Eugenie J. L.
and Hendriks, E. Johannes G.
and Janssen, A. Rob P.",
title="Digital Health Applications to Establish a Remote Diagnosis of Orthopedic Knee Disorders: Scoping Review",
journal="J Med Internet Res",
year="2023",
month="Feb",
day="9",
volume="25",
pages="e40504",
keywords="orthopedic surgery",
keywords="eHealth",
keywords="digital health",
keywords="mobile health",
keywords="mHealth",
keywords="telemedicine",
keywords="artificial intelligence",
keywords="diagnosis",
keywords="remote patient management",
keywords="musculoskeletal system",
keywords="knee",
keywords="mobile phone",
abstract="Background: Knee pain is highly prevalent worldwide, and this number is expected to rise in the future. The COVID-19 outbreak, in combination with the aging population, rising health care costs, and the need to make health care more accessible worldwide, has led to an increasing demand for digital health care applications to deliver care for patients with musculoskeletal conditions. Digital health and other forms of telemedicine can add value in optimizing health care for patients and health care providers. This might reduce health care costs and make health care more accessible while maintaining a high level of quality. Although expectations are high, there is currently no overview comparing digital health applications with face-to-face contact in clinical trials to establish a primary knee diagnosis in orthopedic surgery. Objective: This study aimed to investigate the currently available digital health and telemedicine applications to establish a primary knee diagnosis in orthopedic surgery in the general population in comparison with imaging or face-to-face contact between patients and physicians. Methods: A scoping review was conducted using the PubMed and Embase databases according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) statement. The inclusion criteria were studies reporting methods to determine a primary knee diagnosis in orthopedic surgery using digital health or telemedicine. On April 28 and 29, 2021, searches were conducted in PubMed (MEDLINE) and Embase. Data charting was conducted using a predefined form and included details on general study information, study population, type of application, comparator, analyses, and key findings. A risk-of-bias analysis was not deemed relevant considering the scoping review design of the study. Results: After screening 5639 articles, 7 (0.12\%) were included. In total, 2 categories to determine a primary diagnosis were identified: screening studies (4/7, 57\%) and decision support studies (3/7, 43\%). There was great heterogeneity in the included studies in algorithms used, disorders, input parameters, and outcome measurements. No more than 25 knee disorders were included in the studies. The included studies showed a relatively high sensitivity (67\%-91\%). The accuracy of the different studies was generally lower, with a specificity of 27\% to 48\% for decision support studies and 73\% to 96\% for screening studies. Conclusions: This scoping review shows that there are a limited number of available applications to establish a remote diagnosis of knee disorders in orthopedic surgery. To date, there is limited evidence that digital health applications can assist patients or orthopedic surgeons in establishing the primary diagnosis of knee disorders. Future research should aim to integrate multiple sources of information and a standardized study design with close collaboration among clinicians, data scientists, data managers, lawyers, and service users to create reliable and secure databases. ",
doi="10.2196/40504",
url="https://www.jmir.org/2023/1/e40504",
url="http://www.ncbi.nlm.nih.gov/pubmed/36566450"
}


@Article{info:doi/10.2196/42177,
author="Ali, Mustafa Syed
and Lee, R. Rebecca
and McBeth, John
and James, Ben
and McAlister, Sean
and Chiarotto, Alessandro
and Dixon, G. William
and van der Veer, N. Sabine",
title="Exploring the Cross-cultural Acceptability of Digital Tools for Pain Self-reporting: Qualitative Study",
journal="JMIR Hum Factors",
year="2023",
month="Feb",
day="8",
volume="10",
pages="e42177",
keywords="chronic pain",
keywords="pain perception",
keywords="cross-cultural comparison",
keywords="pain measurement",
keywords="mobile app",
keywords="mobile phone",
abstract="Background: Culture and ethnicity influence how people communicate about their pain. This makes it challenging to develop pain self-report tools that are acceptable across ethnic groups. Objective: We aimed to inform the development of cross-culturally acceptable digital pain self-report tools by better understanding the similarities and differences between ethnic groups in pain experiences and self-reporting needs. Methods: Three web-based workshops consisting of a focus group and a user requirement exercise with people who self-identified as being of Black African (n=6), South Asian (n=10), or White British (n=7) ethnicity were conducted. Results: Across ethnic groups, participants shared similar lived experiences and challenges in communicating their pain to health care professionals. However, there were differences in beliefs about the causes of pain, attitudes toward pain medication, and experiences of how stigma and gender norms influenced pain-reporting behavior. Despite these differences, they agreed on important aspects for pain self-report, but participants from non-White backgrounds had additional language requirements such as culturally appropriate pain terminologies to reduce self-reporting barriers. Conclusions: To improve the cross-cultural acceptability and equity of digital pain self-report tools, future developments should address the differences among ethnic groups on pain perceptions and beliefs, factors influencing pain reporting behavior, and language requirements. ",
doi="10.2196/42177",
url="https://humanfactors.jmir.org/2023/1/e42177",
url="http://www.ncbi.nlm.nih.gov/pubmed/36753324"
}


@Article{info:doi/10.2196/38555,
author="Tan, Ying Jamaica Pei
and Tan, J. Michelle W.
and Towle, Marie Rachel
and Lee, Win Joanne Sze
and Lei, Xiaofeng
and Liu, Yong
and Goh, Mong Rick Siow
and Chee Ping, Tan Franklin
and Tan, Choon Teck
and Ting, Wei Daniel Shu
and Lee, Ee Chen
and Low, Leng Lian",
title="mHealth App to Facilitate Remote Care for Patients With COVID-19: Rapid Development of the DrCovid+ App",
journal="JMIR Form Res",
year="2023",
month="Feb",
day="7",
volume="7",
pages="e38555",
keywords="mobile health",
keywords="mHealth",
keywords="rapid development",
keywords="remote care",
keywords="COVID-19",
keywords="hospital-at-home",
keywords="mobile app",
keywords="app development",
keywords="virtual care",
keywords="Telegram service",
keywords="clinical care",
keywords="continuity of care",
keywords="digital health",
abstract="Background: The 2019 novel COVID-19 has severely burdened the health care system through its rapid transmission. Mobile health (mHealth) is a viable solution to facilitate remote monitoring and continuity of care for patients with COVID-19 in a home environment. However, the conceptualization and development of mHealth apps are often time and labor-intensive and are laden with concerns relating to data security and privacy. Implementing mHealth apps is also a challenging feat as language-related barriers limit adoption, whereas its perceived lack of benefits affects sustained use. The rapid development of an mHealth app that is cost-effective, secure, and user-friendly will be a timely enabler. Objective: This project aimed to develop an mHealth app, DrCovid+, to facilitate remote monitoring and continuity of care for patients with COVID-19 by using the rapid development approach. It also aimed to address the challenges of mHealth app adoption and sustained use. Methods: The Rapid Application Development approach was adopted. Stakeholders including decision makers, physicians, nurses, health care administrators, and research engineers were engaged. The process began with requirements gathering to define and finalize the project scope, followed by an iterative process of developing a working prototype, conducting User Acceptance Tests, and improving the prototype before implementation. Co-designing principles were applied to ensure equal collaborative efforts and collective agreement among stakeholders. Results: DrCovid+ was developed on Telegram Messenger and hosted on a cloud server. It features a secure patient enrollment and data interface, a multilingual communication channel, and both automatic and personalized push messaging. A back-end dashboard was also developed to collect patients' vital signs for remote monitoring and continuity of care. To date, 400 patients have been enrolled into the system, amounting to 2822 hospital bed--days saved. Conclusions: The rapid development and implementation of DrCovid+ allowed for timely clinical care management for patients with COVID-19. It facilitated early patient hospital discharge and continuity of care while addressing issues relating to data security and labor-, time-, and cost-effectiveness. The use case for DrCovid+ may be extended to other medical conditions to advance patient care and empowerment within the community, thereby meeting existing and rising population health challenges. ",
doi="10.2196/38555",
url="https://formative.jmir.org/2023/1/e38555",
url="http://www.ncbi.nlm.nih.gov/pubmed/36649223"
}


@Article{info:doi/10.2196/40844,
author="Moreno-Ligero, Marta
and Moral-Munoz, A. Jose
and Salazar, Alejandro
and Failde, Inmaculada",
title="mHealth Intervention for Improving Pain, Quality of Life, and Functional Disability in Patients With Chronic Pain: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Feb",
day="2",
volume="11",
pages="e40844",
keywords="chronic pain",
keywords="mHealth",
keywords="mobile health",
keywords="mobile app",
keywords="health app",
keywords="digital intervention",
keywords="monitoring",
keywords="pain intensity",
keywords="quality of life",
keywords="functionality",
keywords="disability",
keywords="disabilities",
keywords="systematic review",
keywords="review methodology",
keywords="search strategy",
keywords="library science",
keywords="RCT",
keywords="randomized controlled trial",
keywords="pain",
keywords="health outcome",
keywords="self-management",
abstract="Background: Chronic pain (CP) is 1 of the leading causes of disability worldwide and represents a significant burden on individual, social, and economic aspects. Potential tools, such as mobile health (mHealth) systems, are emerging for the self-management of patients with CP. Objective: A systematic review was conducted to analyze the effects of mHealth interventions on CP management, based on pain intensity, quality of life (QoL), and functional disability assessment, compared to conventional treatment or nonintervention. Methods: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines were followed to conduct a systematic review of randomized controlled trials (RCTs) published in PubMed, Web of Science, Scopus, and Physiotherapy Evidence Database (PEDro) databases from February to March 2022. No filters were used. The eligibility criteria were RCTs of adults (?18 years old) with CP, intervened with mHealth systems based on mobile apps for monitoring pain and health-related outcomes, for pain and behavioral self-management, and for performing therapeutic approaches, compared to conventional treatments (physical, occupational, and psychological therapies; usual medical care; and education) or nonintervention, reporting pain intensity, QoL, and functional disability. The methodological quality and risk of bias (RoB) were assessed using the Checklist for Measuring Quality, the Oxford Centre for Evidence-Based Medicine Levels of Evidence, and the Cochrane RoB 2.0 tool. Results: In total, 22 RCTs, involving 2641 patients with different CP conditions listed in the International Classification of Diseases 11th Revision (ICD-11), including chronic low back pain (CLBP), chronic musculoskeletal pain (CMSP), chronic neck pain (CNP), unspecified CP, chronic pelvic pain (CPP), fibromyalgia (FM), interstitial cystitis/bladder pain syndrome (IC/BPS), irritable bowel syndrome (IBS), and osteoarthritis (OA). A total of 23 mHealth systems were used to conduct a variety of CP self-management strategies, among which monitoring pain and symptoms and home-based exercise programs were the most used. Beneficial effects of the use of mHealth systems in reducing pain intensity (CNP, FM, IC/BPS, and OA), QoL (CLBP, CNP, IBS, and OA), and functional disability (CLBP, CMSP, CNP, and OA) were found. Most of the included studies (18/22, 82\%) reported medium methodological quality and were considered as highly recommendable; in addition, 7/22 (32\%) studies had a low RoB, 10/22 (45\%) had some concerns, and 5/22 (23\%) had a high RoB. Conclusions: The use of mHealth systems indicated positive effects for pain intensity in CNP, FM, IC/BPS, and OA; for QoL in CLBP, CNP, IBS, and OA; and for functional disability in CLBP, CMSP, CNP, and OA. Thus, mHealth seems to be an alternative to improving pain-related outcomes and QoL and could be part of multimodal strategies for CP self-management. High-quality studies are needed to merge the evidence and recommendations of the use of mHealth systems for CP management. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42022315808; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=315808 ",
doi="10.2196/40844",
url="https://mhealth.jmir.org/2023/1/e40844",
url="http://www.ncbi.nlm.nih.gov/pubmed/36729570"
}


@Article{info:doi/10.2196/44138,
author="Owusu, T. Jocelynn
and Wang, Pam
and Wickham, E. Robert
and Smith, F. Sarah
and Lee, L. Jennifer
and Chen, Connie
and Lungu, Anita",
title="Outcomes of a Live Messaging, Blended Care Coaching Program Among Adults With Symptoms of Anxiety: Pragmatic Retrospective Cohort Study",
journal="JMIR Form Res",
year="2023",
month="Feb",
day="1",
volume="7",
pages="e44138",
keywords="text-based coaching",
keywords="anxiety",
keywords="blended care",
abstract="Background: Anxiety disorders are common and can be debilitating. In addition, various barriers exist that can hinder access to adequate care. Coaching that is grounded in evidence-based interventions and delivered via synchronous (ie, live) text-based messaging could potentially increase the reach of mental health services among populations who select this modality instead of other services (eg, face-to-face coaching and psychotherapy). In addition, the delivery of live messaging coaching within a blended care model has the potential to combine the benefits of coaching with those of evidence-based digital mental health tools. Objective: This real-world study evaluates the anxiety and satisfaction outcomes of live messaging coaching blended with digital tools (ie, digital exercises and activities). Methods: This was a retrospective cohort study of 121 adults with moderate levels of anxiety symptoms at the beginning of coaching (Generalized Anxiety Disorder-7 [GAD-7] scores: range 8-14). Participants received an employer-offered blended messaging coaching (BMC) program, and those who opted to receive all live coaching sessions via text-based messaging were included. Anxiety symptom severity was regularly measured by using the GAD-7 scale. Using growth curve models, the change in GAD-7 scores over the course of BMC was evaluated, as were the effects of text-based coaching sessions on GAD-7 scores. The proportion of participants that had a reliable improvement in anxiety symptom severity (GAD-7 score reduction of ?4) or  subclinical symptom severity (GAD-7 score of <8) at the end of care was also estimated. Participants also self-reported their likelihood of recommending their live messaging coach to someone with similar needs. Results: At baseline, the average GAD-7 score was 9.88 (SD 1.80). Anxiety symptom severity significantly decreased with each week in the BMC program (week: b=?1.04; P<.001), and the rate of decline in anxiety symptom severity decreased over time (week2: b=0.06; P<.001). Each live messaging coaching session was associated with significantly lower anxiety symptom severity during the week of the coaching session (b=?1.56; P<.001) and the week immediately following the session (b=?1.03; P<.001). Overall, 86\% (104/121) of participants had subclinical symptom severity or a reliable reduction in anxiety symptom severity by the end of care. Further, 33.1\% (40/121) of participants reported coaching satisfaction levels; of the 40 participants in this subset, 37 (92.5\%) were likely or extremely likely to recommend their live messaging coach. Conclusions: BMC that provides coaching sessions via live messaging can be beneficial for adults with moderate symptoms of anxiety who qualify for and self-select this care modality. Large-scale studies with longer follow-ups are needed. ",
doi="10.2196/44138",
url="https://formative.jmir.org/2023/1/e44138",
url="http://www.ncbi.nlm.nih.gov/pubmed/36724014"
}


@Article{info:doi/10.2196/40237,
author="ter Harmsel, F. Janna
and Smulders, M. Lisanne
and Noordzij, L. Matthijs
and Swinkels, A. Lise T.
and Goudriaan, E. Anna
and Popma, Arne
and van der Pol, M. Thimo",
title="Forensic Psychiatric Outpatients' and Therapists' Perspectives on a Wearable Biocueing App (Sense-IT) as an Addition to Aggression Regulation Therapy: Qualitative Focus Group and Interview Study",
journal="JMIR Form Res",
year="2023",
month="Feb",
day="1",
volume="7",
pages="e40237",
keywords="biocueing",
keywords="biofeedback",
keywords="aggression",
keywords="behavior change",
keywords="forensic psychiatry",
keywords="wearable technology",
keywords="mobile health",
keywords="mHealth",
keywords="implementation",
keywords="mobile phone",
abstract="Background: Given the increased use of smart devices and the advantages of individual behavioral monitoring and assessment over time, wearable sensor--based mobile health apps are expected to become an important part of future (forensic) mental health care. For successful implementation in clinical practice, consideration of barriers and facilitators is of utmost importance. Objective: The aim of this study was to provide insight into the perspectives of both psychiatric outpatients and therapists in a forensic setting on the use and implementation of the Sense-IT biocueing app in aggression regulation therapy. Methods: A combination of qualitative methods was used. First, we assessed the perspectives of forensic outpatients on the use of the Sense-IT biocueing app using semistructured interviews. Next, 2 focus groups with forensic therapists were conducted to gain a more in-depth understanding of their perspectives on facilitators of and barriers to implementation. Results: Forensic outpatients (n=21) and therapists (n=15) showed a primarily positive attitude toward the addition of the biocueing intervention to therapy, with increased interoceptive and emotional awareness as the most frequently mentioned advantage in both groups. In the semistructured interviews, patients mainly reported barriers related to technical or innovation problems (ie, connection and notification issues, perceived inaccuracy of the feedback, and limitations in the ability to personalize settings). In the focus groups with therapists, 92 facilitator and barrier codes were identified and categorized into technical or innovation level (n=13, 14\%), individual therapist level (n=28, 30\%), individual patient level (n=33, 36\%), and environmental and organizational level (n=18, 20\%). The predominant barriers were limitations in usability of the app, patients' motivation, and both therapists' and patients' knowledge and skills. Integration into treatment, expertise within the therapists' team, and provision of time and materials were identified as facilitators. Conclusions: The chances of successful implementation and continued use of sensor-based mobile health interventions such as the Sense-IT biocueing app can be increased by considering the barriers and facilitators from patients' and therapists' perspectives. Technical or innovation-related barriers such as usability issues should be addressed first. At the therapist level, increasing integration into daily routines and enhancing affinity with the intervention are highly recommended for successful implementation. Future research is expected to be focused on further development and personalization of biocueing interventions considering what works for whom at what time in line with the trend toward personalizing treatment interventions in mental health care. ",
doi="10.2196/40237",
url="https://formative.jmir.org/2023/1/e40237",
url="http://www.ncbi.nlm.nih.gov/pubmed/36724008"
}


@Article{info:doi/10.2196/41076,
author="Bults, Marloes
and van Leersum, Margaretha Catharina
and Olthuis, Josef Theodorus Johannes
and Bekhuis, Marije Robin Enya
and den Ouden, Maria Marjolein Elisabeth",
title="Mobile Health Apps for the Control and Self-management of Type 2 Diabetes Mellitus: Qualitative Study on Users' Acceptability and Acceptance",
journal="JMIR Diabetes",
year="2023",
month="Jan",
day="24",
volume="8",
pages="e41076",
keywords="type 2 diabetes",
keywords="self-management",
keywords="mobile health",
keywords="mHealth",
keywords="mobile apps",
keywords="mobile phone",
keywords="acceptability",
keywords="acceptance",
keywords="diabetes",
abstract="Background: Mobile health apps are promising tools to help patients with type 2 diabetes mellitus (T2DM) improve their health status and thereby achieve diabetes control and self-management. Although there is a wide array of mobile health apps for T2DM available at present, apps are not yet integrated into routine diabetes care. Acceptability and acceptance among patients with T2DM is a major challenge and prerequisite for the successful implementation of apps in diabetes care. Objective: This study provides an in-depth understanding of the perceptions of patients with T2DM before use (acceptability) and after use (acceptance) regarding 4 different mobile health apps for diabetes control and self-management. Methods: A descriptive qualitative research design was used in this study. Participants could choose 1 of the 4 selected apps for diabetes control and self-management (ie, Clear.bio in combination with FreeStyle Libre, mySugr, MiGuide, and Selfcare). The selection was based on a systematic analysis of the criteria for (functional) requirements regarding monitoring, data collection, provision of information, coaching, privacy, and security. To explore acceptability, 25 semistructured in-depth interviews were conducted with patients with T2DM before use. This was followed by 4 focus groups to discuss the acceptance after use. The study had a citizen science approach, that is, patients with T2DM collaborated with researchers as coresearchers. All coresearchers actively participated in the preparation of the study, data collection, and data analysis. Data were collected between April and September 2021. Thematic analysis was conducted using a deductive approach using AtlasTi9. Results: In total, 25 coresearchers with T2DM participated in this study. Of them, 12 coresearchers tested Clear, 5 MiGuide, 4 mySugr, and 4 Selfcare. All coresearchers participated in semistructured interviews, and 18 of them attended focus groups. Personal health was the main driver of app use. Most coresearchers were convinced that a healthy lifestyle would improve blood glucose levels. Although most coresearchers did not expect that they need to put much effort into using the apps, the additional effort to familiarize themselves with the app use was experienced as quite high. None of the coresearchers had a health care professional who provided suggestions on using the apps. Reimbursement from insurance companies and the acceptance of apps for diabetes control and self-management by the health care system were mentioned as important facilitating conditions. Conclusions: The research showed that mobile health apps provide support for diabetes control and self-management in patients with T2DM. Integrating app use in care as usual and guidelines for health care professionals are recommended. Future research is needed on how to increase the implementation of mobile health apps in current care pathways. In addition, health care professionals need to improve their digital skills, and lifelong learning is recommended. ",
doi="10.2196/41076",
url="https://diabetes.jmir.org/2023/1/e41076",
url="http://www.ncbi.nlm.nih.gov/pubmed/36692927"
}


@Article{info:doi/10.2196/42799,
author="Sun, Liang
and Qu, Mengbing
and Chen, Bing
and Li, Chuancang
and Fan, Haohao
and Zhao, Yang",
title="Effectiveness of mHealth on Adherence to Antiretroviral Therapy in Patients Living With HIV: Meta-analysis of Randomized Controlled Trials",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Jan",
day="23",
volume="11",
pages="e42799",
keywords="HIV",
keywords="mHealth",
keywords="antiretroviral therapy",
keywords="meta-analysis",
abstract="Background: The World Health Organization recommends that all adults with HIV adhere to antiretroviral therapy (ART). Good adherence to ART is beneficial to patients and the public. Furthermore, mHealth has shown promise in improving HIV medication adherence globally. Objective: The aim of this meta-analysis is to analyze the effectiveness of mHealth on adherence to antiretroviral therapy in patients living with HIV. Methods: Randomized controlled trials (RCTs) of the association between mHealth and adherence to ART published until December 2021 were searched in electronic databases. Odds ratios (ORs), weighted mean differences, and 95\% CIs were calculated. This meta-analysis was performed using the Mantel-Haenszel method or the inverse variance test. We evaluated heterogeneity with the I2 statistic. If I2 was ?50\%, heterogeneity was absent, and a fixed effect model was used. If I2 was >50\%, heterogeneity was present, and a random effects model was used. Results: A total of 2163 participants in 8 studies were included in this meta-analysis. All included studies were RCTs. The random effects model was used for a meta-analysis of the effects of various intervention measures compared to routine nursing; the outcome was not statistically significant (OR 1.54, 95\% CI 0.99-2.38; P=.05). In the subgroups, only short messaging service (SMS)-based interventions significantly increased adherence to ART (OR 1.76, 95\% CI 1.07-2.89; P=.03). Further analysis showed that only interactive or bidirectional SMS could significantly increase ART adherence (OR 1.69, 95\% CI 1.22-2.34; P=.001). After combining the difference in CD4 cell count before and after the interventions, we concluded that there was no statistical heterogeneity among the studies (I2=0\%; tau2=0.37; P=.95). Conclusions: Interactive or bidirectional SMS can enhance intervention effects. However, whether mHealth can improve adherence to ART in patients with HIV needs further study. Owing to a lack of the required significant staff time, training, and ongoing supervision, there is still much more to do to apply mHealth to the clinical use of ART for patients living with HIV. Trial Registration: PROSPERO CRD42022358774; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=358774 ",
doi="10.2196/42799",
url="https://mhealth.jmir.org/2023/1/e42799",
url="http://www.ncbi.nlm.nih.gov/pubmed/36689267"
}


@Article{info:doi/10.2196/41011,
author="Lenoir, M. Kristin
and Sandberg, C. Joanne
and Miller, P. David
and Wells, J. Brian",
title="Patient Perspectives on a Targeted Text Messaging Campaign to Encourage Screening for Diabetes: Qualitative Study",
journal="JMIR Form Res",
year="2023",
month="Jan",
day="17",
volume="7",
pages="e41011",
keywords="mobile health",
keywords="diabetes screening",
keywords="electronic health records",
keywords="text messaging",
keywords="clinical decision support",
keywords="mHealth",
keywords="diabetes",
keywords="mHealth intervention",
abstract="Background: A sizeable proportion of prediabetes and diabetes cases among adults in the United States remain undiagnosed. Patient-facing clinical decision support (CDS) tools that leverage electronic health records (EHRs) have the potential to increase diabetes screening. Given the widespread mobile phone ownership across diverse groups, text messages present a viable mode for delivering alerts directly to patients. The use of unsolicited text messages to offer hemoglobin A1c (HbA1c) screening has not yet been studied. It is imperative to gauge perceptions of ``cold texts'' to ensure that information and language are optimized to promote engagement with text messages that affect follow-through with health behaviors. Objective: This study aims to gauge the perceptions of and receptiveness to text messages to inform content that would facilitate engagement with text messages intended to initiate a mobile health (mHealth) intervention for targeted screening. Messages were designed to invite those not already diagnosed with diabetes to make a decision to take part in HbA1c screening and walk them through the steps required to perform the behavior based solely on an automated text exchange. Methods: In total, 6 focus groups were conducted at Wake Forest Baptist Health (WFBH) between September 2019 and February 2020. The participants were adult patients without diabetes who had completed an in-person visit at the Family and Community Medicine Clinic within the previous year. We displayed a series of text messages and asked the participants to react to the message content and suggest improvements. Content was deductively coded with respect to the Health Belief Model (HBM) and inductively coded to identify other emergent themes that could potentially impact engagement with text messages. Results: Participants (N=36) were generally receptive to the idea of receiving a text-based alert for HbA1c screening. Plain language, personalization, and content, which highlighted perceived benefits over perceived susceptibility and perceived severity, were important to participants' understanding of and receptiveness to messages. The patient-physician relationship emerged as a recurring theme in which patients either had a desire or held an assumption that their provider would be working behind the scenes throughout each step of the process. Participants needed further clarification to understand the steps involved in following through with HbA1c screening and receiving results. Conclusions: Our findings suggest that patients may be receptive to text messages that alert them to a risk of having an elevated HbA1c in direct-to-patient alerts that use cold texting. Using plain and positive language, integrating elements of personalization, and defining new processes clearly were identified by participants as modifiable content elements that could act as facilitators that would help overcome barriers to engagement with these messages. A patient's relationship with their provider and the financial costs associated with texts and screening may affect receptiveness and engagement in this process. ",
doi="10.2196/41011",
url="https://formative.jmir.org/2023/1/e41011",
url="http://www.ncbi.nlm.nih.gov/pubmed/36649056"
}


@Article{info:doi/10.2196/41235,
author="Salas-Groves, Emily
and Galyean, Shannon
and Alcorn, Michelle
and Childress, Allison",
title="Behavior Change Effectiveness Using Nutrition Apps in People With Chronic Diseases: Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Jan",
day="13",
volume="11",
pages="e41235",
keywords="mobile apps",
keywords="apps",
keywords="mobile health",
keywords="mHealth",
keywords="eHealth",
keywords="nutrition education",
keywords="cancer",
keywords="obesity",
keywords="diabetes",
keywords="cardiovascular disease",
keywords="mobile phone",
abstract="Background: Cardiovascular disease, cancer, diabetes mellitus, and obesity are common chronic diseases, and their prevalence is reaching an epidemic level worldwide. As the impact of chronic diseases continues to increase, finding strategies to improve care, access to care, and patient empowerment becomes increasingly essential. Health care providers use mobile health (mHealth) to access clinical information, collaborate with care teams, communicate over long distances with patients, and facilitate real-time monitoring and interventions. However, these apps focus on improving general health care concerns, with limited apps focusing on specific chronic diseases and the nutrition involved in the disease state. Hence, available evidence on the effectiveness of mHealth apps toward behavior change to improve chronic disease outcomes is limited. Objective: The objective of this scoping review was to provide an overview of behavior change effectiveness using mHealth nutrition interventions in people with chronic diseases (ie, cardiovascular disease, diabetes mellitus, cancer, and obesity). We further evaluated the behavior change techniques and theories or models used for behavior change, if any. Methods: A scoping review was conducted through a systematic literature search in the MEDLINE, EBSCO, PubMed, ScienceDirect, and Scopus databases. Studies were excluded from the review if they did not involve an app or nutrition intervention, were written in a language other than English, were duplicates from other database searches, or were literature reviews. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines, the systematic review process included 4 steps: identification of records through the database search, screening of duplicate and excluded records, eligibility assessment of full-text records, and final analysis of included records. Results: In total, 46 studies comprising 256,430 patients were included. There was diversity in the chronic disease state, study design, number of participants, in-app features, behavior change techniques, and behavior models used in the studies. In addition, our review found that less than half (19/46, 41\%) of the studies based their nutrition apps on a behavioral theory or its constructs. Of the 46 studies, 11 (24\%) measured maintenance of health behavior change, of which 7 (64\%) sustained behavior change for approximately 6 to 12 months and 4 (36\%) showed a decline in behavior change or discontinued app use. Conclusions: The results suggest that mHealth apps involving nutrition can significantly improve health outcomes in people with chronic diseases. Tailoring nutrition apps to specific populations is recommended for effective behavior change and improvement of health outcomes. In addition, some studies (7/46, 15\%) showed sustained health behavior change, and some (4/46, 9\%) showed a decline in the use of nutrition apps. These results indicate a need for further investigation on the sustainability of the health behavior change effectiveness of disease-specific nutrition apps. ",
doi="10.2196/41235",
url="https://mhealth.jmir.org/2023/1/e41235",
url="http://www.ncbi.nlm.nih.gov/pubmed/36637888"
}


@Article{info:doi/10.2196/38986,
author="Suh, Myung-Whan
and Park, Kyun Moo
and Kim, Yoonjoong
and Kim, Ho Young",
title="The Treatment Outcome of Smart Device--Based Tinnitus Retraining Therapy: Prospective Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Jan",
day="12",
volume="11",
pages="e38986",
keywords="tinnitus",
keywords="tinnitus retraining therapy",
keywords="smart device",
keywords="sound therapy",
keywords="rehabilitation",
keywords="therapy",
keywords="tablet application",
keywords="app-based",
keywords="digital therapy",
keywords="device-based therapy",
abstract="Background: Tinnitus retraining therapy (TRT) is a standard treatment for tinnitus that consists of directive counseling and sound therapy. However, it is based on face-to-face education and a time-consuming protocol. Smart device--based TRT (smart-TRT) seems to have many advantages, but the efficacy of this new treatment has been questioned. Objective: The aim of this study was to compare the efficacy between smart-TRT and conventional TRT (conv-TRT). Methods: We recruited 84 patients with tinnitus. Results were compared between 42 patients who received smart-TRT and 42 control participants who received conv-TRT. An interactive smart pad application was used for directive counseling in the smart-TRT group. The smart pad application included detailed education on ear anatomy, the neurophysiological model of tinnitus, concept of habituation, and sound therapy. The smart-TRT was bidirectional: There were 17 multiple choice questions between each lesson as an interim check. The conv-TRT group underwent traditional person-to-person counseling. The primary outcome measure was the Tinnitus Handicap Inventory (THI), and the secondary outcome measure was assessed using a visual analogue scale (VAS). Results: Both treatments had a significant treatment effect, which comparably improved during the first 2 months. The best improvements in THI were --23.3 (95\% CI --33.1 to --13.4) points at 3 months and --16.8 (95\% CI --30.8 to --2.8) points at 2 months in the smart-TRT group and conv-TRT group, respectively. The improvements on the VAS were also comparable: smart-TRT group: --1.2 to --3.3; conv-TRT: --0.7 to --1.7. Conclusions: TRT based on smart devices can be an effective alternative for tinnitus patients. Considering the amount of time needed for person-to-person counseling, smart-TRT can be a cost-effective solution with similar treatment outcomes as conv-TRT. ",
doi="10.2196/38986",
url="https://mhealth.jmir.org/2023/1/e38986",
url="http://www.ncbi.nlm.nih.gov/pubmed/36633890"
}


@Article{info:doi/10.2196/39396,
author="Iovanel, Gregory
and Ayers, David
and Zheng, Hua",
title="The Role of Wearable Technology in Measuring and Supporting Patient Outcomes Following Total Joint Replacement: Review of the Literature",
journal="JMIR Perioper Med",
year="2023",
month="Jan",
day="12",
volume="6",
pages="e39396",
keywords="total joint replacement",
keywords="wearables",
keywords="osteoarthritis",
keywords="rehabilitation",
keywords="mobility",
abstract="Background: The incidence rate of total joint replacement (TJR) continues to increase due to the aging population and the surgery that is very successful in providing pain relief to and improving function among patients with advanced knee or hip arthritis. Improving patient outcomes and patient satisfaction after TJR remain important goals. Wearable technologies provide a novel way to capture patient function and activity data and supplement clinical measures and patient-reported outcome measures in order to better understand patient outcomes after TJR. Objective: We examined the current literature to evaluate the potential role of wearable devices and compare them with existing methods for monitoring and improving patient rehabilitation and outcomes following TJR. Methods: We performed a literature search by using the research databases supported by the University of Massachusetts Chan Medical School's Lamar Soutter Library, including PubMed and Scopus, supplemented with the Google Scholar search engine. A specific search strategy was used to identify articles discussing the use of wearable devices in measuring and affecting postoperative outcomes of patients who have undergone TJR. Selected papers were organized into a spreadsheet and categorized for our qualitative literature review to assess how wearable data correlated with clinical measures and patient-reported outcome measures. Results: A total of 9 papers were selected. The literature showed the impact of wearable devices on evaluating and improving postoperative functional outcomes. Wearable-collected data could be used to predict postoperative clinical measures, such as range of motion and Timed Up and Go times. When predicting patient-reported outcomes, specifically Hip Disability and Osteoarthritis Outcome Scores/Knee Injury and Osteoarthritis Outcome Scores and Veterans RAND 12-Item Health Survey scores, strong associations were found between changes in sensor-collected data and changes in patient-reported outcomes over time. Further, the step counts of patients who received feedback from a wearable improved over time when compared to those of patients who did not receive feedback. Conclusions: These findings suggest that wearable technology has the potential to remotely measure and improve postoperative orthopedic patient outcomes. We anticipate that this review will facilitate further investigation into whether wearable devices are viable tools for guiding the clinical management of TJR rehabilitation. ",
doi="10.2196/39396",
url="https://periop.jmir.org/2023/1/e39396",
url="http://www.ncbi.nlm.nih.gov/pubmed/36633891"
}


@Article{info:doi/10.2196/40017,
author="Hietbrink, G. Eclaire A.
and Middelweerd, Anouk
and van Empelen, Pepijn
and Preuhs, Katharina
and Konijnendijk, J. Annemieke A.
and Oude Nijeweme-d'Hollosy, Wendy
and Schrijver, K. Laura
and Laverman, D. Gozewijn
and Vollenbroek-Hutten, R. Miriam M.",
title="A Digital Lifestyle Coach (E-Supporter 1.0) to Support People With Type 2 Diabetes: Participatory Development Study",
journal="JMIR Hum Factors",
year="2023",
month="Jan",
day="12",
volume="10",
pages="e40017",
keywords="eHealth",
keywords="mHealth",
keywords="diet",
keywords="nutrition",
keywords="physical activity",
keywords="lifestyle change",
keywords="coaching",
keywords="dynamic tailoring",
keywords="behavior change",
keywords="blended care",
keywords="type 2 diabetes",
keywords="design",
keywords="treatment",
keywords="chronic disease",
keywords="behavioral",
keywords="theory",
keywords="intervention",
keywords="acceptability",
keywords="usability",
keywords="cost",
abstract="Background: A healthy lifestyle, including regular physical activity and a healthy diet, is becoming increasingly important in the treatment of chronic diseases. eHealth interventions that incorporate behavior change techniques (BCTs) and dynamic tailoring strategies could effectively support a healthy lifestyle. E-Supporter 1.0 is an eCoach designed to support physical activity and a healthy diet in people with type 2 diabetes (T2D). Objective: This paper aimed to describe the systematic development of E-Supporter 1.0. Methods: Our systematic design process consisted of 3 phases. The definition phase included the selection of the target group and formulation of intervention objectives, and the identification of behavioral determinants based on which BCTs were selected to apply in the intervention. In the development phase, intervention content was developed by specifying tailoring variables, intervention options, and decision rules. In the last phase, E-Supporter 1.0 integrated in the Diameter app was evaluated using a usability test in 9 people with T2D to assess intervention usage and acceptability. Results: The main intervention objectives were to stimulate light to moderate-vigorous physical activities or adherence to the Dutch dietary guidelines in people with T2D. The selection of behavioral determinants was informed by the health action process approach and theories explaining behavior maintenance. BCTs were included to address relevant behavioral determinants (eg, action control, self-efficacy, and coping planning). Development of the intervention resulted in 3 types of intervention options, consisting of motivational messages, behavioral feedback, and tailor-made supportive exercises. On the basis of IF-THEN rules, intervention options could be tailored to, among others, type of behavioral goal and (barriers to) goal achievement. Data on these variables could be collected using app data, activity tracker data, and daily ecological momentary assessments. Usability testing revealed that user experiences were predominantly positive, despite some problems in the fixed delivery of content. Conclusions: The systematic development approach resulted in a theory-based and dynamically tailored eCoach. Future work should focus on expanding intervention content to other chronic diseases and lifestyle behaviors, enhancing the degree of tailoring and evaluating intervention effects on acceptability, use, and cost-effectiveness. ",
doi="10.2196/40017",
url="https://humanfactors.jmir.org/2023/1/e40017",
url="http://www.ncbi.nlm.nih.gov/pubmed/36633898"
}


@Article{info:doi/10.2196/40630,
author="Goswami, Aumeya
and Poole, Lydia
and Thorlu-Bangura, Zareen
and Khan, Nushrat
and Hanif, Wasim
and Khunti, Kamlesh
and Gill, Paramjit
and Sajid, Madiha
and Blandford, Ann
and Stevenson, Fiona
and Banerjee, Amitava
and Ramasawmy, Mel",
title="The Use of Digital Health Interventions for Cardiometabolic Diseases Among South Asian and Black Minority Ethnic Groups: Realist Review",
journal="J Med Internet Res",
year="2023",
month="Jan",
day="6",
volume="25",
pages="e40630",
keywords="digital health",
keywords="health inequality",
keywords="cardiometabolic disease",
keywords="cardiometabolic",
keywords="ethnic",
keywords="minority",
keywords="cardiology",
keywords="heart",
keywords="eHealth",
keywords="review",
keywords="realist",
keywords="context-mechanism-outcome",
keywords="South Asia",
keywords="Black",
keywords="migrant",
keywords="systematic search",
keywords="literature search",
keywords="African American",
keywords="CVD",
keywords="cardiovascular",
keywords="diabetes",
keywords="diabetic",
keywords="type 2",
keywords="mobile phone",
abstract="Background: Digital health interventions (DHIs) for the prevention and management of cardiometabolic diseases have become increasingly common. However, there is limited evidence for the suitability of these approaches in minority ethnic populations, who are at an increased risk of these diseases. Objective: This study aimed to investigate the use of DHIs for cardiovascular disease and type 2 diabetes among minority ethnic populations in countries with a majority of White, English-speaking populations, focusing on people who identified as South Asian, Black, or African American. Methods: A realist methodology framework was followed. A literature search was conducted to develop context-mechanism-outcome configurations, including the contexts in which DHIs work for the target minority ethnic groups, mechanisms that these contexts trigger, and resulting health outcomes. After systematic searches, a qualitative analysis of the included studies was conducted using deductive and inductive coding. Results: A total of 15 studies on the uptake of DHIs for cardiovascular disease or diabetes were identified, of which 13 (87\%) focused on people with an African-American background. The review found evidence supporting the use of DHIs in minority ethnic populations when specific factors are considered in implementation and design, including patients' beliefs, health needs, education and literacy levels, material circumstances, culture, social networks, and wider community and the supporting health care systems. Conclusions: Our context-mechanism-outcome configurations provide a useful guide for the future development of DHIs targeted at South Asian and Black minority ethnic populations, with specific recommendations for improving cultural competency and promoting accessibility and inclusivity of design. ",
doi="10.2196/40630",
url="https://www.jmir.org/2023/1/e40630",
url="http://www.ncbi.nlm.nih.gov/pubmed/36607732"
}


@Article{info:doi/10.2196/36072,
author="Chew, Evelyn
and Teo, Huang Sok
and Tang, Ee Wern
and Ng, Liang David Wei
and Koh, Huat Gerald Choon
and Teo, Ying Valerie Hui",
title="Trust and Uncertainty in the Implementation of a Pilot Remote Blood Pressure Monitoring Program in Primary Care: Qualitative Study of Patient and Health Care Professional Views",
journal="JMIR Hum Factors",
year="2023",
month="Jan",
day="5",
volume="10",
pages="e36072",
keywords="telemedicine",
keywords="hypertension",
keywords="remote blood pressure monitoring",
keywords="health IT",
keywords="primary health care",
keywords="trust",
keywords="health care provider relationship",
keywords="blood pressure",
keywords="primary care",
keywords="qualitative study",
keywords="health care workers",
keywords="patients",
abstract="Background: Trust is of fundamental importance to the adoption of technologies in health care. The increasing use of telemedicine worldwide makes it important to consider user views and experiences. In particular, we ask how the mediation of a technological platform alters the trust relationship between patient and health care provider. Objective: To date, few qualitative studies have focused on trust in the use of remote health care technologies. This study examined the perspectives of patients and clinical staff who participated in a remote blood pressure monitoring program, focusing on their experiences of trust and uncertainty in the use of technology and how this telehealth intervention may have affected the patient-provider relationship. Methods: A secondary qualitative analysis using inductive thematic analysis was conducted on interview data from 13 patients and 8 staff members who participated in a remote blood pressure monitoring program to elicit themes related to trust. Results: In total, 4 themes were elicited that showed increased trust (patients felt reassured, patients trusted the telehealth program, staff felt that the data were trustworthy, and a better patient-provider partnership based on the mutually trusted data), and 4 themes were elicited that reflected decreased trust (patients' distrust of technology, clinicians' concerns about the limitations of technologically mediated interactions, experiences of uncertainty, and institutional risk). Conclusions: Managing trust relationships plays an important role in the successful implementation of telemedicine. Ensuring that trust building is incorporated in the design of telehealth interventions can contribute to improved effectiveness and quality of care. ",
doi="10.2196/36072",
url="https://humanfactors.jmir.org/2023/1/e36072",
url="http://www.ncbi.nlm.nih.gov/pubmed/36602847"
}


@Article{info:doi/10.2196/41767,
author="Hogan, P. Timothy
and Etingen, Bella
and Lipschitz, M. Jessica
and Shimada, L. Stephanie
and McMahon, Nicholas
and Bolivar, Derek
and Bixler, R. Felicia
and Irvin, Dawn
and Wacks, Rachel
and Cutrona, Sarah
and Frisbee, L. Kathleen
and Smith, M. Bridget",
title="Factors Associated With Self-reported Use of Web and Mobile Health Apps Among US Military Veterans: Cross-sectional Survey",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Dec",
day="30",
volume="10",
number="12",
pages="e41767",
keywords="mobile health apps",
keywords="patient engagement",
keywords="consumer health informatics",
keywords="provider encouragement",
keywords="veterans",
abstract="Background: Despite their prevalence and reported patient interest in their use, uptake of health-related apps is limited. The Veterans Health Administration (VHA) has developed a variety of apps to support veterans; however, uptake remains low nationally. Objective: We examined the prevalence of VHA health-related app use and how veterans learned about these apps in order to identify factors associated with their use. Methods: As part of a VHA quality improvement initiative, we recruited a national cohort of veterans to obtain feedback on their use of technology for health and collected data from them via a cross-sectional survey. The survey data were supplemented with VHA administrative data. We used descriptive statistics to examine demographic and health characteristics, health-related technology use, and how veterans learned about apps. We assessed factors associated with app use using bivariate analyses and multiple logistic regression models. Results: We had complete data on 1259 veterans. A majority of the sample was male (1069/1259, 84.9\%), aged older than 65 years (740/1259, 58.8\%), White (1086/1259, 86.3\%), and non-Hispanic (1218/1259, 96.7\%). Most respondents (1125/1259, 89.4\%) reported being very comfortable and confident using computers, over half (675/1259, 53.6\%) reported being an early adopter of technology, and almost half (595/1259, 47.3\%) reported having used a VHA health-related app. Just over one-third (435/1259, 34.6\%) reported that their VHA care team members encouraged them to use health-related apps. Respondents reported learning about available VHA health-related apps by reading about them on the VHA's patient portal (468/1259, 37.2\%), being told about them by their VHA health care team (316/1259, 25.1\%), and reading about them on the VHA's website (139/1259, 11\%). Veterans who self-reported having used VHA health-related apps were more likely to receive care at the VHA (OR [odds ratio] 1.3, 95\% CI 1.0-1.7), be in worse health (as assessed by Hierarchical Condition Community score; OR 1.1, 95\% CI 1.0-1.2), report owning a desktop or laptop computer (OR 1.8, 95\% CI 1.1-3.1), have posttraumatic stress disorder (OR 1.4, 95\% CI 1.1-1.9), and report having VHA health care team members encourage them to use the apps (OR 2.7, 95\% CI 2.1-3.4). Conclusions: We found strong associations between self-reported use by veterans of VHA health-related apps and multiple variables in our survey. The strongest association was observed between a veteran self-reporting app use and having received encouragement from their VHA health care team to use the apps. Veterans who reported receiving encouragement from their VHA care team members had nearly 3 times higher odds of using VHA apps than veterans who did not report receiving such encouragement. Our results add to growing evidence suggesting that endorsement of apps by a health care system or health care team can positively impact patient uptake and use. ",
doi="10.2196/41767",
url="https://mhealth.jmir.org/2022/12/e41767",
url="http://www.ncbi.nlm.nih.gov/pubmed/36583935"
}


@Article{info:doi/10.2196/40021,
author="Barbaric, Antonia
and Munteanu, Cosmin
and Ross, Heather
and Cafazzo, A. Joseph",
title="A Voice App Design for Heart Failure Self-management: Proof-of-Concept Implementation Study",
journal="JMIR Form Res",
year="2022",
month="Dec",
day="21",
volume="6",
number="12",
pages="e40021",
keywords="heart failure",
keywords="self-management",
keywords="digital therapeutics",
keywords="voice-activated technology",
keywords="smart speaker",
keywords="formative evaluation",
keywords="mobile phone",
abstract="Background: Voice user interfaces are becoming more prevalent in health care and are commonly being used for patient engagement. There is a growing interest in identifying the potential this form of interface has on patient engagement with digital therapeutics (DTx) in chronic disease management. Making DTx accessible through an alternative interaction model also has the potential to better meet the needs of some patients, such as older adults and those with physical and cognitive impairments, based on existing research. Objective: This study aimed to evaluate how participants with heart failure interacted with a voice app version of a DTx, Medly, through a proof-of-concept implementation study design. The objective was to understand whether the voice app would enable the participants to successfully interact with the DTx, with a focus on acceptability and feasibility. Methods: A mixed methods concurrent triangulation design was used to better understand the acceptability and feasibility of the use of the Medly voice app with the study participants (N=20) over a 4-week period. Quantitative data included engagement levels, accuracy rates, and questionnaires, which were analyzed using descriptive statistics. Qualitative data included semistructured interviews and were analyzed using a qualitative descriptive approach. Results: The overall average engagement level was 73\% (SD 9.5\%), with a 14\% decline between results of weeks 1 and 4. The biggest difference was between the average engagement levels of the oldest and youngest demographics, 84\% and 43\%, respectively, but these results were not significant---Kruskal-Wallis test, H(2)=3.8 (P=.14). The Medly voice app had an overall accuracy rate of 97.8\% and was successful in sending data to the clinic. From an acceptability perspective, the voice app was ranked in the 80th percentile, and overall, the users felt that the voice app was not a lot of work (average of 2.1 on a 7-point Likert scale). However, the overall average score for whether users would use it in the future declined by 13\%. Thematic analysis revealed the following: the theme feasibility of clinical integration had 2 subthemes, namely users adapted to the voice app's conversational style and device unreliability, and the theme voice app acceptability had 3 subthemes, namely the device integrated well within household and users' lives, users blamed themselves when problems arose with the voice app, and voice app was missing specific, desirable user features. Conclusions: In conclusion, participants were largely successful in using the Medly voice app despite some of the barriers faced, proving that an app such as this could be feasible to be deployed in the clinic. Our data begin to piece together the patient profile this technology may be most suitable for, namely those who are older, have flexible schedules, are confident in using technology, and are experiencing other medical conditions. ",
doi="10.2196/40021",
url="https://formative.jmir.org/2022/12/e40021",
url="http://www.ncbi.nlm.nih.gov/pubmed/36542435"
}


@Article{info:doi/10.2196/37885,
author="Gagnon, Joel
and Khau, Michelle
and Lavoie-Hudon, L{\'e}andre
and Vachon, Fran{\c{c}}ois
and Drapeau, Vicky
and Tremblay, S{\'e}bastien",
title="Comparing a Fitbit Wearable to an Electrocardiogram Gold Standard as a Measure of Heart Rate Under Psychological Stress: A Validation Study",
journal="JMIR Form Res",
year="2022",
month="Dec",
day="21",
volume="6",
number="12",
pages="e37885",
keywords="Fitbit device",
keywords="wearable",
keywords="heart rate",
keywords="measurement accuracy",
keywords="criterion validity",
keywords="interdevice agreement",
keywords="psychological stress",
keywords="stress",
keywords="physiological",
keywords="behavioral",
keywords="mental health",
keywords="well-being",
abstract="Background: Wearable devices collect physiological and behavioral data that have the potential to identify individuals at risk of declining mental health and well-being. Past research has mainly focused on assessing the accuracy and the agreement of heart rate (HR) measurement of wearables under different physical exercise conditions. However, the capacity of wearables to sense physiological changes, assessed by increasing HR, caused by a stressful event has not been thoroughly studied. Objective: This study followed 3 objectives: (1) to test the ability of a wearable device (Fitbit Versa 2) to sense an increase in HR upon induction of psychological stress in the laboratory; (2) to assess the accuracy of the wearable device to capture short-term HR variations caused by psychological stress compared to a gold-standard electrocardiogram (ECG) measure (Biopac); and (3) to quantify the degree of agreement between the wearable device and the gold-standard ECG measure across different experimental conditions. Methods: Participants underwent the Trier Social Stress Test protocol, which consists of an oral phase, an arithmetic stress phase, an anticipation phase, and 2 relaxation phases (at the beginning and the end). During the stress protocol, the participants wore a Fitbit Versa 2 and were also connected to a Biopac. A mixed-effect modeling approach was used (1) to assess the effect of experimental conditions on HR, (2) to estimate several metrics of accuracy, and (3) to assess the agreement: the Bland-Altman limits of agreement (LoA), the concordance correlation coefficient, the coverage probability, the total deviation index, and the coefficient of an individual agreement. Mean absolute error and mean absolute percent error were calculated as accuracy indices. Results: A total of 34 university students were recruited for this study (64\% of participants were female with a mean age of 26.8 years, SD 8.3). Overall, the results showed significant HR variations across experimental phases. Post hoc tests revealed significant pairwise differences for all phases. Accuracy analyses revealed acceptable accuracy according to the analyzed metrics of accuracy for the Fitbit Versa 2 to capture the short-term variations in psychological stress levels. However, poor indices of agreement between the Fitbit Versa 2 and the Biopac were found. Conclusions: Overall, the results support the use of the Fitbit Versa 2 to capture short-term stress variations. The Fitbit device showed acceptable levels of accuracy but poor agreement with an ECG gold standard. Greater inaccuracy and smaller agreement were found for stressful experimental conditions that induced a higher HR. Fitbit devices can be used in research to measure HR variations caused by stress, although they cannot replace an ECG instrument when precision is of utmost importance. ",
doi="10.2196/37885",
url="https://formative.jmir.org/2022/12/e37885",
url="http://www.ncbi.nlm.nih.gov/pubmed/36542432"
}


@Article{info:doi/10.2196/42941,
author="Wu, Dezhi
and Lowry, Benjamin Paul
and Zhang, Dongsong
and Tao, Youyou",
title="Patient Trust in Physicians Matters---Understanding the Role of a Mobile Patient Education System and Patient-Physician Communication in Improving Patient Adherence Behavior: Field Study",
journal="J Med Internet Res",
year="2022",
month="Dec",
day="20",
volume="24",
number="12",
pages="e42941",
keywords="mobile health",
keywords="mHealth",
keywords="trust",
keywords="patient adherence",
keywords="mobile patient education system",
keywords="MPES",
keywords="patient-physician communication",
keywords="theory of planned behavior",
keywords="TPB",
keywords="patient-centered care",
keywords="mobile phone",
abstract="Background: The ultimate goal of any prescribed medical therapy is to achieve desired outcomes of patient care. However, patient nonadherence has long been a major problem detrimental to patient health, and thus is a concern for all health care providers. Moreover, nonadherence is extremely costly for global medical systems because of unnecessary complications and expenses. Traditional patient education programs often serve as an intervention tool to increase patients' self-care awareness, disease knowledge, and motivation to change patient behaviors for better adherence. Patient trust in physicians, patient-physician relationships, and quality of communication have also been identified as critical factors influencing patient adherence. However, little is known about how mobile patient education technologies help foster patient adherence. Objective: This study aimed to empirically investigate whether and how a mobile patient education system (MPES) juxtaposed with patient trust can increase patient adherence to prescribed medical therapies. Methods: This study was conducted based on a field survey of 125 patients in multiple states in the United States who have used an innovative mobile health care system for their health care education and information seeking. Partial least squares techniques were used to analyze the collected data. Results: The results revealed that patient-physician communication and the use of an MPES significantly increase patients' trust in their physicians. Furthermore, patient trust has a prominent effect on patient attitude toward treatment adherence, which in turn influences patients' behavioral intention and actual adherence behavior. Based on the theory of planned behavior, the results also indicated that behavioral intention, response efficacy, and self-efficacy positively influenced patients' actual treatment adherence behavior, whereas descriptive norms and subjective norms do not play a role in this process. Conclusions: Our study is one of the first that examines the relationship between patients who actively use an MPES and their trust in their physicians. This study contributes to this context by enriching the trust literature, addressing the call to identify key patient-centered technology determinants of trust, advancing the understanding of patient adherence mechanisms, adding a new explanation of the influence of education mechanisms delivered via mobile devices on patient adherence, and confirming that the theory of planned behavior holds in this patient adherence context. ",
doi="10.2196/42941",
url="https://www.jmir.org/2022/12/e42941",
url="http://www.ncbi.nlm.nih.gov/pubmed/36538351"
}


@Article{info:doi/10.2196/41317,
author="Foster, Marva
and Xiong, Wei
and Quintiliani, Lisa
and Hartmann, W. Christine
and Gaehde, Stephan",
title="Preferences of Older Adult Veterans With Heart Failure for Engaging With Mobile Health Technology to Support Self-care: Qualitative Interview Study Among Patients With Heart Failure and Content Analysis",
journal="JMIR Form Res",
year="2022",
month="Dec",
day="20",
volume="6",
number="12",
pages="e41317",
keywords="qualitative research",
keywords="heart failure",
keywords="self-care",
keywords="mobile health",
keywords="mobile health technology",
keywords="older adults",
keywords="elderly",
keywords="perceptions",
keywords="mhealth intervention",
keywords="veteran health",
keywords="mHealth technology",
keywords="elderly health care",
keywords="elderly self-care",
abstract="Background: Heart failure (HF) affects approximately 6.5 million adults in the United States, disproportionately afflicting older adults. Mobile health (mHealth) has emerged as a promising tool to empower older adults in HF self-care. However, little is known about the use of this approach among older adult veterans. Objective: The goal of this study was to explore which features of an app were prioritized for older adult veterans with HF. Methods: Between January and July 2021, we conducted semistructured interviews with patients with heart failure aged 65 years and older at a single facility in an integrated health care system (the Veterans Health Administration). We performed content analysis and derived themes based on the middle-range theory of chronic illness, generating findings both deductively and inductively. The qualitative questions captured data on the 3 key themes of the theory: self-care maintenance, self-care monitoring, and self-care management. Qualitative responses were analyzed using a qualitative data management platform, and descriptive statistics were used to analyze demographic data. Results: Among patients interviewed (n=9), most agreed that a smartphone app for supporting HF self-care was desirable. In addition to 3 a priori themes, we identified 7 subthemes: education on daily HF care, how often to get education on HF, support of medication adherence, dietary restriction support, goal setting for exercises, stress reduction strategies, and prompts of when to call a provider. In addition, we identified 3 inductive themes related to veteran preferences for app components: simplicity, ability to share data with caregivers, and positive framing of HF language. Conclusions: We identified educational and tracking app features that can guide the development of HF self-care for an older adult veteran population. Future research needs to be done to extend these findings and assess the feasibility of and test an app with these features. ",
doi="10.2196/41317",
url="https://formative.jmir.org/2022/12/e41317",
url="http://www.ncbi.nlm.nih.gov/pubmed/36538348"
}


@Article{info:doi/10.2196/40058,
author="Rey Velasco, Elena
and Pedersen, S{\ae}derup Hanne
and Skinner, Timothy
and ",
title="Analysis of Patient Cues in Asynchronous Health Interactions: Pilot Study Combining Empathy Appraisal and Systemic Functional Linguistics",
journal="JMIR Form Res",
year="2022",
month="Dec",
day="20",
volume="6",
number="12",
pages="e40058",
keywords="telehealth",
keywords="telecoaching",
keywords="asynchronous communication",
keywords="empathy",
keywords="systemic functional linguistics",
keywords="communication",
keywords="health promotion",
keywords="coding",
keywords="linguistic analysis",
keywords="user experience",
keywords="coach-user interaction",
keywords="tool development",
keywords="lifestyle-related disease",
abstract="Background: Lifestyle-related diseases are among the leading causes of death and disability. Their rapid increase worldwide has called for low-cost, scalable solutions to promote health behavior changes. Digital health coaching has proved to be effective in delivering affordable, scalable programs to support lifestyle change. This approach increasingly relies on asynchronous text-based interventions to motivate and support behavior change. Although we know that empathy is a core element for a successful coach-user relationship and positive patient outcomes, we lack research on how this is realized in text-based interactions. Systemic functional linguistics (SFL) is a linguistic theory that may support the identification of empathy opportunities (EOs) in text-based interactions, as well as the reasoning behind patients' linguistic choices in their formulation. Objective: This study aims to determine whether empathy and SFL approaches correspond and complement each other satisfactorily to study text-based communication in a health coaching context. We sought to explore whether combining empathic assessment with SFL categories can provide a means to understand client-coach interactions in asynchronous text-based coaching interactions. Methods: We retrieved 148 text messages sent by 29 women who participated in a randomized trial of telecoaching for the prevention of gestational diabetes mellitus (GDM) and postnatal weight loss. We conducted a pilot study to identify users' explicit and implicit EOs and further investigated these statements using the SFL approach, focusing on the analysis of transitivity and thematic analysis. Results: We identified 164 EOs present in 42.37\% (3478/8209) of the word count in the corpus. These were mainly negative (n=90, 54.88\%) and implicit (n=55, 60.00\%). We distinguished opening, content and closing messages structures. Most of the wording was found in the content (n=7077, 86.21\%) with a declarative structure (n=7084, 86.30\%). Processes represented 22.4\% (n=1839) of the corpus, with half being material (n=876, 10.67\%) and mostly related to food and diet (n=196, 54.92\%), physical activity (n=96, 26.89\%), and lifestyle goals (n=40, 11.20\%). Conclusions: Our findings show that empathy and SFL approaches are compatible. The results from our transitivity analysis reveal novel insights into the meanings of the users' EOs, such as their seek for help or praise, often missed by health care professionals (HCPs), and on the coach-user relationship. The absence of explicit EOs and direct questions could be attributed to low trust on or information about the coach's abilities. In the future, we will conduct further research to explore additional linguistic features and code coach messages. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620001240932; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380020 ",
doi="10.2196/40058",
url="https://formative.jmir.org/2022/12/e40058",
url="http://www.ncbi.nlm.nih.gov/pubmed/36538352"
}


@Article{info:doi/10.2196/39799,
author="Qin, Minghui
and Chen, Bo
and Sun, Shaohua
and Liu, Xiaodong",
title="Effect of Mobile Phone App--Based Interventions on Quality of Life and Psychological Symptoms Among Adult Cancer Survivors: Systematic Review and Meta-analysis of Randomized Controlled Trials",
journal="J Med Internet Res",
year="2022",
month="Dec",
day="19",
volume="24",
number="12",
pages="e39799",
keywords="mobile health app",
keywords="mHealth app",
keywords="quality of life",
keywords="psychological symptoms",
keywords="cancer survivors",
keywords="systematic review and meta-analysis",
keywords="mobile phone",
abstract="Background: Most patients with cancer experience psychological or physical distress, which can adversely affect their quality of life (QOL). Smartphone app interventions are increasingly being used to improve QOL and psychological outcomes in patients with cancer. However, there is insufficient evidence regarding the effect of this type of intervention, with conflicting results in the literature. Objective: In this systematic review and meta-analysis, we investigated the effectiveness of mobile phone app interventions on QOL and psychological outcomes in adult patients with cancer, with a special focus on intervention duration, type of cancer, intervention theory, treatment strategy, and intervention delivery format. Methods: We conducted a literature search of PubMed, Web of Science, the Cochrane Library, Embase, Scopus, China National Knowledge Infrastructure, and WanFang to identify studies involving apps that focused on cancer survivors and QOL or psychological symptoms published from inception to October 30, 2022. We selected only randomized controlled trials that met the inclusion criteria and performed systematic review and meta-analysis. The standardized mean difference (SMD) with a 95\% CI was pooled when needed. Sensitivity and subgroup analyses were also conducted. Results: In total, 30 randomized controlled trials with a total of 5353 participants were included in this meta-analysis. Compared with routine care, app interventions might improve QOL (SMD=0.39, 95\% CI 0.27-0.51; P<.001); enhance self-efficacy (SMD=0.15, 95\% CI 0.02-0.29; P=.03); and alleviate anxiety (SMD=?0.64, 95\% CI ?0.73 to ?0.56; P<.001), depression (SMD=?0.33, 95\% CI ?0.58 to ?0.08; P=.009), and distress (SMD=?0.34, 95\% CI ?0.61 to ?0.08; P=.01). Short-term (duration of ?3 months), physician-patient interaction (2-way communication using a smartphone app), and cognitive behavioral therapy interventions might be the most effective for improving QOL and alleviating adverse psychological effects. Conclusions: Our study showed that interventions using mobile health apps might improve QOL and self-efficacy as well as alleviate anxiety, depression, and distress in adult cancer survivors. However, these results should be interpreted with caution because of the heterogeneity of the interventions and the study design. More rigorous trials are warranted to confirm the suitable duration and validate the different intervention theories as well as address methodological flaws in previous studies. Trial Registration: PROSPERO CRD42022370599; https://www.crd.york.ac.uk/PROSPERO/display\_record.php?RecordID=370599 ",
doi="10.2196/39799",
url="https://www.jmir.org/2022/12/e39799",
url="http://www.ncbi.nlm.nih.gov/pubmed/36534460"
}


@Article{info:doi/10.2196/40382,
author="Axelrad, Jordan
and Long, Millie
and Horst, Sara
and Afzali, Anita
and Sapir, Tamar
and Fajardo, Kristina
and De Felice, Kara
and Sandler, Robert
and Cross, Raymond",
title="A Novel Remote Patient and Medication Monitoring Solution to Improve Adherence and Persistence With Inflammatory Bowel Disease Therapy (ASSIST Study): Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="Dec",
day="15",
volume="11",
number="12",
pages="e40382",
keywords="remote therapy monitoring",
keywords="connected health",
keywords="patient engagement",
keywords="Crohn disease",
keywords="ulcerative colitis",
keywords="inflammatory bowel disease",
keywords="mobile phone",
abstract="Background: Inflammatory bowel diseases (IBDs) are chronic inflammatory conditions of the gastrointestinal tract. Although adherence to IBD therapies is associated with improved clinical outcomes, overall adherence is poor. Consequently, there is a critical need to develop interventions that monitor adherence in real time and identify reasons for nonadherence to support clinical teams in initiating effective interventions. Recently, electronic- and web-based platforms have been developed to monitor adherence and guide interventions. A novel remote therapy monitoring (RTM) technology, the Tappt digital health system, has been developed to monitor real-time medication adherence patterns through smart label technologies, capture patient-reported outcomes and barriers to care, and process patient data through algorithms that trigger personalized digital and human touch points between clinical visits. Such a digital health solution enables care teams to proactively identify and mitigate nonadherence and worsening clinical outcomes. Objective: We propose a 12-month multicenter randomized controlled trial to assess the effectiveness of the Tappt digital health system on adherence, clinical outcomes, and health care use among patients diagnosed with IBD starting a new oral or subcutaneous therapy. Methods: The digital health system intervention will provide automatic measurement of medication adherence via smart labels for pill bottles or injectors as well as a monitoring platform for providers. The system will prompt patients to complete a two-item assessment of symptoms monthly using the PRO-2 scales for UC and Crohn disease, from which increased symptoms will be alerted to providers. Participants will be randomized 2:1 to the intervention group or the control group, which will receive standard of care. All participants are required to complete questionnaires at baseline as well as at 12, 26, and 52 weeks. Assuming an adherence rate of 0.65 and 0.9 among control and intervention participants, respectively, we will need to enroll 123 participants: 82 (66.7\%) in the intervention group and 41 (33.3\%) controls. We will compare adherence as measured by the medication possession ratio, defined as the number of days of supply of medication obtained during the observation period out of the total number of days in the observation period, in participants using the RTM versus those receiving standard of care. We will also compare clinical outcomes and health care use in participants using the RTM versus those receiving standard of care. Results: We anticipate starting recruitment in December 2022. Conclusions: Effective medication adherence monitoring and intervention programs need to be cost-efficient, pose little or no burden to the patient, record reliable data in real time, and provide actionable insights to the health care team. We anticipate the Tappt digital health system to improve the medication possession ratio, clinical outcomes, and health care use compared with standard of care. Trial Registration: ClinicalTrials.gov NCT05316584; https://clinicaltrials.gov/ct2/show/NCT05316584 International Registered Report Identifier (IRRID): PRR1-10.2196/40382 ",
doi="10.2196/40382",
url="https://www.researchprotocols.org/2022/12/e40382",
url="http://www.ncbi.nlm.nih.gov/pubmed/36520519"
}


@Article{info:doi/10.2196/40723,
author="Toh, Yang Sean Han
and Tan, Yan Jessalin Hui
and Kosasih, Roxanne Feodora
and S{\"u}ndermann, Oliver",
title="Efficacy of the Mental Health App Intellect to Reduce Stress: Randomized Controlled Trial With a 1-Month Follow-up",
journal="JMIR Form Res",
year="2022",
month="Dec",
day="14",
volume="6",
number="12",
pages="e40723",
keywords="mobile health",
keywords="mHealth",
keywords="randomized controlled trial",
keywords="RCT",
keywords="self-guided interventions",
keywords="cognitive behavioral therapy",
keywords="CBT",
keywords="stress coping",
keywords="stress management",
keywords="university students",
keywords="psychological mindedness",
keywords="coping self-efficacy",
keywords="mobile phone",
abstract="Background: Excessive stress is a major global health concern, particularly in young adults. Short skills-focused self-guided interventions (SGIs) on smartphones are a scalable way to improve stress-coping skills at the population level. Objective: In this randomized controlled trial, we aimed to examine the possible efficacy of a recently developed stress-coping SGI (Intellect) in improving psychological distress, relative to an active control group and 2 potential moderators of this predicted relationship (ie, psychological mindedness [PM] and coping self-efficacy [CSE]). Methods: University students (N=321) were randomly assigned to either an 8-day SGI on stress-coping or an active control group. Self-reported measures were obtained at baseline, after the intervention, and at the 1-month follow-up. The primary outcome was psychological stress (Psychological Stress Measure-9). Secondary outcomes were anxiety (Generalized Anxiety Disorder-7) and depressive symptoms (Patient Health Questionnaire-9). PM and CSE were assessed as potential moderators at baseline. Results: The final sample (n=264) included 188 (71.2\%) female, 66 (25\%) male, 7 (2.7\%) nonbinary, and 3 (1.1\%) others participants with a mean age of 22.5 (SD 5.41) years. The intervention group reported significantly lower perceived stress (partial eta--squared [$\eta$p2]=0.018; P=.03) and anxiety ($\eta$p2=0.019; P=.03) levels after intervention relative to the active control group. The effects on perceived stress levels remained statistically significant at the 1-month follow-up ($\eta$p2=0.015; P=.05). Students with the lowest CSE and highest PM experienced the fastest decline in perceived stress levels ($\beta$=6.37, 95\% Cl 2.98-9.75). Improvements in anxiety levels were not observed at 1-month follow-up. Similarly, no intervention effects were found for depression levels at postintervention and follow-up periods. Conclusions: This study provides evidence that the Intellect stress-coping SGI is effective in reducing perceived stress and anxiety levels among university students. Mobile health apps are brief, scalable, and can make important contributions to public mental health. Trial Registration: ClinicalTrials.gov NCT04978896; https://www.clinicaltrials.gov/ct2/show/NCT04978896 ",
doi="10.2196/40723",
url="https://formative.jmir.org/2022/12/e40723",
url="http://www.ncbi.nlm.nih.gov/pubmed/36515984"
}


@Article{info:doi/10.2196/40045,
author="Rosenfeld, A. Eve
and Lyman, Cassondra
and Roberts, E. John",
title="Development of an mHealth App--Based Intervention for Depressive Rumination (RuminAid): Mixed Methods Focus Group Evaluation",
journal="JMIR Form Res",
year="2022",
month="Dec",
day="13",
volume="6",
number="12",
pages="e40045",
keywords="depression",
keywords="rumination",
keywords="mobile health",
keywords="mHealth",
keywords="evidence-based treatment",
keywords="focus group",
keywords="mental health",
keywords="mobile app",
keywords="mobile phone",
abstract="Background: Depression is a common mental health condition that poses a significant public health burden. Effective treatments for depression exist; however, access to evidence-based care remains limited. Mobile health (mHealth) apps offer an avenue for improving access. However, few mHealth apps are informed by evidence-based treatments and even fewer are empirically evaluated before dissemination. To address this gap, we developed RuminAid, an mHealth app that uses evidence-based treatment components to reduce depression by targeting a single key depressogenic process---rumination. Objective: The primary objective of this study was to collect qualitative and quantitative feedback that could be used to improve the design of RuminAid before the software development phase. Methods: We reviewed empirically supported interventions for depression and rumination and used the key aspects of each to create a storyboard version of RuminAid. We distributed an audio-guided presentation of the RuminAid storyboard to 22 individuals for viewing and solicited user feedback on app content, design, and perceived functionality across 7 focus group sessions. Results: The consumer-rated quality of the storyboard version of RuminAid was in the acceptable to good range. Indeed, most participants reported that they thought RuminAid would be an engaging, functional, and informational app. Likewise, they endorsed overwhelming positive beliefs about the perceived impact of RuminAid; specifically, 96\% (21/22) believed that RuminAid will help depressed ruminators with depression and rumination. Nevertheless, the results highlighted the need for improved app aesthetics (eg, a more appealing color scheme and modern design). Conclusions: Focus group members reported that the quality of information was quite good and had the potential to help adults who struggle with depression and rumination but expressed concern that poor aesthetics would interfere with users' desire to continue using the app. To address these comments, we hired a graphic designer and redesigned each screen to improve visual appeal. We also removed time gating from the app based on participant feedback and findings from related research. These changes helped elevate RuminAid and informed its initial software build for a pilot trial that focused on evaluating its feasibility and acceptability. ",
doi="10.2196/40045",
url="https://formative.jmir.org/2022/12/e40045",
url="http://www.ncbi.nlm.nih.gov/pubmed/36512400"
}


@Article{info:doi/10.2196/39816,
author="Ntinga, Xolani
and Musiello, Franco
and Keter, Kipyegon Alfred
and Barnabas, Ruanne
and van Heerden, Alastair",
title="The Feasibility and Acceptability of an mHealth Conversational Agent Designed to Support HIV Self-testing in South Africa: Cross-sectional Study",
journal="J Med Internet Res",
year="2022",
month="Dec",
day="12",
volume="24",
number="12",
pages="e39816",
keywords="HIV",
keywords="HIV self-testing",
keywords="HIVST",
keywords="chatbot",
keywords="conversational agents",
keywords="mobile health",
keywords="mHealth",
keywords="mobile phone",
abstract="Background: HIV testing rates in sub-Saharan Africa remain below the targeted threshold, and primary care facilities struggle to provide adequate services. Innovative approaches that leverage digital technologies could improve HIV testing and access to treatment. Objective: This study aimed to examine the feasibility and acceptability of Nolwazi\_bot. It is an isiZulu-speaking conversational agent designed to support HIV self-testing (HIVST) in KwaZulu-Natal, South Africa. Methods: Nolwazi\_bot was designed with 4 different personalities that users could choose when selecting a counselor for their HIVST session. We recruited a convenience sample of 120 consenting adults and invited them to undertake an HIV self-test facilitated by the Nolwazi\_bot. After testing, participants completed an interviewer-led posttest structured survey to assess their experience with the chatbot-supported HIVST. Results: Participants (N=120) ranged in age from 18 to 47 years, with half of them being men (61/120, 50.8\%). Of the 120 participants, 111 (92.5\%) had tested with a human counselor more than once. Of the 120 participants, 45 (37.5\%) chose to be counseled by the female Nolwazi\_bot personality aged between 18 and 25 years. Approximately one-fifth (21/120, 17.5\%) of the participants who underwent an HIV self-test guided by the chatbot tested positive. Most participants (95/120, 79.2\%) indicated that their HIV testing experience with a chatbot was much better than that with a human counselor. Many participants (93/120, 77.5\%) reported that they felt as if they were talking to a real person, stating that the response tone and word choice of Nolwazi\_bot reminded them of how they speak in daily conversations. Conclusions: The study provides insights into the potential of digital technology interventions to support HIVST in low-income and middle-income countries. Although we wait to see the full benefits of mobile health, technological interventions including conversational agents or chatbots provide us with an excellent opportunity to improve HIVST by addressing the barriers associated with clinic-based HIV testing. ",
doi="10.2196/39816",
url="https://www.jmir.org/2022/12/e39816",
url="http://www.ncbi.nlm.nih.gov/pubmed/36508248"
}


@Article{info:doi/10.2196/40705,
author="Simons, E. Laura
and Hess, W. Courtney
and Choate, S. Ellison
and Van Orden, R. Amanda
and Tremblay-McGaw, G. Alexandra
and Menendez, Maria
and Boothroyd, B. Derek
and Parvathinathan, Gomathy
and Griffin, Anya
and Caruso, J. Thomas
and Stinson, Jennifer
and Weisman, Amy
and Liu, Timothy
and Koeppen, Kurt",
title="Virtual Reality--Augmented Physiotherapy for Chronic Pain in Youth: Protocol for a Randomized Controlled Trial Enhanced With a Single-Case Experimental Design",
journal="JMIR Res Protoc",
year="2022",
month="Dec",
day="12",
volume="11",
number="12",
pages="e40705",
keywords="chronic pain",
keywords="adolescents",
keywords="physiotherapy",
keywords="virtual reality",
keywords="single-case experimental design",
keywords="mobile phone",
abstract="Background: Chronic musculoskeletal (MSK) pain is a prominent health concern, resulting in pain-related disability, loss of functioning, and high health care costs. Physiotherapy rehabilitation is a gold-standard treatment for improving functioning in youth with chronic MSK pain. However, increasing physical activity can feel unattainable for many adolescents because of pain-related fear and movement avoidance. Virtual reality (VR) offers an immersive experience that can interrupt the fear-avoidance cycle and improve engagement in physiotherapy. Despite promising initial findings, data are limited and often lack the rigor required to establish VR as an evidence-based treatment for MSK pain. Objective: This trial evaluates physiorehabilitation with VR in adolescents with MSK pain. This protocol outlines the rationale, design, and implementation of a randomized controlled trial enhanced with a single-case experimental design. Methods: This study is a 2-group randomized controlled trial assessing the use of physiorehabilitation with VR in adolescents with MSK pain. The authors will collaborate with physical therapists to integrate VR into their standard clinical care. For participants enrolled in standard physiotherapy, there will be no VR integrated into their physical therapy program. Primary outcomes include physical function and engagement in VR. Secondary outcomes include pain-related fear and treatment adherence. Moreover, we will obtain clinician perspectives regarding the feasibility of integrating the intervention into the flow of clinical practice. Results: The pilot study implementing physiorehabilitation with VR demonstrated that high engagement and use of physiorehabilitation with VR were associated with improvements in pain, fear, avoidance, and function. Coupled with qualitative feedback from patients, families, and clinicians, the pilot study results provide support for this trial to evaluate physiorehabilitation with VR for youth with chronic MSK pain. Analysis of results from the main clinical trial will begin as recruitment progresses, and results are expected in early 2024. Conclusions: Significant breakthroughs for treating MSK pain require mechanistically informed innovative approaches. Physiorehabilitation with VR provides exposure to progressive challenges, real-time feedback, and reinforcement for movement and can include activities that are difficult to achieve in the real world. It has the added benefit of sustaining patient motivation and adherence while enabling clinicians to use objective benchmarks to influence progression. These findings will inform the decision of whether to proceed with a hybrid effectiveness-dissemination trial of physiorehabilitation with VR, serving as the basis for potential large-scale implementation of physiorehabilitation with VR. Trial Registration: ClinicalTrials.gov NCT04636177; https://clinicaltrials.gov/ct2/show/NCT04636177 International Registered Report Identifier (IRRID): DERR1-10.2196/40705 ",
doi="10.2196/40705",
url="https://www.researchprotocols.org/2022/12/e40705",
url="http://www.ncbi.nlm.nih.gov/pubmed/36508251"
}


@Article{info:doi/10.2196/39271,
author="Skiba, B. Meghan
and Harker, Graham
and Guidarelli, Carolyn
and El-Gohary, Mahmoud
and Horak, Fay
and Roeland, J. Eric
and Silbermann, Rebecca
and Hayes-Lattin, Brandon
and Winters-Stone, Kerri",
title="Using Wearable Inertial Sensors to Assess Mobility of Patients With Hematologic Cancer and Associations With Chemotherapy-Related Symptoms Before Autologous Hematopoietic Stem Cell Transplant: Cross-sectional Study",
journal="JMIR Cancer",
year="2022",
month="Dec",
day="8",
volume="8",
number="4",
pages="e39271",
keywords="wearable inertial sensor",
keywords="mobility",
keywords="gait",
keywords="induction chemotherapy",
keywords="autologous hematopoietic stem cell transplant",
keywords="autoHSCT",
keywords="chemotherapy-related symptoms",
abstract="Background: Wearable sensors could be a simple way to quantify and characterize mobility in patients with hematologic cancer scheduled to receive autologous hematopoietic stem cell transplant (autoHSCT) and how they may be related to common treatment-related symptoms and side effects of induction chemotherapy. Objective: We aimed to conduct a cross-sectional study comparing mobility in patients scheduled to receive autoHSCT with that in healthy, age-matched adult controls and determine the relationships between patient mobility and chemotherapy-related symptoms. Methods: Patients scheduled to receive autoHSCT (78/156, 50\%) and controls (78/156, 50\%) completed the prescribed performance tests using wearable inertial sensors to quantify mobility including turning (turn duration and number of steps), gait (gait speed, stride time, stride time variability, double support time, coronal trunk range of motion, heel strike angle, and distance traveled), and balance (coronal sway, coronal range, coronal velocity, coronal centroidal frequency, sagittal sway, sagittal range, sagittal velocity, and sagittal centroidal frequency). Patients completed the validated patient-reported questionnaires to assess symptoms common to chemotherapy: chemotherapy-induced peripheral neuropathy (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group--Neurotoxicity subscale), nausea and pain (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire), fatigue (Patient-Reported Outcomes Measurement Information System Fatigue Short Form 8a), vertigo (Vertigo Symptom Scale--short form), and depression (Center for Epidemiological Studies--Depression). Paired, 2-sided t tests were used to compare mobility between patients and controls. Stepwise multivariable linear regression models were used to evaluate associations between patient mobility and symptoms. Results: Patients aged 60.3 (SD 10.3) years had significantly worse turning (turn duration; P<.001), gait (gait speed, stride time, stride time variability, double support time, heel strike angle, stride length, and distance traveled; all P<.001), and balance (coronal sway; P<.001, range; P<.001, velocity; P=.02, and frequency; P=.02; and sagittal range; P=.008) than controls. In patients, high nausea was associated with worse stride time variability ({\ss}=.001; P=.005) and heel strike angle ({\ss}=?.088; P=.02). Pain was associated with worse gait speed ({\ss}=?.003; P=.003), stride time variability ({\ss}=.012; P=.02), stride length ({\ss}=?.002; P=.004), and distance traveled ({\ss}=?.786; P=.005). Nausea and pain explained 17\% to 33\% and 14\% to 36\% of gait variance measured in patients, respectively. Conclusions: Patients scheduled to receive autoHSCT demonstrated worse mobility in multiple turning, gait, and balance domains compared with controls, potentially related in part to nausea and pain. Wearable inertial sensors used in the clinic setting could provide granular information about mobility before further treatment, which may in turn benefit from rehabilitation or symptom management. Future longitudinal studies are needed to better understand temporal changes in mobility and symptoms across the treatment trajectory to optimally time, design, and implement strategies, to preserve functioning in patients with hematologic cancer in the long term. ",
doi="10.2196/39271",
url="https://cancer.jmir.org/2022/4/e39271",
url="http://www.ncbi.nlm.nih.gov/pubmed/36480243"
}


@Article{info:doi/10.2196/39483,
author="Benton, S. Jack
and Cotterill, Sarah
and Hawkes, E. Rhiannon
and Miles, M. Lisa
and French, P. David",
title="Changes in a Digital Type 2 Diabetes Self-management Intervention During National Rollout: Mixed Methods Study of Fidelity",
journal="J Med Internet Res",
year="2022",
month="Dec",
day="7",
volume="24",
number="12",
pages="e39483",
keywords="type 2 diabetes",
keywords="Healthy Living",
keywords="digital interventions",
keywords="behavior change",
keywords="self-management",
keywords="fidelity",
keywords="implementation",
keywords="mixed methods",
keywords="mobile phone",
abstract="Background: ``Healthy Living for People with type 2 Diabetes (HeLP-Diabetes)'' was a theory-based digital self-management intervention for people with type 2 diabetes mellitus that encouraged behavior change using behavior change techniques (BCTs) and promoted self-management. HeLP-Diabetes was effective in reducing HbA1c levels in a randomized controlled trial (RCT). National Health Service (NHS) England commissioned a national rollout of HeLP-Diabetes in routine care (now called ``Healthy Living''). Healthy Living presents a unique opportunity to examine the fidelity of the national rollout of an intervention originally tested in an RCT. Objective: This research aimed to describe the Healthy Living BCT and self-management content and features of intervention delivery, compare the fidelity of Healthy Living with the original HeLP-Diabetes intervention, and explain the reasons for any fidelity drift during national rollout through qualitative interviews. Methods: Content analysis of Healthy Living was conducted using 3 coding frameworks (objective 1): the BCT Taxonomy v1, a new coding framework for assessing self-management tasks, and the Template for Intervention Description and Replication. The extent to which BCTs and self-management tasks were included in Healthy Living was compared with published descriptions of HeLP-Diabetes (objective 2). Semistructured interviews were conducted with 9 stakeholders involved in the development of HeLP-Diabetes or Healthy Living to understand the reasons for any changes during national rollout (objective 3). Qualitative data were thematically analyzed using a modified framework approach. Results: The content analysis identified 43 BCTs in Healthy Living. Healthy Living included all but one of the self-regulatory BCTs (``commitment'') in the original HeLP-Diabetes intervention. Healthy Living was found to address all areas of self-management (medical, emotional, and role) in line with the original HeLP-Diabetes intervention. However, 2 important changes were identified. First, facilitated access by a health care professional was not implemented; interviews revealed this was because general practices had fewer resources in comparison with the RCT. Second, Healthy Living included an additional structured web-based learning curriculum that was developed by the HeLP-Diabetes team but was not included in the original RCT; interviews revealed that this was because of changes in NHS policy that encouraged referral to structured education. Interviewees described how the service provider had to reformat the content of the original HeLP-Diabetes website to make it more usable and accessible to meet the multiple digital standards required for implementation in the NHS. Conclusions: The national rollout of Healthy Living had good fidelity to the BCT and self-management content of HeLP-Diabetes. Important changes were attributable to the challenges of scaling up a digital intervention from an RCT to a nationally implemented intervention, mainly because of fewer resources available in practice and the length of time since the RCT. This study highlights the importance of considering implementation throughout all phases of intervention development. ",
doi="10.2196/39483",
url="https://www.jmir.org/2022/12/e39483",
url="http://www.ncbi.nlm.nih.gov/pubmed/36476723"
}


@Article{info:doi/10.2196/43208,
author="Chan, Nam Hiu
and Lim, Shen Hong
and Chong, Lin Pui
and Yung, Kwang Chee
and Abd Mulok, Musjarena
and Wei, Yuan
and Yong, Ling Alice Moi",
title="Development and Exploration of the Effectiveness and Feasibility of a Digital Intervention for Type 2 Diabetes Mellitus (DEsireD): Protocol for a Clinical Nonrandomized Pilot Trial in Brunei Darussalam",
journal="JMIR Res Protoc",
year="2022",
month="Dec",
day="7",
volume="11",
number="12",
pages="e43208",
keywords="DEsireD",
keywords="type 2 diabetes mellitus",
keywords="digital intervention",
keywords="mHealth",
keywords="health coaching",
keywords="chronic disease management",
keywords="EMR",
keywords="value-based care",
abstract="Background: The prevalence of type 2 diabetes mellitus (T2DM) is increasing worldwide. Digital interventions that incorporate the use of mobile phones and wearables have been getting popular. A combination of a digital intervention with support from professional management can enhance users' self-efficacy better than a digital intervention alone and provide better accessibility to a lifestyle intervention. However, there are limited studies exploring the feasibility and efficacy of applying a digital intervention in Muslim-majority countries, and none have been conducted in Brunei Darussalam. Objective: The study aims to determine the effectiveness and feasibility of a proposed 16-week digital intervention program for T2DM self-management and to guide the rollout of a mobile app as part of a population health solution for adults with T2DM in Brunei. The primary outcome of this study is to measure the proportion of participants with a hemoglobin A1c (HbA1c) reduction of at least 0.6\% from baseline, and the secondary outcomes include a change in HbA1c, BMI, lipid profile, and EQ-5D-5L score. Methods: This single-arm nonrandomized pilot study will recruit participants using web-based (with the national health care app [BruHealth] and official social media platforms being used for outreach) and offline (in-person recruitment at health centers) approaches. A target of 180 individuals with T2DM aged between 20 and 70 years that meet the inclusion criteria will be enrolled in a 16-week digital intervention program. Baseline and postintervention markers will be evaluated. Results: The study received approval from the Medical and Health Research \& Ethics Committee of the Brunei Darussalam Ministry of Health (MHREC/MOH/2022/4(1)). The recruitment process is ongoing, and we anticipate that the study will conclude by April 2023. This will be followed by data analysis and the reporting of outcomes with the intention to publish. The results of this study will be disseminated through scientific publications and conferences. This study will serve as a guide to launch T2DM digital therapeutic programs and extend to other noncommunicable diseases (NCDs) if proven as an effective and feasible approach in Brunei. Conclusions: The Development and Exploration of the Effectiveness and Feasibility of a Digital Intervention for Type 2 Diabetes Mellitus (DEsireD) study will be the first study to investigate the clinical effectiveness and feasibility of the proposed 16-week T2DM digital intervention program tailored for Brunei, a Muslim-majority country. The findings of this study can potentially scale up the proposed model of care to other NCDs as a national approach for health management solutions. Trial Registration: ClinicalTrials.gov NCT05364476; https://clinicaltrials.gov/ct2/show/NCT05364476 International Registered Report Identifier (IRRID): DERR1-10.2196/43208 ",
doi="10.2196/43208",
url="https://www.researchprotocols.org/2022/12/e43208",
url="http://www.ncbi.nlm.nih.gov/pubmed/36477014"
}


@Article{info:doi/10.2196/36829,
author="Kajubi, Phoebe
and Parkes-Ratanshi, Rosalind
and Twimukye, Adelline
and Bwanika Naggirinya, Agnes
and Nabaggala, Sarah Maria
and Kiragga, Agnes
and Castelnuovo, Barbara
and King, Rachel",
title="Perceptions and Attitudes Toward an Interactive Voice Response Tool (Call for Life Uganda) Providing Adherence Support and Health Information to HIV-Positive Ugandans: Qualitative Study",
journal="JMIR Form Res",
year="2022",
month="Dec",
day="6",
volume="6",
number="12",
pages="e36829",
keywords="mobile health",
keywords="mHealth",
keywords="mobile communication technologies",
keywords="people living with HIV",
keywords="antiretroviral therapy",
keywords="quality of life",
keywords="Uganda",
abstract="Background: The continuing decline in AIDS-related deaths in the African region is largely driven by the steady scale-up of antiretroviral therapy. However, there are challenges to retaining people living with HIV on treatment. Call for Life Uganda (CFLU) is an interactive voice response tool using simple analogue phones. CFLU supports patients with daily pill reminders, preappointment reminders, symptom reporting and management, and weekly health promotion tips. Mobile health tools are being increasingly used in resource-limited settings but are often adopted without rigorous evaluation. Objective: This qualitative study conducted at 12 months after enrollment assessed patients' experiences, perceptions, and attitudes regarding CLFU. Methods: We conducted a qualitative substudy within an open-label randomized controlled trial titled ``Improving outcomes in HIV patients using mobile phone based interactive software support.'' Data were collected through 6 focus group discussions with participants sampled based on proportion of calls responded to---<25\%, between 25\% and 50\%, and >50\%---conducted at the Infectious Diseases Institute, Mulago, and the Kasangati Health Centre IV. NVivo (version 11; QSR International) was used in the management of the data and in the coding of the emerging themes. The data were then analyzed using content thematic analysis. Results: There was consensus across all groups that they had more positive than negative experiences with the CFLU system. Participants who responded to >50\% of the calls reported more frequent use of the specific elements of the CFLU tool and, consequently, experienced more benefits from the system than those who responded to calls less frequently. Irrespective of calls responded to, participants identified pill reminders as the most important aspect in improved quality of life, followed by health promotion tips. The most common challenge faced was difficulty with the secret personal identification number. Conclusions: Findings showed participants' appreciation, high willingness, and interest in the intervention, CFLU, that demonstrated great perceived potential to improve their access to health care; adherence to treatment; health awareness; and, consequently, quality of life. Trial Registration: ClinicalTrials.gov NCT02953080; https://clinicaltrials.gov/ct2/show/NCT02953080 ",
doi="10.2196/36829",
url="https://formative.jmir.org/2022/12/e36829",
url="http://www.ncbi.nlm.nih.gov/pubmed/36472904"
}


@Article{info:doi/10.2196/39881,
author="Cozad, J. Melanie
and Crum, Marissa
and Tyson, Hannah
and Fleming, R. Perry
and Stratton, Jeanine
and Kennedy, Blair Ann
and Lindley, C. Lisa
and Horner, D. Ronnie",
title="Mobile Health Apps for Patient-Centered Care: Review of United States Rheumatoid Arthritis Apps for Engagement and Activation",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Dec",
day="5",
volume="10",
number="12",
pages="e39881",
keywords="rheumatoid arthritis",
keywords="rheumatism",
keywords="arthritis",
keywords="mobile app",
keywords="mobile applications",
keywords="mHealth",
keywords="patient engagement",
keywords="patient activation",
keywords="patient-centered care",
keywords="patient centred",
keywords="person centered",
keywords="Mobile Application Rating Scale",
keywords="social cognitive theory",
keywords="mobile health",
keywords="review",
keywords="systematic search",
keywords="app feature",
keywords="content analysis",
keywords="functionality",
keywords="user rating",
keywords="patient rating",
abstract="Background: Rheumatoid arthritis (RA) is a highly dynamic and individualized disease in terms of its patterns of symptomatic flare-ups and periods of remission. Patient-centered care (PCC) aligns patients' lifestyle goals with their preferences for managing symptoms and side effects through the selection of therapies appropriate for disease management. Mobile health (mHealth) apps have the potential to engage and activate patients in PCC. mHealth apps can provide features that increase disease knowledge, collect patient-generated health indicators and behavioral metrics, and highlight goals for disease management. However, little evidence-based guidance exists as to which apps contain functionality essential for supporting the delivery of PCC. Objective: The objective of this study was to evaluate the patient-centeredness of United States--based rheumatoid arthritis mobile apps in terms of patient engagement and activation. Methods: A search of mobile apps on 2 major United States app stores (Apple App Store and Google Play) was conducted from June 2020 to July 2021 to identify apps designed for use by patients with RA by adapting the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines for mobile health app screening based on the literature. Reviewers conducted a content analysis of mobile app features to evaluate their functionality for patient engagement and activation. Engagement and activation were assessed using the Mobile Application Rating Scale (MARS) and social cognitive theory, respectively. Apps were ranked by their ability to facilitate PCC care along 2 dimensions: engagement and activation. Results: A total of 202 mobile apps were initially identified, and 20 remained after screening. Two apps emerged with the greatest ability to facilitate PCC. Both apps were scored as having acceptable or good patient engagement according to the MARS. These 2 apps also had high patient activation according to social cognitive theory, with many features within those apps representing theoretical constructs such as knowledge, perceived self-efficacy, and expectations about outcomes that support behavioral management of RA. Conclusions: We found very few mobile apps available within the United States that have functionality that both engages and activates the patient to facilitate PCC. As the prevalence of mobile apps expands, the design of mobile apps needs to integrate patients to ensure that their functionality promotes engagement and activation. More research is needed to understand how mobile app use impacts patient engagement and activation, and ultimately, treatment decisions and disease trajectory. ",
doi="10.2196/39881",
url="https://mhealth.jmir.org/2022/12/e39881",
url="http://www.ncbi.nlm.nih.gov/pubmed/36469397"
}


@Article{info:doi/10.2196/38649,
author="Teepe, Wilhelm Gisbert
and Kowatsch, Tobias
and Hans, Patricius Felix
and Benning, Leo",
title="Preliminary Use and Outcome Data of a Digital Home Exercise Program for Back, Hip, and Knee Pain: Retrospective Observational Study With a Time Series and Matched Analysis",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Dec",
day="2",
volume="10",
number="12",
pages="e38649",
keywords="digital health",
keywords="home exercise",
keywords="musculoskeletal conditions",
keywords="digital intervention",
keywords="exercise",
keywords="physical activity",
keywords="smartphone",
keywords="pain",
keywords="management",
keywords="back pain",
keywords="hip pain",
keywords="knee pain",
keywords="mobility",
keywords="intervention",
abstract="Background: Musculoskeletal conditions are among the main contributors to the global burden of disease. International guidelines consider patient education and movement exercises as the preferred therapeutic option for unspecific and degenerative musculoskeletal conditions. Innovative and decentralized therapeutic means are required to provide access to and availability of such care to meet the increasing therapeutic demand for this spectrum of conditions. Objective: This retrospective observational study of preliminary use and outcome data explores the clinical outcomes of Vivira (hereafter referred to as ``program''), a smartphone-based program for unspecific and degenerative pain in the back, hip, and knee before it received regulatory approval for use in the German statutory health insurance system. Methods: An incomplete matched block design was employed to assess pain score changes over the intended 12-week duration of the program. Post hoc analyses were performed. In addition, a matched comparison of self-reported functional scores and adherence rates is presented. Results: A total of 2517 participants met the inclusion criteria and provided sufficient data to be included in the analyses. Overall, initial self-reported pain scores decreased significantly from an average of 5.19 out of 10 (SD 1.96) to an average of 3.35 out of 10 (SD 2.38) after 12 weeks. Post hoc analyses indicate a particularly emphasized pain score reduction over the early use phases. Additionally, participants with back pain showed significant improvements in strength and mobility scores, whereas participants with hip or knee pain demonstrated significant improvements in their coordination scores. Across all pain areas and pain durations, a high yet expected attrition rate could be observed. Conclusions: This observational study provides the first insights into the clinical outcomes of an exercise program for unspecific and degenerative back, hip, and knee pain. Furthermore, it demonstrates a potential secondary benefit of improved functionality (ie, strength, mobility, coordination). However, as this study lacks confirmatory power, further research is required to substantiate the clinical outcomes of the program assessed. Trial Registration: German Clinical Trials Register DRKS00021785; https://drks.de/search/en/trial/DRKS00021785 ",
doi="10.2196/38649",
url="https://mhealth.jmir.org/2022/12/e38649",
url="http://www.ncbi.nlm.nih.gov/pubmed/36459399"
}


@Article{info:doi/10.2196/37684,
author="Tahsin, Farah
and Austin, Tujuanna
and McKinstry, Brian
and Mercer, W. Stewart
and Loganathan, Mayura
and Thavorn, Kednapa
and Upshur, Ross
and Steele Gray, Carolyn",
title="Examining Use Behavior of a Goal-Supporting mHealth App in Primary Care Among Patients With Multiple Chronic Conditions: Qualitative Descriptive Study",
journal="JMIR Hum Factors",
year="2022",
month="Nov",
day="30",
volume="9",
number="4",
pages="e37684",
keywords="mobile health",
keywords="mHealth",
keywords="multimorbidity",
keywords="chronic disease management",
keywords="goal-oriented care",
keywords="multimorbid",
keywords="app",
keywords="primary care",
keywords="telemedicine",
keywords="use",
keywords="usability",
keywords="human factors",
keywords="behavior",
keywords="sociobehavioral",
keywords="health technology",
keywords="mobile phone",
abstract="Background: Although mobile health (mHealth) apps are increasingly being used to support patients with multiple chronic conditions (multimorbidity), most mHealth apps experience low interaction and eventual abandonment. To tackle this engagement issue, when developing an mHealth program, it is important to understand the social-behavioral factors that affect patients' use behavior. Objective: The aim of this study was to explore the social and behavioral factors contributing to patients' use behavior of an mHealth app called the electronic Patient-Reported Outcome (ePRO). The ePRO app supports goal-oriented care delivery in interdisciplinary primary care models. Methods: A descriptive qualitative study was used to analyze interview data collected for a larger mixed methods pragmatic trial. The original 15-month trial was conducted in 6 primary care teams across Ontario, Canada, between 2018 and 2019. The eligibility criteria for patients were being aged ?60 years with ?10 visits within the previous 12 months of study enrollment. For this analysis, patients were classified as long-term or short-term users based on their length of use of the ePRO app during the trial. The Social Cognitive Theory by Bandura was used to categorize social-behavioral factors that contributed to patients' decision to continue or discontinue using the app. Results: The patient-provider relationship emerged as a key factor that shaped patients' experiences with the app and subsequent decision to continue using the app. Other factors that contributed to patients' decision to continue using the app were personal and social circumstances, perceived usefulness, patients' previous experience with goal-related behaviors, and confidence in one's capability. There was an overlap of experience between long- and short-term app users but, in general, long-term users perceived the app to be more useful and their goals to be more meaningful than short-term app users. This observation was complicated by the fact that patient health-related goals were dynamic and changed over time. Conclusions: Complex patients' use behavior of a goal-supporting mHealth app is shaped by an array of sociobehavioral factors that can evolve. To tackle this dynamism, there should be an emphasis on creating adaptable health technologies that are easily customizable by patients and able to respond to their changing contexts and needs. Trial Registration: ClinicalTrials.gov NCT02917954; https://clinicaltrials.gov/ct2/show/NCT02917954 ",
doi="10.2196/37684",
url="https://humanfactors.jmir.org/2022/4/e37684",
url="http://www.ncbi.nlm.nih.gov/pubmed/36449335"
}


@Article{info:doi/10.2196/37501,
author="Anugu, Pramod
and Ansari, Yusuf Md Abu
and Min, Yuan-I
and Benjamin, J. Emelia
and Murabito, Joanne
and Winters, Karen
and Turner, Erica
and Correa, Adolfo",
title="Digital Connectedness in the Jackson Heart Study: Cross-sectional Study",
journal="J Med Internet Res",
year="2022",
month="Nov",
day="21",
volume="24",
number="11",
pages="e37501",
keywords="teleresearch",
keywords="mobile technology",
keywords="cardiovascular disease",
keywords="Jackson Heart Study",
keywords="mobile phone",
abstract="Background: Although new approaches for data collection, such as mobile technology and teleresearch, have demonstrated new opportunities for the conduct of more timely and less costly surveys in community-based studies, literature on the feasibility of conducing cardiovascular disease research using mobile health (mHealth) platforms among middle-aged and older African Americans has been limited. Objective: The purpose of this study was to contribute to the knowledge regarding the penetrance of internet and mobile technologies, such as cellphones or smartphones in existing large cohort studies of cardiovascular disease. Methods: A digital connectedness survey was conducted in the Jackson Heart Study (JHS), a Mississippi-based African American cohort study, as part of the annual follow-up calls with participants from July 2017 to February 2019. Results: Of the 4024 participants contacted, 2564 (63.7\%) completed the survey. Among survey respondents, 2262 (88.2\%) reported use of internet or cellphone, and 1593 (62.1\%) had a smartphone. Compared to nonusers (n=302), internet or cellphone users (n=2262) were younger (mean age 80.1, SD 8.0 vs 68.2, SD 11.3 years), more likely to be affluent (n=778, 40.1\% vs n=39, 15.4\%), and had greater than high school education (n=1636, 72.5\% vs n=85, 28.1\%). Internet or cellphone users were less likely to have cardiovascular disease history compared to nonusers (136/2262, 6.6\% vs 41/302, 15.8\%). The prevalence of current smoking and average BMI were similar between internet or cellphone users and nonusers. Among internet or cellphone users, 1316 (58.3\%) reported use of email, 504 (22.3\%) reported use of apps to track or manage health, and 1269 (56.1\%) expressed interest in using JHS-developed apps. Conclusions: Our findings suggest that it is feasible to use mHealth technologies to collect survey data among African Americans already enrolled in a longitudinal study. Our findings also highlight the need for more efforts to reduce the age and education divide in access and use of internet and smartphones for tracking health and research in African American communities. ",
doi="10.2196/37501",
url="https://www.jmir.org/2022/11/e37501",
url="http://www.ncbi.nlm.nih.gov/pubmed/36409531"
}


@Article{info:doi/10.2196/38910,
author="Smyth, Suzanne
and Curtin, Eimear
and Tully, Elizabeth
and Molphy, Zara
and Breathnach, Fionnuala",
title="Smartphone Apps for Surveillance of Gestational Diabetes: Scoping Review",
journal="JMIR Diabetes",
year="2022",
month="Nov",
day="21",
volume="7",
number="4",
pages="e38910",
keywords="gestational diabetes",
keywords="digital health",
keywords="mHealth",
keywords="telemedicine",
keywords="diabetes",
keywords="apps",
keywords="smartphone",
keywords="remote feedback",
abstract="Background: Developments and evolutions in the information and communication technology sector have provided a solid foundation for the emergence of mobile health (mHealth) in recent years. The cornerstone to management of gestational diabetes mellitus (GDM) is the self-management of glycemic indices, dietary intake, and lifestyle adaptations. Given this, it is readily adaptable to incorporation of remote monitoring strategies involving mHealth solutions. Objective: We sought to examine and assess the available smartphone apps which enable self-monitoring and remote surveillance of GDM with a particular emphasis on the generation of individualized patient feedback. Methods: Five databases were searched systematically for any studies evaluating mHealth-supported smartphone solutions for GDM management from study inception until January 2022. The studies were screened and assessed for eligibility of inclusion by 2 independent reviewers. Ultimately, 17 studies were included involving 1871 patients across 11 different countries. The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) conceptual framework was adhered to for data extraction and categorization purposes. Results: All studies analyzed as part of this review facilitated direct uploading of data from the handheld glucometer to the downloaded patient-facing smartphone app. Glycemic data were captured by all studies and were reassuringly found to be either improved or noninferior to extant models of hospital-based care. Feedback was delivered in either an automated fashion through in-app communication from the health care team or facilitated through bidirectional communication with the app and hospital portal. Although resource utilization and cost-effective analyses were reported in some studies, the results were disparate and require more robust analysis. Where patient and staff satisfaction levels were evaluated, the response was overwhelmingly positive for mHealth smartphone--delivered care strategies. Emergency cesarean section rates were reduced; however, elective cesarean sections were comparatively increased among studies where the mode of delivery was assessed. Most reviewed studies did not identify any differences in maternal, perinatal, or neonatal health when app-based care was compared with usual in-person review. Conclusions: This comprehensive scoping review highlights the feasibility, reliability, and acceptability of app-assisted health care for the management of GDM. Although further exploration of the economic benefit is required prior to implementation in a real-world clinical setting, the prospect of smartphone-assisted health care for GDM is hugely promising ",
doi="10.2196/38910",
url="https://diabetes.jmir.org/2022/4/e38910",
url="http://www.ncbi.nlm.nih.gov/pubmed/36409549"
}


@Article{info:doi/10.2196/40261,
author="Burbach, Frank
and Lecce, Francesca
and Allen, E. Victoria M.
and Porter, M. Catherine",
title="A Conversational, Virtual, Avatar-Led Cognitive Behavioral Therapy App Intervention for Improving the Quality of Life and Mental Health of People With Epilepsy: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="Nov",
day="21",
volume="11",
number="11",
pages="e40261",
keywords="epilepsy",
keywords="mental health",
keywords="anxiety",
keywords="depression",
keywords="quality of life",
keywords="cognitive behavioral therapy",
keywords="digital therapy",
keywords="smartphone",
keywords="mobile phone",
keywords="app",
abstract="Background: Epilepsy is a common neurological disorder affecting about 1 in 100 people in the United Kingdom.  Many individuals experience a lower quality of life as a result of their epilepsy diagnosis and are more likely to develop mental health problems, such as anxiety and depression. Medical interventions for this client group tend to focus on the treatment of seizures, whereas mental health disorders often remain undiagnosed and untreated. Early identification and treatment of mental health difficulties in people with epilepsy are vital to ensure better outcomes and improvements in quality of life. Objective: The aim of this exploratory randomized controlled trial is to evaluate whether an 8-week cognitive behavioral therapy--based intervention delivered through a mobile app---ThinkNinja for Epilepsy---is a clinically effective tool to improve quality of life, mental health, and emotional well-being in a large sample of people with epilepsy and anxiety or comorbid anxiety and depression. Methods: The study aims to recruit 184 individuals, 18 to 65 years of age, with a self-reported diagnosis of epilepsy and anxiety or comorbid anxiety and depression.  Participants will be randomly assigned to the ThinkNinja for Epilepsy app condition (arm A) or the waiting-list control group (arm B).  Participants in arm A will receive access to the ThinkNinja for Epilepsy app first.  After 8 weeks, participants in arm B will receive the same full access to the ThinkNinja for Epilepsy app as the participants in arm A. This design will allow an initial between-subjects analysis between the two conditions as well as a within-subject analysis including all participants. The primary outcome is participants' quality of life, measured by the 10-item patient-weighted Quality of Life in Epilepsy questionnaire. The secondary outcomes include measures of anxiety, using the 7-item Generalized Anxiety Disorder assessment; depression, using the  9-item Patient Health Questionnaire; medication adherence, using the  Medication Adherence Questionnaire; and impression of change, using the Patient Global Impression of Change questionnaire. Results: Recruitment for this study began in March 2022 and was completed in October 2022. We expect data collection to be finalized by May 2023 and study results to be available within 12 months of the final data collection date. Results of the study will be written up as soon as possible thereafter, with the intention of publishing the outcomes in high-quality peer-reviewed journals. Conclusions: This study aims to determine the clinical efficacy and safety of the ThinkNinja for Epilepsy intervention at  improving the quality of life, mental health, and emotional well-being of people with epilepsy.  The findings from our study will hopefully contribute  to  addressing the critical gap in universal provision and accessibility of mental health and emotional well-being support for people with epilepsy. Trial Registration: ISRCTN Registry 16270209 (04/03/2022); https://www.isrctn.com/ISRCTN16270209 International Registered Report Identifier (IRRID): DERR1-10.2196/40261 ",
doi="10.2196/40261",
url="https://www.researchprotocols.org/2022/11/e40261",
url="http://www.ncbi.nlm.nih.gov/pubmed/36409536"
}


@Article{info:doi/10.2196/36947,
author="Nabutovsky, Irene
and Breitner, Daniel
and Heller, Alexis
and Scheinowitz, Mickey
and Klempfner, Yarin
and Klempfner, Robert",
title="The First National Program of Remote Cardiac Rehabilitation in Israel--Goal Achievements, Adherence, and Responsiveness in Older Adult Patients: Retrospective Analysis",
journal="JMIR Cardio",
year="2022",
month="Nov",
day="16",
volume="6",
number="2",
pages="e36947",
keywords="remote cardiac rehabilitation",
keywords="mobile application",
keywords="adherence",
keywords="elderly patients",
keywords="telehealth",
keywords="telemedicine",
keywords="cardiology",
keywords="smartwatch",
keywords="wearable",
keywords="patient monitoring",
abstract="Background: Remote cardiac rehabilitation (RCR) after myocardial infarction is an innovative Israeli national program in the field of telecardiology. RCR is included in the Israeli health coverage for all citizens. It is generally accepted that telemedicine programs better apply to younger patients because it is thought that they are more technologically literate than are older patients. It has also previously been thought that older patients have difficulty using technology-based programs and attaining program goals. Objective: The objectives of this study were as follows: to study patterns of physical activity, goal achievement, and improvement in functional capacity among patients undergoing RCR over 65 years old compared to those of younger patients; and to identify predictors of better adherence with the RCR program. Methods: A retrospective study of patients post--myocardial infarction were enrolled in a 6-month RCR program. The activity of the patients was monitored using a smartwatch. The data were collected and analyzed by a special telemedicine platform. RCR program goals were as follows: 150 minutes of aerobic activity per week, 120 minutes of the activity in the target heart rate recommended by the exercise physiologist, and 8000 steps per day. Models were created to evaluate variables predicting adherence with the program. Results: Out of 306 patients, 80 were older adults (mean age 70 years, SD 3.4 years). At the end of the program, there was a significant improvement in the functional capacity of all patients (P=.002). Specifically, the older adult group improved from a mean 8.1 (SD 2.8) to 11.2 (SD 12.6). The metabolic equivalents of task (METs) and final MET results were similar among older and younger patients. During the entire program period, the older adult group showed better achievement of program goals compared to younger patients (P=.03). Additionally, we found that younger patient age is an independent predictor of early dropout from the program and completion of program goals (P=.045); younger patients were more likely to experience early program dropout and to complete fewer program goals. Conclusions: Older adult patients demonstrated better compliance and achievement of the goals of the remote rehabilitation program in comparison with younger patients. We found that older age is not a limitation but rather a predictor of better RCR program compliance and program goal achievement. ",
doi="10.2196/36947",
url="https://cardio.jmir.org/2022/2/e36947",
url="http://www.ncbi.nlm.nih.gov/pubmed/36383410"
}


@Article{info:doi/10.2196/36696,
author="Choi, Jin-Young
and Jeon, Seonghee
and Kim, Hana
and Ha, Jaeyoung
and Jeon, Gyeong-suk
and Lee, Jeong
and Cho, Sung-il",
title="Health-Related Indicators Measured Using Earable Devices: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Nov",
day="15",
volume="10",
number="11",
pages="e36696",
keywords="digital public health",
keywords="earable",
keywords="wearable",
keywords="biomarker",
keywords="health status",
keywords="disease monitoring",
keywords="prevention strategy",
keywords="Internet of Things",
keywords="systematic review",
keywords="mobile phone",
abstract="Background: Earable devices are novel, wearable Internet of Things devices that are user-friendly and have potential applications in mobile health care. The position of the ear is advantageous for assessing vital status and detecting diseases through reliable and comfortable sensing devices. Objective: Our study aimed to review the utility of health-related indicators derived from earable devices and propose an improved definition of disease prevention. We also proposed future directions for research on the health care applications of earable devices. Methods: A systematic review was conducted of the PubMed, Embase, and Web of Science databases. Keywords were used to identify studies on earable devices published between 2015 and 2020. The earable devices were described in terms of target health outcomes, biomarkers, sensor types and positions, and their utility for disease prevention. Results: A total of 51 articles met the inclusion criteria and were reviewed, and the frequency of 5 health-related characteristics of earable devices was described. The most frequent target health outcomes were diet-related outcomes (9/51, 18\%), brain status (7/51, 14\%), and cardiovascular disease (CVD) and central nervous system disease (5/51, 10\% each). The most frequent biomarkers were electroencephalography (11/51, 22\%), body movements (6/51, 12\%), and body temperature (5/51, 10\%). As for sensor types and sensor positions, electrical sensors (19/51, 37\%) and the ear canal (26/51, 51\%) were the most common, respectively. Moreover, the most frequent prevention stages were secondary prevention (35/51, 69\%), primary prevention (12/51, 24\%), and tertiary prevention (4/51, 8\%). Combinations of ?2 target health outcomes were the most frequent in secondary prevention (8/35, 23\%) followed by brain status and CVD (5/35, 14\% each) and by central nervous system disease and head injury (4/35, 11\% each). Conclusions: Earable devices can provide biomarkers for various health outcomes. Brain status, healthy diet status, and CVDs were the most frequently targeted outcomes among the studies. Earable devices were mostly used for secondary prevention via monitoring of health or disease status. The potential utility of earable devices for primary and tertiary prevention needs to be investigated further. Earable devices connected to smartphones or tablets through cloud servers will guarantee user access to personal health information and facilitate comfortable wearing. ",
doi="10.2196/36696",
url="https://mhealth.jmir.org/2022/11/e36696",
url="http://www.ncbi.nlm.nih.gov/pubmed/36239201"
}


@Article{info:doi/10.2196/38678,
author="Holmen, Heidi
and Singstad, Tone
and Ribu, Lis
and Jensen, Lunde Annesofie
and Weldingh, Mickelson Nina
and Torbj{\o}rnsen, Astrid",
title="Adapting a Patient-Reported Outcome Measure to Digital Outpatient Specialist Health Care Services for Type 1 Diabetes: User Involvement Study",
journal="JMIR Hum Factors",
year="2022",
month="Nov",
day="15",
volume="9",
number="4",
pages="e38678",
keywords="patient-reported outcome measures",
keywords="user involvement",
keywords="type 1 diabetes",
keywords="digital interventions",
abstract="Background: Diabetes self-management is crucial for patients with type 1 diabetes, and digital services can support their self-management and facilitate flexible follow-up. The potential of using digital patient-reported outcome (PRO) measures in routine outpatient care is not fully used owing to a lack of adapted PRO measures. Objective: This study presents the process of identifying and adapting a digital PRO measure for use in clinical diabetes practice and describes the preferred item topics of the adapted PRO measure, as reported by patients and diabetes specialist nurses. Methods: With the involvement of patients, diabetes specialist nurses, management, and researchers, we hosted a series of workshops and 2 dialogue conferences. Scoping searches to identify relevant PRO measures formed the foundation for the process. An in-person dialogue conference was conducted with diabetes specialist nurses as participants, and a digital dialogue conference was conducted with patients with type 1 diabetes as participants. A diabetes-specific PRO measure was translated and adapted to our digital platform. Notes and summaries from the dialogue conferences were imported into NVivo (QSR International) and thematically analyzed as a single combined data set. Results: The thematic analysis of the 2 dialogue conferences aimed to explore the views of patients with type 1 diabetes and diabetes specialist nurses on the outcomes necessary to measure. An overarching theme, Ensuring that the PRO measure captures the patients' needs precisely and accurately, in a way that facilitates care and communication with health care personnel, was identified and supported with data from both the patients and diabetes specialist nurses. This theme contained four categories: The need for explanatory text after questions to ensure understanding and accurate response, Capturing individual needs in standardized questions, getting to the heart of the patient's problem, and The questions increase patient reflection. Conclusions: We successfully conducted an iterative process that identified a PRO measure aligned with the topics raised by the diabetes specialist nurses. Similarly, the patients found the PRO measure to be relevant and one that was addressing their needs. Only minor adjustments were necessary when programming the PRO measure in the digital platform. Our management, patients, and diabetes specialist nurses had a valuable impact on the results. User involvement facilitated a specific focus on the clinical requests to be met by PRO measures and how they must be adapted to local and digital platforms. Overall, this has facilitated the current implementation of the adapted digital PRO measure. ",
doi="10.2196/38678",
url="https://humanfactors.jmir.org/2022/4/e38678",
url="http://www.ncbi.nlm.nih.gov/pubmed/36378513"
}


@Article{info:doi/10.2196/36766,
author="Vilasi, Antonio
and Panuccio, Antonio Vincenzo
and Morante, Salvatore
and Villa, Antonino
and Versace, Carmela Maria
and Mezzatesta, Sabrina
and Mercuri, Sergio
and Inguanta, Rosalinda
and Aiello, Giuseppe
and Cutrupi, Demetrio
and Puglisi, Rossella
and Capria, Salvatore
and Li Vigni, Maurizio
and Tripepi, Giovanni
and Torino, Claudia",
title="Monitoring Risk Factors and Improving Adherence to Therapy in Patients With Chronic Kidney Disease (Smit-CKD Project): Pilot Observational Study",
journal="JMIR Bioinform Biotech",
year="2022",
month="Nov",
day="15",
volume="3",
number="1",
pages="e36766",
keywords="SMIT-CKD",
keywords="mHealth",
keywords="eHealth",
keywords="CKD",
keywords="therapy adherence",
keywords="risk factor",
keywords="kidney",
keywords="adherence",
keywords="integrated system",
keywords="health app",
keywords="monitoring",
keywords="cardiology",
keywords="cardiac",
keywords="renal",
keywords="chronic kidney disease",
keywords="cardiovascular",
keywords="mobile health",
keywords="mobile app",
abstract="Background: Chronic kidney disease is a major public health issue, with about 13\% of the general adult population and 30\% of the elderly affected. Patients in the last stage of this disease have an almost uniquely high risk of death and cardiovascular events, with reduced adherence to therapy representing an additional risk factor for cardiovascular morbidity and mortality. Considering the increased penetration of mobile phones, a mobile app could educate patients to autonomously monitor cardiorenal risk factors. Objective: With this background in mind, we developed an integrated system of a server and app with the aim of improving self-monitoring of cardiovascular and renal risk factors and adherence to therapy. Methods: The software infrastructure for both the Smit-CKD server and Smit-CKD app was developed using standard web-oriented development methodologies preferring open source tools when available. To make the Smit-CKD app suitable for Android and iOS, platforms that allow the development of a multiplatform app starting from a single source code were used. The integrated system was field tested with the help of 22 participants. User satisfaction and adherence to therapy were measured by questionnaires specifically designed for this study; regular use of the app was measured using the daily reports available on the platform. Results: The Smit-CKD app allows the monitoring of cardiorenal risk factors, such as blood pressure, weight, and blood glucose. Collected data are transmitted in real time to the referring general practitioner. In addition, special reminders improve adherence to the medication regimen. Via the Smit-CKD server, general practitioners can monitor the clinical status of their patients and their adherence to therapy. During the test phase, 73\% (16/22) of subjects entered all the required data regularly and sent feedback on drug intake. After 6 months of use, the percentage of regular intake of medications rose from 64\% (14/22) to 82\% (18/22). Analysis of the evaluation questionnaires showed that both the app and server components were well accepted by the users. Conclusions: Our study demonstrated that a simple mobile app, created to self-monitor modifiable cardiorenal risk factors and adherence to therapy, is well tolerated by patients affected by chronic kidney disease. Further studies are required to clarify if the use of this integrated system will have long-term effects on therapy adherence and if self-monitoring of risk factors will improve clinical outcomes in this population. ",
doi="10.2196/36766",
url="https://bioinform.jmir.org/2022/1/e36766"
}


@Article{info:doi/10.2196/39657,
author="Lightfoot, J. Courtney
and Wilkinson, J. Thomas
and Hadjiconstantinou, Michelle
and Graham-Brown, Matthew
and Barratt, Jonathan
and Brough, Christopher
and Burton, O. James
and Hainsworth, Jenny
and Johnson, Vicki
and Martinez, Maria
and Nixon, C. Andrew
and Pursey, Victoria
and Schreder, Sally
and Vadaszy, Noemi
and Wilde, Lucina
and Willingham, Fiona
and Young, L. Hannah M.
and Yates, Thomas
and Davies, J. Melanie
and Smith, C. Alice",
title="The Codevelopment of ``My Kidneys \& Me'': A Digital Self-management Program for People With Chronic Kidney Disease",
journal="J Med Internet Res",
year="2022",
month="Nov",
day="14",
volume="24",
number="11",
pages="e39657",
keywords="kidney disease awareness",
keywords="kidney disease knowledge",
keywords="program development",
keywords="eHealth",
keywords="digital health",
keywords="telehealth",
keywords="mobile health",
keywords="mHealth",
keywords="health promotion",
keywords="self-management behaviors",
keywords="mobile phone",
abstract="Background: Health care self-management is important for people living with nondialysis chronic kidney disease (CKD). However, the few available resources are of variable quality. Objective: This work describes the systematic codevelopment of ``My Kidneys \& Me'' (MK\&M), a theory-driven and evidence-based digital self-management resource for people with nondialysis CKD, guided by an established process used for the successful development of the diabetes education program MyDESMOND (Diabetes Education and Self-Management for Ongoing and Newly Diagnosed, DESMOND). Methods: A multidisciplinary steering group comprising kidney health care professionals and researchers and specialists in the development of complex interventions and digital health provided expertise in the clinical and psychosocial aspects of CKD, self-management, digital health, and behavior change. A patient and public involvement group helped identify the needs and priorities of MK\&M and co-design the resource. MK\&M was developed in 2 sequential phases. Phase 1 involved the codevelopment process of the MK\&M resource (content and materials), using Intervention Mapping (IM) as a framework. The first 4 IM steps guided the development process: needs assessment was conducted to describe the context of the intervention; intervention outcomes, performance objectives, and behavioral determinants were identified; theory- and evidence-based change methods and practical strategies to deliver change methods were selected; and program components were developed and refined. Phase 2 involved the adoption and adaptation of the existing MyDESMOND digital platform to suit the MK\&M resource. Results: The needs assessment identified that individuals with CKD have multiple differing needs and that delivering a self-management program digitally would enable accessible, tailored, and interactive information and support. The intended outcomes of MK\&M were to improve and maintain effective self-management behaviors, including physical activity and lifestyle, improve knowledge, promote self-care skills, increase self-efficacy, and enhance well-being. This was achieved through the provision of content and materials designed to increase CKD knowledge and patient activation, reduce health risks, manage symptoms, and improve physical function. Theories and behavior change techniques selected include Self-Management Framework, Capability, Opportunity, Motivation Behavior model components of Behaviour Change Wheel and taxonomy of behavior change techniques, Health Action Process Approach Model, Common Sense Model, and Social Cognitive Theory. The program components developed comprised educational and behavior change sessions, health trackers (eg, monitoring blood pressure, symptoms, and exercise), goal-setting features, and forums for social support. The MyDESMOND digital platform represented an ideal existing platform to host MK\&M; thus, the MyDESMOND interface and features were adopted and adapted for MK\&M. Conclusions: Applying the IM framework enabled the systematic application of theory, empirical evidence, and practical perspectives in the codevelopment of MK\&M content and materials. Adopting and adapting a preexisting platform provided a cost- and time-efficient approach for developing our digital intervention. In the next stage of work, the efficacy of MK\&M in increasing patient activation will be tested in a randomized controlled trial. ",
doi="10.2196/39657",
url="https://www.jmir.org/2022/11/e39657",
url="http://www.ncbi.nlm.nih.gov/pubmed/36374538"
}


@Article{info:doi/10.2196/41140,
author="Mandal, Soumik
and Belli, M. Hayley
and Cruz, Jocelyn
and Mann, Devin
and Schoenthaler, Antoinette",
title="Analyzing User Engagement Within a Patient-Reported Outcomes Texting Tool for Diabetes Management: Engagement Phenotype Study",
journal="JMIR Diabetes",
year="2022",
month="Nov",
day="14",
volume="7",
number="4",
pages="e41140",
keywords="user engagement",
keywords="patient-reported outcomes",
keywords="mobile health",
keywords="mHealth",
keywords="digital health",
keywords="SMS",
keywords="type 2 diabetes",
keywords="health behavior",
keywords="digital phenotyping",
abstract="Background: Patient-reported outcomes (PROs) capture patients' views on their health conditions and its management, and are increasingly used in clinical trials, including those targeting type 2 diabetes (T2D). Mobile health (mHealth) tools offer novel solutions for collecting PRO data in real time. Although patients are at the center of any PRO-based intervention, few studies have examined user engagement with PRO mHealth tools. Objective: This study aimed to evaluate user engagement with a PRO mHealth tool for T2D management, identify patterns of user engagement and similarities and differences between the patients, and identify the characteristics of patients who are likely to drop out or be less engaged with a PRO mHealth tool. Methods: We extracted user engagement data from an ongoing clinical trial that tested the efficacy of a PRO mHealth tool designed to improve hemoglobin A1c levels in patients with uncontrolled T2D. To date, 61 patients have been randomized to the intervention, where they are sent 6 PRO text messages a day that are relevant to T2D self-management (healthy eating and medication adherence) over the 12-month study. To analyze user engagement, we first compared the response rate (RR) and response time between patients who completed the 12-month intervention and those who dropped out early (noncompleters). Next, we leveraged latent class trajectory modeling to classify patients from the completer group into 3 subgroups based on similarity in the longitudinal engagement data. Finally, we investigated the differences between the subgroups of completers from various cross-sections (time of the day and day of the week) and PRO types. We also explored the patient demographics and their distribution among the subgroups. Results: Overall, 19 noncompleters had a lower RR to PRO questions and took longer to respond to PRO questions than 42 completers. Among completers, the longitudinal RRs demonstrated differences in engagement patterns over time. The completers with the lowest engagement showed peak engagement during month 5, almost at the midstage of the program. The remaining subgroups showed peak engagement at the beginning of the intervention, followed by either a steady decline or sustained high engagement. Comparisons of the demographic characteristics showed significant differences between the high engaged and low engaged subgroups. The high engaged completers were predominantly older, of Hispanic descent, bilingual, and had a graduate degree. In comparison, the low engaged subgroup was composed mostly of African American patients who reported the lowest annual income, with one of every 3 patients earning less than US \$20,000 annually. Conclusions: There are discernible engagement phenotypes based on individual PRO responses, and their patterns vary in the timing of peak engagement and demographics. Future studies could use these findings to predict engagement categories and tailor interventions to promote longitudinal engagement. Trial Registration: Clinicaltrials.gov NCT03652389; https://clinicaltrials.gov/ct2/show/NCT03652389 International Registered Report Identifier (IRRID): RR2-10.2196/18554 ",
doi="10.2196/41140",
url="https://diabetes.jmir.org/2022/4/e41140",
url="http://www.ncbi.nlm.nih.gov/pubmed/36374531"
}


@Article{info:doi/10.2196/39997,
author="Kuo, Fong-Chy Elizabeth
and Cho, Jacklyn
and Olaye, Iredia
and Delgado, Diana
and Dell, Nicola
and Sterling, R. Madeline",
title="Understanding the Technological Landscape of Home Health Aides: Scoping Literature Review and a Landscape Analysis of Existing mHealth Apps",
journal="J Med Internet Res",
year="2022",
month="Nov",
day="11",
volume="24",
number="11",
pages="e39997",
keywords="home health aides",
keywords="home care services",
keywords="mobile health",
keywords="mHealth",
keywords="mobile apps",
keywords="mobile phone apps",
keywords="smartphones",
keywords="educational technology",
keywords="technology",
keywords="mobile phone",
abstract="Background: Home health aides (HHAs) provide necessary hands-on care to older adults and those with chronic conditions in their homes. Despite their integral role, HHAs experience numerous challenges in their work, including their ability to communicate with other health care professionals about patient care while caring for patients and access to educational resources. Although technological interventions have the potential to address these challenges, little is known about the technological landscape and existing technology-based interventions designed for and used by this workforce. Objective: We conducted a scoping review of the scientific literature to identify existing studies that have described, designed, deployed, or tested technology-based tools and apps intended for use by HHAs to care for patients at home. To complement our literature review, we conducted a landscape analysis of existing mobile apps intended for HHAs providing in-home care. Methods: We searched the following databases from their inception to October 2020: Ovid MEDLINE, Ovid Embase, Cochrane Library, and CINAHL (EBSCO). A total of 3 researchers screened the yield using prespecified inclusion and exclusion criteria. In addition, 4 researchers independently reviewed these articles, and a fifth researcher arbitrated when needed. Among studies that met the inclusion criteria, data were extracted and summarized narratively. An analysis of mobile health apps designed for HHAs was performed using a predefined set of terms to search Google Play and Apple App stores. Overall, 2 researchers independently screened the resulting apps, and those that met the inclusion criteria were categorized according to their intended purpose and functionality. Results: Of the 8643 studies retrieved, 182 (2.11\%) underwent full-text review, and 4.9\% (9/182) met our inclusion criteria. Approximately half (4/9, 44\%) of the studies were descriptive in nature, proposing technology-based systems (eg, web portals and dashboards) or prototypes without a technical or user-based evaluation of the technology. In most (7/9, 78\%) papers, HHAs were just one of several users and not the sole or primary intended users of the technology. Our review of mobile apps yielded 166 Android and iOS apps, of which 48 (29\%) met the inclusion criteria. These apps provided HHAs with one or more of the following functions: electronic visit verification (29/48, 60\%), clocking in and out (23/48, 48\%), documentation (22/48, 46\%), task checklist (19/48, 40\%), communication between HHA and agency (14/48, 29\%), patient information (6/48, 13\%), resources (5/48, 10\%), and communication between HHA and patients (4/48, 8\%). Of the 48 apps, 25 (52\%) performed monitoring functions, 4 (8\%) performed supporting functions, and 19 (40\%) performed both. Conclusions: A limited number of studies and mobile apps have been designed to support HHAs in their work. Further research and rigorous evaluation of technology-based tools are needed to assess their impact on the work HHAs provide in patient's homes. ",
doi="10.2196/39997",
url="https://www.jmir.org/2022/11/e39997",
url="http://www.ncbi.nlm.nih.gov/pubmed/36176033"
}


@Article{info:doi/10.2196/40507,
author="Magee, R. Michael
and Gholamrezaei, Ali
and McNeilage, G. Amy
and Sim, Alison
and Dwyer, Leah
and Ferreira, L. Manuela
and Darnall, D. Beth
and Glare, Paul
and Ashton-James, E. Claire",
title="A Digital Video and Text Messaging Intervention to Support People With Chronic Pain During Opioid Tapering: Content Development Using Co-design",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="10",
volume="6",
number="11",
pages="e40507",
keywords="chronic pain",
keywords="deprescribing",
keywords="tapering",
keywords="dose reduction",
keywords="opioids",
keywords="mHealth",
keywords="mobile health",
keywords="SMS",
keywords="text messaging",
keywords="digital health",
keywords="behavior change",
keywords="self-efficacy",
keywords="consumer engagement",
keywords="co-design",
keywords="coproduction",
abstract="Background: People living with chronic pain report that tapering prescribed opioids is challenging and more support is needed. In our formative research, consumers indicated that mobile health (mHealth) technology could be an acceptable form of support for opioid tapering and may improve tapering self-efficacy. Objective: We aimed to evaluate and improve the content of an mHealth intervention before pilot-testing, based on consumer and clinician feedback. Methods: Participants were 12 consumers and 12 clinicians who evaluated an initial draft of a video script and 90 SMS text messages. Consumers and clinicians rated the appropriateness and likely usefulness (consumers) or likely effectiveness (clinicians) of a video script and a random selection of 15 SMS text messages using a 5-point Likert-type scale (1=totally disagree; 5=totally agree). Each draft SMS text message was reviewed by 2 consumers and 2 clinicians. Texts were deemed acceptable for inclusion in the pilot intervention only if the summed participant ratings of text appropriateness and usefulness or effectiveness were ?8. Participants were also invited to provide open-text feedback on the draft script and SMS text messages. Results: Consumers generally agreed that the draft video script and text content were likely to be appropriate (video: mean 4.4, SD 0.52; text: mean 4.3, SD 0.79) and useful (video: mean 4.3, SD 0.65; text: mean 4.2, SD 0.84). Similarly, clinicians generally agreed that the draft video script and text content were likely to be appropriate (video: mean 4.5, SD 0.67; text: mean 4.4, SD 0.81) and effective (video: mean 4.0, SD 0.43; text: mean 4.3, SD 0.76). Overall, 77\% (69/90) of the draft texts met the threshold rating for acceptability for inclusion in the pilot test of mHealth intervention by consumers, and 82\% (74/90) met the threshold for acceptability by clinicians. Consumers' and clinicians' ratings were used to rank order the texts. The top 56 draft texts (all meeting the threshold levels of acceptability) were selected for inclusion in the pilot intervention. When consumer or clinician feedback was provided, the texts meeting the criteria for inclusion in the pilot were further revised and improved. Feedback on the video script was also used to further improve the acceptability of the video script before pilot-testing the intervention. Conclusions: This study describes the process by which a 28-day mHealth intervention to support patients with chronic pain to taper opioid medications was evaluated and improved before pilot-testing. The mHealth intervention consisted of a 10-minute psychoeducational video about pain and opioid tapering and 56 unique SMS text messages providing information and reassurance (texts delivered twice per day for 28 days). Having established that the content of the mHealth intervention is acceptable to both consumer and clinician groups, the mHealth intervention will be piloted in future research. ",
doi="10.2196/40507",
url="https://formative.jmir.org/2022/11/e40507",
url="http://www.ncbi.nlm.nih.gov/pubmed/36355415"
}


@Article{info:doi/10.2196/37280,
author="Campo, David
and Elie, Valery
and de Gallard, Tristan
and Bartet, Pierre
and Morichau-Beauchant, Tristan
and Genain, Nicolas
and Fayol, Antoine
and Fouassier, David
and Pasteur-Rousseau, Adrien
and Puymirat, Etienne
and Nahum, Julien",
title="Atrial Fibrillation Detection With an Analog Smartwatch: Prospective Clinical Study and Algorithm Validation",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="4",
volume="6",
number="11",
pages="e37280",
keywords="atrial fibrillation",
keywords="mobile health",
keywords="mHealth",
keywords="diagnosis",
keywords="electrocardiogram",
keywords="ECG",
keywords="smartwatch",
keywords="smart technology",
keywords="wearable",
keywords="cardiology",
keywords="cardiac",
keywords="heart failure",
keywords="heart disease",
keywords="cardiovascular",
keywords="morbidity",
keywords="automatic detection",
keywords="algorithm",
keywords="physician",
keywords="sensor",
keywords="digital health",
abstract="Background: Atrial fibrillation affects approximately 4\% of the world's population and is one of the major causes of stroke, heart failure, sudden death, and cardiovascular morbidity. It can be difficult to diagnose when asymptomatic or in the paroxysmal stage, and its natural history is not well understood. New wearables and connected devices offer an opportunity to improve on this situation. Objective: We aimed to validate an algorithm for the automatic detection of atrial fibrillation from a single-lead electrocardiogram taken with a smartwatch. Methods: Eligible patients were recruited from 4 sites in Paris, France. Electrocardiograms (12-lead reference and single lead) were captured simultaneously. The electrocardiograms were reviewed by independent, blinded board-certified cardiologists. The sensitivity and specificity of the algorithm to detect atrial fibrillation and normal sinus rhythm were calculated. The quality of single-lead electrocardiograms (visibility and polarity of waves, interval durations, heart rate) was assessed in comparison with the gold standard (12-lead electrocardiogram). Results: A total of 262 patients (atrial fibrillation: n=100, age: mean 74.3 years, SD 12.3; normal sinus rhythm: n=113, age: 61.8 years, SD 14.3; other arrhythmia: n=45, 66.9 years, SD 15.2; unreadable electrocardiograms: n=4) were included in the final analysis; 6.9\% (18/262) were classified as Noise by the algorithm. Excluding other arrhythmias and Noise, the sensitivity for atrial fibrillation detection was 0.963 (95\% CI lower bound 0.894), and the specificity was 1.000 (95\% CI lower bound 0.967). Visibility and polarity accuracies were similar (1-lead electrocardiogram: P waves: 96.9\%, QRS complexes: 99.2\%, T waves: 91.2\%; 12-lead electrocardiogram: P waves: 100\%, QRS complexes: 98.8\%, T waves: 99.5\%). P-wave visibility accuracy was 99\% (99/100) for patients with atrial fibrillation and 95.7\% (155/162) for patients with normal sinus rhythm, other arrhythmias, and unreadable electrocardiograms. The absolute values of the mean differences in PR duration and QRS width were <3 ms, and more than 97\% were <40 ms. The mean difference between the heart rates from the 1-lead electrocardiogram calculated by the algorithm and those calculated by cardiologists was 0.55 bpm. Conclusions: The algorithm demonstrated great diagnostic performance for atrial fibrillation detection. The smartwatch's single-lead electrocardiogram also demonstrated good quality for physician use in daily routine care. Trial Registration: ClinicalTrials.gov NCT04351386; http://clinicaltrials.gov/ct2/show/NCT04351386 ",
doi="10.2196/37280",
url="https://formative.jmir.org/2022/11/e37280",
url="http://www.ncbi.nlm.nih.gov/pubmed/35481559"
}


@Article{info:doi/10.2196/25879,
author="Rumi, Gabriele
and Canonica, Walter G.
and Foster, M. Juliet
and Chavannes, H. Niels
and Valenti, Giuseppe
and Contiguglia, Rosario
and Rapsomaniki, Eleni
and Kocks, H. Janwillem W.
and De Brasi, Dario
and Braido, Fulvio",
title="Digital Coaching Using Smart Inhaler Technology to Improve Asthma Management in Patients With Asthma in Italy: Community-Based Study",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Nov",
day="2",
volume="10",
number="11",
pages="e25879",
keywords="asthma control",
keywords="asthma management",
keywords="connected devices",
keywords="digital health",
keywords="eHealth",
keywords="inhalers",
keywords="maintenance and reliever therapy",
keywords="mobile phone",
abstract="Background: Reliance on short-acting $\beta$-2 agonists and nonadherence to maintenance medication are associated with poor clinical outcomes in asthma. Digital health solutions could support optimal medication use and therefore disease control in patients with asthma; however, their use in community settings has not been determined. Objective: The primary objective of this study is to investigate community implementation of the Turbu+ program designed to support asthma self-management, including adherence to budesonide and formoterol (Symbicort) Turbuhaler, a combination inhaler for both maintenance therapy or maintenance and reliever therapy. The secondary objective is to provide health care professionals with insights into how patients were using their medication in real life. Methods: Patients with physician-diagnosed asthma were prescribed budesonide and formoterol as maintenance therapy, at a dose of either 1 inhalation twice daily (1-BID) or 2 inhalations twice daily (2-BID), or as maintenance and reliever therapy (1-BID and reliever or 2-BID and reliever in a single inhaler), and they received training on Turbu+ in secondary care centers across Italy. An electronic device attached to the patients' inhaler for ?90 days (data cutoff) securely uploaded medication use data to a smartphone app and provided reminders, visualized medication use, and motivational nudge messages. Average medication adherence was defined as the proportion of daily maintenance inhalations taken as prescribed (number of recorded maintenance actuations per day or maintenance inhalations prescribed per day) averaged over the monitoring period. The proportion of adherent days was defined as the proportion of days when all prescribed maintenance inhalations were taken on a given day. The Wilcoxon test was used to compare the proportion of adherent days between patients in the maintenance regimen and patients in the maintenance and reliever regimen of a given dose. Results: In 661 patients, the mean (SD) number of days monitored was 217.2 (SD 109.0) days. The average medication adherence (maintenance doses taken/doses prescribed) was 70.2\% (108,040/153,820) overall and was similar across the groups (1-BID: 6332/9520, 66.5\%; 1?BID and reliever: 43,578/61,360, 71.0\%; 2-BID: 10,088/14,960, 67.4\%; 2-BID and reliever: 48,042/67,980, 70.7\%). The proportion of adherent days (prescribed maintenance doses/doses taken in a given day) was 56.6\% (31,812/56,175) overall and was higher with maintenance and reliever therapy (1-BID and reliever vs 1-BID: 18,413/30,680, 60.0\% vs 2510/4760, 52.7\%; P<.001; 2-BID and reliever vs 2-BID: 8995/16,995, 52.9\% vs 1894/3740, 50.6\%; P=.02). Rates of discontinuation from the Turbu+ program were significantly lower with maintenance and reliever therapy compared with maintenance therapy alone (P=.01). Conclusions: Overall, the high medication adherence observed during the study might be attributed to the electronic monitoring and feedback mechanism provided by the Turbu+ program. ",
doi="10.2196/25879",
url="https://mhealth.jmir.org/2022/11/e25879",
url="http://www.ncbi.nlm.nih.gov/pubmed/36322120"
}


@Article{info:doi/10.2196/36134,
author="D'Amore, Cassandra
and Reid, C. Julie
and Chan, Matthew
and Fan, Samuel
and Huang, Amanda
and Louie, Jonathan
and Tran, Andy
and Chauvin, Stephanie
and Beauchamp, K. Marla",
title="Interventions Including Smart Technology Compared With Face-to-face Physical Activity Interventions in Older Adults: Systematic Review and Meta-analysis",
journal="J Med Internet Res",
year="2022",
month="Oct",
day="31",
volume="24",
number="10",
pages="e36134",
keywords="aging",
keywords="exercise",
keywords="mobile health",
keywords="mHealth",
keywords="wearables",
keywords="mobile phone",
abstract="Background: This is a systematic review of randomized controlled trials and a meta-analysis comparing smart technology with face-to-face physical activity (PA) interventions in community-dwelling older adults (mean age 60 years). Objective: This study aims to determine the effect of interventions including smart technology components compared with face-to-face PA interventions on PA and physical function in older adults. The secondary outcomes are depression, anxiety, and health-related quality of life. Methods: We searched MEDLINE, Embase, CINAHL, and AMED electronic databases from inception to February 2021. Two independent reviewers screened titles, abstracts, and full texts and performed data extraction and risk of bias assessments using the Cochrane risk of bias tool. The Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the quality of the evidence. We provided a narrative synthesis on all included studies and, where possible, performed meta-analyses for similar outcomes. Results: This review included 19 studies with a total of 3455 participants. Random effects meta-analyses showed that interventions with smart technology components resulted in improved step count (mean difference 1440 steps, 95\% CI 500-2390) and total PA (standardized mean difference 0.17, 95\% CI 0.02-0.32) compared with face-to-face alone. There was no difference between groups in terms of the measures of physical function. Smart technology alone did not show significant differences between groups in any outcome. The quality of the evidence was very low based on the Grading of Recommendations Assessment, Development and Evaluation criteria. Conclusions: Interventions that include smart technology may improve daily step counts by an average of 1440 steps in community-dwelling older adults; however, the quality of the evidence was very low. Future studies are needed to improve the certainty of these results. Trial Registration: PROSPERO CRD42020135232; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=135232 ",
doi="10.2196/36134",
url="https://www.jmir.org/2022/10/e36134",
url="http://www.ncbi.nlm.nih.gov/pubmed/36315229"
}


@Article{info:doi/10.2196/34923,
author="McCue, Maggie
and Blair, Christopher
and Fehnert, Ben
and King, James
and Cormack, Francesca
and Sarkey, Sara
and Eramo, Anna
and Kabir, Christopher
and Khatib, Rasha
and Kemp, David",
title="Mobile App to Enhance Patient Activation and Patient-Provider Communication in Major Depressive Disorder Management: Collaborative, Randomized Controlled Pilot Study",
journal="JMIR Form Res",
year="2022",
month="Oct",
day="27",
volume="6",
number="10",
pages="e34923",
keywords="depression",
keywords="major depressive disorder",
keywords="depression management",
keywords="patient engagement",
keywords="patient satisfaction",
keywords="mobile app",
keywords="patient-reported outcomes",
keywords="mobile phone",
abstract="Background: Enhanced patient-provider engagement can improve patient health outcomes in chronic conditions, including major depressive disorder (MDD). Objective: We evaluated the impact of a digitally enabled care mobile app, Pathway, designed to improve MDD patient-provider engagement. Patients used a mobile interface to assess treatment progress and share this information with primary care providers (PCPs). Methods: In this 52-week, real-world effectiveness and feasibility study conducted in primary care clinics, 40 patients with MDD who were recently prescribed antidepressant monotherapy were randomized to use a mobile app with usual care (20/40, 50\%) or usual care alone (20/40, 50\%). Patients in the app arm engaged with the app daily for 18 weeks; a report was generated at 6-week intervals and shared with the PCPs to facilitate shared treatment decision-making discussions. The patients discontinued the app at week 18 and were followed through year 1. Coprimary outcome measures, assessed via research visits, included change from baseline in the 13-item Patient Activation Measure (PAM-13) and 7-item Patient-Provider Engagement Scale scores at week 18. Additional outcome measures included depression severity (9-item Patient Health Questionnaire [PHQ-9]) and cognitive symptoms (5-item Perceived Deficits Questionnaire--Depression). Results: All 37 patients (app arm: n=18, 49\%; usual care arm: n=19, 51\%) who completed the 18-week follow-up period (n=31, 84\% female, mean age 36, SD 11.3 years) had moderate to moderately severe depression. Improvements in PAM-13 and PHQ-9 scores were observed in both arms. Increases in PAM-13 scores from baseline to 18 weeks were numerically greater in the app arm than in the usual care arm (mean 10.5, SD 13.2 vs mean 8.8, SD 9.4; P=.65). At 52 weeks, differences in PAM-13 scores from baseline demonstrated significantly greater improvements in the app arm than in the usual care arm (mean 20.2, SD 17.7 vs mean 1.6, SD 14.2; P=.04). Compared with baseline, PHQ-9 scores decreased in both the app arm and the usual care arm at 18 weeks (mean 7.8, SD 7.2 vs mean 7.0, SD 6.5; P=.73) and 52 weeks (mean 9.5, SD 4.0 vs mean 4.7, SD 6.0; P=.07). Improvements in 7-item Patient-Provider Engagement Scale and WHO-5 scores were observed in both arms at 18 weeks and were sustained through 52 weeks in the app arm. Improvements in WHO-5 scores at 52 weeks were significantly greater in the app arm than in the usual care arm (41.5 vs 20.0; P=.02). Conclusions: Patients with MDD will engage with a mobile app designed to track treatment and disease progression. PCPs will use the data generated as part of their assessment to inform clinical care. The study results suggest that an app-enabled clinical care pathway may enhance patient activation and benefit MDD management. Trial Registration: ClinicalTrials.gov NCT03242213; https://clinicaltrials.gov/ct2/show/NCT03242213 ",
doi="10.2196/34923",
url="https://formative.jmir.org/2022/10/e34923",
url="http://www.ncbi.nlm.nih.gov/pubmed/36301599"
}


@Article{info:doi/10.2196/40546,
author="Sivakumar, Bridve
and Lemonde, Manon
and Stein, Matthew
and Goldstein, Sarah
and Mak, Susanna
and Arcand, JoAnne",
title="Evaluating Health Care Provider Perspectives on the Use of Mobile Apps to Support Patients With Heart Failure Management: Qualitative Descriptive Study",
journal="JMIR Cardio",
year="2022",
month="Oct",
day="26",
volume="6",
number="2",
pages="e40546",
keywords="heart failure",
keywords="mobile health",
keywords="mHealth",
keywords="eHealth",
keywords="mobile apps",
keywords="adherence",
keywords="self-management",
keywords="mobile phone",
abstract="Background: Nonadherence to diet and medical therapies in heart failure (HF) contributes to poor HF outcomes. Mobile apps may be a promising way to improve adherence because they increase knowledge and behavior change via education and monitoring. Well-designed apps with input from health care providers (HCPs) can lead to successful adoption of such apps in practice. However, little is known about HCPs' perspectives on the use of mobile apps to support HF management. Objective: The aim of this study is to determine HCPs' perspectives (needs, motivations, and challenges) on the use of mobile apps to support patients with HF management. Methods: A qualitative descriptive study using one-on-one semistructured interviews, informed by the diffusion of innovation theory, was conducted among HF HCPs, including cardiologists, nurses, and nurse practitioners. Transcripts were independently coded by 2 researchers and analyzed using content analysis. Results: The 21 HCPs (cardiologists: n=8, 38\%; nurses: n=6, 29\%; and nurse practitioners: n=7, 33\%) identified challenges and opportunities for app adoption across 5 themes: participant-perceived factors that affect app adoption---these include patient age, technology savviness, technology access, and ease of use; improved delivery of care---apps can support remote care; collect, share, and assess health information; identify adverse events; prevent hospitalizations; and limit clinic visits; facilitating patient engagement in care---apps can provide feedback and reinforcement, facilitate connection and communication between patients and their HCPs, support monitoring, and track self-care; providing patient support through education---apps can provide HF-related information (ie, diet and medications); and participant views on app features for their patients---HCPs felt that useful apps would have reminders and alarms and participative elements (gamification, food scanner, and quizzes). Conclusions: HCPs had positive views on the use of mobile apps to support patients with HF management. These findings can inform effective development and implementation strategies of HF management apps in clinical practice. ",
doi="10.2196/40546",
url="https://cardio.jmir.org/2022/2/e40546",
url="http://www.ncbi.nlm.nih.gov/pubmed/36287588"
}


@Article{info:doi/10.2196/35722,
author="Motahari-Nezhad, Hossein
and Fgaier, Meriem
and Mahdi Abid, Mohamed
and P{\'e}ntek, M{\'a}rta
and Gul{\'a}csi, L{\'a}szl{\'o}
and Zrubka, Zsombor",
title="Digital Biomarker--Based Studies: Scoping Review of Systematic Reviews",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Oct",
day="24",
volume="10",
number="10",
pages="e35722",
keywords="scoping review",
keywords="digital biomarkers",
keywords="health",
keywords="behavioral data",
keywords="physiological data",
keywords="digital health",
keywords="remote monitoring",
keywords="wearable",
keywords="implantable",
keywords="digestible",
keywords="portable",
keywords="sensor",
keywords="mobile phone",
abstract="Background: Sensors and digital devices have revolutionized the measurement, collection, and storage of behavioral and physiological data, leading to the new term digital biomarkers. Objective: This study aimed to investigate the scope of clinical evidence covered by systematic reviews (SRs) of randomized controlled trials involving digital biomarkers. Methods: This scoping review was organized using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. With the search limited to English publications, full-text SRs of digital biomarkers included randomized controlled trials that involved a human population and reported changes in participants' health status. PubMed and the Cochrane Library were searched with time frames limited to 2019 and 2020. The World Health Organization's classification systems for diseases (International Classification of Diseases, Eleventh Revision), health interventions (International Classification of Health Interventions), and bodily functions (International Classification of Functioning, Disability, and Health [ICF]) were used to classify populations, interventions, and outcomes, respectively. Results: A total of 31 SRs met the inclusion criteria. The majority of SRs studied patients with circulatory system diseases (19/31, 61\%) and respiratory system diseases (9/31, 29\%). Most of the prevalent interventions focused on physical activity behavior (16/31, 52\%) and conversion of cardiac rhythm (4/31, 13\%). Looking after one's health (physical activity; 15/31, 48\%), walking (12/31, 39\%), heart rhythm functions (8/31, 26\%), and mortality (7/31, 23\%) were the most commonly reported outcomes. In total, 16 physiological and behavioral data groups were identified using the ICF tool, such as looking after one's health (physical activity; 14/31, 45\%), walking (11/31, 36\%), heart rhythm (7/31, 23\%), and weight maintenance functions (7/31, 23\%). Various digital devices were also studied to collect these data in the included reviews, such as smart glasses, smartwatches, smart bracelets, smart shoes, and smart socks for measuring heart functions, gait pattern functions, and temperature. A substantial number (24/31, 77\%) of digital biomarkers were used as interventions. Moreover, wearables (22/31, 71\%) were the most common types of digital devices. Position sensors (21/31, 68\%) and heart rate sensors and pulse rate sensors (12/31, 39\%) were the most prevalent types of sensors used to acquire behavioral and physiological data in the SRs. Conclusions: In recent years, the clinical evidence concerning digital biomarkers has been systematically reviewed in a wide range of study populations, interventions, digital devices, and sensor technologies, with the dominance of physical activity and cardiac monitors. We used the World Health Organization's ICF tool for classifying behavioral and physiological data, which seemed to be an applicable tool to categorize the broad scope of digital biomarkers identified in this review. To understand the clinical value of digital biomarkers, the strength and quality of the evidence on their health consequences need to be systematically evaluated. ",
doi="10.2196/35722",
url="https://mhealth.jmir.org/2022/10/e35722",
url="http://www.ncbi.nlm.nih.gov/pubmed/36279171"
}


@Article{info:doi/10.2196/39759,
author="Huang, Ching-Shui
and Tai, Feng-Chuan
and Lien, Heng-Hui
and Wong, Jia-Uei
and Huang, Chi-Cheng",
title="Long-term Follow-up of Patients With Hernia Using the Hernia-Specific Quality-of-Life Mobile App: Feasibility Questionnaire Study",
journal="JMIR Form Res",
year="2022",
month="Oct",
day="19",
volume="6",
number="10",
pages="e39759",
keywords="hernia",
keywords="mobile app",
keywords="quality of life",
keywords="Hernia-Specific Quality-of-Life (HERQL)",
keywords="mobile health",
keywords="mHealth",
keywords="app",
keywords="self-management",
abstract="Background: Hernia repair is one of the most common surgical procedures; however, the long-term outcomes are seldom reported due to incomplete follow-up. Objective: The aim of this study was to examine the use of a mobile app for the long-term follow-up of hernia recurrence, complication, and quality-of-life perception. Methods: A cloud-based corroborative system drove a mobile app with the HERQL (Hernia-Specific Quality-of-Life) questionnaire built in. Patients who underwent hernia repair were identified from medical records, and an invitation to participate in this study was sent through the post. Results: The response rate was 11.89\% (311/2615) during the 1-year study period, whereas the recurrence rate was 1.0\% (3/311). Causal relationships between symptomatic and functional domains of the HERQL questionnaire were indicated by satisfactory model fit indices and significant regression coefficients derived from structural equational modeling. Regarding patients' last hernia surgeries, 88.7\% (276/311) of the patients reported them to be satisfactory or very satisfactory, 68.5\% (213/311) of patients reported no discomfort, and 61.1\% (190/311) of patients never experienced mesh foreign body sensation. Subgroup analysis for the most commonly used mesh repairs found that mesh plug repair inevitably resulted in worse symptoms and quality-of-life perception from the group with groin hernias. Conclusions: The mobile app has the potential to enhance the quality of care for patients with hernia and facilitate outcomes research with more complete follow-up. ",
doi="10.2196/39759",
url="https://formative.jmir.org/2022/10/e39759",
url="http://www.ncbi.nlm.nih.gov/pubmed/36260390"
}


@Article{info:doi/10.2196/40869,
author="Browne, D. Jonathan
and Vaninetti, Michael
and Giard, David
and Kostas, Konstantinos
and Dave, Ankur",
title="An Evaluation of a Mobile App for Chronic Low Back Pain Management: Prospective Pilot Study",
journal="JMIR Form Res",
year="2022",
month="Oct",
day="13",
volume="6",
number="10",
pages="e40869",
keywords="back pain",
keywords="chronic pain",
keywords="mobile",
keywords="app",
keywords="multidisciplinary care",
keywords="biopsychosocial",
keywords="self-management",
keywords="mHealth",
keywords="mobile health",
keywords="mobile app",
abstract="Background: Chronic low back pain is challenging to manage due to multidisciplinary considerations. It has substantial socioeconomic impacts and cannot be simply treated with pharmacotherapy, nonsurgical intervention, or spine surgery. Medical consensus recommends optimizing conservative self-management therapies (eg, home exercise, wellness strategies, yoga, etc) as first-line treatment options for chronic low back pain. However, access to these modalities is often limited and secondary to cost, convenience, and ease of use. Mobile health apps have emerged as a cost-effective and accessible option for chronic low back pain self-management. Established in-person pain programs can provide the structure for an optimal mobile app adaptation. PainNavigator (PainNavigator, Inc) is an example of a mobile app that is based on an Ascension-Illinois group--based pain program---Pain Rehabilitation Outpatient-Camp. Objective: This was a prospective pilot clinical trial that evaluated the PainNavigator platform's utility in low back pain management to inform future trial development. Methods: A total of 75 participants who used PainNavigator were studied. Pain, Enjoyment, and General Activity (PEG-3) scale scores and scores from a brief anxiety and depression scale based on the Patient Health Questionnaire-4 (PHQ-4) were obtained at baseline and following program completion. The PEG-3 total score was used, in addition to individual items---Average Pain, Pain Effect on Enjoyment, and Pain Effect on Activity. The PHQ-4 total score was also used, in addition to other individual items, including Felt Depressed, Loss of Interest, Felt Anxious, and Difficult to Control Worry. Paired sample t tests (2-tailed) compared mean differences in scores from before and after participants received the intervention. Results: The analysis found that PEG-3 (n=27) and PHQ-4 (n=27) total scores were significantly lower upon the completion of PainNavigator (P<.001 and P=.001, respectively). The findings showed a 36\% reduction in PEG-3 total scores, a 40\% reduction in pain intensity, and a 40\% reduction in PHQ-4 total scores. Scores for individual PEG-3 scale and PHQ-4 items also significantly decreased. All PEG-3 measures had large effect sizes. The PHQ-4 total score and Difficult to Control Worry item had large effect sizes, while the other three measures had medium effect sizes. Conclusions: These findings show that PainNavigator has clinical significance in managing chronic low back pain and can be easily utilized to improve patient care. All PEG-3 scale and PHQ-4 measures significantly improved following the use of the platform, supporting the multidimensional, biopsychosocial approach to low back pain management. Differences in effect sizes may inform quality improvement investigations, such as optimizing features that impact measures with only medium effect sizes. This feasibility study demonstrates an effective protocol, and it will inform future, more extensive randomized controlled trials. ",
doi="10.2196/40869",
url="https://formative.jmir.org/2022/10/e40869",
url="http://www.ncbi.nlm.nih.gov/pubmed/36227637"
}


@Article{info:doi/10.2196/36987,
author="Kyt{\"o}, Mikko
and Koivusalo, Saila
and Ruonala, Antti
and Str{\"o}mberg, Lisbeth
and Tuomonen, Heli
and Heinonen, Seppo
and Jacucci, Giulio",
title="Behavior Change App for Self-management of Gestational Diabetes: Design and Evaluation of Desirable Features",
journal="JMIR Hum Factors",
year="2022",
month="Oct",
day="12",
volume="9",
number="4",
pages="e36987",
keywords="gestational diabetes",
keywords="mobile app",
keywords="features",
keywords="behavior change",
keywords="digital health",
keywords="eHealth",
keywords="telehealth",
keywords="self-tracking",
keywords="self-management",
keywords="personalized health care",
abstract="Background: Gestational diabetes (GDM) has considerable and increasing health effects as it raises both the mother's and the offspring's risk for short- and long-term health problems. GDM can usually be treated with a healthier lifestyle, such as appropriate dietary modifications and sufficient physical activity. Although telemedicine interventions providing weekly or more frequent feedback from health care professionals have shown the potential to improve glycemic control among women with GDM, apps without extensive input from health care professionals are limited and have not been shown to be effective. Different features in personalization and support have been proposed to increase the efficacy of GDM apps, but the knowledge of how these features should be designed is lacking. Objective: The aim of this study is to investigate how GDM apps should be designed, considering the desirable features based on the previous literature. Methods: We designed an interactive GDM prototype app that provided example implementations of desirable features, such as providing automatic and personalized suggestions and social support through the app. Women with GDM explored the prototype and provided feedback in semistructured interviews. Results: We identified that (1) self-tracking data in GDM apps should be extended with written feedback, (2) habits and goals should be highly customizable to be useful, (3) the app should have different functions to provide social support, and (4) health care professionals should be notified through the app if something unusual occurs. In addition, we found 2 additional themes. First, basic functionalities that are fast to learn by women with GDM who have recently received the diagnosis should be provided, but there should also be deeper features to maintain interest for women with GDM at a later stage of pregnancy. Second, as women with GDM may have feelings of guilt, the app should have a tolerance for and a supporting approach to unfavorable behavior. Conclusions: The feedback on the GDM prototype app supported the need for desirable features and provided new insights into how these features should be incorporated into GDM apps. We expect that following the proposed designs and feedback will increase the efficacy of GDM self-management apps. Trial Registration: ClinicalTrials.gov NCT03941652; https://clinicaltrials.gov/ct2/show/NCT03941652 ",
doi="10.2196/36987",
url="https://humanfactors.jmir.org/2022/4/e36987",
url="http://www.ncbi.nlm.nih.gov/pubmed/36222806"
}


@Article{info:doi/10.2196/38709,
author="Sieber, Chlo{\'e}
and Chiavi, Deborah
and Haag, Christina
and Kaufmann, Marco
and Horn, B. Andrea
and Dressel, Holger
and Zecca, Chiara
and Calabrese, Pasquale
and Pot, Caroline
and Kamm, Philipp Christian
and von Wyl, Viktor
and ",
title="Electronic Health Diary Campaigns to Complement Longitudinal Assessments in Persons With Multiple Sclerosis: Nested Observational Study",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Oct",
day="5",
volume="10",
number="10",
pages="e38709",
keywords="registry",
keywords="multiple sclerosis",
keywords="digital health",
keywords="electronic health diary",
keywords="diary",
keywords="participation",
keywords="adherence",
keywords="patient-reported outcome",
keywords="natural language processing",
keywords="unstructured text",
abstract="Background: Electronic health diaries hold promise in complementing standardized surveys in prospective health studies but are fraught with numerous methodological challenges. Objective: The study aimed to investigate participant characteristics and other factors associated with response to an electronic health diary campaign in persons with multiple sclerosis, identify recurrent topics in free-text diary entries, and assess the added value of structured diary entries with regard to current symptoms and medication intake when compared with survey-collected information. Methods: Data were collected by the Swiss Multiple Sclerosis Registry during a nested electronic health diary campaign and during a regular semiannual Swiss Multiple Sclerosis Registry follow-up survey serving as comparator. The characteristics of campaign participants were descriptively compared with those of nonparticipants. Diary content was analyzed using the Linguistic Inquiry and Word Count 2015 software (Pennebaker Conglomerates, Inc) and descriptive keyword analyses. The similarities between structured diary data and follow-up survey data on health-related quality of life, symptoms, and medication intake were examined using the Jaccard index. Results: Campaign participants (n=134; diary entries: n=815) were more often women, were not working full time, did not have a higher education degree, had a more advanced gait impairment, and were on average 5 years older (median age 52.5, IQR 43.25-59.75 years) than eligible nonparticipants (median age 47, IQR 38-55 years; n=524). Diary free-text entries (n=632; participants: n=100) most often contained references to the following standard Linguistic Inquiry and Word Count word categories: negative emotion (193/632, 30.5\%), body parts or body functioning (191/632, 30.2\%), health (94/632, 14.9\%), or work (67/632, 10.6\%). Analogously, the most frequently mentioned keywords (diary entries: n=526; participants: n=93) were ``good,'' ``day,'' and ``work.'' Similarities between diary data and follow-up survey data, collected 14 months apart (median), were high for health-related quality of life and stable for slow-changing symptoms such as fatigue or gait disorder. Similarities were also comparatively high for drugs requiring a regular application, including interferon beta-1a (Avonex) and glatiramer acetate (Copaxone), and for modern oral therapies such as fingolimod (Gilenya) and teriflunomide (Aubagio). Conclusions: Diary campaign participation seemed dependent on time availability and symptom burden and was enhanced by reminder emails. Electronic health diaries are a meaningful complement to regular structured surveys and can provide more detailed information regarding medication use and symptoms. However, they should ideally be embedded into promotional activities or tied to concrete research study tasks to enhance regular and long-term participation. ",
doi="10.2196/38709",
url="https://mhealth.jmir.org/2022/10/e38709",
url="http://www.ncbi.nlm.nih.gov/pubmed/36197713"
}


@Article{info:doi/10.2196/35039,
author="Lim, Lin Su
and Tay, Juan Melissa Hui
and Ong, Wen Kai
and Johal, Jolyn
and Yap, Ven Qai
and Chan, Huak Yiong
and Yeo, Ning Genevieve Kai
and Khoo, Meng Chin
and Yaxley, Alison",
title="Association Between Mobile Health App Engagement and Weight Loss and Glycemic Control in Adults With Type 2 Diabetes and Prediabetes (D'LITE Study): Prospective Cohort Study",
journal="JMIR Diabetes",
year="2022",
month="Sep",
day="30",
volume="7",
number="3",
pages="e35039",
keywords="engagement",
keywords="diabetes",
keywords="prediabetes",
keywords="mobile health",
keywords="mHealth",
keywords="mobile apps",
keywords="weight loss",
keywords="glycemic control",
keywords="glycated hemoglobin",
keywords="HbA1c change",
keywords="mobile phone",
abstract="Background: Mobile health apps are increasingly used as early intervention to support behavior change for diabetes prevention and control, with the overarching goal of lowering the overall disease burden. Objective: This prospective cohort study conducted in Singapore aimed to investigate app engagement features and their association with weight loss and improved glycemic control among adults with diabetes and prediabetes from the intervention arm of the Diabetes Lifestyle Intervention using Technology Empowerment randomized controlled trial. Methods: Diabetes and prediabetes participants (N=171) with a median age of 52 years, BMI of 29.3 kg/m2, and glycated hemoglobin (HbA1c) level of 6.5\% and who were being assigned the Nutritionist Buddy Diabetes app were included. Body weight and HbA1c were measured at baseline, 3 months, and 6 months. A total of 476,300 data points on daily app engagement were tracked via the backend dashboard and developer's report. The app engagement data were analyzed by quartiles and weekly means expressed in days per week. Linear mixed model analysis was used to determine the associations between the app engagements with percentage weight and HbA1c change. Results: The median overall app engagement rate was maintained above 90\% at 6 months. Participants who were actively engaged in ?5 app features were associated with the greatest overall weight reduction of 10.6\% from baseline (mean difference ?6, 95\% CI ?8.9 to ?3.2; P<.001) at 6 months. Adhering to the carbohydrate limit of >5.9 days per week and choosing healthier food options for >4.3 days per week had the most impact, eliciting weight loss of 9.1\% (mean difference ?5.2, 95\% CI ?8.2 to ?2.2; P=.001) and 8.8\% (mean difference ?4.2, 95\% CI ?7.1 to ?1.3; P=.005), respectively. Among the participants with diabetes, those who had a complete meal log for >5.1 days per week or kept within their carbohydrate limit for >5.9 days per week each achieved greater HbA1c reductions of 1.2\% (SD 1.3\%; SD 1.5\%), as compared with 0.2\% (SD 1\%; SD 0.6\%). in the reference groups who used the features <1.1 or ?2.5 days per week, respectively. Conclusions: Higher app engagement led to greater weight loss and HbA1c reduction among adults with overweight or obesity with type 2 diabetes or prediabetes. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12617001112358; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12617001112358 ",
doi="10.2196/35039",
url="https://diabetes.jmir.org/2022/3/e35039",
url="http://www.ncbi.nlm.nih.gov/pubmed/36178718"
}


@Article{info:doi/10.2196/37868,
author="Step, M. Mary
and McMillen Smith, Jennifer
and Lewis, A. Steven
and Avery, K. Ann",
title="Using the Positive Peers Mobile App to Improve Clinical Outcomes for Young People With HIV: Prospective Observational Cohort Comparison",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Sep",
day="28",
volume="10",
number="9",
pages="e37868",
keywords="mobile health",
keywords="mHealth",
keywords="HIV",
keywords="Positive Peers",
keywords="retention in care",
keywords="re-engagement in care",
keywords="viral suppression",
abstract="Background: Disparities in HIV outcomes persist among racial, gender, and sexual minorities in the United States. Younger people face a greater risk of contracting HIV, often living without knowledge of their HIV status for long periods. The Positive Peers App (PPA) is a multifunctional HIV support tool designed to improve HIV-related clinical outcomes for young people with HIV. The app was designed according to the specifications of an in-care young adult HIV community in Northeast Ohio. Data provided in this study provide preliminary evidence of the usefulness of PPA as a relevant tool for engaging this clinical patient population in care and facilitating viral suppression. Objective: In this study, we aimed to describe variations in PPA use and examine the associations between use and HIV clinical outcomes between self-selected user and nonuser cohorts in the same clinical population. Methods: The PPA was offered free of charge to persons with HIV, aged 13 to 34 years of age, diagnosed with HIV within the last 12 months, out of care for 6 months during the last 24 months, or not virally suppressed (HIV viral load >200 copies/mL) in the prior 24 months. Baseline and 6- and 12-month surveys were administered via an audio computer-assisted self-interviewing system to all participants. The app's user activity was tracked natively by the app and stored in a secure server. Participant demographic and HIV care data were extracted from clinical records within 12 months before the start of the study and across the duration of the study period. HIV care outcomes of PPA users (n=114) were compared with those of nonusers (n=145) at the end of the study period (n=259). Results: The analysis showed that younger PPA users (aged 13-24 years) were more likely to obtain HIV laboratories (adjusted odds ratio 2.85, 95\% CI 1.03-7.90) and achieve sustained viral suppression than nonusers (adjusted odds ratio 4.2, 95\% CI 1.2-13.9). Conclusions: The PPA appears to help younger users sustain HIV suppression. The app offers an important tool for addressing this critical population. The PPA remains in the field and is currently being adopted by other localities to facilitate their efforts to end the HIV epidemic. Although our reported observational results require additional validation and stringent ongoing surveillance, the results represent our best efforts in a pilot study to provide a measure of efficacy for the PPA. Next steps include a large-scale evaluation of the PPA acceptability and effectiveness. Given the building evidence of user reports and outcomes, the freely available PPA could be a helpful tool for achieving Ending the HIV Epidemic goals. ",
doi="10.2196/37868",
url="https://mhealth.jmir.org/2022/9/e37868",
url="http://www.ncbi.nlm.nih.gov/pubmed/36170001"
}


@Article{info:doi/10.2196/30602,
author="Thorsen, K{\ae}r Ida
and Yang, Yanxiang
and Valentiner, Staun Laura
and Gl{\"u}mer, Charlotte
and Karstoft, Kristian
and Br{\o}nd, Christian Jan
and Nielsen, Oestergaard Rasmus
and Br{\o}ns, Charlotte
and Christensen, Robin
and Nielsen, Steen Jens
and Vaag, Arthur Allan
and Pedersen, Klarlund Bente
and Langberg, Henning
and Ried-Larsen, Mathias",
title="The Effects of a Lifestyle Intervention Supported by the InterWalk Smartphone App on Increasing Physical Activity Among Persons With Type 2 Diabetes: Parallel-Group, Randomized Trial",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Sep",
day="28",
volume="10",
number="9",
pages="e30602",
keywords="type 2 diabetes mellitus",
keywords="exercise",
keywords="telemedicine",
keywords="primary health care",
keywords="accelerometry",
keywords="quality of life",
keywords="waist circumference",
keywords="mHealth",
keywords="mobile app",
abstract="Background: Effective and sustainable implementation of physical activity (PA) in type 2 diabetes (T2D) health care has in general not been successful. Efficacious and contemporary approaches to support PA adherence and adoption are required. Objective: The primary objective of this study was to investigate the effectiveness of including an app-based (InterWalk) approach in municipality-based rehabilitation to increase moderate-and-vigorous PA (MVPA) across 52 weeks compared with standard care among individuals with T2D. Methods: The study was designed as a parallel-group, randomized trial with 52 weeks' intervention and subsequent follow-up for effectiveness (52 weeks from baseline). Participants were recruited between January 2015 and December 2016 and randomly allocated (2:1) into 12 weeks of (1) standard care + InterWalk app--based interval walking training (IWT; IWT group; n=140), or (2) standard care + the standard exercise program (StC group; n=74). Following 12 weeks, the IWT group was encouraged to maintain InterWalk app--based IWT (3 times per week for 30-60 minutes) and the StC group was encouraged to maintain exercise without structured support. Moreover, half of the IWT group (IWTsupport group, n=54) received additional motivational support following the 12-week program until 52-week follow-up. The primary outcome was change in objectively measured MVPA time (minutes/day) from baseline to 52-week follow-up. Key secondary outcomes included changes in self-rated physical and mental health--related quality of life (HRQoL), physical fitness, weight, and waist circumference. Results: Participants had a mean age of 59.6 (SD 10.6) years and 128/214 (59.8\%) were men. No changes in MVPA time were observed from baseline to 52-week follow-up in the StC and IWT groups (least squares means [95\% CI] 0.6 [--4.6 to 5.8] and --0.2 [--3.8 to 3.3], respectively) and no differences were observed between the groups (mean difference [95\% CI] --0.8 [--8.1 to 6.4] minutes/day; P=.82). Physical HRQoL increased by a mean of 4.3 (95\% CI 1.8 to 6.9) 12-item Short-Form Health Survey (SF-12) points more in the IWT group compared with the StC group (Benjamini-Hochberg adjusted P=.007) and waist circumference apparently decreased a mean of --2.3 (95\% CI --4.1 to --0.4) cm more in the IWT group compared with the StC group but with a Benjamini-Hochberg adjusted P=.06. No between-group differences were observed among the remaining key secondary outcomes. Conclusions: Among individuals with T2D referred to municipality-based lifestyle programs, randomization to InterWalk app--based IWT did not increase objectively measured MVPA time over 52 weeks compared with standard health care, although apparent benefits were observed for physical HRQoL. Trial Registration: ClinicalTrials.gov NCT02341690; https://clinicaltrials.gov/ct2/show/NCT02341690 ",
doi="10.2196/30602",
url="https://mhealth.jmir.org/2022/9/e30602",
url="http://www.ncbi.nlm.nih.gov/pubmed/36170002"
}


@Article{info:doi/10.2196/38788,
author="Story, M. Kristin
and Bravata, M. Dawn
and Robb, L. Sheri
and Wasmuth, Sally
and Slaven, E. James
and Whitmire, Leah
and Barker, Barry
and Menen, Tetla
and Bair, J. Matthew",
title="Feasibility and Acceptability of Music Imagery and Listening Interventions for Analgesia: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="Sep",
day="22",
volume="11",
number="9",
pages="e38788",
keywords="chronic pain",
keywords="music therapy",
keywords="veterans",
keywords="clinical trial",
keywords="music imagery",
keywords="pilot study",
keywords="feasibility",
keywords="acceptability",
keywords="mobile phone",
abstract="Background: Chronic pain and access to care are identified as critical needs of the Veterans Health Administration. Music imagery and music listening interventions have shown promise as effective nonpharmacological options for pain management. However, most studies have focused on acute pain, passive music experiences, and in-person delivery. Objective: In this study, we aimed to examine the feasibility and acceptability of 2 music interventions delivered through telehealth for chronic musculoskeletal pain, trial design, and theoretical model before conducting a fully powered efficacy or comparative effectiveness trial. Methods: FAMILIA (Feasibility and Acceptability of Music Imagery and Listening Interventions for Analgesia) is a 3-arm, parallel group, pilot trial. A total of 60 veterans will be randomized to one of the three conditions: music imagery, music listening, or usual care. Aim 1 is to test the feasibility and acceptability of a multicomponent, interactive music imagery intervention (8-weekly, individual sessions) and a single-component, minimally interactive music learning intervention (independent music listening). Feasibility metrics related to recruitment, retention, engagement, and completion of the treatment protocol and questionnaires will be assessed. Up to 20 qualitative interviews will be conducted to assess veteran experiences with both interventions, including perceived benefits, acceptability, barriers, and facilitators. Interview transcripts will be coded and analyzed for emergent themes. Aim 2 is to explore the effects of music imagery and music listening versus usual care on pain and associated patient-centered outcomes. These outcomes and potential mediators will be explored through changes from baseline to follow-up assessments at 1, 3, and 4 months. Descriptive statistics will be used to describe outcomes; this pilot study is not powered to detect differences in outcomes. Results: Recruitment for FAMILIA began in March 2022, and as of July 2022, 16 participants have been enrolled. We anticipate that enrollment will be completed by May 2023. We expect that music imagery and music listening will prove acceptable to veterans and that feasibility benchmarks will be reached. We hypothesize that music imagery and music listening will be more effective than usual care on pain and related outcomes. Conclusions: FAMILIA addresses four limitations in music intervention research for chronic pain: limited studies in veterans, evaluation of a multicomponent music intervention, methodological rigor, and internet-based delivery. Findings from FAMILIA will inform a fully powered trial to identify putative mechanisms and test efficacy. Trial Registration: ClinicalTrials.gov NCT05426941; https://tinyurl.com/3jdhx28u International Registered Report Identifier (IRRID): DERR1-10.2196/38788 ",
doi="10.2196/38788",
url="https://www.researchprotocols.org/2022/9/e38788",
url="http://www.ncbi.nlm.nih.gov/pubmed/36136377"
}


@Article{info:doi/10.2196/39867,
author="Yotsu, R. Rie
and Itoh, Sakiko
and Yao, Aubin Koffi
and Kouadio, Kouam{\'e}
and Ugai, Kazuko
and Koffi, Didier Yao
and Almamy, Diabate
and Vagamon, Bamba
and Blanton, E. Ronald",
title="The Early Detection and Case Management of Skin Diseases With an mHealth App (eSkinHealth): Protocol for a Mixed Methods Pilot Study in C{\^o}te d'Ivoire",
journal="JMIR Res Protoc",
year="2022",
month="Sep",
day="21",
volume="11",
number="9",
pages="e39867",
keywords="skin diseases",
keywords="neglected diseases",
keywords="skin NTDs",
keywords="teledermatology",
keywords="telemedicine",
keywords="remote consultation",
abstract="Background: There is a high prevalence of skin diseases sub-Saharan Africa, including skin neglected tropical diseases (NTDs) that could lead to lifelong disabilities and deformities if not diagnosed and treated early. To achieve early detection and early treatment of these skin diseases, we developed a mobile health app, eSkinHealth. Objective: This paper outlines a protocol for evaluating the effect of our eSkinHealth app in the early detection and effective management of skin diseases in C{\^o}te d'Ivoire. Methods: A mixed methods pilot trial will be conducted in C{\^o}te d'Ivoire and will consist of 3 phases: (1) the development and improvement of the eSkinHealth app, (2) a pilot trial to evaluate the usability of the eSkinHealth app for local medical staff in C{\^o}te d'Ivoire, and (3) a pilot trial to evaluate the effectiveness of early detection and case management of targeted skin NTDs (Buruli ulcer, leprosy, yaws, and lymphatic filariasis) with the eSkinHealth app in C{\^o}te d'Ivoire. The pilot study will be implemented as a 2-arm trial with local health care providers and patients with skin NTDs over a 3-month follow-up period. The local health care providers will be assigned to an intervention group receiving the eSkinHealth app to be used in their daily practices or a control group. Training will be provided on the use and implementation of the app and the diagnostic pipeline to the intervention group only, while both groups will receive training on skin diseases. Our primary outcome is to evaluate the early detection and effective management of skin diseases using the eSkinHealth app in C{\^o}te d'Ivoire by the number of cases diagnosed and managed. Additionally, we will evaluate the eSkinHealth app with validated questionnaires and in-depth interviews. Procedures of our methods have been reviewed and approved by the Institutional Review Board of the Ministry of Health, C{\^o}te d'Ivoire and by Tulane University in 2021. Results: This study was funded in 2021. We started the enrollment of patients in February 2022, and data collection is currently underway. We expect the first results to be submitted for publication in 2023. Conclusions: Our eSkinHealth app is a field-adapted platform that could provide both direct diagnostic and management assistance to health workers in remote settings. The study will provide evidence for the usability and the effectiveness of the eSkinHealth app to improve the early detection and case management of skin NTDs in C{\^o}te d'Ivoire and, furthermore, is expected to contribute to knowledge on mobile health approaches in the control of skin NTDs. Trial Registration: ClinicalTrials.gov NCT05300399; https://clinicaltrials.gov/ct2/show/study/NCT05300399 International Registered Report Identifier (IRRID): DERR1-10.2196/39867 ",
doi="10.2196/39867",
url="https://www.researchprotocols.org/2022/9/e39867",
url="http://www.ncbi.nlm.nih.gov/pubmed/35922062"
}


@Article{info:doi/10.2196/35851,
author="B{\'a}ez Guti{\'e}rrez, Nerea
and Rodr{\'i}guez Ramallo, H{\'e}ctor
and Fern{\'a}ndez Gonz{\'a}lez, Marcos
and Abdel-Kader Mart{\'i}n, Laila",
title="Smartphone Apps for Patients With Hematologic Malignancies: Systematic Review and Evaluation of Content",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Sep",
day="20",
volume="10",
number="9",
pages="e35851",
keywords="hematological malignancies",
keywords="mobile apps",
keywords="smartphone",
keywords="eHealth",
keywords="mHealth",
keywords="cancer",
keywords="mobile app",
keywords="mobile health",
keywords="hematology",
abstract="Background: Hematological malignancies (HMs) are a heterogeneous group of cancers representing a significant cause of morbidity and mortality. The chronification of HMs and the increasing use of smartphones may lead patients to seek their current unmet needs through mobile health apps. Objective: The goal of this review was to identify and assess the quality of smartphone apps aimed at patients diagnosed with HMs. Methods: A systematic search of apps that were aimed at patients diagnosed with HMs, accessed from a Spain IP address, and were available on the iOS (App Store) and Android (Google Play) platforms was conducted in November 2021. The search terms used were ``hematology,'' ``blood cancer,'' ``leukemia,'' ``lymphoma,'' and ``myeloma'' apps in English, Spanish, or both languages. The identified apps were downloaded and analyzed independently by 2 reviewers. Information about general app characteristics was collected. The Mobile Application Rating Scale (MARS) was used to assess quality. The resulting parameter of the analyses, the mean score of the apps, was compared by Student t test. Results: Overall, 18 apps were identified; 7 were available on Android, 5 were available on iOS, and 6 were available on both platforms. All included apps were free; 3 were published in 2021, and among the apps published before 2021, only 6 were updated in 2021. Most (16/18, 89\%) of the apps were aimed at patients with leukemia or lymphoma (16). The primary purposes of the apps were to provide general information about the condition (16/18, 89\%) and monitor symptoms and clinical parameters (11/18, 61\%). Health care professionals contributed to the development of 50\% (9/18) of apps; 6 were owned and supported by scientific societies, and 3 were developed with the participation of health care professionals. The mean MARS score for the overall quality of the apps was 3.1 (SD 1.0). The engagement and aesthetics subscales were the lowest rated subscales, with only 44\% (8/18) and 67\% (12/18), respectively, of the apps obtaining acceptable scores. None of the included apps proved clinical efficacy through clinical trials in patients with HMs. Statistically significant differences were found in the MARS scores between operating systems (+1.0, P=.003) in favor of iOS apps. The participation of health care professionals in the development of the apps did not have a statistically significant impact on the MARS scores. Conclusions: This systematic search and evaluation identified few acceptable quality mobile apps for patients with HMs. Current and future apps for patients with HMs should provide evidence-based valuable information, improve user engagement, incorporate functions according to patient preferences, and generate evidence regarding the efficacy of app use by patients with HMs. ",
doi="10.2196/35851",
url="https://mhealth.jmir.org/2022/9/e35851",
url="http://www.ncbi.nlm.nih.gov/pubmed/36125860"
}


@Article{info:doi/10.2196/36517,
author="McKeown, Eamonn
and McGraw, Caroline
and Holder, Pru
and Shand, Jenny
and Hirani, P. Shashivadan",
title="Acceptability and Impact of an Educational App (iCare) for Informal Carers Looking After People at Risk of Pressure Ulceration: Mixed Methods Pilot Study",
journal="JMIR Form Res",
year="2022",
month="Sep",
day="16",
volume="6",
number="9",
pages="e36517",
keywords="pressure ulcers",
keywords="informal carers",
keywords="smartphone apps",
keywords="mobile health",
keywords="mHealth",
keywords="educational technology",
keywords="health education",
keywords="mobile phone",
abstract="Background: Pressure ulcers are areas of skin damage resulting from sustained pressure. Informal carers play a central role in preventing pressure ulcers among older and disabled people living at home. Studies highlight the paucity of pressure ulcer training for informal carers and suggest that pressure ulcer risk is linked to high levels of carer burden. Objective: This pilot study evaluated a smartphone app with a specific focus on pressure ulcer prevention education for informal carers. The app was developed based on the principles of microlearning. The study aimed to explore carer perspectives on the acceptability of the app and determine whether the app increased knowledge and confidence in their caring role. Methods: In this concurrent mixed methods study, participants completed quantitative questionnaires at baseline and at the end of weeks 2 and 6, which examined caregiving self-efficacy, preparedness for caregiving, caregiver strain, pressure ulcer knowledge, and app acceptability and usability. A subsample of participants participated in a ``think aloud'' interview in week 1 and semistructured interviews at the end of weeks 2 and 6. Results: Of the 32 participants, 23 (72\%) participants completed the week 2 and 16 (50\%) completed the week 6 questionnaires; 66\% (21/32) of carers participated in qualitative ``think aloud'' interviews, and 18 (56\%) also participated in semistructured interviews at week 2, and 13 (41\%) at week 6. Pressure ulcer knowledge scores significantly changed (F1,6.112=21.624; P=.001) from baseline (mean 37.5; SE 2.926) to the second follow-up (mean 59.72, SE 3.985). Regarding the qualitative data, the theme ``I'm more careful now and would react to signs of redness'' captured participants' reflections on the new knowledge they had acquired, the changes they had made to their caring routines, their increased vigilance for signs of skin damage, and their intentions toward the app going forward. There were no significant results pertaining to improved preparedness for caregiving or caregiving self-efficacy or related to the Caregiver Strain Index. Participants reported above average usability scores on a scale of 0 to 100 (mean 69.94, SD 18.108). The app functionality and information quality were also rated relatively high on a scale of 0 to 5 (mean 3.84, SD 0.704 and mean 4.13, SD 0.452, respectively). Overall, 2 themes pertaining to acceptability and usability were identified: ``When you're not used to these things, they take time to get the hang of'' and ``It's not a fun app but it is informative.'' All participants (n=32, 100\%) liked the microlearning approach. Conclusions: The iCare app offers a promising way to improve informal carers' pressure ulcer knowledge. However, to better support carers, the findings may reflect the need for future iterations of the app to use more interactive elements and the introduction of gamification and customization based on user preferences. ",
doi="10.2196/36517",
url="https://formative.jmir.org/2022/9/e36517",
url="http://www.ncbi.nlm.nih.gov/pubmed/36112413"
}


@Article{info:doi/10.2196/40468,
author="Bin, Jia Kaio
and De Pretto, Ramos Lucas
and Sanchez, Beltrame Fabio
and Battistella, Rizzo Linamara",
title="Digital Platform to Continuously Monitor Patients Using a Smartwatch: Preliminary Report",
journal="JMIR Form Res",
year="2022",
month="Sep",
day="15",
volume="6",
number="9",
pages="e40468",
keywords="smartwatch",
keywords="digital health",
keywords="telemedicine",
keywords="wearable",
keywords="telemonitoring",
keywords="mobile health",
keywords="digital platform",
keywords="clinical intervention",
keywords="sensitive data",
keywords="clinical trial",
abstract="Background: Monitoring vital signs such as oximetry, blood pressure, and heart rate is important to follow the evolution of patients. Smartwatches are a revolution in medicine allowing the collection of such data in a continuous and organic way. However, it is still a challenge to make this information available to health care professionals to make decisions during clinical follow-up. Objective: This study aims to build a digital solution that displays vital sign data from smartwatches, collected remotely, continuously, reliably, and from multiple users, with trigger warnings when abnormal results are identified. Methods: This is a single-center prospective study following the guidelines ``Evaluating digital health products'' from the UK Health Security Agency. A digital platform with 3 different applications was created to capture and display data from the mobile phones of volunteers with smartwatches. We selected 80 volunteers who were followed for 24 weeks each, and the synchronization interval between the smartwatch and digital solution was recorded for each vital sign collected. Results: In 14 weeks of project progress, we managed to recruit 80 volunteers, with 68 already registered in the digital solution. More than 2.8 million records have already been collected, without system downtime. Less than 5\% of continuous heart rate measurements (bpm) were synchronized within 2 hours. However, approximately 70\% were synchronized in less than 24 hours, and 90\% were synchronized in less than 119 hours. Conclusions: The digital solution is working properly in its role of displaying data collected from smartwatches. Vital sign values are being monitored by the research team as part of the monitoring of volunteers. Although the digital solution proved unsuitable for monitoring urgent events, it is more than suitable for use in outpatient clinical use. This digital solution, which is based on cloud technology, can be applied in the future for telemonitoring in regions lacking health care professionals. Accuracy and reliability studies still need to be performed at the end of the 24-week follow-up. ",
doi="10.2196/40468",
url="https://formative.jmir.org/2022/9/e40468",
url="http://www.ncbi.nlm.nih.gov/pubmed/36107471"
}


@Article{info:doi/10.2196/40739,
author="Imeraj, Albi
and Olesen, Bastholm Thomas
and Laursen, Hjorth Ditte
and S{\o}ndergaard, Jens
and Brandt, Joakim Carl",
title="Agreement Between Clinically Measured Weight and Self-reported Weight Among Patients With Type 2 Diabetes Through an mHealth Lifestyle Coaching Program in Denmark: Secondary Analysis of a Randomized Controlled Trial",
journal="JMIR Form Res",
year="2022",
month="Sep",
day="14",
volume="6",
number="9",
pages="e40739",
keywords="telemedicine",
keywords="digital behavioral coaching",
keywords="lifestyle change",
keywords="mobile intervention",
keywords="obesity",
keywords="diabetes",
keywords="patient engagement",
keywords="validation",
keywords="self-report",
keywords="body weight",
abstract="Background: Digital health interventions are increasingly used to handle and promote positive health behaviors. Clinical measures are often used, and a certain precision is essential for digital health interventions to have an effect. Only few studies have compared clinically measured weights with self-reported weights. No study has examined the validity of self-reported weight from a mobile app used in a tailored weight loss intervention. Objective: The aim of this study was to analyze the agreement between clinically measured weight and self-reported weight collected from a mobile health lifestyle coaching program during a 12-month weight loss intervention for obese patients with and without type 2 diabetes. The secondary aim was to investigate the determinants for possible discrepancies between clinically measured and self-reported weights of these patients with different demographic and lifestyle characteristics and achievements of weight loss goals. Methods: Weight registrations were collected from participants (N=104) in a Danish randomized controlled trial examining the effect of a digital lifestyle intervention on weight loss among obese patients with and without type 2 diabetes. Data were collected at baseline and after 6 and 12 months. Self-reported weight was measured at home and registered in the app. Results: Self-reported body weight was lower than the weight measured in the clinic after 6 months by 1.03 kg (95\% CI 1.01-1.05; P<.001) and after 12 months also by 1.03 kg (95\% CI 0.99-1.04; P<.001). After 6 months, baseline weight and BMI were associated with a discrepancy of 0.03 kg (95\% CI 0.01-0.04; P=.01) and 0.09 kg (95\% CI 0.02-0.17; P=.02) per increment of 1 kg and 1 kg/m2, respectively, between clinically measured weight and self-reported weight. Weight change during the first 6 months was also associated with a difference of 0.1 kg (95\% CI 0.04-0.01; P<.001) per kilogram of difference in weight between clinically measured weight and self-reported weight. Participants who did not achieve the 5\% weight loss goal underestimated their weight by 0.79 kg (95\% CI 0.34-1.23) at 6 months. After 12 months, only baseline weight was associated with a discrepancy of 0.03 kg (95\% CI 0.01-0.05; P=.02) per increment of kilogram between clinically measured weight and self-reported weight. None of the other factors showed any significant discrepancy after 12 months. Conclusions: Self-reported weight obtained from mobile health is a valid method for collecting anthropometric measurements. Trial Registration: ClinicalTrials.gov NCT03788915; https://clinicaltrials.gov/ct2/show/NCT03788915 ",
doi="10.2196/40739",
url="https://formative.jmir.org/2022/9/e40739",
url="http://www.ncbi.nlm.nih.gov/pubmed/36047606"
}


@Article{info:doi/10.2196/37445,
author="Chamorro-de-Vega, Esther
and Romero-Jim{\'e}nez, Rosa
and Escudero-Vilaplana, Vicente
and Ais-Larisgoitia, Arantza
and Lobato Matilla, Elena Mar{\'i}a
and Gonz{\'a}lez, M. Carlos
and Mench{\'e}n, Luis
and Baniandr{\'e}s, Ofelia
and Ibares-Frias, Luc{\'i}a
and Lobo-Rodr{\'i}guez, Carmen
and Herranz-Alonso, Ana
and Sanjurjo, Mar{\'i}a",
title="Information and Communication Technologies in Patients With Immune-Mediated Inflammatory Diseases: Cross-sectional Survey",
journal="J Med Internet Res",
year="2022",
month="Sep",
day="13",
volume="24",
number="9",
pages="e37445",
keywords="mHealth",
keywords="app",
keywords="information and communication technologies",
keywords="immune-mediated inflammatory diseases",
keywords="IMID",
keywords="cross-sectional survey",
keywords="survey",
keywords="monitoring",
keywords="clinical support",
keywords="clinicians",
keywords="quality of care",
keywords="patient care",
keywords="mobile app",
keywords="tool",
keywords="management tool",
abstract="Background: Information and communication technologies (ICTs) are changing the traditional health care model and redefining personalized health. ICTs offer effective communication and real-time monitoring of patients and provide additional data to support clinical decision-making, improve the quality of care, and contribute to the empowerment of patients. However, evidence on the use of ICTs and digital preferences of immune-mediated inflammatory disease (IMID) patients is scarce. Objective: The aim of this study is to describe the degree of use of ICTs in patients with IMIDs (including rheumatic diseases, inflammatory bowel diseases, and psoriasis), identify their needs, and analyze their interest in the use of apps as tools for better management of their disease. Methods: A questionnaire was created by a multidisciplinary team including pharmacists, rheumatologists, gastroenterologists, dermatologists, and nurses with experience in ICTs applied to the field of IMID. The survey included 27 questions organized into 3 blocks: (1) sociodemographic characteristics, (2) ICT use for health-related information, and (3) patient expectations about mobile health. Results: A total of 472 questionnaires were analyzed. Overall, 52.9\% (250/472) of patients were diagnosed with a rheumatologic disease, 39.4\% (186/472) with inflammatory bowel disease, and 12.3\% (58/472) with psoriasis. The state of health was considered good by 45.6\% (215/472) of patients. Patients were interested in staying informed about health issues in 86.9\% (410/427) of cases and sought health-related information mainly from the internet (334/472, 70.8\%) and health care professionals (318/472, 67.4\%). Overall, 13.6\% (64/472) did not trust the health information they found in internet. Of the patients, 42.8\% (202/472) had a health app, and 42.2\% (199/472) had found it on their own. Patients would like a health app to help mainly to manage appointments (281/472, 59.5\%), obtain information about their diseases and treatments (274/472, 58.1\%), and get in contact with health professionals (250/472, 53.0\%). Overall, 90.0\% (425/472) of patients reported they would use an app to manage their IMID if their health professional recommended it, and 58.0\% (274/472) would pay or probably be willing to pay for it. Conclusions: IMID patients were very interested in finding health-related information via ICTs, especially using smartphones and apps recommended by health professionals. Appointment management, advice on disease and treatment management, and personalized communication with health professionals were the most desired app features identified. Health professionals should play an essential role in recommending and validating these tools to ensure they are of high quality. ",
doi="10.2196/37445",
url="https://www.jmir.org/2022/9/e37445",
url="http://www.ncbi.nlm.nih.gov/pubmed/36099018"
}


@Article{info:doi/10.2196/33247,
author="Aguiar, Maria
and Trujillo, Maria
and Chaves, Deisy
and {\'A}lvarez, Roberto
and Epelde, Gorka",
title="mHealth Apps Using Behavior Change Techniques to Self-report Data: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Sep",
day="9",
volume="10",
number="9",
pages="e33247",
keywords="mobile health",
keywords="mHealth",
keywords="behavior change techniques",
keywords="adherence",
keywords="app",
keywords="mobile health interventions",
keywords="behavior",
abstract="Background: The popularization of mobile health (mHealth) apps for public health or medical care purposes has transformed human life substantially, improving lifestyle behaviors and chronic condition management. Objective: This review aimed to identify behavior change techniques (BCTs) commonly used in mHealth, assess their effectiveness based on the evidence reported in interventions and reviews to highlight the most appropriate techniques to design an optimal strategy to improve adherence to data reporting, and provide recommendations for future interventions and research. Methods: We performed a systematic review of studies published between 2010 and 2021 in relevant scientific databases to identify and analyze mHealth interventions using BCTs that evaluated their effectiveness in terms of user adherence. Search terms included a mix of general (eg, data, information, and adherence), computer science (eg, mHealth and BCTs), and medicine (eg, personalized medicine) terms. Results: This systematic review included 24 studies and revealed that the most frequently used BCTs in the studies were feedback and monitoring (n=20), goals and planning (n=14), associations (n=14), shaping knowledge (n=12), and personalization (n=7). However, we found mixed effectiveness of the techniques in mHealth outcomes, having more effective than ineffective outcomes in the evaluation of apps implementing techniques from the feedback and monitoring, goals and planning, associations, and personalization categories, but we could not infer causality with the results and suggest that there is still a need to improve the use of these and many common BCTs for better outcomes. Conclusions: Personalization, associations, and goals and planning techniques were the most used BCTs in effective trials regarding adherence to mHealth apps. However, they are not necessarily the most effective since there are studies that use these techniques and do not report significant results in the proposed objectives; there is a notable overlap of BCTs within implemented app components, suggesting a need to better understand best practices for applying (a combination of) such techniques and to obtain details on the specific BCTs used in mHealth interventions. Future research should focus on studies with longer follow-up periods to determine the effectiveness of mHealth interventions on behavior change to overcome the limited evidence in the current literature, which has mostly small-sized and single-arm experiments with a short follow-up period. ",
doi="10.2196/33247",
url="https://mhealth.jmir.org/2022/9/e33247",
url="http://www.ncbi.nlm.nih.gov/pubmed/36083606"
}


@Article{info:doi/10.2196/34471,
author="Obro, Faurholt Louise
and Osther, Sloth Palle J{\"o}rn
and Ammentorp, Jette
and Pihl, Thybo Gitte
and Heiselberg, Kvols Kasper
and Krogh, Gall Peter
and Handberg, Charlotte",
title="An Intervention Offering Self-management Support Through mHealth and Health Coaching to Patients With Prostate Cancer: Interpretive Description of Patients' Experiences and Perspectives",
journal="JMIR Form Res",
year="2022",
month="Sep",
day="8",
volume="6",
number="9",
pages="e34471",
keywords="mobile phone",
keywords="mobile health",
keywords="mHealth",
keywords="prostate cancer",
keywords="self-management",
keywords="health coaching",
keywords="coaching",
abstract="Background: Observational management strategies such as active surveillance and watchful waiting are considered to be acceptable approaches in patients with low-risk localized prostate cancer and a safe alternative to aggressive treatment. During observational management, treatment is postponed until the disease progresses, which often never occurs. However, approximately 90\% of patients with a low-risk disease choose aggressive treatment owing to anxiety. Strategies to address anxiety are needed for optimal management of this population and to improve the quality of life of patients with low-risk localized prostate cancer. A review highlighted that mobile health (mHealth) in tandem with health coaching can support patients' self-management of health behaviors and improve well-being. Objective: This study aims to explore patients' experiences with and perspectives on an intervention offering self-management support through the use of mHealth devices and health coaching to identify supportive features that enable patients to perform sustainable changes that improve well-being. Methods: We used an interpretive description approach, combining semistructured interviews with 13 purposively selected patients with prostate cancer and participant observations of patient-coach interactions in coaching sessions. The interviews were transcribed and analyzed. The self-determination theory was used as a theoretical lens. Field notes and coaching notes from each session were used to orient data generation and confirm or challenge the analysis. Results: Our analysis suggested that patients' self-awareness and psychological identity influenced their experiences with and perspectives on the self-management support offered by mHealth and health coaching in clinical practice. The patients' individual experiences and perspectives indicated that they placed themselves in a dynamic continuum of sustaining or repressing their identity, self-awareness, and individual qualities. Our analysis revealed 4 interacting themes, all related to the psychological identity of the patients. Conclusions: For the group of patients with prostate cancer to experience well-being, we found it important for them to sustain their self-image when offered a self-management intervention. Motivation and autonomy were important aspects for the individual patients to sustain their self-image throughout the intervention. In contrast, demotivation and a sense of paternalism could result in fostering an experience of having to repress self-awareness. ",
doi="10.2196/34471",
url="https://formative.jmir.org/2022/9/e34471",
url="http://www.ncbi.nlm.nih.gov/pubmed/35925751"
}


@Article{info:doi/10.2196/37288,
author="Benton, Madeleine
and Iman, Iklil
and Goldsmith, Kimberley
and Forbes, Angus
and Ching, Mooi Siew
and Papachristou Nadal, Iliatha
and Guess, Nicola
and Murphy, R. Helen
and Mohd Yusof, Barakatun-Nisak
and Baharom, Anisah
and Mahamad Sobri, Hafizah Nur
and Basri, Iftida Nurul
and Salim, Sf Mazatulfazura
and Ismail, Zarina Irmi
and Hassan, Faezah
and Ismail, Khalida
and Chew, How Boon",
title="A Mobile Phone App for the Prevention of Type 2 Diabetes in Malaysian Women With Gestational Diabetes Mellitus: Protocol for a Feasibility Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="Sep",
day="8",
volume="11",
number="9",
pages="e37288",
keywords="gestational diabetes mellitus",
keywords="diabetes prevention",
keywords="randomized controlled trial",
keywords="mobile app",
abstract="Background: Over 50\% of women with a history of gestational diabetes mellitus (GDM) will develop type 2 diabetes (T2D) in later life. Asian women experience a disproportionate risk of both GDM and T2D compared to women from other ethnic backgrounds. Lifestyle interventions and behavior change can delay or even prevent the onset of T2D. We have developed a digitalized diabetes prevention intervention for the prevention of T2D in Malaysian women with GDM. Objective: The protocol describes a randomized controlled trial (RCT) to test the feasibility of undertaking a definitive trial of a diabetes prevention intervention, including a smartphone app and group support. Secondary aims are to summarize anthropometric, biomedical, psychological, and lifestyle outcomes overall and by allocation group, and to undertake a process evaluation. Methods: This is a two-arm parallel feasibility RCT. A total of 60 Malaysian women with GDM will be randomized in the antenatal period to receive the intervention or standard care until 12 months post partum. The intervention is a diabetes prevention intervention delivered via a smartphone app developed based on the Information-Motivation-Behavioral Skills model of behavior change and group support using motivational interviewing. The intervention provides women with tailored information and support to encourage weight loss through adapted dietary intake and physical activity. Women in the control arm will receive standard care. The Malaysian Ministry of Health's Medical Research and Ethics Committee has approved the trial (NMRR-21-1667-60212). Results: Recruitment and enrollment began in February 2022. Future outcomes will be published in peer-reviewed health-related research journals and presented at national, regional, or state professional meetings and conferences. This publication is based on protocol version 2, January 19, 2022. Conclusions: To our knowledge, this will be the first study in Malaysia that aims to determine the feasibility of a digital intervention in T2D prevention among women with GDM. Findings from this feasibility study will inform the design of a full-scale RCT in the future. Trial Registration: ClinicalTrials.gov NCT05204706; https://clinicaltrials.gov/ct2/show/NCT05204706 International Registered Report Identifier (IRRID): PRR1-10.2196/37288 ",
doi="10.2196/37288",
url="https://www.researchprotocols.org/2022/9/e37288",
url="http://www.ncbi.nlm.nih.gov/pubmed/36074545"
}


@Article{info:doi/10.2196/37343,
author="Buss, Helen Vera
and Varnfield, Marlien
and Harris, Mark
and Barr, Margo",
title="Mobile Health Use by Older Individuals at Risk of Cardiovascular Disease and Type 2 Diabetes Mellitus in an Australian Cohort: Cross-sectional Survey Study",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Sep",
day="7",
volume="10",
number="9",
pages="e37343",
keywords="cardiovascular diseases",
keywords="diabetes mellitus type 2",
keywords="cohort studies",
keywords="telemedicine",
keywords="mobile applications",
keywords="mHealth",
keywords="mobile health",
keywords="mobile app",
keywords="aging",
keywords="digital health",
keywords="cardiovascular",
keywords="diabetes",
abstract="Background: The digital transformation has the potential to change health care toward more consumers' involvement, for example, in the form of health-related apps which are already widely available through app stores. These could be useful in helping people understand their risk of chronic conditions and helping them to live more healthily. Objective: With this study, we assessed mobile health app use among older Australians in general and among those who were at risk of cardiovascular disease or type 2 diabetes mellitus. Methods: In this cross-sectional analysis, we used data from the second follow-up wave of the 45 and Up Study. It is a cohort study from New South Wales, Australia, with 267,153 participants aged 45 years and older that is based on a random sample from the Services Australia (formerly the Australian Government Department of Human Services) Medicare enrollment database. The 2019 follow-up questionnaire contained questions about technology and mobile health use. We further used data on prescribed drugs and hospitalizations to identify participants who already had cardiovascular disease or diabetes or who were at risk of these conditions. Our primary outcome measure was mobile health use, defined as having used a mobile health app before. We used descriptive statistics and multivariate logistic regression to answer the research questions. Results: Overall, 31,946 individuals with a median age of 69 (IQR 63-76) years had completed the follow-up questionnaire in 2019. We classified half (16,422/31,946, 51.41\%) of these as being at risk of cardiovascular disease or type 2 diabetes mellitus and 38.04\% (12,152/31,946) as having cardiovascular disease or type 1 or type 2 diabetes mellitus. The proportion of mobile health app users among the at-risk group was 31.46\% (5166/16,422) compared to 29.16\% (9314/31,946) in the total sample. Those who used mobile health apps were more likely to be female, younger, without physical disability, and with a higher income. People at risk of cardiovascular disease or type 2 diabetes mellitus were not statistically significantly more likely to use mobile health than were people without risk (odds ratio 1.06, 95\% CI 0.97-1.16; P=.18; adjusted for age, sex, income, and physical disability). Conclusions: People at risk of cardiovascular disease or type 2 diabetes mellitus were not more likely to use mobile health apps than were people without risk. Those who used mobile health apps were less likely to be male, older, with a physical disability, and with a lower income. From the results, we concluded that aspects of equity must be considered when implementing a mobile health intervention to reach all those that can potentially benefit from it. ",
doi="10.2196/37343",
url="https://mhealth.jmir.org/2022/9/e37343",
url="http://www.ncbi.nlm.nih.gov/pubmed/36069764"
}


@Article{info:doi/10.2196/36337,
author="Hodkinson, Alexander
and Kontopantelis, Evangelos
and Zghebi, S. Salwa
and Grigoroglou, Christos
and McMillan, Brian
and Marwijk, van Harm
and Bower, Peter
and Tsimpida, Dialechti
and Emery, F. Charles
and Burge, R. Mark
and Esmiol, Hunter
and Cupples, E. Margaret
and Tully, A. Mark
and Dasgupta, Kaberi
and Daskalopoulou, S. Stella
and Cooke, B. Alexandra
and Fayehun, F. Ayorinde
and Houle, Julie
and Poirier, Paul
and Yates, Thomas
and Henson, Joseph
and Anderson, R. Derek
and Grey, B. Elisabeth
and Panagioti, Maria",
title="Association Between Patient Factors and the Effectiveness of Wearable Trackers at Increasing the Number of Steps per Day Among Adults With Cardiometabolic Conditions: Meta-analysis of Individual Patient Data From Randomized Controlled Trials",
journal="J Med Internet Res",
year="2022",
month="Aug",
day="30",
volume="24",
number="8",
pages="e36337",
keywords="systematic review",
keywords="individual patient data",
keywords="meta-analysis",
keywords="steps/day",
keywords="wearable tracker",
keywords="cardiometabolic conditions",
keywords="diabetes",
keywords="obesity",
keywords="cardiovascular disease",
abstract="Background: Current evidence supports the use of wearable trackers by people with cardiometabolic conditions. However, as the health benefits are small and confounded by heterogeneity, there remains uncertainty as to which patient groups are most helped by wearable trackers. Objective: This study examined the effects of wearable trackers in patients with cardiometabolic conditions to identify subgroups of patients who most benefited and to understand interventional differences. Methods: We obtained individual participant data from randomized controlled trials of wearable trackers that were conducted before December 2020 and measured steps per day as the primary outcome in participants with cardiometabolic conditions including diabetes, overweight or obesity, and cardiovascular disease. We used statistical models to account for clustering of participants within trials and heterogeneity across trials to estimate mean differences with the 95\% CI. Results: Individual participant data were obtained from 9 of 25 eligible randomized controlled trials, which included 1481 of 3178 (47\%) total participants. The wearable trackers revealed that over the median duration of 12 weeks, steps per day increased by 1656 (95\% CI 918-2395), a significant change. Greater increases in steps per day from interventions using wearable trackers were observed in men (interaction coefficient --668, 95\% CI --1157 to --180), patients in age categories over 50 years (50-59 years: interaction coefficient 1175, 95\% CI 377-1973; 60-69 years: interaction coefficient 981, 95\% CI 222-1740; 70-90 years: interaction coefficient 1060, 95\% CI 200-1920), White patients (interaction coefficient 995, 95\% CI 360-1631), and patients with fewer comorbidities (interaction coefficient --517, 95\% CI --1188 to --11) compared to women, those aged below 50, non-White patients, and patients with multimorbidity. In terms of interventional differences, only face-to-face delivery of the tracker impacted the effectiveness of the interventions by increasing steps per day. Conclusions: In patients with cardiometabolic conditions, interventions using wearable trackers to improve steps per day mostly benefited older White men without multimorbidity. Trial Registration: PROSPERO CRD42019143012; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=143012 ",
doi="10.2196/36337",
url="https://www.jmir.org/2022/8/e36337",
url="http://www.ncbi.nlm.nih.gov/pubmed/36040779"
}


@Article{info:doi/10.2196/39682,
author="Rintala, Aki
and Rantalainen, Roy
and Kaksonen, Anu
and Luomajoki, Hannu
and Kauranen, Kari",
title="mHealth Apps for Low Back Pain Self-management: Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Aug",
day="26",
volume="10",
number="8",
pages="e39682",
keywords="low back pain",
keywords="mobile health",
keywords="mHealth",
keywords="app",
keywords="disability",
keywords="self-management",
keywords="mobile phone",
abstract="Background: The role of self-management in health promotion, as well as prevention and rehabilitation, is increasing through the use of mobile health (mHealth) apps. Such mHealth apps are also increasingly being used for self-management of low back pain (LBP), but their effectiveness has not been sufficiently explored. Objective: The aim of this scoping review was to provide an overview of the literature on self-management mHealth apps and their effects on the levels of pain and disability in people with LBP. Methods: We applied the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) methodology, including a priori research questions. A literature search was conducted in 2 databases (PubMed and PEDro) for studies published between January 1, 2015, and June 17, 2021. Interventional, cohort, or case series studies with an interventional period were included if the mHealth app included built-in self-management content, the app was used for self-management for people with LBP, and the study reported outcomes regarding pain and disability in people with LBP. Results: In total, 7 studies were selected for the review with overall 2307 persons with LBP, of whom 1328 (57.56\%) were women. Among the studies (5/7, 71\%) that reported the type of pain, 85\% (390/459) of the participants were experiencing chronic LBP. A total of 5 different mHealth apps were identified, of which 4 contributed to a statistically significant reduction in LBP and clinically meaningful changes. Of the 7 studies, 4 (57\%) used 4 different assessments for disability, of which 3 (75\%) showed statistically significant improvements in the level of functional ability of participants in the experimental groups using an mHealth app with built-in self-management content for LBP. Conclusions: This scoping review supports the conclusion that people with LBP may benefit from mHealth apps that provide self-management content. However, the generalizability of the findings is limited because of heterogeneity in the pain characterization of the included participants and the intervention durations. More high-quality studies with longer follow-up periods to investigate personalized mHealth approaches are recommended for LBP self-management. ",
doi="10.2196/39682",
url="https://mhealth.jmir.org/2022/8/e39682",
url="http://www.ncbi.nlm.nih.gov/pubmed/36018713"
}


@Article{info:doi/10.2196/33772,
author="Van Baelen, Freek
and De Regge, Melissa
and Larivi{\`e}re, Bart
and Verleye, Katrien
and Schelfout, Sam
and Eeckloo, Kristof",
title="Role of Social and App-Related Factors in Behavioral Engagement With mHealth for Improved Well-being Among Chronically Ill Patients: Scenario-Based Survey Study",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Aug",
day="26",
volume="10",
number="8",
pages="e33772",
keywords="mHealth app",
keywords="engagement",
keywords="social influence",
keywords="app integration",
keywords="well-being",
keywords="Belgium",
keywords="mHealth",
keywords="behavioral",
keywords="behavioral engagement",
keywords="mobile health",
keywords="mobile health apps",
keywords="mobile phone",
abstract="Background: The last decade has seen a considerable increase in the number of mobile health (mHealth) apps in everyday life. These mHealth apps have the potential to significantly improve the well-being of chronically ill patients. However, behavioral engagement with mHealth apps remains low. Objective: The aim of this study was to describe the behavioral engagement of chronically ill patients with mHealth apps by investigating (1) how it is affected by social factors (ie, physician recommendation) and app-related factors (ie, app integration) and (2) how it affects patient well-being. This study also considers the moderating effect of attachment to traditional health care and the mobile app experience among patients. Methods: We carried out a scenario-based survey study of chronically ill patients (N=521). A Bayesian structural equation modeling with mediation and moderation analysis was conducted in MPlus. Results: Both physician recommendations for mHealth app use and app integration have positive effects on the behavioral engagement of chronically ill patients with mHealth apps. Higher behavioral engagement positively affects the hedonic well-being (extent of pleasure) and the eudaemonic well-being (extent of self-efficacy) of chronically ill patients. Mobile app experience, however, positively moderates the relationship between app integration and behavioral engagement, whereas patient attachment to traditional care does not moderate the relationship between physician recommendation and behavioral engagement. Taken together, the proportion of variance explained (R{\texttwosuperior}) equals 21\% for behavioral engagement and 52.8\% and 62.2\% for hedonic and eudaemonic well-being, respectively, thereby providing support for the strong influence of app integration and physician recommendation via the mediation of the patients' behavioral engagement on both patients' hedonic and eudaemonic well-being. Conclusions: Physician recommendation and app integration enable behavioral engagement and promote well-being among chronically ill patients. It is thus important to take social and app-related factors into consideration during and after the development of mHealth apps. ",
doi="10.2196/33772",
url="https://mhealth.jmir.org/2022/8/e33772",
url="http://www.ncbi.nlm.nih.gov/pubmed/36018618"
}


@Article{info:doi/10.2196/34786,
author="Breckner, Amanda
and Litke, Nicola
and G{\"o}bl, Linda
and Wiezorreck, Lars
and Miksch, Antje
and Szecsenyi, Joachim
and Wensing, Michel
and Weis, Aline",
title="Effects and Processes of an mHealth Intervention for the Management of Chronic Diseases: Prospective Observational Study",
journal="JMIR Form Res",
year="2022",
month="Aug",
day="25",
volume="6",
number="8",
pages="e34786",
keywords="telemedicine",
keywords="multimorbidity",
keywords="primary health care",
keywords="symptom assessment",
keywords="chronic disease",
keywords="mobile phone",
abstract="Background: Mobile health (mHealth) interventions for self-management are a promising way to meet the needs of patients with chronic diseases in primary care practices. Therefore, an mHealth intervention, TelePraCMan, was developed and evaluated for patients with type 2 diabetes mellitus, chronic obstructive pulmonary disease, high blood pressure, or heart failure in a German primary care setting. TelePraCMan entails a symptom diary, an appointment manager, a manager to document goals, and a warning system. The app should foster the self-management of participating patients. Objective: We aimed to examine the effects of TelePraCMan on patient activation and quality of life and explored the underlying contextual factors, impacts, and degree of implementation. Methods: In a prospective observational study design, we collected data by using interviews and written questionnaires from participating patients (intervention and control groups) and primary care workers (physicians and practice assistants). The primary outcomes of interest were patient-reported quality of life (12-Item Short Form Survey) and patient activation (patient activation measure). The quantitative analysis focused on differences between patients in the intervention and control groups, as well as before (T0) and after (T1) the intervention. Interviews were analyzed by using qualitative content analysis via MAXQDA (VERBI GmbH). Results: At baseline, 25 patients and 24 primary care workers completed the questionnaire, and 18 patients and 21 primary care workers completed the follow-up survey. The patients were predominantly male and, on average, aged 64 (SD 11) years (T0). The primary care workers were mostly female (62\%) and, on average, aged 47 (SD 10) years (T0). No differences were observed in the outcomes before and after the intervention or between the intervention and control groups. In the additional interviews, 4 patients and 11 primary care workers were included. The interviewees perceived that the intervention was useful for some patients. However, contextual factors and problems with implementation activities negatively affected the use of the app with patients. The main reasons for the low participation were the COVID-19 pandemic and the target group, which seemed to have less interest in mHealth; the interviewees attributed this to the older age of patients. However, the respondents felt that the app would be better accepted in 5 or 10 years. Conclusions: Although the TelePraCMan app was rated as very good and important by the participants, few patients used it. The digital intervention was hardly implemented and had limited impact in the current setting of German primary care. Trial Registration: German Clinical Trials Register DRKS00017320; https://tinyurl.com/4uwrzu85 ",
doi="10.2196/34786",
url="https://formative.jmir.org/2022/8/e34786",
url="http://www.ncbi.nlm.nih.gov/pubmed/36006666"
}


@Article{info:doi/10.2196/36741,
author="Reamer, Courtney
and Chi, Ning Wei
and Gordon, Robert
and Sarswat, Nitasha
and Gupta, Charu
and Gaznabi, Safwan
and White VanGompel, Emily
and Szum, Izabella
and Morton-Jost, Melissa
and Vaughn, Jorma
and Larimer, Karen
and Victorson, David
and Erwin, John
and Halasyamani, Lakshmi
and Solomonides, Anthony
and Padman, Rema
and Shah, S. Nirav",
title="Continuous Remote Patient Monitoring in Patients With Heart Failure (Cascade Study): Protocol for a Mixed Methods Feasibility Study",
journal="JMIR Res Protoc",
year="2022",
month="Aug",
day="25",
volume="11",
number="8",
pages="e36741",
keywords="continuous remote patient monitoring",
keywords="remote patient monitoring",
keywords="feasibility",
keywords="heart failure",
keywords="wearable biosensor",
keywords="preliminary efficacy",
keywords="mobile phone",
abstract="Background: Heart failure (HF) is a prevalent chronic disease and is associated with increases in mortality and morbidity. HF is a leading cause of hospitalizations and readmissions in the United States. A potentially promising area for preventing HF readmissions is continuous remote patient monitoring (CRPM). Objective: The primary aim of this study is to determine the feasibility and preliminary efficacy of a CRPM solution in patients with HF at NorthShore University HealthSystem. Methods: This study is a feasibility study and uses a wearable biosensor to continuously remotely monitor patients with HF for 30 days after discharge. Eligible patients admitted with an HF exacerbation at NorthShore University HealthSystem are being recruited, and the wearable biosensor is placed before discharge. The biosensor collects physiological ambulatory data, which are analyzed for signs of patient deterioration. Participants are also completing a daily survey through a dedicated study smartphone. If prespecified criteria from the physiological data and survey results are met, a notification is triggered, and a predetermined electronic health record--based pathway of telephonic management is completed. In phase 1, which has already been completed, 5 patients were enrolled and monitored for 30 days after discharge. The results of phase 1 were analyzed, and modifications to the program were made to optimize it. After analysis of the phase 1 results, 15 patients are being enrolled for phase 2, which is a calibration and testing period to enable further adjustments to be made. After phase 2, we will enroll 45 patients for phase 3. The combined results of phases 1, 2, and 3 will be analyzed to determine the feasibility of a CRPM program in patients with HF. Semistructured interviews are being conducted with key stakeholders, including patients, and these results will be analyzed using the affective adaptation of the technology acceptance model. Results: During phase 1, of the 5 patients, 2 (40\%) were readmitted during the study period. The study completion rate for phase 1 was 80\% (4/5), and the study attrition rate was 20\% (1/5). There were 57 protocol deviations out of 150 patient days in phase 1 of the study. The results of phase 1 were analyzed, and the study protocol was adjusted to optimize it for phases 2 and 3. Phase 2 and phase 3 results will be available by the end of 2022. Conclusions: A CRPM program may offer a low-risk solution to improve care of patients with HF after hospital discharge and may help to decrease readmission of patients with HF to the hospital. This protocol may also lay the groundwork for the use of CRPM solutions in other groups of patients considered to be at high risk. International Registered Report Identifier (IRRID): DERR1-10.2196/36741 ",
doi="10.2196/36741",
url="https://www.researchprotocols.org/2022/8/e36741",
url="http://www.ncbi.nlm.nih.gov/pubmed/36006689"
}


@Article{info:doi/10.2196/36972,
author="Cakmak, S. Ayse
and Perez Alday, A. Erick
and Densen, Samuel
and Najarro, Gabriel
and Rout, Pratik
and Rozell, J. Christopher
and Inan, T. Omer
and Shah, J. Amit
and Clifford, D. Gari",
title="Passively Captured Interpersonal Social Interactions and Motion From Smartphones for Predicting Decompensation in Heart Failure: Observational Cohort Study",
journal="JMIR Form Res",
year="2022",
month="Aug",
day="24",
volume="6",
number="8",
pages="e36972",
keywords="heart failure",
keywords="mobile device",
keywords="social interaction",
keywords="heart disease",
keywords="mobile health",
keywords="hospitalization",
abstract="Background: Heart failure (HF) is a major cause of frequent hospitalization and death. Early detection of HF symptoms using smartphone-based monitoring may reduce adverse events in a low-cost, scalable way. Objective: We examined the relationship of HF decompensation events with smartphone-based features derived from passively and actively acquired data. Methods: This was a prospective cohort study in which we monitored HF participants' social and movement activities using a smartphone app and followed them for clinical events via phone and chart review and classified the encounters as compensated or decompensated by reviewing the provider notes in detail. We extracted motion, location, and social interaction passive features and self-reported quality of life weekly (active) with the short Kansas City Cardiomyopathy Questionnaire (KCCQ-12) survey. We developed and validated an algorithm for classifying decompensated versus compensated clinical encounters (hospitalizations or clinic visits). We evaluated models based on single modality as well as early and late fusion approaches combining patient-reported outcomes and passive smartphone data. We used Shapley additive explanation values to quantify the contribution and impact of each feature to the model. Results: We evaluated 28 participants with a mean age of 67 years (SD 8), among whom 11\% (3/28) were female and 46\% (13/28) were Black. We identified 62 compensated and 48 decompensated clinical events from 24 and 22 participants, respectively. The highest area under the precision-recall curve (AUCPr) for classifying decompensation was with a late fusion approach combining KCCQ-12, motion, and social contact features using leave-one-subject-out cross-validation for a 2-day prediction window. It had an AUCPr of 0.80, with an area under the receiver operator curve (AUC) of 0.83, a positive predictive value (PPV) of 0.73, a sensitivity of 0.77, and a specificity of 0.88 for a 2-day prediction window. Similarly, the 4-day window model had an AUC of 0.82, an AUCPr of 0.69, a PPV of 0.62, a sensitivity of 0.68, and a specificity of 0.87. Passive social data provided some of the most informative features, with fewer calls of longer duration associating with a higher probability of future HF decompensation. Conclusions: Smartphone-based data that includes both passive monitoring and actively collected surveys may provide important behavioral and functional health information on HF status in advance of clinical visits. This proof-of-concept study, although small, offers important insight into the social and behavioral determinants of health and the feasibility of using smartphone-based monitoring in this population. Our strong results are comparable to those of more active and expensive monitoring approaches, and underscore the need for larger studies to understand the clinical significance of this monitoring method. ",
doi="10.2196/36972",
url="https://formative.jmir.org/2022/8/e36972",
url="http://www.ncbi.nlm.nih.gov/pubmed/36001367"
}


@Article{info:doi/10.2196/38475,
author="Akasaki, Yasutsugu
and Inomata, Takenori
and Sung, Jaemyoung
and Okumura, Yuichi
and Fujio, Kenta
and Miura, Maria
and Hirosawa, Kunihiko
and Iwagami, Masao
and Nakamura, Masahiro
and Ebihara, Nobuyuki
and Ide, Takuma
and Nagino, Ken
and Murakami, Akira",
title="Reliability and Validity of Electronic Patient-Reported Outcomes Using the Smartphone App AllerSearch for Hay Fever: Prospective Observational Study",
journal="JMIR Form Res",
year="2022",
month="Aug",
day="23",
volume="6",
number="8",
pages="e38475",
keywords="hay fever",
keywords="AllerSearch",
keywords="smartphone app",
keywords="mobile health",
keywords="mHealth",
keywords="patient-reported outcome",
keywords="reliability",
keywords="validity",
keywords="Japanese Allergic Conjunctival Disease Standard Quality of Life Questionnaire",
keywords="JACQLQ",
keywords="questionnaire",
keywords="allergic conjunctivitis",
abstract="Background: Hay fever is a highly prevalent, heterogenous, and multifactorial disease. Patients may benefit from longitudinal assessments using mobile health (mHealth) principles. We have previously attempted to establish an effective mHealth platform for patients with hay fever through AllerSearch, our in-house smartphone app that assesses electronic patient-reported outcomes through a questionnaire on hay fever and provides evidence-based advice. To be used by the public, an investigation on its reliability and validity is necessary. Objective: The aim of this paper is to assess the reliability and validity of subjective symptom data on hay fever collected through our app, AllerSearch. Methods: This study used a prospective observational design. The participants were patients aged ?20 years recruited from a single university hospital between June 2, 2021, and January 26, 2022. We excluded patients who could not use smartphones as well as those with incomplete data records and outlier data. All participants answered the Japanese Allergic Conjunctival Disease Standard Quality of Life Questionnaire (JACQLQ), first in the paper-and-pencil format and subsequently on AllerSearch on the same day. The JACQLQ comprises the following three domains: Domain I, with 9 items on ocular or nasal symptoms; Domain II, with 17 items on daily activity and psychological well-being; and Domain III, with 3 items on overall condition by face score. The concordance rate of each domain between the 2 platforms was calculated. The internal consistency of Domains I and II of the 2 platforms was assessed using Cronbach alpha coefficients, the concurrent validity of Domains I and II was assessed by calculating Pearson correlation coefficients, and the mean differences between the 2 platforms were assessed using Bland-Altman analysis. Results: In total, 22 participants were recruited; the data of 20 (91\%) participants were analyzed. The average age was 65.4 (SD 12.8) years, and 80\% (16/20) of the participants were women. The concordance rate of Domains I, II, and III between the paper-based and app-based JACQLQ was 0.78, 0.85, and 0.90, respectively. The internal consistency of Domains I and II between the 2 platforms was satisfactory (Cronbach alpha of .964 and .919, respectively). Pearson correlation analysis yielded a significant positive correlation between Domains I and II across the 2 platforms (r=0.920 and r=0.968, respectively). The mean difference in Domains I and II between the 2 platforms was 3.35 units (95\% limits of agreement: --6.51 to 13.2). Conclusions: Our findings indicate that AllerSearch is a valid and reliable tool for the collection of electronic patient-reported outcomes to assess hay fever, contributing to the advantages of the mHealth platform. ",
doi="10.2196/38475",
url="https://formative.jmir.org/2022/8/e38475",
url="http://www.ncbi.nlm.nih.gov/pubmed/35998022"
}


@Article{info:doi/10.2196/35657,
author="Madujibeya, Ifeanyi
and Lennie, Terry
and Aroh, Adaeze
and Chung, L. Misook
and Moser, Debra",
title="Measures of Engagement With mHealth Interventions in Patients With Heart Failure: Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Aug",
day="22",
volume="10",
number="8",
pages="e35657",
keywords="heart failure",
keywords="mobile health interventions",
keywords="mHealth interventions",
keywords="patient engagement",
keywords="system usage data",
keywords="heart failure outcomes",
keywords="mobile phone",
abstract="Background: Despite the potential of mobile health (mHealth) interventions to facilitate the early detection of signs of heart failure (HF) decompensation and provide personalized management of symptoms, the outcomes of such interventions in patients with HF have been inconsistent. As engagement with mHealth is required for interventions to be effective, poor patient engagement with mHealth interventions may be associated with mixed evidence. It is crucial to understand how engagement with mHealth interventions is measured in patients with HF, and the effects of engagement on HF outcomes. Objective: In this review, we aimed to describe measures of patient engagement with mHealth interventions and the effects of engagement on HF outcomes. Methods: We conducted a systematic literature search in 7 databases for relevant studies published in the English language from 2009 to September 2021 and reported the descriptive characteristics of the studies. We used content analysis to identify themes that described patient engagement with mHealth interventions in the qualitative studies included in the review. Results: We synthesized 32 studies that operationalized engagement with mHealth interventions in 4771 patients with HF (3239/4771, 67.88\%, male), ranging from a sample of 7 to 1571 (median 53.3) patients, followed for a median duration of 90 (IQR 45-180) days. Patient engagement with mHealth interventions was measured only quantitatively based on system usage data in 72\% (23/32) of the studies, only qualitatively based on data from semistructured interviews and focus groups in 6\% (2/32) of studies, and by a combination of both quantitative and qualitative data in 22\% (7/32) of studies. System usage data were evaluated using 6 metrics of engagement: number of physiological parameters transmitted (19/30, 63\% studies), number of HF questionnaires completed (2/30, 7\% studies), number of log-ins (4/30, 13\% studies), number of SMS text message responses (1/30, 3\% studies), time spent (5/30, 17\% studies), and the number of features accessed and screen viewed (4/30, 13\% studies). There was a lack of consistency in how the system usage metrics were reported across studies. In total, 80\% of the studies reported only descriptive characteristics of system usage data. The emotional, cognitive, and behavioral domains of patient engagement were identified through qualitative studies. Patient engagement levels ranged from 45\% to 100\% and decreased over time. The effects of engagement on HF knowledge, self-care, exercise adherence, and HF hospitalization were inconclusive. Conclusions: The measures of patient engagement with mHealth interventions in patients with HF are underreported and lack consistency. The application of inferential analytical methods to engagement data is extremely limited. There is a need for a working group on mHealth that may consolidate the previous operational definitions of patient engagement into an optimal and standardized measure. ",
doi="10.2196/35657",
url="https://mhealth.jmir.org/2022/8/e35657",
url="http://www.ncbi.nlm.nih.gov/pubmed/35994345"
}


@Article{info:doi/10.2196/34734,
author="Soulard, Julie
and Carlin, Thomas
and Knitza, Johannes
and Vuillerme, Nicolas",
title="Wearables for Measuring the Physical Activity and Sedentary Behavior of Patients With Axial Spondyloarthritis: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Aug",
day="22",
volume="10",
number="8",
pages="e34734",
keywords="axial spondyloarthritis",
keywords="rheumatology",
keywords="physical activity",
keywords="sedentary behavior",
keywords="objective measures",
keywords="wearable",
keywords="mobile health",
keywords="mHealth",
keywords="eHealth",
keywords="systematic review",
keywords="mobile phone",
abstract="Background: Axial spondyloarthritis (axSpA) is an inflammatory rheumatic disease associated with chronic back pain and restricted mobility and physical function. Increasing physical activity is a viable strategy for improving the health and quality of life of patients with axSpA. Thus, quantifying physical activity and sedentary behavior in this population is relevant to clinical outcomes and disease management. However, to the best of our knowledge, no systematic review to date has identified and synthesized the available evidence on the use of wearable devices to objectively measure the physical activity or sedentary behavior of patients with axSpA. Objective: This study aimed to review the literature on the use of wearable activity trackers as outcome measures for physical activity and sedentary behavior in patients with axSpA. Methods: PubMed, PEDro, and Cochrane electronic databases were searched in July 2021 for relevant original articles, with no limits on publication dates. Studies were included if they were original articles, targeted adults with a diagnosis of axSpA, and reported wearable device--measured physical activity or sedentary behavior among patients with axSpA. Data regarding the study's characteristics, the sample description, the methods used for measuring physical activity and sedentary behavior (eg, wearable devices, assessment methods, and outcomes), and the main results of the physical activity and sedentary behavior assessments were extracted. Results: A total of 31 studies were initially identified; 13 (13/31, 42\%) met the inclusion criteria, including 819 patients with axSpA. All the studies used accelerometer-based wearable devices to assess physical activity. Of the 13 studies, 4 (4/31, 31\%) studies also reported outcomes related to sedentary behavior. Wearable devices were secured on the wrists (3/13 studies, 23\%), lower back (3/13, 23\%), right hip (3/13, 23\%), waist (2/13, 15\%), anterior thigh (1/13, 8\%), or right arm (1/13, 8\%). The methods for reporting physical activity and sedentary behavior were heterogeneous. Approximately 77\% (10/13) of studies had a monitoring period of 1 week, including weekend days. Conclusions: To date, few studies have used wearable devices to quantify the physical activity and sedentary behavior of patients with axSpA. The methodologies and results were heterogeneous, and none of these studies assessed the psychometric properties of these wearables in this specific population. Further investigation in this direction is needed before using wearable device--measured physical activity and sedentary behavior as outcome measures in intervention studies in patients with axSpA. Trial Registration: PROSPERO CRD42020182398; https://tinyurl.com/ec22jzkt International Registered Report Identifier (IRRID): RR2-10.2196/23359 ",
doi="10.2196/34734",
url="https://mhealth.jmir.org/2022/8/e34734",
url="http://www.ncbi.nlm.nih.gov/pubmed/35994315"
}


@Article{info:doi/10.2196/39520,
author="Ajayi, V. Kobi
and Wachira, Elizabeth
and Onyeaka, K. Henry
and Montour, Tyra
and Olowolaju, Samson
and Garney, Whitney",
title="The Use of Digital Health Tools for Health Promotion Among Women With and Without Chronic Diseases: Insights From the 2017-2020 Health Information National Trends Survey",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Aug",
day="19",
volume="10",
number="8",
pages="e39520",
keywords="mHealth",
keywords="health promotion",
keywords="chronic disease",
keywords="women",
keywords="digital health",
keywords="USA",
keywords="United States",
keywords="patient engagement",
abstract="Background: In the United States, almost 90\% of women are at risk of at least one chronic condition. However, the awareness, management, and monitoring of these conditions are low and present a substantial public health problem. Digital health tools can be leveraged to reduce the alarmingly high rates of chronic condition--related mortality and morbidity in women. Objective: This study aimed to investigate the 4-year trend of digital health use for health promotion among women with chronic conditions in the United States. Methods: Data for this study were obtained from the 2017 to 2020 iterations of the Health Information Trends Survey 5. Separate weighted logistic regression models were conducted to test the unadjusted and adjusted association of the study variables and each digital health use. The 95\% CI, adjusted odds ratio (aOR), and P value (.05) were reported. Analysis was conducted using Stata 17 software. Results: In total, 8573 women were included in this study. The weighted prevalence of the use of a smartphone or tablet for various activities were as follows: track health goals, 50.3\% (95\% CI 48.4\%-52.2\%; 3279/7122); make a health decision, 43.6\% (95\% CI 41.9\%-45.3\%; 2998/7101); and discuss with a provider, 40\% (95\% CI 38.2\%-41.8\%; 2834/7099). In the preceding 12 months, 33\% (95\% CI 30.9\%-35.2\%; 1395/4826) of women used an electronic wearable device, 18.7\% (95\% CI 17.3\%-20.2\%; 1532/7653) shared health information, and 35.2\% (95\% CI 33.2\%-37.3\%; 2262/6349) sent or received an SMS text message with a health professional. Between 2017 and 2020, the weighted prevalence of having 0, 1, and multiple chronic conditions were 37.4\% (2718/8564), 33.4\% (2776/8564), and 29.3\% (3070/8564), respectively. However, slightly above half (52.2\%, 95\% CI 0.50\%-0.53\%; 4756/8564) of US women reported having at least one chronic disease. Women with multiple chronic conditions had higher odds of using their tablet or smartphone to achieve a health-related goal (aOR 1.43, 95\% CI 1.16-1.77; P=.001) and discuss with their provider (aOR 1.55 95\% CI 1.20-2.00; P=.001) than those without any chronic conditions. Correspondingly, in the past 12 months, the odds of using an electronic wearable device (aOR 1.40, 95\% CI 1.00-1.96; P=.04), sharing health information (aOR 1.91, 95\% CI 1.46-2.51; P<.001), and communicating via SMS text messaging with a provider (aOR 1.31, 95\% CI 1.02-1.68; P=.03) were significantly higher among women with chronic conditions than those without a chronic condition. Conclusions: This study suggests that women with chronic conditions accept and integrate digital health tools to manage their care. However, certain subpopulations experience a digital disconnect that may exacerbate existing health inequities. Implications for research and opportunities to leverage and integrate digital health tools to prevent, monitor, manage, and treat chronic conditions in women are discussed. ",
doi="10.2196/39520",
url="https://mhealth.jmir.org/2022/8/e39520",
url="http://www.ncbi.nlm.nih.gov/pubmed/35984680"
}


@Article{info:doi/10.2196/26237,
author="Goldthorpe, Joanna
and Allen, Thomas
and Brooks, Joanna
and Kontopantelis, Evangelos
and Holland, Fiona
and Moss, Charlie
and Wake, J. Deborah
and Brodie, Doogie
and Cunningham, G. Scott
and Kanumilli, Naresh
and Bishop, Hannah
and Jones, Ewan
and Milne, Nicola
and Ball, Steve
and Jenkins, Mark
and Nicinska, Bogna
and Ratto, Martina
and Morgan-Curran, Michael
and Johnson, Gemma
and Rutter, K. Martin",
title="Digital Interventions Supporting Self-care in People With Type 2 Diabetes Across Greater Manchester (Greater Manchester Diabetes My Way): Protocol for a Mixed Methods Evaluation",
journal="JMIR Res Protoc",
year="2022",
month="Aug",
day="17",
volume="11",
number="8",
pages="e26237",
keywords="diabetes",
keywords="electronic health",
keywords="self-management",
keywords="complex intervention",
abstract="Background: Type 2 Diabetes (T2D) is common, with a prevalence of approximately 7\% of the population in the United Kingdom. The quality of T2D care is inconsistent across the United Kingdom, and Greater Manchester (GM) does not currently achieve the National Institute for Health and Care Excellence treatment targets. Barriers to delivery of care include low attendance and poor engagement with local T2D interventions, which tend to consist of programs of education delivered in traditional, face-to-face clinical settings. Thus, a flexible approach to T2D management that is accessible to people from different backgrounds and communities is needed. Diabetes My Way (DMW) is a digital platform that offers a comprehensive self-management and educational program that should be accessible to a wide range of people through mobile apps and websites. Building on evidence generated by a Scotland-wide pilot study, DMW is being rolled out and tested across GM. Objective: The overarching objectives are to assess whether DMW improves outcomes for patients with T2D in the GM area, to explore the acceptability of the DMW intervention to stakeholders, and to assess the cost-effectiveness of the intervention. Methods: A mixed methods approach will be used. We will take a census approach to recruitment in that all eligible participants in GM will be invited to participate. The primary outcomes will be intervention-related changes compared with changes observed in a matched group of controls, and the secondary outcomes will be within-person intervention-related changes. The cost-effectiveness analysis will focus on obtaining reliable estimates of how each intervention affects risk factors such as HbA1c and costs across population groups. Qualitative data will be collected via semistructured interviews and focus groups and organized using template analysis. Results: As of May 10, 2021, a total of 316 participants have been recruited for the quantitative study and have successfully enrolled. A total of 278 participants attempted to register but did not have appropriate permissions set by the general practitioners to gain access to their data. In total, 10 participants have been recruited for the qualitative study (7 practitioners and 3 patients). An extension to recruitment has been granted for the quantitative element of the research, and analysis should be complete by December 2022. Recruitment and analysis for the qualitative study should be complete by December 2021. Conclusions: The findings from this study can be used both to develop the DMW system and improve accessibility and usability in more deprived populations generally, thus improving equity in access to support for T2D self-management. International Registered Report Identifier (IRRID): DERR1-10.2196/26237 ",
doi="10.2196/26237",
url="https://www.researchprotocols.org/2022/8/e26237",
url="http://www.ncbi.nlm.nih.gov/pubmed/35976184"
}


@Article{info:doi/10.2196/34737,
author="Harakeh, Zeena
and Van Keulen, Hilde
and Hogenelst, Koen
and Otten, Wilma
and De Hoogh, M. Iris
and Van Empelen, Pepijn",
title="Predictors of the Acceptance of an Electronic Coach Targeting Self-management of Patients With Type 2 Diabetes: Web-Based Survey",
journal="JMIR Form Res",
year="2022",
month="Aug",
day="16",
volume="6",
number="8",
pages="e34737",
keywords="mobile health",
keywords="type 2 diabetes",
keywords="self-management",
keywords="eCoach",
keywords="Technology Acceptance Model",
abstract="Background: Type 2 diabetes (T2D) is a lifestyle-related disease whose prevalence increases with age. Diabetes self-management through mobile health (mHealth) apps enables patients with T2D to improve their health. According to the Technology Acceptance Model (TAM), technology acceptance (ie, intended use) is necessary to ensure mHealth can be implemented successfully. Therefore, the specific acceptance requirements of patients with T2D should be considered. Objective: This cross-sectional study aims to examine the extent to which different TAM predictors are associated with the acceptance of a diabetes app including an electronic coach (eCoach; Iris app) among patients with T2D. Methods: Using a web-based survey, data on 92 patients with T2D (mean age 62.76 years, SD 8.29 years) were collected. Acceptance of the Iris app with the TAM predictors (ie, perceived usefulness, perceived ease of use, social influence, perceived self-efficacy, perceived security, prior usage experience, perceived health, and propensity of data/information sharing) was assessed. Further, control variables (ie, gender, age, education, ethnicity, household, BMI, amount of years with diabetes, diabetes-related complaints, and medication use) were assessed. Results: Multiple linear regression analyses showed that acceptance of the Iris app was positively associated with perceived usefulness ($\beta$=.57, P<.001), social influence (subjective norm; $\beta$=.20, P=.004), and willingness to share data ($\beta$=.25, P<.001). In addition, acceptance regarding the Iris app was higher among patients with T2D with overweight ($\beta$=.23, P=.01) or obese BMI ($\beta$=.21, P=.01). The model explained 75.8\% of the variance in the acceptance of the Iris app by patients with T2D. In addition, perceived usefulness of the Iris app was positively related to perceived ease of use ($\beta$=.32, P<.001), subjective norm ($\beta$=.26, P=.004), perceived control ($\beta$=.19, P=.03), willingness to share data ($\beta$=.20, P=.01) regarding the Iris app, and perceived security regarding general use of apps/smartphone/internet ($\beta$=.15, P=.04). The model explained 58.2\% of the variance in patients' perceived usefulness about the Iris app. Conclusions: Among patients with T2D, the belief that the use of the Iris app is helpful/beneficial, the willingness to share their Iris app data, and others' approval of using this app can stimulate the acceptance of this app. In addition, the belief that the use of (health) apps is reliable and secure, the belief that the use of the Iris app is easy to use, a higher perceived capability and personal control with using this app, the willingness to share their Iris app data, and others' approval of using this app can stimulate the perceived usefulness of such an app. These TAM predictors explained a high variance in acceptance and perceived usefulness of the Iris app. Implications for practice are addressed. ",
doi="10.2196/34737",
url="https://formative.jmir.org/2022/8/e34737",
url="http://www.ncbi.nlm.nih.gov/pubmed/35972769"
}


@Article{info:doi/10.2196/37314,
author="Sarker, Rahman Mohammad Habibur
and Moriyama, Michiko
and Rashid, Ur Harun
and Rahman, Moshiur Md
and Chisti, Jobayer Mohammod
and Das, Kumar Sumon
and Saha, Kumar Samir
and Arifeen, El Shams
and Ahmed, Tahmeed
and Faruque, G. A. S.",
title="Chronic Kidney Disease Awareness Campaign and Mobile Health Education to Improve Knowledge, Quality of Life, and Motivation for a Healthy Lifestyle Among Patients With Chronic Kidney Disease in Bangladesh: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2022",
month="Aug",
day="11",
volume="24",
number="8",
pages="e37314",
keywords="Bangladesh",
keywords="health education",
keywords="health knowledge",
keywords="quality of life",
keywords="motivation",
keywords="randomized controlled trial",
keywords="RCT",
keywords="campaign",
keywords="chronic kidney disease",
keywords="knowledge",
keywords="mobile health",
keywords="mHealth",
keywords="kidney",
keywords="chronic disease",
keywords="chronic condition",
keywords="patient education",
keywords="patient knowledge",
keywords="low- and middle-income countries",
keywords="LMIC",
abstract="Background: Chronic kidney disease (CKD) is linked to major health consequences and a poor quality of life. Despite the fact that CKD is becoming more prevalent, public knowledge of the disease remains low. Objective: This study aimed to evaluate the outcome of a health education intervention designed to enhance knowledge, health-related quality of life (QOL), and motivation about healthy lifestyle among adults with CKD. Methods: This study was a parallel-group (1:1), randomized controlled trial in the Mirzapur subdistrict of Bangladesh that compared 2 groups of patients with CKD. Adults with CKD (stages 1-3) were enrolled in November 2020 and randomly assigned the intervention or control group. The intervention group received health education through a CKD awareness campaign and mobile health technologies and was observed for 6 months, whereas the control group received standard treatment. The primary outcome was the evaluation of improved scores on the CKD knowledge questionnaire, and the secondary outcomes were improved QOL and changes in the levels of blood pressure (BP), BMI, serum creatinine, fasting blood sugar (FBS), hemoglobin, cholesterol, high-density lipoprotein cholesterol, triglyceride, serum uric acid, blood urea nitrogen (BUN), and albumin-to-creatinine ratio. Results: The study enrolled 126 patients (control: n=63; intervention: n=63) and performed intention-to-treat analysis. The analyses included repeated measures ANOVA, and the results were observed to be significantly different from within groups (P<.001), between groups (P<.001), and the interaction of group {\texttimes} time factor (P<.001) for knowledge score. Diastolic BP and BMI showed significant differences arising from within groups (P<.001 and P=.01, respectively) and the interaction of group {\texttimes} time factor (P=.001 and P=.02, respectively); food salinity and hip circumferences showed significant differences arising from within groups (P=.001 and P=.03, respectively) and between groups (P=.001 and P=.02, respectively). Moreover, systolic BP and waist circumference showed significant differences from within groups (P<.001 and P=.003, respectively). However, no significant differences were found arising from within groups, between groups, and the interactions of group {\texttimes} time for QOL, urine salinity, and mid-upper arm circumference. Regarding the laboratory findings, from baseline to 6 months, the mean (SD) FBS decreased by 0.51 (3.77) mmol/L in the intervention group and 0.10 (1.44) mmol/L in the control group (P=.03); however, blood urea nitrogen increased by 3.64 (7.17) mg/dL in the intervention group and 1.68 (10.10) mg/dL in the control group (P=.01). Conclusions: The health education strategy, which included a campaign and mobile health, showed promise for enhancing CKD knowledge among patients with CKD. This strategy may also aid patients with CKD in controlling their FBS and BP. The combined health education initiatives give evidence for scaling them up in Bangladesh and possibly other low- and middle-income countries, particularly in rural and peri-urban settings. Trial Registration: ClinicalTrials.gov NCT04094831; https://clinicaltrials.gov/ct2/show/NCT04094831. International Registered Report Identifier (IRRID): RR2-10.2196/30191 ",
doi="10.2196/37314",
url="https://www.jmir.org/2022/8/e37314",
url="http://www.ncbi.nlm.nih.gov/pubmed/35969429"
}


@Article{info:doi/10.2196/38331,
author="Chu, Brian
and O'Connor, M. Daniel
and Wan, Marilyn
and Barnett, Ian
and Shou, Haochang
and Judson, Marc
and Rosenbach, Misha",
title="Quality of Life and Physical Activity in 629 Individuals With Sarcoidosis: Prospective, Cross-sectional Study Using Smartphones (Sarcoidosis App)",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Aug",
day="10",
volume="10",
number="8",
pages="e38331",
keywords="sarcoidosis",
keywords="smartphone",
keywords="quality of life",
keywords="mobile app",
keywords="mobile health",
keywords="mHealth",
keywords="digital health",
keywords="rare disease",
keywords="physical activity",
keywords="exercise",
keywords="fitness",
keywords="development",
keywords="tracking",
keywords="recruit",
keywords="enroll",
abstract="Background: Large gaps exist in understanding the symptomatic and functional impact of sarcoidosis, a rare multisystem granulomatous disease affecting fewer than 200,000 individuals in the United States. Smartphones could be used for prospective research, especially for rare diseases where organizing large cohorts can be challenging, given their near ubiquitous ownership and ability to track objective and subjective data with increasingly sophisticated technology. Objective: We aimed to investigate whether smartphones could assess the quality of life (QoL) and physical activity of a large cohort of individuals with sarcoidosis. Methods: We developed a mobile app (Sarcoidosis App) for a prospective, cross-sectional study on individuals with sarcoidosis. The Sarcoidosis App was made available on both Apple and Android smartphones. Individuals with sarcoidosis were recruited, consented, and enrolled entirely within the app. Surveys on sarcoidosis history, medical history, and medications were administered. Patients completed modules from the Sarcoidosis Assessment Tool, a validated patient-reported outcomes assessment of physical activity, fatigue, pain, skin symptoms, sleep, and lungs symptoms. Physical activity measured by smartphones was tracked as available. Results: From April 2018 to May 2020, the App was downloaded 2558 times, and 629 individuals enrolled (404, 64.2\% female; mean age 51 years; 513, 81.6\% White; 86, 13.7\% Black). Two-thirds of participants had a college or graduate degree, and more than half of them reported an income greater than US \$60,000. Both QoL related to physical activity (P<.001, $\rho$=0.250) and fatigue (P<.01, $\rho$=--0.203) correlated with actual smartphone-tracked physical activity. Overall, 19.0\% (98/517) of participants missed at least 1 week of school or work in an observed month owing to sarcoidosis, and 44.4\% (279/629) reported that finances ``greatly'' or ``severely'' affected by sarcoidosis. Furthermore, 71.2\% (437/614) of participants reported taking medications for sarcoidosis, with the most common being prednisone, methotrexate, hydroxychloroquine, and infliximab. Moreover, 46.4\% (244/526) reported medication side effects, most commonly due to prednisone. Conclusions: We demonstrate that smartphones can prospectively recruit, consent, and study physical activity, QoL, and medication usage in a large sarcoidosis cohort, using both passively collected objective data and qualitative surveys that did not require any in-person encounters. Our study's limitations include the study population being weighted toward more educated and wealthier individuals, suggesting that recruitment was not representative of the full spectrum of patients with sarcoidosis in the United States. Our study provides a model for future smartphone-enabled clinical research for rare diseases and highlights key technical challenges that future research teams interested in smartphone-based research for rare diseases should anticipate. ",
doi="10.2196/38331",
url="https://mhealth.jmir.org/2022/8/e38331",
url="http://www.ncbi.nlm.nih.gov/pubmed/35947439"
}


@Article{info:doi/10.2196/36010,
author="Ahmed, Arfan
and Aziz, Sarah
and Abd-alrazaq, Alaa
and Farooq, Faisal
and Sheikh, Javaid",
title="Overview of Artificial Intelligence--Driven Wearable Devices for Diabetes: Scoping Review",
journal="J Med Internet Res",
year="2022",
month="Aug",
day="9",
volume="24",
number="8",
pages="e36010",
keywords="diabetes",
keywords="artificial intelligence",
keywords="wearable devices",
keywords="machine learning",
keywords="mobile phone",
abstract="Background: Prevalence of diabetes has steadily increased over the last few decades with 1.5 million deaths reported in 2012 alone. Traditionally, analyzing patients with diabetes has remained a largely invasive approach. Wearable devices (WDs) make use of sensors historically reserved for hospital settings. WDs coupled with artificial intelligence (AI) algorithms show promise to help understand and conclude meaningful information from the gathered data and provide advanced and clinically meaningful analytics. Objective: This review aimed to provide an overview of AI-driven WD features for diabetes and their use in monitoring diabetes-related parameters. Methods: We searched 7 of the most popular bibliographic databases using 3 groups of search terms related to diabetes, WDs, and AI. A 2-stage process was followed for study selection: reading abstracts and titles followed by full-text screening. Two reviewers independently performed study selection and data extraction, and disagreements were resolved by consensus. A narrative approach was used to synthesize the data. Results: From an initial 3872 studies, we report the features from 37 studies post filtering according to our predefined inclusion criteria. Most of the studies targeted type 1 diabetes, type 2 diabetes, or both (21/37, 57\%). Many studies (15/37, 41\%) reported blood glucose as their main measurement. More than half of the studies (21/37, 57\%) had the aim of estimation and prediction of glucose or glucose level monitoring. Over half of the reviewed studies looked at wrist-worn devices. Only 41\% of the study devices were commercially available. We observed the use of multiple sensors with photoplethysmography sensors being most prevalent in 32\% (12/37) of studies. Studies reported and compared >1 machine learning (ML) model with high levels of accuracy. Support vector machine was the most reported (13/37, 35\%), followed by random forest (12/37, 32\%). Conclusions: This review is the most extensive work, to date, summarizing WDs that use ML for people with diabetes, and provides research direction to those wanting to further contribute to this emerging field. Given the advancements in WD technologies replacing the need for invasive hospital setting devices, we see great advancement potential in this domain. Further work is needed to validate the ML approaches on clinical data from WDs and provide meaningful analytics that could serve as data gathering, monitoring, prediction, classification, and recommendation devices in the context of diabetes. ",
doi="10.2196/36010",
url="https://www.jmir.org/2022/8/e36010",
url="http://www.ncbi.nlm.nih.gov/pubmed/35943772"
}


@Article{info:doi/10.2196/35283,
author="Pedamallu, Havisha
and Ehrhardt, J. Matthew
and Maki, Julia
and Carcone, Idalski April
and Hudson, M. Melissa
and Waters, A. Erika",
title="Technology-Delivered Adaptations of Motivational Interviewing for the Prevention and Management of Chronic Diseases: Scoping Review",
journal="J Med Internet Res",
year="2022",
month="Aug",
day="9",
volume="24",
number="8",
pages="e35283",
keywords="motivational interviewing",
keywords="technology",
keywords="telehealth",
keywords="health behavior",
keywords="chronic disease",
keywords="socioeconomic factors",
keywords="health promotion",
keywords="disease management",
keywords="primary prevention",
keywords="secondary prevention",
keywords="minority health",
abstract="Background: Motivational interviewing (MI) can increase health-promoting behaviors and decrease health-damaging behaviors. However, MI is often resource intensive, precluding its use with people with limited financial or time resources. Mobile health--based versions of MI interventions or technology-delivered adaptations of MI (TAMIs) might increase reach. Objective: We aimed to understand the characteristics of existing TAMIs. We were particularly interested in the inclusion of people from marginalized sociodemographic groups, whether the TAMI addressed sociocontextual factors, and how behavioral and health outcomes were reported. Methods: We employed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews to conduct our scoping review. We searched PubMed, CINAHL, and PsycInfo from January 1, 1996, to April 6, 2022, to identify studies that described interventions incorporating MI into a mobile or electronic health platform. For inclusion, the study was required to (1) describe methods/outcomes of an MI intervention, (2) feature an intervention delivered automatically via a mobile or electronic health platform, and (3) report a behavioral or health outcome. The exclusion criteria were (1) publication in a language other than English and (2) description of only in-person intervention delivery (ie, no TAMI). We charted results using Excel (Microsoft Corp). Results: Thirty-four studies reported the use of TAMIs. Sample sizes ranged from 10 to 2069 participants aged 13 to 70 years. Most studies (n=27) directed interventions toward individuals engaging in behaviors that increased chronic disease risk. Most studies (n=22) oversampled individuals from marginalized sociodemographic groups, but few (n=3) were designed specifically with marginalized groups in mind. TAMIs used text messaging (n=8), web-based intervention (n=22), app + text messaging (n=1), and web-based intervention + text messaging (n=3) as delivery platforms. Of the 34 studies, 30 (88\%) were randomized controlled trials reporting behavioral and health-related outcomes, 23 of which reported statistically significant improvements in targeted behaviors with TAMI use. TAMIs improved targeted health behaviors in the remaining 4 studies. Moreover, 11 (32\%) studies assessed TAMI feasibility, acceptability, or satisfaction, and all rated TAMIs highly in this regard. Among 20 studies with a disproportionately high number of people from marginalized racial or ethnic groups compared with the general US population, 16 (80\%) reported increased engagement in health behaviors or better health outcomes. However, no TAMIs included elements that addressed sociocontextual influences on behavior or health outcomes. Conclusions: Our findings suggest that TAMIs may improve some health promotion and disease management behaviors. However, few TAMIs were designed specifically for people from marginalized sociodemographic groups, and none included elements to help address sociocontextual challenges. Research is needed to determine how TAMIs affect individual health outcomes and how to incorporate elements that address sociocontextual factors, and to identify the best practices for implementing TAMIs into clinical practice. ",
doi="10.2196/35283",
url="https://www.jmir.org/2022/8/e35283",
url="http://www.ncbi.nlm.nih.gov/pubmed/35943775"
}


@Article{info:doi/10.2196/36879,
author="LeBaron, Virginia
and Alam, Ridwan
and Bennett, Rachel
and Blackhall, Leslie
and Gordon, Kate
and Hayes, James
and Homdee, Nutta
and Jones, Randy
and Lichti, Kathleen
and Martinez, Yudel
and Mohammadi, Sahar
and Ogunjirin, Emmanuel
and Patel, Nyota
and Lach, John",
title="Deploying the Behavioral and Environmental Sensing and Intervention for Cancer Smart Health System to Support Patients and Family Caregivers in Managing Pain: Feasibility and Acceptability Study",
journal="JMIR Cancer",
year="2022",
month="Aug",
day="9",
volume="8",
number="3",
pages="e36879",
keywords="mobile health",
keywords="mHealth",
keywords="smart health",
keywords="cancer",
keywords="pain",
keywords="palliative care",
keywords="family caregiver",
keywords="remote monitoring",
keywords="feasibility and acceptability",
keywords="rural",
abstract="Background: Distressing cancer pain remains a serious symptom management issue for patients and family caregivers, particularly within home settings. Technology can support home-based cancer symptom management but must consider the experience of patients and family caregivers, as well as the broader environmental context. Objective: This study aimed to test the feasibility and acceptability of a smart health sensing system---Behavioral and Environmental Sensing and Intervention for Cancer (BESI-C)---that was designed to support the monitoring and management of cancer pain in the home setting. Methods: Dyads of patients with cancer and their primary family caregivers were recruited from an outpatient palliative care clinic at an academic medical center. BESI-C was deployed in each dyad home for approximately 2 weeks. Data were collected via environmental sensors to assess the home context (eg, light and temperature); Bluetooth beacons to help localize dyad positions; and smart watches worn by both patients and caregivers, equipped with heart rate monitors, accelerometers, and a custom app to deliver ecological momentary assessments (EMAs). EMAs enabled dyads to record and characterize pain events from both their own and their partners' perspectives. Sensor data streams were integrated to describe and explore the context of cancer pain events. Feasibility was assessed both technically and procedurally. Acceptability was assessed using postdeployment surveys and structured interviews with participants. Results: Overall, 5 deployments (n=10 participants; 5 patient and family caregiver dyads) were completed, and 283 unique pain events were recorded. Using our ``BESI-C Performance Scoring Instrument,'' the overall technical feasibility score for deployments was 86.4 out of 100. Procedural feasibility challenges included the rurality of dyads, smart watch battery life and EMA reliability, and the length of time required for deployment installation. Postdeployment acceptability Likert surveys (1=strongly disagree; 5=strongly agree) found that dyads disagreed that BESI-C was a burden (1.7 out of 5) or compromised their privacy (1.9 out of 5) and agreed that the system collected helpful information to better manage cancer pain (4.6 out of 5). Participants also expressed an interest in seeing their own individual data (4.4 out of 5) and strongly agreed that it is important that data collected by BESI-C are shared with their respective partners (4.8 out of 5) and health care providers (4.8 out of 5). Qualitative feedback from participants suggested that BESI-C positively improved patient-caregiver communication regarding pain management. Importantly, we demonstrated proof of concept that seriously ill patients with cancer and their caregivers will mark pain events in real time using a smart watch. Conclusions: It is feasible to deploy BESI-C, and dyads find the system acceptable. By leveraging human-centered design and the integration of heterogenous environmental, physiological, and behavioral data, the BESI-C system offers an innovative approach to monitor cancer pain, mitigate the escalation of pain and distress, and improve symptom management self-efficacy. International Registered Report Identifier (IRRID): RR2-10.2196/16178 ",
doi="10.2196/36879",
url="https://cancer.jmir.org/2022/3/e36879",
url="http://www.ncbi.nlm.nih.gov/pubmed/35943791"
}


@Article{info:doi/10.2196/23261,
author="Nagata, Tomohisa
and Aoyagi, Sona-Sanae
and Takahashi, Minekazu
and Nagata, Masako
and Mori, Koji",
title="Effects of Feedback From Self-Monitoring Devices on Lifestyle Changes in Workers with Diabetes: 3-Month Randomized Controlled Pilot Trial",
journal="JMIR Form Res",
year="2022",
month="Aug",
day="9",
volume="6",
number="8",
pages="e23261",
keywords="mobile health",
keywords="digital health",
keywords="diabetes",
keywords="workers",
keywords="self-monitoring",
keywords="BMI",
keywords="daily activity",
keywords="randomized controlled trial",
keywords="smartphone",
keywords="mobile phone",
abstract="Background: Although lifestyle interventions are useful in the prevention and management of diabetes, they can be expensive and time-consuming. There is some evidence on the effectiveness of automated mobile technology for health self-monitoring; however, few studies have used such devices in the occupational health field. Objective: We aimed to examine the effectiveness of a digital self-monitoring device on glucose levels and activity of workers with diabetes in Japan. The primary outcomes were changes in blood glucose levels, and the secondary outcomes were changes in weight and BMI. Methods: A 2-arm randomized controlled pilot trial was conducted with workers from 23 organizations. The intervention group (n=50) wore an armband activity monitor, a body composition monitor, and a blood pressure monitor for 3 months and received semiautomated weekly email messages tailored to their device data. The control group (n=53) engaged in no self-monitoring. Messages were developed by a physician and a dietician. Postintervention changes in blood glucose levels, weight, and BMI were compared between the intervention and control groups, using blood tests and questionnaires. Results: At the end of 3 months, the intervention group showed significantly lower blood glucose levels (HbA1c: intervention group mean 6.4\% (SD 0.3\%) vs control group mean 6.6\% (SD 0.3\%); Cohen d=0.7, 95\% CI 0.2-1.1; P=.009). There were no significant between-group differences in weight and BMI. Conclusions: Mobile digital self-monitoring was effective in improving blood glucose levels in workers with diabetes. The use of digital health devices is a cost-effective way of implementing health self-monitoring for large numbers of individuals in the workplace. However, due to the large volume of missing values in this study, we need to be careful in interpreting the results, and well-designed intervention studies need to be conducted. Trial Registration: University Hospital Medical Information Network UMIN000023651;https://upload.umin.ac.jp/cgi-open-bin/icdr/ctr\_view\_cb.cgi?recptno=R000027244\&flwp\_key=1008PYbOcXKmk7CAg4Th1FWS ",
doi="10.2196/23261",
url="https://formative.jmir.org/2022/8/e23261",
url="http://www.ncbi.nlm.nih.gov/pubmed/35943766"
}


@Article{info:doi/10.2196/39789,
author="Lei, Zhengdong
and Martignetti, Lisa
and Ridgway, Chelsea
and Peacock, Simon
and Sakata, T. Jon
and Li-Jessen, K. Nicole Y.",
title="Wearable Neck Surface Accelerometers for Occupational Vocal Health Monitoring: Instrument and Analysis Validation Study",
journal="JMIR Form Res",
year="2022",
month="Aug",
day="5",
volume="6",
number="8",
pages="e39789",
keywords="mechano-acoustic sensing",
keywords="voice monitoring",
keywords="wearable device",
keywords="neck surface accelerometer",
abstract="Background: Neck surface accelerometer (NSA) wearable devices have been developed for voice and upper airway health monitoring. As opposed to acoustic sounds, NSA senses mechanical vibrations propagated from the vocal tract to neck skin, which are indicative of a person's voice and airway conditions. NSA signals do not carry identifiable speech information and a speaker's privacy is thus protected, which is important and necessary for continuous wearable monitoring. Our device was already tested for its durable endurance and signal processing algorithms in controlled laboratory conditions. Objective: This study aims to further evaluate both instrument and analysis validity in a group of occupational vocal users, namely, voice actors, who use their voices extensively at work in an ecologically valid setting. Methods: A total of 16 professional voice actors (age range 21-50 years; 11 females and 5 males) participated in this study. All participants were mounted with an NSA on their sternal notches during the voice acting and voice assessment sessions. The voice acting session was 4-hour long, directed by a voice director in a professional sound studio. Voice assessment sessions were conducted before, during, and 48 hours after the acting session. The assessment included phonation tasks of passage reading, sustained vowels, maximum vowel phonation, and pitch glides. Clinical acoustic metrics (eg, fundamental frequency, cepstral measures) and a vocal dose measure (ie, accumulated distance dose from acting) were computed from NSA signals. A commonly used online questionnaire (Self-Administered Voice Rating questionnaire) was also implemented to track participants' perception of vocal fatigue. Results: The NSA wearables stayed in place for all participants despite active body movements during the acting. The ensued body noise did not interfere with the NSA signal quality. All planned acoustic metrics were successfully derived from NSA signals and their numerical values were comparable with literature data. For a 4-hour long voice acting, the averaged distance dose was about 8354 m with no gender differences. Participants perceived vocal fatigue as early as 2 hours after the start of voice acting, with recovery 24-48 hours after the acting session. Among all acoustic metrics across phonation tasks, cepstral peak prominence and spectral tilt from the passage reading most closely mirrored trends in perceived fatigue. Conclusions: The ecological validity of an in-house NSA wearable was vetted in a workplace setting. One key application of this wearable is to prompt occupational voice users when their vocal safety limits are reached for duly protection. Signal processing algorithms can thus be further developed for near real-time estimation of clinically relevant metrics, such as accumulated distance dose, cepstral peak prominence, and spectral tilt. This functionality will enable continuous self-awareness of vocal behavior and protection of vocal safety in occupational voice users. ",
doi="10.2196/39789",
url="https://formative.jmir.org/2022/8/e39789",
url="http://www.ncbi.nlm.nih.gov/pubmed/35930317"
}


@Article{info:doi/10.2196/36975,
author="Boutilier, J. Justin
and Loganathar, Priya
and Linden, Anna
and Scheer, Eleanore
and Noejovich, Sofia
and Elliott, Christian
and Zuraw, Matthew
and Werner, E. Nicole",
title="A Web-Based Platform (CareVirtue) to Support Caregivers of People Living With Alzheimer Disease and Related Dementias: Mixed Methods Feasibility Study",
journal="JMIR Aging",
year="2022",
month="Aug",
day="4",
volume="5",
number="3",
pages="e36975",
keywords="Alzheimer disease and related dementias",
keywords="mHealth",
keywords="caregivers",
keywords="dementia caregiving",
keywords="eHealth",
keywords="telehealth",
abstract="Background: People living with Alzheimer disease and related dementias (ADRD) require prolonged and complex care that is primarily managed by informal caregivers who face significant unmet needs regarding support for communicating and coordinating across their informal care network. To address this unmet need, we developed CareVirtue, which provides (1) the ability to invite care network members; (2) a care guide detailing the care plan; (3) a journal where care network members can document, communicate, and coordinate; (4) a shared calendar; and (5) vetted geolocated caregiver resources. Objective: This study aims to evaluate CareVirtue's feasibility based on: (1) Who used CareVirtue? (2) How did caregivers use CareVirtue? (3) How did caregivers perceive the acceptability of CareVirtue? (4) What factors were associated with CareVirtue use? Methods: We conducted a feasibility study with 51 care networks over a period of 8 weeks and used a mixed methods approach that included both quantitative CareVirtue usage data and semistructured interviews. Results: Care networks ranged from 1 to 8 members. Primary caregivers were predominantly female (38/51, 75\%), White (44/51, 86\%), married (37/51, 73\%), college educated (36/51, 71\%), and were, on average, 60.3 (SD 9.8) years of age, with 18\% (9/51) living in a rural area. CareVirtue usage varied along 2 axes (total usage and type of usage), with heterogeneity in how the most engaged care networks interacted with CareVirtue. Interviews identified a range of ways CareVirtue was useful, including practically, organizationally, and emotionally. On the Behavioral Intention Scale, 72\% (26/36) of primary caregivers reported an average score of at least 3, indicating an above average intention to use. The average was 81.8 (SD 12.8) for the System Usability Scale score, indicating ``good'' usability, and 3.4 (SD 1.0) for perceived usefulness, suggesting above average usefulness. The average confidence score increased significantly over the study duration from 7.8 in week 2 to 8.9 in week 7 (P=.005; r=0.91, 95\% CI 0.84-0.95). The following sociodemographic characteristics were associated with posting in the journal: retired (mean 59.5 posts for retired caregivers and mean 16.9 for nonretired caregivers), income (mean 13 posts for those reporting >US \$100K and mean 55.4 for those reporting <US \$100K), relationship to care recipient (mean 18.7 posts for child and mean 56.4 for partners/spouses), and living situation (mean 44.7 for those who live with the care recipient and mean 13.1 for those who do not). Older care recipients were associated with fewer posts (r=--0.33, 95\% CI --0.55 to --0.06). Conclusions: This study establishes the acceptability and feasibility of CareVirtue among ADRD care networks and highlights the importance of designing flexible, multicomponent interventions that allow care networks to tailor their engagement according to their needs. The results will be used to improve CareVirtue feasibility and acceptability in preparation for a subsequent randomized trial to test CareVirtue's effectiveness in improving caregiver outcomes. ",
doi="10.2196/36975",
url="https://aging.jmir.org/2022/3/e36975",
url="http://www.ncbi.nlm.nih.gov/pubmed/35925654"
}


@Article{info:doi/10.2196/36442,
author="Chu, Cherry
and Stamenova, Vess
and Fang, Jiming
and Shakeri, Ahmad
and Tadrous, Mina
and Bhatia, Sacha R.",
title="The Association Between Telemedicine Use and Changes in Health Care Usage and Outcomes in Patients With Congestive Heart Failure: Retrospective Cohort Study",
journal="JMIR Cardio",
year="2022",
month="Aug",
day="4",
volume="6",
number="2",
pages="e36442",
keywords="telemedicine",
keywords="telehealth",
keywords="eHealth",
keywords="digital health",
keywords="population",
keywords="outcomes",
keywords="health service",
keywords="health system",
keywords="utilization",
keywords="congestive heart failure",
keywords="cardiology",
keywords="health outcome",
keywords="clinical outcome",
keywords="patient outcome",
keywords="heart",
keywords="cardiac",
keywords="ambulatory",
keywords="COVID-19",
abstract="Background: Telemedicine use has become widespread owing to the COVID-19 pandemic, but its impact on patient outcomes remains unclear. Objective: We sought to investigate the effect of telemedicine use on changes in health care usage and clinical outcomes in patients diagnosed with congestive heart failure (CHF). Methods: We conducted a population-based retrospective cohort study using administrative data in Ontario, Canada. Patients were included if they had at least one ambulatory visit between March 14 and September 30, 2020, and a heart failure diagnosis any time prior to March 14, 2020. Telemedicine users were propensity score--matched with unexposed users based on several baseline characteristics. Monthly use of various health care services was compared between the 2 groups during 12 months before to 3 months after their index in-person or telemedicine ambulatory visit after March 14, 2020, using generalized estimating equations. Results: A total of 11,131 pairs of telemedicine and unexposed patients were identified after matching (49\% male; mean age 78.9, SD 12.0 years). All patients showed significant reductions in health service usage from pre- to postindex visit. There was a greater decline across time in the unexposed group than in the telemedicine group for CHF admissions (ratio of slopes for high- vs low-frequency users 1.02, 95\% CI 1.02-1.03), cardiovascular admissions (1.03, 95\% CI 1.02-1.04), any-cause admissions (1.03, 95\% CI 1.02-1.04), any-cause ED visits (1.03, 95\% CI 1.03-1.04), visits with any cardiologist (1.01, 95\% CI 1.01-1.02), laboratory tests (1.02, 95\% CI 1.02-1.03), diagnostic tests (1.04, 95\% CI 1.03-1.05), and new prescriptions (1.02, 95\% CI 1.01-1.03). However, the decline in primary care visit rates was steeper among telemedicine patients than among unexposed patients (ratio of slopes 0.99, 95\% CI 0.99-1.00). Conclusions: Overall health care usage over time appeared higher among telemedicine users than among low-frequency users or nonusers, suggesting that telemedicine was used by patients with the greatest need or that it allowed patients to have better access or continuity of care among those who received it. ",
doi="10.2196/36442",
url="https://cardio.jmir.org/2022/2/e36442",
url="http://www.ncbi.nlm.nih.gov/pubmed/35881831"
}


@Article{info:doi/10.2196/38424,
author="van de Vijver, Steven
and Hummel, Deirdre
and van Dijk, Hester Annericht
and Cox, Jan
and van Dijk, Oscar
and Van den Broek, Nicoline
and Metting, Esther",
title="Evaluation of a Digital Self-management Platform for Patients With Chronic Illness in Primary Care: Qualitative Study of Stakeholders' Perspectives",
journal="JMIR Form Res",
year="2022",
month="Aug",
day="3",
volume="6",
number="8",
pages="e38424",
keywords="primary care",
keywords="chronic disease",
keywords="telemonitoring",
keywords="digital health",
keywords="self-management",
keywords="patient-centered care",
keywords="chronic care",
keywords="chronic care management",
keywords="illness",
keywords="healthcare",
keywords="healthcare professional",
keywords="user",
keywords="patient",
keywords="platform",
keywords="tool",
keywords="communication",
keywords="empowerment",
keywords="online",
abstract="Background: Population aging and multimorbidity has led to increasing chronic care needs associated with new challenges in managing growing costs, rising health care professional workloads, and the adoption of rigorous guidelines. These issues could all benefit from greater digitalization and a more patient-centered approach to chronic care, a situation brought to the fore by the COVID-19 pandemic. Little is known about real-life use in primary care. Objective: This study aimed to explore the views, thoughts, usability, and experiences concerning a recently introduced digital self-care platform for chronic conditions in 3 Dutch primary care practices. Methods: We conducted an explorative study combining questionnaires and interviews among patients and general practitioners from 3 general practices that used the digital platform. Questionnaires were sent to patients in each practice to seek the views and experiences of both patient nonusers (n=20) and patient users (n=58) of the platform, together with standardized questionnaires about illness perception and quality of life. In addition, patients (n=15) and general practitioners (n=4) who used the platform took part in semistructured interviews. We transcribed interviews verbatim and performed qualitative content analysis using a deductive approach. The results of the questionnaires were analyzed with descriptive analysis. Results: Among patients who had not actively used the platform but had received an explanation, only 35\% (7/20) would recommend its use due to concerns over communication and handling. However, this percentage increased to 76.3\% (45/59) among the people who actively used the platform. Interviews with patients and general practitioners who used the platform uncovered several key benefits, including reduced time requirements, reduced workload, improved care quality, and improved accessibility due to the greater patient-centeredness and use of different communication tools. In addition, the self-management tool led to greater patient autonomy and empowerment. Although users considered the platform feasible, usable, and easy to use, some technical issues remained and some patients expressed concerns about the reduction in human contact and feedback. Conclusions: The overall experience and usability of the platform was good. Support for the online self-management platform for chronic care increased when patients actively used the tool and could experience or identify important advantages. However, patients still noted several areas for improvement that need to be tackled in future iterations. To ensure benefit in the wider population, we must also evaluate this platform in cohorts with lower digital and health literacy. ",
doi="10.2196/38424",
url="https://formative.jmir.org/2022/8/e38424",
url="http://www.ncbi.nlm.nih.gov/pubmed/35921145"
}


@Article{info:doi/10.2196/34355,
author="Ryan, Sh{\'i}ofra
and N{\'i} Chasaide, Noir{\'i}n
and O' Hanrahan, Shane
and Corcoran, Darragh
and Caulfield, Brian
and Argent, Rob",
title="mHealth Apps for Musculoskeletal Rehabilitation: Systematic Search in App Stores and Content Analysis",
journal="JMIR Rehabil Assist Technol",
year="2022",
month="Aug",
day="1",
volume="9",
number="3",
pages="e34355",
keywords="mHealth",
keywords="musculoskeletal rehabilitation",
keywords="app",
keywords="home exercise program",
keywords="home exercise",
keywords="telehealth",
keywords="mobile health",
keywords="connected health",
abstract="Background: The number of mobile health (mHealth) apps released for musculoskeletal (MSK) injury treatment and self-management with home exercise programs (HEPs) has risen rapidly in recent years as digital health interventions are explored and researched in more detail. As this number grows, it is becoming increasingly difficult for users to navigate the market and select the most appropriate app for their use case. It is also unclear what features the developers of these apps are harnessing to support patient self-management and how they fit into clinical care pathways. Objective: The objective of this study was to scope the current market of mHealth apps for MSK rehabilitation and to report on their features, claims, evidence base, and functionalities. Methods: A cross-sectional study of apps for MSK rehabilitation was performed across the iTunes App Store and Google Play Store. Four search terms were used, namely, physiotherapy rehabilitation, physical therapy rehabilitation, rehabilitation exercise, and therapeutic exercise to identify apps, which were then cross-referenced against set selection criteria by 4 reviewers. Each reviewer, where possible, downloaded the app and accessed supplementary literature available on the product to assist in data extraction. Results: A total of 1322 apps were identified. After applying the inclusion and exclusion criteria and removing duplicates, 144 apps were included in the study. Over half (n=81, 56.3\%) of the included apps had been released within the past 3 years. Three quarters (n=107, 74.3\%) of the apps made no reference to evidence supporting the design or efficacy of the app, with only 11.1\% (n=16) providing direct citations to research. Most of the apps did utilize exercise pictures (n=138, 95.8\%) or videos (n=97, 67.4\%); however, comparatively few harnessed additional features to encourage engagement and support self-management, such as an adherence log (n=66, 45.8\%), communication portal (n=32, 22.2\%), patient-reported outcome capture (n=36, 25\%), or direct feedback (n=57, 39.6\%). Of note and concern, many of these apps prescribed generic exercises (n=93, 64.6\%) in the absence of individualized input to the user, with few providing specific patient education (n=43, 34\%) and safety advice or disclaimers (n=38, 26.4\%). Conclusions: The cohort of apps included in this study contained a large heterogeneity of features, so it is difficult for users to identify the most appropriate or effective app. Many apps are missing the opportunity to offer key features that could promote exercise adherence and encourage self-management in MSK rehabilitation. Furthermore, very few developers currently offering products on the market are providing evidence to support the design and efficacy of their technologies. ",
doi="10.2196/34355",
url="https://rehab.jmir.org/2022/3/e34355",
url="http://www.ncbi.nlm.nih.gov/pubmed/35916688"
}


@Article{info:doi/10.2196/35396,
author="Hiraoka, Daisuke
and Inui, Tomohiko
and Kawakami, Eiryo
and Oya, Megumi
and Tsuji, Ayumu
and Honma, Koya
and Kawasaki, Yohei
and Ozawa, Yoshihito
and Shiko, Yuki
and Ueda, Hideki
and Kohno, Hiroki
and Matsuura, Kaoru
and Watanabe, Michiko
and Yakita, Yasunori
and Matsumiya, Goro",
title="Diagnosis of Atrial Fibrillation Using Machine Learning With Wearable Devices After Cardiac Surgery: Algorithm Development Study",
journal="JMIR Form Res",
year="2022",
month="Aug",
day="1",
volume="6",
number="8",
pages="e35396",
keywords="wearable device",
keywords="atrial fibrillation",
keywords="photoplethysmography",
keywords="cardiology",
keywords="heart",
keywords="mHealth",
keywords="mobile health",
keywords="pulse",
keywords="development",
keywords="pilot study",
keywords="Apple Watch",
keywords="sensor",
keywords="algorithm",
keywords="detection",
keywords="diagnose",
keywords="cardiac surgery",
keywords="machine learning",
abstract="Background: Some attempts have been made to detect atrial fibrillation (AF) with a wearable device equipped with photoelectric volumetric pulse wave technology, and it is expected to be applied under real clinical conditions. Objective: This study is the second part of a 2-phase study aimed at developing a method for immediate detection of paroxysmal AF, using a wearable device with built-in photoplethysmography (PPG). The objective of this study is to develop an algorithm to immediately diagnose AF by an Apple Watch equipped with a PPG sensor that is worn by patients undergoing cardiac surgery and to use machine learning on the pulse data output from the device. Methods: A total of 80 patients who underwent cardiac surgery at a single institution between June 2020 and March 2021 were monitored for postoperative AF, using a telemetry-monitored electrocardiogram (ECG) and an Apple Watch. AF was diagnosed by qualified physicians from telemetry-monitored ECGs and 12-lead ECGs; a diagnostic algorithm was developed using machine learning on the pulse rate data output from the Apple Watch. Results: One of the 80 patients was excluded from the analysis due to redness caused by wearing the Apple Watch. Of 79 patients, 27 (34.2\%) developed AF, and 199 events of AF including brief AF were observed. Of them, 18 events of AF lasting longer than 1 hour were observed, and cross-correlation analysis showed that pulse rate measured by Apple Watch was strongly correlated (cross-correlation functions [CCF]: 0.6-0.8) with 8 events and very strongly correlated (CCF>0.8) with 3 events. The diagnostic accuracy by machine learning was 0.9416 (sensitivity 0.909 and specificity 0.838 at the point closest to the top left) for the area under the receiver operating characteristic curve. Conclusions: We were able to safely monitor pulse rate in patients who wore an Apple Watch after cardiac surgery. Although the pulse rate measured by the PPG sensor does not follow the heart rate recorded by telemetry-monitored ECGs in some parts, which may reduce the accuracy of AF diagnosis by machine learning, we have shown the possibility of clinical application of using only the pulse rate collected by the PPG sensor for the early detection of AF. ",
doi="10.2196/35396",
url="https://formative.jmir.org/2022/8/e35396",
url="http://www.ncbi.nlm.nih.gov/pubmed/35916709"
}


@Article{info:doi/10.2196/33818,
author="Ezenwa, O. Miriam
and Yao, Yingwei
and Mandernach, W. Molly
and Fedele, A. David
and Lucero, J. Robert
and Corless, Inge
and Dyal, W. Brenda
and Belkin, H. Mary
and Rohatgi, Abhinav
and Wilkie, J. Diana",
title="A Stress and Pain Self-management mHealth App for Adult Outpatients With Sickle Cell Disease: Protocol for a Randomized Controlled Study",
journal="JMIR Res Protoc",
year="2022",
month="Jul",
day="29",
volume="11",
number="7",
pages="e33818",
keywords="sickle cell disease",
keywords="self-management",
keywords="stress",
keywords="pain",
keywords="opioid use",
keywords="analgesics",
keywords="intervention",
keywords="support",
keywords="protocol",
keywords="randomized controlled trial",
abstract="Background: This paper describes the research protocol for a randomized controlled trial of a self-management intervention for adults diagnosed with sickle cell disease (SCD). People living with SCD experience lifelong recurrent episodes of acute and chronic pain, which are exacerbated by stress. Objective: This study aims to decrease stress and improve SCD pain control with reduced opioid use through an intervention with self-management relaxation exercises, named You Cope, We Support (YCWS). Building on our previous findings from formative studies, this study is designed to test the efficacy of YCWS on stress intensity, pain intensity, and opioid use in adults with SCD. Methods: A randomized controlled trial of the short-term (8 weeks) and long-term (6 months) effects of YCWS on stress, pain, and opioid use will be conducted with 170 adults with SCD. Patients will be randomized based on 1:1 ratio (stratified on pain intensity [?5 or >5]) to be either in the experimental (self-monitoring of outcomes, alerts or reminders, and use of YCWS [relaxation and distraction exercises and support]) or control (self-monitoring of outcomes and alerts or reminders) group. Patients will be asked to report outcomes daily. During weeks 1 to 8, patients in both groups will receive system-generated alerts or reminders via phone call, text, or email to facilitate data entry (both groups) and intervention use support (experimental). If the participant does not enter data after 24 hours, the study support staff will contact them for data entry troubleshooting (both groups) and YCWS use (experimental). We will time stamp and track patients' web-based activities to understand the study context and conduct exit interviews on the acceptability of system-generated and staff support. This study was approved by our institutional review board. Results: This study was funded by the National Institute of Nursing Research of the National Institutes of Health in 2020. The study began in March 2021 and will be completed in June 2025. As of April 2022, we have enrolled 45.9\% (78/170) of patients. We will analyze the data using mixed effects regression models (short term and long term) to account for the repeated measurements over time and use machine learning to construct and evaluate prediction models. Owing to the COVID-19 pandemic, the study was modified to allow for mail-in consent process, internet-based consent process via email or Zoom videoconference, devices delivered by FedEx, and training via Zoom videoconference. Conclusions: We expect the intervention group to report reductions in pain intensity (primary outcome; 0-10 scale) and in stress intensity (0-10 scale) and opioid use (Wisepill event medication monitoring system), which are secondary outcomes. Our study will contribute to advancing the use of nonopioid therapy such as guided relaxation and distraction techniques for managing SCD pain. Trial Registration: ClinicalTrials.gov NCT04484272; https://clinicaltrials.gov/ct2/show/NCT04484272 International Registered Report Identifier (IRRID): PRR1-10.2196/33818 ",
doi="10.2196/33818",
url="https://www.researchprotocols.org/2022/7/e33818",
url="http://www.ncbi.nlm.nih.gov/pubmed/35904878"
}


@Article{info:doi/10.2196/37430,
author="Lee, Young Eun
and Cha, Seon-Ah
and Yun, Jae-Seung
and Lim, Sun-Young
and Lee, Jin-Hee
and Ahn, Yu-Bae
and Yoon, Kun-Ho
and Hyun, Kyung Min
and Ko, Seung-Hyun",
title="Efficacy of Personalized Diabetes Self-care Using an Electronic Medical Record--Integrated Mobile App in Patients With Type 2 Diabetes: 6-Month Randomized Controlled Trial",
journal="J Med Internet Res",
year="2022",
month="Jul",
day="28",
volume="24",
number="7",
pages="e37430",
keywords="type 2 diabetes mellitus",
keywords="digital health",
keywords="mobile health",
keywords="mHealth",
keywords="mobile app",
keywords="self-monitoring blood glucose",
keywords="mobile phone",
abstract="Background: A system that combines technology and web-based coaching can help treat chronic conditions such as diabetes. However, the effectiveness of apps in mobile health (mHealth) interventions is inconclusive and unclear due to heterogeneous interventions and varying follow-up durations. In addition, randomized controlled trial data are limited, and long-term follow-up is lacking, especially for apps integrated into electronic medical records. Objective: We aimed to assess the effect of an electronic medical record--integrated mobile app for personalized diabetes self-care, focusing on the self-monitoring of blood glucose and lifestyle modifications, on glycemic control in patients with type 2 diabetes mellitus. Methods: In a 26-week, 3-arm, randomized, controlled, open-label, parallel group trial, patients with type 2 diabetes mellitus and a hemoglobin A1c (HbA1c) level of ?7.5\% were recruited. The mHealth intervention consisted of self-monitoring of blood glucose with the automatic transfer of glucose, diet, and physical activity counseling data (iCareD system). Participants were randomly assigned to the following three groups: usual care (UC), mobile diabetes self-care (MC), and MC with personalized, bidirectional feedback from physicians (MPC). The primary outcome was the change in HbA1c levels at 26 weeks. In addition, diabetes-related self-efficacy, self-care activities, and satisfaction with the iCareD system were assessed after the intervention. Results: A total of 269 participants were enrolled, and 234 patients (86.9\%) remained in the study at 26 weeks. At 12 weeks after the intervention, the mean decline in HbA1c levels was significantly different among the 3 groups (UC vs MC vs MPC: ?0.49\% vs ?0.86\% vs ?1.04\%; P=.02). The HbA1c level decreased in all groups; however, it did not differ among groups after 26 weeks. In a subgroup analysis, HbA1c levels showed a statistically significant decrease after the intervention in the MPC group compared with the change in the UC or MC group, especially in patients aged <65 years (P=.02), patients with a diabetes duration of ?10 years (P=.02), patients with a BMI of ?25.0 kg/m2 (P=.004), patients with a C-peptide level of ?0.6 ng/mL (P=.008), and patients who did not undergo treatment with insulin (P=.004) at 12 weeks. A total of 87.2\% (137/157) of the participants were satisfied with the iCareD system. Conclusions: The mHealth intervention for diabetes self-care showed short-term efficacy in glycemic control, and the effect decreased over time. The participants were comfortable with using the iCareD system and exhibited high adherence. Trial Registration: Clinical Research Information Service, Republic of Korea KCT0004128; https://tinyurl.com/bdd6pa9m ",
doi="10.2196/37430",
url="https://www.jmir.org/2022/7/e37430",
url="http://www.ncbi.nlm.nih.gov/pubmed/35900817"
}


@Article{info:doi/10.2196/39335,
author="Berridge, Clara
and Turner, R. Natalie
and Liu, Liu
and Karras, W. Sierramatice
and Chen, Amy
and Fredriksen-Goldsen, Karen
and Demiris, George",
title="Advance Planning for Technology Use in Dementia Care: Development, Design, and Feasibility of a Novel Self-administered Decision-Making Tool",
journal="JMIR Aging",
year="2022",
month="Jul",
day="27",
volume="5",
number="3",
pages="e39335",
keywords="Alzheimer disease",
keywords="advance care planning",
keywords="dyadic intervention",
keywords="technology",
keywords="remote monitoring",
keywords="artificial intelligence",
keywords="older adult",
keywords="seniors",
keywords="human-computer interaction",
keywords="aging",
keywords="elderly population",
keywords="digital tool",
keywords="educational tool",
keywords="dementia care",
keywords="ethics",
keywords="informed consent",
abstract="Background: Monitoring technologies are used to collect a range of information, such as one's location out of the home or movement within the home, and transmit that information to caregivers to support aging in place. Their surveilling nature, however, poses ethical dilemmas and can be experienced as intrusive to people living with Alzheimer disease (AD) and AD-related dementias. These challenges are compounded when older adults are not engaged in decision-making about how they are monitored. Dissemination of these technologies is outpacing our understanding of how to communicate their functions, risks, and benefits to families and older adults. To date, there are no tools to help families understand the functions of monitoring technologies or guide them in balancing their perceived need for ongoing surveillance and the older adult's dignity and wishes. Objective: We designed, developed, and piloted a communication and education tool in the form of a web application called Let's Talk Tech to support family decision-making about diverse technologies used in dementia home care. The knowledge base about how to design online interventions for people living with mild dementia is still in development, and dyadic interventions used in dementia care remain rare. We describe the intervention's motivation and development process, and the feasibility of using this self-administered web application intervention in a pilot sample of people living with mild AD and their family care partners. Methods: We surveyed 29 mild AD dementia care dyads living together before and after they completed the web application intervention and interviewed each dyad about their experiences with it. We report postintervention measures of feasibility (recruitment, enrollment, and retention) and acceptability (satisfaction, quality, and usability). Descriptive statistics were calculated for survey items, and thematic analysis was used with interview transcripts to illuminate participants' experiences and recommendations to improve the intervention. Results: The study enrolled 33 people living with AD and their care partners, and 29 (88\%) dyads completed the study (all but one were spousal dyads). Participants were asked to complete 4 technology modules, and all completed them. The majority of participants rated the tool as having the right length (>90\%), having the right amount of information (>84\%), being very clearly worded (>74\%), and presenting information in a balanced way (>90\%). Most felt the tool was easy to use and helpful, and would likely recommend it to others. Conclusions: This study demonstrated that our intervention to educate and facilitate conversation and documentation of preferences is preliminarily feasible and acceptable to mild AD care dyads. Effectively involving older adults in these decisions and informing care partners of their preferences could enable families to avoid conflicts or risks associated with uninformed or disempowered use and to personalize use so both members of the dyad can experience benefits. ",
doi="10.2196/39335",
url="https://aging.jmir.org/2022/3/e39335",
url="http://www.ncbi.nlm.nih.gov/pubmed/35896014"
}


@Article{info:doi/10.2196/33881,
author="Lee, Rebecca Abigail
and McDermott, Orii
and Guo, Boliang
and Roe, James
and Orrell, Martin",
title="A Self-management App for People Living With Mild Dementia (PRIDE): Protocol for a Pre-Post Feasibility Study",
journal="JMIR Res Protoc",
year="2022",
month="Jul",
day="27",
volume="11",
number="7",
pages="e33881",
keywords="dementia",
keywords="protocol",
keywords="self-management",
keywords="quality of life",
keywords="web-based",
keywords="psychology",
keywords="social",
keywords="intervention",
keywords="app",
abstract="Background: With the rapid increase in the prevalence of dementia in the United Kingdom and beyond, the emotional, social, and economic burden on individuals, families, and health care services continues to rise. Currently, interventions that enable people living with dementia to better manage their condition and achieve a good quality of life are needed. Objective: This study aimed to explore how the Promoting Independence in Dementia (PRIDE) app can promote and support the self-management of people living with mild dementia. Methods: Feasibility of a pre-post study design incorporating the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework will be studied. We will use up to 6 National Health Service Trusts as research sites and the Join Dementia Research website and accept self-referrals to recruit 60 to 90 people living with mild dementia. Participants will complete the PRIDE app intervention over 8 weeks with support from a dementia adviser facilitator. Measures exploring mood, physical well-being, and quality of life will be collected at baseline and at follow-ups at 3 and 6 months. Facilitators and National Health Service staff will be invited to complete interviews shortly after the intervention phase. Results: Data collection began in June 2021 and is predicted to cease by the end of August 2022. Analysis of the quantitative measures will explore the impact of the PRIDE app on participants' independence, mood, and quality of life. Interview data will discuss participant experiences, how the use of the app affected them, and if it has the potential to be successfully implemented and maintained in dementia services. Conclusions: This study will show the potential reach, effectiveness, and adoption of the PRIDE app intervention in the lives of people with mild dementia. The findings from this study will inform future research on the PRIDE app and any further developments to improve its effectiveness. International Registered Report Identifier (IRRID): DERR1-10.2196/33881 ",
doi="10.2196/33881",
url="https://www.researchprotocols.org/2022/7/e33881",
url="http://www.ncbi.nlm.nih.gov/pubmed/35896033"
}


@Article{info:doi/10.2196/39263,
author="Lerret, Marie Stacee
and Flynn, Erin
and White-Traut, Rosemary
and Alonso, Estella
and Mavis, M. Alisha
and Jensen, Kyle M.
and Peterson, G. Caitlin
and Schiffman, Rachel",
title="Acceptability of an mHealth Family Self-management Intervention (myFAMI) for Pediatric Transplantation Families: Qualitative Focus",
journal="JMIR Nursing",
year="2022",
month="Jul",
day="15",
volume="5",
number="1",
pages="e39263",
keywords="mHealth",
keywords="pediatric patients",
keywords="transplantation",
keywords="family self-management",
keywords="qualitative",
abstract="Background: Around 1800 pediatric transplantations were performed in 2021, which is approximately 5\% of the annual rate of solid organ transplantations carried out in the United States. Effective family self-management in the transition from hospital to home-based recovery promotes successful outcomes of transplantation. The use of mHealth to deliver self-management interventions is a strategy that can be used to support family self-management for transplantation recipients and their families. Objective: The study aims to evaluate the acceptability of an mHealth intervention (myFAMI) that combined use of a smartphone app with triggered nurse communication with family members of pediatric transplantation recipients. Methods: This is a secondary analysis of qualitative data from family members who received the myFAMI intervention within a larger randomized controlled trial. Eligible participants used the app in the 30-day time frame after discharge and participated in a 30-day postdischarge telephone interview. Content analysis was used to generate themes. Results: A total of 4 key themes were identified: (1) general acceptance, (2) positive interactions, (3) home management after hospital discharge, and (4) opportunities for improvement. Conclusions: Acceptability of the intervention was high. Family members rated the smartphone application as easy to use. myFAMI allowed the opportunity for families to feel connected to and engage with the medical team while in their home environment. Family members valued and appreciated ongoing support and education specifically in this first 30 days after their child's hospital discharge and many felt it contributed positively to the management of their child's medical needs at home. Family members provided recommendations for future refinement of the app and some suggested that a longer follow-up period would be beneficial. The development and refinement of mHealth care delivery strategies hold potential for improving outcomes for solid organ transplantation patients and their families and as a model to consider in other chronic illness populations. Trial Registration: ClinicalTrials.gov NCT03533049; https://clinicaltrials.gov/ct2/show/NCT03533049 ",
doi="10.2196/39263",
url="https://nursing.jmir.org/2022/1/e39263",
url="http://www.ncbi.nlm.nih.gov/pubmed/35838761"
}


@Article{info:doi/10.2196/35684,
author="Kang, Singh Harjeevan
and Exworthy, Mark",
title="Wearing the Future---Wearables to Empower Users to Take Greater Responsibility for Their Health and Care: Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Jul",
day="13",
volume="10",
number="7",
pages="e35684",
keywords="wearable",
keywords="device",
keywords="tracker",
keywords="activity tracker",
keywords="fitness tracker",
keywords="technology",
keywords="MedTech",
keywords="HealthTech",
keywords="sensor",
keywords="monitor",
keywords="gadget",
keywords="smartwatch",
keywords="empowerment",
keywords="self-care",
keywords="management",
keywords="behavior",
keywords="responsibility",
keywords="attitude",
keywords="personalization",
keywords="mobile phone",
keywords="self-management",
keywords="smartphone",
keywords="wearable electronic devices",
keywords="health promotion",
keywords="health behavior",
keywords="mHealth",
keywords="digital health",
keywords="health care wearables",
keywords="scoping review",
abstract="Background: Wearables refer to devices that are worn by individuals. In the health care field, wearables may assist with individual monitoring and diagnosis. In fact, the potential for wearable technology to assist with health care has received recognition from health systems around the world, including a place in the strategic Long Term Plan shared by the National Health Service in England. However, wearables are not limited to specialist medical devices used by patients. Leading technology companies, including Apple, have been exploring the capabilities of wearable health technology for health-conscious consumers. Despite advancements in wearable health technology, research is yet to be conducted on wearables and empowerment. Objective: This study aimed to identify, summarize, and synthesize knowledge on how wearable health technology can empower individuals to take greater responsibility for their health and care. Methods: This study was a scoping review with thematic analysis and narrative synthesis. Relevant guidance, such as the Arksey and O'Malley framework, was followed. In addition to searching gray literature, we searched MEDLINE, EMBASE, PsycINFO, HMIC, and Cochrane Library. Studies were included based on the following selection criteria: publication in English, publication in Europe or the United States, focus on wearables, relevance to the research, and the availability of the full text. Results: After identifying 1585 unique records and excluding papers based on the selection criteria, 20 studies were included in the review. On analysis of these 20 studies, 3 main themes emerged: the potential barriers to using wearables, the role of providers and the benefits to providers from promoting the use of wearables, and how wearables can drive behavior change. Conclusions: Considerable literature findings suggest that wearables can empower individuals by assisting with diagnosis, behavior change, and self-monitoring. However, greater adoption of wearables and engagement with wearable devices depend on various factors, including promotion and support from providers to encourage uptake; increased short-term investment to upskill staff, especially in the area of data analysis; and overcoming the barriers to use, particularly by improving device accuracy. Acting on these suggestions will require investment and constructive input from key stakeholders, namely users, health care professionals, and designers of the technology. As advancements in technology to make wearables viable health care devices have only come about recently, further studies will be important for measuring the effectiveness of wearables in empowering individuals. The investigation of user outcomes through large-scale studies would also be beneficial. Nevertheless, a significant challenge will be in the publication of research to keep pace with rapid developments related to wearable health technology. ",
doi="10.2196/35684",
url="https://mhealth.jmir.org/2022/7/e35684",
url="http://www.ncbi.nlm.nih.gov/pubmed/35830222"
}


@Article{info:doi/10.2196/34767,
author="Kassavou, Aikaterini
and Wang, Michael
and Mirzaei, Venus
and Shpendi, Sonia
and Hasan, Rana",
title="The Association Between Smartphone App--Based Self-monitoring of Hypertension-Related Behaviors and Reductions in High Blood Pressure: Systematic Review and Meta-analysis",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Jul",
day="12",
volume="10",
number="7",
pages="e34767",
keywords="self-monitoring",
keywords="smartphone apps",
keywords="behavior change",
keywords="hypertension",
keywords="blood pressure",
keywords="mobile health",
keywords="mHealth",
keywords="mobile app",
keywords="self-management",
keywords="lifestyle",
abstract="Background: Self-monitoring of behavior can support lifestyle modifications; however, we do not know whether such interventions are effective in supporting positive changes in hypertension-related health behaviors and thus in reducing blood pressure in patients treated for hypertension. Objective: This systematic literature review evaluates the extent to which smartphone app--based self-monitoring of health behavior supports reductions in blood pressure and changes in hypertension-related behaviors. It also explores the behavioral components that might explain intervention effectiveness. Methods: A systematic search of 7 databases was conducted in August 2021. Article screening, study and intervention coding, and data extraction were completed independently by reviewers. The search strategy was developed using keywords from previous reviews and relevant literature. Trials involving adults, published after the year 2000, and in the English language were considered for inclusion. The random-effects meta-analysis method was used to account for the distribution of the effect across the studies. Results: We identified 4638 articles, of which 227 were included for full-text screening. A total of 15 randomized controlled trials were included in the review. In total, 7415 patients with hypertension were included in the meta-analysis. The results indicate that app-based behavioral self-monitoring interventions had a small but significant effect in reducing systolic blood pressure (SBP), on average, by 1.64 mmHg (95\% CI 2.73-0.55, n=7301; odds ratio [OR] 1.60, 95\% CI 0.74-3.42, n=114) and in improving changes in medication adherence behavior (standardized mean difference [SMD] 0.78, 95\% CI 0.22-1.34) compared to usual care or minimal intervention. The review found the intervention had a small effect on supporting improvements in healthy diet by changing habits related to high sodium food (SMD --0.44, 95\% CI --0.79 to --0.08) and a trend, although insignificant, toward supporting smoking cessation, low alcohol consumption, and better physical activity behaviors. A subgroup analysis found that behavioral self-monitoring interventions combined with tailored advice resulted in higher and significant changes in both SBP and diastolic blood pressure (DBP) in comparison to those not providing tailored advice (SBP: --2.92 mmHg, 95\% CI --3.94 to --1.90, n=3102 vs --0.72 mmHg, 95\% CI --1.67 to 0.23, n=4199, $\chi$2=9.65, P=.002; DBP: --2.05 mmHg, 95\% CI --3.10 to --1.01, n=968 vs 1.54 mmHg, 95\% CI --0.53 to 3.61, n=400, $\chi$2=9.19, P=.002). Conclusions: Self-monitoring of hypertension-related behaviors via smartphone apps combined with tailored advice has a modest but potentially clinically significant effect on blood pressure reduction. Future studies could use rigorous methods to explore its effects on supporting changes in both blood pressure and hypertension-related health behaviors to inform recommendations for policy making and service provision. Trial Registration: PROSPERO CRD42019136158; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=136158 ",
doi="10.2196/34767",
url="https://mhealth.jmir.org/2022/7/e34767",
url="http://www.ncbi.nlm.nih.gov/pubmed/35819830"
}


@Article{info:doi/10.2196/36226,
author="Ngo, Elin
and Truong, Bich-Thuy Maria
and Wright, David
and Nordeng, Hedvig",
title="Impact of a Mobile Application for Tracking Nausea and Vomiting During Pregnancy (NVP) on NVP Symptoms, Quality of Life, and Decisional Conflict Regarding NVP Treatments: MinSafeStart Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Jul",
day="5",
volume="10",
number="7",
pages="e36226",
keywords="eHealth",
keywords="mHealth",
keywords="decision support tool",
keywords="nausea and vomiting",
keywords="pregnancy",
keywords="RCT",
abstract="Background: Pregnant women are active users of mobile apps for health purposes. These apps may improve self-management of health-related conditions. Up to 70\% of pregnant women experience nausea and vomiting (NVP). Even mild NVP can significantly reduce quality of life (QoL), and it can become an economic burden for both the woman and society. NVP often occurs before the first maternal care visit; therefore, apps can potentially play an important role in empowering pregnant women to recognize, manage, and seek appropriate treatment for NVP, when required. Objective: This study investigated whether the MinSafeStart (MSS) mobile app could impact NVP-related symptoms, QoL, and decisional conflict regarding NVP treatment. Methods: This randomized controlled trial enrolled 268 pregnant women with NVP in Norway from 2019 to 2020. The intervention group had access to the MSS app, which could be used to track NVP symptoms and access tailored advice. NVP severity was rated with the Pregnancy Unique Quantification of Emesis (PUQE) score. The control group followed standard maternal care. We collected data on maternal baseline characteristics, NVP severity, QoL, and decisional conflict using 2 sets of online questionnaires. One set of questionnaires was completed at enrollment, and the other was completed after 2 weeks. We performed linear regression analyses to explore whether the use of the MSS app was associated with NVP severity, QoL, or decisional conflict. Results: Among the 268 women enrolled in the study, 192 (86.5\%) completed the baseline questionnaires and were randomized to either the intervention (n=89) or control group (n=103). In the intervention group, 88 women downloaded the app, and 468 logs were recorded. In both groups, women were enrolled at a median of 8 gestational weeks. At baseline, the average PUQE scores were 4.9 and 4.7; the average QoL scores were 146 and 149; and the average DCS scores were 40 and 43 in the intervention and control groups, respectively. The app had no impact on NVP severity (a$\beta$ 0.6, 95\% Cl ?0.1 to 1.2), QoL (a$\beta$ ?5.3, 95\% Cl ?12.5 to 1.9), or decisional conflict regarding NVP treatment (a$\beta$ ?1.1, 95\% Cl ?6.2 to 4.2), compared with standard care. Conclusions: Tracking NVP symptoms with the MSS app was not associated with improvements in NVP symptoms, QoL, or decisional conflict after 2 weeks, compared with standard care. Future studies should include a process evaluation to improve our understanding of how pregnant women use the app and how to optimize its utility within maternity care. Specifically, studies should focus on how digital tools might facilitate counseling and communication between pregnant women and health care providers regarding NVP management during pregnancy. Trial Registration: ClinicalTrails.gov (NCT04719286): https://www.clinicaltrials.gov/ct2/show/NCT04719286 ",
doi="10.2196/36226",
url="https://mhealth.jmir.org/2022/7/e36226",
url="http://www.ncbi.nlm.nih.gov/pubmed/35787487"
}


@Article{info:doi/10.2196/36690,
author="Mattison, Graeme
and Canfell, Oliver
and Forrester, Doug
and Dobbins, Chelsea
and Smith, Daniel
and T{\"o}yr{\"a}s, Juha
and Sullivan, Clair",
title="The Influence of Wearables on Health Care Outcomes in Chronic Disease: Systematic Review",
journal="J Med Internet Res",
year="2022",
month="Jul",
day="1",
volume="24",
number="7",
pages="e36690",
keywords="wearable",
keywords="chronic disease",
keywords="health care outcome",
abstract="Background: Chronic diseases contribute to high rates of disability and mortality. Patient engagement in chronic disease self-management is an essential component of chronic disease models of health care. Wearables provide patient-centered health data in real time, which can help inform self-management decision-making. Despite the perceived benefits of wearables in improving chronic disease self-management, their influence on health care outcomes remains poorly understood. Objective: This review aimed to examine the influence of wearables on health care outcomes in individuals with chronic diseases through a systematic review of the literature. Methods: A narrative systematic review was conducted by searching 6 databases for randomized and observational studies published between January 1, 2016, and July 1, 2021, that included the use of a wearable intervention in a chronic disease group to assess its impact on a predefined outcome measure. These outcomes were defined as any influence on the patient or clinician experience, cost-effectiveness, or health care outcomes as a result of the wearable intervention. Data from the included studies were extracted based on 6 key themes, which formed the basis for a narrative qualitative synthesis. All outcomes were mapped against each component of the Quadruple Aim of health care. The guidelines of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement were followed in this study. Results: A total of 30 articles were included; studies reported 2446 participants (mean age: range 10.1-74.4 years), and the influence of 14 types of wearables on 18 chronic diseases was presented. The most studied chronic diseases were type 2 diabetes (4/30, 13\%), Parkinson disease (3/30, 10\%), and chronic lower back pain (3/30, 10\%). The results were mixed when assessing the impact on a predefined primary outcome, with 50\% (15/30) of studies finding a positive influence on the studied outcome and 50\% (15/30) demonstrating a nil effect. There was a positive effect of 3D virtual reality systems on chronic pain in 7\% (2/30) of studies that evaluated 2 distinct chronic pain syndromes. Mixed results were observed in influencing exercise capacity; weight; and biomarkers of disease, such as hemoglobin A1c, in diabetes. In total, 155 outcomes were studied. Most (139/155, 89.7\%) addressed the health care outcomes component. This included pain (11/155, 7.5\%), quality of life (7/155, 4.8\%), and physical function (5/155, 3.4\%). Approximately 7.7\% (12/155) of outcome measures represented the patient experience component, with 1.3\% (2/155) addressing the clinician experience and cost. Conclusions: Given their popularity and capability, wearables may play an integral role in chronic disease management. However, further research is required to generate a strong evidence base for safe and effective implementation. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021244562; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=244562 ",
doi="10.2196/36690",
url="https://www.jmir.org/2022/7/e36690",
url="http://www.ncbi.nlm.nih.gov/pubmed/35776492"
}


@Article{info:doi/10.2196/35916,
author="Drabarek, Dorothy
and Habgood, Emily
and Janda, Monika
and Hersch, Jolyn
and Ackermann, Deonna
and Low, Don
and Low, Cynthia
and Morton, L. Rachael
and Dieng, Mbathio
and Cust, E. Anne
and Morgan, Adelaide
and Smith, Elloise
and Bell, J. Katy L.",
title="Experiences of Patient-Led Surveillance, Including Patient-Performed Teledermoscopy, in the MEL-SELF Pilot Randomized Controlled Trial: Qualitative Interview Study",
journal="JMIR Dermatol",
year="2022",
month="Jul",
day="1",
volume="5",
number="3",
pages="e35916",
keywords="melanoma",
keywords="self-surveillance",
keywords="digital technologies",
keywords="teledermoscopy",
keywords="teledermatology",
keywords="mHealth",
keywords="mobile phone",
abstract="Background: Current clinician-led melanoma surveillance models require frequent routinely scheduled clinic visits, with associated travel, cost, and time burden for patients. Patient-led surveillance is a new model of follow-up care that could reduce health care use such as clinic visits and medical procedures and their associated costs, increase access to care, and promote early diagnosis of a subsequent new melanoma after treatment of a primary melanoma. Understanding patient experiences may allow improvements in implementation. Objective: This study aims to explore patients' experiences and perceptions of patient-led surveillance during the 6 months of participation in the MEL-SELF pilot randomized controlled trial. Patient-led surveillance comprised regular skin self-examination, use of a mobile dermatoscope to image lesions of concern, and a smartphone app to track and send images to a teledermatologist for review, in addition to usual care. Methods: Semistructured interviews were conducted with patients previously treated for melanoma localized to the skin in New South Wales, Australia, who were randomized to the patient-led surveillance (intervention group) in the trial. Thematic analysis was used to analyze the data with reference to the technology acceptance model. Results: We interviewed 20 patients (n=8, 40\% women and n=12, 60\% men; median age 62 years). Patients who were more adherent experienced benefits such as increased awareness of their skin and improved skin self-examination practice, early detection of melanomas, and opportunities to be proactive in managing their clinical follow-up. Most participants experienced difficulty in obtaining clear images and technical problems with the app. These barriers were overcome or persevered by participants with previous experience with digital technology and with effective help from a skin check partner (such as a spouse, sibling, or friend). Having too many or too few moles decreased perceived usefulness. Conclusions: Patients with melanoma are receptive to and experience benefits from patient-led surveillance using teledermoscopy. Increased provision of training and technical support to patients and their skin check partners may help to realize the full potential benefits of this new model of melanoma surveillance. ",
doi="10.2196/35916",
url="https://derma.jmir.org/2022/3/e35916",
url="http://www.ncbi.nlm.nih.gov/pubmed/37632893"
}


@Article{info:doi/10.2196/32873,
author="Bhatia, Ankit
and Ewald, Gregory
and Maddox, Thomas",
title="The Novel Data Collection and Analytics Tools for Remote Patient Monitoring in Heart Failure (Nov-RPM-HF) Trial: Protocol for a Single-Center Prospective Trial",
journal="JMIR Res Protoc",
year="2022",
month="Jun",
day="30",
volume="11",
number="6",
pages="e32873",
keywords="heart failure",
keywords="remote patient monitoring",
keywords="clinical innovation",
keywords="digital health",
keywords="mHealth",
keywords="mobile health",
keywords="cardiology",
abstract="Background: Heart failure remains a leading cause of mortality and a major driver of health care utilization. Despite numerous medical advances in heart failure, associated hospitalizations continue to increase, owing largely to suboptimal outpatient management. Remote patient monitoring (RPM) aims to further address this current need in heart failure care by providing data to clinical teams to act pre-emptively to address clinical decompensation. However, to date, RPM approaches using noninvasive home-based patient sensors have failed to demonstrate clinical efficacy. Objective: The Novel Data Collection and Analytics Tools for Remote Patient Monitoring in Heart Failure (Nov-RPM-HF) Trial aims to address current noninvasive RPM limitations. Nov-RPM-HF will evaluate a clinician co-designed RPM platform using emerging data collection and presentation tools for heart failure management. These tools include a ballistocardiograph to monitor nocturnal patient biometrics, clinical alerts for abnormal biometrics, and longitudinal data presentation for clinician review. Methods: Nov-RPM-HF is a 100-patient single-center prospective trial, evaluating patients over 6 months. The outcomes will include patient adherence to data collection, patient/clinician-perceived utility of the RPM platform, medication changes including the titration of guideline-directed medical therapy to target doses, heart failure symptoms/performance status, and unplanned heart failure hospitalizations or emergency department visits. Results: This prospective trial began enrollment in March 2020 and anticipates enrollment completion by June 2022, with trial completion by December 2022. Conclusions: This trial protocol aims to provide a systematic framework for the evaluation of heart failure RPM strategies, which are currently heavily used but seldom robustly studied. The trial results will help to inform the role of noninvasive RPM as a viable clinical management strategy in heart failure care. International Registered Report Identifier (IRRID): DERR1-10.2196/32873 ",
doi="10.2196/32873",
url="https://www.researchprotocols.org/2022/6/e32873",
url="http://www.ncbi.nlm.nih.gov/pubmed/35771609"
}


@Article{info:doi/10.2196/36140,
author="Lin, Kuei Yu
and Richardson, Caroline
and Dobrin, Iulia
and Pop-Busui, Rodica
and Piatt, Gretchen
and Piette, John",
title="Accessibility and Openness to Diabetes Management Support With Mobile Phones: Survey Study of People With Type 1 Diabetes Using Advanced Diabetes Technologies",
journal="JMIR Diabetes",
year="2022",
month="Jun",
day="24",
volume="7",
number="2",
pages="e36140",
keywords="type 1 diabetes",
keywords="diabetes technology",
keywords="diabetes self-management",
keywords="diabetes",
keywords="self-management",
keywords="cross-sectional",
keywords="glucose monitor",
keywords="insulin pump",
keywords="mHealth",
keywords="mobile health",
keywords="access",
keywords="acceptability",
keywords="feasibility",
keywords="cell phone",
keywords="text message",
keywords="smartphone",
keywords="cellphone",
keywords="mobile device",
keywords="patient communication",
keywords="interactive voice response call",
keywords="glycemic control",
abstract="Background: Little is known about the feasibility of mobile health (mHealth) support among people with type 1 diabetes (T1D) using advanced diabetes technologies including continuous glucose monitoring (CGM) systems and hybrid closed-loop insulin pumps (HCLs). Objective: This study aims to evaluate patient access and openness to receiving mHealth diabetes support in people with T1D using CGM systems or HCLs. Methods: We conducted a cross-sectional survey among patients with T1D using CGM systems or HCLs managed in an academic medical center. Participants reported information regarding their mobile device use; cellular call, SMS text message, or internet connectivity; and openness to various channels of mHealth communication (smartphone apps, SMS text messages, and interactive voice response [IVR] calls). Participants' demographic characteristics and CGM data were collected from medical records. The analyses focused on differences in openness to mHealth and mHealth communication channels across groups defined by demographic variables and measures of glycemic control. Results: Among all participants (N=310; female: n=198, 63.9\%; mean age 45, SD 16 years), 98.1\% (n=304) reported active cellphone use and 80\% (n=248) were receptive to receiving mHealth support to improve glucose control. Among participants receptive to mHealth support, 98\% (243/248) were willing to share CGM glucose data for mHealth diabetes self-care assistance. Most (176/248, 71\%) were open to receiving messages via apps, 56\% (139/248) were open to SMS text messages, and 12.1\% (30/248) were open to IVR calls. Older participants were more likely to prefer SMS text messages (P=.009) and IVR calls (P=.03) than younger participants. Conclusions: Most people with T1D who use advanced diabetes technologies have access to cell phones and are receptive to receiving mHealth support to improve diabetes control. ",
doi="10.2196/36140",
url="https://diabetes.jmir.org/2022/2/e36140",
url="http://www.ncbi.nlm.nih.gov/pubmed/35749207"
}


@Article{info:doi/10.2196/36761,
author="Minen, T. Mia
and George, Alexis
and Camacho, Erica
and Yao, Leslie
and Sahu, Ananya
and Campbell, Maya
and Soviero, Mia
and Hossain, Quazi
and Verma, Deepti
and Torous, John",
title="Assessment of Smartphone Apps for Common Neurologic Conditions (Headache, Insomnia, and Pain): Cross-sectional Study",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Jun",
day="21",
volume="10",
number="6",
pages="e36761",
keywords="headache",
keywords="pain",
keywords="insomnia",
keywords="mobile health",
keywords="smartphone apps",
keywords="mobile phone",
abstract="Background: There are thousands of apps for individuals struggling with headache, insomnia, and pain, but it is difficult to establish which of these apps are best suited for patients' specific needs. If clinicians were to have access to a platform that would allow them to make an informed decision on the efficacy and feasibility of smartphone apps for patient care, they would feel confident in prescribing specific apps. Objective: We sought to evaluate the quality of apps for some of the top common, disabling neurologic conditions (headache, insomnia, and pain) based on principles derived from the American Psychiatric Association's (APA) app evaluation model. Methods: We used the Mobile Health Index and Navigation database and expanded upon the database's current supported conditions by adding 177 new app entries. Each app was rated for consistency with the APA's app evaluation model, which includes 105 objective questions based on the following 5 major classes of consideration: (1) accessibility, (2) privacy and security, (3) clinical foundation, (4) engagement style, and (5) interoperability. These characteristics were evaluated to gain a broader understanding of the significant features of each app category in comparison against a control group. Results: Approximately 90\% (187/201) of all apps evaluated were free to download, but only 50\% (63/201) of headache- and pain-related apps were truly free. Most (87/106, 81\%) sleep apps were not truly free to use. The apps had similar limitations with limited privacy, accessibility, and crisis management resources. For example, only 17\% (35/201) of the apps were available in Spanish. The apps offered mostly self-help tools with little tailoring; symptom tracking was the most common feature in headache- (32/48, 67\%) and pain-related apps (21/47, 45\%), whereas mindfulness was the most common feature in sleep-related apps (73/106, 69\%). Conclusions: Although there are many apps for headache, pain, and insomnia, all 3 types of apps have room for improvement around accessibility and privacy. Pain and headache apps share many common features, whereas insomnia apps offer mostly mindfulness-based resources. Given the many available apps to pick from, clinicians and patients should seek apps that offer the highest-quality features, such as complete privacy, remedial features, and the ability to download the app at no cost. These results suggest that there are many opportunities for the improvement of apps centered on headache, insomnia, and pain. ",
doi="10.2196/36761",
url="https://mhealth.jmir.org/2022/6/e36761",
url="http://www.ncbi.nlm.nih.gov/pubmed/35727625"
}


@Article{info:doi/10.2196/33264,
author="Islam, Shariful Sheikh Mohammed
and Mishra, Vinaytosh
and Siddiqui, Umer Muhammad
and Moses, Chandir Jeban
and Adibi, Sasan
and Nguyen, Lemai
and Wickramasinghe, Nilmini",
title="Smartphone Apps for Diabetes Medication Adherence: Systematic Review",
journal="JMIR Diabetes",
year="2022",
month="Jun",
day="21",
volume="7",
number="2",
pages="e33264",
keywords="smartphones",
keywords="digital health",
keywords="diabetes",
keywords="medication adherence",
keywords="applications",
keywords="apps",
keywords="mHealth",
keywords="mobile health",
keywords="task-technology fit",
abstract="Background: Diabetes is one of the leading noncommunicable chronic diseases globally. In people with diabetes, blood glucose levels need to be monitored regularly and managed adequately through healthy lifestyles and medications. However, various factors contribute to poor medication adherence. Smartphone apps can improve medication adherence in people with diabetes, but it is not clear which app features are most beneficial. Objective: This study aims to systematically review and evaluate high-quality apps for diabetes medication adherence, which are freely available to the public in Android and Apple app stores and present the technical features of the apps. Methods: We systematically searched Apple App Store and Google Play for apps that assist in diabetes medication adherence, using predefined selection criteria. We assessed apps using the Mobile App Rating Scale (MARS) and calculated the mean app-specific score (MASS) by taking the average of app-specific scores on 6 dimensions, namely, awareness, knowledge, attitudes, intention to change, help-seeking, and behavior change rated on a 5-point scale (1=strongly disagree and 5=strongly agree). We used the mean of the app's performance on these 6 dimensions to calculate the MASS. Apps that achieved a total MASS mean quality score greater than 4 out of 5 were considered to be of high quality in our study. We formulated a task-technology fit matrix to evaluate the apps for diabetes medication adherence. Results: We identified 8 high-quality apps (MASS score?4) and presented the findings under 3 main categories: characteristics of the included apps, app features, and diabetes medication adherence. Our framework to evaluate smartphone apps in promoting diabetes medication adherence considered physiological factors influencing diabetes and app features. On evaluation, we observed that 25\% of the apps promoted high adherence and another 25\% of the apps promoted moderate adherence. Finally, we found that 50\% of the apps provided low adherence to diabetes medication. Conclusions: Our findings show that almost half of the high-quality apps publicly available for free did not achieve high to moderate medication adherence. Our framework could have positive implications for the future design and development of apps for patients with diabetes. Additionally, apps need to be evaluated using a standardized framework, and only those promoting higher medication adherence should be prescribed for better health outcomes. ",
doi="10.2196/33264",
url="https://diabetes.jmir.org/2022/2/e33264",
url="http://www.ncbi.nlm.nih.gov/pubmed/35727613"
}


@Article{info:doi/10.2196/31230,
author="Santala, E. Onni
and Lipponen, A. Jukka
and J{\"a}ntti, Helena
and Rissanen, T. Tuomas
and Tarvainen, P. Mika
and Laitinen, P. Tomi
and Laitinen, M. Tiina
and Castr{\'e}n, Maaret
and V{\"a}liaho, Eemu-Samuli
and Rantula, A. Olli
and Naukkarinen, S. Noora
and Hartikainen, K. Juha E.
and Halonen, Jari
and Martikainen, J. Tero",
title="Continuous mHealth Patch Monitoring for the Algorithm-Based Detection of Atrial Fibrillation: Feasibility and Diagnostic Accuracy Study",
journal="JMIR Cardio",
year="2022",
month="Jun",
day="21",
volume="6",
number="1",
pages="e31230",
keywords="atrial fibrillation",
keywords="heart rate variability",
keywords="HRV",
keywords="algorithm",
keywords="stroke",
keywords="mobile health",
keywords="mHealth",
keywords="Awario analysis Service, screening",
keywords="risk",
keywords="stroke risk",
keywords="heart rate",
keywords="feasibility",
keywords="reliability",
keywords="artificial intelligence",
keywords="mobile patch",
keywords="wearable",
keywords="arrhythmia",
keywords="screening",
abstract="Background: The detection of atrial fibrillation (AF) is a major clinical challenge as AF is often paroxysmal and asymptomatic. Novel mobile health (mHealth) technologies could provide a cost-effective and reliable solution for AF screening. However, many of these techniques have not been clinically validated. Objective: The purpose of this study is to evaluate the feasibility and reliability of artificial intelligence (AI) arrhythmia analysis for AF detection with an mHealth patch device designed for personal well-being. Methods: Patients (N=178) with an AF (n=79, 44\%) or sinus rhythm (n=99, 56\%) were recruited from the emergency care department. A single-lead, 24-hour, electrocardiogram-based heart rate variability (HRV) measurement was recorded with the mHealth patch device and analyzed with a novel AI arrhythmia analysis software. Simultaneously registered 3-lead electrocardiograms (Holter) served as the gold standard for the final rhythm diagnostics. Results: Of the HRV data produced by the single-lead mHealth patch, 81.5\% (3099/3802 hours) were interpretable, and the subject-based median for interpretable HRV data was 99\% (25th percentile=77\% and 75th percentile=100\%). The AI arrhythmia detection algorithm detected AF correctly in all patients in the AF group and suggested the presence of AF in 5 patients in the control group, resulting in a subject-based AF detection accuracy of 97.2\%, a sensitivity of 100\%, and a specificity of 94.9\%. The time-based AF detection accuracy, sensitivity, and specificity of the AI arrhythmia detection algorithm were 98.7\%, 99.6\%, and 98.0\%, respectively. Conclusions: The 24-hour HRV monitoring by the mHealth patch device enabled accurate automatic AF detection. Thus, the wearable mHealth patch device with AI arrhythmia analysis is a novel method for AF screening. Trial Registration: ClinicalTrials.gov NCT03507335; https://clinicaltrials.gov/ct2/show/NCT03507335 ",
doi="10.2196/31230",
url="https://cardio.jmir.org/2022/1/e31230",
url="http://www.ncbi.nlm.nih.gov/pubmed/35727618"
}


@Article{info:doi/10.2196/29481,
author="Praus, Friederike
and Krzowski, Bartosz
and Walther, Tabea
and Gratzke, Christian
and Balsam, Pawe?
and Miernik, Arkadiusz
and Pohlmann, Fabian Philippe",
title="Smartphone Apps for Managing Antithrombotic Therapy: Scoping Literature Review",
journal="JMIR Cardio",
year="2022",
month="Jun",
day="21",
volume="6",
number="1",
pages="e29481",
keywords="anticoagulation",
keywords="mobile app",
keywords="telehealth",
keywords="telemedicine",
keywords="mHealth",
keywords="smartphone",
keywords="educational apps",
keywords="digital tools",
keywords="physician support",
abstract="Background: Antithrombotic therapy is complex and requires informed decisions and high therapy adherence. Several mobile phone apps exist to either support physicians in the management of antithrombotic therapies or to educate and support patients. For the majority of these apps, both their medical evidence and their development background are unknown. Objective: This review aims to investigate the available literature describing high-quality apps for managing antithrombotic therapy based on professional scientific information. Methods: Keywords and Medical Subject Heading terms were used to search MEDLINE via PubMed and Ovid between December 2019 and January 2022. Inclusion criteria were the availability of full text and publications in the English language. Apps that solely focused on atrial fibrillation were excluded. Qualitative findings were thematically synthesized and reported narratively. Results: Out of 149 identified records, 32 were classified as eligible. We identified four groups: (1) apps for patients supporting self-management of vitamin K antagonists, (2) apps for patients increasing therapy adherence, (3) educational apps for patients, and (4) apps for physicians in supporting guideline adherence. Conclusions: Throughout the evaluated data, patients from all age groups receiving antithrombotic drugs expressed the desire for a digital tool that could support their therapy management. In addition, physicians using mobile guideline-based apps may have contributed to decreased adverse event rates among their patients. In general, digital apps encompassing both user-friendly designs and scientific backgrounds may enhance the safety of antithrombotic therapies. However, our evaluation did not identify any apps that addressed all antithrombotic drugs in combination with perioperative stratification strategies. Currently, strict regulations for smartphone apps seem to negatively affect the development of new apps. Therefore, new legal policies for medical digital apps are urgently needed. ",
doi="10.2196/29481",
url="https://cardio.jmir.org/2022/1/e29481",
url="http://www.ncbi.nlm.nih.gov/pubmed/35727608"
}


@Article{info:doi/10.2196/31652,
author="Gosak, Lucija
and Pajnkihar, Majda
and Stiglic, Gregor",
title="The Impact of Mobile Health Use on the Self-care of Patients With Type 2 Diabetes: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="Jun",
day="17",
volume="11",
number="6",
pages="e31652",
keywords="diabetes",
keywords="mobile application",
keywords="disease management",
keywords="self-care",
abstract="Background: Chronic diseases are a substantial public health issue worldwide and affect an individual's quality of life. Due to the alarming rise in type 2 diabetes, health care that was primarily focused on diagnosis and treatment of the disease is increasingly focused on prevention and self-care. Patients who adhere to a constant and strict treatment regimen (physical activity, diet, medication) and regularly monitor their health are more likely to maintain self-care and health, prevent the exacerbation of the disease, and avoid the complications of diabetes (retinopathy, diabetic feet, etc). In recent years, many innovative devices that have become increasingly present in inpatient health care, such as mobile apps, are available to help patients maintain consistency in monitoring their health status. Mobile apps make it easier for individuals to monitor their self-care and illness and follow instructions regarding disease control. Objective: This study aims to determine the impact of mobile app use on self-care in patients with type 2 diabetes. We will evaluate and test the usefulness of the forDiabetes app as a tool to improve the self-care of individuals with type 2 diabetes. Methods: We will perform a double-blind randomized controlled trial. The study will include individuals aged over 18 years diagnosed with or have regulated type 2 diabetes who are treated in family medicine practices. Additionally, the individuals included in the study should not have any acute complications due to the consequences of type 2 diabetes. They will use an Android or iOS mobile phone and a blood glucose meter during the investigation. With the help of simple randomization, individuals will be divided into the intervention and control groups. Individuals in the intervention group will use the forDiabetes mobile app to monitor their self-care for type 2 diabetes. Individuals in the control group will not receive a particular intervention. Data will be collected using the Self-care of Diabetes Inventory questionnaire and Brief Illness Perception Questionnaire. Blood sugar, blood pressure, glycated hemoglobin (HbA1c), and weight measurements will be monitored using calibrated instruments during the study by the nurses employed at the family medicine practice. Data will be collected at the beginning of the study and after a patient visits the family medicine practice. Results: In the first half of 2020, we have prepared a translation of the mobile app that will be used by the participants of the intervention group, as well as more detailed instructions for using the app. We have also prepared a translation of the questionnaires in Slovene. The research results will be published in 2023. Conclusions: This research contributes to greater visibility and usability of mobile apps for the self-care of patients with type 2 diabetes and raises awareness of the possible use of innovative methods. Trial Registration: Clinicaltrials.gov NCT04999189; https://clinicaltrials.gov/ct2/show/NCT04999189 International Registered Report Identifier (IRRID): PRR1-10.2196/31652 ",
doi="10.2196/31652",
url="https://www.researchprotocols.org/2022/6/e31652",
url="http://www.ncbi.nlm.nih.gov/pubmed/35713944"
}


@Article{info:doi/10.2196/31764,
author="Chang, Ya-Ting
and Tu, Yu-Zhen
and Chiou, Hung-Yi
and Lai, Ken
and Yu, Chun Neng",
title="Real-world Benefits of Diabetes Management App Use and Self-monitoring of Blood Glucose on Glycemic Control: Retrospective Analyses",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Jun",
day="15",
volume="10",
number="6",
pages="e31764",
keywords="diabetes care",
keywords="digital intervention",
keywords="mobile app",
keywords="real-world data",
keywords="glycemic control",
keywords="mobile health",
keywords="digital therapeutics",
keywords="diabetes",
keywords="therapy",
keywords="app",
abstract="Background: Among self-care measures, the self-monitoring of blood glucose (SMBG) is a critical component for checking blood glucose levels. In addition, there is growing evidence suggesting that digital technologies are being adopted as an additional method for health care systems to increase patient contact. However, for patients with non--insulin-treated diabetes mellitus type 2 (DMT2), the value of SMBG was inconsistent among studies, and the evidence for digital technologies from real-world clinical practice is still limited. Objective: Our study aimed to assess patients with non--insulin-treated DMT2 who were receiving care from a single clinic and analyze whether the use of a diabetes management app and SMBG behavior would affect glycemic control in a real-world clinical setting. Methods: We collaborated with a large clinic focused on diabetes care in Taiwan that had been using the Health2Sync mobile app and web-based Patient Management Platform to collect the data. The patients were divided into 2 groups (app-engaged-user group and only-data-uploader group) according to different activities in the app, and blood glucose was recorded every month from 1 to 6 months after registration in the app. A sample of 420 patients was included in the analysis, and a linear mixed model was built to investigate which factors affected the patients' blood glucose percentage change. Results: Using the mixed model coefficient estimates, we found that the percentage change was significantly negative when the only-data-uploader group was set as the baseline (t=--3.873, df=1.81 {\texttimes} 104; P<.001 for the patients of the app-engaged-user group). We found that for patients with shorter diabetes duration, their blood glucose decreased more than patients with longer diabetes duration (t=2.823, df=1.71 {\texttimes} 104; P=.005 for the number of years of diabetes duration). In addition, we found that for younger patients, their blood glucose decreased more than older patients (t=2.652, df=1.71 {\texttimes} 104; P=.008 for the age of the patients). Furthermore, the patients with an education level of junior high school or lower saw a significantly greater decrease in blood glucose percentage change than the patients with an education level of senior high school or higher (t=4.996, df=1.72 {\texttimes} 104; P<.001 for the patients with an education level of senior high school or higher). We also found that the count of blood glucose measured enlarged the decrease along the interaction months (t=--8.266, df=1.97 {\texttimes} 104; P<.001 for the nth month {\texttimes} the count of blood glucose in the nth month). Lastly, the gender of the patients did not significantly affect the percentage change (t=0.534, df=1.74 {\texttimes} 104; P=.59 for female patients). Conclusions: Our analysis showed the following: the blood glucose percentage change of the patients in the app-engaged-user group dropped more than that in the only-data-uploader group; shorter diabetes duration is associated with a steeper decrease in the patients' blood glucose percentage change; the percentage decrease in blood glucose change in younger patients is greater than older patients; the blood glucose percentage change of the patients with an education level of junior high school or lower dropped more than those with an education level of senior high school or higher; and the more frequently the patients test SMBG each month, the greater the decrease in the patients' blood glucose percentage. Further studies can be performed to consider the differences in daily behaviors such as exercise and diet across the patients and whether these factors could have vital effects on glycemic control. ",
doi="10.2196/31764",
url="https://mhealth.jmir.org/2022/6/e31764",
url="http://www.ncbi.nlm.nih.gov/pubmed/35704371"
}


@Article{info:doi/10.2196/37084,
author="Yu, Hong
and Tan, Lingcan
and Teng, Yi
and Xu, Zhao
and Xiao, Kun
and Yin, Jin
and Zuo, Yunxia
and Zhu, Tao
and Deng, Xiaoqian",
title="The First National Remote Emergency System for Malignant Hyperthermia (MH-NRES) in China: Protocol for the Design, Development, and Evaluation of a WeChat Applet",
journal="JMIR Res Protoc",
year="2022",
month="Jun",
day="10",
volume="11",
number="6",
pages="e37084",
keywords="malignant hyperthermia",
keywords="hyperthermia",
keywords="anesthetic",
keywords="anesthesia",
keywords="anesthesiology",
keywords="anesthesiologist",
keywords="mHealth",
keywords="mobile health",
keywords="health app",
keywords="evaluation",
keywords="user experience",
keywords="perception",
keywords="development",
keywords="uni-app",
keywords="digital health",
keywords="national remote emergency system",
keywords="WeChat",
keywords="emergency",
keywords="WeChat applet",
keywords="dantrolene",
keywords="China",
keywords="Chinese",
keywords="applet",
keywords="messaging app",
keywords="calling app",
keywords="diagnosis",
keywords="diagnostic service",
abstract="Background: Malignant hyperthermia (MH) is a rare life-threatening anesthetic emergency. With respect to the high fatality rate, difficulty in early recognition, and the lack of disease-specific drug (ie, dantrolene) in China, more effort is needed to strengthen early diagnosis and effective treatment of MH emergencies. Nowadays, mobile health (mHealth) apps are changing the way of medical practice; they can serve as an accessible tool to help anesthesiologists deal with MH crises. However, no related mHealth-based emergency system is available currently. Objective: The aim of this study is to outline the protocol for the development of a WeChat applet used to design a National Remote Emergency System for Malignant Hyperthermia (MH-NRES) in China, as well as the protocol for the evaluation of the user experience and perception of the system. Methods: The system adopts the client-server architecture, with a custom user interface operating as clients and the back-end system operating as the server. The client-side software was developed using uni-app technology with Vue.js-based framework, which consists of 6 modules: Quick Diagnosis, Dantrolene Mobilization, Instruction on Dantrolene Use, MH Treatment, Recovery Period Treatment, and DNA Test and Biopsy. The back-end system was developed based on the Spring framework. The system will be evaluated by administrating a modified user version of the Mobile App Rating Scale. Pilot testing will be conducted in Sichuan Province, China, and a subsequent evaluation on a national scale is planned. Results: The theoretical framework design of this system was completed in August 2021. The development of the system was completed in February 2022, and the refinement is currently ongoing. Pilot testing after the implementation of the system in Sichuan Province is planned to take 2 months, and the subsequent evaluation on a national scale is planned to take 2 months. Conclusions: We have described a novel approach using the WeChat applet to develop the MH-NRES. Findings from the usability testing process in the current study may lead to refinements and is expected to suggest that this system is both feasible and welcomed by anesthesiologists. Depending on the availability of research funding, this system will be extended nationally across China. International Registered Report Identifier (IRRID): PRR1-10.2196/37084 ",
doi="10.2196/37084",
url="https://www.researchprotocols.org/2022/6/e37084",
url="http://www.ncbi.nlm.nih.gov/pubmed/35687418"
}


@Article{info:doi/10.2196/35053,
author="Bhatt, Paras
and Liu, Jia
and Gong, Yanmin
and Wang, Jing
and Guo, Yuanxiong",
title="Emerging Artificial Intelligence--Empowered mHealth: Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Jun",
day="9",
volume="10",
number="6",
pages="e35053",
keywords="mobile health units",
keywords="telemedicine",
keywords="machine learning",
keywords="artificial intelligence",
keywords="review literature as topic",
abstract="Background: Artificial intelligence (AI) has revolutionized health care delivery in recent years. There is an increase in research for advanced AI techniques, such as deep learning, to build predictive models for the early detection of diseases. Such predictive models leverage mobile health (mHealth) data from wearable sensors and smartphones to discover novel ways for detecting and managing chronic diseases and mental health conditions. Objective: Currently, little is known about the use of AI-powered mHealth (AIM) settings. Therefore, this scoping review aims to map current research on the emerging use of AIM for managing diseases and promoting health. Our objective is to synthesize research in AIM models that have increasingly been used for health care delivery in the last 2 years. Methods: Using Arksey and O'Malley's 5-point framework for conducting scoping reviews, we reviewed AIM literature from the past 2 years in the fields of biomedical technology, AI, and information systems. We searched 3 databases, PubsOnline at INFORMS, e-journal archive at MIS Quarterly, and Association for Computing Machinery (ACM) Digital Library using keywords such as ``mobile healthcare,'' ``wearable medical sensors,'' ``smartphones'', and ``AI.'' We included AIM articles and excluded technical articles focused only on AI models. We also used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) technique for identifying articles that represent a comprehensive view of current research in the AIM domain. Results: We screened 108 articles focusing on developing AIM models for ensuring better health care delivery, detecting diseases early, and diagnosing chronic health conditions, and 37 articles were eligible for inclusion, with 31 of the 37 articles being published last year (76\%). Of the included articles, 9 studied AI models to detect serious mental health issues, such as depression and suicidal tendencies, and chronic health conditions, such as sleep apnea and diabetes. Several articles discussed the application of AIM models for remote patient monitoring and disease management. The considered primary health concerns belonged to 3 categories: mental health, physical health, and health promotion and wellness. Moreover, 14 of the 37 articles used AIM applications to research physical health, representing 38\% of the total studies. Finally, 28 out of the 37 (76\%) studies used proprietary data sets rather than public data sets. We found a lack of research in addressing chronic mental health issues and a lack of publicly available data sets for AIM research. Conclusions: The application of AIM models for disease detection and management is a growing research domain. These models provide accurate predictions for enabling preventive care on a broader scale in the health care domain. Given the ever-increasing need for remote disease management during the pandemic, recent AI techniques, such as federated learning and explainable AI, can act as a catalyst for increasing the adoption of AIM and enabling secure data sharing across the health care industry. ",
doi="10.2196/35053",
url="https://mhealth.jmir.org/2022/6/e35053",
url="http://www.ncbi.nlm.nih.gov/pubmed/35679107"
}


@Article{info:doi/10.2196/23641,
author="Treacy-Abarca, Sean
and Mercado, Janisse
and Serrano, Jorge
and Gonzalez, Jennifer
and Menchine, Michael
and Arora, Sanjay
and Wu, Shinyi
and Burner, Elizabeth",
title="Technological Proficiencies, Engagement, and Practical Considerations for mHealth Programs at an Urban Safety-Net Hospital Emergency Departments: Data Analysis",
journal="JMIR Diabetes",
year="2022",
month="Jun",
day="6",
volume="7",
number="2",
pages="e23641",
keywords="mHealth",
keywords="engagement",
keywords="practical considerations",
keywords="safety-net hospital",
keywords="emergency department",
keywords="minority health",
keywords="low income",
abstract="Background: Safety-net emergency departments often serve as the primary entry point for medical care for low income predominantly minority patient populations. Herein, we sought to provide insight into the feasibility, technological proficiencies, engagement characteristics, and practical considerations for a mHealth intervention at a safety-net emergency department. Objective: We aimed to analyze patient technological proficiency to understand the feasibility of and draw practical considerations for mobile phone technology (mHealth) solutions for patients with chronic disease served by safety-net emergency departments. Methods: We analyzed data from a previous diabetes randomized clinical mHealth trial for a diabetes social support intervention. Patients from a safety-net emergency department with preexisting diabetes who used SMS text messages, owned a mobile phone, and with hemoglobin A1c levels >8.5\% were enrolled. A text message--based mHealth program to improve disease self-management was provided to all patients. Supporters of patients were randomized to receive a mailed copy or mHealth-based curriculum designed to improve diabetes support. Among enrolled patients, we surveyed mobile technological capacity and frequency of use. We performed latent class analysis to identify classes of patients by level of technological proficiency and compared demographic characteristics between the latent classes to identify demographic subgroups that may require more training or tailoring of the mHealth approach. Study engagement between classes was assessed by comparing the mean number of text messages exchanged, loss to follow-up, and early termination. Results: Of 1876 patients who were approached, 44.2\% (n=829) of patients had a stable mobile phone and were able to use text messages. Among them 166 met the trial inclusion and enrolled, 90\% (149/166) of the cohort were ethnically diverse. Significant variance was found in technology capacity and frequency of use. Our latent class analysis classified 75\% (124/166) of patients as highly technologically proficient and 25\% (42/166) patients as minimally technologically proficient. Age (P<.001) and level of education (P<.001) were associated with class membership. Highly technologically proficient patients were younger and had higher levels of education (45.74 years old; high school or more: 90\%) than minimally technologically proficient patients (53.64 years old; high school or more: 18\%). Highly technologically proficient participants exchanged a mean of 40 text messages with the system coordinators compared to a mean of 10 text messages by minimally technologically proficient patients (P<.001). Conclusions: This study found that nearly half of the patients screened at the safety-net emergency department were equipped for an SMS text message--based mHealth intervention. In the small sample of patients who were enrolled, the majority were classified as highly technologically proficient. These highly proficient patients had greater study engagement. mHealth use in emergency departments may be an opportunity to improve health of ethnically diverse populations by pairing sophisticated chronic disease self-management program with SMS text message--based and traditional in-person interventions to reach patients through the method that is most familiar and comfortable. International Registered Report Identifier (IRRID): RR2-10.1016/j.cct.2019.03.003 ",
doi="10.2196/23641",
url="https://diabetes.jmir.org/2022/2/e23641",
url="http://www.ncbi.nlm.nih.gov/pubmed/35666555"
}


@Article{info:doi/10.2196/31491,
author="Dramburg, Stephanie
and Perna, Serena
and Di Fraia, Marco
and Tripodi, Salvatore
and Arasi, Stefania
and Castelli, Sveva
and Villalta, Danilo
and Buzzulini, Francesca
and Sfika, Ifigenia
and Villella, Valeria
and Potapova, Ekaterina
and Brighetti, Antonia Maria
and Travaglini, Alessandro
and Verardo, Pierluigi
and Pelosi, Simone
and Matricardi, Maria Paolo",
title="Validation Parameters of Patient-Generated Data for Digitally Recorded Allergic Rhinitis Symptom and Medication Scores in the @IT.2020 Project: Exploratory Study",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Jun",
day="3",
volume="10",
number="6",
pages="e31491",
keywords="allergic rhinitis",
keywords="symptom scores",
keywords="patient-generated data",
keywords="patient-reported outcomes",
keywords="mHealth",
keywords="mobile health",
keywords="health applications",
keywords="allergies",
keywords="allergy monitor",
keywords="digital health",
keywords="medication scores",
abstract="Background: Mobile health technologies enable allergists to monitor disease trends by collecting daily patient-reported outcomes of allergic rhinitis. To this end, patients with allergies are usually required to enter their symptoms and medication repetitively over long time periods, which may present a risk to data completeness and quality in the case of insufficient effort reporting. Completeness of patient's recording is easily measured. In contrast, the intrinsic quality and accuracy of the data entered by the patients are more elusive. Objective: The aim of this study was to explore the association of adherence to digital symptom recording with a predefined set of parameters of the patient-generated symptom and medication scores and to identify parameters that may serve as proxy measure of the quality and reliability of the information recorded by the patient. Methods: The @IT.2020 project investigates the diagnostic synergy of mobile health and molecular allergology in patients with seasonal allergic rhinitis. In its pilot phase, 101 children with seasonal allergic rhinitis were recruited in Rome and instructed to record their symptoms, medication intake, and general conditions daily via a mobile app (AllergyMonitor) during the relevant pollen season. We measured adherence to daily recording as the percentage of days with data recording in the observation period. We examined the patient's trajectories of 3 disease indices (Rhinoconjunctivitis Total Symptom Score [RTSS], Combined Symptom and Medication Score [CSMS], and Visual Analogue Scale [VAS]) as putative proxies of data quality with the following 4 parameters: (1) intravariation index, (2) percentage of zero values, (3) coefficient of variation, and (4) percentage of changes in trend. Lastly, we examined the relationship between adherence to recording and each of the 4 proxy measures. Results: Adherence to recording ranged from 20\% (11/56) to 100\% (56/56), with 64.4\% (65/101) and 35.6\% (36/101) of the patients' values above (highly adherent patients) or below (low adherent patients) the threshold of 80\%, respectively. The percentage of zero values, the coefficient of variation, and the intravariation index did not significantly change with the adherence to recording. By contrast, the proportion of changes in trend was significantly higher among highly adherent patients, independently from the analyzed score (RTSS, CSMS, and VAS). Conclusions: The percentage of changes in the trend of RTSS, CSMS, and VAS is a valuable candidate to validate the quality and accuracy of the data recorded by patients with allergic rhinitis during the pollen season. The performance of this parameter must be further investigated in real-life conditions before it can be recommended for routine use in apps and electronic diaries devoted to the management of patients with allergic rhinitis. ",
doi="10.2196/31491",
url="https://mhealth.jmir.org/2022/6/e31491",
url="http://www.ncbi.nlm.nih.gov/pubmed/35657659"
}


@Article{info:doi/10.2196/35086,
author="Pinto da Costa, Mariana
and ",
title="An Intervention to Connect Patients With Psychosis and Volunteers via Smartphone (the Phone Pal): Development Study",
journal="JMIR Form Res",
year="2022",
month="Jun",
day="2",
volume="6",
number="6",
pages="e35086",
keywords="intervention",
keywords="intervention development",
keywords="digital mental health",
keywords="psychosis",
keywords="severe mental illness",
keywords="volunteering",
keywords="volunteer",
keywords="mental health",
keywords="mental illness",
keywords="development",
keywords="design",
keywords="user centered design",
keywords="smartphone",
keywords="mobile phone",
keywords="mobile health",
keywords="mHealth",
keywords="MRC framework",
keywords="Medical Research Council framework",
abstract="Background: Intervention development is a critical stage. However, evidence indicates that the substandard reporting of intervention details is widespread. Objective: This study aimed to provide an overview of the guiding frameworks, methodology, and stages for the design and construction of a new complex intervention---the Phone Pal. Methods: The intervention development process followed the Medical Research Council framework for developing complex interventions as well as the person-based approach. The intervention was developed following the evidence synthesis of a literature review, a focus group study, and a survey after consultation and input from advisory groups with a range of stakeholders, including patients, volunteers, clinicians, and academics. Results: The developed logic model outlines the contextual factors, intervention, mechanisms of change, and short- and long-term outcomes. The operationalized intervention required matching 1 patient with 1 volunteer to communicate with each other through a smartphone via SMS text messages, WhatsApp messages or email, and audio or video calls. Each participant was encouraged to communicate with their match at least once per week for a 12-week period using informal conversation. Conclusions: The systematic process and theoretically sound strategy through which this intervention was developed can provide insights to future researchers on the reality of developing and preparing the operationalization of a digital intervention using multiple components. ",
doi="10.2196/35086",
url="https://formative.jmir.org/2022/6/e35086",
url="http://www.ncbi.nlm.nih.gov/pubmed/35653171"
}


@Article{info:doi/10.2196/32147,
author="Apantaku, Glory
and Mitton, Craig
and Wong, Hubert
and Ho, Kendall",
title="Home Telemonitoring Technology for Patients With Heart Failure: Cost-Consequence Analysis of a Pilot Study",
journal="JMIR Form Res",
year="2022",
month="Jun",
day="2",
volume="6",
number="6",
pages="e32147",
keywords="cost-consequence analysis",
keywords="feasibility study",
keywords="pilot study",
keywords="heart failure",
keywords="cardiology",
keywords="cardiovascular disease",
keywords="economic analysis",
keywords="telehealth",
keywords="health care cost",
keywords="home monitoring",
keywords="digital monitor",
keywords="health monitor",
abstract="Background: Heart failure (HF) is a costly health condition and a major public health problem. It is estimated that 2\%-3\% of the population in developed countries has HF, and the prevalence increases to 8\% among patients aged ?75 years. Home telemonitoring is a form of noninvasive, remote patient monitoring that aims to improve the care and management of patients with chronic HF. Telehealth for Emergency-Community Continuity of Care Connectivity via Home-Telemonitoring (TEC4Home) is a project that implements and evaluates a comprehensive home monitoring protocol designed to support patients with HF as they transition from the emergency department to home. Objective: The aim of this study is to assess the cost of using the home monitoring platform (TEC4Home) relative to usual care for patients with HF. Methods: This study is a cost-consequence analysis of the TEC4Home pilot study. The analysis was conducted from a partial societal perspective, including direct and indirect health care costs. The aim is to assess the costs of the home monitoring platform relative to usual care and track costs related to health care utilization during the 90-day postdischarge period. Results: Economic analysis of the TEC4Home pilot study showed a positive trend in cost savings for patients using TEC4Home. From both the health system perspective (Pre TEC4Home cost per patient: CAD \$2924 vs post TEC4Home cost per patient: CAD \$1293; P=.01) and partial societal perspective (Pre TEC4Home cost per patient: CAD \$2411 vs post TEC4Home cost per patient: CAD \$1108; P=.01), we observed a statistically significant cost saving per patient. Conclusions: In line with the advantages of conducting an economic analysis alongside a feasibility study, the economic analysis of the TEC4Home pilot study facilitated the piloting of patient questionnaires and informed the methodology for a full clinical trial. ",
doi="10.2196/32147",
url="https://formative.jmir.org/2022/6/e32147",
url="http://www.ncbi.nlm.nih.gov/pubmed/35653179"
}


@Article{info:doi/10.2196/36065,
author="Schmeelk, Suzanna
and Davis, Alison
and Li, Qiaozheng
and Shippey, Caroline
and Utah, Michelle
and Myers, Annie
and Reading Turchioe, Meghan
and Masterson Creber, Ruth",
title="Monitoring Symptoms of COVID-19: Review of Mobile Apps",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Jun",
day="1",
volume="10",
number="6",
pages="e36065",
keywords="COVID-19",
keywords="mobile apps",
keywords="mobile health",
keywords="mHealth",
keywords="symptom assessment",
keywords="symptom tracking",
keywords="public health",
keywords="mobile health application",
keywords="surveillance",
keywords="digital surveillance",
keywords="monitoring system",
keywords="digital health",
abstract="Background: Mobile health (mHealth) apps have facilitated symptom monitoring of COVID-19 symptoms globally and have been used to share data with health care professionals and support disease prediction, prevention, management, diagnostics, and improvements in treatments and patient education. Objective: The aim of this review is to evaluate the quality and functionality of COVID-19 mHealth apps that support tracking acute and long-term symptoms of COVID-19. Methods: We systematically reviewed commercially available mHealth apps for COVID-19 symptom monitoring by searching Google Play and Apple iTunes using search terms such as ``COVID-19,'' ``Coronavirus,'' and ``COVID-19 and symptoms.'' All apps underwent three rounds of screening. The final apps were independently assessed using the Mobile Application Rating Scale (MARS), an informatics functionality scoring system, and the Center for Disease Control and World Health Organization symptom guidelines. The MARS is a 19-item standardized tool to evaluate the quality of mHealth apps on engagement, functionality, aesthetics, and information quality. Functionality was quantified across the following criteria: inform, instruct, record (collect, share, evaluate, and intervene), display, guide, remind or alert, and communicate. Interrater reliability between the reviewers was calculated. Results: A total of 1017 mobile apps were reviewed, and 20 (2\%) met the inclusion criteria. The majority of the 20 included apps (n=18, 90\%) were designed to track acute COVID-19 symptoms, and only 2 (10\%) addressed long-term symptoms. Overall, the apps scored high on quality, with an overall MARS rating of 3.89 out of 5, and the highest domain score for functionality (4.2). The most common functionality among all apps was the instruct function (n=19, 95\%). The most common symptoms included in the apps for tracking were fever and dry cough (n=18, 90\%), aches and pains (n=17, 85\%), difficulty breathing (n=17, 85\%), tiredness, sore throat, headache, loss of taste or smell (n=16, 80\%), and diarrhea (n=15, 75\%). Only 2 (10\%) apps specifically tracked long-term symptoms of COVID-19. The top 4 rated apps overall were state-specific apps developed and deployed for public use. Conclusions: Overall, mHealth apps designed to monitor symptoms of COVID-19 were of high quality, but the majority of apps focused almost exclusively on acute symptoms. Future apps should also incorporate monitoring long-term symptoms of COVID-19 and evidence-based educational materials; they should also include a feature that would allow patients to communicate their symptoms to specific caregivers or their own health care team. App developers should also follow updated technical and clinical guidelines from the Center for Disease Control and the World Health Organization. ",
doi="10.2196/36065",
url="https://mhealth.jmir.org/2022/6/e36065",
url="http://www.ncbi.nlm.nih.gov/pubmed/35609313"
}


@Article{info:doi/10.2196/34017,
author="Lull, Christian
and von Ahnen, Alwin Jan
and Gross, Georg
and Olsavszky, Victor
and Knitza, Johannes
and Leipe, Jan
and Schmieder, Astrid",
title="German Mobile Apps for Patients With Psoriasis: Systematic Search and Evaluation",
journal="JMIR Mhealth Uhealth",
year="2022",
month="May",
day="26",
volume="10",
number="5",
pages="e34017",
keywords="psoriasis",
keywords="eHealth",
keywords="mHealth",
keywords="telemedicine",
keywords="teledermatology",
keywords="disease management",
keywords="smartphone application",
keywords="mental health",
keywords="mobile health",
keywords="health app",
keywords="dermatology",
keywords="skin",
abstract="Background: Psoriasis is a chronic inflammatory skin disease. The visibility of erythematous plaques on the skin as well as the pain and itchiness caused by the skin lesions frequently leads to psychological distress in patients. Smartphone apps are widespread and easily accessible. Earlier studies have shown that apps can effectively complement current management strategies for patients with psoriasis. However, no analysis of such apps has been published to date. Objective: The aim of this study is to systematically identify and objectively assess the quality of current publicly available German apps for patients with psoriasis using the Mobile Application Rating Scale (MARS) and compile brief ready-to-use app descriptions. Methods: We conducted a systematic search and assessment of German apps for patients with psoriasis available in the Google Play Store and Apple App Store. The identified apps were randomly assigned to 1 of 3 reviewers, who independently rated them using the German MARS (MARS-G). The MARS-G includes 15 items from 4 different sections (engagement, functionality, aesthetics, and information) to create an overall mean score for every app. Scores can range from 1 for the lowest-quality apps to 5 for the highest-quality apps. Apps were ranked according to their mean MARS-G rating, and the highest-ranked app was evaluated independently by 2 patients with psoriasis using the user version of the MARS-G (uMARS-G). Furthermore, app information, including origin, main function, and technical aspects, was compiled into a brief overview. Results: In total, we were able to identify 95 unique apps for psoriasis, of which 15 were available in both app stores. Of these apps, 5 were not specifically intended for patients with psoriasis, 1 was designed for clinical trials only, and 1 was no longer available at the time the evaluation process began. Consequently, the remaining 8 apps were included in the final evaluation. The mean MARS-G scores ranged from 3.51 to 4.18. The app with the highest mean MARS-G score was Psoriasis Helferin (4.18/5.00). When rated by patients, however, the app was rated lower in all subcategories, resulting in a mean uMARS-G score of 3.48. Most apps had a commercial background and a focus on symptom tracking. However, only a fraction of the apps assessed used validated instruments to measure the user's disease activity. Conclusions: App quality was heterogeneous, and only a minority of the identified apps were available in both app stores. When evaluated by patients, app ratings were lower than when evaluated by health care professionals. This discrepancy highlights the importance of involving patients when developing and evaluating health-related apps as the factors that make an app appealing to users may differ between these 2 groups. Trial Registration: Deutsches Register Klinischer Studien DRKS00020963; https://tinyurl.com/ye98an5b ",
doi="10.2196/34017",
url="https://mhealth.jmir.org/2022/5/e34017",
url="http://www.ncbi.nlm.nih.gov/pubmed/35617014"
}


@Article{info:doi/10.2196/34339,
author="Agnew, R. Jonathon M.
and Nugent, Chris
and Hanratty, E. Catherine
and Martin, Elizabeth
and Kerr, P. Daniel
and McVeigh, G. Joseph",
title="Rating the Quality of Smartphone Apps Related to Shoulder Pain: Systematic Search and Evaluation Using the Mobile App Rating Scale",
journal="JMIR Form Res",
year="2022",
month="May",
day="26",
volume="6",
number="5",
pages="e34339",
keywords="mobile app",
keywords="shoulder pain",
keywords="mHealth",
keywords="Mobile App Rating Scale",
keywords="mobile phone",
abstract="Background: The successful rehabilitation of musculoskeletal pain requires more than medical input alone. Conservative treatment, including physiotherapy and exercise therapy, can be an effective way of decreasing pain associated with musculoskeletal pain. However, face-to-face appointments are currently not feasible. New mobile technologies, such as mobile health technologies in the form of an app for smartphones, can be a solution to this problem. In many cases, these apps are not backed by scientific literature. Therefore, it is important that they are reviewed and quality assessed. Objective: The aim is to evaluate and measure the quality of apps related to shoulder pain by using the Mobile App Rating Scale. Methods: This study included 25 free and paid apps---8 from the Apple Store and 17 from the Google Play Store. A total of 5 reviewers were involved in the evaluation process. A descriptive analysis of the Mobile App Rating Scale results provided a general overview of the quality of the apps. Results: Overall, app quality was generally low, with an average star rating of 1.97 out of 5. The best scores were in the ``Functionality'' and ``Aesthetics'' sections, and apps were scored poorer in the ``Engagement'' and ``Information'' sections. The apps were also rated poorly in the ``Subjective Quality'' section. Conclusions: In general, the apps were well built technically and were aesthetically pleasing. However, the apps failed to provide quality information to users, which resulted in a lack of engagement. Most of the apps were not backed by scientific literature (24/25, 96\%), and those that contained scientific references were vastly out-of-date. Future apps would need to address these concerns while taking simple measures to ensure quality control. ",
doi="10.2196/34339",
url="https://formative.jmir.org/2022/5/e34339",
url="http://www.ncbi.nlm.nih.gov/pubmed/35617008"
}


@Article{info:doi/10.2196/35371,
author="Jakob, Robert
and Harperink, Samira
and Rudolf, Maria Aaron
and Fleisch, Elgar
and Haug, Severin
and Mair, Louise Jacqueline
and Salamanca-Sanabria, Alicia
and Kowatsch, Tobias",
title="Factors Influencing Adherence to mHealth Apps for Prevention or Management of Noncommunicable Diseases: Systematic Review",
journal="J Med Internet Res",
year="2022",
month="May",
day="25",
volume="24",
number="5",
pages="e35371",
keywords="intended use",
keywords="adherence",
keywords="engagement",
keywords="attrition",
keywords="retention",
keywords="mHealth",
keywords="eHealth",
keywords="digital health intervention",
keywords="noncommunicable disease",
keywords="NCD",
keywords="mobile phone",
abstract="Background: Mobile health (mHealth) apps show vast potential in supporting patients and health care systems with the increasing prevalence and economic costs of noncommunicable diseases (NCDs) worldwide. However, despite the availability of evidence-based mHealth apps, a substantial proportion of users do not adhere to them as intended and may consequently not receive treatment. Therefore, understanding the factors that act as barriers to or facilitators of adherence is a fundamental concern in preventing intervention dropouts and increasing the effectiveness of digital health interventions. Objective: This review aimed to help stakeholders develop more effective digital health interventions by identifying factors influencing the continued use of mHealth apps targeting NCDs. We further derived quantified adherence scores for various health domains to validate the qualitative findings and explore adherence benchmarks. Methods: A comprehensive systematic literature search (January 2007 to December 2020) was conducted on MEDLINE, Embase, Web of Science, Scopus, and ACM Digital Library. Data on intended use, actual use, and factors influencing adherence were extracted. Intervention-related and patient-related factors with a positive or negative influence on adherence are presented separately for the health domains of NCD self-management, mental health, substance use, nutrition, physical activity, weight loss, multicomponent lifestyle interventions, mindfulness, and other NCDs. Quantified adherence measures, calculated as the ratio between the estimated intended use and actual use, were derived for each study and compared with the qualitative findings. Results: The literature search yielded 2862 potentially relevant articles, of which 99 (3.46\%) were included as part of the inclusion criteria. A total of 4 intervention-related factors indicated positive effects on adherence across all health domains: personalization or tailoring of the content of mHealth apps to the individual needs of the user, reminders in the form of individualized push notifications, user-friendly and technically stable app design, and personal support complementary to the digital intervention. Social and gamification features were also identified as drivers of app adherence across several health domains. A wide variety of patient-related factors such as user characteristics or recruitment channels further affects adherence. The derived adherence scores of the included mHealth apps averaged 56.0\% (SD 24.4\%). Conclusions: This study contributes to the scarce scientific evidence on factors that positively or negatively influence adherence to mHealth apps and is the first to quantitatively compare adherence relative to the intended use of various health domains. As underlying studies mostly have a pilot character with short study durations, research on factors influencing adherence to mHealth apps is still limited. To facilitate future research on mHealth app adherence, researchers should clearly outline and justify the app's intended use; report objective data on actual use relative to the intended use; and, ideally, provide long-term use and retention data. ",
doi="10.2196/35371",
url="https://www.jmir.org/2022/5/e35371",
url="http://www.ncbi.nlm.nih.gov/pubmed/35612886"
}


@Article{info:doi/10.2196/37118,
author="Kim, Sunyoung
and Stanton, Kaitlyn
and Park, Yunoh
and Thomas, Stephen",
title="A Mobile App for Children With Asthma to Monitor Indoor Air Quality (AirBuddy): Development and Usability Study",
journal="JMIR Form Res",
year="2022",
month="May",
day="23",
volume="6",
number="5",
pages="e37118",
keywords="asthma",
keywords="children",
keywords="indoor air quality",
keywords="mobile app",
keywords="smartphone",
keywords="mHealth",
abstract="Background: Indoor air quality is an important environmental factor that triggers and exacerbates asthma, the most common chronic disease in children. A mobile app to monitor indoor air quality could help occupants keep their indoor air quality clean. However, no app is available that allows children to monitor and improve their indoor air quality. Objective: Previously, we conducted a series of user-centered design studies to identify user needs and design requirements toward creating a mobile app that helps children with asthma to engage in monitoring and improving indoor air quality as part of their asthma management. Based on the findings from these studies, we created AirBuddy, a child-friendly app that visualizes air quality indoors and outdoors. Methods: This paper reports on the findings from a field deployment with 7 pediatric asthma patients, where we evaluated AirBuddy's usability and usefulness in real-world settings by conducting weekly semistructured interviews for 8 weeks. Results: All participants positively responded to the usefulness and usability of AirBuddy, which we believe is thanks to the iterative, user-centered design approach that allowed us to identify and address potential usability issues early on and throughout the design process. Conclusions: This project contributes to the field of mHealth app design for children by demonstrating how a user-centered design process can lead to the development of digital devices that are more acceptable and relevant to target users' needs. ",
doi="10.2196/37118",
url="https://formative.jmir.org/2022/5/e37118",
url="http://www.ncbi.nlm.nih.gov/pubmed/35604753"
}


@Article{info:doi/10.2196/34509,
author="Iio, Misa
and Sato, Miori
and Narita, Masami
and Yamamoto-Hanada, Kiwako
and Oishi, Taku
and Kishino, Ai
and Kawaguchi, Takahiro
and Nishi, Rin
and Nagata, Mayumi
and Ohya, Yukihiro",
title="Development and Feasibility of a Mobile Asthma App for Children and Their Caregivers: Mixed Methods Study",
journal="JMIR Form Res",
year="2022",
month="May",
day="20",
volume="6",
number="5",
pages="e34509",
keywords="children",
keywords="caregivers",
keywords="asthma",
keywords="mobile app",
keywords="feasibility",
keywords="health app",
keywords="mHealth",
keywords="pediatric",
keywords="usability",
keywords="mobile phone",
abstract="Background: Mobile health apps can support the self-management of pediatric asthma. Previous studies on mobile apps for children aged >7 years with asthma are limited, and most reports on asthma apps do not consider interactions between the children and their caregivers. Therefore, we developed an asthma app for children aged 0-12 years and their caregivers based on the results of our previous study regarding user needs. Objective: The aim of this study was to evaluate the feasibility of a developed mobile app for children with asthma and their caregivers and to modify and complete the app according to the feasibility results. Methods: We recruited children diagnosed with persistent asthma by an allergy specialist at 2 children's hospitals, 1 university hospital, 2 general hospitals, and 1 pediatric clinic. Thereafter, the app usage was assessed, and questionnaires were administered. This study used convergent mixed methods, including providing user feedback about the pediatric asthma app, completing questionnaire surveys regarding preferences, and obtaining quantitative data about app usage. Quantitative data were analyzed based on the ratings provided for the app features used by the participants, and the usage of the app features was analyzed using descriptive statistics. Qualitative data were analyzed via a descriptive qualitative research analysis and were used to identify codes from the content-characteristic words. Results: In total, 30 pairs of children aged 2-12 years and their caregivers responded to the 3-month survey, and 20 pairs of children aged 4-12 years and their caregivers responded to the 6-month survey. In the 3- and 6-month surveys, ``record'' was the most commonly used feature by both caregivers and children. The average access logs per month among the 20 pairs ranged from 50 to 79 in the 6-month survey. The number of access logs decreased over time. In the qualitative results, app utilization difficulties were identified for 6 categories: record, preparing, alert settings, change settings, mobile phone owner, and display and motivation. Regarding app feasibility, 60\% (12/20) of the caregivers strongly agreed or agreed for all evaluation items, while 63\% (7/11) of the children strongly agreed or agreed for 6 items, excluding satisfaction. In the qualitative results, feasibility evaluation of the app was classified into 3 categories: high feasibility of the app, improvement points for the app, and personal factors preventing app utilization. Based on the results of the feasibility analysis, the final version of the app was modified and completed. Conclusions: The app feasibility among children with asthma and their caregivers was generally good. Children aged 7-12 years used elements such as record, quiz, and manga. This app can support the continuous self-management of pediatric asthma. However, efforts must be taken to maintain and improve the app quality. Trial Registration: UMIN Clinical Trials Registry UMIN000039058; https://tinyurl.com/3na9zyf8 ",
doi="10.2196/34509",
url="https://formative.jmir.org/2022/5/e34509",
url="http://www.ncbi.nlm.nih.gov/pubmed/35594073"
}


@Article{info:doi/10.2196/34906,
author="Patel, Tejal
and Ivo, Jessica
and Pitre, Teresa
and Faisal, Sadaf
and Antunes, Kristen
and Oda, Kasumi",
title="An In-Home Medication Dispensing System to Support Medication Adherence for Patients With Chronic Conditions in the Community Setting: Prospective Observational Pilot Study",
journal="JMIR Form Res",
year="2022",
month="May",
day="19",
volume="6",
number="5",
pages="e34906",
keywords="smart",
keywords="medication adherence",
keywords="usability",
keywords="geriatric",
keywords="in-home",
keywords="community",
keywords="chronic diseases",
keywords="medication dispensing",
keywords="eHealth",
keywords="platform",
keywords="self management",
keywords="support tool",
keywords="chronic disease",
keywords="caregiver",
keywords="satisfaction",
abstract="Background: Innovative digital technology systems that support and monitor real-time medication intake are now available commercially; however, there is limited knowledge of the use of such technology in patients' homes. One such smart medication dispenser, spencer, provides alerts to patients to take their medications and allows for tracking and reporting real-time medication adherence data. Objective: The objectives of this study were to examine the use of a smart medication dispenser as a medication adherence and self-management support tool for community dwelling adults over a 6-month period, in addition to usability, usefulness, satisfaction, and impact on caregiver support. Methods: This prospective, observational study invited community-dwelling adults aged 45 years and older taking at least one chronic medication and their caregivers to use this smart medication dispenser for their medication administration for 6 months. Adherence was defined as a dose intake within 2 hours post scheduled time. Real-time adherence data were collected using the smart medication dispenser and the AdhereNet platform. Usability, usefulness, and satisfaction were measured using the System Usability Scale and the Usefulness, Satisfaction, and Ease of Use questionnaire, respectively. Caregiver burden was measured on a visual analog scale at baseline and at the end of the 6-month study period. Results: A total of 58 participants were recruited, of which 55\% (32/58) were female with a mean age of 66.36 (SD 11.28; range 48-90) years. Eleven caregiver participants were recruited, of whom 91\% (10/11) were female. The average monthly adherence over 6 months was 98\% (SD 3.1\%; range 76.5\%-100\%). The average System Usability score was 85.74 (n=47; SD 12.7; range 47.5-100). Of the 46 participants who provided data, 44 (96\%) rated the product as easy, 43 (93\%) as simple to use, and 43 (93\%) were satisfied with the product. Caregiver burden prior to and following smart medication dispenser use for 6 months was found to be statistically significantly different (P<.001; CI 2.11-5.98). Conclusions: Smart medication adherence products such as spencer, when connected and clinically monitored, can be a useful solution for medication management and have the potential to improve caregiver burden. ",
doi="10.2196/34906",
url="https://formative.jmir.org/2022/5/e34906",
url="http://www.ncbi.nlm.nih.gov/pubmed/35587371"
}


@Article{info:doi/10.2196/35867,
author="Itoh, Naohiro
and Mishima, Hirokazu
and Yoshida, Yuki
and Yoshida, Manami
and Oka, Hiroyuki
and Matsudaira, Ko",
title="Evaluation of the Effect of Patient Education and Strengthening Exercise Therapy Using a Mobile Messaging App on Work Productivity in Japanese Patients With Chronic Low Back Pain: Open-Label, Randomized, Parallel-Group Trial",
journal="JMIR Mhealth Uhealth",
year="2022",
month="May",
day="16",
volume="10",
number="5",
pages="e35867",
keywords="mobile app",
keywords="patient education",
keywords="chronic low back pain",
keywords="exercise regimen",
keywords="mobile phone",
abstract="Background: Artificial intelligence--assisted interactive health promotion systems are useful tools for the management of musculoskeletal conditions. Objective: This study aimed to explore the effects of web-based video patient education and strengthening exercise therapy, using a mobile messaging app, on work productivity and pain in patients with chronic low back pain (CLBP) receiving pharmacological treatment. Methods: Patients with CLBP were randomly allocated to either the exercise group, who received education and exercise therapy using a mobile messaging app, or the conventional group. For patient education, a web-based video program was used to provide evidence-based thinking regarding the importance of a cognitive behavioral approach for CLBP. The exercise therapy was developed in accordance with the recommendations for alignment, core muscles, and endogenous activation, including improvement of posture and mobility for proper alignment, stimulation and/or strengthening of deep muscles for spinal stability, and operation of intrinsic pain for the activation of endogenous substances by aerobic exercise. Both groups continued to receive the usual medical care with pharmacological treatment. The end points were changes in work productivity, pain intensity, quality of life, fear of movement, and depression. The observation period for this study was 12 weeks. An analysis adjusted for baseline values, age at the time of consent acquisition, sex, and willingness to strengthen the exercise therapy was performed. Results: The exercise and conventional groups included 48 and 51 patients, with a mean age of 47.9 years (SD 10.2 years; n=27, 56.3\% male patients) and 46.9 years (SD 12.3 years; n=28, 54.9\% male patients) in the full analysis set, respectively. No significant impact of these interventions on work productivity was observed in the exercise group compared with the conventional group (primary end point: Quantity and Quality method; 0.062 vs 0.114; difference between groups ?0.053, 95\% CI ?0.184 to 0.079; P=.43). However, the exercise group showed consistently better trends for the other end points than did the conventional group. Compared with the conventional group, the exercise group showed a significant improvement in the symptoms of low back pain (3.2 vs 3.8; difference between groups ?0.5, 95\% CI ?1.1 to 0.0; P=.04), quality of life (EuroQoL 5 Dimensions 5 Level: 0.068 vs 0.006; difference between groups 0.061, 95\% CI 0.008 to 0.114; P=.03), and fear of movement at week 12 (?2.3 vs 0.5; difference between groups ?2.8, 95\% CI ?5.5 to ?0.1; P=.04). Conclusions: This study suggests that patient education and strengthening exercise therapy using a mobile messaging app may be useful for treating CLBP. This study does not reveal the effect of therapeutic interventions on CLBP on work productivity. Thus, further research is required to assess work productivity with therapeutic interventions. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000041037; https://center6.umin.ac.jp/cgi-open-bin/ctr\_e/ctr\_view.cgi?recptno=R000046866 ",
doi="10.2196/35867",
url="https://mhealth.jmir.org/2022/5/e35867",
url="http://www.ncbi.nlm.nih.gov/pubmed/35576560"
}


@Article{info:doi/10.2196/36654,
author="Mangsbacka, Maria
and Gustavell, Tina",
title="Nurses' Experiences Using an Interactive System to Assess and Manage Treatment-Related Symptoms of Patients With Pancreatic Cancer: Interview Study",
journal="JMIR Nursing",
year="2022",
month="May",
day="16",
volume="5",
number="1",
pages="e36654",
keywords="app",
keywords="health care professionals",
keywords="mobile health",
keywords="mHealth",
keywords="nurses",
keywords="pancreatic cancer",
keywords="person-centered care",
keywords="symptom-management",
keywords="qualitative interview",
keywords="nursing",
keywords="interview",
abstract="Background: Treatment for pancreatic cancer entails symptom distress and a high burden of self-care. Patient-reported outcomes, collected with the support of mobile health (mHealth), have shown positive effects on symptom management, patient satisfaction, and quality of life for patients with cancer. For mHealth tools to become an integral part of clinical routine, experiences from health care professionals are needed. Objective: The aim of this paper is to describe nurses' experiences of integrating an interactive system (Interaktor) for symptom assessment and management into daily practice, when caring for patients following pancreaticoduodenectomy and during chemotherapy treatment due to pancreatic cancer. Methods: Patients reported symptoms via the Interaktor app daily for 6 months. In the event of alarming symptoms, an alert was triggered to the patient's nurse who then called the patient to offer advice and support. All nurses (n=8) who assessed patients were interviewed either individually or in a group. Transcribed interviews were analyzed using qualitative thematic analysis. Results: mHealth can facilitate person-centered care by offering nurses a way to gain knowledge about patients and to build relationships. Further, obstacles to implementation could be seen due to a lack of structural prerequisites and uncertainty about multiple ways to interact with patients. Conclusions: The Interaktor system can provide person-centered care. However, to implement mHealth tools as a clinical routine, focus needs to be placed on creating the necessary organizational conditions. ",
doi="10.2196/36654",
url="https://nursing.jmir.org/2022/1/e36654",
url="http://www.ncbi.nlm.nih.gov/pubmed/35576577"
}


@Article{info:doi/10.2196/36114,
author="Morcillo-Mu{\~n}oz, Yolanda
and S{\'a}nchez-Guarnido, Jos{\'e} Antonio
and Calz{\'o}n-Fern{\'a}ndez, Silvia
and Baena-Parejo, Isabel",
title="Multimodal Chronic Pain Therapy for Adults via Smartphone: Randomized Controlled Clinical Trial",
journal="J Med Internet Res",
year="2022",
month="May",
day="11",
volume="24",
number="5",
pages="e36114",
keywords="chronic pain",
keywords="eHealth",
keywords="multimodal intervention",
keywords="catastrophizing",
keywords="self-management",
keywords="mHealth",
keywords="mobile phone",
keywords="randomized controlled trials",
abstract="Background: Combination therapies delivered remotely via the internet or mobile devices are increasingly being used to improve and promote the self-management of chronic conditions. However, little is known regarding the long-term effects of these interventions. Objective: The aim of this study is to evaluate the effectiveness of a multimodal intervention program that measures associated variables such as catastrophizing, pain acceptance, and quality of life using a mobile device in people with chronic pain in an outpatient setting. Methods: A randomized controlled clinical trial was performed using parallel treatment groups. A total of 209 patients with chronic musculoskeletal pain were randomly assigned to one of the two study arms. The intervention group received a standard web-based psychosocial therapy-type program of activities through a smartphone for 6 weeks. The control group only had access to the Find out more section of the app, which contained audiovisual material for pain management based on a self-help approach. The primary outcome was catastrophizing measured using the Pain Catastrophizing Scale (PCS). Secondary outcomes were pain acceptance measured using the Chronic Pain Acceptance Questionnaire and health-related quality of life measured using the EuroQol Visual Analogue Scale. Assessments were conducted at baseline (T1), after treatment (T2), and at the 3-month follow-up (T3). The variations between the different phases were assessed using the percentage change rescaled with log base 2. The Cohen d was calculated based on the results of the linear mixed model. The investigators of the study who evaluated the results were not involved in patient recruitment and were blinded to the group assignment. Results: Positive effects were found in the intervention group (T2--T1) in catastrophizing between the baseline and posttreatment phases (P<.001) and in helplessness (?0.72 vs 0.1; P=.002), rumination (?1.59 vs ?0.53; P<.001), acceptance (0.38 vs 0.05; P=.001), and quality of life (0.43 vs ?0.01; P=.002), although no significant changes were found for magnification (0.2 vs 0.77; P=.14) and satisfaction with health (0.25 vs ?0.27; P=.13). Three months after treatment, significant differences were observed in the intervention group for the outcome variable of catastrophizing (PCS; ?0.59 vs 0.2; P=.006) and the PCS subscales of helplessness (?0.65 vs 0.01; P=.07), rumination (1.23 vs ?0.59; P=.04), and magnification (0.1 vs 0.86; P=.02). Conclusions: The results of our study suggest that app-based mobile multidimensional treatments for adults with chronic pain improve catastrophizing, quality of life, and psychological flexibility immediately after treatment and that the effects are maintained for the primary outcome of catastrophizing for at least 3 months following treatment. Moreover, they promote self-management and can be used to complement face-to-face pain treatments. Trial Registration: ClinicalTrials.gov NCT04509154; https://clinicaltrials.gov/ct2/show/NCT04509154 ",
doi="10.2196/36114",
url="https://www.jmir.org/2022/5/e36114",
url="http://www.ncbi.nlm.nih.gov/pubmed/35373"
}


@Article{info:doi/10.2196/34402,
author="Goudman, Lisa
and Jansen, Julie
and Billot, Maxime
and Vets, Nieke
and De Smedt, Ann
and Roulaud, Manuel
and Rigoard, Philippe
and Moens, Maarten",
title="Virtual Reality Applications in Chronic Pain Management: Systematic Review and Meta-analysis",
journal="JMIR Serious Games",
year="2022",
month="May",
day="10",
volume="10",
number="2",
pages="e34402",
keywords="virtual reality",
keywords="chronic pain",
keywords="systematic review",
keywords="multilevel meta-analysis",
keywords="immersive technologies",
keywords="clinical outcomes",
keywords="mobile phone",
abstract="Background: Virtual reality (VR) is a computer technology that immerses a user in a completely different reality. The application of VR in acute pain settings is well established. However, in chronic pain, the applications and outcome parameters influenced by VR are less clear. Objective: This review aimed to systematically identify all outcome parameters that are reported in relation to VR in patients with chronic pain. Methods: A total of 4 electronic databases (PubMed, Scopus, Web of Science, and Embase) were searched for relevant studies. Multilevel random-effect meta-analyses were performed, whereby the standardized mean difference was chosen as the effect size to denote the difference between measurements before and after a VR intervention. Results: The initial database search identified 1430 studies, of which 41 (2.87\%) were eventually included in the systematic review. Evidence has been found for the effects of VR on pain, functioning, mobility, functional capacity, psychological outcomes, quality of life, neuropsychological outcomes, and physical sensations. The overall effect size (a total of 194 effect sizes from 25 studies) based on a three level meta-analysis was estimated at 1.22 (95\% CI 0.55-1.89; z=3.56; P<.001), in favor of improvements after a VR intervention. When categorizing effect sizes, the overall effect sizes were reported as follows: 1.60 (95\% CI 0.83-2.36; z=4.09; P<.001) for the effect of VR on pain (n=31), 1.40 (95\% CI 0.13-2.67; z=2.17; P=.03) for functioning (n=60), 0.49 (95\% CI ?0.71 to 1.68; z=0.80; P=.42) for mobility (n=24), and 0.34 (95\% CI ?1.52 to 2.20; z=0.36; P=.72) for functional capacity (n=21). Conclusions: This systematic review revealed a broad range of outcome variables influenced by an intervention of VR technology, with statistically significant pain relief and improvements in functioning. These findings indicate that VR not only has applications in acute pain management but also in chronic pain settings, whereby VR might be able to become a promising first-line intervention as complementary therapy for patients with chronic pain. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021227016; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=227016 ",
doi="10.2196/34402",
url="https://games.jmir.org/2022/2/e34402",
url="http://www.ncbi.nlm.nih.gov/pubmed/35536641"
}


@Article{info:doi/10.2196/31736,
author="Potter, Eden
and Burstein, Frada
and Flynn, Daphne
and Hwang, Dae In
and Dinh, Tina
and Goh, Yu Tian
and Mohammad Ebrahim, Mina
and Gilfillan, Christopher",
title="Physician-Authored Feedback in a Type 2 Diabetes Self-management App: Acceptability Study",
journal="JMIR Form Res",
year="2022",
month="May",
day="10",
volume="6",
number="5",
pages="e31736",
keywords="mobile app",
keywords="mobile apps",
keywords="apps",
keywords="mHealth",
keywords="mobile health",
keywords="smartphone",
keywords="mobile phone",
keywords="digital health",
keywords="health",
keywords="type 2 diabetes",
keywords="diabetes mellitus",
keywords="empirical test",
keywords="activity",
keywords="food consumption",
keywords="daily feedback",
keywords="behavior change",
abstract="Background: Type 2 diabetes (T2D) is increasingly prevalent in society, in part because of behavioral issues, with sedentary behavior, reduced exercise, and the consumption of foods with a high glycemic index being major contributors. There is evidence for the efficacy of mobile apps in promoting behavior change and lifestyle improvements in people with T2D. Many mobile phone apps help to monitor the condition of people with T2D and inform them about their health. Some of these digital interventions involve patients using apps on their own or in conjunction with health care professionals. Objective: This study aimed to test the acceptability of receiving app-based, daily physician feedback for patients with T2D that is informed by the continuous monitoring of their activity, food choices, and glucose profiles, with the aim of encouraging healthier behavior. The GLOOK! app was designed and developed by an academic research team and pilot-tested at an Australian public hospital. Methods: A total of 15 patients diagnosed with T2D wore a glucose monitor and an Apple Watch for 12 days. The uploaded data were integrated into the GLOOK! app on the patients' smartphones, which also enabled the recording of activity and consumed food. A physician provided daily feedback to each individual through the app based on their data from each of the 12 days. At the beginning and end of the study, data were collected on vital signs, anthropometry, hemoglobin A1c level, fructosamine level, and fasting lipids level. Participants were also interviewed at the beginning and end of the study to assess the acceptability of the intervention and its potential impact on promoting positive behavior change. Results: Over the 12 days of the study, there was a significant reduction of 0.22\% (P=.004) in hemoglobin A1c level. There were favorable changes in fructosamine and lipid fractions; however, none reached significance. There was also a fall of 0.65 kg in body weight and falls in blood pressure and pulse rate that did not reach significance. Patient feedback on the GLOOK! system was positive. Of the 15 participants, 13 (87\%) were enthusiastic about continuing to use the app system if some usability and reliability aspects were improved. All participants regarded the personalized physician feedback as supportive and helpful in understanding their own health behavior. Of the 15 participants, 4 (27\%) felt that using the system encouraged long-term behavior changes. Conclusions: A mobile app system that provides people with T2D daily, physician-generated, personalized feedback can produce favorable changes in glycemic and cardiovascular risk parameters---even in the short term---and encourage better self-management of their condition. Study participants found the experience of using the mobile app system acceptable and were motivated to establish longer-term lifestyle improvements through behavior changes. ",
doi="10.2196/31736",
url="https://formative.jmir.org/2022/5/e31736",
url="http://www.ncbi.nlm.nih.gov/pubmed/35536614"
}


@Article{info:doi/10.2196/37946,
author="Baptist, Alan
and Gibson-Scipio, Wanda
and Carcone, Idalski April
and Ghosh, Samiran
and Jacques-Tiura, J. Angela
and Hall, Amy
and MacDonell, Kolmodin Karen",
title="Asthma and Technology in Emerging African American Adults (The ATHENA Project): Protocol for a Trial Using the Multiphase Optimization Strategy Framework",
journal="JMIR Res Protoc",
year="2022",
month="May",
day="10",
volume="11",
number="5",
pages="e37946",
keywords="African American emerging adults",
keywords="asthma management",
keywords="mHealth",
keywords="mobile health",
keywords="motivational interviewing",
keywords="asthma control",
keywords="physical activity",
abstract="Background: Asthma causes substantial morbidity and mortality in the United States, particularly among African American emerging adults (AAEAs; aged 18-30 years), but very few asthma programs have targeted this population. Interventions that provide education and address underlying motivation for managing asthma may be the most effective. However, intensive face-to-face interventions are often difficult to implement in this population. Objective: The purpose of this study is to develop an effective mobile asthma management intervention to improve control among AAEAs. Methods: We will assess the ability of multiple technologic components to assist and improve traditional asthma education. The first component is the Motivational Enhancement System for asthma management. It is a mobile 4-session intervention using supported self-regulation and motivational interviewing. Personalized content is based on each participant's activity level, daily experiences, and goals. The second component is supportive accountability. It is administered by asthma nurses using targeted mobile support (Skype/voice calls) to provide education, promote self-efficacy, and overcome barriers through a motivational interviewing--based framework. The third component is SMS text messaging. It provides reminders for asthma education, medication adherence, and physical activity. The fourth component is physical activity tracking. It uses wearable technology to help meet user-defined physical activity goals. Using a multiphase optimization strategy (MOST) framework, we will test intervention components and combinations of components to identify the most effective mobile intervention. The MOST framework is an innovative, and cost- and time-effective framework that uses engineering principles to produce effective behavioral interventions. We will conduct a component selection experiment using a factorial research design to build an intervention that has been optimized for maximum efficacy, using a clinically significant improvement in asthma. Participants (N=180) will be randomized to 1 of 6 intervention arms. Participants will be recruited from multiple sites of the American Lung Association-Airway Clinical Research Centers network and ambulatory care clinics at the Detroit Medical Center. Data collections will occur at baseline, and 3, 6, and 12 months. Results: At study completion, we will have an empirically supported optimized mobile asthma management intervention to improve asthma control for AAEAs. We hypothesize that postintervention (3, 6, and 12 months), participants with uncontrolled asthma will show a clinically significant improvement in asthma control. We also hypothesize that improvements in asthma management behaviors (including physical activity), quality of life, symptoms, adherence, and exacerbation (secondary outcomes) will be observed. Conclusions: AAEAs are disproportionately impacted by asthma, but have been underrepresented in research. Mobile asthma management interventions may help improve asthma control and allow people to live healthier lives. During this project, we will use an innovative strategy to develop an optimized mobile asthma management intervention using the most effective combination of nurse-delivered asthma education, a smartphone app, and text messaging. International Registered Report Identifier (IRRID): PRR1-10.2196/37946 ",
doi="10.2196/37946",
url="https://www.researchprotocols.org/2022/5/e37946",
url="http://www.ncbi.nlm.nih.gov/pubmed/35536642"
}


@Article{info:doi/10.2196/35163,
author="Depczynski, Barbara
and Poynten, Ann",
title="Acceptance and Effect of Continuous Glucose Monitoring on Discharge From Hospital in Patients With Type 2 Diabetes: Open-label, Prospective, Controlled Study",
journal="JMIR Diabetes",
year="2022",
month="May",
day="9",
volume="7",
number="2",
pages="e35163",
keywords="CGM",
keywords="continuous glucose monitor",
keywords="hospital",
keywords="discharge",
keywords="T2DM",
keywords="type 2 diabetes",
keywords="diabetes",
keywords="glucose monitoring",
abstract="Background: Continuous glucose monitors (CGM) can provide detailed information on glucose excursions. There is little information on safe transitioning from hospital back to the community for patients who have had diabetes therapies adjusted in hospital and it is unclear whether newer technologies may facilitate this process. Objective: Our aim was to determine whether offering CGM on discharge would be acceptable and if CGM initiated on hospital discharge in people with type 2 diabetes (T2DM) would reduce hospital re-presentations at 1 month. Methods: This was an open-label study. Adult inpatients with T2DM, who were to be discharged home and required postdischarge glycemic stabilization, were offered usual care consisting of clinic review at 2 weeks and at 3 months. In addition to usual care, participants in the intervention arm were provided with a Libre flash glucose monitoring system (Abbott Australia). An initial run-in phase for the first 20 participants was planned, where all consenting participants were enrolled in an active arm. Subsequently, all participants were to be randomized to the active arm or usual care control group. Results: Of 237 patients screened during their hospital admission, 34 had comorbidities affecting cognition that prevented informed consent and affected their ability to learn to use the CGM device. In addition, 21 were not able to be approached as the material was only in English. Of 101 potential participants who fulfilled eligibility criteria, 19 provided consent and were enrolled. Of the 82 patients who declined to participate, 31 advised that the learning of a new task toward discharge was overwhelming or too stressful and 26 were not interested, with no other details. Due to poor recruitment, the study was terminated without entering the randomization phase to determine whether CGM could reduce readmission rate. Conclusions: These results suggest successful and equitable implementation of telemedicine programs requires that any human factors such as language, cognition, and possible disengagement be addressed. Recovery from acute illness may not be the ideal time for introduction of newer technologies or may require more novel implementation frameworks. ",
doi="10.2196/35163",
url="https://diabetes.jmir.org/2022/2/e35163",
url="http://www.ncbi.nlm.nih.gov/pubmed/35532995"
}


@Article{info:doi/10.2196/34531,
author="Ju, HyoRim
and Kang, EunKyo
and Kim, YoungIn
and Ko, HyunYoung
and Cho, Belong",
title="The Effectiveness of a Mobile Health Care App and Human Coaching Program in Primary Care Clinics: Pilot Multicenter Real-World Study",
journal="JMIR Mhealth Uhealth",
year="2022",
month="May",
day="6",
volume="10",
number="5",
pages="e34531",
keywords="healthcare",
keywords="health care",
keywords="mobile application",
keywords="app",
keywords="self-management",
keywords="primary care",
keywords="chronic conditions",
abstract="Background: As the global burden of chronic conditions increases, their effective management is a concern. Although the need for chronic disease management using mobile self-management health care apps is increasing, there are still many barriers to their practical application in the primary care field. Objective: This study evaluated the effectiveness of primary care services combining a mobile self-management health care app with human coaching for patients with chronic diseases in the current primary care system. Methods: A total of 110 patients (mean age 53.2, SD 9.2 years; 64 of 110, 58.2\% female) with hypertension, diabetes, dyslipidemia, or metabolic syndrome who visited one of 17 participating primary care clinics from September to November 2020 were included in this study. All participants recorded data regarding changes in body weight, sleep conditions, quality of life, depression, anxiety, stress, BMI, waist circumference, blood sugar levels, blood pressure, and blood lipids levels. The app user group (n=65) used a mobile self-management health care app with human coaching for 12 weeks, and the control group (n=45) underwent conventional self-managed health care. Results: Patients in the app user group reported significantly more weight loss than those in the control group---the body weight of the app user group decreased by 1.43 kg (95\% CI --2.07 to --0.79) and that of the control group decreased by 0.13 kg (95\% CI --0.67 to 0.41; P=.002). The weight loss was markedly greater after using the app for 9 weeks than that when used for 4 weeks or 5-8 weeks (P=.002). Patients in the app user group reported better sleep quality (P=.04) and duration (P=.004) than those in the control group. Conclusions: The combination of primary care clinics and a mobile self-management health care app with human coaching results in better management of chronic conditions. This study shows that the primary care services combining a mobile self-management health care app with human coaching are effective in the current primary care system. An implication of this study is the possibility that a mobile self-management health care app with human coaching is a treatment option in the current primary care system. ",
doi="10.2196/34531",
url="https://mhealth.jmir.org/2022/5/e34531",
url="http://www.ncbi.nlm.nih.gov/pubmed/35522461"
}


@Article{info:doi/10.2196/34960,
author="Rohde, A. Jacob
and Fisher, B. Edwin
and Boynton, H. Marcella
and Freelon, Deen
and Frohlich, O. Dennis
and Barnes, L. Edward
and Noar, M. Seth",
title="A Self-management SMS Text Messaging Intervention for People With Inflammatory Bowel Disease: Feasibility and Acceptability Study",
journal="JMIR Form Res",
year="2022",
month="May",
day="6",
volume="6",
number="5",
pages="e34960",
keywords="inflammatory bowel disease",
keywords="mHealth",
keywords="self-management",
keywords="SMS text messaging",
keywords="mobile phone",
abstract="Background: Mobile health technologies can be useful for providing disease self-management information and support to people with inflammatory bowel disease (IBD). Objective: The aim of this study was to test a self-management SMS text messaging intervention for people with IBD. Our goal was to examine intervention feasibility, acceptability, and engagement and to preliminarily evaluate improvements in certain self-reported health outcomes among participants. Methods: We developed an SMS text messaging program called Text4IBD. The program sent daily support messages and resources about disease self-management over the course of a 2-week, single-group, pretest-posttest intervention to participants (N=114) diagnosed with IBD. We examined intervention feasibility, acceptability, and engagement through Text4IBD message topic recall and use of resources (ie, visiting supplemental websites recommended by the Text4IBD program). We also assessed pretest-posttest measures of IBD-related distress, self-efficacy, perceived support, use of coping strategies, and medication adherence. Analyses examined participants' evaluations of the intervention and compared pretest-posttest changes in secondary outcomes using paired-samples statistics. Results: Approximately all participants who completed the intervention (n=105) were receptive to Text4IBD and viewed the program as feasible and acceptable. In addition, most participants (103/105, 98.1\%) recalled at least one of the message topics sent by the program, and 79\% (83/105) of them self-reported engaging with at least one of the external self-management resources recommended by the Text4IBD program. Pretest-posttest results showed reduced IBD-related distress (mean 3.33, SD 0.68 vs mean 2.86, SD 0.73; P<.001) and improvements in most other secondary outcomes. Conclusions: Findings from this study highlight the value of SMS text messaging as a useful digital medium for providing support to people with IBD, particularly to those who may struggle with disease-related distress. Text4IBD was highly feasible and acceptable and may help people self-manage their IBD. Future studies should aim to evaluate this program in a randomized controlled trial in clinical settings. ",
doi="10.2196/34960",
url="https://formative.jmir.org/2022/5/e34960",
url="http://www.ncbi.nlm.nih.gov/pubmed/35522471"
}


@Article{info:doi/10.2196/37672,
author="Elf, Marie
and Klockar, Erika
and Kyl{\'e}n, Maya
and von Koch, Lena
and Ytterberg, Charlotte
and Wallin, Lars
and Finch, Tracy
and Gustavsson, Catharina
and Jones, Fiona",
title="Tailoring and Evaluating an Intervention to Support Self-management After Stroke: Protocol for a Multi-case, Mixed Methods Comparison Study",
journal="JMIR Res Protoc",
year="2022",
month="May",
day="6",
volume="11",
number="5",
pages="e37672",
keywords="self-management",
keywords="self-management support",
keywords="self-efficacy",
keywords="stroke rehabilitation",
keywords="home rehabilitation",
keywords="person-centered care",
abstract="Background: Self-management programs are recognized as a valuable approach to supporting people with long-term conditions, such as stroke, in managing their daily lives. Bridges Self-Management (Bridges) focuses on how practitioners interact and support patients' confidence, skills, and knowledge, and it is an example of a complex intervention. Bridges has been developed and used across multiple health care pathways in the United Kingdom and is theoretically informed by social cognition theory and self-efficacy principles. Evidence shows that self-management programs based on the construct of self-efficacy can be effective. There is still much to learn about how health care services or pathways should implement support for self-management in a sustainable way and whether this implementation process is different depending on the context or culture of the team or service provided. Objective: The aim of this study is to tailor and evaluate an intervention (Bridges) to support self-management after stroke in a Swedish context. Methods: We will use a pretest-posttest design with a case study approach to evaluate the feasibility and implementation of self-management support in two stroke settings. This project includes a complex intervention and depends on the actions of individuals, different contexts, and the adaptation of behavior over time. A mixed methods approach was chosen to understand both outcomes and mechanisms of impact. Data collection will comprise outcome measurements and assessment tools as well as qualitative interviews. Data will be collected concurrently and integrated into a mixed methods design. Results: Recruitment and data collection for the first site of the project ran from September 1, 2021, to January 17, 2022. The intervention at the first site was conducted from November 1, 2021, to March 5, 2022. The evaluation will start after the implementation phase.  The second site has been recruited, and the baseline data collection will start in spring 2022. The intervention will start in early autumn 2022. Data collection will be completed by the end of 2022. Conclusions: This study represents a unique, highly relevant, and innovative opportunity to maximize knowledge and minimize practice gaps in rehabilitation stroke care. The study will produce robust data on the intervention and in-depth data on the contextual factors and mechanisms related to the feasibility of the intervention and for whom it is feasible. Bridges has been used in the United Kingdom for more than 10 years, and this study will explore its contextualization and implementation within a Swedish stroke environment. The evaluation will study results at the patient, staff, and organizational levels and provide recommendations for the adoption and refinement of future efforts to support self-management. International Registered Report Identifier (IRRID): DERR1-10.2196/37672 ",
doi="10.2196/37672",
url="https://www.researchprotocols.org/2022/5/e37672",
url="http://www.ncbi.nlm.nih.gov/pubmed/35522476"
}


@Article{info:doi/10.2196/37522,
author="Gustafson, H. David
and Mares, Marie-Louise
and Johnston, C. Darcie
and Landucci, Gina
and Pe-Romashko, Klaren
and Vjorn, J. Olivia
and Hu, Yaxin
and Maus, Adam
and Mahoney, E. Jane
and Mutlu, Bilge",
title="Using Smart Displays to Implement an eHealth System for Older Adults With Multiple Chronic Conditions: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="May",
day="5",
volume="11",
number="5",
pages="e37522",
keywords="eHealth",
keywords="aged",
keywords="geriatrics",
keywords="multiple chronic conditions",
keywords="chronic pain",
keywords="smart displays",
keywords="smart speakers",
keywords="quality of life",
keywords="primary care",
keywords="health expenditures",
keywords="mobile phone",
abstract="Background: Voice-controlled smart speakers and displays have a unique but unproven potential for delivering eHealth interventions. Many laptop- and smartphone-based interventions have been shown to improve multiple outcomes, but voice-controlled platforms have not been tested in large-scale rigorous trials. Older adults with multiple chronic health conditions, who need tools to help with their daily management, may be especially good candidates for interventions on voice-controlled devices because these patients often have physical limitations, such as tremors or vision problems, that make the use of laptops and smartphones challenging. Objective: The aim of this study is to assess whether participants using an evidence-based intervention (ElderTree) on a smart display will experience decreased pain interference and improved quality of life and related measures in comparison with participants using ElderTree on a laptop and control participants who are given no device or access to ElderTree. Methods: A total of 291 adults aged ?60 years with chronic pain and ?3 additional chronic conditions will be recruited from primary care clinics and community organizations and randomized 1:1:1 to ElderTree access on a smart display along with their usual care, ElderTree access on a touch screen laptop along with usual care, or usual care alone. All patients will be followed for 8 months. The primary outcomes are differences between groups in measures of pain interference and psychosocial quality of life. The secondary outcomes are between-group differences in system use at 8 months, physical quality of life, pain intensity, hospital readmissions, communication with medical providers, health distress, well-being, loneliness, and irritability. We will also examine mediators and moderators of the effects of ElderTree on both platforms. At baseline, 4 months, and 8 months, patients will complete written surveys comprising validated scales selected for good psychometric properties with similar populations. ElderTree use data will be collected continuously in system logs. We will use linear mixed-effects models to evaluate outcomes over time, with treatment condition and time acting as between-participant factors. Separate analyses will be conducted for each outcome. Results: Recruitment began in August 2021 and will run through April 2023. The intervention period will end in December 2023. The findings will be disseminated via peer-reviewed publications. Conclusions: To our knowledge, this is the first study with a large sample and long time frame to examine whether a voice-controlled smart device can perform as well as or better than a laptop in implementing a health intervention for older patients with multiple chronic health conditions. As patients with multiple conditions are such a large cohort, the implications for cost as well as patient well-being are significant. Making the best use of current and developing technologies is a critical part of this effort. Trial Registration: ClinicalTrials.gov NCT04798196; https://clinicaltrials.gov/ct2/show/NCT04798196 International Registered Report Identifier (IRRID): PRR1-10.2196/37522 ",
doi="10.2196/37522",
url="https://www.researchprotocols.org/2022/5/e37522",
url="http://www.ncbi.nlm.nih.gov/pubmed/35511229"
}


@Article{info:doi/10.2196/35549,
author="Braund, A. Taylor
and Zin, The May
and Boonstra, W. Tjeerd
and Wong, J. Quincy J.
and Larsen, E. Mark
and Christensen, Helen
and Tillman, Gabriel
and O'Dea, Bridianne",
title="Smartphone Sensor Data for Identifying and Monitoring Symptoms of Mood Disorders: A Longitudinal Observational Study",
journal="JMIR Ment Health",
year="2022",
month="May",
day="4",
volume="9",
number="5",
pages="e35549",
keywords="depression",
keywords="bipolar disorder",
keywords="sensors",
keywords="mobile app",
keywords="circadian rhythm",
keywords="mobile phone",
abstract="Background: Mood disorders are burdensome illnesses that often go undetected and untreated. Sensor technologies within smartphones may provide an opportunity for identifying the early changes in circadian rhythm and social support/connectedness that signify the onset of a depressive or manic episode. Objective: Using smartphone sensor data, this study investigated the relationship between circadian rhythm, which was determined by GPS data, and symptoms of mental health among a clinical sample of adults diagnosed with major depressive disorder or bipolar disorder. Methods: A total of 121 participants were recruited from a clinical setting to take part in a 10-week observational study. Self-report questionnaires for mental health outcomes, social support, social connectedness, and quality of life were assessed at 6 time points throughout the study period. Participants consented to passively sharing their smartphone GPS data for the duration of the study. Circadian rhythm (ie, regularity of location changes in a 24-hour rhythm) was extracted from GPS mobility patterns at baseline. Results: Although we found no association between circadian rhythm and mental health functioning at baseline, there was a positive association between circadian rhythm and the size of participants' social support networks at baseline (r=0.22; P=.03; R2=0.049). In participants with bipolar disorder, circadian rhythm was associated with a change in anxiety from baseline; a higher circadian rhythm was associated with an increase in anxiety and a lower circadian rhythm was associated with a decrease in anxiety at time point 5. Conclusions: Circadian rhythm, which was extracted from smartphone GPS data, was associated with social support and predicted changes in anxiety in a clinical sample of adults with mood disorders. Larger studies are required for further validations. However, smartphone sensing may have the potential to monitor early symptoms of mood disorders. ",
doi="10.2196/35549",
url="https://mental.jmir.org/2022/5/e35549",
url="http://www.ncbi.nlm.nih.gov/pubmed/35507385"
}


@Article{info:doi/10.2196/31102,
author="Gerner, Maximilian
and Vuillerme, Nicolas
and Aubourg, Timoth{\'e}e
and Messner, Eva-Maria
and Terhorst, Yannik
and H{\"o}rmann, Verena
and Ganzleben, Ingo
and Schenker, Hannah
and Schett, Georg
and Atreya, Raja
and Neurath, F. Markus
and Knitza, Johannes
and Orlemann, Till",
title="Review and Analysis of German Mobile Apps for Inflammatory Bowel Disease Management Using the Mobile Application Rating Scale: Systematic Search in App Stores and Content Analysis",
journal="JMIR Mhealth Uhealth",
year="2022",
month="May",
day="3",
volume="10",
number="5",
pages="e31102",
keywords="mHealth",
keywords="IBD",
keywords="ulcerative colitis",
keywords="Crohn disease",
keywords="inflammatory bowel disease",
keywords="telemedicine",
keywords="mobile apps",
keywords="rating",
keywords="rating scale",
keywords="quality",
keywords="usability",
keywords="chronic disease",
keywords="IBS",
keywords="app store",
abstract="Background: Patients suffering from inflammatory bowel disease (IBD) frequently need long-term medical treatment. Mobile apps promise to complement and improve IBD management, but so far there has been no scientific analysis of their quality. Objective: This study evaluated the quality of German mobile apps targeting IBD patients and physicians treating IBD patients using the Mobile Application Rating Scale (MARS). Methods: The German Apple App Store and Google Play Store were systematically searched to identify German IBD mobile apps for patient and physician use. MARS was used by 6 physicians (3 using Android smartphones and 3 using iPhones) to independently assess app quality. Apps were randomly assigned so that the 4 apps with the most downloads were rated by all raters and the remaining apps were rated by 1 Android and 1 iOS user. Results: In total, we identified 1764 apps in the Apple App Store and Google Play Store. After removing apps that were not related to IBD (n=1386) or not available in German (n=317), 61 apps remained. After removing duplicates (n=3) and apps for congresses (n=7), journals (n=4), and clinical studies (n=6), as well as excluding apps that were available in only 1 of the 2 app stores (n=20) and apps that could only be used with an additional device (n=7), we included a total of 14 apps. The app ``CED Dokumentation und Tipps'' had the highest overall median MARS score at 4.11/5. On the whole, the median MARS scores of the 14 apps ranged between 2.38/5 and 4.11/5. As there was no significant difference between iPhone and Android raters, we used the Wilcoxon comparison test to calculate P values. Conclusions: The MARS ratings showed that the quality of German IBD apps varied. We also discovered a discrepancy between app store ratings and MARS ratings, highlighting the difficulty of assessing perceived app quality. Despite promising results from international studies, there is little evidence for the clinical benefits of German IBD apps. Clinical studies and patient inclusion in the app development process are needed to effectively implement mobile apps in routine care. ",
doi="10.2196/31102",
url="https://mhealth.jmir.org/2022/5/e31102",
url="http://www.ncbi.nlm.nih.gov/pubmed/35503246"
}


@Article{info:doi/10.2196/35219,
author="Kopka, Marvin
and Schmieding, L. Malte
and Rieger, Tobias
and Roesler, Eileen
and Balzer, Felix
and Feufel, A. Markus",
title="Determinants of Laypersons' Trust in Medical Decision Aids: Randomized Controlled Trial",
journal="JMIR Hum Factors",
year="2022",
month="May",
day="3",
volume="9",
number="2",
pages="e35219",
keywords="symptom checkers",
keywords="disposition advice",
keywords="anthropomorphism",
keywords="artificial intelligence",
keywords="urgency assessment",
keywords="patient-centered care",
keywords="human-computer interaction",
keywords="consumer health",
keywords="information technology",
keywords="IT",
keywords="mobile phone",
abstract="Background: Symptom checker apps are patient-facing decision support systems aimed at providing advice to laypersons on whether, where, and how to seek health care (disposition advice). Such advice can improve laypersons' self-assessment and ultimately improve medical outcomes. Past research has mainly focused on the accuracy of symptom checker apps' suggestions. To support decision-making, such apps need to provide not only accurate but also trustworthy advice. To date, only few studies have addressed the question of the extent to which laypersons trust symptom checker app advice or the factors that moderate their trust. Studies on general decision support systems have shown that framing automated systems (anthropomorphic or emphasizing expertise), for example, by using icons symbolizing artificial intelligence (AI), affects users' trust. Objective: This study aims to identify the factors influencing laypersons' trust in the advice provided by symptom checker apps. Primarily, we investigated whether designs using anthropomorphic framing or framing the app as an AI increases users' trust compared with no such framing. Methods: Through a web-based survey, we recruited 494 US residents with no professional medical training. The participants had to first appraise the urgency of a fictitious patient description (case vignette). Subsequently, a decision aid (mock symptom checker app) provided disposition advice contradicting the participants' appraisal, and they had to subsequently reappraise the vignette. Participants were randomized into 3 groups: 2 experimental groups using visual framing (anthropomorphic, 160/494, 32.4\%, vs AI, 161/494, 32.6\%) and a neutral group without such framing (173/494, 35\%). Results: Most participants (384/494, 77.7\%) followed the decision aid's advice, regardless of its urgency level. Neither anthropomorphic framing (odds ratio 1.120, 95\% CI 0.664-1.897) nor framing as AI (odds ratio 0.942, 95\% CI 0.565-1.570) increased behavioral or subjective trust (P=.99) compared with the no-frame condition. Even participants who were extremely certain in their own decisions (ie, 100\% certain) commonly changed it in favor of the symptom checker's advice (19/34, 56\%). Propensity to trust and eHealth literacy were associated with increased subjective trust in the symptom checker (propensity to trust b=0.25; eHealth literacy b=0.2), whereas sociodemographic variables showed no such link with either subjective or behavioral trust. Conclusions: Contrary to our expectation, neither the anthropomorphic framing nor the emphasis on AI increased trust in symptom checker advice compared with that of a neutral control condition. However, independent of the interface, most participants trusted the mock app's advice, even when they were very certain of their own assessment. Thus, the question arises as to whether laypersons use such symptom checkers as substitutes rather than as aids in their own decision-making. With trust in symptom checkers already high at baseline, the benefit of symptom checkers depends on interface designs that enable users to adequately calibrate their trust levels during usage. Trial Registration: Deutsches Register Klinischer Studien DRKS00028561; https://tinyurl.com/rv4utcfb (retrospectively registered). ",
doi="10.2196/35219",
url="https://humanfactors.jmir.org/2022/2/e35219",
url="http://www.ncbi.nlm.nih.gov/pubmed/35503248"
}


@Article{info:doi/10.2196/34624,
author="Imrisek, D. Steven
and Lee, Matthew
and Goldner, Dan
and Nagra, Harpreet
and Lavaysse, M. Lindsey
and Hoy-Rosas, Jamillah
and Dachis, Jeff
and Sears, E. Lindsay",
title="Effects of a Novel Blood Glucose Forecasting Feature on Glycemic Management and Logging in Adults With Type 2 Diabetes Using One Drop: Retrospective Cohort Study",
journal="JMIR Diabetes",
year="2022",
month="May",
day="3",
volume="7",
number="2",
pages="e34624",
keywords="blood glucose forecast",
keywords="health forecasting",
keywords="machine learning",
keywords="model",
keywords="precision health",
keywords="blood glucose",
keywords="blood glucose logging",
keywords="type 2 diabetes",
keywords="forecast",
keywords="mHealth",
keywords="digital health",
keywords="smartphone",
keywords="precision",
keywords="monitoring",
keywords="cohort",
keywords="retrospective",
keywords="diabetes",
abstract="Background: Personalized feedback is an effective behavior change technique frequently incorporated into mobile health (mHealth) apps. Innovations in data science create opportunities for leveraging the wealth of user data accumulated by mHealth apps to generate personalized health forecasts. One Drop's digital program is one of the first to implement blood glucose forecasts for people with type 2 diabetes. The impact of these forecasts on behavior and glycemic management has not been evaluated to date. Objective: This study sought to evaluate the impact of exposure to blood glucose forecasts on blood glucose logging behavior, average blood glucose, and percentage of glucose points in range. Methods: This retrospective cohort study examined people with type 2 diabetes who first began using One Drop to record their blood glucose between 2019 and 2021. Cohorts included those who received blood glucose forecasts and those who did not receive forecasts. The cohorts were compared to evaluate the effect of exposure to blood glucose forecasts on logging activity, average glucose, and percentage of glucose readings in range, after controlling for potential confounding factors. Data were analyzed using analysis of covariance (ANCOVA) and regression analyses. Results: Data from a total of 1411 One Drop users with type 2 diabetes and elevated baseline glucose were analyzed. Participants (60.6\% male, 795/1311; mean age 50.2 years, SD 11.8) had diabetes for 7.1 years on average (SD 7.9). After controlling for potential confounding factors, blood glucose forecasts were associated with more frequent blood glucose logging (P=.004), lower average blood glucose (P<.001), and a higher percentage of readings in range (P=.03) after 12 weeks. Blood glucose logging partially mediated the relationship between exposure to forecasts and average glucose. Conclusions: Individuals who received blood glucose forecasts had significantly lower average glucose, with a greater amount of glucose measurements in a healthy range after 12 weeks compared to those who did not receive forecasts. Glucose logging was identified as a partial mediator of the relationship between forecast exposure and week-12 average glucose, highlighting a potential mechanism through which glucose forecasts exert their effect. When administered as a part of a comprehensive mHealth program, blood glucose forecasts may significantly improve glycemic management among people living with type 2 diabetes. ",
doi="10.2196/34624",
url="https://diabetes.jmir.org/2022/2/e34624",
url="http://www.ncbi.nlm.nih.gov/pubmed/35503521"
}


@Article{info:doi/10.2196/33261,
author="Treadwell, R. Jonathan
and Rouse, Benjamin
and Reston, James
and Fontanarosa, Joann
and Patel, Neha
and Mull, K. Nikhil",
title="Consumer Devices for Patient-Generated Health Data Using Blood Pressure Monitors for Managing Hypertension: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2022",
month="May",
day="2",
volume="10",
number="5",
pages="e33261",
keywords="patient-generated health data",
keywords="consumer devices",
keywords="hypertension",
keywords="blood pressure monitors",
keywords="digital health",
keywords="cardiovascular diseases",
keywords="wearable devices",
keywords="health information",
keywords="mobile phone",
abstract="Background: In the era of digital health information technology, there has been a proliferation of devices that collect patient-generated health data (PGHD), including consumer blood pressure (BP) monitors. Despite their widespread use, it remains unclear whether such devices can improve health outcomes. Objective: We performed a systematic review of the literature on consumer BP monitors that collect PGHD for managing hypertension to summarize their clinical impact on health and surrogate outcomes. We focused particularly on studies designed to measure the specific effect of using a BP monitor independent of cointerventions. We have also summarized the process and consumer experience outcomes. Methods: An information specialist searched PubMed, MEDLINE, and Embase for controlled studies on consumer BP monitors published up to May 12, 2020. We assessed the risk of bias using an adapted 9-item appraisal tool and performed a narrative synthesis of the results. Results: We identified 41 different types of BP monitors used in 49 studies included for review. Device engineers judged that 38 (92\%) of those devices were similar to the currently available consumer BP monitors. The median sample size was 222 (IQR 101-416) participants, and the median length of follow-up was 6 (IQR 3-12) months. Of the included studies, 18 (36\%) were designed to isolate the clinical effects of BP monitors; 6 of the 18 (33\%) studies evaluated health outcomes (eg, mortality, hospitalizations, and quality of life), and data on those outcomes were unclear. The lack of clarity was due to low event rates, short follow-up duration, and risk of bias. All 18 studies that isolated the effect of BP monitors measured both systolic and diastolic BP and generally demonstrated a decrease of 2 to 4 mm Hg in systolic BP and 1 to 3 mm Hg in diastolic BP compared with non--BP monitor groups. Adherence to using consumer BP monitors ranged from 38\% to 89\%, and ease of use and satisfaction ratings were generally high. Adverse events were infrequent, but there were a few technical problems with devices (eg, incorrect device alerts). Conclusions: Overall, BP monitors offer small benefits in terms of BP reduction; however, the health impact of these devices continues to remain unclear. Future studies are needed to examine the effectiveness of BP monitors that transmit data to health care providers. Additional data from implementation studies may help determine which components are critical for sustained BP improvement, which in turn may improve prescription decisions by clinicians and coverage decisions by policy makers. ",
doi="10.2196/33261",
url="https://mhealth.jmir.org/2022/5/e33261",
url="http://www.ncbi.nlm.nih.gov/pubmed/35499862"
}


@Article{info:doi/10.2196/25494,
author="Hunter, Alex
and Leckie, Todd
and Coe, Oliver
and Hardy, Benjamin
and Fitzpatrick, Daniel
and Gon{\c{c}}alves, Ana-Carolina
and Standing, Mary-Kate
and Koulouglioti, Christina
and Richardson, Alan
and Hodgson, Luke",
title="Using Smartwatches to Observe Changes in Activity During Recovery From Critical Illness Following COVID-19 Critical Care Admission: 1-Year, Multicenter Observational Study",
journal="JMIR Rehabil Assist Technol",
year="2022",
month="May",
day="2",
volume="9",
number="2",
pages="e25494",
keywords="COVID-19",
keywords="telemedicine",
keywords="rehabilitation",
keywords="critical illness",
keywords="smartphone",
keywords="digital health",
keywords="mobile health",
keywords="remote therapy",
keywords="device usability",
abstract="Background: As a sequela of the COVID-19 pandemic, a large cohort of critical illness survivors have had to recover in the context of ongoing societal restrictions. Objective: We aimed to use smartwatches (Fitbit Charge 3; Fitbit LLC) to assess changes in the step counts and heart rates of critical care survivors following hospital admission with COVID-19, use these devices within a remote multidisciplinary team (MDT) setting to support patient recovery, and report on our experiences with this. Methods: We conducted a prospective, multicenter observational trial in 8 UK critical care units. A total of 50 participants with moderate or severe lung injury resulting from confirmed COVID-19 were recruited at discharge from critical care and given a smartwatch (Fitbit Charge 3) between April and June 2020. The data collected included step counts and daily resting heart rates. A subgroup of the overall cohort at one site---the MDT site (n=19)---had their smartwatch data used to inform a regular MDT meeting. A patient feedback questionnaire and direct feedback from the MDT were used to report our experience. Participants who did not upload smartwatch data were excluded from analysis. Results: Of the 50 participants recruited, 35 (70\%) used and uploaded data from their smartwatch during the 1-year period. At the MDT site, 74\% (14/19) of smartwatch users uploaded smartwatch data, whereas 68\% (21/31) of smartwatch users at the control sites uploaded smartwatch data. For the overall cohort, we recorded an increase in mean step count from 4359 (SD 3488) steps per day in the first month following discharge to 7914 (SD 4146) steps per day at 1 year (P=.003). The mean resting heart rate decreased from 79 (SD 7) beats per minute in the first month to 69 (SD 4) beats per minute at 1 year following discharge (P<.001). The MDT subgroup's mean step count increased more than that of the control group (176\% increase vs 42\% increase, respectively; +5474 steps vs +2181 steps, respectively; P=.04) over 1 year. Further, 71\% (10/14) of smartwatch users at the MDT site and 48\% (10/21) of those at the control sites strongly agreed that their Fitbit motivated them to recover, and 86\% (12/14) and 48\% (10/21), respectively, strongly agreed that they aimed to increase their activity levels over time. Conclusions: This is the first study to use smartwatch data to report on the 1-year recovery of patients who survived a COVID-19 critical illness. This is also the first study to report on smartwatch use within a post--critical care MDT. Future work could explore the role of smartwatches as part of a randomized controlled trial to assess clinical and economic effectiveness. International Registered Report Identifier (IRRID): RR2-10.12968/ijtr.2020.0102  ",
doi="10.2196/25494",
url="https://rehab.jmir.org/2022/2/e25494",
url="http://www.ncbi.nlm.nih.gov/pubmed/35417402"
}


@Article{info:doi/10.2196/29258,
author="Wiklund, Tobias
and Molander, Peter
and Lindner, Philip
and Andersson, Gerhard
and Gerdle, Bj{\"o}rn
and Dragioti, Elena",
title="Internet-Delivered Cognitive Behavioral Therapy for Insomnia Comorbid With Chronic Pain: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2022",
month="Apr",
day="29",
volume="24",
number="4",
pages="e29258",
keywords="insomnia",
keywords="chronic pain",
keywords="comorbid",
keywords="CBT-i",
keywords="RCT",
keywords="web-based CBT",
keywords="pain",
keywords="online health",
keywords="online treatment",
keywords="digital health",
keywords="mental health",
keywords="rehabilitation",
abstract="Background: Patients with chronic pain often experience insomnia symptoms. Pain initiates, maintains, and exacerbates insomnia symptoms, and vice versa, indicating a complex situation with an additional burden for these patients. Hence, the evaluation of insomnia-related interventions for patients with chronic pain is important. Objective: This randomized controlled trial examined the effectiveness of internet-based cognitive behavioral therapy for insomnia (ICBT-i) for reducing insomnia severity and other sleep- and pain-related parameters in patients with chronic pain. Participants were recruited from the Swedish Quality Registry for Pain Rehabilitation. Methods: We included 54 patients (mean age 49.3, SD 12.3 years) who were randomly assigned to the ICBT-i condition and 24 to an active control condition (applied relaxation). Both treatment conditions were delivered via the internet. The Insomnia Severity Index (ISI), a sleep diary, and a battery of anxiety, depression, and pain-related parameter measurements were assessed at baseline, after treatment, and at a 6-month follow-up (only ISI, anxiety, depression, and pain-related parameters). For the ISI and sleep diary, we also recorded weekly measurements during the 5-week treatment. Negative effects were also monitored and reported. Results: Results showed a significant immediate interaction effect (time by treatment) on the ISI and other sleep parameters, namely, sleep efficiency, sleep onset latency, early morning awakenings, and wake time after sleep onset. Participants in the applied relaxation group reported no significant immediate improvements, but both groups exhibited a time effect for anxiety and depression at the 6-month follow-up. No significant improvements on pain-related parameters were found. At the 6-month follow-up, both the ICBT-i and applied relaxation groups had similar sleep parameters. For both treatment arms, increased stress was the most frequently reported negative effect. Conclusions: In patients with chronic pain, brief ICBT-i leads to a more rapid decline in insomnia symptoms than does applied relaxation. As these results are unique, further research is needed to investigate the effect of ICBT-i on a larger sample size of people with chronic pain. Using both treatments might lead to an even better outcome in patients with comorbid insomnia and chronic pain. Trial Registration: ClinicalTrials.gov NCT03425942; https://clinicaltrials.gov/ct2/show/NCT03425942 ",
doi="10.2196/29258",
url="https://www.jmir.org/2022/4/e29258",
url="http://www.ncbi.nlm.nih.gov/pubmed/35486418"
}


@Article{info:doi/10.2196/35945,
author="Bas-Sarmiento, Pilar
and Fern{\'a}ndez-Guti{\'e}rrez, Martina
and Poza-M{\'e}ndez, Miriam
and Mar{\'i}n-Paz, Jes{\'u}s Antonio
and Paloma-Castro, Olga
and Romero-S{\'a}nchez, Manuel Jos{\'e}
and ",
title="Development and Effectiveness of a Mobile Health Intervention in Improving Health Literacy and Self-management of Patients With Multimorbidity and Heart Failure: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="Apr",
day="29",
volume="11",
number="4",
pages="e35945",
keywords="complex health needs",
keywords="health literacy",
keywords="heart failure",
keywords="mHealth",
keywords="multimorbidity",
abstract="Background: Patients with multimorbidity and complex health needs are defined as a priority by the World Health Organization (WHO) and the European Union. There is a need to develop appropriate strategies with effective measures to meet the challenge of chronicity, reorienting national health systems. The increasing expansion of mobile health (mHealth) interventions in patient communication, the reduction of health inequalities, improved access to health care resources, adherence to treatment, and self-care of chronic diseases all point to an optimistic outlook. However, only few mobile apps demonstrate their effectiveness in these patients, which is diminished when they are not based on evidence, or when they are not designed by and for users with different levels of health literacy (HL). Objective: This study aims to evaluate the efficacy of an mHealth intervention relative to routine clinical practice in improving HL and self-management in patients with multimorbidity with heart failure (HF) and complex health needs. Methods: This is a randomized, multicenter, blinded clinical trial evaluating 2 groups, namely, a control group (standard clinical practice) and an intervention group (standard clinical practice and an ad hoc designed mHealth intervention previously developed), for 12 months. Results: The contents of the mHealth intervention will address user-perceived needs based on the development of user stories regarding diet, physical exercise, cardiac rehabilitation, therapeutic adherence, warning signs and symptoms, and emotional management. These contents have been validated by expert consensus. The creation and development of the contents of the mHealth intervention (app) took 18 months and was completed during 2021. The mobile app is expected to be developed by the end of 2022, after which it will be applied to the experimental group as an adjunct to standard clinical care during 12 months. Conclusions: The trial will demonstrate whether the mobile app improves HL and self-management in patients with HF and complex health needs, improves therapeutic adherence, and reduces hospital admissions. This study can serve as a starting point for developing other mHealth tools in other pathologies and for their generalization to other contexts. Trial Registration: ClinicalTrials.gov NCT04725526; https://tinyurl.com/bd8va27w International Registered Report Identifier (IRRID): DERR1-10.2196/35945 ",
doi="10.2196/35945",
url="https://www.researchprotocols.org/2022/4/e35945",
url="http://www.ncbi.nlm.nih.gov/pubmed/35486437"
}


@Article{info:doi/10.2196/30224,
author="Wendrich, Karine
and Krabbenborg, Lotte",
title="Digital Self-monitoring of Multiple Sclerosis: Interview Study With Dutch Health Care Providers on the Expected New Configuration of Roles and Responsibilities",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Apr",
day="27",
volume="10",
number="4",
pages="e30224",
keywords="digital self-monitoring",
keywords="smartphone apps",
keywords="multiple sclerosis",
keywords="technology assessment",
keywords="health care providers",
keywords="user participation",
keywords="mobile phone",
abstract="Background: Digital self-monitoring allows patients to produce and share personal health data collected at home. This creates a novel situation in which health care providers and patients must engage in a reconfiguration of roles and responsibilities. Although existing research pays considerable attention to the perceptions of patients regarding digital self-monitoring, less attention has been paid to the needs, wishes, and concerns of health care providers. As several companies and public institutions are developing and testing digital self-monitoring at the time of writing, it is timely and relevant to explore how health care providers envision using these technologies in their daily work practices. Our findings can be considered in decision-making processes concerning the further development and implementation of digital self-monitoring. Objective: This study aims to explore how health care providers envisage using smartphone apps for digital self-monitoring of multiple sclerosis (MS) in their daily work practices, with a particular focus on physician-patient communication and on how health care providers respond to self-monitoring data and delegate tasks and responsibilities to patients. Methods: We conducted semistructured in-depth interviews with 14 MS health care providers: 4 neurologists, 7 MS specialist nurses, and 3 rehabilitation professionals. They are affiliated with 3 different hospitals in the Netherlands that will participate in a pilot study to assess the efficiency and effectiveness of a specific smartphone app for self-monitoring. Results: The interviewed health care providers seemed willing to use these smartphone apps and valued the quantitative data they produce that can complement the narratives that patients provide during medical appointments. The health care providers primarily want to use digital self-monitoring via prescription, meaning that they want a standardized smartphone app and want to act as its gatekeepers. Furthermore, they envisioned delegating particular tasks and responsibilities to patients via digital self-monitoring, such as sharing data with the health care providers or acting on the data, if necessary. The health care providers expected patients to become more proactive in the management of their disease. However, they also acknowledged that not all patients are willing or able to use digital self-monitoring apps and were concerned about the potential psychological and emotional burden on patients caused by this technology. Conclusions: Our findings show that health care providers envisage a particular type of patient empowerment and personalized health care in which tensions arise between health care providers acting as gatekeepers and patient autonomy, between patient empowerment and patient disempowerment, and between the weight given to quantitative objective data and that given to patients' subjective experiences. In future research, it would be very interesting to investigate the actual experiences of health care providers with regard to digital self-monitoring to ascertain how the tensions mentioned in this paper play out in practice. ",
doi="10.2196/30224",
url="https://mhealth.jmir.org/2022/4/e30224",
url="http://www.ncbi.nlm.nih.gov/pubmed/35475770"
}


@Article{info:doi/10.2196/35671,
author="Meheli, Saha
and Sinha, Chaitali
and Kadaba, Madhura",
title="Understanding People With Chronic Pain Who Use a Cognitive Behavioral Therapy--Based Artificial Intelligence Mental Health App (Wysa): Mixed Methods Retrospective Observational Study",
journal="JMIR Hum Factors",
year="2022",
month="Apr",
day="27",
volume="9",
number="2",
pages="e35671",
keywords="chronic pain",
keywords="digital mental health",
keywords="mobile health",
keywords="mHealth",
keywords="pain management",
keywords="artificial intelligence",
keywords="cognitive behavioral therapy",
keywords="conversational agent",
keywords="software agent",
keywords="pain conditions",
keywords="depression",
keywords="anxiety",
abstract="Background: Digital health interventions can bridge barriers in access to treatment among individuals with chronic pain. Objective: This study aimed to evaluate the perceived needs, engagement, and effectiveness of the mental health app Wysa with regard to mental health outcomes among real-world users who reported chronic pain and engaged with the app for support. Methods: Real-world data from users (N=2194) who reported chronic pain and associated health conditions in their conversations with the mental health app were examined using a mixed methods retrospective observational study. An inductive thematic analysis was used to analyze the conversational data of users with chronic pain to assess perceived needs, along with comparative macro-analyses of conversational flows to capture engagement within the app. Additionally, the scores from a subset of users who completed a set of pre-post assessment questionnaires, namely Patient Health Questionnaire-9 (PHQ-9) (n=69) and Generalized Anxiety Disorder Assessment-7 (GAD-7) (n=57), were examined to evaluate the effectiveness of Wysa in providing support for mental health concerns among those managing chronic pain. Results: The themes emerging from the conversations of users with chronic pain included health concerns, socioeconomic concerns, and pain management concerns. Findings from the quantitative analysis indicated that users with chronic pain showed significantly greater app engagement (P<.001) than users without chronic pain, with a large effect size (Vargha and Delaney A=0.76-0.80). Furthermore, users with pre-post assessments during the study period were found to have significant improvements in group means for both PHQ-9 and GAD-7 symptom scores, with a medium effect size (Cohen d=0.60-0.61). Conclusions: The findings indicate that users look for tools that can help them address their concerns related to mental health, pain management, and sleep issues. The study findings also indicate the breadth of the needs of users with chronic pain and the lack of support structures, and suggest that Wysa can provide effective support to bridge the gap. ",
doi="10.2196/35671",
url="https://humanfactors.jmir.org/2022/2/e35671",
url="http://www.ncbi.nlm.nih.gov/pubmed/35314422"
}


@Article{info:doi/10.2196/32348,
author="Hammond, M. Michael
and Zhang, Yuankai
and Pathiravasan, H. Chathurangi
and Lin, Honghuang
and Sardana, Mayank
and Trinquart, Ludovic
and Benjamin, J. Emelia
and Borrelli, Belinda
and Manders, S. Emily
and Fusco, Kelsey
and Kornej, Jelena
and Spartano, L. Nicole
and Kheterpal, Vik
and Nowak, Christopher
and McManus, D. David
and Liu, Chunyu
and Murabito, M. Joanne",
title="Relations Between BMI Trajectories and Habitual Physical Activity Measured by a Smartwatch in the Electronic Cohort of the Framingham Heart Study: Cohort Study",
journal="JMIR Cardio",
year="2022",
month="Apr",
day="27",
volume="6",
number="1",
pages="e32348",
keywords="mobile health",
keywords="BMI",
keywords="smartwatch",
keywords="physical activity",
keywords="cardiovascular diseases",
keywords="cardiology",
keywords="digital health",
keywords="mHealth",
keywords="mobile health apps",
abstract="Background: The prevalence of obesity is rising. Most previous studies that examined the relations between BMI and physical activity (PA) measured BMI at a single timepoint. The association between BMI trajectories and habitual PA remains unclear. Objective: This study assesses the relations between BMI trajectories and habitual step-based PA among participants enrolled in the electronic cohort of the Framingham Heart Study (eFHS). Methods: We used a semiparametric group-based modeling to identify BMI trajectories from eFHS participants who attended research examinations at the Framingham Research Center over 14 years. Daily steps were recorded from the smartwatch provided at examination 3. We excluded participants with <30 days or <5 hours of smartwatch wear data. We used generalized linear models to examine the association between BMI trajectories and daily step counts. Results: We identified 3 trajectory groups for the 837 eFHS participants (mean age 53 years; 57.8\% [484/837] female). Group 1 included 292 participants whose BMI was stable (slope 0.005; P=.75), group 2 included 468 participants whose BMI increased slightly (slope 0.123; P<.001), and group 3 included 77 participants whose BMI increased greatly (slope 0.318; P<.001). The median follow-up period for step count was 516 days. Adjusting for age, sex, wear time, and cohort, participants in groups 2 and 3 took 422 (95\% CI --823 to --21) and 1437 (95\% CI --2084 to --790) fewer average daily steps, compared with participants in group 1. After adjusting for metabolic and social risk factors, group 2 took 382 (95\% CI --773 to 10) and group 3 took 1120 (95\% CI --1766 to --475) fewer steps, compared with group 1. Conclusions: In this community-based eFHS, participants whose BMI trajectory increased greatly over time took significantly fewer steps, compared with participants with stable BMI trajectories. Our findings suggest that greater weight gain may correlate with lower levels of step-based physical activity. ",
doi="10.2196/32348",
url="https://cardio.jmir.org/2022/1/e32348",
url="http://www.ncbi.nlm.nih.gov/pubmed/35476038"
}


@Article{info:doi/10.2196/30236,
author="Treskes, Willem Roderick
and van den Akker-van Marle, Elske M.
and van Winden, Louise
and van Keulen, Nicole
and van der Velde, Tjeerd Enno
and Beeres, Saskia
and Atsma, Douwe
and Schalij, Jan Martin",
title="The Box---eHealth in the Outpatient Clinic Follow-up of Patients With Acute Myocardial Infarction: Cost-Utility Analysis",
journal="J Med Internet Res",
year="2022",
month="Apr",
day="25",
volume="24",
number="4",
pages="e30236",
keywords="smart technology",
keywords="myocardial infarction",
keywords="cost-utility",
keywords="outpatients",
keywords="cost-effectiveness",
keywords="eHealth",
keywords="remote monitoring",
keywords="cost of care",
keywords="quality of life",
abstract="Background: Smartphone compatible wearables have been released on the consumers market, enabling remote monitoring. Remote monitoring is often named as a tool to reduce the cost of care. Objective: The primary purpose of this paper is to describe a cost-utility analysis of an eHealth intervention compared to regular follow-up in patients with acute myocardial infarction (AMI). Methods: In this trial, of which clinical results have been published previously, patients with an AMI were randomized in a 1:1 fashion between an eHealth intervention and regular follow-up. The remote monitoring intervention consisted of a blood pressure monitor, weight scale, electrocardiogram device, and step counter. Furthermore, two in-office outpatient clinic visits were replaced by e-visits. The control group received regular care. The differences in mean costs and quality of life per patient between both groups during one-year follow-up were calculated. Results: Mean costs per patient were {\texteuro}2417{\textpm}2043 (US \$2657{\textpm}2246) for the intervention and {\texteuro}2888{\textpm}2961 (US \$3175{\textpm}3255) for the control group. This yielded a cost reduction of {\texteuro}471 (US \$518) per patient. This difference was not statistically significant (95\% CI --{\texteuro}275 to {\texteuro}1217; P=.22, US \$--302 to \$1338). The average quality-adjusted life years in the first year of follow-up was 0.74 for the intervention group and 0.69 for the control (difference --0.05, 95\% CI --0.09 to --0.01; P=.01). Conclusions: eHealth in the outpatient clinic setting for patients who suffered from AMI is likely to be cost-effective compared to regular follow-up. Further research should be done to corroborate these findings in other patient populations and different care settings. Trial Registration: ClinicalTrials.gov NCT02976376; https://clinicaltrials.gov/ct2/show/NCT02976376 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.8038 ",
doi="10.2196/30236",
url="https://www.jmir.org/2022/4/e30236",
url="http://www.ncbi.nlm.nih.gov/pubmed/35468091"
}


@Article{info:doi/10.2196/32825,
author="McBeth, John
and Dixon, G. William
and Moore, Mary Susan
and Hellman, Bruce
and James, Ben
and Kyle, D. Simon
and Lunt, Mark
and Cordingley, Lis
and Yimer, Birlie Belay
and Druce, L. Katie",
title="Sleep Disturbance and Quality of Life in Rheumatoid Arthritis: Prospective mHealth Study",
journal="J Med Internet Res",
year="2022",
month="Apr",
day="22",
volume="24",
number="4",
pages="e32825",
keywords="mobile health",
keywords="sleep",
keywords="rheumatoid arthritis",
keywords="pain",
keywords="fatigue",
keywords="mood",
keywords="sleep disturbance",
keywords="HRQoL",
keywords="quality of life",
keywords="health-related quality of life",
keywords="QoL",
keywords="sleep efficiency",
keywords="WHOQoL-BREF",
keywords="mobile phone",
abstract="Background: Sleep disturbances and poor health-related quality of life (HRQoL) are common in people with rheumatoid arthritis (RA). Sleep disturbances, such as less total sleep time, more waking periods after sleep onset, and higher levels of nonrestorative sleep, may be a driver of HRQoL. However, understanding whether these sleep disturbances reduce HRQoL has, to date, been challenging because of the need to collect complex time-varying data at high resolution. Such data collection is now made possible by the widespread availability and use of mobile health (mHealth) technologies. Objective: This mHealth study aimed to test whether sleep disturbance (both absolute values and variability) causes poor HRQoL. Methods: The quality of life, sleep, and RA study was a prospective mHealth study of adults with RA. Participants completed a baseline questionnaire, wore a triaxial accelerometer for 30 days to objectively assess sleep, and provided daily reports via a smartphone app that assessed sleep (Consensus Sleep Diary), pain, fatigue, mood, and other symptoms. Participants completed the World Health Organization Quality of Life-Brief (WHOQoL-BREF) questionnaire every 10 days. Multilevel modeling tested the relationship between sleep variables and the WHOQoL-BREF domains (physical, psychological, environmental, and social). Results: Of the 268 recruited participants, 254 were included in the analysis. Across all WHOQoL-BREF domains, participants' scores were lower than the population average. Consensus Sleep Diary sleep parameters predicted the WHOQoL-BREF domain scores. For example, for each hour increase in the total time asleep physical domain scores increased by 1.11 points ($\beta$=1.11, 95\% CI 0.07-2.15) and social domain scores increased by 1.65 points. These associations were not explained by sociodemographic and lifestyle factors, disease activity, medication use, anxiety levels, sleep quality, or clinical sleep disorders. However, these changes were attenuated and no longer significant when pain, fatigue, and mood were included in the model. Increased variability in total time asleep was associated with poorer physical and psychological domain scores, independent of all covariates. There was no association between actigraphy-measured sleep and WHOQoL-BREF. Conclusions: Optimizing total sleep time, increasing sleep efficiency, decreasing sleep onset latency, and reducing variability in total sleep time could improve HRQoL in people with RA. ",
doi="10.2196/32825",
url="https://www.jmir.org/2022/4/e32825",
url="http://www.ncbi.nlm.nih.gov/pubmed/35451978"
}


@Article{info:doi/10.2196/36977,
author="Ramachandram, Dhanesh
and Ramirez-GarciaLuna, Luis Jose
and Fraser, J. Robert D.
and Mart{\'i}nez-Jim{\'e}nez, Aurelio Mario
and Arriaga-Caballero, E. Jesus
and Allport, Justin",
title="Fully Automated Wound Tissue Segmentation Using Deep Learning on Mobile Devices: Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Apr",
day="22",
volume="10",
number="4",
pages="e36977",
keywords="wound",
keywords="tissue segmentation",
keywords="automated tissue identification",
keywords="deep learning",
keywords="mobile imaging",
keywords="mobile phone",
abstract="Background: Composition of tissue types within a wound is a useful indicator of its healing progression. Tissue composition is clinically used in wound healing tools (eg, Bates-Jensen Wound Assessment Tool) to assess risk and recommend treatment. However, wound tissue identification and the estimation of their relative composition is highly subjective. Consequently, incorrect assessments could be reported, leading to downstream impacts including inappropriate dressing selection, failure to identify wounds at risk of not healing, or failure to make appropriate referrals to specialists. Objective: This study aimed to measure inter- and intrarater variability in manual tissue segmentation and quantification among a cohort of wound care clinicians and determine if an objective assessment of tissue types (ie, size and amount) can be achieved using deep neural networks. Methods: A data set of 58 anonymized wound images of various types of chronic wounds from Swift Medical's Wound Database was used to conduct the inter- and intrarater agreement study. The data set was split into 3 subsets with 50\% overlap between subsets to measure intrarater agreement. In this study, 4 different tissue types (epithelial, granulation, slough, and eschar) within the wound bed were independently labeled by the 5 wound clinicians at 1-week intervals using a browser-based image annotation tool. In addition, 2 deep convolutional neural network architectures were developed for wound segmentation and tissue segmentation and were used in sequence in the workflow. These models were trained using 465,187 and 17,000 image-label pairs, respectively. This is the largest and most diverse reported data set used for training deep learning models for wound and wound tissue segmentation. The resulting models offer robust performance in diverse imaging conditions, are unbiased toward skin tones, and could execute in near real time on mobile devices. Results: A poor to moderate interrater agreement in identifying tissue types in chronic wound images was reported. A very poor Krippendorff $\alpha$ value of .014 for interrater variability when identifying epithelization was observed, whereas granulation was most consistently identified by the clinicians. The intrarater intraclass correlation (3,1), however, indicates that raters were relatively consistent when labeling the same image multiple times over a period. Our deep learning models achieved a mean intersection over union of 0.8644 and 0.7192 for wound and tissue segmentation, respectively. A cohort of wound clinicians, by consensus, rated 91\% (53/58) of the tissue segmentation results to be between fair and good in terms of tissue identification and segmentation quality. Conclusions: The interrater agreement study validates that clinicians exhibit considerable variability when identifying and visually estimating wound tissue proportion. The proposed deep learning technique provides objective tissue identification and measurements to assist clinicians in documenting the wound more accurately and could have a significant impact on wound care when deployed at scale. ",
doi="10.2196/36977",
url="https://mhealth.jmir.org/2022/4/e36977",
url="http://www.ncbi.nlm.nih.gov/pubmed/35451982"
}


@Article{info:doi/10.2196/32557,
author="Alhussein, Ghada
and Hadjileontiadis, Leontios",
title="Digital Health Technologies for Long-term Self-management of Osteoporosis: Systematic Review and Meta-analysis",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Apr",
day="21",
volume="10",
number="4",
pages="e32557",
keywords="mHealth",
keywords="digital health",
keywords="osteoporosis",
keywords="self-management",
keywords="systematic review",
keywords="meta-analysis",
keywords="chronic disease",
keywords="bone health",
keywords="nutrition",
keywords="physical activity",
keywords="risk assessment",
keywords="mobile phone",
abstract="Background: Osteoporosis is the fourth most common chronic disease worldwide. The adoption of preventative measures and effective self-management interventions can help improve bone health. Mobile health (mHealth) technologies can play a key role in the care and self-management of patients with osteoporosis. Objective: This study presents a systematic review and meta-analysis of the currently available mHealth apps targeting osteoporosis self-management, aiming to determine the current status, gaps, and challenges that future research could address, as well as propose appropriate recommendations. Methods: A systematic review of all English articles was conducted, in addition to a survey of all apps available in iOS and Android app stores as of May 2021. A comprehensive literature search (2010 to May 2021) of PubMed, Scopus, EBSCO, Web of Science, and IEEE Xplore was conducted. Articles were included if they described apps dedicated to or useful for osteoporosis (targeting self-management, nutrition, physical activity, and risk assessment) delivered on smartphone devices for adults aged ?18 years. Of the 32 articles, a random effects meta-analysis was performed on 13 (41\%) studies of randomized controlled trials, whereas the 19 (59\%) remaining studies were only included in the narrative synthesis as they did not provide enough data. Results: In total, 3906 unique articles were identified. Of these 3906 articles, 32 (0.81\%) articles met the inclusion criteria and were reviewed in depth. The 32 studies comprised 14,235 participants, of whom, on average, 69.5\% (n=9893) were female, with a mean age of 49.8 (SD 17.8) years. The app search identified 23 relevant apps for osteoporosis self-management. The meta-analysis revealed that mHealth-supported interventions resulted in a significant reduction in pain (Hedges g ?1.09, 95\% CI ?1.68 to ?0.45) and disability (Hedges g ?0.77, 95\% CI ?1.59 to 0.05). The posttreatment effect of the digital intervention was significant for physical function (Hedges g 2.54, 95\% CI ?4.08 to 4.08) but nonsignificant for well-being (Hedges g 0.17, 95\% CI ?1.84 to 2.17), physical activity (Hedges g 0.09, 95\% CI ?0.59 to 0.50), anxiety (Hedges g ?0.29, 95\% CI ?6.11 to 5.53), fatigue (Hedges g ?0.34, 95\% CI ?5.84 to 5.16), calcium (Hedges g ?0.05, 95\% CI ?0.59 to 0.50), vitamin D intake (Hedges g 0.10, 95\% CI ?4.05 to 4.26), and trabecular score (Hedges g 0.06, 95\% CI ?1.00 to 1.12). Conclusions: Osteoporosis apps have the potential to support and improve the management of the disease and its symptoms; they also appear to be valuable tools for patients and health professionals. However, most of the apps that are currently available lack clinically validated evidence of their efficacy and focus on a limited number of symptoms. A more holistic and personalized approach within a cocreation design ecosystem is needed. Trial Registration: PROSPERO 2021 CRD42021269399; https://tinyurl.com/2sw454a9 ",
doi="10.2196/32557",
url="https://mhealth.jmir.org/2022/4/e32557",
url="http://www.ncbi.nlm.nih.gov/pubmed/35451968"
}


@Article{info:doi/10.2196/33543,
author="Kutyba, Jolanta Justyna
and J?drzejczak, Wiktor W.
and Gos, El?bieta
and Raj-Koziak, Danuta
and Skarzynski, Henryk Piotr",
title="Chronic Tinnitus and the Positive Effects of Sound Treatment via a Smartphone App: Mixed-Design Study",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Apr",
day="21",
volume="10",
number="4",
pages="e33543",
keywords="tinnitus",
keywords="mobile app",
keywords="smartphone",
keywords="sound therapy",
keywords="telemedicine",
keywords="mobile phone",
abstract="Background: Tinnitus is a phantom auditory sensation in the absence of an external stimulus. It is accompanied by a broad range of negative emotional symptoms and a significantly lower quality of life. So far, there is no cure for tinnitus, although various treatment options have been tried. One of them is mobile technology employing dedicated apps based on sound therapy. The apps can be managed by the patient and tailored according to their needs. Objective: The study aims to assess the effect of a mobile app that generates background sounds on the severity of tinnitus. Methods: The study involved 68 adults who had chronic tinnitus. Participants were divided into a study group (44 patients) and a control group (24 patients). For 6 months those in the study group used a free mobile app that enriched the sound environment with a background sound. Participants were instructed to use the app for at least 30 minutes a day using their preferred sound. The participants in the control group did not use the app. Subjective changes in the day-to-day functioning of both groups were evaluated using the Tinnitus Handicap Inventory (THI) questionnaire, a visual analog scale, and a user survey. Results: After 3 months of using the app, the THI global score significantly decreased (P<.001) in the study group, decreasing again at 6 months (P<.001). The largest improvements were observed in the emotional and catastrophic reactions subscales. A clinically important change in the THI was reported by 39\% of the study group (17/44). Almost 90\% of the study participants (39/44) chose environmental sounds to listen to, the most popular being rain and ocean waves. In the control group, tinnitus severity did not change over 3 or 6 months. Conclusions: Although the participants still experienced limitations caused by tinnitus, the advantage of the app was that it led to lower negative emotions and thus reduced overall tinnitus severity. It is worth considering whether a mobile app might be incorporated into the management of tinnitus in a professional setting. ",
doi="10.2196/33543",
url="https://mhealth.jmir.org/2022/4/e33543",
url="http://www.ncbi.nlm.nih.gov/pubmed/35451975"
}


@Article{info:doi/10.2196/26339,
author="Olson, Jenny
and Hadjiconstantinou, Michelle
and Luff, Carly
and Watts, Karen
and Watson, Natasha
and Miller, Venus
and Schofield, Deborah
and Khunti, Kamlesh
and Davies, J. Melanie
and Calginari, Sara",
title="From the United Kingdom to Australia---Adapting a Web-Based Self-management Education Program to Support the Management of Type 2 Diabetes: Tutorial",
journal="J Med Internet Res",
year="2022",
month="Apr",
day="20",
volume="24",
number="4",
pages="e26339",
keywords="diabetes mellitus",
keywords="type 2",
keywords="technology",
keywords="self-management",
doi="10.2196/26339",
url="https://www.jmir.org/2022/4/e26339",
url="http://www.ncbi.nlm.nih.gov/pubmed/35442198"
}


@Article{info:doi/10.2196/36675,
author="Burda, V{\'a}clav
and Mr{\'a}z, Milo{\vs}
and Schneider, Jakub
and Nov{\'a}k, Daniel",
title="Managing Diabetes Using Mobiab: Long-Term Case Study of the Impact of a Mobile App on Self-management",
journal="JMIR Diabetes",
year="2022",
month="Apr",
day="20",
volume="7",
number="2",
pages="e36675",
keywords="diabetes mellitus",
keywords="self-management",
keywords="mobile app",
keywords="case study",
keywords="long-term data",
abstract="Background: This paper describes the development of a mobile app for diabetes mellitus (DM) control and self-management and presents the results of long-term usage of this system in the Czech Republic. DM is a chronic disease affecting large numbers of people worldwide, and this number is continuously increasing. There is massive potential to increase adherence to self-management of DM with the use of smartphones and digital therapeutics interventions. Objective: This study aims to describe the process of development of a mobile app, called Mobiab, for DM management and to investigate how individual features are used and how the whole system benefits its long-term users. Using at least 1 year of daily records from users, we analyzed the impact of the app on self-management of DM. Methods: We have developed a mobile app that serves as an alternative form to the classic paper-based protocol or diary. The development was based on cooperation with both clinicians and people with DM. The app consists of independent individual modules. Therefore, the user has the possibility to use only selected features that they find useful. Mobiab was available free of charge on Google Play Store from mid-2014 until 2019. No targeted recruitment was performed to attract users. Results: More than 500 users from the Czech Republic downloaded and signed up for the mobile app. Approximately 80\% of the users used Mobiab for less than 1 week. The rest of the users used it for a longer time and 8 of the users produced data that were suitable for long-term analysis. Additionally, one of the 8 users provided their medical records, which were compared with the gathered data, and the improvements in their glucose levels and overall metabolic stability were consistent with the way in which the mobile app was used. Conclusions: The results of this study showed that the usability of a DM-centered self-management smartphone mobile app and server-based systems could be satisfactory and promising. Nonetheless, some better ways of motivating people with diabetes toward participation in self-management are needed. Further studies involving a larger number of participants are warranted to assess the effect on long-term diabetes management. ",
doi="10.2196/36675",
url="https://diabetes.jmir.org/2022/2/e36675",
url="http://www.ncbi.nlm.nih.gov/pubmed/35442201"
}


@Article{info:doi/10.2196/33992,
author="Bezerra Giordan, Leticia
and Ronto, Rimante
and Chau, Josephine
and Chow, Clara
and Laranjo, Liliana",
title="Use of Mobile Apps in Heart Failure Self-management: Qualitative Study Exploring the Patient and Primary Care Clinician Perspective",
journal="JMIR Cardio",
year="2022",
month="Apr",
day="20",
volume="6",
number="1",
pages="e33992",
keywords="mobile app",
keywords="mHealth",
keywords="heart failure",
keywords="self-management",
keywords="eHealth",
keywords="telehealth",
abstract="Background: Mobile apps have the potential to support patients with heart failure and facilitate disease self-management, but this area of research is recent and rapidly evolving, with inconsistent results for efficacy. So far, most of the published studies evaluated the feasibility of a specific app or assessed the quality of apps available in app stores. Research is needed to explore patients' and clinicians' perspectives to guide app development, evaluation, and implementation into models of care. Objective: This study aims to explore the patient and primary care clinician perspective on the facilitators and barriers to using mobile apps, as well as desired features, to support heart failure self-management. Methods: This is a qualitative phenomenological study involving face-to-face semistructured interviews. Interviews were conducted in a general practice clinic in Sydney, Australia. Eligible participants were adult patients with heart failure and health care professionals who provided care to these patients at the clinic. Patients did not need to have previous experience using heart failure mobile apps to be eligible for this study. The interviews were audio-recorded, transcribed, and analyzed using inductive thematic data analysis in NVivo 12. Results: A total of 12 participants were interviewed: 6 patients (mean age 69 [SD 7.9] years) and 6 clinicians. The interviews lasted from 25 to 45 minutes. The main facilitators to the use of apps to support heart failure self-management were communication ability, personalized feedback and education, and automated self-monitoring. Patients mentioned that chat-like features and ability to share audio-visual information can be helpful for getting support outside of clinical appointments. Clinicians considered helpful to send motivational messages to patients and ask them about signs and symptoms of heart failure decompensation. Overall, participants highlighted the importance of personalization, particularly in terms of feedback and educational content. Automated self-monitoring with wireless devices was seen to alleviate the burden of tracking measures such as weight and blood pressure. Other desired features included tools to monitor patient-reported outcomes and support patients' mental health and well-being. The main barriers identified were the patients' unwillingness to engage in a new strategy to manage their condition using an app, particularly in the case of low digital literacy. However, clinicians mentioned this barrier could potentially be overcome by introducing the app soon after an exacerbation, when patients might be more willing to improve their self-management and avoid rehospitalization. Conclusions: The use of mobile apps to support heart failure self-management may be facilitated by features that increase the usefulness and utility of the app, such as communication ability in-between consultations and personalized feedback. Also important is facilitating ease of use by supporting automated self-monitoring through integration with wireless devices. Future research should consider these features in the co-design and testing of heart failure mobile apps with patients and clinicians. ",
doi="10.2196/33992",
url="https://cardio.jmir.org/2022/1/e33992",
url="http://www.ncbi.nlm.nih.gov/pubmed/35442205"
}


@Article{info:doi/10.2196/33628,
author="Cai, Yiyuan
and Gong, Wenjie
and He, Wenjun
and He, Hua
and Hughes, P. James
and Simoni, Jane
and Xiao, Shuiyuan
and Gloyd, Stephen
and Lin, Meijuan
and Deng, Xinlei
and Liang, Zichao
and Dai, Bofeng
and Liao, Jing
and Hao, Yuantao
and Xu, Roman Dong",
title="Residual Effect of Texting to Promote Medication Adherence for Villagers with Schizophrenia in China: 18-Month Follow-up Survey After the Randomized Controlled Trial Discontinuation",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Apr",
day="19",
volume="10",
number="4",
pages="e33628",
keywords="medication adherence",
keywords="mobile texting",
keywords="lay health worker",
keywords="resource-poor community",
keywords="primary health care",
keywords="quality of care",
keywords="mHealth",
keywords="schizophrenia",
keywords="maintenance",
keywords="residual effect",
keywords="mental health",
keywords="patient outcomes",
abstract="Background: Reducing the treatment gap for mental health in low- and middle-income countries is a high priority. Even with treatment, adherence to antipsychotics is rather low. Our integrated intervention package significantly improved medication adherence within 6 months for villagers with schizophrenia in resource-poor communities in rural China. However, considering the resource constraint, we need to test whether the effect of those behavior-shaping interventions may be maintained even after the suspension of the intervention. Objective: The aim of this study is to explore the primary outcome of adherence and other outcomes at an 18-month follow-up after the intervention had been suspended. Methods: In a 6-month randomized trial, 277 villagers with schizophrenia were randomized to receive either a government community mental health program (686 Program) or the 686 Program plus Lay health supporters, e-platform, award, and integration (LEAN), which included health supporters for medication or care supervision, e-platform access for sending mobile SMS text messaging reminders and education message, a token gift for positive behavior changes (eg, continuing taking medicine), and integrating the e-platform with the existing 686 Program. After the 6-month intervention, both groups received only the 686 Program for 18 months (phase 2). Outcomes at both phases included antipsychotic medication adherence, functioning, symptoms, number of rehospitalization, suicide, and violent behaviors. The adherence and functioning were assessed at the home visit by trained assessors. We calculated the adherence in the past 30 days by counting the percentage of dosages taken from November to December 2018 by unannounced home-based pill counts. The functioning was assessed using the World Health Organization Disability Assessment Schedule 2.0. The symptoms were evaluated using the Clinical Global Impression--Schizophrenia during their visits to the 686 Program psychiatrists. Other outcomes were routinely collected in the 686 Program system. We used intention-to-treat analysis, and missing data were dealt with using multiple imputation. The generalized estimating equation model was used to assess program effects on adherence, functioning, and symptoms. Results: In phase 1, antipsychotic adherence and rehospitalization incidence improved significantly. However, in phase 2, the difference of the mean of antipsychotic adherence (adjusted mean difference 0.05, 95\% CI ?0.06 to 0.16; P=.41; Cohen d effect size=0.11) and rehospitalization incidence (relative risk 0.65, 95\% CI 0.32-1.33; P=.24; number needed to treat 21.83, 95\% CI 8.30-34.69) was no longer statistically significant, and there was no improvement in other outcomes in either phase (P?.05). Conclusions: The simple community-based LEAN intervention could not continually improve adherence and reduce the rehospitalization of people with schizophrenia. Our study inclined to suggest that prompts for medication may be necessary to maintain medication adherence for people with schizophrenia, although we cannot definitively exclude other alternative interpretations. ",
doi="10.2196/33628",
url="https://mhealth.jmir.org/2022/4/e33628",
url="http://www.ncbi.nlm.nih.gov/pubmed/35438649"
}


@Article{info:doi/10.2196/29408,
author="Luo, Xueyan
and Xu, Wei
and Ming, Wai-Kit
and Jiang, Xinchan
and Yuan, Quan
and Lai, Han
and Huang, Chunji
and Zhong, Xiaoni",
title="Cost-Effectiveness of Mobile Health--Based Integrated Care for Atrial Fibrillation: Model Development and Data Analysis",
journal="J Med Internet Res",
year="2022",
month="Apr",
day="19",
volume="24",
number="4",
pages="e29408",
keywords="mobile health",
keywords="integrated care",
keywords="ABC pathway",
keywords="atrial fibrillation",
keywords="model-based",
keywords="cost-effectiveness",
keywords="health economic evaluation",
abstract="Background: Mobile health (mHealth) technology is increasingly used in disease management. Using mHealth tools to integrate and streamline care has improved clinical outcomes of patients with atrial fibrillation (AF). Objective: The aim of this study was to investigate the potential clinical and health economic outcomes of mHealth-based integrated care for AF from the perspective of a public health care provider in China. Methods: A Markov model was designed to compare outcomes of mHealth-based care and usual care in a hypothetical cohort of patients with AF in China. The time horizon was 30 years with monthly cycles. Model outcomes measured were direct medical cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed to examine the robustness of the base-case results. Results: In the base-case analysis, mHealth-based care gained higher QALYs of 0.0730 with an incurred cost of US \$1090. Using US \$33,438 per QALY (three times the gross domestic product) as the willingness-to-pay threshold, mHealth-based care was cost-effective, with an ICER of US \$14,936 per QALY. In one-way sensitivity analysis, no influential factor with a threshold value was identified. In probabilistic sensitivity analysis, mHealth-based care was accepted as cost-effective in 92.33\% of 10,000 iterations. Conclusions: This study assessed the expected cost-effectiveness of applying mHealth-based integrated care for AF according to a model-based health economic evaluation. The exploration suggested the potential cost-effective use of mHealth apps in streamlining and integrating care via the Atrial fibrillation Better Care (ABC) pathway for AF in China. Future economic evaluation alongside randomized clinical trials is highly warranted to verify the suggestion and investigate affecting factors such as geographical variations in patient characteristics, identification of subgroups, and constraints on local implementation. ",
doi="10.2196/29408",
url="https://www.jmir.org/2022/4/e29408",
url="http://www.ncbi.nlm.nih.gov/pubmed/35438646"
}


@Article{info:doi/10.2196/32643,
author="Mackey, Rachel
and Gleason, Ann
and Ciulla, Robert",
title="A Novel Method for Evaluating Mobile Apps (App Rating Inventory): Development Study",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Apr",
day="15",
volume="10",
number="4",
pages="e32643",
keywords="mobile health apps",
keywords="app rating",
keywords="app analysis methodology",
keywords="app market research",
keywords="mobile phone",
abstract="Background: Selecting and integrating health-related apps into patient care is impeded by the absence of objective guidelines for identifying high-quality apps from the many thousands now available. Objective: This study aimed to evaluate the App Rating Inventory, which was developed by the Defense Health Agency's Connected Health branch, to support clinical decisions regarding app selection and evaluate medical and behavioral apps. Methods: To enhance the tool's performance, eliminate item redundancy, reduce scoring system subjectivity, and ensure a broad application of App Rating Inventory--derived results, inventory development included 3 rounds of validation testing and 2 trial periods conducted over a 6-month interval. The development focused on content validity testing, dimensionality (ie, whether the tool's criteria performed as operationalized), factor and commonality analysis, and interrater reliability (reliability scores improved from 0.62 to 0.95 over the course of development). Results: The development phase culminated in a review of 248 apps for a total of 6944 data points and a final 28-item, 3-category app rating system. The App Rating Inventory produces scores for the following three categories: evidence (6 items), content (11 items), and customizability (11 items). The final (fourth) metric is the total score, which constitutes the sum of the 3 categories. All 28 items are weighted equally; no item is considered more (or less) important than any other item. As the scoring system is binary (either the app contains the feature or it does not), the ratings' results are not dependent on a rater's nuanced assessments. Conclusions: Using predetermined search criteria, app ratings begin with an environmental scan of the App Store and Google Play. This first step in market research funnels hundreds of apps in a given disease category down to a manageable top 10 apps that are, thereafter, rated using the App Rating Inventory. The category and final scores derived from the rating system inform the clinician about whether an app is evidence informed and easy to use. Although a rating allows a clinician to make focused decisions about app selection in a context where thousands of apps are available, clinicians must weigh the following factors before integrating apps into a treatment plan: clinical presentation, patient engagement and preferences, available resources, and technology expertise. ",
doi="10.2196/32643",
url="https://mhealth.jmir.org/2022/4/e32643",
url="http://www.ncbi.nlm.nih.gov/pubmed/35436227"
}


@Article{info:doi/10.2196/34756,
author="Wu, Wen-Lan
and Huang, Yu-Ling
and Liang, Jing-Min
and Chen, Chia-Hsin
and Wang, Chih-Chung
and Ho, Wen-Hsien",
title="Interactive Digital Game for Improving Visual--Perceptual Defects in Children With a Developmental Disability: Randomized Controlled Trial",
journal="JMIR Serious Games",
year="2022",
month="Apr",
day="15",
volume="10",
number="2",
pages="e34756",
keywords="interactive digital game",
keywords="visual--perceptual defect",
keywords="developmental disability",
keywords="Children",
keywords="Test of Visual Perceptual Skills",
keywords="rehabilitation",
abstract="Background: Visual--perceptual defects in children can negatively affect their ability to perform activities of daily living. Conventional rehabilitation training for correcting visual--perceptual defects has limited training patterns and limited interactivity, which makes motivation difficult to sustain. Objective: We aimed to develop and evaluate an interactive digital game system for correcting visual--perceptual defects and evaluate its effectiveness. Methods: Participants were children aged 5 to 10 years with a diagnosis of visual--perceptual defect associated with a developmental disability. The children were randomized into a digital game group who received the traditional course of rehabilitation combined with an interactive digital game intervention (n=12) and a standard rehabilitation group (n=11) who only received the traditional course of rehabilitation. Each group underwent rehabilitation once a week for 4 weeks. Overall improvement in Test of Visual Perceptual Skills 3rd edition (TVPS-3) score and overall improvement in performance in the interactive digital game were evaluated. Parents and therapists were asked to complete a satisfaction questionnaire. Results: After 4 weeks, the TVPS-3 score had significantly increased (P=.002) in the digital game group (pre: mean 41.67, SD 13.88; post: 61.50, SD 21.64). In the standard rehabilitation group, the TVPS-3 score also increased, but the increase was not statistically significant (P=.58). Additionally, TVPS-3 score increases were significantly larger for the digital game group compared with those for the standard rehabilitation group (P=.005). Moreover, both parents and therapists were highly satisfied with the system. All 5 themes of satisfaction had mean scores higher than 4 in a 5-point scale questionnaire (mean 4.30, SD 0.56). Conclusions: The system has potential applications for improving visual--perceptual function in children undergoing medical rehabilitation for developmental disability. Trial Registration: ClinicalTrials.gov NCT05016492; http://clinicaltrials.gov/ct2/show/NCT05016492 ",
doi="10.2196/34756",
url="https://games.jmir.org/2022/2/e34756",
url="http://www.ncbi.nlm.nih.gov/pubmed/35436215"
}


@Article{info:doi/10.2196/36721,
author="Mehdizadeh, Hamed
and Asadi, Farkhondeh
and Emami, Hassan
and Mehrvar, Azim
and Nazemi, Eslam",
title="An mHealth Self-management System for Support Children With Acute Lymphocytic Leukemia and Their Caregivers: Qualitative Co-design Study",
journal="JMIR Form Res",
year="2022",
month="Apr",
day="15",
volume="6",
number="4",
pages="e36721",
keywords="digital health",
keywords="eHealth",
keywords="mHealth",
keywords="mobile app",
keywords="smartphone",
keywords="mobile phone",
keywords="self-management",
keywords="patient education",
keywords="children",
keywords="caregivers",
keywords="acute lymphocytic leukemia",
keywords="user-centered design",
abstract="Background: The unique features of smartphones have extended their use in different fields, especially in the health care domain. These features offer new opportunities to support patients with chronic conditions by providing them with information, education, and self-management skills. We developed a digital self-management system to support children with cancer and their caregivers in Iran (low- and middle-income country). Objective: This study is aimed at the development and preliminary evaluation of a cancer self-management system (CanSelfMan) tailored to the needs of children with cancer and their parents or caregivers. Methods: This study was conducted in collaboration with a multidisciplinary team between January and February 2020 at MAHAK's Pediatric Cancer Treatment and Research Center. We developed a self-management system in six stages: requirement analysis, conformity assessment, preparation of educational content, app prototyping, preliminary evaluation, and developing the final version. Results: A total of 35 people (n=24, 69\% parents and n=11, 31\% children) volunteered to participate in the study. However, only 63\% (15/24) of parents and 73\% (8/11) of children were eligible to participate. By adopting a user-centered design approach, we developed a mobile app, CanSelfMan, that includes five main modules (knowledge base, self-management tips, self-assessment report, ask a question, and reminders) that provide access to reliable information about acute lymphocytic leukemia and the self-management skills required for side effect measurement and reporting. A web-based dashboard was also developed for oncologists and included a dashboard to monitor users' symptoms and answer their questions. Conclusions: The CanSelfMan app can support these groups by providing access to reliable information about cancer, facilitating communication between children or parents and health care providers, and helping promote medication adherence through a reminder function. The active participation of the target group can help identify their needs. Therefore, through the involvement of stakeholders such as patients, caregivers, and oncologists in the design process, we improved usability and ensured that the final product was useful. This app is now ready to proceed with feasibility studies. ",
doi="10.2196/36721",
url="https://formative.jmir.org/2022/4/e36721",
url="http://www.ncbi.nlm.nih.gov/pubmed/35228195"
}


@Article{info:doi/10.2196/33938,
author="Cook, Paul
and Jankowski, Catherine
and Erlandson, M. Kristine
and Reeder, Blaine
and Starr, Whitney
and Flynn Makic, Beth Mary",
title="Low- and High-Intensity Physical Activity Among People with HIV: Multilevel Modeling Analysis Using Sensor- and Survey-Based Predictors",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Apr",
day="14",
volume="10",
number="4",
pages="e33938",
keywords="ecological momentary assessment",
keywords="fatigue",
keywords="HIV",
keywords="physical activity",
keywords="stress",
keywords="mobile phone",
abstract="Background: High-intensity physical activity improves the health of people with HIV. Even when people have good intentions to engage in physical activity, they often find it difficult to maintain physical activity behavior in the long term. Two Minds Theory is a neurocognitive model that explains gaps between people's intentions and behaviors based on the operations of 2 independent mental systems. This model predicts that everyday experiences will affect physical activity and that factors outside people's awareness, such as sleep and stress, can have particularly strong effects on physical activity behaviors. Objective: We designed this study to test the effects of daily experiences on physical activity among people with HIV, including measures of people's conscious experiences using daily electronic surveys and measures of nonconscious influences using sensor devices. Methods: In this study, 55 people with HIV wore a Fitbit Alta for 30 days to monitor their physical activity, sleep, and heart rate variability (HRV) as a physiological indicator of stress. Participants also used their smartphones to complete daily electronic surveys for the same 30 days about fatigue, self-efficacy, mood, stress, coping, motivation, and barriers to self-care. Time-lagged, within-person, multilevel models were used to identify the best prospective predictors of physical activity, considering the daily survey responses of people with HIV and sensor data as predictors of their physical activity the following day. We also tested baseline surveys as predictors of physical activity for comparison with daily variables. Results: Different people had different average levels of physical activity; however, physical activity also varied substantially from day to day, and daily measures were more predictive than baseline surveys. This suggests a chance to intervene based on day-to-day variations in physical activity. High-intensity physical activity was more likely when people with HIV reported less subjective fatigue on the prior day (r=?0.48) but was unrelated to actual sleep based on objective sensor data. High-intensity physical activity was also predicted by higher HRV (r=0.56), indicating less stress, lower HIV-related stigma (r=?0.21), fewer barriers to self-care (r=?0.34), and less approach coping (r=?0.34). Similar variables predicted lower-level physical activity measured based on the number of steps per day of people with HIV. Conclusions: Some predictors of physical activity, such as HRV, were only apparent based on sensor data, whereas others, such as fatigue, could be measured via self-report. Findings about coping were unexpected; however, other findings were in line with the literature. This study extends our prior knowledge on physical activity by demonstrating a prospective effect of everyday experiences on physical activity behavior, which is in line with the predictions of Two Minds Theory. Clinicians can support the physical activity of people with HIV by helping their patients reduce their daily stress, fatigue, and barriers to self-care. ",
doi="10.2196/33938",
url="https://mhealth.jmir.org/2022/4/e33938",
url="http://www.ncbi.nlm.nih.gov/pubmed/35436236"
}


@Article{info:doi/10.2196/33372,
author="Chua, Valerie
and Koh, Hean Jin
and Koh, Gerald Choon Huat
and Tyagi, Shilpa",
title="The Willingness to Pay for Telemedicine Among Patients With Chronic Diseases: Systematic Review",
journal="J Med Internet Res",
year="2022",
month="Apr",
day="13",
volume="24",
number="4",
pages="e33372",
keywords="willingness to pay",
keywords="telemedicine",
keywords="chronic disease",
keywords="patients",
keywords="systematic review",
keywords="mobile phone",
abstract="Background: Telemedicine is increasingly being leveraged, as the need for remote access to health care has been driven by the rising chronic disease incidence and the COVID-19 pandemic. It is also important to understand patients' willingness to pay (WTP) for telemedicine and the factors contributing toward it, as this knowledge may inform health policy planning processes, such as resource allocation or the development of a pricing strategy for telemedicine services. Currently, most of the published literature is focused on cost-effectiveness analysis findings, which guide health care financing from the health system's perspective. However, there is limited exploration of the WTP from a patient's perspective, despite it being pertinent to the sustainability of telemedicine interventions. Objective: To address this gap in research, this study aims to conduct a systematic review to describe the WTP for telemedicine interventions and to identify the factors influencing WTP among patients with chronic diseases in high-income settings. Methods: We systematically searched 4 databases (PubMed, PsycINFO, Embase, and EconLit). A total of 2 authors were involved in the appraisal. Studies were included if they reported the WTP amounts or identified the factors associated with patients' WTP, involved patients aged ?18 years who were diagnosed with chronic diseases, and were from high-income settings. Results: A total of 11 studies from 7 countries met this study's inclusion criteria. The proportion of people willing to pay for telemedicine ranged from 19\% to 70\% across the studies, whereas the values for WTP amounts ranged from US \$0.89 to US \$821.25. We found a statistically significant correlation of age and distance to a preferred health facility with the WTP for telemedicine. Higher age was associated with a lower WTP, whereas longer travel distance was associated with a higher WTP. Conclusions: On the basis of our findings, the following are recommendations that may enhance the WTP: exposure to the telemedicine intervention before assessing the WTP, the lowering of telemedicine costs, and the provision of patient education to raise awareness on telemedicine's benefits and address patients' concerns. In addition, we recommend that future research be directed at standardizing the reporting of WTP studies with the adoption of a common metric for WTP amounts, which may facilitate the generalization of findings and effect estimates. ",
doi="10.2196/33372",
url="https://www.jmir.org/2022/4/e33372",
url="http://www.ncbi.nlm.nih.gov/pubmed/35416779"
}


@Article{info:doi/10.2196/34827,
author="Mande, Archana
and Moore, L. Susan
and Banaei-Kashani, Farnoush
and Echalier, Benjamin
and Bull, Sheana
and Rosenberg, A. Michael",
title="Assessment of a Mobile Health iPhone App for Semiautomated Self-management of Chronic Recurrent Medical Conditions Using an N-of-1 Trial Framework: Feasibility Pilot Study",
journal="JMIR Form Res",
year="2022",
month="Apr",
day="12",
volume="6",
number="4",
pages="e34827",
keywords="mHealth",
keywords="patient-specific modeling",
keywords="chronic disease",
keywords="smartphone",
keywords="implementation and deployment",
keywords="facilitators and barriers",
abstract="Background: Management of chronic recurrent medical conditions (CRMCs), such as migraine headaches, chronic pain, and anxiety/depression, remains a major challenge for modern providers. Our team has developed an edge-based, semiautomated mobile health (mHealth) technology called iMTracker that employs the N-of-1 trial approach to allow self-management of CRMCs. Objective: This study examines the patterns of adoption, identifies CRMCs that users selected for self-application, and explores barriers to use of the iMTracker app. Methods: This is a feasibility pilot study with internet-based recruitment that ran from May 15, 2019, to December 23, 2020. We recruited 180 patients to pilot test the iMTracker app for user-selected CRMCs for a 3-month period. Patients were administered surveys before and after the study. Results: We found reasonable usage rates: a total of 73/103 (70.9\%) patients who were not lost to follow-up reported the full 3-month use of the app. Most users chose to use the iMTracker app to self-manage chronic pain (other than headaches; 80/212, 37.7\%), followed by headaches in 36/212 (17.0\%) and mental health (anxiety and depression) in 27/212 (12.8\%). The recurrence rate of CRMCs was at least weekly in over 93\% (169/180) of patients, with 36.1\% (65/180) of CRMCs recurring multiple times in a day, 41.7\% (75/180) daily, and 16.1\% (29/180) weekly. We found that the main barriers to use were the design and technical function of the app, but that use of the app resulted in an improvement in confidence in the efficiency and safety/privacy of this approach. Conclusions: The iMTracker app provides a feasible platform for the N-of-1 trial approach to self-management of CRMCs, although internet-based recruitment provided limited follow-up, suggesting that in-person evaluation may be needed. The rate of CRMC recurrence was high enough to allow the N-of-1 trial assessment for most traits. ",
doi="10.2196/34827",
url="https://formative.jmir.org/2022/4/e34827",
url="http://www.ncbi.nlm.nih.gov/pubmed/35412460"
}


@Article{info:doi/10.2196/31006,
author="Zhou, Joanne
and Lamichhane, Bishal
and Ben-Zeev, Dror
and Campbell, Andrew
and Sano, Akane",
title="Predicting Psychotic Relapse in Schizophrenia With Mobile Sensor Data: Routine Cluster Analysis",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Apr",
day="11",
volume="10",
number="4",
pages="e31006",
keywords="schizophrenia",
keywords="psychotic relapse",
keywords="machine learning",
keywords="clustering",
keywords="mobile phone",
keywords="routine",
keywords="Gaussian mixture models",
keywords="partition around medoids",
keywords="dynamic time warping",
keywords="balanced random forest",
abstract="Background: Behavioral representations obtained from mobile sensing data can be helpful for the prediction of an oncoming psychotic relapse in patients with schizophrenia and the delivery of timely interventions to mitigate such relapse. Objective: In this study, we aim to develop clustering models to obtain behavioral representations from continuous multimodal mobile sensing data for relapse prediction tasks. The identified clusters can represent different routine behavioral trends related to daily living of patients and atypical behavioral trends associated with impending relapse. Methods: We used the mobile sensing data obtained from the CrossCheck project for our analysis. Continuous data from six different mobile sensing-based modalities (ambient light, sound, conversation, acceleration, etc) obtained from 63 patients with schizophrenia, each monitored for up to a year, were used for the clustering models and relapse prediction evaluation. Two clustering models, Gaussian mixture model (GMM) and partition around medoids (PAM), were used to obtain behavioral representations from the mobile sensing data. These models have different notions of similarity between behaviors as represented by the mobile sensing data, and thus, provide different behavioral characterizations. The features obtained from the clustering models were used to train and evaluate a personalized relapse prediction model using balanced random forest. The personalization was performed by identifying optimal features for a given patient based on a personalization subset consisting of other patients of similar age. Results: The clusters identified using the GMM and PAM models were found to represent different behavioral patterns (such as clusters representing sedentary days, active days but with low communication, etc). Although GMM-based models better characterized routine behaviors by discovering dense clusters with low cluster spread, some other identified clusters had a larger cluster spread, likely indicating heterogeneous behavioral characterizations. On the other hand, PAM model-based clusters had lower variability of cluster spread, indicating more homogeneous behavioral characterization in the obtained clusters. Significant changes near the relapse periods were observed in the obtained behavioral representation features from the clustering models. The clustering model-based features, together with other features characterizing the mobile sensing data, resulted in an F2 score of 0.23 for the relapse prediction task in a leave-one-patient-out evaluation setting. The obtained F2 score was significantly higher than that of a random classification baseline with an average F2 score of 0.042. Conclusions: Mobile sensing can capture behavioral trends using different sensing modalities. Clustering of the daily mobile sensing data may help discover routine and atypical behavioral trends. In this study, we used GMM-based and PAM-based cluster models to obtain behavioral trends in patients with schizophrenia. The features derived from the cluster models were found to be predictive for detecting an oncoming psychotic relapse. Such relapse prediction models can be helpful in enabling timely interventions. ",
doi="10.2196/31006",
url="https://mhealth.jmir.org/2022/4/e31006",
url="http://www.ncbi.nlm.nih.gov/pubmed/35404256"
}


@Article{info:doi/10.2196/35479,
author="Antoun, Jumana
and Itani, Hala
and Alarab, Natally
and Elsehmawy, Amir",
title="The Effectiveness of Combining Nonmobile Interventions With the Use of Smartphone Apps With Various Features for Weight Loss: Systematic Review and Meta-analysis",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Apr",
day="8",
volume="10",
number="4",
pages="e35479",
keywords="obesity",
keywords="weight loss",
keywords="mobile app",
keywords="self-monitoring",
keywords="behavioral",
keywords="tracker",
keywords="behavioral coaching",
keywords="coach",
keywords="dietitian",
keywords="mobile phone",
abstract="Background: The effectiveness of smartphone apps for weight loss is limited by the diversity of interventions that accompany such apps. This research extends the scope of previous systematic reviews by including 2 subgroup analyses based on nonmobile interventions that accompanied smartphone use and human-based versus passive behavioral interventions. Objective: The primary objective of this study is to systematically review and perform a meta-analysis of studies that evaluated the effectiveness of smartphone apps on weight loss in the context of other interventions combined with app use. The secondary objective is to measure the impact of different mobile app features on weight loss and mobile app adherence. Methods: We conducted a systematic review and meta-analysis of relevant studies after an extensive search of the PubMed, MEDLINE, and EBSCO databases from inception to January 31, 2022. Gray literature, such as abstracts and conference proceedings, was included. Working independently, 2 investigators extracted the data from the articles, resolving disagreements by consensus. All randomized controlled trials that used smartphone apps in at least 1 arm for weight loss were included. The weight loss outcome was the change in weight from baseline to the 3- and 6-month periods for each arm. Net change estimates were pooled across the studies using random-effects models to compare the intervention group with the control group. The risk of bias was assessed independently by 2 authors using the Cochrane Collaboration tool for assessing the risk of bias in randomized trials. Results: Overall, 34 studies were included that evaluated the use of a smartphone app in at least 1 arm. Compared with controls, the use of a smartphone app--based intervention showed a significant weight loss of --1.99 kg (95\% CI --2.19 to --1.79 kg; I2=81\%) at 3 months and --2.80 kg (95\% CI --3.03 to --2.56 kg; I2=91\%) at 6 months. In the subgroup analysis, based on the various intervention components that were added to the mobile app, the combination of the mobile app, tracker, and behavioral interventions showed a statistically significant weight loss of --2.09 kg (95\% CI --2.32 to --1.86 kg; I2=91\%) and --3.77 kg (95\% CI --4.05 to --3.49 kg; I2=90\%) at 3 and 6 months, respectively. When a behavioral intervention was present, only the combination of the mobile app with intensive behavior coaching or feedback by a human coach showed a statistically significant weight loss of --2.03 kg (95\% CI --2.80 to --1.26 kg; I2=83\%) and --2.63 kg (95\% CI --2.97 to --2.29 kg; I2=91\%) at 3 and 6 months, respectively. Neither the type nor the number of mobile app features was associated with weight loss. Conclusions: Smartphone apps have a role in weight loss management. Nevertheless, the human-based behavioral component remained key to higher weight loss results. ",
doi="10.2196/35479",
url="https://mhealth.jmir.org/2022/4/e35479",
url="http://www.ncbi.nlm.nih.gov/pubmed/35394443"
}


@Article{info:doi/10.2196/29510,
author="Cho, Jaeho Peter
and Yi, Jaehan
and Ho, Ethan
and Shandhi, Hasan Md Mobashir
and Dinh, Yen
and Patil, Aneesh
and Martin, Leatrice
and Singh, Geetika
and Bent, Brinnae
and Ginsburg, Geoffrey
and Smuck, Matthew
and Woods, Christopher
and Shaw, Ryan
and Dunn, Jessilyn",
title="Demographic Imbalances Resulting From the Bring-Your-Own-Device Study Design",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Apr",
day="8",
volume="10",
number="4",
pages="e29510",
keywords="bring your own device",
keywords="wearable device",
keywords="mHealth",
doi="10.2196/29510",
url="https://mhealth.jmir.org/2022/4/e29510",
url="http://www.ncbi.nlm.nih.gov/pubmed/34913871"
}


@Article{info:doi/10.2196/28901,
author="Daskalaki, Elena
and Parkinson, Anne
and Brew-Sam, Nicola
and Hossain, Zakir Md
and O'Neal, David
and Nolan, J. Christopher
and Suominen, Hanna",
title="The Potential of Current Noninvasive Wearable Technology for the Monitoring of Physiological Signals in the Management of Type 1 Diabetes: Literature Survey",
journal="J Med Internet Res",
year="2022",
month="Apr",
day="8",
volume="24",
number="4",
pages="e28901",
keywords="type 1 diabetes",
keywords="wearable sensors",
keywords="big data",
keywords="consumer health informatics",
keywords="mobile health",
keywords="survey",
abstract="Background: Monitoring glucose and other parameters in persons with type 1 diabetes (T1D) can enhance acute glycemic management and the diagnosis of long-term complications of the disease. For most persons living with T1D, the determination of insulin delivery is based on a single measured parameter---glucose. To date, wearable sensors exist that enable the seamless, noninvasive, and low-cost monitoring of multiple physiological parameters. Objective: The objective of this literature survey is to explore whether some of the physiological parameters that can be monitored with noninvasive, wearable sensors may be used to enhance T1D management. Methods: A list of physiological parameters, which can be monitored by using wearable sensors available in 2020, was compiled by a thorough review of the devices available in the market. A literature survey was performed using search terms related to T1D combined with the identified physiological parameters. The selected publications were restricted to human studies, which had at least their abstracts available. The PubMed and Scopus databases were interrogated. In total, 77 articles were retained and analyzed based on the following two axes: the reported relations between these parameters and T1D, which were found by comparing persons with T1D and healthy control participants, and the potential areas for T1D enhancement via the further analysis of the found relationships in studies working within T1D cohorts. Results: On the basis of our search methodology, 626 articles were returned, and after applying our exclusion criteria, 77 (12.3\%) articles were retained. Physiological parameters with potential for monitoring by using noninvasive wearable devices in persons with T1D included those related to cardiac autonomic function, cardiorespiratory control balance and fitness, sudomotor function, and skin temperature. Cardiac autonomic function measures, particularly the indices of heart rate and heart rate variability, have been shown to be valuable in diagnosing and monitoring cardiac autonomic neuropathy and, potentially, predicting and detecting hypoglycemia. All identified physiological parameters were shown to be associated with some aspects of diabetes complications, such as retinopathy, neuropathy, and nephropathy, as well as macrovascular disease, with capacity for early risk prediction. However, although they can be monitored by available wearable sensors, most studies have yet to adopt them, as opposed to using more conventional devices. Conclusions: Wearable sensors have the potential to augment T1D sensing with additional, informative biomarkers, which can be monitored noninvasively, seamlessly, and continuously. However, significant challenges associated with measurement accuracy, removal of noise and motion artifacts, and smart decision-making exist. Consequently, research should focus on harvesting the information hidden in the complex data generated by wearable sensors and on developing models and smart decision strategies to optimize the incorporation of these novel inputs into T1D interventions. ",
doi="10.2196/28901",
url="https://www.jmir.org/2022/4/e28901",
url="http://www.ncbi.nlm.nih.gov/pubmed/35394448"
}


@Article{info:doi/10.2196/35600,
author="Fonseka, N. Lakshan
and Woo, P. Benjamin K.",
title="Wearables in Schizophrenia: Update on Current and Future Clinical Applications",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Apr",
day="7",
volume="10",
number="4",
pages="e35600",
keywords="wearables",
keywords="smartwatch",
keywords="schizophrenia",
keywords="digital phenotype",
keywords="wearable",
keywords="mHealth",
keywords="mobile health",
keywords="review",
keywords="clinical application",
keywords="clinical utility",
keywords="clinical use",
keywords="literature search",
keywords="diagnosis",
keywords="prevention",
doi="10.2196/35600",
url="https://mhealth.jmir.org/2022/4/e35600",
url="http://www.ncbi.nlm.nih.gov/pubmed/35389361"
}


@Article{info:doi/10.2196/35462,
author="Rodr{\'i}guez S{\'a}nchez-Laulh{\'e}, Pablo
and Luque-Romero, Gabriel Luis
and Barrero-Garc{\'i}a, Jos{\'e} Francisco
and Biscarri-Carbonero, {\'A}ngela
and Blanquero, Jes{\'u}s
and Suero-Pineda, Alejandro
and Heredia-Rizo, Marcos Alberto",
title="An Exercise and Educational and Self-management Program Delivered With a Smartphone App (CareHand) in Adults With Rheumatoid Arthritis of the Hands: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Apr",
day="7",
volume="10",
number="4",
pages="e35462",
keywords="rheumatoid arthritis",
keywords="telerehabilitation",
keywords="self-management",
keywords="mHealth",
keywords="primary health care",
keywords="physical therapy",
keywords="exercise therapy",
keywords="mobile applications",
keywords="telehealth",
keywords="health education",
keywords="mobile phone",
abstract="Background: Rheumatoid arthritis (RA) is a prevalent autoimmune disease that usually involves problems of the hand or wrist. Current evidence recommends a multimodal therapy including exercise, self-management, and educational strategies. To date, the efficacy of this approach, as delivered using a smartphone app, has been scarcely investigated. Objective: This study aims to assess the short- and medium-term efficacy of a digital app (CareHand) that includes a tailored home exercise program, together with educational and self-management recommendations, compared with usual care, for people with RA of the hands. Methods: A single-blinded randomized controlled trial was conducted between March 2020 and February 2021, including 36 participants with RA of the hands (women: 22/36, 61\%) from 2 community health care centers. Participants were allocated to use the CareHand app, consisting of tailored exercise programs, and self-management and monitoring tools or to a control group that received a written home exercise routine and recommendations, as per the usual protocol provided at primary care settings. Both interventions lasted for 3 months (4 times a week). The primary outcome was hand function, assessed using the Michigan Hand Outcome Questionnaire (MHQ). Secondary measures included pain and stiffness intensity (visual analog scale), grip strength (dynamometer), pinch strength (pinch gauge), and upper limb function (shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire). All measures were collected at baseline and at a 3-month follow-up. Furthermore, the MHQ and self-reported stiffness were assessed 6 months after baseline, whereas pain intensity and scores on the shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire were collected at the 1-, 3-, and 6-month follow-ups. Results: In total, 30 individuals, corresponding to 58 hands (CareHand group: 26/58, 45\%; control group: 32/58, 55\%), were included in the analysis; 53\% (19/36) of the participants received disease-modifying antirheumatic drug treatment. The ANOVA demonstrated a significant time{\texttimes}group effect for the total score of the MHQ (F1.62,85.67=9.163; P<.001; $\eta$2=0.15) and for several of its subscales: overall hand function, work performance, pain, and satisfaction (all P<.05), with mean differences between groups for the total score of 16.86 points (95\% CI 8.70-25.03) at 3 months and 17.21 points (95\% CI 4.78-29.63) at 6 months. No time{\texttimes}group interaction was observed for the secondary measures (all P>.05). Conclusions: Adults with RA of the hands who used the CareHand app reported better results in the short and medium term for overall hand function, work performance, pain, and satisfaction, compared with usual care. The findings of this study suggest that the CareHand app is a promising tool for delivering exercise therapy and self-management recommendations to this population. Results must be interpreted with caution because of the lack of efficacy of the secondary outcomes. Trial Registration: ClinicalTrials.gov NCT04263974; https://clinicaltrials.gov/ct2/show/NCT04263974 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-04713-4 ",
doi="10.2196/35462",
url="https://mhealth.jmir.org/2022/4/e35462",
url="http://www.ncbi.nlm.nih.gov/pubmed/35389367"
}


@Article{info:doi/10.2196/23657,
author="Ogawa, Takahisa
and Castelo-Branco, Luis
and Hatta, Kotaro
and Usui, Chie",
title="Association Between Step Count Measured With a Smartphone App (Pain-Note) and Pain Level in Patients With Chronic Pain: Observational Study",
journal="JMIR Form Res",
year="2022",
month="Apr",
day="6",
volume="6",
number="4",
pages="e23657",
keywords="smartphone",
keywords="iPhone",
keywords="cross-sectional study",
keywords="chronic pain",
keywords="fibromyalgia",
keywords="step count",
abstract="Background: Chronic pain is the leading cause of disability, affecting between 20\% and 50\% of the global population. The key recommended treatment is physical activity, which can be measured in daily life using a pedometer. However, poor adherence to pedometer use can result in incorrect measurements. Furthermore, only a few studies have investigated a possible curvilinear association between physical activity and chronic pain. Objective: In this study, we developed the Pain-Note smartphone app to collect real-world data on step count, using the smartphone's built-in pedometer. The aims of our research are (1) to evaluate the association between daily step count and pain level among patients with chronic pain and (2) determine if the association between daily step count and pain level was curvilinear. Methods: We conducted a cross-sectional study based on step count data collected with the app and on the results of questionnaires, which measured the duration and intensity of pain, the widespread pain index, the symptom severity score, and the insomnia severity scale, including 7 questions for symptoms of depression. We analyzed the association between step count and pain level as a nonlinear relationship using a restricted cubic spline model. A prespecified subgroup analysis was also conducted based on fibromyalgia criteria. Results: Between June 1, 2018, and June 11, 2020, a total of 6138 records were identified, of which 1273 were analyzed. The mean age of the participants was 38.7 years, 81.9\% (1043/1273) were female, and chronic pain was present for more than 5 years in 43.2\% (550/1273) of participants. Participants in the third and fourth quartiles for step count (more than 3045 and 5668 steps a day, respectively) showed a significant positive association between higher step count and lower numerical pain rating scale (mean difference --0.43, 95\% CI --0.78 to --0.08, P=.02; --0.45; 95\% CI --0.8 to --0.1, P=.01, respectively) than those in the first quartile (less than or equal to 1199 steps a day). The restricted cubic spline model for the association between step count and pain scale displayed a steep decline followed by a moderate decrease as the step count increased; the inflection point was 5000 steps. However, this association was not observed among participants who met the fibromyalgia criteria (491/1273), who showed a steep positive increase below 2000 steps. Data were collected between June 1, 2018, and June 11, 2020, and were analyzed on November 18, 2021. Conclusions: Step count measured with the Pain-Note app showed a nonlinear association with pain level. Although participants with and without fibromyalgia showed a negative correlation between step count and pain level, participants who meet the criteria for fibromyalgia may present a different relationship between walking and pain perception compared to those in the general chronic pain population. ",
doi="10.2196/23657",
url="https://formative.jmir.org/2022/4/e23657",
url="http://www.ncbi.nlm.nih.gov/pubmed/35384846"
}


@Article{info:doi/10.2196/33527,
author="Arroyo, Carmen Amber
and Zawadzki, J. Matthew",
title="The Implementation of Behavior Change Techniques in mHealth Apps for Sleep: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Apr",
day="4",
volume="10",
number="4",
pages="e33527",
keywords="behavior change techniques",
keywords="sleep",
keywords="mHealth",
keywords="apps",
keywords="digital health",
keywords="mobile phone",
abstract="Background: Mobile health (mHealth) apps targeting health behaviors using behavior change techniques (BCTs) have been successful in promoting healthy behaviors; however, their efficacy with sleep is unclear. Some work has shown success in promoting sleep through mHealth, whereas there have been reports that sleep apps can be adverse and lead to unhealthy obsessions with achieving perfect sleep. Objective: This study aims to report and describe the use of BCTs in mHealth apps for sleep with the following research questions: How many BCTs are used on average in sleep apps, and does this relate to their effectiveness on sleep outcomes? Are there specific BCTs used more or less often in sleep apps, and does this relate to their effectiveness on sleep outcomes? Does the effect of mHealth app interventions on sleep change when distinguishing between dimension and measurement of sleep? Methods: We conducted a systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to review articles on mHealth app interventions for sleep published between 2010 and 2020. Results: A total of 12 studies met the eligibility criteria. Most studies reported positive sleep outcomes, and there were no negative effects reported. Sleep quality was the most common dimension of sleep targeted. Subjective measures of sleep were used across all apps, whereas objective measures were often assessed but rarely reported as part of results. The average number of BCTs used was 7.67 (SD 2.32; range 3-11) of 16. Of the 12 studies, the most commonly used BCTs were feedback and monitoring (n=11, 92\%), shaping knowledge (n=11, 92\%), goals and planning (n=10, 83\%), and antecedents (n=10, 83\%), whereas the least common were scheduled consequences (n=0, 0\%), self-belief (n=0, 0\%), and covert learning (n=0, 0\%). Most apps used a similar set of BCTs that unfortunately did not allow us to distinguish which BCTs were present when studies reported more positive outcomes. Conclusions: Our study describes the peer-reviewed literature on sleep apps and provides a foundation for further examination and optimization of BCTs used in mHealth apps for sleep. We found strong evidence that mHealth apps are effective in improving sleep, and the potential reasons for the lack of adverse sleep outcome reporting are discussed. We found evidence that the type of BCTs used in mHealth apps for sleep differed from other health outcomes, although more research is needed to understand how BCTs can be implemented effectively to improve sleep using mHealth and the mechanisms of action through which they are effective (eg, self-efficacy, social norms, and attitudes). ",
doi="10.2196/33527",
url="https://mhealth.jmir.org/2022/4/e33527",
url="http://www.ncbi.nlm.nih.gov/pubmed/35377327"
}


@Article{info:doi/10.2196/32344,
author="Triantafyllidis, Andreas
and Kondylakis, Haridimos
and Katehakis, Dimitrios
and Kouroubali, Angelina
and Koumakis, Lefteris
and Marias, Kostas
and Alexiadis, Anastasios
and Votis, Konstantinos
and Tzovaras, Dimitrios",
title="Deep Learning in mHealth for Cardiovascular Disease, Diabetes, and Cancer: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Apr",
day="4",
volume="10",
number="4",
pages="e32344",
keywords="mHealth",
keywords="deep learning",
keywords="chronic disease",
keywords="review",
keywords="mobile phone",
abstract="Background: Major chronic diseases such as cardiovascular disease (CVD), diabetes, and cancer impose a significant burden on people and health care systems around the globe. Recently, deep learning (DL) has shown great potential for the development of intelligent mobile health (mHealth) interventions for chronic diseases that could revolutionize the delivery of health care anytime, anywhere. Objective: The aim of this study is to present a systematic review of studies that have used DL based on mHealth data for the diagnosis, prognosis, management, and treatment of major chronic diseases and advance our understanding of the progress made in this rapidly developing field. Methods: A search was conducted on the bibliographic databases Scopus and PubMed to identify papers with a focus on the deployment of DL algorithms that used data captured from mobile devices (eg, smartphones, smartwatches, and other wearable devices) targeting CVD, diabetes, or cancer. The identified studies were synthesized according to the target disease, the number of enrolled participants and their age, and the study period as well as the DL algorithm used, the main DL outcome, the data set used, the features selected, and the achieved performance. Results: In total, 20 studies were included in the review. A total of 35\% (7/20) of DL studies targeted CVD, 45\% (9/20) of studies targeted diabetes, and 20\% (4/20) of studies targeted cancer. The most common DL outcome was the diagnosis of the patient's condition for the CVD studies, prediction of blood glucose levels for the studies in diabetes, and early detection of cancer. Most of the DL algorithms used were convolutional neural networks in studies on CVD and cancer and recurrent neural networks in studies on diabetes. The performance of DL was found overall to be satisfactory, reaching >84\% accuracy in most studies. In comparison with classic machine learning approaches, DL was found to achieve better performance in almost all studies that reported such comparison outcomes. Most of the studies did not provide details on the explainability of DL outcomes. Conclusions: The use of DL can facilitate the diagnosis, management, and treatment of major chronic diseases by harnessing mHealth data. Prospective studies are now required to demonstrate the value of applied DL in real-life mHealth tools and interventions. ",
doi="10.2196/32344",
url="https://mhealth.jmir.org/2022/4/e32344",
url="http://www.ncbi.nlm.nih.gov/pubmed/35377325"
}


@Article{info:doi/10.2196/33493,
author="Menon, Rijuta
and Meyer, Julien
and Nippak, Pria
and Begum, Housne",
title="Smartphone Alcohol Use Disorder Recovery Apps: Cross-sectional Survey of Behavioral Intention to Use",
journal="JMIR Hum Factors",
year="2022",
month="Apr",
day="1",
volume="9",
number="2",
pages="e33493",
keywords="mobile health",
keywords="alcohol use disorder",
keywords="disease management",
keywords="mobile apps",
keywords="Unified Theory of Acceptance and Use of Technology",
abstract="Background: Alcohol use disorder (AUD) carries a huge health and economic cost to society. Effective interventions exist but numerous challenges limit their adoption, especially in a pandemic context. AUD recovery apps (AUDRA) have emerged as a potential complement to in-person interventions. They are easy to access and show promising results in terms of efficacy. However, they rely on individual adoption decisions and remain underused. Objective: The aim of this survey study is to explore the beliefs that determine the intention to use AUDRA. Methods: We conducted a cross-sectional survey study of people with AUD. We used the Unified Theory of Acceptance and Use of Technology, which predicts use and behavioral intention to use based on performance expectancy, effort expectancy, social influence, and facilitating conditions. Participants were recruited directly from 2 sources; first, respondents at addiction treatment facilities in Ontario, Canada, were contacted in person, and they filled a paper form; second, members from AUD recovery support groups on social media were contacted and invited to fill an internet-based survey. The survey was conducted between October 2019 and June 2020. Results: The final sample comprised 159 participants (124 involved in the web-based survey and 35 in the paper-based survey) self-identifying somewhat or very much with AUD. Most participants (n=136, 85.5\%) were aware of AUDRA and those participants scored higher on performance expectancy, effort expectancy, and social influence. Overall, the model explains 35.4\% of the variance in the behavioral intention to use AUDRA and 11.1\% of the variance in use. Social influence (P=.31), especially for women (P=.23), and effort expectancy (P=.25) were key antecedents of behavioral intention. Facilitating conditions were not significant overall but were moderated by age (P=.23), suggesting that it matters for older participants. Performance expectancy did not predict behavioral intention, which is unlike many other technologies but confirms other findings associated with mobile health (mHealth). Open-ended questions suggest that privacy concerns may significantly influence the use of AUDRA. Conclusions: This study suggests that unlike many other technologies, the adoption of AUDRA is not mainly determined by utilitarian factors such as performance expectancy. Rather, effort expectancy and social influence play a key role in determining the intention to use AUDRA. ",
doi="10.2196/33493",
url="https://humanfactors.jmir.org/2022/2/e33493",
url="http://www.ncbi.nlm.nih.gov/pubmed/35363145"
}


@Article{info:doi/10.2196/30571,
author="Xia, Shu-Fang
and Maitiniyazi, Gusonghan
and Chen, Yue
and Wu, Xiao-Ya
and Zhang, Yu
and Zhang, Xiao-Yan
and Li, Zi-Yuan
and Liu, Yuan
and Qiu, Yu-Yu
and Wang, Jun",
title="Web-Based TangPlan and WeChat Combination to Support Self-management for Patients With Type 2 Diabetes: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Mar",
day="30",
volume="10",
number="3",
pages="e30571",
keywords="type 2 diabetes",
keywords="glucose control",
keywords="TangPlan",
keywords="WeChat",
keywords="self-management",
abstract="Background: China has the largest number of patients with type 2 diabetes mellitus (T2DM) in the world. However, owing to insufficient knowledge of self-management in patients with diabetes, blood glucose (BG) control is poor. Most diabetes-related self-management applications fail to bring significant benefits to patients with T2DM because of the low use rate and difficult operation. Objective: This study aims to examine the effectiveness of the combination of the self-designed web-based T2DM management software TangPlan and WeChat on fasting BG (FBG), glycated hemoglobin (HbA1c), body weight, blood pressure (BP), and lipid profiles in patients with T2DM over a 6-month period. Methods: Participants were recruited and randomized into the TangPlan and WeChat or control groups. Participants in the control group received usual care, whereas the TangPlan and WeChat participants received self-management guidance with the help of TangPlan and WeChat from health care professionals, including BG self-monitoring; healthy eating; active physical exercise; increasing medication compliance; and health education during follow-ups, lectures, or web-based communication. They were also asked to record and send self-management data to the health care professionals via WeChat to obtain timely and effective guidance on diabetes self-management. Results: In this study, 76.9\% (120/156) of participants completed the 6-month follow-up visit. After the intervention, FBG (mean 6.51, SD 1.66 mmol/L; P=.048), HbA1c (mean 6.87\%, SD 1.11\%; P<.001), body weight (mean 66.50, SD 9.51 kg; P=.006), systolic BP (mean 127.03, SD 8.00 mm?Hg; P=.005), diastolic BP (mean 75.25, SD 5.88 mm?Hg; P=.03), serum low-density lipoprotein cholesterol (mean 2.50, SD 0.61 mmol/L; P=.006), and total cholesterol (mean 4.01, SD 0.83 mmol/L; P=.02) in the TangPlan and WeChat group were all significantly lower, whereas serum high-density lipoprotein cholesterol (mean 1.20, SD 0.25 mmol/L; P=.01) was remarkably higher than in those in the control group. Compared with the baseline data, significance was found in the mean change in FBG (95\% CI ?0.83 to ?0.20; P=.002), HbA1c (95\% CI ?1.92 to ?1.28; P<.001), body weight (95\% CI ?3.13 to ?1.68; P<.001), BMI (95\% CI ?1.10 to ?0.60; P<.001), systolic BP (95\% CI ?7.37 to ?3.94; P<.001), diastolic BP (95\% CI ?4.52 to ?2.33; P<.001), triglycerides (95\% CI ?0.16 to ?0.03; P=.004), serum low-density lipoprotein cholesterol (95\% CI ?0.54 to ?0.30; P<.001), and total cholesterol (95\% CI ?0.60 to ?0.34; P<.001) in the TangPlan and WeChat group but not in the control group (P=.08-.88). Conclusions: Compared with usual care for patients with T2DM, the combination of TangPlan and WeChat was effective in improving glycemic control (decrease in HbA1c and BG levels) and serum lipid profiles as well as reducing body weight in patients with T2DM after 6 months. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000028843; https://tinyurl.com/559kuve6 ",
doi="10.2196/30571",
url="https://mhealth.jmir.org/2022/3/e30571",
url="http://www.ncbi.nlm.nih.gov/pubmed/35353055"
}


@Article{info:doi/10.2196/34301,
author="Marcu, Gabriela
and Ondersma, J. Steven
and Spiller, N. Allison
and Broderick, M. Brianna
and Kadri, Reema
and Buis, R. Lorraine",
title="Barriers and Considerations in the Design and Implementation of Digital Behavioral Interventions: Qualitative Analysis",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="30",
volume="24",
number="3",
pages="e34301",
keywords="computers",
keywords="mobile apps",
keywords="screening",
keywords="brief interventions",
keywords="diagnosis",
keywords="computer-assisted/methods",
keywords="surveys and questionnaires",
keywords="motivational interviewing",
keywords="therapy",
keywords="implementation",
keywords="qualitative",
keywords="mobile phone",
abstract="Background: Digital behavioral interventions have become increasingly popular for their ability to support patient diagnosis and treatment, chronic disease self-management, behavior change, and adherence to recommended care. However, digital intervention development is impeded by challenges such as limited technical skills, limited access to developers, and cost. The purpose of this study is to elicit in-depth qualitative feedback from intervention developers who have interest in digital behavioral interventions but lack programming skills regarding the barriers they experience and key considerations in the design and implementation of digital interventions. Objective: This study aims to understand barriers in the design and implementation of digital behavioral interventions, as well as to identify key considerations for researchers who are developing these interventions. Methods: We conducted semistructured qualitative interviews with 18 researchers who had experience either designing (but not coding) digital behavioral interventions or running research studies with them. Participants were a convenience sample of users of the Computerized Intervention Authoring System platform, an existing no-code development platform for building digital intervention content, and were recruited through either direct email solicitation or snowball sampling. All interviews were conducted and recorded over videoconference between February and April 2020. Recordings from interviews were transcribed and thematically analyzed by multiple coders. Results: Interviews were completed with 18 participants and lasted between 24 and 65 (mean 46.9, SD 11.3) minutes. Interviewees were predominantly female (17/18, 94\%) and represented different job roles, ranging from researcher to project/study staff. Three key barriers in the development of digital behavior interventions were identified during interviews: lack of cross-disciplinary understanding; variability in recipients' technology access, infrastructure, and literacy; and the idea that evidence-based in-person interactions do not translate directly to digital interactions. Interviewees identified several key considerations that interventionists learned to prioritize, which have the potential to overcome these barriers and lead to successful interventions. Conclusions: Barriers in the development of digital behavioral interventions are often created by a lack of cross-disciplinary understanding, which can lead to difficulties conceptualizing interventions, unrealistic expectations in terms of cost, and confusion about the development process. Moreover, concerns about research study participant characteristics and access to technology, as well as the translation of in-person interventions to digital, are apparent. Appropriate training in how to work with software development teams may help future digital behavior intervention creators overcome these barriers and may lead to new, exciting innovations in this space. ",
doi="10.2196/34301",
url="https://www.jmir.org/2022/3/e34301",
url="http://www.ncbi.nlm.nih.gov/pubmed/35353043"
}


@Article{info:doi/10.2196/33955,
author="N{\o}rlev, Jannie
and Derosche, Christina
and Sondrup, Katrine
and Hejlesen, Ole
and Hangaard, Stine",
title="Using Distance Communication for the User-Centered Development of a Smartphone-Based Serious Game for Children With Type 1 Diabetes: Participatory Design Approach",
journal="JMIR Serious Games",
year="2022",
month="Mar",
day="29",
volume="10",
number="1",
pages="e33955",
keywords="type 1 diabetes",
keywords="children",
keywords="serious game",
keywords="distance communication",
keywords="user-centered approach",
keywords="evaluation",
keywords="playtest",
keywords="mobile phone",
abstract="Background: The complications of type 1 diabetes (T1D) can be delayed or prevented in children with T1D who receive proper self-management education. Smartphone-based serious games are increasingly being used as an effective tool for teaching self-management. When developing a serious game, it is important that the development process be user-centered. Traditionally, different face-to-face methods have been used when children participate in the development process. However, face-to-face data collection is not always feasible. In such situations, distance communication can be used when developing a serious game. Objective: The objective of this study is to develop a user-centered smartphone-based serious game that teaches self-management focused on carbohydrate intake in children aged 8-14 years with T1D using distance communication in both the development and evaluation of the game. Methods: The development and evaluation of a smartphone-based serious game prototype was inspired by the Lean principles, and a user-centered approach was applied. The development process included 1 expert interview and design workshops with children with T1D. On the basis of the interview and design workshop results, a serious game prototype was developed using Microsoft PowerPoint. The evaluation of the serious game prototype included an interview with a dietitian and a playtest with children with T1D. All data were collected using distance communication. Results: A user-centered smartphone-based serious game prototype was developed and evaluated. The expert interview with the dietitian formed the basis for the learning outcomes in the game. Four children and their parents contributed to the preferences, needs, requirements, and ideas for selected parts of the game design. The dietitian evaluated the prototype positively and validated its content and accuracy. The serious game prototype was well-received by the children and their parents during the playtest. The serious game prototype was perceived as a useful and engaging way to learn. However, the difficulty level was not appropriate, and the information was too basic for participants who had been diagnosed over a year ago. The use of digital communication platforms did not cause any problems. Conclusions: The smartphone-based serious game prototype has the potential to be a useful and attractive tool for teaching disease self-management. The use of distance communication proved to be a useful approach in the development of a serious game. ",
doi="10.2196/33955",
url="https://games.jmir.org/2022/1/e33955",
url="http://www.ncbi.nlm.nih.gov/pubmed/35348466"
}


@Article{info:doi/10.2196/29479,
author="Merschel, Steve
and Reinhardt, Lars",
title="Analyzability of Photoplethysmographic Smartwatch Data by the Preventicus Heartbeats Algorithm During Everyday Life: Feasibility Study",
journal="JMIR Form Res",
year="2022",
month="Mar",
day="28",
volume="6",
number="3",
pages="e29479",
keywords="photoplethysmography",
keywords="wearable",
keywords="smartwatch",
keywords="heart rate monitoring",
keywords="cardiac arrhythmia screening",
keywords="atrial fibrillation",
keywords="signal quality",
keywords="activity profile",
abstract="Background: Continuous heart rate monitoring via mobile health technologies based on photoplethysmography (PPG) has great potential for the early detection of sustained cardiac arrhythmias such as atrial fibrillation. However, PPG measurements are impaired by motion artifacts. Objective: The aim of this investigation was to evaluate the analyzability of smartwatch-derived PPG data during everyday life and to determine the relationship between the analyzability of the data and the activity level of the participant. Methods: A total of 41 (19 female and 22 male) adults in good cardiovascular health (aged 19-79 years) continuously wore a smartwatch equipped with a PPG sensor and a 3D accelerometer (Cardio Watch 287, Corsano Health BV) for a period of 24 hours that represented their individual daily routine. For each participant, smartwatch data were analyzed on a 1-minute basis by an algorithm designed for heart rhythm analysis (Preventicus Heartbeats, Preventicus GmbH). As outcomes, the percentage of analyzable data (PAD) and the mean acceleration (ACC) were calculated. To map changes of the ACC and PAD over the course of one day, the 24-hour period was divided into 8 subintervals comprising 3 hours each. Results: Univariate analysis of variance showed a large effect ($\eta$p2> 0.6; P<.001) of time interval (phase) on the ACC and PAD. The PAD ranged between 34\% and 100\%, with an average of 71.5\% for the whole day, which is equivalent to a period of 17.2 hours. Between midnight and 6 AM, the mean values were the highest for the PAD (>94\%) and the lowest for the ACC (<6{\texttimes}10-3 m/s2). Regardless of the time of the day, the correlation between the PAD and ACC was strong (r=--0.64). A linear regression analysis for the averaged data resulted in an almost perfect coefficient of determination (r2=0.99). Conclusions: This study showed a large relationship between the activity level and the analyzability of smartwatch-derived PPG data. Given the high yield of analyzable data during the nighttime, continuous arrhythmia screening seems particularly effective during sleep phases. ",
doi="10.2196/29479",
url="https://formative.jmir.org/2022/3/e29479",
url="http://www.ncbi.nlm.nih.gov/pubmed/35343902"
}


@Article{info:doi/10.2196/34148,
author="Makhmutova, Mariko
and Kainkaryam, Raghu
and Ferreira, Marta
and Min, Jae
and Jaggi, Martin
and Clay, Ieuan",
title="Predicting Changes in Depression Severity Using the PSYCHE-D (Prediction of Severity Change-Depression) Model Involving Person-Generated Health Data: Longitudinal Case-Control Observational Study",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Mar",
day="25",
volume="10",
number="3",
pages="e34148",
keywords="depression",
keywords="machine learning",
keywords="person-generated health data",
abstract="Background: In 2017, an estimated 17.3 million adults in the United States experienced at least one major depressive episode, with 35\% of them not receiving any treatment. Underdiagnosis of depression has been attributed to many reasons, including stigma surrounding mental health, limited access to medical care, and barriers due to cost. Objective: This study aimed to determine if low-burden personal health solutions, leveraging person-generated health data (PGHD), could represent a possible way to increase engagement and improve outcomes. Methods: Here, we present the development of PSYCHE-D (Prediction of Severity Change-Depression), a predictive model developed using PGHD from more than 4000 individuals, which forecasts the long-term increase in depression severity. PSYCHE-D uses a 2-phase approach. The first phase supplements self-reports with intermediate generated labels, and the second phase predicts changing status over a 3-month period, up to 2 months in advance. The 2 phases are implemented as a single pipeline in order to eliminate data leakage and ensure results are generalizable. Results: PSYCHE-D is composed of 2 Light Gradient Boosting Machine (LightGBM) algorithm--based classifiers that use a range of PGHD input features, including objective activity and sleep, self-reported changes in lifestyle and medication, and generated intermediate observations of depression status. The approach generalizes to previously unseen participants to detect an increase in depression severity over a 3-month interval, with a sensitivity of 55.4\% and a specificity of 65.3\%, nearly tripling sensitivity while maintaining specificity when compared with a random model. Conclusions: These results demonstrate that low-burden PGHD can be the basis of accurate and timely warnings that an individual's mental health may be deteriorating. We hope this work will serve as a basis for improved engagement and treatment of individuals experiencing depression. ",
doi="10.2196/34148",
url="https://mhealth.jmir.org/2022/3/e34148",
url="http://www.ncbi.nlm.nih.gov/pubmed/35333186"
}


@Article{info:doi/10.2196/28978,
author="Pang, Lanlan
and Liu, Hengyu
and Liu, Zhidong
and Tan, Jinyu
and Zhou, Long-yuan
and Qiu, Yun
and Lin, Xiaoqing
and He, Jinshen
and Li, Xuehua
and Lin, Sinan
and Ghosh, Subrata
and Mao, Ren
and Chen, Minhu",
title="Role of Telemedicine in Inflammatory Bowel Disease: Systematic Review and Meta-analysis of Randomized Controlled Trials",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="24",
volume="24",
number="3",
pages="e28978",
keywords="telemedicine",
keywords="inflammatory bowel disease",
keywords="quality of life",
keywords="disease activity",
keywords="mobile phone",
abstract="Background: Telemedicine plays an important role in the management of inflammatory bowel disease (IBD), particularly during a pandemic such as COVID-19. However, the effectiveness and efficiency of telemedicine in managing IBD are unclear. Objective: This systematic review and meta-analysis aimed to compare the impact of telemedicine with that of standard care on the management of IBD. Methods: We systematically searched the PubMed, Cochrane Library, EMBASE, Web of Science, and Scopus databases on April 22, 2020. Randomized controlled trials comparing telemedicine with standard care in patients with IBD were included, while conference abstracts, letters, reviews, laboratory studies, and case reports were excluded. The IBD-specific quality of life (QoL), disease activity, and remission rate in patients with IBD were assessed as primary outcomes, and the number of in-person clinic visits per patient, patient satisfaction, psychological outcome, and medication adherence were assessed as secondary outcomes. Review Manage 5.3 and Stata 15.1 were used for data analysis. Results: A total of 17 randomized controlled trials (2571 participants) were included in this meta-analysis. The telemedicine group had higher IBD-specific QoL than the standard care group (standard mean difference 0.18, 95\% CI 0.01 to 0.34; P.03). The number of clinic visits per patient in the telemedicine group was significantly lower than that in the standard care group (standard mean difference ?0.71, 95\% CI ?1.07 to ?0.36; P<.001). Subgroup analysis showed that adolescents in the telemedicine group had significantly higher IBD-specific QoL than those in the standard care group (standard mean difference 0.42, 95\% CI 0.15 to 0.69; I2=0; P.002), but there was no significant difference between adults in the 2 groups. There were no significant differences in disease activity, remission rate, patient satisfaction, depression, self-efficacy, generic QoL, and medication adherence outcomes between the telemedicine and standard care groups. Conclusions: Telemedicine intervention showed a promising role in improving IBD-specific QoL among adolescents and decreased the number of clinic visits among patients with IBD. Further research is warranted to identify the group of patients with IBD who would most benefit from telemedicine. ",
doi="10.2196/28978",
url="https://www.jmir.org/2022/3/e28978",
url="http://www.ncbi.nlm.nih.gov/pubmed/35323120"
}


@Article{info:doi/10.2196/31449,
author="Leong, Man Cheng
and Lee, Ting-I
and Chien, Yu-Mei
and Kuo, Li-Na
and Kuo, Yu-Feng
and Chen, Hsiang-Yin",
title="Social Media--Delivered Patient Education to Enhance Self-management and Attitudes of Patients with Type 2 Diabetes During the COVID-19 Pandemic: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="23",
volume="24",
number="3",
pages="e31449",
keywords="diabetes",
keywords="COVID-19",
keywords="education",
keywords="video",
keywords="social media",
keywords="health literacy",
keywords="self-care activity",
keywords="type 2 diabetes",
keywords="attitude",
keywords="mHealth",
abstract="Background: The use of mobile health technologies has been necessary to deliver patient education to patients with diabetes during the COVID-19 pandemic. Objective: This open-label randomized controlled trial evaluated the effects of a diabetes educational platform---Taipei Medical University--LINE Oriented Video Education---delivered through a social media app. Methods: Patients with type 2 diabetes were recruited from a clinic through physician referral. The social media--based program included 51 videos: 10 about understanding diabetes, 10 about daily care, 6 about nutrition care, 21 about diabetes drugs, and 4 containing quizzes. The intervention group received two or three videos every week and care messages every 2 weeks through the social media platform for 3 months, in addition to usual care. The control group only received usual care. Outcomes were measured at clinical visits through self-reported face-to-face questionnaires at baseline and at 3 months after the intervention, including the Simplified Diabetes Knowledge Scale (true/false version), the Diabetes Care Profile--Attitudes Toward Diabetes Scales, the Summary of Diabetes Self-Care Activities, and glycated hemoglobin (HbA1c) levels. Health literacy was measured at baseline using the Newest Vital Sign tool. Differences in HbA1c levels and questionnaire scores before and after the intervention were compared between groups. The associations of knowledge, attitudes, and self-care activities with health literacy were assessed. Results: Patients with type 2 diabetes completed the 3-month study, with 91 out of 181 (50.3\%) patients in the intervention group and 90 (49.7\%) in the control group. The change in HbA1c did not significantly differ between groups (intervention group: mean 6.9\%, SD 0.8\% to mean 7.0\%, SD 0.9\%, P=.34; control group: mean 6.7\%, SD 0.6\% to mean 6.7\%, SD 0.7\%, P=.91). Both groups showed increased mean knowledge scores at 12 weeks, increasing from 68.3\% (SD 16.4\%) to 76.7\% (SD 11.7\%; P<.001) in the intervention group and from 64.8\% (SD 18.2\%) to 73.2\% (SD 12.6\%; P<.001) in the control group. Positive improvements in attitudes and self-care activities were only observed in the intervention group (attitudes: mean difference 0.2, SD 0.5, P=.001; self-care activities: mean difference 0.3, SD 1.2, P=.03). A 100\% utility rate was achieved for 8 out of 21 (38\%) medication-related videos. Low health literacy was a significant risk factor for baseline knowledge scores in the intervention group, with an odds ratio of 2.80 (95\% CI 1.28-6.12; P=.01); this became insignificant after 3 months. Conclusions: The social media--based program was effective at enhancing the knowledge, attitudes, and self-care activities of patients with diabetes. This intervention was also helpful for patients with low health literacy in diabetes knowledge. The program represents a potentially useful tool for delivering diabetes education to patients through social media, especially during the COVID-19 pandemic. Trial Registration: ClinicalTrials.gov NCT04876274; https://clinicaltrials.gov/ct2/show/results/NCT04876274 ",
doi="10.2196/31449",
url="https://www.jmir.org/2022/3/e31449",
url="http://www.ncbi.nlm.nih.gov/pubmed/35319478"
}


@Article{info:doi/10.2196/35134,
author="Lee, M. Jennifer
and Woon, Rex
and Ramsum, Mandy
and Halperin, S. Daniel
and Jain, Roshini",
title="User Engagement and Assessment of Treatment Effectiveness in Patients Using a Novel Digital mHealth App During Spinal Cord Stimulation Screening Trials",
journal="JMIR eHum Factors",
year="2022",
month="Mar",
day="23",
volume="9",
number="1",
pages="e35134",
keywords="spinal cord stimulation",
keywords="SCS",
keywords="chronic pain",
keywords="digital health",
keywords="smartphone app",
keywords="mobile health",
keywords="mHealth",
keywords="smart device",
keywords="digital application",
keywords="application",
keywords="app",
keywords="spine",
abstract="Background: Patient outcomes and experience during a Spinal Cord Stimulation (SCS) screening trial can have a significant effect on whether to proceed with long-term, permanent implantation of an SCS device for the treatment of chronic pain. Enhancing the ability to track and assess patients during this initial trial evaluation offers the potential for improved understanding regarding the suitability of permanent device implantation as well as identification of the SCS-based neurostimulative modalities and parameters that may provide substantial analgesia in a patient-specific manner. Objective: In this report, we aimed to describe a preliminary, real-world assessment of a new, real time tracking, smart, device-based digital app used by patients with chronic pain undergoing trial screening for SCS therapy. Methods: This is a real-world, retrospective evaluation of 13,331 patients diagnosed with chronic pain who used the new ``mySCS'' mobile app during an SCS screening trial. The app design is health insurance portability and accountability act (HIPAA)-compliant and compatible with most commercially available smartphones (eg, Apple, iPhone, and Android). The app enables tracking of user-inputted health-related responses (ie, pain relief, activity level, and sleep quality) in addition to personal trial goals and a summary of overall experience during the SCS trial. A deidentified, aggregate analysis of user engagement, user-submitted responses, and overall trial success was conducted. Results: When provided the opportunity, the percentage of users who engaged with the tracking app for ?50\% of the time during their trial was found to be 64.43\% (n=8589). Among the 13,331 patients who used the app, 58.24\% (n=7764) entered a trial goal. Most patients underwent SCS screening with a trial duration of at least 7 days (n=7739, 58.05\%). Of those patients who undertook a 7-day SCS trial, 62.30\% (n=3456) engaged the app for 4 days or more. In addition, among all who submitted descriptive responses using the app, health-related improvements were reported by 77.84\% (n=10,377) of patients who reached day 3 of the screening phase assessment and by 83.04\% (n=11,070) of those who reached trial completion. A trial success rate of 91\% was determined for those who used the app (versus 85\% success rate for nonusers). Conclusions: Data from this initial, real-world examination of a mobile, digital-health--based tracking app (``mySCS''), as used during the SCS screening phase, demonstrate that substantial patient engagement can be achieved while also providing for the acquisition of more real time patient-outcome measures that may help facilitate improved SCS trial success. ",
doi="10.2196/35134",
url="https://humanfactors.jmir.org/2022/1/e35134",
url="http://www.ncbi.nlm.nih.gov/pubmed/35167484"
}


@Article{info:doi/10.2196/28751,
author="Jaffar, Aida
and Tan, Chai-Eng
and Mohd-Sidik, Sherina
and Admodisastro, Novia
and Goodyear-Smith, Felicity",
title="Persuasive Technology in an mHealth App Designed for Pelvic Floor Muscle Training Among Women: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Mar",
day="22",
volume="10",
number="3",
pages="e28751",
keywords="urinary incontinence",
keywords="pelvic floor muscle training",
keywords="mHealth app",
keywords="persuasive technology",
keywords="capability, opportunity, and motivation--behavior model",
keywords="mobile phone",
abstract="Background: Pelvic floor muscle training (PFMT) is one of the first-line treatments for stress urinary incontinence among pregnant women. Mobile health (mHealth) technology is potentially effective for delivering PFMT to pregnant women. Persuasive technology in the development of such mobile apps may facilitate behavior change by improving adherence to the exercises. The Capability, Opportunity, and Motivation--Behavior (COM-B) model is potentially useful in selecting the appropriate interventions to be incorporated into the apps. Objective: This review of mHealth apps for PFMT aims to describe the principles of persuasion used for each app and to propose mHealth app design features based on the COM-B model. Methods: A systematic literature search was conducted to answer three main research questions: what are the available mHealth apps for PFMT in the published literature, what persuasive strategies were used in their studies how were they mapped to the COM-B model, and how effective were the selected persuasive strategies for PFMT adherence? We searched PubMed, CINAHL, Web of Science, Scopus, and local Malaysian databases such as MyCite and MyMedR for articles reporting mHealth apps used for the delivery of PFMT. We included original articles reporting experimental and cross-sectional studies, including pilot or feasibility trials. Systematic and narrative reviews were excluded. Narrative and thematic syntheses were conducted on the eligible articles based on the research questions. The Cochrane risk of bias tool and the Risk of Bias Assessment Tool for Non-randomized Studies were used to assess study bias. Results: Of the 169 records from the initial search, 10 (5.9\%) articles meeting the selection criteria were included in this review. There were 8 mHealth apps designed for the delivery of PFMT. The T{\"a}t, which used 3 categories of persuasive system design, improved PFMT adherence and was cost-effective. Only 1 app, the iBall app, used all categories of persuasive system design, by including social support such as ``competition'' in its design. The Di{\'a}rio Sa{\'u}de app was the only app developed using operant conditioning. All apps incorporated Tailoring and Expertise as part of their PSD strategies. Only 3 apps, the Di{\'a}rio Sa{\'u}de, T{\"a}t, and Pen Yi Kang demonstrated improved PFMT adherence. Conclusions: Persuasive technology used in mobile apps may target desired behavior change more effectively. The persuasive system design can be mapped to the COM-B model to explain its effectiveness on behaviour change outcomes. ",
doi="10.2196/28751",
url="https://mhealth.jmir.org/2022/3/e28751",
url="http://www.ncbi.nlm.nih.gov/pubmed/35315777"
}


@Article{info:doi/10.2196/33286,
author="Johnson, E. Amber
and Routh, Shuvodra
and Taylor, N. Christy
and Leopold, Meagan
and Beatty, Kathryn
and McNamara, M. Dennis
and Davis, M. Esa",
title="Developing and Implementing an mHealth Heart Failure Self-care Program to Reduce Readmissions: Randomized Controlled Trial",
journal="JMIR Cardio",
year="2022",
month="Mar",
day="21",
volume="6",
number="1",
pages="e33286",
keywords="mHealth",
keywords="heart failure",
keywords="self-care",
keywords="remote monitoring",
keywords="telehealth",
keywords="cardiology",
keywords="hospital readmission",
keywords="self-management",
keywords="mobile health",
keywords="patient-centered",
abstract="Background: Patients admitted with decompensated heart failure (HF) are at risk for hospital readmission and poor quality of life during the discharge period. Lifestyle behavior modifications that promote the self-management of chronic cardiac diseases have been associated with an improved quality of life. However, whether a mobile health (mHealth) program can assist patients in the self-management of HF during the acute posthospital discharge period is unknown. Objective: We aimed to develop an mHealth program designed to enhance patients' self-management of HF by increasing knowledge, self-efficacy, and symptom detection. We hypothesized that patients hospitalized with HF would be willing to use a feasibly deployed mHealth program after their hospital discharge. Methods: We employed a patient-centered outcomes research methodology to design a stakeholder-informed mHealth program. Adult patients with HF admitted to a large academic hospital were enrolled and randomized to receive the mHealth intervention versus usual care. Our feasibility outcomes included ease of program deployment, use of the clinical escalation process, duration of participant recruitment, and participant attrition. Surveys assessing the demographics and clinical characteristics of HF were measured at baseline and at 30 and 90 days after discharge. Results: The study period was between July 1, 2019, and April 7, 2020. The mean cohort (N=31) age was 60.4 (range 22-85) years. Over half of the participants were men (n=18, 58\%) and 77\% (n=24) were White. There were no significant differences in baseline measures. We determined that an educational mHealth program tailored for patients with HF is feasibly deployed and acceptable by patients. Though not significant, we found notable trends including a higher mean quality of life at 30 days posthospitalization among program users and a longer duration before rehospitalization, which are suggestive of better HF prognosis. Conclusions: Our mHealth tool should be further assessed in a larger comparative effectiveness trial. Our pilot intervention offers promise as an innovative means to help HF patients lead healthy, independent lives. These preliminary data suggest that patient-centered mHealth tools can enable high-risk patients to play a role in the management of their HF after discharge. Trial Registration: ClinicalTrials.gov NCT03982017; https://clinicaltrials.gov/ct2/show/NCT03982017 ",
doi="10.2196/33286",
url="https://cardio.jmir.org/2022/1/e33286",
url="http://www.ncbi.nlm.nih.gov/pubmed/35311679"
}


@Article{info:doi/10.2196/34758,
author="Gelbman, D. Brian
and Reed, R. Carol",
title="An Integrated, Multimodal, Digital Health Solution for Chronic Obstructive Pulmonary Disease: Prospective Observational Pilot Study",
journal="JMIR Form Res",
year="2022",
month="Mar",
day="17",
volume="6",
number="3",
pages="e34758",
keywords="COPD",
keywords="patient engagement",
keywords="mHealth",
keywords="digital health",
keywords="mobile phone",
keywords="telemedicine",
keywords="mobile apps",
keywords="remote monitoring",
keywords="spirometry",
keywords="pulse oximetry",
abstract="Background: Chronic obstructive pulmonary disease (COPD) affects millions of Americans and has a high economic impact partially due to frequent emergency room visits and hospitalizations. Advances in digital health have made it possible to collect data remotely from multiple devices to assist in managing chronic diseases such as COPD. Objective: In this pilot study, we evaluated the ability of patients with COPD to use the Wellinks mHealth platform to collect information from multiple modalities important to the management of COPD. We also assessed patient satisfaction and engagement with the platform. Methods: A single-site, observational, prospective pilot study (N=19) was conducted using the Wellinks platform in adults with COPD. All patients were aged over 30 years at screening, owned an iPhone, and were currently undergoing a treatment regimen that included nebulized therapy. Enrolled patients received a study kit consisting of the Flyp nebulizer, Smart One spirometer, the Nonin pulse oximeter, plus the Wellinks mHealth app, and training for all devices. For 8 weeks, participants were to enter daily symptoms and medication use manually; spirometry, nebulizer, and pulse oximeter data were automatically recorded. Data were sent to the attending physician in a monthly report. Patient satisfaction was measured via a 5-point scale and the Net Promoter Score (NPS) captured in interviews at the end of the observation period. Results: Average age of the patients was 79.6 (range 65-95) years. Participants (10 female; 9 male) had an average FEV1\% (forced expiratory volume in 1 second as \% of predicted for the patient) of 56.2\% of predicted (range 23\%-113\%) and FEV1/forced vital capacity of 65\%. COPD severity, as assessed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, was mild in 2 patients, moderate in 6, and severe/very severe in 11; 9 patients were on home oxygen. During this 8-week study, average use of the spirometer was 2.5 times/week, and the pulse oximeter 4.2 times/week. Medication use was manually documented 9.0 times/week, nebulizer use 1.9 times/week, and symptoms recorded 1.2 times/week on average. The correlation coefficients of home to office measurements for peak flow and FEV1 were high (r=0.94 and 0.96, respectively). Patients found the app valuable (13/16, 81\%) and easy to use (15/16, 94\%). The NPS was 59. Conclusions: This study demonstrates that our cohort of patients with COPD engaged with the Wellinks mHealth platform avidly and consistently over the 8-week period, and that patient satisfaction was high, as indicated by the satisfaction survey and the NPS of 59. In this small, selected sample, patients were both willing to use the technology and capable of doing so successfully regardless of disease severity, age, or gender. The Wellinks mHealth platform was considered useful and valuable by patients, and can assist clinicians in improved, timely decision making for better COPD management. ",
doi="10.2196/34758",
url="https://formative.jmir.org/2022/3/e34758",
url="http://www.ncbi.nlm.nih.gov/pubmed/35142291"
}


@Article{info:doi/10.2196/35687,
author="Allen, A. Nancy
and Litchman, L. Michelle
and Chamberlain, James
and Grigorian, G. Ernest
and Iacob, Eli
and Berg, A. Cynthia",
title="Continuous Glucose Monitoring Data Sharing in Older Adults With Type 1 Diabetes: Pilot Intervention Study",
journal="JMIR Diabetes",
year="2022",
month="Mar",
day="16",
volume="7",
number="1",
pages="e35687",
keywords="older adults",
keywords="type 1 diabetes",
keywords="caregiver",
keywords="CGM",
keywords="data sharing",
keywords="mobile phone",
abstract="Background: Family members or friends (care partners [CPs]) of older adults with type 1 diabetes (T1DM) regularly become part of the diabetes care team, but they often lack knowledge about how to become involved to prevent hypo- and hyperglycemia. Continuous glucose monitoring (CGM) allows a person with diabetes to see their glucose levels continuously and to receive predictive alerts. A smartphone data-sharing app called the Follow app allows the person with diabetes to share continuous glucose numbers with others and to receive predictive alerts of impending hypo- and hyperglycemia. However, there are barriers to sharing this continuous glucose level data with CPs. Objective: This study aimed to address the barriers to sharing CGM data. Our objective was to examine the feasibility of using CGM with the Follow app and a data-sharing intervention called SHARE plus in older adults with T1DM and their CPs. SHARE plus includes dyadic communication strategies, problem-solving strategies, and action planning to facilitate CGM data sharing. Methods: Older adults with T1DM (n=20) and their CPs (n=20) received the SHARE plus intervention at baseline. People with diabetes wore the CGM for 12 weeks while sharing their glucose data using the Follow app with CPs. Feasibility data were analyzed using descriptive statistics. Results: The SHARE plus intervention was feasible and was associated with high self-reported satisfaction for people with diabetes and their CPs as well as high adherence to CGM (mean 96\%, SD 6.8\%). Broad improvements were shown in the diabetes-related quality of life through the use of CGM in people with diabetes and their CPs. Although the majority of people with diabetes (11/20, 55\%) were willing to share hyperglycemia data, several chose not to. The majority of people with diabetes (14/20, 70\%) were willing to talk about glucose numbers with a CP. Conclusions: Older adults with T1DM and their CPs identified having someone else aware of glucose levels and working together with a partner on diabetes self-management as positive aspects of the use of the SHARE plus intervention. Clinicians can use these results to provide data sharing coaching in older adults and their CPs. ",
doi="10.2196/35687",
url="https://diabetes.jmir.org/2022/1/e35687",
url="http://www.ncbi.nlm.nih.gov/pubmed/35293868"
}


@Article{info:doi/10.2196/29171,
author="Sitges, Carolina
and Terrasa, L. Juan
and Garc{\'i}a-Dopico, Nuria
and Segur-Ferrer, Joan
and Velasco-Rold{\'a}n, Olga
and Cresp{\'i}-Palmer, Jaume
and Gonz{\'a}lez-Rold{\'a}n, Mar{\'i}a Ana
and Montoya, Pedro",
title="An Educational and Exercise Mobile Phone--Based Intervention to Elicit Electrophysiological Changes and to Improve Psychological Functioning in Adults With Nonspecific Chronic Low Back Pain (BackFit App): Nonrandomized Clinical Trial",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Mar",
day="15",
volume="10",
number="3",
pages="e29171",
keywords="low back pain",
keywords="chronic pain",
keywords="mobile apps",
keywords="education",
keywords="exercise",
keywords="brain",
keywords="cognition",
keywords="depression",
keywords="pain threshold",
keywords="mHealth",
keywords="mobile phone",
abstract="Background: Concomitant psychological and cognitive impairments modulate nociceptive processing and contribute to chronic low back pain (CLBP) maintenance, poorly correlated with radiological findings. Clinical practice guidelines recommend self-management and multidisciplinary educational and exercise-based interventions. However, these recommendations are based on self-reported measurements, which lack evidence of related electrophysiological changes. Furthermore, current mobile health (mHealth) tools for self-management are of low quality and scarce evidence. Thus, it is necessary to increase knowledge on mHealth and electrophysiological changes elicited by current evidence-based interventions. Objective: The aim of this study is to investigate changes elicited by a self-managed educational and exercise-based 4-week mHealth intervention (BackFit app) in electroencephalographic and electrocardiographic activity, pressure pain thresholds (PPTs), pain, disability, and psychological and cognitive functioning in CLBP versus the same intervention in a face-to-face modality. Methods: A 2-arm parallel nonrandomized clinical trial was conducted at the University of the Balearic Islands (Palma, Spain). A total of 50 patients with nonspecific CLBP were assigned to a self-managed group (23/50, 46\%; mean age 45.00, SD 9.13 years; 10/23, 43\% men) or a face-to-face group (27/50, 54\%; mean age 48.63, SD 7.54 years; 7/27, 26\% men). The primary outcomes were electroencephalographic activity (at rest and during a modified version of the Eriksen flanker task) and heart rate variability (at rest), PPTs, and pressure pain intensity ratings. The secondary outcomes were pain, disability, psychological functioning (mood, anxiety, kinesiophobia, pain catastrophizing, and fear-avoidance beliefs), and cognitive performance (percentage of hits and reaction times). Results: After the intervention, frequency analysis of electroencephalographic resting-state data showed increased beta-2 (16-23 Hz; 0.0020 vs 0.0024; P=.02) and beta-3 (23-30 Hz; 0.0013 vs 0.0018; P=.03) activity. In addition, source analyses revealed higher power density of beta (16-30 Hz) at the anterior cingulate cortex and alpha (8-12 Hz) at the postcentral gyrus and lower power density of delta (2-4 Hz) at the cuneus and precuneus. Both groups also improved depression (7.74 vs 5.15; P=.01), kinesiophobia (22.91 vs 20.87; P=.002), activity avoidance (14.49 vs 12.86; P<.001), helplessness (6.38 vs 4.74; P=.02), fear-avoidance beliefs (35 vs 29.11; P=.03), and avoidance of physical activity (12.07 vs 9.28; P=.01) scores, but there was an increase in the disability score (6.08 vs 7.5; P=.01). No significant differences between the groups or sessions were found in heart rate variability resting-state data, electroencephalographic data from the Eriksen flanker task, PPTs, subjective ratings, or cognitive performance. Conclusions: Both intervention modalities increased mainly beta activity at rest and improved psychological functioning. Given the limitations of our study, conclusions must be drawn carefully and further research will be needed. Nevertheless, to the best of our knowledge, this is the first study reporting electroencephalographic changes in patients with CLBP after an mHealth intervention. Trial Registration: ClinicalTrials.gov NCT04576611; https://clinicaltrials.gov/ct2/show/NCT04576611 ",
doi="10.2196/29171",
url="https://mhealth.jmir.org/2022/3/e29171",
url="http://www.ncbi.nlm.nih.gov/pubmed/35289758"
}


@Article{info:doi/10.2196/33571,
author="Turesson, Christina
and Liedberg, Gunilla
and Bj{\"o}rk, Mathilda",
title="Development of a Digital Support Application With Evidence-Based Content for Sustainable Return to Work for Persons With Chronic Pain and Their Employers: User-Centered Agile Design Approach",
journal="JMIR Hum Factors",
year="2022",
month="Mar",
day="14",
volume="9",
number="1",
pages="e33571",
keywords="agile design process",
keywords="chronic pain",
keywords="digital support",
keywords="eHealth",
keywords="return to work",
keywords="self-management",
keywords="smartphone apps",
keywords="user-centered design",
keywords="mobile phone",
abstract="Background: Persons with chronic pain experience a lack of support after completing rehabilitation and the responsibility for the return-to-work (RTW) process is taken over by the employer. In addition, employers describe not knowing how to support their employees. Smartphone apps have been increasingly used for self-management, but there is a lack of available eHealth apps with evidence-based content providing digital support for persons with chronic pain and their employers when they return to work. Objective: This study aims to describe the development of a digital support application with evidence-based content that includes a biopsychosocial perspective on chronic pain for sustainable RTW for persons with chronic pain and their employers (SWEPPE [Sustainable Worker Digital Support for Persons With Chronic Pain and Their Employers]). Methods: A user-centered agile design approach was applied. The multidisciplinary project team consisted of health care researchers, a user representative, and a software team. A total of 2 reference groups of 7 persons with chronic pain and 4 employers participated in the development process and usability testing. Mixed methods were used for data collection. The design was revised using feedback from the reference groups. The content of SWEPPE was developed based on existing evidence and input from the reference groups. Results: The reference groups identified the following as important characteristics to include in SWEPPE: keeping users motivated, tracking health status and work situation, and following progress. SWEPPE was developed as a smartphone app for the persons with chronic pain and as a web application for their employers. SWEPPE consists of six modules: the action plan, daily self-rating, self-monitoring graphs, the coach, the library, and shared information with the employer. The employers found the following functions in SWEPPE to be the most useful: employees' goals related to RTW, barriers to RTW, support wanted from the employer, and the ability to follow employees' progress. The persons with chronic pain found the following functions in SWEPPE to be the most useful: setting a goal related to RTW, identifying barriers and strategies, and self-monitoring. Usability testing revealed that SWEPPE was safe, useful (ie, provided relevant information), logical, and easy to use with an appealing interface. Conclusions: This study reports the development of a digital support application for persons with chronic pain and their employers. SWEPPE fulfilled the need of support after an interdisciplinary pain rehabilitation program with useful functions such as setting a goal related to RTW, identification of barriers and strategies for RTW, self-monitoring, and sharing information between the employee and the employer. The user-centered agile design approach contributed to creating SWEPPE as a relevant and easy-to-use eHealth intervention. Further studies are needed to examine the effectiveness of SWEPPE in a clinical setting. ",
doi="10.2196/33571",
url="https://humanfactors.jmir.org/2022/1/e33571",
url="http://www.ncbi.nlm.nih.gov/pubmed/35285814"
}


@Article{info:doi/10.2196/31972,
author="Limmroth, Volker
and Bayer-Gersmann, Kirsten
and Mueller, Christian
and Sch{\"u}rks, Markus",
title="Ascertaining Medication Use and Patient-Reported Outcomes via an App and Exploring Gamification in Patients With Multiple Sclerosis Treated With Interferon $\beta$-1b: Observational Study",
journal="JMIR Form Res",
year="2022",
month="Mar",
day="14",
volume="6",
number="3",
pages="e31972",
keywords="digital observational study",
keywords="BETACONNECT",
keywords="app",
keywords="interferon $\beta$-1b",
keywords="multiple sclerosis",
keywords="medication adherence",
keywords="medication compliance",
keywords="medication persistence",
keywords="health-related quality of life",
keywords="gamification",
keywords="mobile phone",
abstract="Background: The BETACONNECT autoinjector and myBETAapp app were designed to support patients with multiple sclerosis receiving interferon $\beta$-1b and are an ideal platform for digital observational studies. A recent pilot study in Germany demonstrated the feasibility of using the app to recruit patients, obtain informed consent, and evaluate medication-taking behavior over 6 months. Objective: This study aims to describe medication-taking behavior for 1 year in patients with multiple sclerosis receiving interferon $\beta$-1b based on data collected from the app and to provide information on patient-reported outcomes (PROs). The optional use of the cognitive training tool PEAK (Peak, formerly Brainbow Ltd) is included to test the feasibility of gamification in this setting. Methods: A prospective and retrospective, exploratory, digital, observational cohort study was conducted among users of the app in Germany. Invitations to participate were sent to patients' apps between February and May 2019. Participants provided electronic informed consent. Injection-related data from consenting patients' devices were collected prospectively for 1 year following the consent date and retrospectively for ?1 year from the first day of use (if historical data were available). Participants also completed three electronic PRO instruments every 3 months: the EuroQol 5-Dimension, 5-Level questionnaire (EQ-5D-5L); the Treatment Satisfaction Questionnaire for Medication (TSQM; version II); and a questionnaire on satisfaction with treatment support (on a server accessed via an emailed hyperlink). All patients were offered optional access to the professional version of PEAK. Results: Of 1778 registered app accounts (May 2019), 79 patients (4.44\%) provided informed consent; 62 (3.49\%) were eligible for inclusion in the prospective analysis, of whom, 60 (97\%) also had retrospective data. The mean age of the 62 participants was 43.2 (SD 11.5) years and 41 (66\%) were women. Compliance over the 1-year prospective observational period (primary end point) was high (median 98.9\%, IQR 94.3\%-100\%) and similar among men and women. Persistence and adherence (coprimary end points) decreased from 85\% (53/62) and 74\% (46/62), respectively, at 6 months to 76\% (47/62) and 65\% (40/62), respectively, at 12 months; both were higher in men than in women. A retrospective analysis showed similar patterns. The PRO questionnaires were answered by 79\% (49/62) of the participants at baseline and 50\% (31/62) of them at month 12. Women had more severe problems in some EQ-5D-5L dimensions (mobility, usual activities, and pain/discomfort) and lower median convenience scores on the TSQM (version II) than men. At month 12, 84\% (26/31) of the patients were satisfied or very satisfied with the app. PEAK was used by 67\% (14/21) of men and 49\% (20/41) of women. Conclusions: This study showed high compliance and decreasing persistence and adherence over 1 year and demonstrated the feasibility of including remotely completed electronic PRO instruments in digital observational studies. ",
doi="10.2196/31972",
url="https://formative.jmir.org/2022/3/e31972",
url="http://www.ncbi.nlm.nih.gov/pubmed/35285806"
}


@Article{info:doi/10.2196/34898,
author="Zhang, Yuezhou
and Folarin, A. Amos
and Sun, Shaoxiong
and Cummins, Nicholas
and Vairavan, Srinivasan
and Bendayan, Rebecca
and Ranjan, Yatharth
and Rashid, Zulqarnain
and Conde, Pauline
and Stewart, Callum
and Laiou, Petroula
and Sankesara, Heet
and Matcham, Faith
and White, M. Katie
and Oetzmann, Carolin
and Ivan, Alina
and Lamers, Femke
and Siddi, Sara
and Vilella, Elisabet
and Simblett, Sara
and Rintala, Aki
and Bruce, Stuart
and Mohr, C. David
and Myin-Germeys, Inez
and Wykes, Til
and Haro, Maria Josep
and Penninx, WJH Brenda
and Narayan, A. Vaibhav
and Annas, Peter
and Hotopf, Matthew
and Dobson, JB Richard
and ",
title="Longitudinal Relationships Between Depressive Symptom Severity and Phone-Measured Mobility: Dynamic Structural Equation Modeling Study",
journal="JMIR Ment Health",
year="2022",
month="Mar",
day="11",
volume="9",
number="3",
pages="e34898",
keywords="depression",
keywords="mobile health",
keywords="location data",
keywords="mobility",
keywords="dynamic structural equation modeling",
keywords="mHealth",
keywords="mental health",
keywords="medical informatics",
keywords="modeling",
abstract="Background: The mobility of an individual measured by phone-collected location data has been found to be associated with depression; however, the longitudinal relationships (the temporal direction of relationships) between depressive symptom severity and phone-measured mobility have yet to be fully explored. Objective: We aimed to explore the relationships and the direction of the relationships between depressive symptom severity and phone-measured mobility over time. Methods: Data used in this paper came from a major EU program, called the Remote Assessment of Disease and Relapse--Major Depressive Disorder, which was conducted in 3 European countries. Depressive symptom severity was measured with the 8-item Patient Health Questionnaire (PHQ-8) through mobile phones every 2 weeks. Participants' location data were recorded by GPS and network sensors in mobile phones every 10 minutes, and 11 mobility features were extracted from location data for the 2 weeks prior to the PHQ-8 assessment. Dynamic structural equation modeling was used to explore the longitudinal relationships between depressive symptom severity and phone-measured mobility. Results: This study included 2341 PHQ-8 records and corresponding phone-collected location data from 290 participants (age: median 50.0 IQR 34.0, 59.0) years; of whom 215 (74.1\%) were female, and 149 (51.4\%) were employed. Significant negative correlations were found between depressive symptom severity and phone-measured mobility, and these correlations were more significant at the within-individual level than the between-individual level. For the direction of relationships over time, Homestay (time at home) ($\phi$=0.09, P=.01), Location Entropy (time distribution on different locations) ($\phi$=?0.04, P=.02), and Residential Location Count (reflecting traveling) ($\phi$=0.05, P=.02) were significantly correlated with the subsequent changes in the PHQ-8 score, while changes in the PHQ-8 score significantly affected ($\phi$=?0.07, P<.001) the subsequent periodicity of mobility. Conclusions: Several phone-derived mobility features have the potential to predict future depression, which may provide support for future clinical applications, relapse prevention, and remote mental health monitoring practices in real-world settings. ",
doi="10.2196/34898",
url="https://mental.jmir.org/2022/3/e34898",
url="http://www.ncbi.nlm.nih.gov/pubmed/35275087"
}


@Article{info:doi/10.2196/28942,
author="Martinengo, Laura
and Stona, Anne-Claire
and Tudor Car, Lorainne
and Lee, Jimmy
and Griva, Konstadina
and Car, Josip",
title="Education on Depression in Mental Health Apps: Systematic Assessment of Characteristics and Adherence to Evidence-Based Guidelines",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="9",
volume="24",
number="3",
pages="e28942",
keywords="health literacy",
keywords="mental health literacy",
keywords="depression",
keywords="mobile apps",
keywords="apps",
keywords="telemedicine",
keywords="mHealth",
keywords="self-management",
keywords="mobile phone",
abstract="Background: Suboptimal understanding of depression and mental health disorders by the general population is an important contributor to the wide treatment gap in depression. Mental health literacy encompasses knowledge and beliefs about mental disorders and supports their recognition, management, and prevention. Besides knowledge improvement, psychoeducational interventions reduce symptoms of depression, enhance help-seeking behavior, and decrease stigma. Mental health apps often offer educational content, but the trustworthiness of the included information is unclear. Objective: The aim of this study is to systematically evaluate adherence to clinical guidelines on depression of the information offered by mental health apps available in major commercial app stores. Methods: A systematic assessment of the educational content regarding depression in the apps available in the Apple App Store and Google Play was conducted in July 2020. A systematic search for apps published or updated since January 2019 was performed using 42matters. Apps meeting the inclusion criteria were downloaded and assessed using two smartphones: an iPhone 7 (iOS version 14.0.1) and a Sony XPERIA XZs (Android version 8.0.0). The 156-question assessment checklist comprised general characteristics of apps, appraisal of 38 educational topics and their adherence to evidence-based clinical guidelines, as well as technical aspects and quality assurance. The results were tabulated and reported as a narrative review, using descriptive statistics. Results: The app search retrieved 2218 apps, of which 58 were included in the analysis (Android apps: n=29, 50\%; iOS apps: n=29, 50\%). Of the 58 included apps, 37 (64\%) apps offered educational content within a more comprehensive depression or mental health management app. Moreover, 21\% (12/58) of apps provided non--evidence-based information. Furthermore, 88\% (51/58) of apps included up to 20 of the educational topics, the common ones being listing the symptoms of depression (52/58, 90\%) and available treatments (48/58, 83\%), particularly psychotherapy. Depression-associated stigma was mentioned by 38\% (22/58) of the apps, whereas suicide risk was mentioned by 71\% (41/58), generally as an item in a list of symptoms. Of the 58 included apps, 44 (76\%) highlighted the importance of help seeking, 29 (50\%) emphasized the importance of involving the user's support network. In addition, 52\% (30/58) of apps referenced their content, and 17\% (10/58) included advertisements. Conclusions: Information in mental health and depression apps is often brief and incomplete, with 1 in 5 apps providing non--evidence-based information. Given the unmet needs and stigma associated with the disease, it is imperative that apps seize the opportunity to offer quality, evidence-based education or point the users to relevant resources. A multistakeholder consensus on a more stringent development and publication process for mental health apps is essential. ",
doi="10.2196/28942",
url="https://www.jmir.org/2022/3/e28942",
url="http://www.ncbi.nlm.nih.gov/pubmed/35262489"
}


@Article{info:doi/10.2196/34918,
author="Schretzlmaier, Patrik
and Hecker, Achim
and Ammenwerth, Elske",
title="Suitability of the Unified Theory of Acceptance and Use of Technology 2 Model for Predicting mHealth Acceptance Using Diabetes as an Example: Qualitative Methods Triangulation Study",
journal="JMIR Hum Factors",
year="2022",
month="Mar",
day="9",
volume="9",
number="1",
pages="e34918",
keywords="mHealth",
keywords="mobile health",
keywords="mobile apps",
keywords="diabetes mellitus",
keywords="technology acceptance",
keywords="UTAUT2",
keywords="mobile phone",
abstract="Background: In recent years, the use of mobile health (mHealth) apps to manage chronic diseases has increased significantly. Although mHealth apps have many benefits, their acceptance is still low in certain areas and groups. Most mHealth acceptance studies are based on technology acceptance models. In particular, the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) model was developed to predict technology acceptance in a consumer context. However, to date, only a few studies have used the UTAUT2 model to predict mHealth acceptance and confirm its suitability for the health sector. Thus, it is unclear whether the UTAUT2 model is suitable for predicting mHealth acceptance and whether essential variables for a health-related context are missing. Objective: This study aims to validate the suitability of UTAUT2 for predicting mHealth acceptance. Methods: In this study, diabetes was used as an example as mHealth apps are a significant element of diabetes self-management. In addition, diabetes is one of the most common chronic diseases affecting young and older people worldwide. An explorative literature review and guided interviews with 11 mHealth or technology acceptance experts and 8 mHealth users in Austria and Germany were triangulated to identify all relevant constructs for predicting mHealth acceptance. The interview participants were recruited by purposive sampling until theoretical saturation was reached. Data were analyzed using structured content analysis based on inductive and deductive approaches. Results: This study was able to confirm the relevance of all exogenous UTAUT2 constructs. However, it revealed two additional constructs that may also need to be considered to better predict mHealth acceptance: trust and perceived disease threat. Conclusions: This study showed that the UTAUT2 model is suitable for predicting mHealth acceptance. However, the model should be extended to include 2 additional constructs for use in the mHealth context. ",
doi="10.2196/34918",
url="https://humanfactors.jmir.org/2022/1/e34918",
url="http://www.ncbi.nlm.nih.gov/pubmed/35262493"
}


@Article{info:doi/10.2196/33038,
author="Neale, Joanne
and Bowen, May Alice",
title="Lessons for Uptake and Engagement of a Smartphone App (SURE Recovery) for People in Recovery From Alcohol and Other Drug Problems: Interview Study of App Users",
journal="JMIR Hum Factors",
year="2022",
month="Mar",
day="8",
volume="9",
number="1",
pages="e33038",
keywords="apps",
keywords="digital literacy",
keywords="mHealth",
keywords="substance use",
keywords="recovery",
keywords="qualitative",
keywords="mobile phone",
abstract="Background: Mobile health apps promoting health and well-being have substantial potential but low uptake and engagement. Barriers common to addiction treatment app uptake and engagement include poor access to mobile technology, Wi-Fi, or mobile data, plus low motivation among non--treatment-seeking users to cut down or quit. Working with people who used substances, we had previously designed and published an app to support recovery from alcohol and other drug problems. The app, which is available for free from the Apple App Store and Google Play, is called SURE Recovery. Objective: The aim of this paper is to undertake a qualitative study to ascertain end users' views and experiences of the SURE Recovery app, including how it might be improved, and present the findings on uptake and engagement to assist other researchers and app developers working on similar apps for people experiencing alcohol and other drug problems. Methods: Semistructured telephone interviews were conducted with 20 people (n=12, 60\%, men and n=8, 40\%, women aged 25-63 years; all identifying as White British) who had varied patterns of using the app. The audio recordings were transcribed, and the data were coded and analyzed through Iterative Categorization. Results: Analyses identified three main factors relevant to uptake (discoverability of the app, personal relevance, and expectations and motivations) and three main factors relevant to engagement (the appeal and relevance of specific features, perceived benefits, and the need for improvements). The findings on uptake and engagement were largely consistent with our own earlier developmental work and with other published literature. However, we additionally found that uptake was strongly affected by first impressions, including trust and personal recommendations; that users were attracted to the app by their need for support and curiosity but had relatively modest expectations; that engagement increased if the app made users feel positive; and that people were unlikely to download, or engage with, the app if they could not relate to, or identify with, aspects of its content. Conclusions: Incorporating end-user views into app design and having a network of supportive partners (ie, credible organizations and individuals who will champion the app) seem to increase uptake and engagement among people experiencing alcohol and other drug problems. Although better digital literacy and access to devices and mobile data are needed if addiction recovery apps are to reach their full potential, we should not evaluate them based only on observable changes in substance use behaviors. How using an app makes a person feel is more transient and difficult to quantify but also relevant to uptake and engagement. ",
doi="10.2196/33038",
url="https://humanfactors.jmir.org/2022/1/e33038",
url="http://www.ncbi.nlm.nih.gov/pubmed/35258474"
}


@Article{info:doi/10.2196/30364,
author="Wilj{\'e}n, Angelica
and Chaplin, Eric John
and Crine, Vanessa
and Jobe, William
and Johnson, Ensa
and Karlsson, Katarina
and Lindroth, Tomas
and Schwarz, Anneli
and Stenmarker, Margaretha
and Thunberg, Gunilla
and {\"O}hl{\'e}n, Joakim
and Nilsson, Stefan",
title="The Development of an mHealth Tool for Children With Long-term Illness to Enable Person-Centered Communication: User-Centered Design Approach",
journal="JMIR Pediatr Parent",
year="2022",
month="Mar",
day="8",
volume="5",
number="1",
pages="e30364",
keywords="children",
keywords="communication",
keywords="long-term illness",
keywords="mHealth",
keywords="pediatric care",
keywords="person-centered care",
keywords="symptom assessment",
keywords="universal design",
abstract="Background: Children with long-term illnesses frequently experience symptoms that could negatively affect their daily lives. These symptoms are often underreported in health care. Despite a large number of mobile health (mHealth) tools, few are based on a theoretical framework or supported by scientific knowledge. Incorporating universal design when developing a product can promote accessibility and facilitate person-centered communication. Objective: The aim of this study is to identify the symptom-reporting needs of children with cancer and congenital heart defects that could be satisfied by using a mobile app. Another aim is to evaluate how the child might interact with the app by considering universal design principles and to identify parents' views and health care professionals' expectations and requirements for an mHealth tool. Methods: User-centered design is an iterative process that focuses on an understanding of the users. The adapted user-centered design process includes 2 phases with 4 stages. Phase 1 involved interviews with 7 children with long-term illnesses, 8 parents, and 19 health care professionals to determine their needs and wishes for support; a workshop with 19 researchers to deepen our understanding of the needs; and a workshop with developers to establish a preliminary tool to further investigate needs and behaviors. Phase 2 involved interviews with 10 children with long-term illnesses, 9 parents, and 21 health care professionals to evaluate the mock-up (prototype) of the mHealth tool. Data were synthesized using the interpretive description technique. Results: A total of 4 aspects of needs emerged from the synthesis of the data, as follows: different perspectives on provided and perceived support; the need for an easy-to-use, non--clinic-based tool to self-report symptoms and to facilitate communication; the need for safety by being in control and reaching the child's voice; and a way of mapping the illness journey to facilitate recall and improve diagnostics. The children with long-term illnesses expressed a need to not only communicate about pain but also communicate about anxiety, fatigue, fear, and nausea. Conclusions: The findings of this study indicated that the PicPecc (Pictorial Support in Person-Centered Care for Children) app is a potential solution for providing communicative support to children with long-term illnesses dealing with multiple symptoms and conditions. The interview data also highlighted symptoms that are at risk of being overlooked if they are not included in the mobile app. Further studies are needed to include usability testing and evaluation in hospitals and home care settings. ",
doi="10.2196/30364",
url="https://pediatrics.jmir.org/2022/1/e30364",
url="http://www.ncbi.nlm.nih.gov/pubmed/35258466"
}


@Article{info:doi/10.2196/34452,
author="Chen, Jinying
and Wijesundara, G. Jessica
and Enyim, E. Gabrielle
and Lombardini, M. Lisa
and Gerber, S. Ben
and Houston, K. Thomas
and Sadasivam, S. Rajani",
title="Understanding Patients' Intention to Use Digital Health Apps That Support Postdischarge Symptom Monitoring by Providers Among Patients With Acute Coronary Syndrome: Survey Study",
journal="JMIR Hum Factors",
year="2022",
month="Mar",
day="7",
volume="9",
number="1",
pages="e34452",
keywords="coronary",
keywords="monitor",
keywords="elder",
keywords="health app",
keywords="symptom",
keywords="eHealth",
keywords="mobile health",
keywords="intention",
keywords="barrier",
keywords="facilitator",
abstract="Background: After hospital discharge, patients with acute coronary syndrome (ACS) often experience symptoms that prompt them to seek acute medical attention. Early evaluation of postdischarge symptoms by health care providers may reduce unnecessary acute care utilization. However, hospital-initiated follow-up encounters are insufficient for timely detection and assessment of symptoms. While digital health tools can help address this issue, little is known about the intention to use such tools in ACS patients. Objective: This study aimed to assess ACS patients' intention to use digital health apps that support postdischarge symptom monitoring by health care providers and identify patient-perceived facilitators and barriers to app use. Methods: Using email invitations or phone calls, we recruited ACS patients discharged from a central Massachusetts health care system between December 2020 and April 2021, to participate in the study. Surveys were delivered online or via phone to individual participants. Demographics and access to technology were assessed. The intention to use a symptom monitoring app was assessed using 5-point Likert-type (from strongly agree to strongly disagree) items, such as ``If this app were available to me, I would use it.'' Responses were compared across demographic subgroups and survey delivery methods. Two open-ended questions assessed perceived facilitators and barriers to app use, with responses analyzed using qualitative content analysis. Results: Among 100 respondents (response rate 8.1\%), 45 (45\%) completed the survey by phone. The respondents were on average 68 years old (SD 13 years), with 90\% (90/100) White, 39\% (39/100) women, and 88\% (88/100) having access to the internet or a mobile phone. Most participants (65/100, 65\%) agreed or strongly agreed that they would use the app, among which 53 (82\%) would use the app as often as possible. The percentage of participants with the intention to use the app was 75\% among those aged 65-74 years and dropped to 44\% among those older than 75 years. The intention to use was higher in online survey respondents (vs phone survey respondents; odds ratio 3.07, 95\% CI 1.20-7.88) after adjusting for age and access to technology. The analysis of open-ended questions identified the following 4 main facilitators (motivations): (1) easily reaching providers, (2) accessing or providing information, (3) quickly reaching providers, and (4) consulting providers for symptoms, and the following 4 main barriers: (1) privacy/security concerns, (2) uncomfortable using technology, (3) user-unfriendly app interface, and (4) preference for in-person/phone care. Conclusions: There was a strong intention to use a symptom monitoring app postdischarge among ACS patients. However, this intent decreased in patients older than 75 years. The survey identified barriers related to technology use, privacy/security, and the care delivery mode. Further research is warranted to determine if such intent translates into app use, and better symptom management and health care quality. ",
doi="10.2196/34452",
url="https://humanfactors.jmir.org/2022/1/e34452",
url="http://www.ncbi.nlm.nih.gov/pubmed/35254269"
}


@Article{info:doi/10.2196/31016,
author="Romero-Jimenez, Rosa
and Escudero-Vilaplana, Vicente
and Chamorro-De-Vega, Esther
and Ais-Larisgoitia, Arantza
and Lobato Matilla, Elena Maria
and Herranz-Alonso, Ana
and Sanjurjo, Maria",
title="The Characteristics and Functionalities of Mobile Apps Aimed at Patients Diagnosed With Immune-Mediated Inflammatory Diseases: Systematic App Search",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="4",
volume="24",
number="3",
pages="e31016",
keywords="immune-mediated inflammatory disease",
keywords="mobile app",
keywords="mHealth",
keywords="mobile health",
keywords="chronic disease",
keywords="disease management",
keywords="outcomes",
keywords="functionality",
keywords="quality",
keywords="patient education",
keywords="health outcomes",
keywords="reliability",
abstract="Background: Immune-mediated inflammatory diseases (IMIDs) are systemic conditions associated with a high social and health impact. New treatments have changed the prognosis of IMIDs and have increased patient autonomy in disease management. Mobile apps have enormous potential to improve health outcomes in patients with IMIDs. Although a large number of IMID apps are available, the app market is not regulated, and functionality and reliability remain uncertain. Objective: Our aims are to review available apps for patients with IMIDs or caregivers and to describe the main characteristics and functionalities of these apps. Methods: We performed an observational, cross-sectional, descriptive study of all apps for patients with IMIDs. Between April 5 and 14, 2021, we conducted a search of the App Store (iOS) and Play Store (Android) platforms. We used the names of the different IMIDs as search terms. The inclusion criteria were as follows: content related to IMIDs, English or Spanish language, and user population consisting of patients and health care consumers, including family and caregivers. The variables analyzed were as follows: app name, type of IMID, platform (Android or iOS), country of origin, language, category of the app, cost, date of the last update, size, downloads, author affiliation, and functionalities. Results: We identified 713 apps in the initial search, and 243 apps met the criteria and were analyzed. Of these, 37\% (n=90) were on Android, 27.2\% (n=66) on iOS, and 35.8\% (n=87) on both platforms. The most frequent categories were health and well-being/fitness apps (n=188, 48.5\%) and medicine (n=82, 37.9\%). A total of 211 (82.3\%) apps were free. The mean time between the date of the analysis and the date of the most recent update was 18.5 (SD 19.3) months. Health care professionals were involved in the development of 100 (41.1\%) apps. We found differences between Android and iOS in the mean time since the last update (16.2, SD 14.7 months vs 30.3, SD 25.7 months) and free apps (85.6\% vs 75.8\%; respectively). The functionalities were as follows: general information about lifestyles, nutrition, or exercises (n=135, 55.6\%); specific information about the disease or treatment (n=102, 42\%); recording of symptoms or adverse events (n=51, 21\%); agenda/calendar (n=44, 18.1\%); reminder medication (n=41, 16.9\%); and recording of patient-reported outcomes (n=41, 16.9\%). A total of 147 (60.5\%) apps had more than one functionality. Conclusions: IMID-related apps are heterogeneous in terms of functionality and reliability. Apps may be a useful complement to IMID care, especially inpatient education (their most frequent functionality). However, more than half of the IMID apps had not been developed by health care professionals or updated in the last year. ",
doi="10.2196/31016",
url="https://www.jmir.org/2022/3/e31016",
url="http://www.ncbi.nlm.nih.gov/pubmed/35254286"
}


@Article{info:doi/10.2196/21959,
author="Zhang, Peng
and Fonnesbeck, Christopher
and Schmidt, C. Douglas
and White, Jules
and Kleinberg, Samantha
and Mulvaney, A. Shelagh",
title="Using Momentary Assessment and Machine Learning to Identify Barriers to Self-management in Type 1 Diabetes: Observational Study",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Mar",
day="3",
volume="10",
number="3",
pages="e21959",
keywords="machine learning",
keywords="type 1 diabetes",
keywords="psychosocial",
keywords="self-management",
keywords="adolescents",
keywords="behavioral medicine",
keywords="ecological momentary assessment",
keywords="informatics",
keywords="mobile phone",
abstract="Background: For adolescents living with type 1 diabetes (T1D), completion of multiple daily self-management tasks, such as monitoring blood glucose and administering insulin, can be challenging because of psychosocial and contextual barriers. These barriers are hard to assess accurately and specifically by using traditional retrospective recall. Ecological momentary assessment (EMA) uses mobile technologies to assess the contexts, subjective experiences, and psychosocial processes that surround self-management decision-making in daily life. However, the rich data generated via EMA have not been frequently examined in T1D or integrated with machine learning analytic approaches. Objective: The goal of this study is to develop a machine learning algorithm to predict the risk of missed self-management in young adults with T1D. To achieve this goal, we train and compare a number of machine learning models through a learned filtering architecture to explore the extent to which EMA data were associated with the completion of two self-management behaviors: mealtime self-monitoring of blood glucose (SMBG) and insulin administration. Methods: We analyzed data from a randomized controlled pilot study using machine learning--based filtering architecture to investigate whether novel information related to contextual, psychosocial, and time-related factors (ie, time of day) relate to self-management. We combined EMA-collected contextual and insulin variables via the MyDay mobile app with Bluetooth blood glucose data to construct machine learning classifiers that predicted the 2 self-management behaviors of interest. Results: With 1231 day-level SMBG frequency counts for 45 participants, demographic variables and time-related variables were able to predict whether daily SMBG was below the clinical threshold of 4 times a day. Using the 1869 data points derived from app-based EMA data of 31 participants, our learned filtering architecture method was able to infer nonadherence events with high accuracy and precision. Although the recall score is low, there is high confidence that the nonadherence events identified by the model are truly nonadherent. Conclusions: Combining EMA data with machine learning methods showed promise in the relationship with risk for nonadherence. The next steps include collecting larger data sets that would more effectively power a classifier that can be deployed to infer individual behavior. Improvements in individual self-management insights, behavioral risk predictions, enhanced clinical decision-making, and just-in-time patient support in diabetes could result from this type of approach. ",
doi="10.2196/21959",
url="https://mhealth.jmir.org/2022/3/e21959",
url="http://www.ncbi.nlm.nih.gov/pubmed/35238791"
}


@Article{info:doi/10.2196/29415,
author="Cao, Weidan
and Milks, Wesley M.
and Liu, Xiaofu
and Gregory, E. Megan
and Addison, Daniel
and Zhang, Ping
and Li, Lang",
title="mHealth Interventions for Self-management of Hypertension: Framework and Systematic Review on Engagement, Interactivity, and Tailoring",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Mar",
day="2",
volume="10",
number="3",
pages="e29415",
keywords="mHealth",
keywords="mobile app",
keywords="digital behavior change",
keywords="interventions",
keywords="systematic review",
keywords="hypertension",
keywords="engagement",
keywords="interactivity",
keywords="tailoring",
keywords="mobile phone",
abstract="Background: Engagement is essential for the effectiveness of digital behavior change interventions. Existing systematic reviews examining hypertension self-management interventions via mobile apps have primarily focused on intervention efficacy and app usability. Engagement in the prevention or management of hypertension is largely unknown. Objective: This systematic review explores the definition and role of engagement in hypertension-focused mobile health (mHealth) interventions, as well as how determinants of engagement (ie, tailoring and interactivity) have been implemented. Methods: A systematic review of mobile app interventions for hypertension self-management targeting adults, published from 2013 to 2020, was conducted. A total of 21 studies were included in this systematic review. Results: The engagement was defined or operationalized as a microlevel concept, operationalized as interaction with the interventions (ie, frequency of engagement, time or duration of engagement with the program, and intensity of engagement). For all 3 studies that tested the relationship, increased engagement was associated with better biomedical outcomes (eg, blood pressure change). Interactivity was limited in digital behavior change interventions, as only 7 studies provided 2-way communication between users and a health care professional, and 9 studies provided 1-way communication in possible critical conditions; that is, when abnormal blood pressure values were recorded, users or health care professionals were notified. The tailoring of interventions varied at different aspects, from the tailoring of intervention content (including goals, patient education, advice and feedback from health professionals, reminders, and motivational messages) to the tailoring of intervention dose and communication mode. Tailoring was carried out in a number of ways, considering patient characteristics such as goals, preferences, disease characteristics (eg, hypertension stage and medication list), disease self-management experience levels, medication adherence rate, and values and beliefs. Conclusions: Available studies support the importance of engagement in intervention effectiveness as well as the essential roles of patient factors in tailoring, interactivity, and engagement. A patient-centered engagement framework for hypertension self-management using mHealth technology is proposed here, with the intent of facilitating intervention design and disease self-management using mHealth technology. ",
doi="10.2196/29415",
url="https://mhealth.jmir.org/2022/3/e29415",
url="http://www.ncbi.nlm.nih.gov/pubmed/35234655"
}


@Article{info:doi/10.2196/30797,
author="Germini, Federico
and Borg Debono, Victoria
and Page, David
and Zuk, Victoria
and Kucher, Alexandra
and Cotoi, Chris
and Hobson, Nicholas
and Sevestre, Michael
and Skinner, W. Mark
and Iorio, Alfonso
and ",
title="User-Centered Development and Testing of the Online Patient-Reported Outcomes, Burdens, and Experiences (PROBE) Survey and the myPROBE App and Integration With the Canadian Bleeding Disorder Registry: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2022",
month="Mar",
day="2",
volume="9",
number="1",
pages="e30797",
keywords="health-related quality of life",
keywords="EQ-5D",
keywords="mobile app",
keywords="Patient-Reported Outcomes, Burdens, and Experiences (PROBE)",
keywords="hemophilia",
keywords="mobile health",
keywords="mHealth",
keywords="eHealth",
keywords="telehealth",
keywords="user-centered design",
abstract="Background: The Patient-Reported Outcomes, Burdens, and Experiences (PROBE) questionnaire is a tool for assessing the quality of life and disease burden in people living with hemophilia. Objective: The objectives of our study were (1) to assess the needs of relevant stakeholders involved in the use of PROBE, (2) to develop the software infrastructure needed to meet these needs, and (3) to test the usability of the final product. Methods: We conducted a series of semistructured interviews of relevant stakeholders, including PROBE investigators, people with hemophilia, and representatives of the sponsor. Based on these, we developed an online survey and a mobile app for iOS and Android. A user group evaluated the final product using the System Usability Scale (SUS) and an open feedback framework. Results: The online survey was updated, and the myPROBE app for mobile devices and a new application programming interface were developed. The app was tested and modified according to user feedback over multiple cycles. The final version of the app was released in July 2019. Seventeen users aged 23 to 67 years evaluated the final version of the app using the SUS. The median (first, third quartile) SUS score for the app was 85 (68, 88) out of 100. The newly introduced functionalities were as follows: (1) capability to longitudinally track repeated fillings of the questionnaire at different time points by the same participant (as opposed to anonymous completion); (2) linking of the questionnaire with hemophilia registries, starting with the Canadian Bleeding Disorders Registry as a proof of concept; (3) removing or adding questions as needed; and (4) sending notifications to the users (eg, reminders). A new secure database was built for securely storing personal information separately from the questionnaire data. The PROBE online survey is currently available in 96 countries and 34 languages. Conclusions: The online survey was updated successfully, and the myPROBE app was developed, with a SUS score of 85 (out of 100). The app has been released in 81 countries and 34 languages. This will facilitate data collection for research and advocacy purposes, and the use of this tool in everyday clinical practice. ",
doi="10.2196/30797",
url="https://humanfactors.jmir.org/2022/1/e30797",
url="http://www.ncbi.nlm.nih.gov/pubmed/35234648"
}


@Article{info:doi/10.2196/28697,
author="Kela, Neta
and Eytam, Eleanor
and Katz, Adi",
title="Supporting Management of Noncommunicable Diseases With Mobile Health (mHealth) Apps: Experimental Study",
journal="JMIR Hum Factors",
year="2022",
month="Mar",
day="2",
volume="9",
number="1",
pages="e28697",
keywords="mHealth",
keywords="digital health",
keywords="instrumentality",
keywords="aesthetics",
keywords="symbolic value",
keywords="preference",
abstract="Background: Noncommunicable diseases (NCDs) are the leading global health problem in this century and are the principal causes of death and health care spending worldwide. Mobile health (mHealth) apps can help manage and prevent NCDs if people are willing to use them as supportive tools. Still, many people are reluctant to adopt these technologies. Implementing new apps could result in earlier intervention for many health conditions, preventing more serious complications. Objective: This research project aimed to test the factors that facilitate the adoption of mHealth apps by users with NCDs. We focused on determining, first, what user interface (UI) qualities and complexity levels appeal to users in evaluating mHealth apps. We also wanted to determine whether people prefer that the data collected by an mHealth app be analyzed using a physician or an artificial intelligence (AI) algorithm. The contribution of this work is both theoretical and practical. We examined users' considerations when adopting mHealth apps that promote healthy lifestyles and helped them manage their NCDs. Our results can also help direct mHealth app UI designers to focus on the most appealing aspects of our findings. Methods: A total of 347 respondents volunteered to rate 3 models of mHealth apps based on 16 items that measured instrumentality, aesthetics, and symbolism. Respondents rated each model after reading 1 of 2 different scenarios. In one scenario, a physician analyzed the data, whereas, in the other, the data were analyzed by an AI algorithm. These scenarios tested the degree of trust people placed in AI algorithms versus the ``human touch'' of a human physician regarding analyzing data collected by an mHealth app. Results: As shown by the responses, the involvement of a human physician in the application had a significant effect (P<.001) on the perceived instrumentality of the simple model. The complex model with more controls was rated significantly more aesthetic when associated with a physician performing data analysis rather than an AI algorithm (P=.03). Conclusions: Generally, when participants found a human touch in the mHealth app (connection to a human physician who they assumed would analyze their data), they judged the app more favorably. Simple models were evaluated more positively than complex ones, and aesthetics and symbolism were salient predictors of preference. These trends suggest that designers and developers of mHealth apps should keep the designs simple and pay special attention to aesthetics and symbolic value. ",
doi="10.2196/28697",
url="https://humanfactors.jmir.org/2022/1/e28697",
url="http://www.ncbi.nlm.nih.gov/pubmed/35234653"
}


@Article{info:doi/10.2196/30052,
author="Kerckhove, Nicolas
and Delage, No{\'e}mie
and Cambier, S{\'e}bastien
and Cantagrel, Nathalie
and Serra, Eric
and Marcaillou, Fabienne
and Maindet, Caroline
and Picard, Pascale
and Martin{\'e}, Gaelle
and Deleens, Rodrigue
and Trouvin, Anne-Priscille
and Fourel, Lauriane
and Espagne-Dubreuilh, Gaelle
and Douay, Ludovic
and Foulon, St{\'e}phane
and Dufraisse, B{\'e}n{\'e}dicte
and Gov, Christian
and Viel, Eric
and Jedryka, Fran{\c{c}}ois
and Pouplin, Sophie
and Lestrade, C{\'e}cile
and Combe, Emmanuel
and Perrot, Serge
and Perocheau, Dominique
and De Brisson, Valentine
and Vergne-Salle, Pascale
and Mertens, Patrick
and Pereira, Bruno
and Djiberou Mahamadou, Jalil Abdoul
and Antoine, Violaine
and Corteval, Alice
and Eschalier, Alain
and Dual{\'e}, Christian
and Attal, Nadine
and Authier, Nicolas",
title="eDOL mHealth App and Web Platform for Self-monitoring and Medical Follow-up of Patients With Chronic Pain: Observational Feasibility Study",
journal="JMIR Form Res",
year="2022",
month="Mar",
day="2",
volume="6",
number="3",
pages="e30052",
keywords="mHealth",
keywords="chronic pain",
keywords="feasibility study",
keywords="eHealth",
keywords="self-monitoring",
abstract="Background: Chronic pain affects approximately 30\% of the general population, severely degrades quality of life (especially in older adults) and professional life (inability or reduction in the ability to work and loss of employment), and leads to billions in additional health care costs. Moreover, available painkillers are old, with limited efficacy and can cause significant adverse effects. Thus, there is a need for innovation in the management of chronic pain. Better characterization of patients could help to identify the predictors of successful treatments, and thus, guide physicians in the initial choice of treatment and in the follow-up of their patients. Nevertheless, current assessments of patients with chronic pain provide only fragmentary data on painful daily experiences. Real-life monitoring of subjective and objective markers of chronic pain using mobile health (mHealth) programs can address this issue. Objective: We hypothesized that regular patient self-monitoring using an mHealth app would lead physicians to obtain deeper understanding and new insight into patients with chronic pain and that, for patients, regular self-monitoring using an mHealth app would play a positive therapeutic role and improve adherence to treatment. We aimed to evaluate the feasibility and acceptability of a new mHealth app called eDOL. Methods: We conducted an observational study to assess the feasibility and acceptability of the eDOL tool. Patients completed several questionnaires using the tool over a period of 2 weeks and repeated assessments weekly over a period of 3 months. Physicians saw their patients at a follow-up visit that took place at least 3 months after the inclusion visit. A composite criterion of the acceptability and feasibility of the eDOL tool was calculated after the completion of study using satisfaction surveys from both patients and physicians. Results: Data from 105 patients (of 133 who were included) were analyzed. The rate of adherence was 61.9\% (65/105) after 3 months. The median acceptability score was 7 (out of 10) for both patients and physicians. There was a high rate of completion of the baseline questionnaires and assessments (mean 89.3\%), and a low rate of completion of the follow-up questionnaires and assessments (63.8\% (67/105) and 61.9\% (65/105) respectively). We were also able to characterize subgroups of patients and determine a profile of those who adhered to eDOL. We obtained 4 clusters that differ from each other in their biopsychosocial characteristics. Cluster 4 corresponds to patients with more disabling chronic pain (daily impact and comorbidities) and vice versa for cluster 1. Conclusions: This work demonstrates that eDOL is highly feasible and acceptable for both patients with chronic pain and their physicians. It also shows that such a tool can integrate many parameters to ensure the detailed characterization of patients for future research works and pain management. Trial Registration: ClinicalTrial.gov NCT03931694; http://clinicaltrials.gov/ct2/show/NCT03931694 ",
doi="10.2196/30052",
url="https://formative.jmir.org/2022/3/e30052",
url="http://www.ncbi.nlm.nih.gov/pubmed/35234654"
}


@Article{info:doi/10.2196/32554,
author="Indraratna, Praveen
and Biswas, Uzzal
and McVeigh, James
and Mamo, Andrew
and Magdy, Joseph
and Vickers, Dominic
and Watkins, Elaine
and Ziegl, Andreas
and Liu, Hueiming
and Cholerton, Nicholas
and Li, Joan
and Holgate, Katie
and Fildes, Jennifer
and Gallagher, Robyn
and Ferry, Cate
and Jan, Stephen
and Briggs, Nancy
and Schreier, Guenter
and Redmond, J. Stephen
and Loh, Eugene
and Yu, Jennifer
and Lovell, H. Nigel
and Ooi, Sze-Yuan",
title="A Smartphone-Based Model of Care to Support Patients With Cardiac Disease Transitioning From Hospital to the Community (TeleClinical Care): Pilot Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Feb",
day="28",
volume="10",
number="2",
pages="e32554",
keywords="digital health",
keywords="telemedicine",
keywords="mHealth",
keywords="heart failure",
keywords="ischemic heart disease",
keywords="mobile phone",
abstract="Background: Patients hospitalized with acute coronary syndrome (ACS) or heart failure (HF) are frequently readmitted. This is the first randomized controlled trial of a mobile health intervention that combines telemonitoring and education for inpatients with ACS or HF to prevent readmission. Objective: This study aims to investigate the feasibility, efficacy, and cost-effectiveness of a smartphone app--based model of care (TeleClinical Care [TCC]) in patients discharged after ACS or HF admission. Methods: In this pilot, 2-center randomized controlled trial, TCC was applied at discharge along with usual care to intervention arm participants. Control arm participants received usual care alone. Inclusion criteria were current admission with ACS or HF, ownership of a compatible smartphone, age ?18 years, and provision of informed consent. The primary end point was the incidence of unplanned 30-day readmissions. Secondary end points included all-cause readmissions, cardiac readmissions, cardiac rehabilitation completion, medication adherence, cost-effectiveness, and user satisfaction. Intervention arm participants received the app and Bluetooth-enabled devices for measuring weight, blood pressure, and physical activity daily plus usual care. The devices automatically transmitted recordings to the patients' smartphones and a central server. Thresholds for blood pressure, heart rate, and weight were determined by the treating cardiologists. Readings outside these thresholds were flagged to a monitoring team, who discussed salient abnormalities with the patients' usual care providers (cardiologists, general practitioners, or HF outreach nurses), who were responsible for further management. The app also provided educational push notifications. Participants were followed up after 6 months. Results: Overall, 164 inpatients were randomized (TCC: 81/164, 49.4\%; control: 83/164, 50.6\%; mean age 61.5, SD 12.3 years; 130/164, 79.3\% men; 128/164, 78\% admitted with ACS). There were 11 unplanned 30-day readmissions in both groups (P=.97). Over a mean follow-up of 193 days, the intervention was associated with a significant reduction in unplanned hospital readmissions (21 in TCC vs 41 in the control arm; P=.02), including cardiac readmissions (11 in TCC vs 25 in the control arm; P=.03), and higher rates of cardiac rehabilitation completion (20/51, 39\% vs 9/49, 18\%; P=.03) and medication adherence (57/76, 75\% vs 37/74, 50\%; P=.002). The average usability rating for the app was 4.5/5. The intervention cost Aus \$6028 (US \$4342.26) per cardiac readmission saved. When modeled in a mainstream clinical setting, enrollment of 237 patients was projected to have the same expenditure compared with usual care, and enrollment of 500 patients was projected to save approximately Aus \$100,000 (approximately US \$70,000) annually. Conclusions: TCC was feasible and safe for inpatients with either ACS or HF. The incidence of 30-day readmissions was similar; however, long-term benefits were demonstrated, including fewer readmissions over 6 months, improved medication adherence, and improved cardiac rehabilitation completion. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618001547235; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375945 ",
doi="10.2196/32554",
url="https://mhealth.jmir.org/2022/2/e32554",
url="http://www.ncbi.nlm.nih.gov/pubmed/35225819"
}


@Article{info:doi/10.2196/24916,
author="McGillion, H. Michael
and Dvirnik, Nazari
and Yang, Stephen
and Belley-C{\^o}t{\'e}, Emilie
and Lamy, Andre
and Whitlock, Richard
and Marcucci, Maura
and Borges, K. Flavia
and Duceppe, Emmanuelle
and Ouellette, Carley
and Bird, Marissa
and Carroll, L. Sandra
and Conen, David
and Tarride, Jean-Eric
and Harsha, Prathiba
and Scott, Ted
and Good, Amber
and Gregus, Krysten
and Sanchez, Karla
and Benoit, Pamela
and Owen, Julian
and Harvey, Valerie
and Peter, Elizabeth
and Petch, Jeremy
and Vincent, Jessica
and Graham, Michelle
and Devereaux, J. P.",
title="Continuous Noninvasive Remote Automated Blood Pressure Monitoring With Novel Wearable Technology: A Preliminary Validation Study",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Feb",
day="28",
volume="10",
number="2",
pages="e24916",
keywords="validation study",
keywords="continuous vital signs monitor",
keywords="continuous non-invasive blood pressure monitoring",
keywords="wearable",
keywords="blood pressure",
keywords="monitoring",
keywords="validation",
keywords="mHealth",
keywords="vital sign",
keywords="biosensor",
keywords="accuracy",
keywords="usability",
abstract="Background: Wearable continuous monitoring biosensor technologies have the potential to transform postoperative care with early detection of impending clinical deterioration. Objective: Our aim was to validate the accuracy of Cloud DX Vitaliti continuous vital signs monitor (CVSM) continuous noninvasive blood pressure (cNIBP) measurements in postsurgical patients. A secondary aim was to examine user acceptance of the Vitaliti CVSM with respect to comfort, ease of application, sustainability of positioning, and aesthetics. Methods: Included participants were ?18 years old and recovering from surgery in a cardiac intensive care unit (ICU). We targeted a maximum recruitment of 80 participants for verification and acceptance testing. We also oversampled to minimize the effect of unforeseen interruptions and other challenges to the study. Validation procedures were according to the International Standards Organization (ISO) 81060-2:2018 standards for wearable, cuffless blood pressure (BP) measuring devices. Baseline BP was determined from the gold-standard ICU arterial catheter. The Vitaliti CVSM was calibrated against the reference arterial catheter. In static (seated in bed) and supine positions, 3 cNIBP measurements, each 30 seconds, were taken for each patient with the Vitaliti CVSM and an invasive arterial catheter. At the conclusion of each test session, captured cNIBP measurements were extracted using MediCollector BEDSIDE data extraction software, and Vitaliti CVSM measurements were extracted to a secure laptop through a cable connection. The errors of these determinations were calculated. Participants were interviewed about device acceptability. Results: The validation analysis included data for 20 patients. The average times from calibration to first measurement in the static position and to first measurement in the supine position were 133.85 seconds (2 minutes 14 seconds) and 535.15 seconds (8 minutes 55 seconds), respectively. The overall mean errors of determination for the static position were --0.621 (SD 4.640) mm Hg for systolic blood pressure (SBP) and 0.457 (SD 1.675) mm Hg for diastolic blood pressure (DBP). Errors of determination were slightly higher for the supine position, at 2.722 (SD 5.207) mm Hg for SBP and 2.650 (SD 3.221) mm Hg for DBP. The majority rated the Vitaliti CVSM as comfortable. This study was limited to evaluation of the device during a very short validation period after calibration (ie, that commenced within 2 minutes after calibration and lasted for a short duration of time). Conclusions: We found that the Cloud DX's Vitaliti CVSM demonstrated cNIBP measurement in compliance with ISO 81060-2:2018 standards in the context of evaluation that commenced within 2 minutes of device calibration; this device was also well-received by patients in a postsurgical ICU setting. Future studies will examine the accuracy of the Vitaliti CVSM in ambulatory contexts, with attention to assessment over a longer duration and the impact of excessive patient motion on data artifacts and signal quality. Trial Registration: ClinicalTrials.gov NCT03493867; https://clinicaltrials.gov/ct2/show/NCT03493867 ",
doi="10.2196/24916",
url="https://mhealth.jmir.org/2022/2/e24916",
url="http://www.ncbi.nlm.nih.gov/pubmed/34876396"
}


@Article{info:doi/10.2196/33636,
author="Gram, Torhild Inger
and Skeie, Guri
and Oyeyemi, Oluwafemi Sunday
and Borch, Benjaminsen Kristin
and Hopstock, Arnesdatter Laila
and L{\o}chen, Maja-Lisa",
title="A Smartphone-Based Information Communication Technology Solution for Primary Modifiable Risk Factors for Noncommunicable Diseases: Pilot and Feasibility Study in Norway",
journal="JMIR Form Res",
year="2022",
month="Feb",
day="25",
volume="6",
number="2",
pages="e33636",
keywords="eHealth",
keywords="feasibility study",
keywords="modifiable risk factor",
keywords="noncommunicable disease",
keywords="pilot study",
keywords="smartphone-based information communication technology solution",
keywords="short text message service",
keywords="feasibility",
keywords="risk",
keywords="factor",
keywords="information communication technology",
keywords="smartphone",
keywords="development",
keywords="monitoring",
abstract="Background: Cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes are the 4 main noncommunicable diseases. These noncommunicable diseases share 4 modifiable risk factors (tobacco use, harmful use of alcohol, physical inactivity, and unhealthy diet). Short smartphone surveys have the potential to identify modifiable risk factors for individuals to monitor trends. Objective: We aimed to pilot a smartphone-based information communication technology solution to collect nationally representative data, annually, on 4 modifiable risk factors. Methods: We developed an information communication technology solution with functionalities for capturing sensitive data from smartphones, receiving, and handling data in accordance with general data protection regulations. The main survey comprised 26 questions: 8 on socioeconomic factors, 17 on the 4 risk factors, and 1 about current or previous noncommunicable diseases. For answers to the continuous questions, a keyboard was displayed for entering numbers; there were preset upper and lower limits for acceptable response values. For categorical questions, pull-down menus with response options were displayed. The second survey comprised 9 yes-or-no questions. For both surveys, we used SMS text messaging. For the main survey, we invited 11,000 individuals, aged 16 to 69 years, selected randomly from the Norwegian National Population Registry (1000 from each of the 11 counties). For the second survey, we invited a random sample of 100 individuals from each county who had not responded to the main survey. All data, except county of residence, were self-reported. We calculated the distribution for socioeconomic background, tobacco use, diet, physical activity, and health condition factors overall and by sex. Results: The response rate was 21.9\% (2303/11,000; women: 1397/2263; 61.7\%, men: 866/2263, 38.3\%; missing: 40/2303, 1.7\%). The median age for men was 52 years (IQR 40-61); the median age for women was 48 years (IQR 35-58). The main reported reason for nonparticipation in the main survey was that the sender of the initial SMS was unknown. Conclusions: We successfully developed and piloted a smartphone-based information communication technology solution for collecting data on the 4 modifiable risk factors for the 4 main noncommunicable diseases. Approximately 1 in 5 invitees responded; thus, these data may not be nationally representative. The smartphone-based information communication technology solution should be further developed with the long-term goal to reduce premature mortality from the 4 main noncommunicable diseases. ",
doi="10.2196/33636",
url="https://formative.jmir.org/2022/2/e33636",
url="http://www.ncbi.nlm.nih.gov/pubmed/35212636"
}


@Article{info:doi/10.2196/34059,
author="Kim, Jin Hee
and Lee, Hyun Kang
and Lee, Hun Jung
and Youk, Hyun
and Lee, Young Hee",
title="The Effect of a Mobile and Wearable Device Intervention on Increased Physical Activity to Prevent Metabolic Syndrome: Observational Study",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Feb",
day="24",
volume="10",
number="2",
pages="e34059",
keywords="mHealth",
keywords="physical activity",
keywords="wearable device",
keywords="metabolic syndrome",
keywords="health care",
keywords="exercise",
keywords="intervention",
keywords="Asia",
keywords="Korea",
keywords="rural",
abstract="Background: Research on whether wearable devices and app-based interventions can effectively prevent metabolic syndrome (MetS) by increasing physical activity (PA) among middle-aged people living in the rural areas of South Korea remains insufficient. Objective: The aim of this study was to determine whether mobile and wearable device interventions can improve health indicators, including PA, in MetS risk groups in rural South Korea. Methods: In this clinical trial, performed from December 2019 to June 2020, participants were asked to use a wearable device (GalaxyWatch Active1) alone (standard intervention) or the wearable device and mobile app (Yonsei Health Korea) (enhanced intervention). Clinical measures and International Physical Activity Questionnaire (IPAQ) scores were evaluated initially and after 6 months. The number of steps was monitored through the website. The primary outcome was the difference in PA and clinical measures between the enhanced intervention and standard intervention groups. The secondary outcome was the decrease in MetS factors related to the change in PA. Results: A total of 267 participants were randomly selected, 221 of whom completed the 6-month study. Among the 221 participants, 113 were allocated to the enhanced intervention group and 108 were allocated to the standard intervention group. After 6 months, the body weight and BMI for the enhanced intervention group decreased by 0.6 (SD 1.87) and 0.21 (SD 0.76), respectively (P<.001). In both groups, systolic blood pressure, diastolic blood pressure, waist circumference, and glycated hemoglobin A1c (HbA1c) decreased (P<.001). The total PA was approximately 2.8 times lower in the standard intervention group (mean 44.47, SD 224.85) than in the enhanced intervention group (mean 124.36, SD 570.0). Moreover, the enhanced intervention group achieved the recommended level of moderate to vigorous physical activity (MVPA), whereas the standard intervention group did not (188 minutes/week vs 118 minutes/week). Additionally, the number of participants in the enhanced intervention group (n=113) that reached 10,000 daily steps or more after the intervention increased from 9 (8.0\%) to 26 (23.1\%) (P=.002), whereas this number did not increase significantly in the standard intervention group (n=108), from 8 (7.4\%) to 16 (14.8\%) (P=.72). The number of participants without any MetS factors increased by 12 (11\%) and 8 (7\%) in the enhanced and standard intervention group, respectively. Conclusions: PA monitoring and an intervention using wearable devices were effective in preventing MetS in a rural population in Korea. Blood pressure, waist circumference, and HbA1c were improved in both intervention groups, which were effective in reducing MetS factors. However, only the participants in the enhanced intervention group continuously increased their MVPA and step counts above the recommended level to prevent MetS. Body weight and BMI were further improved, and a higher number of participants with zero MetS factors was attained from the enhanced intervention. Trial Registration: Clinical Research Information Service KCT0005783; https://cris.nih.go.kr/cris/search/detailSearch.do/16123 ",
doi="10.2196/34059",
url="https://mhealth.jmir.org/2022/2/e34059",
url="http://www.ncbi.nlm.nih.gov/pubmed/35200145"
}


@Article{info:doi/10.2196/30671,
author="Tran, Steven
and Smith, Lorraine
and El-Den, Sarira
and Carter, Stephen",
title="The Use of Gamification and Incentives in Mobile Health Apps to Improve Medication Adherence: Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Feb",
day="21",
volume="10",
number="2",
pages="e30671",
keywords="gamification",
keywords="incentives",
keywords="mobile application",
keywords="mHealth",
keywords="medication adherence",
keywords="mobile phone",
abstract="Background: Emerging health care strategies addressing medication adherence include the use of direct-to-patient incentives or elements adapted from computer games. However, there is currently no published evidence synthesis on the use of gamification or financial incentives in mobile apps to improve medication adherence. Objective: The aim of this scoping review is to synthesize and appraise the literature pertaining to the use of mobile apps containing gamification or financial incentives for medication adherence. There were two objectives: to explore the reported effectiveness of these features and to describe and appraise the design and development process, including patient involvement. Methods: The following databases were searched for relevant articles published in English from database inception to September 24, 2020: Embase, MEDLINE, PsycINFO, CINAHL, and Web of Science. The framework by Arksey and O'Malley and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist guided this scoping review. Using a systematic screening process, studies were included if incentives or game features were used within mobile apps to specifically address medication adherence. An appraisal using risk of bias tools was also applied to their respective study design. Results: A total of 11 studies from the initial 691 retrieved articles were included in this review. Across the studies, gamification alone (9/11, 82\%) was used more than financial incentives (1/11, 9\%) alone or a combination of the two (1/11, 9\%). The studies generally reported improved or sustained optimal medication adherence outcomes; however, there was significant heterogeneity in the patient population, methodology such as outcome measures, and reporting of these studies. There was considerable variability in the development process and evaluation of the apps, with authors opting for either the waterfall or agile methodology. App development was often guided by a theory, but across the reviewed studies, there were no common theories used. Patient involvement was not commonly evident in predevelopment phases but were generally reserved for evaluations of feasibility, acceptance, and effectiveness. Patient perspectives on gamified app features indicated a potential to motivate positive health behaviors such as medication adherence along with critical themes of repetitiveness and irrelevance of certain features. The appraisal indicated a low risk of bias in most studies, although concerns were identified in potential confounding. Conclusions: To effectively address medication adherence via gamified and incentivized mobile apps, an evidence-based co-design approach and agile methodology should be used. This review indicates some adoption of an agile approach in app development; however, patient involvement is lacking in earlier stages. Further research in a generalized cohort of patients living with chronic conditions would facilitate the identification of barriers, potential opportunities, and the justification for the use of gamification and financial incentives in mobile apps for medication adherence. ",
doi="10.2196/30671",
url="https://mhealth.jmir.org/2022/2/e30671",
url="http://www.ncbi.nlm.nih.gov/pubmed/35188475"
}


@Article{info:doi/10.2196/28686,
author="Sunshine, Jacob",
title="Smart Speakers: The Next Frontier in mHealth",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Feb",
day="21",
volume="10",
number="2",
pages="e28686",
keywords="digital health",
keywords="mobile health",
keywords="machine learning",
keywords="smart speaker",
keywords="smartphone",
doi="10.2196/28686",
url="https://mhealth.jmir.org/2022/2/e28686",
url="http://www.ncbi.nlm.nih.gov/pubmed/35188467"
}


@Article{info:doi/10.2196/30710,
author="Goulding, H. Evan
and Dopke, A. Cynthia
and Rossom, C. Rebecca
and Michaels, Tania
and Martin, R. Clair
and Ryan, Chloe
and Jonathan, Geneva
and McBride, Alyssa
and Babington, Pamela
and Bernstein, Mary
and Bank, Andrew
and Garborg, Spencer C.
and Dinh, M. Jennifer
and Begale, Mark
and Kwasny, J. Mary
and Mohr, C. David",
title="A Smartphone-Based Self-management Intervention for Individuals With Bipolar Disorder (LiveWell): Empirical and Theoretical Framework, Intervention Design, and Study Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="Feb",
day="21",
volume="11",
number="2",
pages="e30710",
keywords="bipolar disorder",
keywords="self-management",
keywords="mHealth",
keywords="eHealth",
keywords="smartphone",
keywords="mobile phone",
keywords="mental health",
keywords="mobile health",
abstract="Background: Bipolar disorder is a severe mental illness with high morbidity and mortality rates. Even with pharmacological treatment, frequent recurrence of episodes, long episode durations, and persistent interepisode symptoms are common and disruptive. Combining psychotherapy with pharmacotherapy improves outcomes; however, many individuals with bipolar disorder do not receive psychotherapy. Mental health technologies can increase access to self-management strategies derived from empirically supported bipolar disorder psychotherapies while also enhancing treatment by delivering real-time assessments, personalized feedback, and provider alerts. In addition, mental health technologies provide a platform for self-report, app use, and behavioral data collection to advance understanding of the longitudinal course of bipolar disorder, which can then be used to support ongoing improvement of treatment. Objective: A description of the theoretical and empirically supported framework, design, and protocol for a randomized controlled trial (RCT) of LiveWell, a smartphone-based self-management intervention for individuals with bipolar disorder, is provided to facilitate the ability to replicate, improve, implement, and disseminate effective interventions for bipolar disorder. The goal of the trial is to determine the effectiveness of LiveWell for reducing relapse risk and symptom burden as well as improving quality of life (QOL) while simultaneously clarifying behavioral targets involved in staying well and better characterizing the course of bipolar disorder and treatment response. Methods: The study is a single-blind RCT (n=205; 2:3 ratio of usual care vs usual care plus LiveWell). The primary outcome is the time to relapse. Secondary outcomes are percentage time symptomatic, symptom severity, and QOL. Longitudinal changes in target behaviors proposed to mediate the primary and secondary outcomes will also be determined, and their relationships with the outcomes will be assessed. A database of clinical status, symptom severity, real-time self-report, behavioral sensor, app use, and personalized content will be created to better predict treatment response and relapse risk. Results: Recruitment and screening began in March 2017 and ended in April 2019. Follow-up ended in April 2020. The results of this study are expected to be published in 2022. Conclusions: This study will examine whether LiveWell reduces relapse risk and symptom burden and improves QOL for individuals with bipolar disorder by increasing access to empirically supported self-management strategies. The role of selected target behaviors (medication adherence, sleep duration, routine, and management of signs and symptoms) in these outcomes will also be examined. Simultaneously, a database will be created to initiate the development of algorithms to personalize and improve treatment for bipolar disorder. In addition, we hope that this description of the theoretical and empirically supported framework, intervention design, and study protocol for the RCT of LiveWell will facilitate the ability to replicate, improve, implement, and disseminate effective interventions for bipolar and other mental health disorders. Trial Registration: ClinicalTrials.gov NCT03088462; https://www.clinicaltrials.gov/ct2/show/NCT03088462 International Registered Report Identifier (IRRID): DERR1-10.2196/30710 ",
doi="10.2196/30710",
url="https://www.researchprotocols.org/2022/2/e30710",
url="http://www.ncbi.nlm.nih.gov/pubmed/35188473"
}


@Article{info:doi/10.2196/34117,
author="Sonney, Jennifer
and Cho, E. Emily
and Zheng, Qiming
and Kientz, A. Julie",
title="Refinement of a Parent--Child Shared Asthma Management Mobile Health App: Human-Centered Design Study",
journal="JMIR Pediatr Parent",
year="2022",
month="Feb",
day="17",
volume="5",
number="1",
pages="e34117",
keywords="parent--child shared management",
keywords="school-age children",
keywords="asthma",
keywords="participatory design",
keywords="mHealth",
keywords="prototype",
keywords="usability",
keywords="family health informatics",
abstract="Background: The school-age years, approximately ages 7 through 11, represent a natural transition when children begin assuming some responsibility for their asthma management. Previously, we designed a theoretically derived, tailored parent--child shared asthma management mobile health app prototype, Improving Asthma Care Together (IMPACT). Objective: The purpose of this study was to use human-centered design (HCD) to iteratively refine IMPACT to optimize user experience and incorporate evidence-based longitudinal engagement strategies. Methods: This study used a mixed methods design from December 2019 to April 2021. Our app refinement used the HCD process of research, ideation, design, evaluation, and implementation, including 6 cycles of design and evaluation. The design and evaluation cycles focused on core app functionality, child engagement, and overall refinement. Evaluation with parent--child dyads entailed in-person and remote concept testing and usability testing sessions, after which rapid cycle thematic analyses identified key insights that informed future design refinement. Results: Twelve parent--child dyads enrolled in at least one round of this study. Eight of the 12 child participants were male with a mean age of 9.9 (SD 1.6) years and all parent participants were female. Throughout evaluation cycles, dyads selected preferred app layouts, gamification concepts, and overall features with a final design prototype emerging for full-scale development and implementation. Conclusions: A theoretically derived, evidence-based shared asthma management app was co-designed with end users to address real-world pain points and priorities. An 8-week pilot study testing app feasibility, acceptability, and preliminary efficacy is forthcoming. ",
doi="10.2196/34117",
url="https://pediatrics.jmir.org/2022/1/e34117",
url="http://www.ncbi.nlm.nih.gov/pubmed/35175214"
}


@Article{info:doi/10.2196/32826,
author="Narrillos-Moraza, {\'A}lvaro
and G{\'o}mez-Mart{\'i}nez-Sagrera, Patricia
and Amor-Garc{\'i}a, {\'A}ngel Miguel
and Escudero-Vilaplana, Vicente
and Collado-Borrell, Roberto
and Villanueva-Bueno, Cristina
and G{\'o}mez-Centuri{\'o}n, Ignacio
and Herranz-Alonso, Ana
and Sanjurjo-S{\'a}ez, Mar{\'i}a",
title="Mobile Apps for Hematological Conditions: Review and Content Analysis Using the Mobile App Rating Scale",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Feb",
day="16",
volume="10",
number="2",
pages="e32826",
keywords="blood",
keywords="hematology",
keywords="mHealth",
keywords="mobile apps",
keywords="quality",
keywords="rating tool",
keywords="mobile phone",
abstract="Background: Hematological conditions are prevalent disorders that are associated with significant comorbidities and have a major impact on patient care. Concerning new tools for the care of these patients, the number of health apps aimed at hematological patients is growing. Currently, there are no quality analyses or classifications of apps for patients diagnosed with hematological conditions. Objective: The aim of this study is to analyze the characteristics and quality of apps designed for patients diagnosed with hematological conditions by using the Mobile App Rating Scale (MARS). Methods: We performed an observational, cross-sectional descriptive study of all smartphone apps for patients diagnosed with hematological conditions. A search was conducted in March 2021 using the following terms: anemia, blood cancer, blood disorder, hematological cancer, hematological malignancy, hematological tumor, hematology, hemophilia, hemorrhage, lymphoma, leukemia, multiple myeloma, thalassemia, thrombocytopenia, and thrombosis. The apps identified were downloaded and evaluated by 2 independent researchers. General characteristics were registered, and quality was analyzed using MARS scores. Interrater reliability was measured by using the Cohen $\kappa$ coefficient. Results: We identified 2100 apps in the initial search, and 4.19\% (88/2100) of apps met the inclusion criteria and were analyzed. Of the 88 apps, 61\% (54/88) were available on Android, 30\% (26/88) were available on iOS, and 9\% (8/88) were available on both platforms. Moreover, 7\% (6/88) required payment, and 49\% (43/88) were updated in the last year. Only 26\% (23/88) of the apps were developed with the participation of health professionals. Most apps were informative (60/88, 68\%), followed by preventive (23/88, 26\%) and diagnostic (5/88, 6\%). Most of the apps were intended for patients with anemia (23/88, 26\%). The mean MARS score for the overall quality of the 88 apps was 3.03 (SD 1.14), ranging from 1.19 (lowest-rated app) to 4.86 (highest-rated app). Only 47\% (41/88) of the apps obtained a MARS score of over 3 points (acceptable quality). Functionality was the best-rated section, followed by aesthetics, engagement, information, and app subjective quality. The five apps with the highest MARS score were the following: Multiple Myeloma Manager, Hodgkin Lymphoma Manager, Focus On Lymphoma, ALL Manager, and CLL Manager. The analysis by operating system, developer, and cost revealed statistically significant differences in MARS scores (P<.001, P<.001, and P=.049, respectively). The interrater agreement between the 2 reviewers was substantial (k=0.78). Conclusions: There is great heterogeneity in the quality of apps for patients with hematological conditions. More than half of the apps do not meet acceptable criteria for quality and content. Most of them only provide information about the pathology, lacking interactivity and personalization options. The participation of health professionals in the development of these apps is low, although it is narrowly related to better quality. ",
doi="10.2196/32826",
url="https://mhealth.jmir.org/2022/2/e32826",
url="http://www.ncbi.nlm.nih.gov/pubmed/35171109"
}


@Article{info:doi/10.2196/30091,
author="Hawthorne, Grace
and Greening, Neil
and Esliger, Dale
and Briggs-Price, Samuel
and Richardson, Matthew
and Chaplin, Emma
and Clinch, Lisa
and Steiner, C. Michael
and Singh, J. Sally
and Orme, W. Mark",
title="Usability of Wearable Multiparameter Technology to Continuously Monitor Free-Living Vital Signs in People Living With Chronic Obstructive Pulmonary Disease: Prospective Observational Study",
journal="JMIR Hum Factors",
year="2022",
month="Feb",
day="16",
volume="9",
number="1",
pages="e30091",
keywords="chronic obstructive pulmonary disease",
keywords="digital health",
keywords="physical activity",
keywords="respiratory rate",
keywords="wearable technology",
keywords="wearable device",
keywords="vital signs monitor",
abstract="Background: Vital signs monitoring (VSM) is routine for inpatients, but monitoring during free-living conditions is largely untested in chronic obstructive pulmonary disease (COPD). Objective: This study investigated the usability and acceptability of continuous VSM for people with COPD using wearable multiparameter technology. Methods: In total, 50 people following hospitalization for an acute exacerbation of COPD (AECOPD) and 50 people with stable COPD symptoms were asked to wear an Equivital LifeMonitor during waking hours for 6 weeks (42 days). The device recorded heart rate (HR), respiratory rate (RR), skin temperature, and physical activity. Adherence was defined by the number of days the vest was worn and daily wear time. Signal quality was examined, with thresholds of ?85\% for HR and ?80\% for RR, based on the device's proprietary confidence algorithm. Data quality was calculated as the percentage of wear time with acceptable signal quality. Participant feedback was assessed during follow-up phone calls. Results: In total, 84\% of participants provided data, with average daily wear time of 11.8 (SD 2.2) hours for 32 (SD 11) days (average of study duration 76\%, SD 26\%). There was greater adherence in the stable group than in the post-AECOPD group (?5 weeks wear: 71.4\% vs 45.7\%; P=.02). For all 84 participants, the median HR signal quality was 90\% (IQR 80\%-94\%) and the median RR signal quality was 93\% (IQR 92\%-95\%). The median HR data quality was 81\% (IQR 58\%-91\%), and the median RR data quality was 85\% (IQR 77\%-91\%). Stable group BMI was associated with HR signal quality (rs=0.45, P=.008) and HR data quality (rs=0.44, P=.008). For the AECOPD group, RR data quality was associated with waist circumference and BMI (rs=--0.49, P=.009; rs=--0.44, P=.02). In total, 36 (74\%) participants in the Stable group and 21 (60\%) participants in the AECOPD group accepted the technology, but 10 participants (12\%) expressed concerns with wearing a device around their chest. Conclusions: This wearable multiparametric technology showed good user acceptance and was able to measure vital signs in a COPD population. Data quality was generally high but was influenced by body composition. Overall, it was feasible to continuously measure vital signs during free-living conditions in people with COPD symptoms but with additional challenges in the post-AECOPD context. ",
doi="10.2196/30091",
url="https://humanfactors.jmir.org/2022/1/e30091",
url="http://www.ncbi.nlm.nih.gov/pubmed/35171101"
}


@Article{info:doi/10.2196/31448,
author="Kohlbrenner, Dario
and Clarenbach, F. Christian
and Ivankay, Adam
and Zimmerli, Lukas
and Gross, S. Christoph
and Kuhn, Manuel
and Brunschwiler, Thomas",
title="Multisensory Home-Monitoring in Individuals With Stable Chronic Obstructive Pulmonary Disease and Asthma: Usability Study of the CAir-Desk",
journal="JMIR Hum Factors",
year="2022",
month="Feb",
day="16",
volume="9",
number="1",
pages="e31448",
keywords="home monitoring",
keywords="digital health",
keywords="respiratory disease",
keywords="usability",
keywords="feasibility",
keywords="adherence",
keywords="disease management",
keywords="chronic disease",
keywords="patient monitoring",
abstract="Background: Research integrating multisensory home-monitoring in respiratory disease is scarce. Therefore, we created a novel multisensory home-monitoring device tailored for long-term respiratory disease management (named the CAir-Desk). We hypothesize that recent technological accomplishments can be integrated into a multisensory participant-driven platform. We also believe that this platform could improve chronic disease management and be accessible to large groups at an acceptable cost. Objective: This study aimed to report on user adherence and acceptance as well as system functionality of the CAir-Desk in a sample of participants with stable chronic obstructive pulmonary disease (COPD) or asthma. Methods: We conducted an observational usability study. Participants took part in 4 weeks of home-monitoring with the CAir-Desk. The CAir-Desk recorded data from all participants on symptom burden, physical activity, spirometry, and environmental air quality; data on sputum production, and nocturnal cough were only recorded for participants who experienced symptoms. After the study period, participants reported on their perceptions of the usability of the monitoring device through a purpose-designed questionnaire. We used descriptive statistics and visualizations to display results. Results: Ten participants, 5 with COPD and 5 with asthma took part in this study. They completed symptom burden questionnaires on a median of 96\% (25th percentile 14\%, 75th percentile 96\%), spirometry recordings on 55\% (20\%, 94\%), wrist-worn physical activity recordings on 100\% (97\%, 100\%), arm-worn physical activity recordings on 45\% (13\%, 63\%), nocturnal cough recordings on 34\% (9\%, 54\%), sputum recordings on 5\% (3\%, 12\%), and environmental air quality recordings on 100\% (99\%, 100\%) of the study days. The participants indicated that the measurements consumed a median of 13 (10, 15) min daily, and that they preferred the wrist-worn physical activity monitor to the arm-worn physical activity monitor. Conclusions: The CAir-Desk showed favorable technical performance and was well-accepted by our sample of participants with stable COPD and asthma. The obtained insights were used in a redesign of the CAir-Desk, which is currently applied in a randomized controlled trial including an interventional program. ",
doi="10.2196/31448",
url="https://humanfactors.jmir.org/2022/1/e31448",
url="http://www.ncbi.nlm.nih.gov/pubmed/35171107"
}


@Article{info:doi/10.2196/32251,
author="Li, Yuxi
and Gong, Yanjun
and Zheng, Bo
and Fan, Fangfang
and Yi, Tieci
and Zheng, Yimei
and He, Pengkang
and Fang, Jin
and Jia, Jia
and Zhu, Qin
and Jiang, Jie
and Huo, Yong",
title="Effects on Adherence to a Mobile App--Based Self-management Digital Therapeutics Among Patients With Coronary Heart Disease: Pilot Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Feb",
day="15",
volume="10",
number="2",
pages="e32251",
keywords="coronary heart disease",
keywords="secondary prevention",
keywords="self-management",
keywords="mobile app",
keywords="adherence",
keywords="digital therapeutics",
keywords="mobile phone",
abstract="Background: The adherence to secondary prevention treatment in patients with coronary heart disease (CHD) is low. Digital therapeutics (DTx) refers to an emerging branch of medicine that delivers medical interventions directly to patients using evidence-based, clinically evaluated, technology-based software algorithms or apps to facilitate disease management, which may be an efficient tool to optimize adherence. Objective: This paper aims to investigate the effect of mobile app--based self-management DTx on long-term use of secondary prevention medications in patients with CHD in China. Methods: This pilot study was a parallel-designed, open-labeled, single-center, randomized controlled trial. Hospitalized patients with CHD admitted to Peking University First Hospital between April 2016 and June 2017 were randomized before discharge on a 1:1 ratio. The intervention group received regular follow-up combined with DTx, which is a self-management mobile app already installed on an Android 5 (Mi Pad 1, Xiaomi Corporation) tablet. Structured data from the hospital informatics system were integrated automatically, and medication, lifestyle intervention plan, follow-up protocol, and patient education materials were also provided according to the diagnosis. Participants could use DTx for self-management at home. The control group was under conventional hospital--based follow-up care. Patients were followed up for 1 year, and the primary end point was the percentage of all guideline-recommended medications at 12 months. The secondary end points included the percentage adhered to standard secondary prevention medications at 6 months, the control rate of lipid profile, and blood pressure at 6 months and 1 year. Results: Among 300 randomized patients with CHD, 290 (96.7\%) were included in the final analysis, including 49.3\% (143/290) and 50.7\% (147/290) of patients from the intervention and control groups, respectively. Baseline characteristics were similar between the 2 groups. There was a statistically significant improvement in the percentage of all guideline-recommended medications at 12 months in the intervention group compared with the control group (relative risk [RR] 1.34, 95\% CI 1.12-1.61; P=.001), and there was no interaction with baseline characteristics. The intervention group had a significantly higher proportion of patients achieving blood pressure under control (systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg) and low-density lipoprotein cholesterol <1.8 mmol/L (RR 1.45, 95\% CI 1.22-1.72; P<.001 and RR 1.40, 95\% CI 1.11-1.75; P=.004, respectively) at 12 months. Furthermore, on logistic regression, the intervention group had a lower risk of withdrawing from guideline-recommended medications (odds ratio 0.46, 95\% CI 0.27-0.78; P=.004). Conclusions: Among patients with CHD, using a mobile app--based self-management DTx in addition to traditional care resulted in a significant improvement in guideline-recommended medication adherence at 12 months. The results of the trial will be applicable to primary care centers, especially in rural areas with less medical resources. Trial Registration: ClinicalTrials.gov NCT03565978; https://clinicaltrials.gov/ct2/show/NCT03565978 ",
doi="10.2196/32251",
url="https://mhealth.jmir.org/2022/2/e32251",
url="http://www.ncbi.nlm.nih.gov/pubmed/34906924"
}


@Article{info:doi/10.2196/26275,
author="Suo, Lingge
and Ke, Xianghan
and Zhang, Di
and Qin, Xuejiao
and Chen, Xuhao
and Hong, Ying
and Dai, Wanwei
and Wu, Defu
and Zhang, Chun
and Zhang, Dongsong",
title="Use of Mobile Apps for Visual Acuity Assessment: Systematic Review and Meta-analysis",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Feb",
day="14",
volume="10",
number="2",
pages="e26275",
keywords="smartphone",
keywords="iPad",
keywords="eye screening",
keywords="visual acuity",
keywords="app",
keywords="meta-analysis",
abstract="Background: Vision impairments (VIs) and blindness are major global public health issues. A visual acuity (VA) test is one of the most crucial standard psychophysical tests of visual function and has been widely used in a broad range of health care domains, especially in many clinical settings. In recent years, there has been increasing research on mobile app--based VA assessment designed to allow people to test their VA at any time and any location. Objective: The goal of the review was to assess the accuracy and reliability of using mobile VA measurement apps. Methods: We searched PubMed, Embase, Cochrane Library, and Google Scholar for relevant articles on mobile apps for VA assessment published between January 1, 2008, and July 1, 2020. Two researchers independently inspected and selected relevant studies. Eventually, we included 22 studies that assessed tablet or smartphone apps for VA measurement. We then analyzed sensitivity, specificity, and accuracy in the 6 papers we found through a meta-analysis. Results: Most of the 22 selected studies can be considered of high quality based on the Quality Assessment of Diagnostic Accuracy Studies--2. In a meta-analysis of 6 studies involving 24,284 participants, we categorized the studies based on the age groups of the study participants (ie, aged 3-5 years, aged 6-22 years, and aged 55 years and older), examiner (ie, professional and nonprofessional examiners), and the type of mobile devices (ie, smartphone, iPad). In the group aged 3 to 5 years, the pooled sensitivity for VA app tests versus clinical VA tests was 0.87 (95\% CI 0.79-0.93; P=.39), and the pooled specificity was 0.78 (95\% CI 0.70-0.85; P=.37). In the group aged 6 to 22 years, the pooled sensitivity for VA app tests versus clinical VA tests was 0.86 (95\% CI 0.84-0.87; P<.001), and the pooled specificity for VA app tests versus clinical VA tests was 0.91 (95\% CI 0.90-0.91; P=.27). In the group aged 55 years and older, the pooled sensitivity for VA app tests versus clinical VA tests was 0.85 (95\% CI 0.55-0.98), and the pooled specificity for VA app tests versus clinical VA tests was 0.98 (95\% CI 0.95-0.99). We found that the nonprofessional examiner group (AUC 0.93) had higher accuracy than the professional examiner group (AUC 0.87). In the iPad-based group, the pooled sensitivity for VA app tests versus clinical VA tests was 0.86, and the pooled specificity was 0.79. In the smartphone-based group, the pooled sensitivity for VA app tests versus clinical VA tests was 0.86 (P<.001), and the pooled specificity for VA app tests versus clinical VA tests was 0.91 (P<.001). Conclusions: In this study, we conducted a comprehensive review of the research on existing mobile apps for VA tests to investigate their diagnostic value and limitations. Evidence gained from this study suggests that mobile app--based VA tests can be useful for on-demand VI detection. ",
doi="10.2196/26275",
url="https://mhealth.jmir.org/2022/2/e26275",
url="http://www.ncbi.nlm.nih.gov/pubmed/35156935"
}


@Article{info:doi/10.2196/28372,
author="Della Vecchia, Claire
and Leroy, Tanguy
and Bauquier, Charlotte
and Pannard, Myriam
and Sarradon-Eck, Aline
and Darmon, David
and Dufour, Jean-Charles
and Preau, Marie",
title="Willingness of French General Practitioners to Prescribe mHealth Apps and Devices: Quantitative Study",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Feb",
day="11",
volume="10",
number="2",
pages="e28372",
keywords="mHealth",
keywords="health applications",
keywords="connected health and wellness devices",
keywords="general practitioners",
keywords="patients",
keywords="prescription",
keywords="quantitative study",
keywords="mobile phone",
abstract="Background: The field of mobile health (mHealth) is constantly expanding. Integrating mHealth apps and devices in clinical practice is a major and complex challenge. General practitioners (GPs) are an essential link in a patient's care pathway. As they are patients' preferred health care intermediaries, GPs play an important role in supporting patients' transition to mHealth. Objective: This study aims to identify the factors associated with the willingness of French GPs to prescribe mHealth apps and devices to their patients. Methods: This study was part of the ApiAppS project whose overall objective was to help remove barriers GPs face when prescribing mHealth apps and devices by developing a custom-built platform to aid them. The study included GPs recruited from the general practice department of several medical faculties in France (Lyon, Nice, and Rouen) and mailing lists of academic GPs, health care professional associations, and social and professional networks. Participants were asked to complete a web-based questionnaire that collected data on various sociodemographic variables, indicators of their involvement in continued education programs and the amount of time they dedicated to promoting healthy behaviors during patient consultations, and indicators characterizing their patient population. Data on their perceptions of mHealth apps and devices were also collected. Finally, the questionnaire included items to measure GPs' acceptability of prescribing mHealth apps and devices for several health-related dimensions. Results: Of the 174 GPs, 129 (74.1\%) declared their willingness to prescribe mHealth apps and devices to their patients. In multivariate analysis, involvement in continued education programs (odds ratio [OR] 6.17, 95\% CI 1.52-28.72), a better patient base command of the French language (OR 1.45, 95\% CI 1.13-1.88), GP-perceived benefits of mHealth apps and devices for both patients and their medical practice and GP-perceived drivers for mHealth apps and device implementation in their medical practice (OR 1.04, 95\% CI 1.01-1.07), and validation of mHealth apps and devices through randomized clinical trials (OR 1.02, 95\% CI 1.00-1.04) were all associated with GPs' willingness to prescribe mHealth apps and devices. In contrast, older GPs (OR 0.95, 95\% CI 0.91-0.98), female GPs (OR 0.26, 95\% CI 0.09-0.69), and those who perceived risks for the patient or their medical practice (OR 0.96, 95\% CI 0.94-0.99) were less inclined to prescribe mHealth apps and devices. Conclusions: mHealth apps and devices were generally seen by GPs as useful in general medicine and were, for the most part, favorable to prescribing them. Their full integration in general medicine will be conditioned by the need for conclusive certification, transparency (reliable and precise data concerning mHealth app and device methods of construction and clinical validation), software aids to assist GPs prescribe them, and dedicated training programs. ",
doi="10.2196/28372",
url="https://mhealth.jmir.org/2022/2/e28372",
url="http://www.ncbi.nlm.nih.gov/pubmed/35147508"
}


@Article{info:doi/10.2196/33103,
author="Robinson, Billy
and Gong, Enying
and Oldenburg, Brian
and See, Katharine",
title="Functionality and Quality of Asthma mHealth Apps and Their Consistency With International Guidelines: Protocol for a Systematic Search and Evaluation of Mobile Apps",
journal="JMIR Res Protoc",
year="2022",
month="Feb",
day="9",
volume="11",
number="2",
pages="e33103",
keywords="asthma",
keywords="mHealth",
keywords="mobile phone",
keywords="applications",
keywords="self-management",
keywords="chronic disease",
keywords="respiratory",
keywords="smartphone",
keywords="asthma app",
abstract="Background: Asthma is a chronic respiratory disorder that requires long-term pharmacotherapy and patient empowerment to manage the condition and recognize and respond to asthma exacerbations. Mobile health (mHealth) apps represent a potential medium through which patients can improve their ability to self-manage their asthma. Few studies have conducted a systematic evaluation of asthma mobile apps for quality and functionality using a validated tool. None of these reviews have systematically assessed these apps for their content and evaluated them against the available international best practice guidelines. Objective: The objective of this study is to conduct a systematic search and evaluation of adult-targeted asthma mHealth apps. As part of this review, the potential of an mHealth app to improve asthma self-management and the overall quality of the app will be evaluated using the Mobile App Rating Scale framework, and the quality of the information within an app will be evaluated using the current Global Initiative for Asthma guidelines as a reference. Methods: A stepwise methodological approach was taken in creating this review. First, the most recent Global Initiative for Asthma guidelines were independently reviewed by 2 authors to identify key recommendations that could be feasibly incorporated into an mHealth app. A previously developed asthma assessment framework was identified and was modified to suit our research and ensure that all of these identified recommendations were included. In total, 2 popular app stores were reviewed to identify potential mHealth apps. These apps were screened based on predefined inclusion and exclusion criteria. Suitable apps were then evaluated. Technical information was obtained from publicly available information. The next step was to perform an app quality assessment using the validated Mobile App Rating Scale framework to objectively determine the quality of an app. App functionality was assessed using the Intercontinental Medical Statistics Institute for Health Informatics Functionality Scoring System. Finally, the mHealth apps were assessed using our developed checklist. Results: Funding has been received for the project from the Respiratory Department at Northern Health, Victoria. Three reviewers have been recruited to systematically evaluate the apps. The results of this study are expected in 2022. Conclusions: To our knowledge, this review represents the first study to examine all mHealth apps available in Australia that are targeted to adults with asthma for their functionality, quality, and consistency with international best practice guidelines. Although this review will only be conducted on mHealth apps available in Australia, many apps are available worldwide; thus, this study should be largely generalizable to other English-speaking regions and users. The results of this review will help to fill gaps in the literature and assist clinicians in providing evidence-based advice to patients wishing to use mHealth apps as part of their asthma self-management. Trial Registration: PROSPERO 269894; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=269894 International Registered Report Identifier (IRRID): PRR1-10.2196/33103 ",
doi="10.2196/33103",
url="https://www.researchprotocols.org/2022/2/e33103",
url="http://www.ncbi.nlm.nih.gov/pubmed/35138257"
}


@Article{info:doi/10.2196/31497,
author="Aggarwal, Ravi
and Visram, Sheena
and Martin, Guy
and Sounderajah, Viknesh
and Gautama, Sanjay
and Jarrold, Kevin
and Klaber, Robert
and Maxwell, Shona
and Neal, John
and Pegg, Jack
and Redhead, Julian
and King, Dominic
and Ashrafian, Hutan
and Darzi, Ara",
title="Defining the Enablers and Barriers to the Implementation of Large-scale, Health Care--Related Mobile Technology: Qualitative Case Study in a Tertiary Hospital Setting",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Feb",
day="8",
volume="10",
number="2",
pages="e31497",
keywords="mHealth",
keywords="implementation science",
keywords="mobile technology",
keywords="mobile apps",
keywords="clinical applications",
keywords="smartphone apps",
keywords="health care industry",
keywords="stakeholders",
keywords="mobile phone",
abstract="Background: The successful implementation of clinical smartphone apps in hospital settings requires close collaboration with industry partners. A large-scale, hospital-wide implementation of a clinical mobile app for health care professionals developed in partnership with Google Health and academic partners was deployed on a bring-your-own-device basis using mobile device management at our UK academic hospital. As this was the first large-scale implementation of this type of innovation in the UK health system, important insights and lessons learned from the deployment may be useful to other organizations considering implementing similar technology in partnership with commercial companies. Objective: The aims of this study are to define the key enablers and barriers and to propose a road map for the implementation of a hospital-wide clinical mobile app developed in collaboration with an industry partner as a data processor and an academic partner for independent evaluation. Methods: Semistructured interviews were conducted with high-level stakeholders from industry, academia, and health care providers who had instrumental roles in the implementation of the app at our hospital. The interviews explored the participants' views on the enablers and barriers to the implementation process. The interviews were analyzed using a broadly deductive approach to thematic analysis. Results: In total, 14 participants were interviewed. Key enablers identified were the establishment of a steering committee with high-level clinical involvement, well-defined roles and responsibilities between partners, effective communication strategies with end users, safe information governance precautions, and increased patient engagement and transparency. Barriers identified were the lack of dedicated resources for mobile change at our hospital, risk aversion, unclear strategy and regulation, and the implications of bring-your-own-device and mobile device management policies. The key lessons learned from the deployment process were highlighted, and a road map for the implementation of large-scale clinical mobile apps in hospital settings was proposed. Conclusions: Despite partnering with one of the world's biggest technology companies, the cultural and technological change required for mobile working and implementation in health care was found to be a significant challenge. With an increasing requirement for health care organizations to partner with industry for advanced mobile technologies, the lessons learned from our implementation can influence how other health care organizations undertake a similar mobile change and improve the chances of successful widespread mobile transformation. ",
doi="10.2196/31497",
url="https://mhealth.jmir.org/2022/2/e31497",
url="http://www.ncbi.nlm.nih.gov/pubmed/35133287"
}


@Article{info:doi/10.2196/32923,
author="Fundoiano-Hershcovitz, ?Yifat
and Bacher, Dror
and Ritholz, D. Marilyn
and Horwitz, L. David
and Manejwala, Omar
and Goldstein, Pavel",
title="Blood Pressure Monitoring as a Digital Health Tool for Improving Diabetes Clinical Outcomes: Retrospective Real-world Study",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="8",
volume="24",
number="2",
pages="e32923",
keywords="blood glucose",
keywords="blood pressure",
keywords="monitoring",
keywords="digital therapeutic",
keywords="diabetes",
keywords="hypertension",
keywords="app",
keywords="model",
keywords="chronic disease",
keywords="health data",
abstract="Background: Remote data capture for blood glucose (BG) or blood pressure (BP) monitoring and the use of a supportive digital app are becoming the model in diabetes and hypertension chronic care. One of the goals in chronic condition management is to increase awareness and generate behavioral change in order to improve outcomes in diabetes and related comorbidities, such as hypertension. In addition, there is a lack of understanding of the association between BG and BP levels when using digital health tools. Objective: By applying a rigorous study framework to digital health data, this study investigated the relationship between BP monitoring and BG and BP levels, as well as a lagged association between BP and BG. We hypothesized that during the first 6 months of BP monitoring, BG and BP levels would decrease. Finally, we suggested a positive association between BP levels and the following month's BG levels. Methods: In this retrospective, real-world case-control study, we extracted the data of 269 people with type 2 diabetes (T2D) who tracked their BG levels using the Dario digital platform for a chronic condition. We analyzed the digital data of the users who, in addition to BG, monitored their BP using the same app (BP-monitoring [BPM] group, n=137) 6 months before and after starting their BP monitoring. Propensity score matching established a control group, no blood pressure monitoring (NBPM, n=132), matched on demographic and baseline clinical measures to the BPM group. A piecewise mixed model was used for analyzing the time trajectories of BG, BP, and their lagged association. Results: Analysis revealed a significant difference in BG time trajectories associated with BP monitoring in BPM and NBPM groups (t=--2.12, P=.03). The BPM group demonstrated BG reduction improvement in the monthly average BG levels during the first 6 months (t=--3.57, P<.001), while BG did not change for the NBPM group (t=0.39, P=.70). Both groups showed similarly stable BG time trajectories (B=0.98, t=1.16, P=.25) before starting the use of the BP-monitoring system. In addition, the BPM group showed a significant reduction in systolic (t=--6.42, P<.001) and diastolic (t=--4.80, P<.001) BP during the first 6 months of BP monitoring. Finally, BG levels were positively associated with systolic (B=0.24, t=2.77, P=.001) and diastolic (B=0.30, t=2.41, P=.02) BP. Conclusions: The results of this study shed light on the association between BG and BP levels and on the role of BP self-monitoring in diabetes management. Our findings also underscore the need and provide a basis for a comprehensive approach to understanding the mechanism of BP regulation associated with BG. ",
doi="10.2196/32923",
url="https://www.jmir.org/2022/2/e32923",
url="http://www.ncbi.nlm.nih.gov/pubmed/35133284"
}


@Article{info:doi/10.2196/35042,
author="Lewkowicz, Daniel
and Wohlbrandt, M. Attila
and Bottinger, Erwin",
title="Digital Therapeutic Care Apps With Decision-Support Interventions for People With Low Back Pain in Germany: Cost-Effectiveness Analysis",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Feb",
day="7",
volume="10",
number="2",
pages="e35042",
keywords="cost-utility analysis",
keywords="low back pain",
keywords="back pain",
keywords="cost-effectiveness",
keywords="Markov model",
keywords="digital therapy",
keywords="digital health app",
keywords="mHealth",
keywords="orthopedic",
keywords="eHealth",
keywords="mobile health",
keywords="digital health",
keywords="pain management",
keywords="health apps",
abstract="Background: Digital therapeutic care apps provide a new effective and scalable approach for people with nonspecific low back pain (LBP). Digital therapeutic care apps are also driven by personalized decision-support interventions that support the user in self-managing LBP, and may induce prolonged behavior change to reduce the frequency and intensity of pain episodes. However, these therapeutic apps are associated with high attrition rates, and the initial prescription cost is higher than that of face-to-face physiotherapy. In Germany, digital therapeutic care apps are now being reimbursed by statutory health insurance; however, price targets and cost-driving factors for the formation of the reimbursement rate remain unexplored. Objective: The aim of this study was to evaluate the cost-effectiveness of a digital therapeutic care app compared to treatment as usual (TAU) in Germany. We further aimed to explore under which circumstances the reimbursement rate could be modified to consider value-based pricing. Methods: We developed a state-transition Markov model based on a best-practice analysis of prior LBP-related decision-analytic models, and evaluated the cost utility of a digital therapeutic care app compared to TAU in Germany. Based on a 3-year time horizon, we simulated the incremental cost and quality-adjusted life years (QALYs) for people with nonacute LBP from the societal perspective. In the deterministic sensitivity and scenario analyses, we focused on diverging attrition rates and app cost to assess our model's robustness and conditions for changing the reimbursement rate. All costs are reported in Euro ({\texteuro}1=US \$1.12). Results: Our base case results indicated that the digital therapeutic care strategy led to an incremental cost of {\texteuro}121.59, but also generated 0.0221 additional QALYs compared to the TAU strategy, with an estimated incremental cost-effectiveness ratio (ICER) of {\texteuro}5486 per QALY. The sensitivity analysis revealed that the reimbursement rate and the capability of  digital therapeutic care to prevent reoccurring LBP episodes have a significant impact on the ICER. At the same time, the other parameters remained unaffected and thus supported the robustness of our model. In the scenario analysis, the different model time horizons and attrition rates strongly influenced the economic outcome. Reducing the cost of the app to {\texteuro}99 per 3 months or decreasing the app's attrition rate resulted in digital therapeutic care being significantly less costly with more generated QALYs, and is thus considered to be the dominant strategy over TAU. Conclusions: The current reimbursement rate for a digital therapeutic care app in the statutory health insurance can be considered a cost-effective measure compared to TAU. The app's attrition rate and effect on the patient's prolonged behavior change essentially influence the settlement of an appropriate reimbursement rate. Future value-based pricing targets should focus on additional outcome parameters besides pain intensity and functional disability by including attrition rates and the app's long-term effect on quality of life. ",
doi="10.2196/35042",
url="https://mhealth.jmir.org/2022/2/e35042",
url="http://www.ncbi.nlm.nih.gov/pubmed/35129454"
}


@Article{info:doi/10.2196/30782,
author="Cooper, Rowena
and Giangreco, Adam
and Duffy, Michelle
and Finlayson, Elaine
and Hamilton, Shellie
and Swanson, Mahri
and Colligan, Judith
and Gilliatt, Joanna
and McIvor, Mairi
and Sage, Kathryn Elizabeth",
title="Evaluation of myCOPD Digital Self-management Technology in a Remote and Rural Population: Real-world Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Feb",
day="7",
volume="10",
number="2",
pages="e30782",
keywords="digital self-management",
keywords="COPD",
keywords="remote and rural",
keywords="mobile health",
keywords="application",
keywords="chronic pulmonary obstructive disease",
keywords="rural communities",
abstract="Background: Chronic obstructive pulmonary disease (COPD) is a common, costly, and incurable respiratory disease affecting 1.2 million people in the United Kingdom alone. Acute COPD exacerbations requiring hospitalization place significant demands on health services, and the incidence of COPD in poor, remote, and rural populations is up to twice that of cities. Objective: myCOPD is a commercial, digital health, self-management technology designed to improve COPD outcomes and mitigate demands on health services. In this pragmatic real-world feasibility study, we aimed to evaluate myCOPD use and its clinical effectiveness at reducing hospitalizations, inpatient bed days, and other National Health Service (NHS) resource use. Methods: myCOPD engagement and NHS resource use was monitored for up to 1 year after myCOPD activation and was compared against health service use in the year prior to activation. A total of 113 participants from predominantly remote and rural communities were recruited via community-based care settings, including scheduled home visits, outpatient appointments, pulmonary rehabilitation, and phone or group appointments. There were no predetermined age, disease severity, geographical, or socioeconomic inclusion or exclusion criteria. Results: Out of 113 participants, 89 activated myCOPD (78.8\%), with 56\% (50/89) of those participants doing so on the day of enrollment and 90\% (80/89) doing so within 1 month. There was no correlation between participant enrollment, activation, or myCOPD engagement and either age, socioeconomics, rurality, or COPD severity. Most active participants used at least one myCOPD module and entered their symptom scores at least once (79/89, 89\%). A subgroup (15/89, 17\%) recorded their symptom scores very frequently (>1 time every 5 days), 14 of whom (93\%) also used four or five myCOPD modules. Overall, there were no differences in hospital admissions, inpatient bed days, or other health service use before or after myCOPD activation, apart from a modest increase in home visits. Subgroup analysis did, however, identify a trend toward reduced inpatient bed days and hospital admissions for those participants with very high myCOPD usage. Conclusions: Our results suggest that neither age, wealth, nor geographical location represent significant barriers to using myCOPD. This finding may help mitigate perceived risks of increased health inequalities associated with the use of digital health technologies as part of routine care provision. Despite high levels of activation, myCOPD did not reduce overall demands on health services, such as hospital admissions or inpatient bed days. Subgroup analysis did, however, suggest that very high myCOPD usage was associated with a moderate reduction in NHS resource use. Thus, although our study does not support implementation of myCOPD to reduce health service demands on a population-wide basis, our results do indicate that highly engaged patients may derive benefits. ",
doi="10.2196/30782",
url="https://mhealth.jmir.org/2022/2/e30782",
url="http://www.ncbi.nlm.nih.gov/pubmed/35129453"
}


@Article{info:doi/10.2196/33168,
author="Bricca, Alessio
and Pellegrini, Alessandro
and Zangger, Graziella
and Ahler, Jonas
and J{\"a}ger, Madalina
and Skou, T. S{\o}ren",
title="The Quality of Health Apps and Their Potential to Promote Behavior Change in Patients With a Chronic Condition or Multimorbidity: Systematic Search in App Store and Google Play",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Feb",
day="4",
volume="10",
number="2",
pages="e33168",
keywords="app",
keywords="self-management",
keywords="behavior change",
keywords="multimorbidity",
keywords="chronic conditions",
keywords="health apps",
keywords="mHealth",
keywords="mobile health",
keywords="mobile phone",
abstract="Background: Mobile apps offer an opportunity to improve the lifestyle of patients with chronic conditions or multimorbidity. However, for apps to be recommended in clinical practice, their quality and potential for promoting behavior change must be considered. Objective: We aimed to investigate the quality of health apps for patients with a chronic condition or multimorbidity (defined as 2 or more chronic conditions) and their potential for promoting behavior change. Methods: We followed the Cochrane Handbook guidelines to conduct and report this study. A systematic search of apps available in English or Danish on App Store (Apple Inc) and Google Play (Google LLC) for patients with 1 or more of the following common and disabling conditions was conducted: osteoarthritis, heart conditions (heart failure and ischemic heart disease), hypertension, type 2 diabetes mellitus, depression, and chronic obstructive pulmonary disease. For the search strategy, keywords related to these conditions were combined. One author screened the titles and content of the identified apps. Subsequently, 3 authors independently downloaded the apps onto a smartphone and assessed the quality of the apps and their potential for promoting behavior change by using the Mobile App Rating Scale (MARS; number of items: 23; score: range 0-5 [higher is better]) and the App Behavior Change Scale (ABACUS; number of items: 21; score: range 0-21 [higher is better]), respectively. We included the five highest-rated apps and the five most downloaded apps but only assessed free content for their quality and potential for promoting behavior change. Results: We screened 453 apps and ultimately included 60. Of the 60 apps, 35 (58\%) were available in both App Store and Google Play. The overall average quality score of the apps was 3.48 (SD 0.28) on the MARS, and their overall average score for their potential to promote behavior change was 8.07 (SD 2.30) on the ABACUS. Apps for depression and apps for patients with multimorbidity tended to have higher overall MARS and ABACUS scores, respectively. The most common app features for supporting behavior change were the self-monitoring of physiological parameters (eg, blood pressure monitoring; apps: 38/60, 63\%), weight and diet (apps: 25/60, 42\%), or physical activity (apps: 22/60, 37\%) and stress management (apps: 22/60, 37\%). Only 8 out of the 60 apps (13\%) were completely free. Conclusions: Apps for patients with a chronic condition or multimorbidity appear to be of acceptable quality but have low to moderate potential for promoting behavior change. Our results provide a useful overview for patients and clinicians who would like to use apps for managing chronic conditions and indicate the need to improve health apps in terms of their quality and potential for promoting behavior change. ",
doi="10.2196/33168",
url="https://mhealth.jmir.org/2022/2/e33168",
url="http://www.ncbi.nlm.nih.gov/pubmed/35119367"
}


@Article{info:doi/10.2196/31877,
author="Beukenhorst, L. Anna
and Burke, M. Katherine
and Scheier, Zoe
and Miller, M. Timothy
and Paganoni, Sabrina
and Keegan, Mackenzie
and Collins, Ella
and Connaghan, P. Kathryn
and Tay, Anna
and Chan, James
and Berry, D. James
and Onnela, Jukka-Pekka",
title="Using Smartphones to Reduce Research Burden in a Neurodegenerative Population and Assessing Participant Adherence: A Randomized Clinical Trial and Two Observational Studies",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Feb",
day="4",
volume="10",
number="2",
pages="e31877",
keywords="digital phenotyping",
keywords="mobile health",
keywords="trial",
keywords="smartphones",
keywords="attrition",
keywords="mobile phone",
abstract="Background: Smartphone studies provide an opportunity to collect frequent data at a low burden on participants. Therefore, smartphones may enable data collection from people with progressive neurodegenerative diseases such as amyotrophic lateral sclerosis at high frequencies for a long duration. However, the progressive decline in patients' cognitive and functional abilities could also hamper the feasibility of collecting patient-reported outcomes, audio recordings, and location data in the long term. Objective: The aim of this study is to investigate the completeness of survey data, audio recordings, and passively collected location data from 3 smartphone-based studies of people with amyotrophic lateral sclerosis. Methods: We analyzed data completeness in three studies: 2 observational cohort studies (study 1: N=22; duration=12 weeks and study 2: N=49; duration=52 weeks) and 1 clinical trial (study 3: N=49; duration=20 weeks). In these studies, participants were asked to complete weekly surveys; weekly audio recordings; and in the background, the app collected sensor data, including location data. For each of the three studies and each of the three data streams, we estimated time-to-discontinuation using the Kaplan--Meier method. We identified predictors of app discontinuation using Cox proportional hazards regression analysis. We quantified data completeness for both early dropouts and participants who remained engaged for longer. Results: Time-to-discontinuation was shortest in the year-long observational study and longest in the clinical trial. After 3 months in the study, most participants still completed surveys and audio recordings: 77\% (17/22) in study 1, 59\% (29/49) in study 2, and 96\% (22/23) in study 3. After 3 months, passively collected location data were collected for 95\% (21/22), 86\% (42/49), and 100\% (23/23) of the participants. The Cox regression did not provide evidence that demographic characteristics or disease severity at baseline were associated with attrition, although it was somewhat underpowered. The mean data completeness was the highest for passively collected location data. For most participants, data completeness declined over time; mean data completeness was typically lower in the month before participants dropped out. Moreover, data completeness was lower for people who dropped out in the first study month (very few data points) compared with participants who adhered long term (data completeness fluctuating around 75\%). Conclusions: These three studies successfully collected smartphone data longitudinally from a neurodegenerative population. Despite patients' progressive physical and cognitive decline, time-to-discontinuation was higher than in typical smartphone studies. Our study provides an important benchmark for participant engagement in a neurodegenerative population. To increase data completeness, collecting passive data (such as location data) and identifying participants who are likely to adhere during the initial phase of a study can be useful. Trial Registration: ClinicalTrials.gov NCT03168711; https://clinicaltrials.gov/ct2/show/NCT03168711 ",
doi="10.2196/31877",
url="https://mhealth.jmir.org/2022/2/e31877",
url="http://www.ncbi.nlm.nih.gov/pubmed/35119373"
}


@Article{info:doi/10.2196/30880,
author="Gardner, Tania
and Schultz, Regina
and Haskelberg, Hila
and Newby, M. Jill
and Wheatley, Jane
and Millard, Michael
and Faux, G. Steven
and Shiner, T. Christine",
title="The Effect of Adjunct Telephone Support on Adherence and Outcomes of the Reboot Online Pain Management Program: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="3",
volume="24",
number="2",
pages="e30880",
keywords="chronic pain",
keywords="online pain management",
keywords="telephone support",
keywords="clinician guidance",
keywords="adherence",
keywords="digital health",
keywords="eHealth",
keywords="internet interventions",
keywords="multidisciplinary",
abstract="Background: Internet-based treatment programs present a solution for providing access to pain management for those unable to access clinic-based multidisciplinary pain programs. Attrition from internet interventions is a common issue. Clinician-supported guidance can be an important feature in web-based interventions; however, the optimal level of therapist guidance and expertise required to improve adherence remains unclear. Objective: The aim of this study is to evaluate whether augmenting the existing Reboot Online program with telephone support by a clinician improves program adherence and effectiveness compared with the web-based program alone. Methods: A 2-armed, CONSORT (Consolidated Standards of Reporting Trials)--compliant, registered randomized controlled trial with one-to-one group allocation was conducted. It compared a web-based multidisciplinary pain management program, Reboot Online, combined with telephone support (n=44) with Reboot Online alone (n=45) as the control group. Participants were recruited through web-based social media and the This Way Up service provider network. The primary outcome for this study was adherence to the Reboot Online program. Adherence was quantified through three metrics: completion of the program, the number of participants who enrolled into the program, and the number of participants who commenced the program. Data on adherence were collected automatically through the This Way Up platform. Secondary measures of clinical effectiveness were also collected. Results: Reboot Online combined with telephone support had a positive effect on enrollment and commencement of the program compared with Reboot Online without telephone support. Significantly more participants from the Reboot Online plus telephone support group enrolled (41/44, 93\%) into the course than those from the control group (35/45, 78\%; $\chi$21=4.2; P=.04). Furthermore, more participants from the intervention group commenced the course than those from the control group (40/44, 91\% vs 27/45, 60\%, respectively; $\chi$21=11.4; P=.001). Of the participants enrolled in the intervention group, 43\% (19/44) completed the course, and of those in the control group, 31\% (14/45) completed the course. When considering the subgroup of those who commenced the program, there was no significant difference between the proportions of people who completed all 8 lessons in the intervention (19/40, 48\%) and control groups (14/27, 52\%; $\chi$21=1.3; P=.24). The treatment efficacy on clinical outcome measures did not differ between the intervention and control groups. Conclusions: Telephone support improves participants' registration, program commencement, and engagement in the early phase of the internet intervention; however, it did not seem to have an impact on overall course completion or efficacy. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001076167; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12619001076167 ",
doi="10.2196/30880",
url="https://www.jmir.org/2022/2/e30880",
url="http://www.ncbi.nlm.nih.gov/pubmed/35113021"
}


@Article{info:doi/10.2196/33189,
author="Wu, Dan
and Huyan, Xiaoyuan
and She, Yutong
and Hu, Junbin
and Duan, Huilong
and Deng, Ning",
title="Exploring and Characterizing Patient Multibehavior Engagement Trails and Patient Behavior Preference Patterns in Pathway-Based mHealth Hypertension Self-Management: Analysis of Use Data",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Feb",
day="3",
volume="10",
number="2",
pages="e33189",
keywords="hypertension",
keywords="mobile health",
keywords="patient behavior",
keywords="engagement",
keywords="data analysis",
abstract="Background: Hypertension is a long-term medical condition. Mobile health (mHealth) services can help out-of-hospital patients to self-manage. However, not all management is effective, possibly because the behavior mechanism and behavior preferences of patients with various characteristics in hypertension management were unclear. Objective: The purpose of this study was to (1) explore patient multibehavior engagement trails in the pathway-based hypertension self-management, (2) discover patient behavior preference patterns, and (3) identify the characteristics of patients with different behavior preferences. Methods: This study included 863 hypertensive patients who generated 295,855 use records in the mHealth app from December 28, 2016, to July 2, 2020. Markov chain was used to infer the patient multibehavior engagement trails, which contained the type, quantity, time spent, sequence, and transition probability value (TP value) of patient behavior. K-means algorithm was used to group patients by the normalized behavior preference features: the number of behavioral states that a patient performed in each trail. The pages in the app represented the behavior states. Chi-square tests, Z-test, analyses of variance, and Bonferroni multiple comparisons were conducted to characterize the patient behavior preference patterns. Results: Markov chain analysis revealed 3 types of behavior transition (1-way transition, cycle transition, and self-transition) and 4 trails of patient multibehavior engagement. In perform task trail (PT-T), patients preferred to start self-management from the states of task blood pressure (BP), task drug, and task weight (TP value 0.29, 0.18, and 0.20, respectively), and spent more time on the task food state (35.87 s). Some patients entered the states of task BP and task drug (TP value 0.20, 0.25) from the reminder item state. In the result-oriented trail (RO-T), patients spent more energy on the ranking state (19.66 s) compared to the health report state (13.25 s). In the knowledge learning trail (KL-T), there was a high probability of cycle transition (TP value 0.47, 0.31) between the states of knowledge list and knowledge content. In the support acquisition trail (SA-T), there was a high probability of self-transition in the questionnaire (TP value 0.29) state. Cluster analysis discovered 3 patient behavior preference patterns: PT-T cluster, PT-T and KL-T cluster, and PT-T and SA-T cluster. There were statistically significant associations between the behavior preference pattern and gender, education level, and BP. Conclusions: This study identified the dynamic, longitudinal, and multidimensional characteristics of patient behavior. Patients preferred to focus on BP, medications, and weight conditions and paid attention to BP and medications using reminders. The diet management and questionnaires were complicated and difficult to implement and record. Competitive methods such as ranking were more likely to attract patients to pay attention to their own self-management states. Female patients with lower education level and poorly controlled BP were more likely to be highly involved in hypertension health education. ",
doi="10.2196/33189",
url="https://mhealth.jmir.org/2022/2/e33189",
url="http://www.ncbi.nlm.nih.gov/pubmed/35113032"
}


@Article{info:doi/10.2196/30457,
author="Butler, Sonia
and Sculley, Dean
and Santos, Derek
and Fellas, Antoni
and Giron{\`e}s, Xavier
and Singh-Grewal, Davinder
and Coda, Andrea",
title="Effectiveness of eHealth and mHealth Interventions Supporting Children and Young People Living With Juvenile Idiopathic Arthritis: Systematic Review and Meta-analysis",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="2",
volume="24",
number="2",
pages="e30457",
keywords="eHealth",
keywords="mobile health",
keywords="mHealth",
keywords="juvenile idiopathic arthritis",
keywords="pediatric",
keywords="effectiveness",
keywords="pain",
keywords="physical activity",
keywords="health-related quality of life",
keywords="self-management",
keywords="education",
keywords="mobile phone",
abstract="Background: Juvenile idiopathic arthritis (JIA) management aims to promote remission through timely, individualized, well-coordinated interdisciplinary care using a range of pharmacological, physical, psychological, and educational interventions. However, achieving this goal is workforce-intensive. Harnessing the burgeoning eHealth and mobile health (mHealth) interventions could be a resource-efficient way of supplementing JIA management. Objective: This systematic review aims to identify the eHealth and mHealth interventions that have been proven to be effective in supporting health outcomes for children and young people (aged 1-18 years) living with JIA. Methods: We systematically searched 15 databases (2018-2021). Studies were eligible if they considered children and young people (aged 1-18 years) diagnosed with JIA, an eHealth or mHealth intervention, any comparator, and health outcomes related to the used interventions. Independently, 2 reviewers screened the studies for inclusion and appraised the study quality using the Downs and Black (modified) checklist. Study outcomes were summarized using a narrative, descriptive method and, where possible, combined for a meta-analysis using a random-effects model. Results: Of the 301 studies identified in the search strategy, 15 (5\%) fair-to-good--quality studies met the inclusion criteria, which identified 10 interventions for JIA (age 4-18.6 years). Of these 10 interventions, 5 (50\%) supported symptom monitoring by capturing real-time data using health applications, electronic diaries, or web-based portals to monitor pain or health-related quality of life (HRQoL). Within individual studies, a preference was demonstrated for real-time pain monitoring over recall pain assessments because of a peak-end effect, improved time efficiency (P=.002), and meeting children's and young people's HRQoL needs (P<.001) during pediatric rheumatology consultations. Furthermore, 20\% (2/10) of interventions supported physical activity promotion using a web-based program or a wearable activity tracker. The web-based program exhibited a moderate effect, which increased endurance time, physical activity levels, and moderate to vigorous physical activity (standardized mean difference [SMD] 0.60, SD 0.02-1.18; I2=79\%; P=.04). The final 30\% (3/10) of interventions supported self-management development through web-based programs, or apps, facilitating a small effect, reducing pain intensity (SMD ?0.14, 95\% CI ?0.43 to 0.15; I2=53\%; P=.33), and increasing disease knowledge and self-efficacy (SMD 0.30, 95\% CI 0.03-0.56; I2=74\%; P=.03). These results were not statistically significant. No effect was seen regarding pain interference, HRQoL, anxiety, depression, pain coping, disease activity, functional ability, or treatment adherence. Conclusions: Evidence that supports the inclusion of eHealth and mHealth interventions in JIA management is increasing. However, this evidence needs to be considered cautiously because of the small sample size, wide CIs, and moderate to high statistical heterogeneity. More rigorous research is needed on the longitudinal effects of real-time monitoring, web-based pediatric rheumatologist--children and young people interactions, the comparison among different self-management programs, and the use of wearable technologies as an objective measurement for monitoring physical activity before any recommendations that inform current practice can be given. ",
doi="10.2196/30457",
url="https://www.jmir.org/2022/2/e30457",
url="http://www.ncbi.nlm.nih.gov/pubmed/35107431"
}


@Article{info:doi/10.2196/27355,
author="Hu, Lu
and Trinh-Shevrin, Chau
and Islam, Nadia
and Wu, Bei
and Cao, Shimin
and Freeman, Jincong
and Sevick, Ann Mary",
title="Mobile Device Ownership, Current Use, and Interest in Mobile Health Interventions Among Low-Income Older Chinese Immigrants With Type 2 Diabetes: Cross-sectional Survey Study",
journal="JMIR Aging",
year="2022",
month="Feb",
day="2",
volume="5",
number="1",
pages="e27355",
keywords="technology use",
keywords="Chinese immigrants",
keywords="type 2 diabetes",
keywords="mHealth",
keywords="health disparities",
keywords="immigrant health",
keywords="diabetes",
keywords="mobile health",
keywords="intervention",
keywords="smartphone",
keywords="immigrant",
abstract="Background: Chinese immigrants suffer a disproportionately high type 2 diabetes (T2D) burden and tend to have poorly controlled disease. Mobile health (mHealth) interventions have been shown to increase access to care and improve chronic disease management in minority populations. However, such interventions have not been developed for or tested in Chinese immigrants with T2D. Objective: This study aims to examine mobile device ownership, current use, and interest in mHealth interventions among Chinese immigrants with T2D. Methods: In a cross-sectional survey, Chinese immigrants with T2D were recruited from Chinese community centers in New York City. Sociodemographic characteristics, mobile device ownership, current use of social media software applications, current use of technology for health-related purposes, and interest in using mHealth for T2D management were assessed. Surveys were administered face-to-face by bilingual study staff in the participant's preferred language. Descriptive statistics were used to characterize the study sample and summarize technology use. Results: The sample (N=91) was predominantly female (n=57, 63\%), married (n=68, 75\%), and had a high school education or less (n=58, 64\%); most participants had an annual household income of less than US \$25,000 (n=63, 69\%) and had limited English proficiency (n=78, 86\%). The sample had a mean age of 70 (SD 11) years. Almost all (90/91, 99\%) participants had a mobile device (eg, basic cell phones, smart devices), and the majority (n=83, 91\%) reported owning a smart device (eg, smartphone or tablet). WeChat was the most commonly used social media platform (65/91, 71\%). When asked about their top source for diabetes-related information, 63 of the 91 participants (69\%) reported health care providers, followed by 13 who reported the internet (14\%), and 10 who reported family, friends, and coworkers (11\%). Less than one-quarter (21/91, 23\%) of the sample reported using the internet to search for diabetes-related information in the past 12 months. About one-third of the sample (34/91, 37\%) reported that they had watched a health-related video on their cell phone or computer in the past 12 months. The majority (69/91, 76\%) of participants reported interest in receiving an mHealth intervention in the future to help with T2D management. Conclusions: Despite high mobile device ownership, the current use of technology for health-related issues remained low in older Chinese immigrants with T2D. Given the strong interest in future mHealth interventions and high levels of social media use (eg, WeChat), future studies should consider how to leverage these existing low-cost platforms and deliver tailored mHealth interventions to this fast-growing minority group. ",
doi="10.2196/27355",
url="https://aging.jmir.org/2022/1/e27355",
url="http://www.ncbi.nlm.nih.gov/pubmed/35107426"
}


@Article{info:doi/10.2196/34778,
author="Wong, Cheong Kam
and Nguyen, N. Tu
and Marschner, Simone
and Turnbull, Samual
and Burns, Jenner Mason
and Ne, Anna Jia Yi
and Gopal, Vishal
and Indrawansa, Balasuriya Anupama
and Trankle, A. Steven
and Usherwood, Tim
and Kumar, Saurabh
and Lindley, I. Richard
and Chow, K. Clara",
title="Patient-Led Mass Screening for Atrial Fibrillation in the Older Population Using Handheld Electrocardiographic Devices Integrated With a Clinician-Coordinated Remote Central Monitoring System: Protocol for a Randomized Controlled Trial and Process Evaluation",
journal="JMIR Res Protoc",
year="2022",
month="Feb",
day="1",
volume="11",
number="2",
pages="e34778",
keywords="atrial fibrillation",
keywords="screening",
keywords="handheld",
keywords="electrocardiogram",
keywords="ECG",
keywords="acceptability",
keywords="user perception",
keywords="user experience",
keywords="barrier",
keywords="enabler",
keywords="older adults",
keywords="elderly",
keywords="feasibility",
keywords="effectiveness",
keywords="implementation",
keywords="monitoring",
keywords="aging",
keywords="cardiovascular",
keywords="cardiology",
keywords="heart disease",
keywords="mobile phone",
abstract="Background: Atrial fibrillation (AF) is common in older people and increases the risk of stroke. The feasibility and effectiveness of the implementation of a patient-led AF screening program for older people are unknown. Objective: This study aims to examine the feasibility and effectiveness of an AF screening program comprising patient-led monitoring of single-lead electrocardiograms (ECGs) with clinician-coordinated central monitoring to diagnose AF among community-dwelling people aged ?75 years in Australia. Methods: This is a nationwide randomized controlled implementation trial conducted via the internet and remotely among 200 community-dwelling adults aged ?75 years with no known AF. Randomization will be performed in a 1:1 allocation ratio for the intervention versus control. Intervention group participants will be enrolled in the monitoring program at randomization. They will receive a handheld single-lead ECG device and training on the self-recording of ECGs on weekdays and submit their ECGs via their smartphones. The control group participants will receive usual care from their general practitioners for the initial 6 months and then commence the 6-month monitoring program. The ECGs will be reviewed centrally by trained personnel. Participants and their general practitioners will be notified of AF and other clinically significant ECG abnormalities. Results: This study will establish the feasibility and effectiveness of implementing the intervention in this patient population. The primary clinical outcome is the AF detection rate, and the primary feasibility outcome is the patient satisfaction score. Other outcomes include appropriate use of anticoagulant therapy, participant recruitment rate, program engagement (eg, frequency of ECG transmission), agreement in ECG interpretation between the device automatic algorithm and clinicians, the proportion of participants who complete the trial and number of dropouts, and the impact of frailty on feasibility and outcomes. We will conduct a qualitative evaluation to examine the barriers to and acceptability and enablers of implementation. Ethics approval was obtained from the human research ethics committee at the University of Sydney (project number 2020/680). The results will be disseminated via conventional scienti?c forums, including peer-reviewed publications and presentations at national and international conferences. Conclusions: By incorporating an integrated health care approach involving patient empowerment, centralized clinician-coordinated ECG monitoring, and facilitation of primary care and specialist services, it is possible to diagnose and treat AF early to reduce stroke risk. This study will provide new information on how to implement AF screening using digital health technology practicably and feasibly for older and frail populations residing in the community. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000184875; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380877 International Registered Report Identifier (IRRID): DERR1-10.2196/34778 ",
doi="10.2196/34778",
url="https://www.researchprotocols.org/2022/2/e34778",
url="http://www.ncbi.nlm.nih.gov/pubmed/35103614"
}


@Article{info:doi/10.2196/28095,
author="Laiou, Petroula
and Kaliukhovich, A. Dzmitry
and Folarin, A. Amos
and Ranjan, Yatharth
and Rashid, Zulqarnain
and Conde, Pauline
and Stewart, Callum
and Sun, Shaoxiong
and Zhang, Yuezhou
and Matcham, Faith
and Ivan, Alina
and Lavelle, Grace
and Siddi, Sara
and Lamers, Femke
and Penninx, WJH Brenda
and Haro, Maria Josep
and Annas, Peter
and Cummins, Nicholas
and Vairavan, Srinivasan
and Manyakov, V. Nikolay
and Narayan, A. Vaibhav
and Dobson, JB Richard
and Hotopf, Matthew
and ",
title="The Association Between Home Stay and Symptom Severity in Major Depressive Disorder: Preliminary Findings From a Multicenter Observational Study Using Geolocation Data From Smartphones",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Jan",
day="28",
volume="10",
number="1",
pages="e28095",
keywords="major depressive disorder",
keywords="PHQ-8",
keywords="smartphone",
keywords="GPS",
keywords="home stay",
keywords="mobile phone",
abstract="Background: Most smartphones and wearables are currently equipped with location sensing (using GPS and mobile network information), which enables continuous location tracking of their users. Several studies have reported that various mobility metrics, as well as home stay, that is, the amount of time an individual spends at home in a day, are associated with symptom severity in people with major depressive disorder (MDD). Owing to the use of small and homogeneous cohorts of participants, it is uncertain whether the findings reported in those studies generalize to a broader population of individuals with MDD symptoms. Objective: The objective of this study is to examine the relationship between the overall severity of depressive symptoms, as assessed by the 8-item Patient Health Questionnaire, and median daily home stay over the 2 weeks preceding the completion of a questionnaire in individuals with MDD. Methods: We used questionnaire and geolocation data of 164 participants with MDD collected in the observational Remote Assessment of Disease and Relapse--Major Depressive Disorder study. The participants were recruited from three study sites: King's College London in the United Kingdom (109/164, 66.5\%); Vrije Universiteit Medisch Centrum in Amsterdam, the Netherlands (17/164, 10.4\%); and Centro de Investigaci{\'o}n Biom{\'e}dica en Red in Barcelona, Spain (38/164, 23.2\%). We used a linear regression model and a resampling technique (n=100 draws) to investigate the relationship between home stay and the overall severity of MDD symptoms. Participant age at enrollment, gender, occupational status, and geolocation data quality metrics were included in the model as additional explanatory variables. The 95\% 2-sided CIs were used to evaluate the significance of model variables. Results: Participant age and severity of MDD symptoms were found to be significantly related to home stay, with older (95\% CI 0.161-0.325) and more severely affected individuals (95\% CI 0.015-0.184) spending more time at home. The association between home stay and symptoms severity appeared to be stronger on weekdays (95\% CI 0.023-0.178, median 0.098; home stay: 25th-75th percentiles 17.8-22.8, median 20.9 hours a day) than on weekends (95\% CI ?0.079 to 0.149, median 0.052; home stay: 25th-75th percentiles 19.7-23.5, median 22.3 hours a day). Furthermore, we found a significant modulation of home stay by occupational status, with employment reducing home stay (employed participants: 25th-75th percentiles 16.1-22.1, median 19.7 hours a day; unemployed participants: 25th-75th percentiles 20.4-23.5, median 22.6 hours a day). Conclusions: Our findings suggest that home stay is associated with symptom severity in MDD and demonstrate the importance of accounting for confounding factors in future studies. In addition, they illustrate that passive sensing of individuals with depression is feasible and could provide clinically relevant information to monitor the course of illness in patients with MDD. ",
doi="10.2196/28095",
url="https://mhealth.jmir.org/2022/1/e28095",
url="http://www.ncbi.nlm.nih.gov/pubmed/35089148"
}


@Article{info:doi/10.2196/26049,
author="Buck, Benjamin
and Nguyen, Janelle
and Porter, Shelan
and Ben-Zeev, Dror
and Reger, M. Greg",
title="FOCUS mHealth Intervention for Veterans With Serious Mental Illness in an Outpatient Department of Veterans Affairs Setting: Feasibility, Acceptability, and Usability Study",
journal="JMIR Ment Health",
year="2022",
month="Jan",
day="28",
volume="9",
number="1",
pages="e26049",
keywords="mHealth",
keywords="veterans",
keywords="schizophrenia",
keywords="serious mental illness",
keywords="mobile phone",
abstract="Background: Veterans with serious mental illnesses (SMIs) face barriers to accessing in-person evidence-based interventions that improve illness management. Mobile health (mHealth) has been demonstrated to be feasible, acceptable, effective, and engaging among individuals with SMIs in community mental health settings. mHealth for SMIs has not been tested within the Department of Veterans Affairs (VA). Objective: This study examines the feasibility, acceptability, and preliminary effectiveness of an mHealth intervention for SMI in the context of VA outpatient care. Methods: A total of 17 veterans with SMIs were enrolled in a 1-month pilot trial of FOCUS, a smartphone-based self-management intervention for SMI. At baseline and posttest, they completed measures examining symptoms and functional recovery. The participants provided qualitative feedback related to the usability and acceptability of the intervention. Results: Veterans completed on an average of 85.0 (SD 96.1) interactions with FOCUS over the 1-month intervention period. They reported high satisfaction, usability, and acceptability, with nearly all participants (16/17, 94\%) reporting that they would recommend the intervention to a fellow veteran. Clinicians consistently reported finding mHealth-related updates useful for informing their care. Qualitative feedback indicated that veterans thought mHealth complemented their existing VA services well and described potential opportunities to adapt FOCUS to specific subpopulations (eg, combat veterans) as well as specific delivery modalities (eg, groups). In the 1-month period, the participants experienced small improvements in self-assessed recovery, auditory hallucinations, and quality of life. Conclusions: The FOCUS mHealth intervention is feasible, acceptable, and usable among veterans. Future work should develop and examine VA-specific implementation approaches of FOCUS for this population. ",
doi="10.2196/26049",
url="https://mental.jmir.org/2022/1/e26049",
url="http://www.ncbi.nlm.nih.gov/pubmed/35089151"
}


@Article{info:doi/10.2196/30204,
author="Skime, K. Michelle
and Puspitasari, J. Ajeng
and Gentry, T. Melanie
and Heredia Jr, Dagoberto
and Sawchuk, N. Craig
and Moore, R. Wendy
and Taylor-Desir, J. Monica
and Schak, M. Kathryn",
title="Patient Satisfaction and Recommendations for Delivering a Group-Based Intensive Outpatient Program via Telemental Health During the COVID-19 Pandemic: Cross-sectional Cohort Study",
journal="JMIR Ment Health",
year="2022",
month="Jan",
day="28",
volume="9",
number="1",
pages="e30204",
keywords="COVID-19",
keywords="telemental health",
keywords="teletherapy",
keywords="telepsychiatry",
keywords="telemedicine",
keywords="intensive outpatient",
keywords="patient satisfaction",
abstract="Background: Although group-based intensive outpatient programs (IOPs) are a level of care commonly utilized by adults with serious mental illness, few studies have examined the acceptability of group-based IOPs that required rapid transition to a telemental health (TMH) format during the COVID-19 pandemic. Objective: The aim of this study was to evaluate patient satisfaction and future recommendations for a group-based IOP that was transitioned to a TMH format during the COVID-19 pandemic. Methods: A 17-item patient satisfaction questionnaire was completed by patients at discharge and covered 3 areas: IOP TMH satisfaction, future recommendations, and video technology challenges. Descriptive and content analyses were conducted for the quantitative and open-ended questions, respectively. Results: A total of 76 patients completed the program in 2020. A subset of patients (n=40, 53\%) responded to the survey at program discharge. The results indicated that the patients were satisfied overall with the TMH program format; 50\% (n=20) of the patients preferred the program continue offering the TMH format, and the rest preferred returning to in-person formats after the pandemic. The patients indicated the elements of the program that they found most valuable and provided recommendations for future program improvement. Conclusions: Overall, adults with serious mental illness reported high satisfaction with the group-based IOP delivered via TMH. Health care systems may want to consider offering both TMH and in-person formats regardless of the state of the pandemic. Patients' feedback on future improvements should be considered to help ensure long-term success. ",
doi="10.2196/30204",
url="https://mental.jmir.org/2022/1/e30204",
url="http://www.ncbi.nlm.nih.gov/pubmed/34878999"
}


@Article{info:doi/10.2196/29621,
author="Serrano-Ripoll, J. Maria
and Zamanillo-Campos, Roc{\'i}o
and Fiol-DeRoque, A. Maria
and Castro, Adoraci{\'o}n
and Ricci-Cabello, Ignacio",
title="Impact of Smartphone App--Based Psychological Interventions for Reducing Depressive Symptoms in People With Depression: Systematic Literature Review and Meta-analysis of Randomized Controlled Trials",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Jan",
day="27",
volume="10",
number="1",
pages="e29621",
keywords="smartphone technology",
keywords="mental health interventions",
keywords="depression",
keywords="eHealth",
keywords="mHealth",
keywords="apps",
keywords="systematic review",
keywords="meta-analysis",
keywords="mobile phone",
abstract="Background: Depression is a serious, disabling mental disorder that severely affects quality of life. Patients with depression often do not receive adequate treatment. App-based psychotherapy is considered to have great potential to treat depression owing to its reach and easy accessibility. Objective: We aim to analyze the impact of app-based psychological interventions for reducing depressive symptoms in people with depression. Methods: We conducted a systematic literature review and meta-analysis. We searched Medline, Embase, PsycINFO, Web of Science, and Cochrane Central Register of Controlled Trials from inception to December 23, 2020. We selected randomized controlled trials to examine the impact of app-based psychological interventions for reducing depressive symptoms in people with depression. Study selection, data extraction, and critical appraisal (using the Cochrane Risk of Bias tool for randomized studies and the ROBINS-I tool for nonrandomized studies) were conducted independently by 2 reviewers. Where possible, we pooled data using random effects meta-analyses to obtain estimates of the effect size of the intervention. We conducted post hoc meta-regression analyses to explore the factors associated with intervention success. Results: After screening 3468 unique references retrieved from bibliographic searches and assessing the eligibility of 79 full texts, we identified 12 trials (2859 participants) evaluating 14 different interventions. Of 14 trials, 7 (58\%) were conducted in the United States; 3 (25\%) trials, in Asia (Japan, South Korea, and China); 1 (8\%) trial, in Australia; and 1 (8\%) trial, in Germany. Of the 12 trials, 5 (42\%) trials presented a low risk of bias. The mean duration of the interventions was 6.6 (SD 2.8) weeks. Two-thirds of the interventions were based on cognitive behavioral therapy alone or included it in combination with cognitive control therapy, positive psychology, brief behavioral activation, or mindfulness- and acceptance-based therapy. With no evidence of publication bias, a pooled analysis of 83\% (10/12) of the trials and 86\% (12/14) of the interventions showed that app-based interventions, compared with a control group receiving usual care or minimal intervention, produced a moderate reduction in depressive symptoms (standardized mean difference [SMD] ?0.51, 95\% CI ?0.69 to ?0.33; 2018/2859, 70.58\% of the participants; I2=70\%). Our meta-regression analyses indicated that there was a greater reduction in symptoms of depression (P=.04) in trials that included participants with moderate to severe depression (SMD ?0.67, 95\% CI ?0.79 to ?0.55), compared with trials with participants exhibiting mild to moderate depression (SMD ?0.15, 95\% CI ?0.43 to ?0.12). Conclusions: App-based interventions targeted at people with depression produce moderate reductions in the symptoms of depression. More methodologically robust trials are needed to confirm our findings, determine which intervention features are associated with greater improvements, and identify those populations most likely to benefit from this type of intervention. Trial Registration: PROSPERO CRD42019145689; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=145689 ",
doi="10.2196/29621",
url="https://mhealth.jmir.org/2022/1/e29621",
url="http://www.ncbi.nlm.nih.gov/pubmed/35084346"
}


@Article{info:doi/10.2196/30361,
author="Hendricks-Sturrup, Rachele",
title="Pulse Oximeter App Privacy Policies During COVID-19: Scoping Assessment",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Jan",
day="27",
volume="10",
number="1",
pages="e30361",
keywords="COVID-19",
keywords="pulse oximeters",
keywords="mobile apps",
keywords="mHealth",
keywords="privacy",
abstract="Background: Pulse oximeter apps became of interest to consumers during the COVID-19 pandemic, particularly when traditional over-the-counter pulse oximeter devices were in short supply. Yet, no study to date has examined or scoped the state of privacy policies and notices for the top-rated and most downloaded pulse oximeter apps during COVID-19. Objective: The aim of this study was to examine, through a high-level qualitative assessment, the state and nature of privacy policies for the downloaded and top-rated pulse oximeter apps during the COVID-19 pandemic to (1) compare findings against comparable research involving other mobile health (mHealth) apps and (2) begin discussions on opportunities for future research or investigation. Methods: During August-October 2020, privacy policies were reviewed for pulse oximeter apps that had either at least 500 downloads (Google Play Store apps only) or a three out of five-star rating (Apple Store apps only). In addition to determining if the apps had an accessible privacy policy, other key privacy policy--related details that were extracted included, but were not limited to, app developer location (country); whether the app was free or required paid use/subscription; whether an ads disclosure was provided on the app's site; the scope of personal data collected; proportionality, fundamental rights, and data protection and privacy issues; and privacy safeguards. Results: Six pulse oximeter apps met the inclusion criteria and only 33\% (n=2) of the six apps had an accessible privacy policy that was specific to the pulse oximeter app feature (vs the app developer's website or at all). Variation was found in both the regulatory nature and data privacy protections offered by pulse oximeter apps, with notable privacy protection limitations and gaps, although each app provided at least some information about the scope of personal data collected upon installing the app. Conclusions: Pulse oximeter app developers should invest in offering stronger privacy protections for their app users, and should provide more accessible and transparent privacy policies. This is a necessary first step to ensure that the data privacy of mHealth consumers is not exploited during public health emergency situations such as the COVID-19 pandemic, where over-the-counter personal health monitoring devices could be in short supply and patients and consumers may, as a result, turn to mHealth apps to fill such supply gaps. Future research considerations and recommendations are also suggested for mHealth technology and privacy researchers who are interested in examining privacy implications associated with the use of pulse oximeter apps during and after the COVID-19 pandemic. ",
doi="10.2196/30361",
url="https://mhealth.jmir.org/2022/1/e30361",
url="http://www.ncbi.nlm.nih.gov/pubmed/35084348"
}


@Article{info:doi/10.2196/31451,
author="Bults, Marloes
and van Leersum, Margaretha Catharina
and Olthuis, Josef Theodorus Johannes
and Bekhuis, Marije Robin Enya
and den Ouden, Maria Marjolein Elisabeth",
title="Barriers and Drivers Regarding the Use of Mobile Health Apps Among Patients With Type 2 Diabetes Mellitus in the Netherlands: Explanatory Sequential Design Study",
journal="JMIR Diabetes",
year="2022",
month="Jan",
day="27",
volume="7",
number="1",
pages="e31451",
keywords="type 2 diabetes",
keywords="self-management",
keywords="mobile health, mobile apps",
keywords="prevention",
keywords="mixed methods research",
keywords="acceptance",
keywords="mobile phone",
abstract="Background: Self-monitoring of blood glucose levels, food intake, and physical activity supports self-management of patients with type 2 diabetes mellitus (T2DM). There has been an increase in the development and availability of mobile health apps for T2DM. Objective: The aim of this study is to explore the actual use of mobile health apps for diabetes among patients with T2DM and the main barriers and drivers among app users and nonusers. Methods: An explanatory sequential design was applied, starting with a web-based questionnaire followed by semistructured in-depth interviews. Data were collected between July and December 2020. Questionnaire data from 103 respondents were analyzed using IBM SPSS Statistics (version 25.0). Descriptive statistics were performed for the actual use of apps and items of the Unified Theory of Acceptance and Use of Technology (UTAUT). The UTAUT includes 4 key constructs: performance expectancy (the belief that an app will help improve health performance), effort expectancy (level of ease associated with using an app), social influence (social support), and facilitating conditions (infrastructural support). Differences between users and nonusers were analyzed using chi-square tests for individual items. Independent 2-tailed t tests were performed to test for differences in mean scores per the UTAUT construct. In total, 16 respondents participated in the interviews (10 users and 6 nonusers of apps for T2DM). We performed content analysis using a deductive approach on all transcripts, guided by the UTAUT. Results: Regarding actual use, 55.3\% (57/103) were nonusers and 44.7\% (46/103) were users of apps for T2DM. The main driver for the use of apps was the belief that using apps for managing diabetes would result in better personal health and well-being. The time and energy required to keep track of the data and understand the app were mentioned as barriers. Mean scores were significantly higher among users compared with nonusers of apps for T2DM for the constructs performance expectancy (4.06, SD 0.64 vs 3.29, SD 0.89; P<.001), effort expectancy (4.04, SD 0.62 vs 3.50, SD 0.82; P<.001), social influence (3.59, SD 0.55 vs 3.29, SD 0.54; P=.007), and facilitating conditions (4.22, SD 0.48 vs 3.65, SD 0.70; P<.001). On the basis of 16 in-depth interviews, it was recognized that health care professionals play an important role in supporting patients with T2DM in using apps. However, respondents noticed that their health care professionals were often not supportive of the use of apps for managing diabetes, did not show interest, or did not talk about apps. Reimbursement by insurance companies was mentioned as a missing facilitator. Conclusions: Empowering health care professionals' engagement is of utmost importance in supporting patients with T2DM in the use of apps. Insurance companies can play a role in facilitating the use of diabetes apps by ensuring reimbursement. ",
doi="10.2196/31451",
url="https://diabetes.jmir.org/2022/1/e31451",
url="http://www.ncbi.nlm.nih.gov/pubmed/35084357"
}


@Article{info:doi/10.2196/31754,
author="Ware, Patrick
and Shah, Amika
and Ross, Joan Heather
and Logan, Gordon Alexander
and Segal, Phillip
and Cafazzo, Antony Joseph
and Szacun-Shimizu, Katarzyna
and Resnick, Myles
and Vattaparambil, Tessy
and Seto, Emily",
title="Challenges of Telemonitoring Programs for Complex Chronic Conditions: Randomized Controlled Trial With an Embedded Qualitative Study",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="26",
volume="24",
number="1",
pages="e31754",
keywords="telemonitoring",
keywords="telemedicine",
keywords="heart failure",
keywords="diabetes",
keywords="hypertension",
keywords="tertiary health care",
keywords="multiple chronic conditions",
keywords="mobile phone",
abstract="Background: Despite the growing prevalence of people with complex conditions and evidence of the positive impact of telemonitoring for single conditions, little research exists on telemonitoring for this population. Objective: This randomized controlled trial and embedded qualitative study aims to evaluate the impact on and experiences of patients and health care providers (HCPs) using a telemonitoring system with decision support to manage patients with complex conditions, including those with multiple chronic conditions, compared with the standard of care. Methods: A pragmatic, unblinded, 6-month randomized controlled trial sought to recruit 146 patients with ?1 diagnosis of heart failure (HF), uncontrolled hypertension (HT), and insulin-requiring diabetes mellitus (DM) from outpatient specialty settings in Toronto, Ontario, Canada. Participants were randomized into the control and telemonitoring groups, with the latter being instructed to take readings relevant to their conditions. The telemonitoring system contained an algorithm that generated decision support in the form of actionable self-care directives to patients and alerts to HCPs. The primary outcome was health status (36-Item Short Form Health Survey questionnaire). Secondary outcomes included anxiety and depression, self-efficacy in chronic disease management, and self-reported health service use. HF-related quality of life and self-care measures were also collected from patients followed for HF. Within- and between-group change scores were analyzed for statistical significance (P<.05). A convenience sample of HCPs and patients in the intervention group was interviewed about their experiences. Results: A total of 96 patients were recruited and randomized. Recruitment was terminated early because of implementation challenges and the onset of the COVID-19 pandemic. No significant within- and between-group differences were found for the main primary and secondary outcomes. However, a within-group analysis of patients with HF found improvements in self-care maintenance (P=.04) and physical quality of life (P=.046). Opinions expressed by the 5 HCPs and 13 patients who were interviewed differed based on the monitored conditions. Although patients with HF reported benefitting from actionable self-care guidance and meaningful interactions with their HCPs, patient and HCP users of the DM and HT modules did not think telemonitoring improved the clinical management of those conditions to the same degree. These differing experiences were largely attributed to the siloed nature of specialty care and the design of the decision support, whereby fluctuations in the status of HT and DM typically required less urgent interventions compared with patients with HF. Conclusions: We recommend that future research conceive telemonitoring as a program and that self-management and clinical decision support are necessary but not sufficient components of such programs for patients with complex conditions and lower acuity. We conclude that telemonitoring for patients with complex conditions or within multidisciplinary care settings may be best operationalized through nurse-led models of care. Trial Registration: ClinicalTrials.gov NCT03127852; https://clinicaltrials.gov/ct2/show/NCT03127852 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.8367 ",
doi="10.2196/31754",
url="https://www.jmir.org/2022/1/e31754",
url="http://www.ncbi.nlm.nih.gov/pubmed/35080502"
}


@Article{info:doi/10.2196/27349,
author="Passardi, Alessandro
and Foca, Flavia
and Caffo, Orazio
and Tondini, Alberto Carlo
and Zambelli, Alberto
and Vespignani, Roberto
and Bartolini, Giulia
and Sullo, Giulio Francesco
and Andreis, Daniele
and Dianti, Marco
and Eccher, Claudio
and Piras, Maria Enrico
and Forti, Stefano",
title="A Remote Monitoring System to Optimize the Home Management of Oral Anticancer Therapies (ONCO-TreC): Prospective Training--Validation Trial",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="26",
volume="24",
number="1",
pages="e27349",
keywords="adherence",
keywords="oral anticancer drug",
keywords="mHealth",
keywords="ONCO-TreC",
keywords="electronic diary",
abstract="Background: A platform designed to support the home management of oral anticancer treatments and provide a secure web-based patient--health care professional communication modality, ONCO-TreC, was tested in 3 cancer centers in Italy. Objective: The overall aims of the trial are to customize the platform; assess the system's ability to facilitate the shared management of oral anticancer therapies by patients and health professionals; and evaluate system usability and acceptability by patients, caregivers, and health care professionals. Methods: Patients aged ?18 years who were candidates for oral anticancer treatment as monotherapy with an Eastern Cooperative Oncology Group performance status score of 0 to 1 and a sufficient level of familiarity with mobile devices were eligible. ONCO-TreC consisted of a mobile app for patients and a web-based dashboard for health care professionals. Adherence to treatment (pill count) and toxicities reported by patients through the app were compared with those reported by physicians in medical records. Usability and acceptability were evaluated using questionnaires. Results: A total of 40 patients were enrolled, 38 (95\%) of whom were evaluable for adherence to treatment. The ability of the system to measure adherence to treatment was high, with a concordance of 97.3\% (95\% CI 86.1\%-99.9\%) between the investigator and system pill count. Only 60\% (3/5) of grade 3, 54\% (13/24) of grade 2, and 19\% (7/36) of grade 1 adverse events reported by physicians in the case report forms were also reported in the app directly by patients. In total, 94\% (33/35) of patients had ?1 app launch each week, and the median number of daily accesses per patient was 2. Approximately 71\% (27/38) and 68\% (26/38) of patients used the app for messages and vital sign entering, respectively, at least once during the study period. Conclusions: ONCO-TreC is an important tool for measuring and monitoring adherence to oral anticancer drugs. System usability and acceptability were very high, whereas its reliability in registering toxicity could be improved. Trial Registration: ClinicalTrials.gov NCT02921724; https://www.clinicaltrials.gov/ct2/show/NCT02921724 ",
doi="10.2196/27349",
url="https://www.jmir.org/2022/1/e27349",
url="http://www.ncbi.nlm.nih.gov/pubmed/35080505"
}


@Article{info:doi/10.2196/16447,
author="Haggstrom, A. David
and Carr, Thomas",
title="Uses of Personal Health Records for Communication Among Colorectal Cancer Survivors, Caregivers, and Providers: Interview and Observational Study in a Human-Computer Interaction Laboratory",
journal="JMIR Hum Factors",
year="2022",
month="Jan",
day="25",
volume="9",
number="1",
pages="e16447",
keywords="personal health record",
keywords="communication",
keywords="cancer survivorship",
keywords="colorectal cancer",
abstract="Background: Personal health records (PHRs) may be useful for patient self-management and participation in communication with their caregivers and health care providers. As each potential participant's role is different, their perception of the best uses of a PHR may vary. Objective: The perspectives of patients, caregivers, and providers were all evaluated concurrently in relation to a PHR developed for colorectal cancer (CRC) survivors. Methods: We explored group perceptions of a CRC PHR prototype. Scenario-based testing across eight use cases, with semistructured follow-up interviews, was videotaped in a human-computer interaction laboratory with patients, caregivers, and health care providers. Providers included oncologists, gastroenterologists, and primary care physicians. Discrete observations underwent grounded theory visual affinity analysis to identify emergent themes. Results: Observations fell into three major themes: the network (who should be granted access to the PHR by the patient), functions (helpful activities the PHR enabled), and implementation (how to adopt the PHR into workflow). Patients wanted physician access to their PHR, as well as family member access, especially when they lived at a distance. All groups noted the added value of linking the PHR to an electronic health record, self-tracking, self-management, and secure messaging. Patients and caregivers also saw information in the PHR as a useful memory tool given their visits to multiple doctors. Providers had reservations about patients viewing raw data, which they were not prepared to interpret or might be inaccurate; patients and caregivers did not express any reservations about having access to more information. Patients saw PHR communication functions as a potential tool for relationship building. Patients and caregivers valued the journal as a tool for reflection and delivery of emotional support. Providers felt the PHR would facilitate patient-physician communication but worried that sharing journal access would make the doctor-patient relationship less professional and had reservations about the time burden of reviewing. Strategies suggested for efficient adoption into workflow included team delegation. Establishment of parameters for patient uses and provider responses was perceived as good standard practice. Conclusions: PHR perceptions differed by role, with providers seeing the PHR as informational, while patients and caregivers viewed the tool as more relational. Personal health records should be linked to electronic health records for ease of use. Tailoring access, content, and implementation of the PHR is essential. Technology changes have the potential to change the nature of the patient-physician relationship. Patients and providers should establish shared expectations about the optimal use of the PHR and explore how emerging patient-centered technologies can be successfully implemented in modern medical practice to improve the relational quality of care. ",
doi="10.2196/16447",
url="https://humanfactors.jmir.org/2022/1/e16447",
url="http://www.ncbi.nlm.nih.gov/pubmed/35076406"
}


@Article{info:doi/10.2196/26555,
author="Svendsen, Jagd Malene
and Sandal, Fleng Louise
and Kj{\ae}r, Per
and Nicholl, I. Barbara
and Cooper, Kay
and Mair, Frances
and Hartvigsen, Jan
and Stochkendahl, Jensen Mette
and S{\o}gaard, Karen
and Mork, Jarle Paul
and Rasmussen, Charlotte",
title="Using Intervention Mapping to Develop a Decision Support System--Based Smartphone App (selfBACK) to Support Self-management of Nonspecific Low Back Pain: Development and Usability Study",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="24",
volume="24",
number="1",
pages="e26555",
keywords="intervention mapping",
keywords="behavior change",
keywords="low back pain",
keywords="self-management",
keywords="mHealth",
keywords="app-based intervention",
keywords="decision support system",
keywords="digital health intervention",
keywords="mobile phone",
abstract="Background: International guidelines consistently endorse the promotion of self-management for people with low back pain (LBP); however, implementation of these guidelines remains a challenge. Digital health interventions, such as those that can be provided by smartphone apps, have been proposed as a promising mode of supporting self-management in people with chronic conditions, including LBP. However, the evidence base for digital health interventions to support self-management of LBP is weak, and detailed descriptions and documentation of the interventions are lacking. Structured intervention mapping (IM) constitutes a 6-step process that can be used to guide the development of complex interventions. Objective: The aim of this paper is to describe the IM process for designing and creating an app-based intervention designed to support self-management of nonspecific LBP to reduce pain-related disability. Methods: The first 5 steps of the IM process were systematically applied. The core processes included literature reviews, brainstorming and group discussions, and the inclusion of stakeholders and representatives from the target population. Over a period of >2 years, the intervention content and the technical features of delivery were created, tested, and revised through user tests, feasibility studies, and a pilot study. Results: A behavioral outcome was identified as a proxy for reaching the overall program goal, that is, increased use of evidence-based self-management strategies. Physical exercises, education, and physical activity were the main components of the self-management intervention and were designed and produced to be delivered via a smartphone app. All intervention content was theoretically underpinned by the behavior change theory and the normalization process theory. Conclusions: We describe a detailed example of the application of the IM approach for the development of a theory-driven, complex, and digital intervention designed to support self-management of LBP. This description provides transparency in the developmental process of the intervention and can be a possible blueprint for designing and creating future digital health interventions for self-management. ",
doi="10.2196/26555",
url="https://www.jmir.org/2022/1/e26555",
url="http://www.ncbi.nlm.nih.gov/pubmed/35072645"
}


@Article{info:doi/10.2196/31857,
author="Buhr, Lorina
and Schicktanz, Silke
and Nordmeyer, Eike",
title="Attitudes Toward Mobile Apps for Pandemic Research Among Smartphone Users in Germany: National Survey",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Jan",
day="24",
volume="10",
number="1",
pages="e31857",
keywords="user",
keywords="pandemic",
keywords="smartphone apps",
keywords="mobile apps",
keywords="telephone-based survey",
keywords="Germany",
keywords="data sharing",
keywords="data donation",
keywords="ethics",
keywords="trust",
keywords="COVID-19",
keywords="mHealth",
keywords="mobile applications",
keywords="digital health",
keywords="health applications",
abstract="Background: During the COVID-19 pandemic, but also in the context of previous epidemic diseases, mobile apps for smartphones were developed with different goals and functions, such as digital contact tracing, test management, symptom monitoring, quarantine compliance, and epidemiological and public health research. Objective: The aim of this study was to explore the potential for the acceptance of research-orientated apps (ROAs) in the German population. To this end, we identified distinctive attitudes toward pandemic apps and data sharing for research purposes among smartphone users in general and with a focus on differences in attitudes between app users and nonusers in particular. Methods: We conducted a cross-sectional, national, telephone-based survey of 1003 adults in Germany, of which 924 were useable for statistical analysis. The 17-item survey assessed current usage of pandemic apps, motivations for using or not using pandemic apps, trust in app distributors and attitudes toward data handling (data storage and transmission), willingness to share coded data with researchers using a pandemic app, social attitudes toward app use, and demographic and personal characteristics. Results: A vast majority stated that they used a smartphone (778/924, 84.2\%), but less than half of the smartphone users stated that they used a pandemic app (326/778, 41.9\%). The study focused on the subsample of smartphone users. Interestingly, when asked about preferred organizations for data storage and app distribution, trust in governmental (federal or state government, regional health office), public-appointed (statutory health insurance), or government-funded organizations (research institutes) was much higher than in private organizations (private research institutions, clinics, health insurances, information technology [IT] companies). Having a university degree significantly (P<.001) increased the likelihood of using a pandemic app, while having a migration background significantly (P<.001) decreased it. The overwhelming majority (653/778, 83.9\%) of smartphone users were willing to provide their app data for state-funded research. Regarding attitudes toward app usage, striking differences between users and nonusers were found. Almost all app users (317/327, 96.9\%) stated they would be willing to share data, whereas only 74.3\% (336/452) of nonusers supported data sharing via an app. Two-thirds (216/326, 66.3\%) of app users fully or rather agreed with the statement that using a pandemic app is a social duty, whereas almost the same proportion of nonusers entirely or rather disagreed with that statement (273/451, 60.5\%). Conclusions: These findings indicate a high potential for the adoption of ROAs among smartphone users in Germany as long as organizational providers engaged in development, operation, and distribution are state-funded or governmental institutions and transparency about data-using research institutions is provided. ",
doi="10.2196/31857",
url="https://mhealth.jmir.org/2022/1/e31857",
url="http://www.ncbi.nlm.nih.gov/pubmed/35072646"
}


@Article{info:doi/10.2196/33944,
author="Lee, JuHee
and Yeom, Insun
and Chung, L. Misook
and Kim, Yielin
and Yoo, Subin
and Kim, Eunyoung",
title="Use of Mobile Apps for Self-care in People With Parkinson Disease: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Jan",
day="21",
volume="10",
number="1",
pages="e33944",
keywords="systematic review",
keywords="Parkinson disease",
keywords="motor symptoms",
keywords="nonmotor symptoms",
keywords="smartphone",
keywords="mobile phone",
keywords="mobile health",
keywords="mobile apps",
keywords="self-care",
keywords="symptom",
keywords="monitoring",
keywords="review",
keywords="disability",
keywords="app",
keywords="care",
keywords="quality of life",
keywords="self-management",
abstract="Background: Self-care is essential for people with Parkinson disease (PD) to minimize their disability and adapt to alterations in physical abilities due to this progressive neurodegenerative disorder. With rapid developments in mobile technology, many health-related mobile apps for PD have been developed and used. However, research on mobile app--based self-care in PD is insufficient. Objective: This study aimed to explore the features and characteristics of mobile apps for self-care in people with PD. Methods: This study was performed sequentially according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Web of Science, and PsycINFO were searched in consultation with a librarian on June 8, 2021. We used keywords including ''Parkinson disease'' and ''mobile.'' Results: A total of 17 studies were selected based on the inclusion criteria, including 3 randomized controlled trials and 14 observational studies or quasi-experimental studies. The use of mobile apps for self-care in people with PD focused on symptom monitoring, especially motor symptoms. Motor symptoms were objectively measured mainly through the sensors of smartphones or wearable devices and task performance. Nonmotor symptoms were monitored through task performance or self-reported questionnaires in mobile apps. Most existing studies have focused on clinical symptom assessment in people with PD, and there is a lack of studies focusing on symptom management. Conclusions: Mobile apps for people with PD have been developed and used, but strategies for self-management are insufficient. We recommend the development of mobile apps focused on self-care that can enhance symptom management and health promotion practices. Studies should also evaluate the effects of mobile apps on symptom improvement and quality of life in people with PD. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021267374; https://www.crd.york.ac.uk/prospero/display\_record.php?ID=CRD42021267374. ",
doi="10.2196/33944",
url="https://mhealth.jmir.org/2022/1/e33944",
url="http://www.ncbi.nlm.nih.gov/pubmed/35060910"
}


@Article{info:doi/10.2196/26453,
author="Voth, Melissa
and Chisholm, Shannon
and Sollid, Hannah
and Jones, Chelsea
and Smith-MacDonald, Lorraine
and Br{\'e}mault-Phillips, Suzette",
title="Efficacy, Effectiveness, and Quality of Resilience-Building Mobile Health Apps for Military, Veteran, and Public Safety Personnel Populations: Scoping Literature Review and App Evaluation",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Jan",
day="19",
volume="10",
number="1",
pages="e26453",
keywords="occupational stress injury",
keywords="trauma",
keywords="mHealth",
keywords="resilience",
keywords="mental health",
keywords="military",
keywords="veteran",
keywords="public safety personnel",
keywords="OSI",
keywords="PTSD",
keywords="mental health intervention",
keywords="mobile phone",
abstract="Background: Military members (MMs) and public safety personnel (PSP) are vulnerable to occupational stress injuries because of their job demands. When MMs and PSP transition out of these professions, they may continue to experience mental health challenges. The development and implementation of resilience-building mobile health (mHealth) apps as an emergent mental health intervention platform has allowed for targeted, cost-effective, and easily accessible treatment when in-person therapy may be limited or unavailable. However, current mHealth app development is not regulated, and often lacks both clear evidence-based research and the input of health care professionals. Objective: This study aims to evaluate the evidence-based quality, efficacy, and effectiveness of resilience-building mobile apps targeted toward the MMs, PSP, and veteran populations via a scoping literature review of the current evidence base regarding resilience apps for these populations and an evaluation of free resilience apps designed for use among these populations. Methods: The studies were selected using a comprehensive search of MEDLINE, CINAHL Plus, PsycINFO, SocINDEX, Academic Search Complete, Embase, and Google and were guided by PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). A narrative synthesis of the resulting papers was performed. The Alberta Rating Index for Apps was used to conduct a review of each of the identified apps. The inclusion criteria consisted of apps that were free to download in either the Google Play Store or the Apple App Store; updated within the last 3 years; available in English and in Canada; and intended for use by MMs, veterans, and PSP. Results: In total, 22 apps met the inclusion criteria for evaluation. The resilience strategies offered by most apps included psychoeducation, mindfulness, cognitive behavioral therapy, and acceptance and commitment therapy. Overall, 50\% (11/22) of apps had been tested in randomized controlled trials, 7 (32\%) apps had been evaluated using other research methods, and 5 (23\%) apps had not been studied. Using the Alberta Rating Index for Apps, the app scores ranged from 37 to 56 out of 72, with higher rated apps demonstrating increased usability and security features. Conclusions: The mHealth apps reviewed are well-suited to providing resilience strategies for MMs, PSP, and veterans. They offer easy accessibility to evidence-based tools while working to encourage the use of emotional and professional support with safety in mind. Although not intended to function as a substitute for professional services, research has demonstrated that mHealth apps have the potential to foster a significant reduction in symptom severity for posttraumatic stress disorder, depression, anxiety, and other mental health conditions. In clinical practice, apps can be used to supplement treatment and provide clients with population-specific confidential tools to increase engagement in the treatment process. ",
doi="10.2196/26453",
url="https://mhealth.jmir.org/2022/1/e26453",
url="http://www.ncbi.nlm.nih.gov/pubmed/35044307"
}


@Article{info:doi/10.2196/24239,
author="Miller, Sascha
and Yardley, Lucy
and Smith, Peter
and Weal, Mark
and Anderson, Alexander
and Stuart, Beth
and Little, Paul
and Morrison, Leanne",
title="A Digital Intervention for Respiratory Tract Infections (Internet Dr): Process Evaluation to Understand How to Support Self-care for Minor Ailments",
journal="JMIR Form Res",
year="2022",
month="Jan",
day="19",
volume="6",
number="1",
pages="e24239",
keywords="illness behavior",
keywords="self-care",
keywords="internet",
keywords="evaluation studies",
keywords="respiratory tract infection",
keywords="mobile phone",
abstract="Background: Approximately 57 million physician appointments annually in the United Kingdom are for minor ailments. These illnesses could be self-cared for, which would potentially lower patients' anxiety, increase their confidence, and be more convenient. In a randomized controlled trial of the Internet Dr digital intervention, patients with access to the intervention had fewer consultations for respiratory tract infections (RTIs). Having established intervention efficacy, further examination of trial data is required to understand how the intervention works. Objective: This paper reports a process evaluation of Internet Dr usage by the intervention group. The evaluation aims to demonstrate how meaningful usage metrics (ie, interactions that are specific and relevant to the intervention) can be derived from the theoretical principles underlying the intervention, then applied to examine whether these interactions are effective in supporting self-care for RTIs, for whom, and at what time. Methods: The Internet Dr trial recorded patients' characteristics and usage data over 24 weeks. At follow-up, users reported whether their levels of enablement to cope with their illness changed over the trial period. The Medical Research Council process evaluation guidance and checklists from the framework for Analyzing and Measuring Usage and Engagement Data were applied to structure research questions examining associations between usage and enablement. Results: Viewing pages containing advice on caring for RTIs were identified as a meaningful metric for measuring intervention usage. Almost half of the users (616/1491, 42.31\%) viewed at least one advice page, with most people (478/616, 77.6\%) accessing them when they initially enrolled in the study. Users who viewed an advice page reported increased enablement to cope with their illness as a result of having participated in the study compared with users who did not (mean 2.12, SD 2.92 vs mean 1.65, SD 3.10; mean difference 0.469, 95\% CI 0.082-0.856). The target population was users who had visited their general practitioners for an RTI in the year before the trial, and analyses revealed that this group was more likely to access advice pages (odds ratio 1.35, 95\% CI 1.159-1.571; P<.001). Conclusions: The process evaluation identifies viewing advice pages as associated with increased enablement to self-care, even when accessed in the absence of a RTI, meaning that dissemination activities need not be restricted to targeting users who are ill. The intervention was effective at reaching the target population of users who had previously consulted their general practitioners. However, attrition before reaching advice pages was high, highlighting the necessity of prioritizing access during the design phase. These findings provide guidance on how the intervention may be improved and disseminated and have wider implications for minor ailment interventions. ",
doi="10.2196/24239",
url="https://formative.jmir.org/2022/1/e24239",
url="http://www.ncbi.nlm.nih.gov/pubmed/35044317"
}


@Article{info:doi/10.2196/29703,
author="Wang, Yiwen
and Liu, Xingkang
and Wang, Weimin
and Shi, Yanyun
and Ji, Xiaojian
and Hu, Lidong
and Wang, Lei
and Yin, Yiquan
and Xie, Siyuan
and Zhu, Jian
and Zhang, Jianglin
and Jiao, Wei
and Huang, Feng",
title="Adherence, Efficacy, and Safety of Wearable Technology--Assisted Combined Home-Based Exercise in Chinese Patients With Ankylosing Spondylitis: Randomized Pilot Controlled Clinical Trial",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="18",
volume="24",
number="1",
pages="e29703",
keywords="ankylosing spondylitis",
keywords="wearable technology",
keywords="home-based exercise",
keywords="combined exercise",
keywords="randomized controlled trial",
keywords="RCT",
keywords="exercise",
keywords="wearable",
keywords="photoplethysmography",
keywords="spondyloarthritis",
abstract="Background: Clinical practice guidelines recommend that exercise is essential in the self-management of ankylosing spondylitis (AS). Attending supervised interventions requiring periodic medical center visits can be difficult and patients may decline participation, whereas effective home-based exercise interventions that do not require regular medical center visits are likely to be more accessible for AS patients. Objective: The goal of the research was to investigate the adherence, efficacy, and safety of a wearable technology--assisted combined home-based exercise program in AS. Methods: This was a 16-week investigator-initiated, assessor-blinded, randomized, pilot controlled trial conducted at Chinese People's Liberation Army General Hospital. We enrolled patients with AS who had no regular exercise habits and had been stable in drug treatment for the preceding month. Patients were randomly assigned (1:1) using a computer algorithm. An exercise program consisting of moderate-intensity aerobic exercise and functional exercise was given to the patients in the intervention group. The exercise intensity was controlled by a Mio FUSE Heart Rate Monitor wristband, which uses photoplethysmography to measure heart rate. Patients in the control group received usual care. The primary outcome was the difference in the Ankylosing Spondylitis Disease Activity Score (ASDAS). The secondary outcomes were patient global assessment (PGA), physician global assessment (PhGA), total pain, nocturnal pain, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), BAS Functional Index (BASFI), BAS Metrology Index (BASMI), Spondyloarthritis International Society Health Index (ASAS HI), 36-item Short Form Survey (SF-36), maximal oxygen uptake (VO2) max, body composition, range of motion of joints, and muscle endurance tests. Retention rate, adherence rate, barriers to being active, and adverse events were also assessed. Results: A total of 77 patients were screened, of whom 55 (71\%) patients were enrolled; 2\% (1/55) withdrew without treatment after randomization. Patients were assigned to the intervention (n=26) or control group (n=28). The median adherence rate of the prescribed exercise protocol was 84.2\% (IQR 48.7\%-97.9\%). For the primary outcome, between-group difference of ASDAS was significant, favoring the intervention (--0.2, 95\% CI --0.4 to 0.02, P=.03). For the secondary outcomes, significant between-group differences at 16 weeks were detected in PGA, PhGA, total pain, BASDAI, BASDAI-fatigue, BASDAI--spinal pain, BASDAI--morning stiffness intensity, BASFI, and BASMI. Moreover, the frequency of difficulty in ASAS HI-motivation at 16 weeks was less in the intervention group (P=.03). Between-group difference for change from baseline were also detected in VO2 max, SF-36, back extensor endurance test, and the range of motion of cervical lateral flexion at 16 weeks. Lack of time, energy, and willpower were the most distinct barriers to being active. Incidences of adverse events were similar between groups (P=.11). Conclusions: Our pilot study suggests that this technology-assisted combined home-based exercise program can improve the clinical outcomes of patients with AS who have no exercise habit, with good adherence and safety profile. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900024244; http://www.chictr.org.cn/showproj.aspx?proj=40176 ",
doi="10.2196/29703",
url="https://www.jmir.org/2022/1/e29703",
url="http://www.ncbi.nlm.nih.gov/pubmed/35040798"
}


@Article{info:doi/10.2196/27095,
author="Schomakers, Eva-Maria
and Lidynia, Chantal
and Vervier, Sophie Luisa
and Calero Valdez, Andr{\'e}
and Ziefle, Martina",
title="Applying an Extended UTAUT2 Model to Explain User Acceptance of Lifestyle and Therapy Mobile Health Apps: Survey Study",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Jan",
day="18",
volume="10",
number="1",
pages="e27095",
keywords="technology acceptance",
keywords="UTAUT2",
keywords="mHealth",
keywords="privacy concerns",
keywords="trust",
abstract="Background: Mobile health (mHealth) care apps are a promising technology to monitor and control health individually and cost-effectively with a technology that is widely used, affordable, and ubiquitous in many people's lives. Download statistics show that lifestyle apps are widely used by young and healthy users to improve fitness, nutrition, and more. While this is an important aspect for the prevention of future chronic diseases, the burdened health care systems worldwide may directly profit from the use of therapy apps by those patients already in need of medical treatment and monitoring. Objective: We aimed to compare the factors influencing the acceptance of lifestyle and therapy apps to better understand what drives and hinders the use of mHealth apps. Methods: We applied the established unified theory of acceptance and use of technology 2 (UTAUT2) technology acceptance model to evaluate mHealth apps via an online questionnaire with 707 German participants. Moreover, trust and privacy concerns were added to the model and, in a between-subject study design, the influence of these predictors on behavioral intention to use apps was compared between lifestyle and therapy apps. Results: The results show that the model only weakly predicted the intention to use mHealth apps (R2=0.019). Only hedonic motivation was a significant predictor of behavioral intentions regarding both app types, as determined by path coefficients of the model (lifestyle: 0.196, P=.004; therapy: 0.344, P<.001). Habit influenced the behavioral intention to use lifestyle apps (0.272, P<.001), while social influence (0.185, P<.001) and trust (0.273, P<.001) predicted the intention to use therapy apps. A further exploratory correlation analysis of the relationship between user factors on behavioral intention was calculated. Health app familiarity showed the strongest correlation to the intention to use (r=0.469, P<.001), stressing the importance of experience. Also, age (r=--0.15, P=.004), gender (r=--0.075, P=.048), education level (r=0.088, P=.02), app familiarity (r=0.142, P=.007), digital health literacy (r=0.215, P<.001), privacy disposition (r=--0.194, P>.001), and the propensity to trust apps (r=0.191, P>.001) correlated weakly with behavioral intention to use mHealth apps. Conclusions: The results indicate that, rather than by utilitarian factors like usefulness, mHealth app acceptance is influenced by emotional factors like hedonic motivation and partly by habit, social influence, and trust. Overall, the findings give evidence that for the health care context, new and extended acceptance models need to be developed with an integration of user diversity, especially individuals' prior experience with apps and mHealth. ",
doi="10.2196/27095",
url="https://mhealth.jmir.org/2022/1/e27095",
url="http://www.ncbi.nlm.nih.gov/pubmed/35040801"
}


@Article{info:doi/10.2196/33470,
author="Larsen, Kevin
and Akindele, Bilikis
and Head, Henry
and Evans, Rick
and Mehta, Purvi
and Hlatky, Quinn
and Krause, Brendan
and Chen, Sydney
and King, Dominic",
title="Developing a User-Centered Digital Clinical Decision Support App for Evidence-Based Medication Recommendations for Type 2 Diabetes Mellitus: Prototype User Testing and Validation Study",
journal="JMIR Hum Factors",
year="2022",
month="Jan",
day="18",
volume="9",
number="1",
pages="e33470",
keywords="clinical decision support",
keywords="user-centered design",
keywords="user testing",
keywords="type 2 diabetes mellitus",
keywords="evidence-based guidelines",
keywords="validation",
keywords="workflows",
keywords="electronic health record",
keywords="decision support",
keywords="design",
keywords="diabetes",
abstract="Background: Closing the gap between care recommended by evidence-based guidelines and care delivered in practice is an ongoing challenge across systems and delivery models. Clinical decision support systems (CDSSs) are widely deployed to augment clinicians in their complex decision-making processes. Despite published success stories, the poor usability of many CDSSs has contributed to fragmented workflows and alert fatigue. Objective: This study aimed to validate the application of a user-centered design (UCD) process in the development of a standards-based medication recommender for type 2 diabetes mellitus in a simulated setting. The prototype app was evaluated for effectiveness, efficiency, and user satisfaction. Methods: We conducted interviews with 8 clinical leaders with 8 rounds of iterative user testing with 2-8 prescribers in each round to inform app development. With the resulting prototype app, we conducted a validation study with 43 participants. The participants were assigned to one of two groups and completed a 2-hour remote user testing session. Both groups reviewed mock patient facts and ordered diabetes medications for the patients. The Traditional group used a mock electronic health record (EHR) for the review in Period 1 and used the prototype app in Period 2, while the Tool group used the prototype app during both time periods. The perceived cognitive load associated with task performance during each period was assessed with the National Aeronautics and Space Administration Task Load Index. Participants also completed the System Usability Scale (SUS) questionnaire and Kano Survey. Results: Average SUS scores from the questionnaire, taken at the end of 5 of the 8 user testing sessions, ranged from 68-86. The results of the validation study are as follows: percent adherence to evidence-based guidelines was greater with the use of the prototype app than with the EHR across time periods with the Traditional group (prototype app mean 96.2 vs EHR mean 72.0, P<.001) and between groups during Period 1 (Tool group mean 92.6 vs Traditional group mean 72.0, P<.001). Task completion times did not differ between groups (P=.23), but the Tool group completed medication ordering more quickly in Period 2 (Period 1 mean 130.7 seconds vs Period 2 mean 107.7 seconds, P<.001). Based on an adjusted $\alpha$ level owing to violation of the assumption of homogeneity of variance (Ps>.03), there was no effect on screens viewed and on perceived cognitive load (all Ps>.14). Conclusions: Through deployment of the UCD process, a point-of-care medication recommender app holds promise of improving adherence to evidence-based guidelines; in this case, those from the American Diabetes Association. Task-time performance suggests that with practice the T2DM app may support a more efficient ordering process for providers, and SUS scores indicate provider satisfaction with the app. ",
doi="10.2196/33470",
url="https://humanfactors.jmir.org/2022/1/e33470",
url="http://www.ncbi.nlm.nih.gov/pubmed/34784293"
}


@Article{info:doi/10.2196/33118,
author="Wu, Xi Vivien
and Dong, Yanhong
and Tan, Choo Poh
and Gan, Peiying
and Zhang, Di
and Chi, Yuchen
and Chao, Ting Felicia Fang
and Lu, Jinhua
and Teo, Dennis Boon Heng
and Tan, Qian Yue",
title="Development of a Community-Based e-Health Program for Older Adults With Chronic Diseases: Pilot Pre-Post Study",
journal="JMIR Aging",
year="2022",
month="Jan",
day="17",
volume="5",
number="1",
pages="e33118",
keywords="eHealth",
keywords="self-management",
keywords="older adults",
keywords="chronic disease",
keywords="community care",
keywords="elderly",
keywords="community",
keywords="innovation",
keywords="development",
keywords="pilot",
keywords="evaluation",
keywords="health literacy",
keywords="empowerment",
keywords="feasibility",
keywords="engagement",
abstract="Background: Chronic diseases may impact older adults' health outcomes, health care costs, and quality of life. Self-management is expected to encourage individuals to make autonomous decisions, adhere to treatment plans, deal with emotional and social consequences, and provide choices for healthy lifestyle. New eHealth solutions significantly increase the health literacy and empower patients in self-management of chronic conditions. Objective: This study aims to develop a Community-Based e-Health Program (CeHP) for older adults with chronic diseases and conduct a pilot evaluation. Methods: A pilot study with a 2-group pre- and posttest repeated measures design was adopted. Community-dwelling older adults with chronic diseases were recruited from senior activity centers in Singapore. A systematic 3-step process of developing CeHP was coupled with a smart-device application. The development of the CeHP intervention consists of theoretical framework, client-centric participatory action research process, content validity assessment, and pilot testing. Self-reported survey questionnaires and health outcomes were measured before and after the CeHP. The instruments used were the Self-care of Chronic Illness Inventory (SCCII), Healthy Aging Instrument (HAI), Short-Form Health Literacy Scale, 12 Items (HLS-SF 12), Patient Empowerment Scale (PES), and Social Support Questionnaire, 6 items. The following health outcomes were measured: Montreal Cognitive Assessment, Symbol Digit Modalities Test, total cholesterol (TC), high-density lipoproteins, low-density lipoproteins/very-low-density lipoproteins (LDL/VLDL), fasting glucose, glycated hemoglobin (HbA1c), and BMI. Results: The CeHP consists of health education, monitoring, and an advisory system for older adults to manage their chronic conditions. It is an 8-week intensive program, including face-to-face and eHealth (Care4Senior App) sessions. Care4Senior App covers health education topics focusing on the management of hypertension, hyperlipidemia, and diabetes, brain health, healthy diet, lifestyle modification, medication adherence, exercise, and mindfulness practice. Content validity assessment indicated that the content of the CeHP is valid, with a content validity index (CVI) ranging 0.86-1 and a scale-CVI of 1. Eight participants in the CeHP group and 4 in the control group completed both baseline and post intervention assessments. Participants in the CeHP group showed improvements in fasting glucose, HbA1c, TC, LDL/VLDL, BMI, SCCII indices (Maintenance, Monitoring, and Management), HAI, and PES scores post intervention, although these changes were not significant. For the participants in the control group, the scores for SCCII (management and confidence) and HLS-SF 12 decreased post intervention. Conclusions: The CeHP is feasible, and it engages and empowers community-dwelling older adults to manage their chronic conditions. The rigorous process of program development and pilot evaluation provided valid evidence to expand the CeHP to a larger-scale implementation to encourage self-management, reduce debilitating complications of poorly controlled chronic diseases, promote healthy longevity and social support, and reduce health care costs. ",
doi="10.2196/33118",
url="https://aging.jmir.org/2022/1/e33118",
url="http://www.ncbi.nlm.nih.gov/pubmed/35037882"
}


@Article{info:doi/10.2196/24483,
author="Fox, Sarah
and Brown, E. Laura J.
and Antrobus, Steven
and Brough, David
and Drake, J. Richard
and Jury, Francine
and Leroi, Iracema
and Parry-Jones, R. Adrian
and Machin, Matthew",
title="Co-design of a Smartphone App for People Living With Dementia by Applying Agile, Iterative Co-design Principles: Development and Usability Study",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Jan",
day="14",
volume="10",
number="1",
pages="e24483",
keywords="agile",
keywords="dementia",
keywords="co-design",
keywords="cognition",
keywords="mHealth",
keywords="patient public involvement",
keywords="software development",
keywords="mobile phone",
abstract="Background: The benefits of involving those with lived experience in the design and development of health technology are well recognized, and the reporting of co-design best practices has increased over the past decade. However, it is important to recognize that the methods and protocols behind patient and public involvement and co-design vary depending on the patient population accessed. This is especially important when considering individuals living with cognitive impairments, such as dementia, who are likely to have needs and experiences unique to their cognitive capabilities. We worked alongside individuals living with dementia and their care partners to co-design a mobile health app. This app aimed to address a gap in our knowledge of how cognition fluctuates over short, microlongitudinal timescales. The app requires users to interact with built-in memory tests multiple times per day, meaning that co-designing a platform that is easy to use, accessible, and appealing is particularly important. Here, we discuss our use of Agile methodology to enable those living with dementia and their care partners to be actively involved in the co-design of a mobile health app. Objective: The aim of this study is to explore the benefits of co-design in the development of smartphone apps. Here, we share our co-design methodology and reflections on how this benefited the completed product. Methods: Our app was developed using Agile methodology, which allowed for patient and care partner input to be incorporated iteratively throughout the design and development process. Our co-design approach comprised 3 core elements, aligned with the values of patient co-design and adapted to meaningfully involve those living with cognitive impairments: end-user representation at research and software development meetings via a patient proxy; equal decision-making power for all stakeholders based on their expertise; and continuous user consultation, user-testing, and feedback. Results: This co-design approach resulted in multiple patient and care partner--led software alterations, which, without consultation, would not have been anticipated by the research team. This included 13 software design alterations, renaming of the product, and removal of a cognitive test deemed to be too challenging for the target demographic. Conclusions: We found patient and care partner input to be critical throughout the development process for early identification of design and usability issues and for identifying solutions not previously considered by our research team. As issues addressed in early co-design workshops did not reoccur subsequently, we believe this process made our product more user-friendly and acceptable, and we will formally test this assumption through future pilot-testing. ",
doi="10.2196/24483",
url="https://mhealth.jmir.org/2022/1/e24483",
url="http://www.ncbi.nlm.nih.gov/pubmed/35029539"
}


@Article{info:doi/10.2196/31567,
author="Poduval, Shoba
and Ross, Jamie
and Pal, Kingshuk
and Newhouse, Nikki
and Hamilton, Fiona
and Murray, Elizabeth",
title="Web-Based Structured Education for Type 2 Diabetes: Interdisciplinary User-Centered Design Approach",
journal="JMIR Hum Factors",
year="2022",
month="Jan",
day="14",
volume="9",
number="1",
pages="e31567",
keywords="type 2 diabetes",
keywords="patient self-management",
keywords="diabetes education",
keywords="primary care",
keywords="digital health",
abstract="Background: Digital health research encompasses methods from human-computer interaction and health research. Objective: This paper aims to describe how these methods were combined to develop HeLP-Diabetes: Starting Out, a web-based structured education program for people newly diagnosed with type 2 diabetes. Methods: The development process consisted of three phases: initial design for effectiveness, optimization for usability, and in the wild testing in the National Health Service with people newly diagnosed with type 2 diabetes, and further revisions. We adopted an iterative user-centered approach and followed steps from the human-computer interaction design life cycle and the Medical Research Council guidelines on developing and evaluating complex interventions. Results: The initial design process resulted in an 8-session program containing information and behavior change techniques targeting weight loss, being more active, and taking medication. The usability testing was highlighted at an early stage, where changes needed to be made to the language and layout of the program. The in the wild testing provided data on uptake of and barriers to use. The study suggested low uptake and completion of the program, but those who used it seemed to benefit from it. The qualitative findings suggested that barriers to use included an expectation that the program would take too long. This informed refinements to the program. Conclusions: The use of interdisciplinary methods resulted in an iterative development process and refinements to the program that were based on user needs and data on uptake. The final intervention was more suitable for a definitive evaluation than the initial version. The description of our approach informs other digital health researchers on how to make interventions more sensitive to user needs. ",
doi="10.2196/31567",
url="https://humanfactors.jmir.org/2022/1/e31567",
url="http://www.ncbi.nlm.nih.gov/pubmed/35029531"
}


@Article{info:doi/10.2196/31982,
author="Leigh, W. Jonathan
and Gerber, S. Ben
and Gans, P. Christopher
and Kansal, M. Mayank
and Kitsiou, Spyros",
title="Smartphone Ownership and Interest in Mobile Health Technologies for Self-care Among Patients With Chronic Heart Failure: Cross-sectional Survey Study",
journal="JMIR Cardio",
year="2022",
month="Jan",
day="14",
volume="6",
number="1",
pages="e31982",
keywords="mHealth",
keywords="smartphone",
keywords="mobile phone",
keywords="heart failure",
keywords="self-care",
keywords="self-management",
abstract="Background: Heart failure (HF) is a highly prevalent chronic condition that places a substantial burden on patients, families, and health care systems worldwide. Recent advances in mobile health (mHealth) technologies offer great opportunities for supporting many aspects of HF self-care. There is a need to better understand patients' adoption of and interest in using mHealth for self-monitoring and management of HF symptoms. Objective: The purpose of this study is to assess smartphone ownership and patient attitudes toward using mHealth technologies for HF self-care in a predominantly minority population in an urban clinical setting. Methods: We conducted a cross-sectional survey of adult outpatients (aged ?18 years) at an academic outpatient HF clinic in the Midwest. The survey comprised 34 questions assessing patient demographics, ownership of smartphones and other mHealth devices, frequently used smartphone features, use of mHealth apps, and interest in using mHealth technologies for vital sign and HF symptom self-monitoring and management. Results: A total of 144 patients were approached, of which 100 (69.4\%) participated in the study (63/100, 63\% women). The participants had a mean age of 61.3 (SD 12.25) years and were predominantly Black or African American (61/100, 61\%) and Hispanic or Latino (18/100, 18\%). Almost all participants (93/100, 93\%) owned a cell phone. The share of patients who owned a smartphone was 68\% (68/100). Racial and ethnic minorities that identified as Black or African American or Hispanic or Latino reported higher smartphone ownership rates compared with White patients with HF (45/61, 74\% Black or African American and 11/18, 61\% Hispanic or Latino vs 9/17, 53\% White). There was a moderate and statistically significant association between smartphone ownership and age (Cram{\'e}r V [$\Phi$C]=0.35; P<.001), education ($\Phi$C=0.29; P=.001), and employment status ($\Phi$C=0.3; P=.01). The most common smartphone features used by the participants were SMS text messaging (51/68, 75\%), internet browsing (43/68, 63\%), and mobile apps (41/68, 60\%). The use of mHealth apps and wearable activity trackers (eg, Fitbits) for self-monitoring of HF-related parameters was low (15/68, 22\% and 15/100, 15\%, respectively). The most popular HF-related self-care measures participants would like to monitor using mHealth technologies were physical activity (46/68, 68\%), blood pressure (44/68, 65\%), and medication use (40/68, 59\%). Conclusions: Most patients with HF have smartphones and are interested in using commercial mHealth apps and connected health devices to self-monitor their condition. Thus, there is a great opportunity to capitalize on the high smartphone ownership among racial and ethnic minority patients to increase reach and enhance HF self-management through mHealth interventions. ",
doi="10.2196/31982",
url="https://cardio.jmir.org/2022/1/e31982",
url="http://www.ncbi.nlm.nih.gov/pubmed/35029533"
}


@Article{info:doi/10.2196/32458,
author="Huberty, Jennifer
and Bhuiyan, Nishat
and Neher, Taylor
and Joeman, Lynda
and Mesa, Ruben
and Larkey, Linda",
title="Leveraging a Consumer-Based Product to Develop a Cancer-Specific Mobile Meditation App: Prototype Development Study",
journal="JMIR Form Res",
year="2022",
month="Jan",
day="14",
volume="6",
number="1",
pages="e32458",
keywords="cancer patients/survivors",
keywords="meditation",
keywords="mHealth",
keywords="app development",
keywords="qualitative research",
abstract="Background: Mobile meditation apps may offer a long-term, accessible, and effective solution for ongoing symptom management in cancer patients/survivors. However, there are currently no commercial cancer-specific meditation apps that reflect cancer specialist expertise, input from cancer patients/survivors, and features and content specific to cancer patients'/survivors' needs. Objective: The aim of this study was to gain insight (via surveys, daily journals, and focus groups) from cancer patients/survivors, health care providers, and current subscribers of Calm (a consumer-based mobile meditation app) who were patients/survivors to develop a prototype of a mobile meditation app specifically designed for cancer patients/survivors. Methods: Participants were recruited via prior partnerships, word-of-mouth referrals, and recruitment posts on Facebook and Instagram. Cancer patients/survivors and health care providers were instructed to download and use the Calm app for at least 10 minutes a day for 7 days, complete an online daily journal for 7 days, and participate in a virtual focus group (one for cancer patients/survivors and one for providers). Current Calm subscribers who were cancer patients/survivors completed an online survey about different aspects of the Calm app and participated in a third virtual focus group. Data were qualitatively analyzed using a combination of deductive and inductive coding. Results: A total of 27 participants (11 cancer patients/survivors, 10 health care providers, 6 current Calm subscribers) completed the study. Similar themes and subthemes were found across surveys, daily journals, and focus groups, and fell into two major categories, content and functionality, with cancer-specific and noncancer-specific themes identified within each category. The majority of content preferences and suggestions that arose were cancer-specific, such as content related to negative emotions or feelings (eg, anxiety, grief, trauma/posttraumatic stress disorder, fear of recurrence, isolation), positive feelings and finding meaning (eg, gratitude, storytelling, acceptance), scenarios and experiences (eg, waiting, treatment-specific mediations), type and stage of cancer journey, and movement modifications. Some of the noncancer-specific themes under app content included sleep, music, and visualizations. In terms of app functionality, the majority of participants expressed interest in having a section/tab/area of the app that was specifically geared toward cancer patients/survivors. Preferences and suggestions for cancer-specific functionality features included options based on symptoms or journey, being able to communicate with other patients or survivors to share suggestions for specific meditations, and having an emergency toolkit for patients/survivors. Conclusions: Findings from cancer patients/survivors, health care providers, and current Calm subscribers who were patients/survivors to be incorporated into the development of the prototype fell into two major categories: (1) content of the app and (2) functionality of the app. The prototype's form and function will be pilot-tested among 30 cancer patients/survivors in a 4-week study, and the resulting feasibility data will be used to inform the final app design and an efficacy study. ",
doi="10.2196/32458",
url="https://formative.jmir.org/2022/1/e32458",
url="http://www.ncbi.nlm.nih.gov/pubmed/35029528"
}


@Article{info:doi/10.2196/27192,
author="Oh, Woo Sang
and Kim, Kyoung-Kon
and Kim, Soo Sung
and Park, Kyung Su
and Park, Sangshin",
title="Effect of an Integrative Mobile Health Intervention in Patients With Hypertension and Diabetes: Crossover Study",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Jan",
day="11",
volume="10",
number="1",
pages="e27192",
keywords="diabetes mellitus type 2",
keywords="obesity",
keywords="hypertension",
keywords="mHealth",
keywords="mobile phone",
abstract="Background: Obesity, hypertension, and type 2 diabetes mellitus (T2DM) are worldwide epidemics that inflict burdens on both public health and health care costs. Self-management plays an important role in the proper management of these 3 chronic diseases, and in this context, mobile health (mHealth) can be a cost-effective self-management tool. Objective: The aim of this pilot study is to evaluate the effects of an integrative mHealth approach for obesity, hypertension, and T2DM on body fat, blood pressure, and blood glucose levels and demonstrate the clinical outcomes. The participants were patients aged 40 to 70 years who were treated for T2DM (hemoglobin A1c [HbA1c] above 6.0\%) without insulin or hypertension and obesity, controlled with pharmacotherapy. Methods: This pilot study was performed using a controlled, randomized, 3-month, 2-period crossover design. A total of 37 participants were recruited from 2 university hospitals in South Korea. Integrative mHealth comprised 4 parts: self-measuring home devices for monitoring blood glucose and blood pressure; 2 smartphone apps, where one gathered lifestyle data, giving them feedback with health information, and the other provided drug information and reminders of the medication schedule; unmanned kiosks for official measurement of blood pressure and body composition; and web-based access to participants' health information. Results: Data from the 32 participants were analyzed. Their mean HbA1c level was 7.5\% (SD 0.8, ranging from 6.1\% to 9.4\%). Approximately 38\% (12/32) of the participants had hypertension. BMIs of all participants except 1 were >23 kg/m2. The input rates of food intake and exercise to the smartphone app were very low (24.9\% and 5.3\%, respectively). On the contrary, the input rate of medicine intake was high (84.0\%). Moreover, there was no significant difference in the input rate of taking medicine irrespective of whether the mHealth period was before or after the conventional treatment period (80.3\% and 87.3\%, respectively; P=.06). Among the 3 input functions of food intake, exercise, and medicine intake in smartphone apps, the input of medicine intake was a more helpful, easier to use, and better-designed function than the others. There were no significant differences in changes in body weight (?0.519 kg vs 0 kg), BMI (?0.133 kg/m2 vs ?0.167 kg/m2), body composition (body fat ?0.255\% vs 0.172\%), blood pressure (systolic ?0.226 mm Hg vs ?2.839 mm Hg), and HbA1c (?0.269\% vs --0.009\%) between the integrative mHealth and conventional treatment groups. However, in proportion to the elevation in the input rate of taking medicine, body fat mass (P=.04) and HbA1c (P=.03) were lower in the integrative mHealth group. Conclusions: Although smartphone apps can influence body fat and blood glucose levels, they have failed to show clinical improvement. A higher input rate of taking medicine was related to significantly lower body fat mass and HbA1c levels. ",
doi="10.2196/27192",
url="https://mhealth.jmir.org/2022/1/e27192",
url="http://www.ncbi.nlm.nih.gov/pubmed/35014961"
}


@Article{info:doi/10.2196/27952,
author="Shaikh, Ahmed
and Bhatia, Abhishek
and Yadav, Ghanshyam
and Hora, Shashwat
and Won, Chung
and Shankar, Mark
and Heerboth, Aaron
and Vemulapalli, Prakash
and Navalkar, Paresh
and Oswal, Kunal
and Heaton, Clay
and Saunik, Sujata
and Khanna, Tarun
and Balsari, Satchit",
title="Applying Human-Centered Design Principles to Digital Syndromic Surveillance at a Mass Gathering in India: Viewpoint",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="10",
volume="24",
number="1",
pages="e27952",
keywords="mHealth",
keywords="design",
keywords="human centered design",
keywords="intervention",
keywords="syndromic surveillance",
keywords="digital health",
doi="10.2196/27952",
url="https://www.jmir.org/2022/1/e27952",
url="http://www.ncbi.nlm.nih.gov/pubmed/35006088"
}


@Article{info:doi/10.2196/27809,
author="Han, Sang Jae
and Park, Yong-Ho
and Song, Jae-Jun
and Moon, Joon Il
and Lee, Woojoo
and Kim, Yoonjoong
and Cho, Sang Young
and Seo, Jae-Hyun
and Park, Kyun Moo",
title="Knowledge and Expectations of Hearing Aid Apps Among Smartphone Users and Hearing Professionals: Cross-sectional Survey",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Jan",
day="7",
volume="10",
number="1",
pages="e27809",
keywords="smartphone",
keywords="hearing aids",
keywords="app",
keywords="perception",
keywords="survey",
keywords="hearing loss",
keywords="mobile phone",
abstract="Background: Despite the increasing prevalence of hearing loss, the cost and psychological barriers to the use of hearing aids may prevent their use in individuals with hearing loss. Patients with hearing loss can benefit from smartphone-based hearing aid apps (SHAAs), which are smartphone apps that use a mobile device as a sound amplifier. Objective: The aim of this study is to determine how ear, nose, and throat outpatients perceive SHAAs, analyze the factors that affect their perceptions, and estimate the costs of an annual subscription to an app through a self-administered questionnaire survey of smartphone users and hearing specialists. Methods: This study used a cross-sectional, multicenter survey of both ear, nose, and throat outpatients and hearing specialists. The questionnaire was designed to collect personal information about the respondents and their responses to 18 questions concerning SHAAs in five domains: knowledge, needs, cost, expectations, and information. Perception questions were rated on a scale of 1 (strongly disagree) to 5 (strongly agree). Questions about the expected cost of SHAAs were included in the questionnaire distributed to hearing experts. Results: Among the 219 smartphone users and 42 hearing specialists, only 8 (3.7\%) respondents recognized SHAAs, whereas 18\% (47/261) of respondents reported considering the use of an assistive device to improve their hearing capacity. The average perception score was 2.81 (SD 1.22). Among the factors that shaped perceptions of SHAAs, the needs category received the lowest scores (2.02, SD 1.42), whereas the cost category received the highest scores (3.29, SD 1.14). Age was correlated with the information domain (P<.001), and an increased level of hearing impairment resulted in significantly higher points in the needs category (P<.001). Patients expected the cost of an annual app subscription to an SHAA to be approximately US \$86, and the predicted cost was associated with economic status (P=.02) and was higher than the prices expected by hearing specialists (P<.001). Conclusions: Outpatients expected SHAAs to cost more than hearing specialists. However, the perception of the SHAA was relatively low. In this regard, enhanced awareness is required to popularize SHAAs. ",
doi="10.2196/27809",
url="https://mhealth.jmir.org/2022/1/e27809",
url="http://www.ncbi.nlm.nih.gov/pubmed/34994699"
}


@Article{info:doi/10.2196/31482,
author="Pach, Daniel
and Bl{\"o}dt, Susanne
and Wang, Jiani
and Keller, Theresa
and Bergmann, Beatrice
and Rogge, A. Aliz{\'e}
and Barth, J{\"u}rgen
and Icke, Katja
and Roll, Stephanie
and Witt, M. Claudia",
title="App-Based Relaxation Exercises for Patients With Chronic Neck Pain: Pragmatic Randomized Trial",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Jan",
day="7",
volume="10",
number="1",
pages="e31482",
keywords="neck pain",
keywords="relaxation",
keywords="RCT",
keywords="mHealth",
keywords="smartphone app",
keywords="mobile phone",
abstract="Background: Chronic neck pain is a highly prevalent condition. Learning a relaxation technique is recommended by numerous guidelines for chronic neck pain. Smartphone apps can provide relaxation exercises; however, their effectiveness, especially in a self-care setting, is unclear. Objective: The aim of this pragmatic randomized trial is to evaluate whether app-based relaxation exercises, including audio-based autogenic training, mindfulness meditation, or guided imagery, are more effective in reducing chronic neck pain than usual care alone. Methods: Smartphone owners aged 18 to 65 years with chronic (>12 weeks) neck pain and the previous week's average neck pain intensity ?4 on the Numeric Rating Scale (0=no pain to 10=worst possible pain) were randomized into either an intervention group to practice app-based relaxation exercises or a control group (usual care and app for data entry only). For both groups, the follow-up data were collected using app-based diaries and questionnaires. The primary outcome was the mean neck pain intensity during the first 3 months based on daily measurements. Secondary outcomes included neck pain based on weekly measurements, pain acceptance, neck pain--related stress, sick-leave days, pain medication intake, and adherence, which were all measured until the 6-month follow-up. For the primary analysis, analysis of covariance adjusted for baseline neck pain intensity was used. Results: We screened 748 participants and enrolled 220 participants (mean age 38.9, SD 11.3 years; mean baseline neck pain 5.7, SD 1.3 points). The mean neck pain intensity in both groups decreased over 3 months; however, no statistically significant difference between the groups was found (intervention: 4.1 points, 95\% CI 3.8-4.4; control: 3.8 points, 95\% CI 3.5-4.1; group difference: 0.3 points, 95\% CI ?0.2 to 0.7; P=.23). In addition, no statistically significant between-group differences regarding neck pain intensity after 6 months, responder rate, pain acceptance, pain medication intake, or sick-leave days were observed. There were no serious adverse events that were considered related to the trial intervention. In week 12, only 40\% (44/110) of the participants in the intervention group continued to practice the exercises with the app. Conclusions: The study app did not effectively reduce chronic neck pain or keep the participants engaged in exercising in a self-care setting. Future studies on app-based relaxation interventions should take into account the most recent scientific findings for behavior change techniques. Trial Registration: ClinicalTrials.gov NCT02019134; https://clinicaltrials.gov/ct2/show/NCT02019134 International Registered Report Identifier (IRRID): RR2-10.1186/1745-6215-15-490 ",
doi="10.2196/31482",
url="https://mhealth.jmir.org/2022/1/e31482",
url="http://www.ncbi.nlm.nih.gov/pubmed/34994708"
}


@Article{info:doi/10.2196/30807,
author="Senoo, Keitaro
and Miki, Tomonori
and Ohkura, Takashi
and Iwakoshi, Hibiki
and Nishimura, Tetsuro
and Shiraishi, Hirokazu
and Teramukai, Satoshi
and Matoba, Satoaki",
title="A Smartphone App to Improve Oral Anticoagulation Adherence in Patients With Atrial Fibrillation: Prospective Observational Study",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Jan",
day="7",
volume="10",
number="1",
pages="e30807",
keywords="atrial fibrillation",
keywords="smartphone app",
keywords="anticoagulants",
keywords="drug adherence",
keywords="education",
keywords="patient involvement",
abstract="Background: Poor adherence to oral anticoagulation in elderly patients with atrial fibrillation (AF) has been shown to negatively impact health care costs, morbidity, and mortality. Although various methods such as automated reminders, counseling, telephone support, and patient education have been effective in improving medication adherence, the burden on health care providers has been considerable. Recently, an attempt has been made to improve medication adherence without burdening health care providers by using smartphone apps; however, the use of the app for elderly patients with AF is still limited. Objective: The purpose of this study was to determine whether the newly developed smartphone app for patients with AF (the Smart AF), which integrates education, automatic reminder, and patient engagement strategies with a simple user interface, can improve medication adherence in elderly patients with AF. Methods: Patient enrollment was carried out by obtaining informed consent from patients with AF attending Kyoto Prefectural University of Medicine hospital between May 2019 and September 2020. Follow-up was planned at 1, 3, and 6 months after enrollment, and questionnaire reminders were automatically sent to patient apps at designated follow-up time points. A questionnaire-based survey of medication adherence was performed electronically using the self-reported 8-item Morisky Medication Adherence Scale (MMAS-8) as the survey tool. Results: A total of 136 patients with AF were enrolled in this study. During the follow-up period, 112 (82\%) patients underwent follow-up at 1 month, 107 (79\%) at 3 months, and 96 (71\%) at 6 months. The mean age of the enrolled patients was 64.3 years (SD 9.6), and male participants accounted for 79.4\% (108/136) of the study population. The mean CHADS2 (congestive heart failure, hypertension, age, diabetes, previous stroke, or transient ischemic attack) score was 1.2, with hypertension being the most common comorbidity. At the time of enrollment, 126 (93\%) and 10 (7\%) patients were taking direct oral anticoagulants and warfarin, respectively. For medication adherence as measured according to the MMAS-8, MMAS scores at 1 month, 3 months, and 6 months were significantly improved compared with baseline MMAS scores (all P values less than .01). The overall improvement in medication adherence achieved by the 6-month intervention was as follows: 77.8\% (14/18) of the patients in the high adherence group (score=8) at baseline remained in the same state, 45.3\% (24/53) of the patients in the medium adherence group (score=6 to <8) at baseline moved to the high adherence group, and 72\% (18/25) of the patients in the low adherence group (score <6) moved to either the medium or high adherence group. Conclusions: The Smart AF app improved medication adherence among elderly patients with AF. In the realm of medication management, an approach using a mobile health technology that emphasizes education, automatic reminder, and patient engagement may be helpful. ",
doi="10.2196/30807",
url="https://mhealth.jmir.org/2022/1/e30807",
url="http://www.ncbi.nlm.nih.gov/pubmed/34894626"
}


@Article{info:doi/10.2196/27689,
author="Rao, Nema
and Perdomo, Sophy
and Jonassaint, Charles",
title="A Novel Method for Digital Pain Assessment Using Abstract Animations: Human-Centered Design Approach",
journal="JMIR Hum Factors",
year="2022",
month="Jan",
day="7",
volume="9",
number="1",
pages="e27689",
keywords="pain",
keywords="pain measurement",
keywords="chronic pain",
keywords="animations",
keywords="mobile apps",
keywords="human-centered design",
abstract="Background: Patients with chronic pain face several challenges in using clinical tools to help them monitor, understand, and make meaningful decisions about their pain conditions. Our group previously presented data on Painimation, a novel electronic tool for communicating and assessing pain. Objective: This paper describes the human-centered design and development approach (inspiration, ideation, and implementation) that led to the creation of Painimation. Methods: We planned an iterative and cyclical development process that included stakeholder engagement and feedback from users. Stakeholders included patients with acute and chronic pain, health care providers, and design students. Target users were adults with acute or chronic pain who needed clinical assessment and tracking of the course of their pain over time. Phase I (inspiration) consisted of empathizing with users, understanding how patients experience pain, and identifying the barriers to accurately expressing and assessing pain. This phase involved understanding how patients communicate pain symptoms to providers, as well as defining limitations of current models of clinical pain assessment tools. In Phase II (ideate) we conceptualized and evaluated different approaches to expressing and assessing pain. The most promising concept was developed through an iterative process that involved end users and stakeholders. In Phase III (implementation), based on stakeholder feedback from initial designs and prototypes of abstract pain animations (painimations), we incorporated all concepts to test a minimally viable product, a fully functioning pain assessment app. We then gathered feedback through an agile development process and applied this feedback to finalizing a testable version of the app that could ultimately be used in a pain clinic. Results: Engaging intended users and stakeholders in an iterative, human-centered design process identified 5 criteria that a pain assessment tool would need to meet to be effective in the medical setting. These criteria were used as guiding design principles to generate a series of pain assessment concept ideas. This human-centered approach generated 8 highly visual painimations that were found to be acceptable and useable for communicating pain with medical providers, by both patients with general pain and patients with sickle cell disease (SCD). While these initial steps continued refinement of the tool, further data are needed. Agile development will allow us to continue to incorporate precision medicine tools that are validated in the clinical research arena. Conclusions: A multiphase, human-centered design approach successfully resulted in the development of an innovation that has potential to improve the quality of medical care, particularly for underserved populations. The use of Painimation may especially benefit the medical care of minority populations with chronic and difficult-to-treat pain, such as adults with SCD. The insights generated from this study can be applied to the development of patient-reported outcomes tools that are more patient-centered, engaging, and effective. ",
doi="10.2196/27689",
url="https://humanfactors.jmir.org/2022/1/e27689",
url="http://www.ncbi.nlm.nih.gov/pubmed/34994697"
}


@Article{info:doi/10.2196/31617,
author="Breil, Bernhard
and Salewski, Christel
and Apolin{\'a}rio-Hagen, Jennifer",
title="Comparing the Acceptance of Mobile Hypertension Apps for Disease Management Among Patients Versus Clinical Use Among Physicians: Cross-sectional Survey",
journal="JMIR Cardio",
year="2022",
month="Jan",
day="6",
volume="6",
number="1",
pages="e31617",
keywords="patient acceptance of health care",
keywords="mobile apps",
keywords="blood pressure",
keywords="mobile health",
keywords="health applications",
keywords="technology acceptance",
keywords="patients",
keywords="physicians",
keywords="digital health",
abstract="Background: High blood pressure or hypertension is a vastly prevalent chronic condition among adults that can, if not appropriately treated, contribute to several life-threatening secondary diseases and events, such as stroke. In addition to first-line medication, self-management in daily life is crucial for tertiary prevention and can be supported by mobile health apps, including medication reminders. However, the prescription of medical apps is a relatively novel approach. There is limited information regarding the determinants of acceptance of such mobile health (mHealth) apps among patients as potential users and physicians as impending prescribers in direct comparison. Objective: The present study aims to investigate the determinants of the acceptance of health apps (in terms of intention to use) among patients for personal use and physicians for clinical use in German-speaking countries. Moreover, we assessed patients' preferences regarding different delivery modes for self-care service (face-to-face services, apps, etc). Methods: Based on an extended model of the unified theory of acceptance and use of technology (UTAUT2), we performed a web-based cross-sectional survey to explore the acceptance of mHealth apps for self-management of hypertension among patients and physicians in Germany. In addition to UTAUT2 variables, we measured self-reported self-efficacy, eHealth literacy, previous experiences with health apps, perceived threat to privacy, and protection motivation as additional determinants of mHealth acceptance. Data from 163 patients and 46 physicians were analyzed using hierarchical regression and mediation analyses. Results: As expected, a significant influence of the unified theory of acceptance and use of technology (UTAUT) predictors on intentions to use hypertension apps was confirmed, especially for performance expectancy. Intention to use was moderate in patients (mean 3.5; SD 1.1; range 1-5) and physicians (mean 3.4, SD 0.9), and did not differ between both groups. Among patients, a higher degree of self-reported self-efficacy and protection motivation contributed to an increased explained variance in acceptance with R2=0.09, whereas eHealth literacy was identified as exerting a positive influence on physicians (increased R2=0.10). Furthermore, our findings indicated mediating effects of performance expectancy on the acceptance among patients but not among physicians. Conclusions: In summary, this study has identified performance expectancy as the most important determinant of the acceptance of mHealth apps for self-management of hypertension among patients and physicians. Concerning patients, we also identified mediating effects of performance expectancy on the relationships between effort expectancy and social influence and the acceptance of apps. Self-efficacy and protection motivation also contributed to an increase in the explained variance in app acceptance among patients, whereas eHealth literacy was a predictor in physicians. Our findings on additional determinants of the acceptance of health apps may help tailor educational material and self-management interventions to the needs and preferences of prospective users of hypertension apps in future research. ",
doi="10.2196/31617",
url="https://cardio.jmir.org/2022/1/e31617",
url="http://www.ncbi.nlm.nih.gov/pubmed/34989683"
}


@Article{info:doi/10.2196/27418,
author="Kenny, Lorna
and Moore, Kevin
and O' Riordan, Cl{\'i}ona
and Fox, Siobhan
and Barton, John
and Tedesco, Salvatore
and Sica, Marco
and Crowe, Colum
and Alam{\"a}ki, Antti
and Condell, Joan
and Nordstr{\"o}m, Anna
and Timmons, Suzanne",
title="The Views and Needs of People With Parkinson Disease Regarding Wearable Devices for Disease Monitoring: Mixed Methods Exploration",
journal="JMIR Form Res",
year="2022",
month="Jan",
day="6",
volume="6",
number="1",
pages="e27418",
keywords="Parkinson disease",
keywords="wearable devices",
keywords="technology",
keywords="mixed method",
keywords="focus group",
keywords="survey",
keywords="mobile phone",
abstract="Background: Wearable devices can diagnose, monitor, and manage neurological disorders such as Parkinson disease. With a growing number of wearable devices, it is no longer a case of whether a wearable device can measure Parkinson disease motor symptoms, but rather which features suit the user. Concurrent with continued device development, it is important to generate insights on the nuanced needs of the user in the modern era of wearable device capabilities. Objective: This study aims to understand the views and needs of people with Parkinson disease regarding wearable devices for disease monitoring and management. Methods: This study used a mixed method parallel design, wherein survey and focus groups were concurrently conducted with people living with Parkinson disease in Munster, Ireland. Surveys and focus group schedules were developed with input from people with Parkinson disease. The survey included questions about technology use, wearable device knowledge, and Likert items about potential device features and capabilities. The focus group participants were purposively sampled for variation in age (all were aged >50 years) and sex. The discussions concerned user priorities, perceived benefits of wearable devices, and preferred features. Simple descriptive statistics represented the survey data. The focus groups analyzed common themes using a qualitative thematic approach. The survey and focus group analyses occurred separately, and results were evaluated using a narrative approach. Results: Overall, 32 surveys were completed by individuals with Parkinson disease. Four semistructured focus groups were held with 24 people with Parkinson disease. Overall, the participants were positive about wearable devices and their perceived benefits in the management of symptoms, especially those of motor dexterity. Wearable devices should demonstrate clinical usefulness and be user-friendly and comfortable. Participants tended to see wearable devices mainly in providing data for health care professionals rather than providing feedback for themselves, although this was also important. Barriers to use included poor hand function, average technology confidence, and potential costs. It was felt that wearable device design that considered the user would ensure better compliance and adoption. Conclusions: Wearable devices that allow remote monitoring and assessment could improve health care access for patients living remotely or are unable to travel. COVID-19 has increased the use of remotely delivered health care; therefore, future integration of technology with health care will be crucial. Wearable device designers should be aware of the variability in Parkinson disease symptoms and the unique needs of users. Special consideration should be given to Parkinson disease--related health barriers and the users' confidence with technology. In this context, a user-centered design approach that includes people with Parkinson disease in the design of technology will likely be rewarded with improved user engagement and the adoption of and compliance with wearable devices, potentially leading to more accurate disease management, including self-management. ",
doi="10.2196/27418",
url="https://formative.jmir.org/2022/1/e27418",
url="http://www.ncbi.nlm.nih.gov/pubmed/34989693"
}


@Article{info:doi/10.2196/25586,
author="Li, Yiran
and Guo, Yan
and Hong, Alicia Y.
and Zeng, Yu
and Monroe-Wise, Aliza
and Zeng, Chengbo
and Zhu, Mengting
and Zhang, Hanxi
and Qiao, Jiaying
and Xu, Zhimeng
and Cai, Weiping
and Li, Linghua
and Liu, Cong",
title="Dose--Response Effects of Patient Engagement on Health Outcomes in an mHealth Intervention: Secondary Analysis of a Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Jan",
day="4",
volume="10",
number="1",
pages="e25586",
keywords="mHealth",
keywords="patient engagement",
keywords="dose--response relationship",
keywords="long-term effect",
keywords="generalized linear mixed effects model",
abstract="Background: The dose--response relationship between patient engagement and long-term intervention effects in mobile health (mHealth) interventions are understudied. Studies exploring long-term and potentially changing relationships between patient engagement and health outcomes in mHealth interventions are needed. Objective: This study aims to examine dose--response relationships between patient engagement and 3 psychosocial outcomes in an mHealth intervention, Run4Love, using repeated measurements of outcomes at baseline and 3, 6, and 9 months. Methods: This study is a secondary analysis using longitudinal data from the Run4Love trial, a randomized controlled trial with 300 people living with HIV and elevated depressive symptoms to examine the effects of a 3-month mHealth intervention on reducing depressive symptoms and improving quality of life (QOL). We examined the relationships between patient engagement and depressive symptoms, QOL, and perceived stress in the intervention group (N=150) using 4--time-point outcome measurements. Patient engagement was assessed using the completion rate of course assignments and frequency of items completed. Cluster analysis was used to categorize patients into high- and low-engagement groups. Generalized linear mixed effects models were conducted to investigate the dose--response relationships between patient engagement and outcomes. Results: The cluster analysis identified 2 clusters that were distinctively different from each other. The first cluster comprised 72 participants with good compliance to the intervention, completing an average of 74\% (53/72) of intervention items (IQR 0.22). The second cluster comprised 78 participants with low compliance to the intervention, completing an average of 15\% (11/72) of intervention items (IQR 0.23). Results of the generalized linear mixed effects models showed that, compared with the low-engagement group, the high-engagement group had a significant reduction in more depressive symptoms ($\beta$=?1.93; P=.008) and perceived stress ($\beta$=?1.72; P<.001) and an improved QOL ($\beta$=2.41; P=.01) over 9 months. From baseline to 3, 6, and 9 months, the differences in depressive symptoms between the 2 engagement groups were 0.8, 1.6, 2.3, and 3.7 points, respectively, indicating widening between-group differences over time. Similarly, between-group differences in QOL and perceived stress increased over time (group differences in QOL: 0.9, 1.9, 4.7, and 5.1 points, respectively; group differences in the Perceived Stress Scale: 0.9, 1.4, 2.3, and 3.0 points, respectively). Conclusions: This study revealed a positive long-term dose--response relationship between patient engagement and 3 psychosocial outcomes among people living with HIV and elevated depressive symptoms in an mHealth intervention over 9 months using 4 time-point repeat measurement data. The high- and low-engagement groups showed significant and widening differences in depressive symptoms, QOL, and perceived stress at the 3-, 6-, and 9-month follow-ups. Future mHealth interventions should improve patient engagement to achieve long-term and sustained intervention effects. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IPR-17012606; https://www.chictr.org.cn/showproj.aspx?proj=21019 ",
doi="10.2196/25586",
url="https://mhealth.jmir.org/2022/1/e25586",
url="http://www.ncbi.nlm.nih.gov/pubmed/34982724"
}


@Article{info:doi/10.2196/32785,
author="Adib, Riddhiman
and Das, Dipranjan
and Ahamed, Iqbal Sheikh
and Lerret, Marie Stacee",
title="An mHealth App-Based Self-management Intervention for Family Members of Pediatric Transplant Recipients (myFAMI): Framework Design and Development Study",
journal="JMIR Nursing",
year="2022",
month="Jan",
day="4",
volume="5",
number="1",
pages="e32785",
keywords="pediatric patients",
keywords="transplant",
keywords="mobile health",
keywords="mHealth",
keywords="family self-management",
keywords="smartphone",
abstract="Background: Solid-organ transplantation is the treatment of choice for children with end-stage organ failure. Ongoing recovery and medical management at home after transplant are important for recovery and transition to daily life. Smartphones are widely used and hold the potential for aiding in the establishment of mobile health (mHealth) protocols. Health care providers, nurses, and computer scientists collaboratively designed and developed mHealth family self-management intervention (myFAMI), a smartphone-based intervention app to promote a family self-management intervention for pediatric transplant patients' families. Objective: This paper presents outcomes of the design stages and development actions of the myFAMI app framework, along with key challenges, limitations, and strengths. Methods: The myFAMI app framework is built upon a theory-based intervention for pediatric transplant patients, with aid from the action research (AR) methodology. Based on initially defined design motivation, the team of researchers collaboratively explored 4 research stages (research discussions, feedback and motivations, alpha testing, and deployment and release improvements) and developed features required for successful inauguration of the app in the real-world setting. Results: Deriving from app users and their functionalities, the myFAMI app framework is built with 2 primary components: the web app (for nurses' and superadmin usage) and the smartphone app (for participant/family member usage). The web app stores survey responses and triggers alerts to nurses, when required, based on the family members' response. The smartphone app presents the notifications sent from the server to the participants and captures survey responses. Both the web app and the smartphone app were built upon industry-standard software development frameworks and demonstrate great performance when deployed and used by study participants. Conclusions: The paper summarizes a successful and efficient mHealth app-building process using a theory-based intervention in nursing and the AR methodology in computer science. Focusing on factors to improve efficiency enabled easy navigation of the app and collection of data. This work lays the foundation for researchers to carefully integrate necessary information (from the literature or experienced clinicians) to provide a robust and efficient solution and evaluate the acceptability, utility, and usability for similar studies in the future. International Registered Report Identifier (IRRID): RR2-10.1002/nur.22010 ",
doi="10.2196/32785",
url="https://nursing.jmir.org/2022/1/e32785",
url="http://www.ncbi.nlm.nih.gov/pubmed/34780344"
}


@Article{info:doi/10.2196/32575,
author="Wang, Tianyu
and Stanforth, R. Philip
and Fleming, Declan R. Y.
and Wolf Jr, Stuart J.
and Stanforth, Dixie
and Tanaka, Hirofumi",
title="A Mobile App With Multimodality Prehabilitation Programs for Patients Awaiting Elective Surgery: Development and Usability Study",
journal="JMIR Perioper Med",
year="2021",
month="Dec",
day="30",
volume="4",
number="2",
pages="e32575",
keywords="mobile app",
keywords="prehabilitation",
keywords="perioperative care",
keywords="rehabilitation",
keywords="surgery",
keywords="perioperative",
keywords="elective surgery",
keywords="mobile health",
keywords="health applications",
keywords="health apps",
abstract="Background: Complying with a prehabilitation program is difficult for patients who will undergo surgery, owing to transportation challenges and a limited intervention time window. Mobile health (mHealth) using smartphone apps has the potential to remove barriers and improve the effectiveness of prehabilitation. Objective: This study aimed to develop a mobile app as a tool for facilitating a multidisciplinary prehabilitation protocol involving blood flow restriction training and sport nutrition supplementation. Methods: The app was developed using ``Appy Pie,'' a noncoding app development platform. The development process included three stages: (1) determination of principles and requirements of the app through prehabilitation research team meetings; (2) app prototype design using the Appy Pie platform; and (3) app evaluation by clinicians and exercise and fitness specialists, technical professionals from Appy Pie, and non--team-member users. Results: We developed a prototype of the app with the core focus on a multidisciplinary prehabilitation program with accessory features to improve engagement and adherence to the mHealth intervention as well as research-focused features to evaluate the effects of the program on frailty status, health-related quality of life, and anxiety level among patients awaiting elective surgery. Evaluations by research members and random users (n=8) were consistently positive. Conclusions: This mobile app has great potential for improving and evaluating the effectiveness of the multidisciplinary prehabilitation intervention in the format of mHealth in future. ",
doi="10.2196/32575",
url="https://periop.jmir.org/2021/2/e32575",
url="http://www.ncbi.nlm.nih.gov/pubmed/34967752"
}


@Article{info:doi/10.2196/31890,
author="Elzinga, O. Willem
and Prins, Samantha
and Borghans, M. Laura G. J.
and Gal, Pim
and Vargas, A. Gabriel
and Groeneveld, J. Geert
and Doll, J. Robert",
title="Detection of Clenbuterol-Induced Changes in Heart Rate Using At-Home Recorded Smartwatch Data: Randomized Controlled Trial",
journal="JMIR Form Res",
year="2021",
month="Dec",
day="30",
volume="5",
number="12",
pages="e31890",
keywords="photoplethysmography",
keywords="smartwatch",
keywords="wearable",
keywords="at-home",
keywords="heart rate",
keywords="RCT",
keywords="wearable device",
keywords="digital health",
keywords="cardiovascular",
keywords="cardiology",
keywords="sensors",
keywords="heart rate sensor",
keywords="smart technology",
abstract="Background: Although electrocardiography is the gold standard for heart rate (HR) recording in clinical trials, the increasing availability of smartwatch-based HR monitors opens up possibilities for drug development studies. Smartwatches allow for inexpensive, unobtrusive, and continuous HR estimation for potential detection of treatment effects outside the clinic, during daily life. Objective: The aim of this study is to evaluate the repeatability and sensitivity of smartwatch-based HR estimates collected during a randomized clinical trial. Methods: The data were collected as part of a multiple-dose, investigator-blinded, randomized, placebo-controlled, parallel-group study of 12 patients with Parkinson disease. After a 6-day baseline period, 4 and 8 patients were treated for 7 days with an ascending dose of placebo and clenbuterol, respectively. Throughout the study, the smartwatch provided HR and sleep state estimates. The HR estimates were quantified as the 2.5th, 50th, and 97.5th percentiles within awake and asleep segments. Linear mixed models were used to calculate the following: (1) the intraclass correlation coefficient (ICC) of estimated sleep durations, (2) the ICC and minimum detectable effect (MDE) of the HR estimates, and (3) the effect sizes of the HR estimates. Results: Sleep duration was moderately repeatable (ICC=0.64) and was not significantly affected by study day (P=.83), clenbuterol (P=.43), and study day by clenbuterol (P=.73). Clenbuterol-induced changes were detected in the asleep HR as of the first night (+3.79 beats per minute [bpm], P=.04) and in the awake HR as of the third day (+8.79 bpm, P=.001). The median HR while asleep had the highest repeatability (ICC=0.70). The MDE (N=12) was found to be smaller when patients were asleep (6.8 bpm to 11.7 bpm) than while awake (10.7 bpm to 22.1 bpm). Overall, the effect sizes for clenbuterol-induced changes were higher while asleep (0.49 to 2.75) than while awake (0.08 to 1.94). Conclusions: We demonstrated the feasibility of using smartwatch-based HR estimates to detect clenbuterol-induced changes during clinical trials. The asleep HR estimates were most repeatable and sensitive to treatment effects. We conclude that smartwatch-based HR estimates obtained during daily living in a clinical trial can be used to detect and track treatment effects. Trial Registration: Netherlands Trials Register NL8002; https://www.trialregister.nl/trial/8002 ",
doi="10.2196/31890",
url="https://formative.jmir.org/2021/12/e31890",
url="http://www.ncbi.nlm.nih.gov/pubmed/34967757"
}


@Article{info:doi/10.2196/30767,
author="Wang, Y. Elizabeth
and Breyer, N. Benjamin
and Lee, W. Austin
and Rios, Natalie
and Oni-Orisan, Akinyemi
and Steinman, A. Michael
and Sim, Ida
and Kenfield, A. Stacey
and Bauer, R. Scott",
title="Perceptions of Older Men Using a Mobile Health App to Monitor Lower Urinary Tract Symptoms and Tamsulosin Side Effects: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2021",
month="Dec",
day="24",
volume="8",
number="4",
pages="e30767",
keywords="BPH",
keywords="mobile health",
keywords="mHealth",
keywords="telehealth",
keywords="telemedicine",
abstract="Background: Mobile health (mHealth) apps may provide an efficient way for patients with lower urinary tract symptoms (LUTS) to log and communicate symptoms and medication side effects with their clinicians. Objective: The aim of this study was to explore the perceptions of older men with LUTS after using an mHealth app to track their symptoms and tamsulosin side effects. Methods: Structured phone interviews were conducted after a 2-week study piloting the daily use of a mobile app to track the severity of patient-selected LUTS and tamsulosin side effects. Quantitative and qualitative data were considered. Results: All 19 (100\%) pilot study participants completed the poststudy interviews. Most of the men (n=13, 68\%) reported that the daily questionnaires were the right length, with 32\% (n=6) reporting that the questionnaires were too short. Men with more severe symptoms were less likely to report changes in perception of health or changes in self-management; 47\% (n=9) of the men reported improved awareness of symptoms and 5\% (n=1) adjusted fluid intake based on the questionnaire. All of the men were willing to share app data with their clinicians. Thematic analysis of qualitative data yielded eight themes: (1) orientation (setting up app, format, symptom selection, and side-effect selection), (2) triggers (routine or habit and symptom timing), (3) daily questionnaire (reporting symptoms, reporting side effects, and tailoring), (4) technology literacy, (5) perceptions (awareness, causation or relevance, data quality, convenience, usefulness, and other apps), (6) self-management, (7) clinician engagement (communication and efficiency), and (8) improvement (reference materials, flexibility, language, management recommendations, and optimize clinician engagement). Conclusions: We assessed the perceptions of men using an mHealth app to monitor and improve management of LUTS and medication side effects. LUTS management may be further optimized by tailoring the mobile app experience to meet patients' individual needs, such as tracking a greater number of symptoms and integrating the app with clinicians' visits. mHealth apps are likely a scalable modality to monitor symptoms and improve care of older men with LUTS. Further study is required to determine the best ways to tailor the mobile app and to communicate data to clinicians or incorporate data into the electronical medical record meaningfully. ",
doi="10.2196/30767",
url="https://humanfactors.jmir.org/2021/4/e30767",
url="http://www.ncbi.nlm.nih.gov/pubmed/34951599"
}


@Article{info:doi/10.2196/28285,
author="Peyroteo, Mariana
and Ferreira, Augusto In{\^e}s
and Elvas, Brito Lu{\'i}s
and Ferreira, Carlos Jo{\~a}o
and Lap{\~a}o, Velez Lu{\'i}s",
title="Remote Monitoring Systems for Patients With Chronic Diseases in Primary Health Care: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Dec",
day="21",
volume="9",
number="12",
pages="e28285",
keywords="sensors",
keywords="wearables",
keywords="remote monitoring",
keywords="digital health",
keywords="primary health care",
keywords="chronic diseases",
abstract="Background: The digital age, with digital sensors, the Internet of Things (IoT), and big data tools, has opened new opportunities for improving the delivery of health care services, with remote monitoring systems playing a crucial role and improving access to patients. The versatility of these systems has been demonstrated during the current COVID-19 pandemic. Health remote monitoring systems (HRMS) present various advantages such as the reduction in patient load at hospitals and health centers. Patients that would most benefit from HRMS are those with chronic diseases, older adults, and patients that experience less severe symptoms recovering from SARS-CoV-2 viral infection. Objective: This paper aimed to perform a systematic review of the literature of HRMS in primary health care (PHC) settings, identifying the current status of the digitalization of health processes, remote data acquisition, and interactions between health care personnel and patients. Methods: A systematic literature review was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines to identify articles that explored interventions with HRMS in patients with chronic diseases in the PHC setting. Results: The literature review yielded 123 publications, 18 of which met the predefined inclusion criteria. The selected articles highlighted that sensors and wearables are already being used in multiple scenarios related to chronic disease management at the PHC level. The studies focused mostly on patients with diabetes (9/26, 35\%) and cardiovascular diseases (7/26, 27\%). During the evaluation of the implementation of these interventions, the major difficulty that stood out was the integration of information into already existing systems in the PHC infrastructure and in changing working processes of PHC professionals (83\%). Conclusions: The PHC context integrates multidisciplinary teams and patients with often complex, chronic pathologies. Despite the theoretical framework, objective identification of problems, and involvement of stakeholders in the design and implementation processes, these interventions mostly fail to scale up. Despite the inherent limitations of conducting a systematic literature review, the small number of studies in the PHC context is a relevant limitation. This study aimed to demonstrate the importance of matching technological development to the working PHC processes in interventions regarding the use of sensors and wearables for remote monitoring as a source of information for chronic disease management, so that information with clinical value is not lost along the way. ",
doi="10.2196/28285",
url="https://mhealth.jmir.org/2021/12/e28285",
url="http://www.ncbi.nlm.nih.gov/pubmed/34932000"
}


@Article{info:doi/10.2196/32653,
author="White, M. Katie
and Matcham, Faith
and Leightley, Daniel
and Carr, Ewan
and Conde, Pauline
and Dawe-Lane, Erin
and Ranjan, Yatharth
and Simblett, Sara
and Henderson, Claire
and Hotopf, Matthew",
title="Exploring the Effects of In-App Components on Engagement With a Symptom-Tracking Platform Among Participants With Major Depressive Disorder (RADAR-Engage): Protocol for a 2-Armed Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Dec",
day="21",
volume="10",
number="12",
pages="e32653",
keywords="app",
keywords="engagement",
keywords="major depressive disorder",
keywords="remote measurement technologies",
keywords="research",
keywords="mobile phone",
abstract="Background: Multi-parametric remote measurement technologies (RMTs) comprise smartphone apps and wearable devices for both active and passive symptom tracking. They hold potential for understanding current depression status and predicting future depression status. However, the promise of using RMTs for relapse prediction is heavily dependent on user engagement, which is defined as both a behavioral and experiential construct. A better understanding of how to promote engagement in RMT research through various in-app components will aid in providing scalable solutions for future remote research, higher quality results, and applications for implementation in clinical practice. Objective: The aim of this study is to provide the rationale and protocol for a 2-armed randomized controlled trial to investigate the effect of insightful notifications, progress visualization, and researcher contact details on behavioral and experiential engagement with a multi-parametric mobile health data collection platform, Remote Assessment of Disease and Relapse (RADAR)--base. Methods: We aim to recruit 140 participants upon completion of their participation in the RADAR Major Depressive Disorder study in the London site. Data will be collected using 3 weekly tasks through an active smartphone app, a passive (background) data collection app, and a Fitbit device. Participants will be randomly allocated at a 1:1 ratio to receive either an adapted version of the active app that incorporates insightful notifications, progress visualization, and access to researcher contact details or the active app as usual. Statistical tests will be used to assess the hypotheses that participants using the adapted app will complete a higher percentage of weekly tasks (behavioral engagement: primary outcome) and score higher on self-awareness measures (experiential engagement). Results: Recruitment commenced in April 2021. Data collection was completed in September 2021. The results of this study will be communicated via publication in 2022. Conclusions: This study aims to understand how best to promote engagement with RMTs in depression research. The findings will help determine the most effective techniques for implementation in both future rounds of the RADAR Major Depressive Disorder study and, in the long term, clinical practice. Trial Registration: ClinicalTrials.gov NCT04972474; http://clinicaltrials.gov/ct2/show/NCT04972474 International Registered Report Identifier (IRRID): DERR1-10.2196/32653 ",
doi="10.2196/32653",
url="https://www.researchprotocols.org/2021/12/e32653",
url="http://www.ncbi.nlm.nih.gov/pubmed/34932005"
}


@Article{info:doi/10.2196/19543,
author="Davies, Karen
and Cheraghi-Sohi, Sudeh
and Ong, Nio Bie
and Perryman, Katherine
and Sanders, Caroline",
title="Co-designing an Adaption of a Mobile App to Enhance Communication, Safety, and Well-being Among People Living at Home With Early-Stage Dementia: Protocol for an Exploratory Multiple Case Study",
journal="JMIR Res Protoc",
year="2021",
month="Dec",
day="20",
volume="10",
number="12",
pages="e19543",
keywords="design research",
keywords="co-design",
keywords="dementia",
keywords="mobile app",
keywords="communication",
keywords="safety",
keywords="mobile phone",
abstract="Background: There is a growing interest in using mobile apps to support communication, safety, and well-being. Evidence directly from people with dementia regarding the usability, usefulness, and relevance of mobile apps is limited. Objective: This paper describes the protocol of a study that will evaluate an app designed for supporting communication, safety, and well-being among people living with dementia. The study aims to understand if the app can enhance safety through improved communication among users. Methods: The study will use participatory qualitative methods over 3 cycles of evaluation with co-designers (service users, their families, and care practitioners). The study will be developed in partnership with a specialist home care service in England. Purposive case selection will be performed to ensure that the cases exemplify differences in experiences. The app will be evaluated in a walk-through workshop by people living with early-stage dementia and then trialed at home by up to 12 families in a try-out cycle. An amended version will be evaluated in a final walk-through workshop during cycle 3. Data will be collected from at least 4 data sources during the try-out phase and analyzed thematically. An explanatory multiple case study design will be used to synthesize and present the evidence from the three cycles, drawing on the Normalization Process Theory to support the interpretation of the findings. Results: The study is ready to be implemented, but it was paused to protect vulnerable individuals during the COVID-19 pandemic in 2020. The findings will be particularly relevant for understanding how to support vulnerable people living in the community during social distancing and the period following the pandemic as well as for providing insight into the challenges of social isolation that arise from living with dementia. Conclusions: Evaluating a mobile app for enhancing communication, safety, and well-being among people living with dementia contributes to the key ambitions enshrined in policy and practice---championing the use of digital technology and supporting people with dementia to live safely in their own homes. The study will involve co-designers living with dementia, so that the voices of service users can be used to highlight the benefits and challenges of assistive technology and shape the future development of apps that enhance safety by improving communication. International Registered Report Identifier (IRRID): PRR1-10.2196/19543 ",
doi="10.2196/19543",
url="https://www.researchprotocols.org/2021/12/e19543",
url="http://www.ncbi.nlm.nih.gov/pubmed/34932011"
}


@Article{info:doi/10.2196/28128,
author="Black, Melissa
and Brunet, Jennifer",
title="A Wearable Activity Tracker Intervention With and Without Weekly Behavioral Support Emails to Promote Physical Activity Among Women Who Are Overweight or Obese: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Dec",
day="16",
volume="9",
number="12",
pages="e28128",
keywords="behavior change",
keywords="motivation",
keywords="obesity",
keywords="physical activity",
keywords="women",
keywords="mobile phone",
abstract="Background: Physical activity (PA) plays a fundamental role in combating the current obesity epidemic; however, most women who are overweight or obese are generally physically inactive. Wearable activity tracker interventions can help increase the PA levels in this population. Supplementing such interventions with behavioral support emails may further improve their effectiveness, but this remains to be confirmed. Objective: This study aims to determine if adding behavioral support emails to a wearable activity tracker intervention can further increase PA levels among women who are overweight or obese in comparison to a wearable activity tracker--only intervention and a control condition. Methods: Women with a BMI ?25 kg/m2 who were not meeting the Canadian PA guidelines for aerobic and strength training were randomized into 1 of 3 groups. Group 1 received 6 weekly behavioral support emails, a wearable activity tracker, and a copy of the Canadian PA guidelines. Group 2 received a wearable activity tracker and a copy of the Canadian PA guidelines, and group 3 (control condition) received a copy of the Canadian PA guidelines. Self-reported data for walking and moderate to vigorous intensity PA were collected preintervention (week 0; prerandomization), postintervention (7 weeks postrandomization), and at follow-up (21 weeks postrandomization) and analyzed as metabolic equivalent of task minutes per week. In addition, potential mechanisms of behavior change (ie, basic psychological needs satisfaction and motivational regulations) were assessed for within- and between-group differences at all 3 time points. Data were analyzed using nonparametric statistical tests. Results: A total of 49 women were recruited; data from 47 women (mean age 37.57 years, SD 11.78 years; mean BMI 31.69 kg/m2, SD 5.97 kg/m2) were available for analysis. Group 1 reported a significant increase in walking from preintervention to postintervention ($\chi$22=7.5; P=.02) but not in moderate to vigorous intensity PA (P=.24). Group 1 also reported significant increases in perceptions of competence from preintervention to follow-up ($\chi$22=7.6; P=.02) and relatedness from preintervention to follow-up ($\chi$22=8.7; P=.005). Increases in perceived autonomy were observed for group 2 ($\chi$22=7.0) and group 3 ($\chi$22=10.6). There were no significant changes in the motivational regulations within the groups. The difference between the groups was not significant for any outcome variable. Conclusions: The results suggest that adding behavioral support emails to a wearable activity tracker intervention may help to increase time spent walking and perceptions of competence and relatedness for PA among women who are overweight or obese. Trial Registration: ClinicalTrials.gov NCT03601663; http://clinicaltrials.gov/ct2/show/NCT03601663 ",
doi="10.2196/28128",
url="https://mhealth.jmir.org/2021/12/e28128",
url="http://www.ncbi.nlm.nih.gov/pubmed/34927590"
}


@Article{info:doi/10.2196/29098,
author="Szinay, Dorothy
and Perski, Olga
and Jones, Andy
and Chadborn, Tim
and Brown, Jamie
and Naughton, Felix",
title="Perceptions of Factors Influencing Engagement With Health and Well-being Apps in the United Kingdom: Qualitative Interview Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Dec",
day="16",
volume="9",
number="12",
pages="e29098",
keywords="behavior change",
keywords="health apps",
keywords="mHealth",
keywords="smartphone app",
keywords="framework analysis",
keywords="COM-B",
keywords="TDF",
keywords="user engagement",
keywords="motivation",
keywords="usability",
keywords="engagement",
keywords="mobile phone",
abstract="Background: Digital health devices, such as health and well-being smartphone apps, could offer an accessible and cost-effective way to deliver health and well-being interventions. A key component of the effectiveness of health and well-being apps is user engagement. However, engagement with health and well-being apps is typically poor. Previous studies have identified a list of factors that could influence engagement; however, most of these studies were conducted on a particular population or for an app targeting a particular behavior. An understanding of the factors that influence engagement with a wide range of health and well-being apps can inform the design and the development of more engaging apps in general. Objective: The aim of this study is to explore user experiences of and reasons for engaging and not engaging with a wide range of health and well-being apps. Methods: A sample of adults in the United Kingdom (N=17) interested in using a health or well-being app participated in a semistructured interview to explore experiences of engaging and not engaging with these apps. Participants were recruited via social media platforms. Data were analyzed with the framework approach, informed by the Capability, Opportunity, Motivation--Behaviour (COM-B) model and the Theoretical Domains Framework, which are 2 widely used frameworks that incorporate a comprehensive set of behavioral influences. Results: Factors that influence the capability of participants included available user guidance, statistical and health information, reduced cognitive load, well-designed reminders, self-monitoring features, features that help establish a routine, features that offer a safety net, and stepping-stone app characteristics. Tailoring, peer support, and embedded professional support were identified as important factors that enhance user opportunities for engagement with health and well-being apps. Feedback, rewards, encouragement, goal setting, action planning, self-confidence, and commitment were judged to be the motivation factors that affect engagement with health and well-being apps. Conclusions: Multiple factors were identified across all components of the COM-B model that may be valuable for the development of more engaging health and well-being apps. Engagement appears to be influenced primarily by features that provide user guidance, promote minimal cognitive load, support self-monitoring (capability), provide embedded social support (opportunity), and provide goal setting with action planning (motivation). This research provides recommendations for policy makers, industry, health care providers, and app developers for increasing effective engagement. ",
doi="10.2196/29098",
url="https://mhealth.jmir.org/2021/12/e29098",
url="http://www.ncbi.nlm.nih.gov/pubmed/34927597"
}


@Article{info:doi/10.2196/22672,
author="Doyle, Julie
and Murphy, Emma
and Gavin, Shane
and Pascale, Alessandra
and Deparis, St{\'e}phane
and Tommasi, Pierpaolo
and Smith, Suzanne
and Hannigan, Caoimhe
and Sillevis Smitt, Myriam
and van Leeuwen, Cora
and Lastra, Julia
and Galvin, Mary
and McAleer, Patricia
and Tompkins, Lorraine
and Jacobs, An
and M Marques, Marta
and Medina Maestro, Jaime
and Boyle, Gordon
and Dinsmore, John",
title="A Digital Platform to Support Self-management of Multiple Chronic Conditions (ProACT): Findings in Relation to Engagement During a One-Year Proof-of-Concept Trial",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="15",
volume="23",
number="12",
pages="e22672",
keywords="digital health",
keywords="aging",
keywords="multimorbidity",
keywords="chronic disease",
keywords="self-management",
keywords="integrated care",
keywords="longitudinal study",
keywords="engagement",
keywords="usability",
keywords="mobile phone",
abstract="Background: Populations globally are ageing, resulting in higher incidence rates of chronic diseases. Digital health platforms, designed to support those with chronic conditions to self-manage at home, offer a promising solution to help people monitor their conditions and lifestyle, maintain good health, and reduce unscheduled clinical visits. However, despite high prevalence rates of multimorbidity or multiple chronic conditions, most platforms tend to focus on a single disease. A further challenge is that despite the importance of users actively engaging with such systems, little research has explored engagement. Objective: The objectives of this study are to design and develop a digital health platform, ProACT, for facilitating older adults self-managing multimorbidity, with support from their care network, and evaluate end user engagement and experiences with this platform through a 12-month trial. Methods: The ProACT digital health platform is presented in this paper. The platform was evaluated in a year-long proof-of-concept action research trial with 120 older persons with multimorbidity in Ireland and Belgium. Alongside the technology, participants had access to a clinical triage service responding to symptom alerts and a technical helpdesk. Interactions with the platform during the trial were logged to determine engagement. Semistructured interviews were conducted with participants and analyzed using inductive thematic analysis, whereas usability and user burden were examined using validated questionnaires. Results: This paper presents the ProACT platform and its components, along with findings on engagement with the platform and its usability. Of the 120 participants who participated, 24 (20\%) withdrew before the end of the study, whereas 3 (2.5\%) died. The remaining 93 participants actively used the platform until the end of the trial, on average, taking 2 or 3 health readings daily over the course of the trial in Ireland and Belgium, respectively. The participants reported ProACT to be usable and of low burden. Findings from interviews revealed that participants experienced multiple benefits as a result of using ProACT, including improved self-management, health, and well-being and support from the triage service. For those who withdrew, barriers to engagement were poor health and frustration when technology, in particular sensing devices, did not work as expected. Conclusions: This is the first study to present findings from a longitudinal study of older adults using digital health technology to self-manage multimorbidity. Our findings show that older adults sustained engagement with the technology and found it usable. Potential reasons for these results include a strong focus on user-centered design and engagement throughout the project lifecycle, resulting in a platform that meets user needs, as well as the integration of behavior change techniques and personal analytics into the platform. The provision of triage and technical support services alongside the platform during the trial were also important facilitators of engagement. International Registered Report Identifier (IRRID): RR2-10.2196/22125 ",
doi="10.2196/22672",
url="https://www.jmir.org/2021/12/e22672",
url="http://www.ncbi.nlm.nih.gov/pubmed/34914612"
}


@Article{info:doi/10.2196/22125,
author="Dinsmore, John
and Hannigan, Caoimhe
and Smith, Suzanne
and Murphy, Emma
and Kuiper, L. Janneke M.
and O'Byrne, Emma
and Galvin, Mary
and Jacobs, An
and Sillevis Smitt, Myriam
and van Leeuwen, Cora
and McAleer, Patricia
and Tompkins, Lorraine
and Brady, Anne-Marie
and McCarron, Mary
and Doyle, Julie",
title="A Digital Health Platform for Integrated and Proactive Patient-Centered Multimorbidity Self-management and Care (ProACT): Protocol for an Action Research Proof-of-Concept Trial",
journal="JMIR Res Protoc",
year="2021",
month="Dec",
day="15",
volume="10",
number="12",
pages="e22125",
keywords="multimorbidity",
keywords="digital health",
keywords="chronic disease",
keywords="self-management",
keywords="older adults",
keywords="integrated care",
keywords="behaviour change",
keywords="mobile phone",
keywords="smart phone",
keywords="smart device",
abstract="Background: Multimorbidity is defined as the presence of two or more chronic diseases and associated comorbidities. There is a need to improve best practices around the provision of well-coordinated, person-centered care for persons with multimorbidities. Present health systems across the European Union (EU) focus on supporting a single-disease framework of care; the primary challenge is to create a patient-centric, integrated care ecosystem to understand and manage multimorbidity. ProACT is a large-scale project funded by the European Commission under the Horizon 2020 programme, that involved the design, development, and evaluation of a digital health platform to improve and advance home-based integrated care, and supported self-management, for older adults (aged ?65 years) living with multimorbidity. Objective: This paper describes the trial implementation protocol of a proof-of-concept digital health platform (ProACT) in 2 EU member states (Ireland and Belgium) to support older persons with multimorbidities self-managing at home, supported by their care network (CN). Methods: Research was conducted across 2 EU member states, Ireland and Belgium. A 12-month action research trial design, divided into 3 evaluation cycles and lasting 3 months each, with a reflective redesign and development phase of 1 month after cycles 1 and 2 was conducted. Participants were 120 (60/120, 50\% in Ireland and 60/120, 50\% in Belgium) older persons with multimorbidities diagnosed with two or more of the following chronic conditions: diabetes, chronic obstructive pulmonary disease, chronic heart failure, and cardiovascular diseases. With permission from persons with multimorbidities, members of their CN were invited to participate in the study. Persons with multimorbidities were provided with ProACT technologies (tablet, devices, or sensors) to support them in self-managing their conditions. CN members also received access to an app to remotely support their persons with multimorbidity. Qualitative and quantitative feedback and evaluation data from persons with multimorbidity and CN participants were collected across four time points: baseline (T1), at the end of each 3-month action research cycle (T2 and T3), and in a final posttrial interview (T4). Thematic analysis was used to analyze the qualitative interview data. Quantitative data were analyzed via platform use statistics (to assess engagement) and standardized questionnaires (using descriptive and inferential statistics). This study is approved by the ethics committees of Ireland and Belgium. Results: The trial implementation phase for this 44-month (2016-2019) funded study was April 2018 to June 2019. The trial outcomes are at various stages of publication since 2021. Conclusions: ProACT aims to co-design and develop a digital intervention with persons with multimorbidities and their CN, incorporating clinical guidelines with the state of the art in human-computer interaction, behavioral science, health psychology, and data analytic methods to deliver a digital health platform to advance self-management of multimorbidity at home, as part of a proactive, integrated model of supported person-centered care. International Registered Report Identifier (IRRID): RR1-10.2196/22125 ",
doi="10.2196/22125",
url="https://www.researchprotocols.org/2021/12/e22125",
url="http://www.ncbi.nlm.nih.gov/pubmed/34914613"
}


@Article{info:doi/10.2196/29197,
author="Markossian, W. Talar
and Boyda, Jason
and Taylor, Jennifer
and Etingen, Bella
and Modave, Fran{\c{c}}ois
and Price, Ron
and Kramer, J. Holly",
title="A Mobile App to Support Self-management of Chronic Kidney Disease: Development Study",
journal="JMIR Hum Factors",
year="2021",
month="Dec",
day="15",
volume="8",
number="4",
pages="e29197",
keywords="chronic kidney disease",
keywords="mobile app",
keywords="self-management",
keywords="mHealth",
keywords="mobile apps",
keywords="digital health",
keywords="kidney disease",
keywords="smartphone",
abstract="Background: Chronic kidney disease (CKD) is a common and costly condition that is usually accompanied by multiple comorbidities including type 2 diabetes, hypertension, and obesity. Proper management of CKD can delay or prevent kidney failure and help mitigate cardiovascular disease risk, which increases as kidney function declines. Smart device apps hold potential to enhance patient self-management of chronic conditions including CKD. Objective: The objective of this study was to develop a mobile app to facilitate self-management of nondialysis-dependent CKD. Methods: Our stakeholder team included 4 patients with stage 3-4 nondialysis-dependent CKD; a kidney transplant recipient; a caretaker; CKD care providers (pharmacists, a nurse, primary care physicians, a nephrologist, and a cardiologist); 2 health services and CKD researchers; a researcher in biomedical informatics, nutrition, and obesity; a system developer; and 2 programmers. Focus groups and in-person interviews with the patients and providers were conducted using a focus group and interview guide based on existing literature on CKD self-management and the mobile app quality criteria from the Mobile App Rating Scale. Qualitative analytic methods including the constant comparative method were used to analyze the focus group and interview data. Results: Patients and providers identified and discussed a list of requirements and preferences regarding the content, features, and technical aspects of the mobile app, which are unique for CKD self-management. Requirements and preferences centered along themes of communication between patients and caregivers, partnership in care, self-care activities, adherence to treatment regimens, and self-care self-efficacy. These identified themes informed the features and content of our mobile app. The mobile app user can enter health data including blood pressure, weight, and blood glucose levels. Symptoms and their severity can also be entered, and users are prompted to contact a physician as indicated by the symptom and its severity. Next, mobile app users can select biweekly goals from a set of predetermined goals with the option to enter customized goals. The user can also keep a list of medications and track medication use. Our app includes feedback mechanisms where in-range values for health data are depicted in green and out-of-range values are depicted in red. We ensured that data entered by patients could be downloaded into a user-friendly report, which could be emailed or uploaded to an electronic health record. The mobile app also includes a mechanism that allows either group or individualized video chat meetings with a provider to facilitate either group support, education, or even virtual clinic visits. The CKD app also includes educational material on CKD and its symptoms. Conclusions: Patients with CKD and CKD care providers believe that a mobile app can enhance CKD self-management by facilitating patient-provider communication and enabling self-care activities including treatment adherence. ",
doi="10.2196/29197",
url="https://humanfactors.jmir.org/2021/4/e29197",
url="http://www.ncbi.nlm.nih.gov/pubmed/34914614"
}


@Article{info:doi/10.2196/30151,
author="Bekkelund, Ivar Svein
and M{\"u}ller, Ivar Kai",
title="One-Year Remission Rate of Chronic Headache Comparing Video and Face-to-Face Consultations by Neurologist: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="13",
volume="23",
number="12",
pages="e30151",
keywords="chronic headache",
keywords="remission",
keywords="video consultation",
keywords="telemedicine",
keywords="eHealth",
keywords="digital consultation",
keywords="consultation",
keywords="treatment",
keywords="follow-up",
keywords="RCT",
keywords="randomized controlled trial",
abstract="Background: Chronic headache causing severe headache-related disability for those affected by the disease is under- or misdiagnosed in many cases and therefore requires easy access to a specialist for optimal health care management. Objective: The goal of the research is to determine whether video consultations are noninferior to face-to-face consultations in treating chronic headache patients referred to a specialist in Northern Norway. Methods: Patients included in the study were recruited from general practice referrals to a specialist at a neurological department in Northern Norway (Troms{\o}) and diagnosed according to the International Headache Society classification system. In a randomized controlled design, the 1-year remission rate of chronic headache (change from ?15 to <15 headache days per month during the last 3 months), patient satisfaction with a specialist consultation, and need for follow-up consultations by general practitioners were compared between groups consulted by video and face-to-face in a post hoc analysis. Data were collected by interview (baseline) and questionnaire (follow-up). Results: From a baseline cohort of 402 headache patients consecutively referred from general practice to a specialist over 2.5 years, 58.0\% (233/402) were classified as chronic headache and included in this study. Response rates were 71.7\% (86/120) in the video group and 67.3\% (76/113) in the face-to-face group. One-year remission from chronic headache was achieved in 43.0\% (37/86) in the video group and 39.5\% (30/76) in the face-to-face group (P=.38). Patient satisfaction with consultations were 86.5\% (32/37; video) and 93.3\% (28/30; face-to-face; P=.25). A total of 30\% (11/37) in the video group and 53\% (16/30) in the face-to-face group consulted general practitioners during the follow-up period (P=.03), and median number of consultations was 1 (IQR 0-13) and 1.5 (IQR 0-15), respectively (P=.19). Conclusions: One-year remission rate from chronic headache was about 40\% regardless of consultation form. Likewise, patient satisfaction with consultation and need for follow-up visits in general practice post consultation was similar. Treating chronic headache patients by using video consultations is not inferior to face-to-face consultations and may be used in clinical neurological practice. Trial Registration: ClinicalTrials.gov NCT02270177; https://clinicaltrials.gov/ct2/show/NCT02270177 ",
doi="10.2196/30151",
url="https://www.jmir.org/2021/12/e30151",
url="http://www.ncbi.nlm.nih.gov/pubmed/34898455"
}


@Article{info:doi/10.2196/26439,
author="Chen, Yuling
and Ji, Meihua
and Wu, Ying
and Wang, Qingyu
and Deng, Ying
and Liu, Yong
and Wu, Fangqin
and Liu, Mingxuan
and Guo, Yiqiang
and Fu, Ziyuan
and Zheng, Xiaoying",
title="An Intelligent Individualized Cardiovascular App for Risk Elimination (iCARE) for Individuals With Coronary Heart Disease: Development and Usability Testing Analysis",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Dec",
day="13",
volume="9",
number="12",
pages="e26439",
keywords="mobile health",
keywords="health behavior",
keywords="system",
keywords="development",
keywords="usability",
keywords="coronary heart disease",
abstract="Background: Death and disability from coronary heart disease (CHD) can be largely reduced by improving risk factor management. However, adhering to evidence-based recommendations is challenging and requires interventions at the level of the patient, provider, and health system. Objective: The aim of this study was to develop an Intelligent Individualized Cardiovascular App for Risk Elimination (iCARE) to facilitate adherence to health behaviors and preventive medications, and to test the usability of iCARE. Methods: We developed iCARE based on a user-centered design approach, which included 4 phases: (1) function design, (2) iterative design, (3) expert inspections and walkthroughs of the prototypes, and (4) usability testing with end users. The usability testing of iCARE included 2 stages: stage I, which included a task analysis and a usability evaluation (January to March 2019) of the iCARE patient app using the modified Health Information Technology Usability Survey (Health-ITUES); and stage II (June 2020), which used the Health-ITUES among end users who used the app for 6 months. The end users were individuals with a confirmed diagnosis of CHD from 2 university-affiliated hospitals in Beijing, China. Results: iCARE consists of a patient app, a care provider app, and a cloud platform. It has a set of algorithms that trigger tailored feedback and can send individualized interventions based on data from initial assessment and health monitoring via manual entry or wearable devices. For stage I usability testing, 88 hospitalized patients (72\% [63/88] male; mean age 60 [SD 9.9] years) with CHD were included in the study. The mean score of the usability testing was 90.1 (interquartile range 83.3-99.0). Among enrolled participants, 90\% (79/88) were satisfied with iCARE; 94\% (83/88) and 82\% (72/88) reported that iCARE was useful and easy to use, respectively. For stage II usability testing, 61 individuals with CHD (85\% [52/61] male; mean age 53 [SD 8.2] years) who were from an intervention arm and used iCARE for at least six months were included. The mean total score on usability testing based on the questionnaire was 89.0 (interquartile distance: 77.0-99.5). Among enrolled participants, 89\% (54/61) were satisfied with the use of iCARE, 93\% (57/61) perceived it as useful, and 70\% (43/61) as easy to use. Conclusions: This study developed an intelligent, individualized, evidence-based, and theory-driven app (iCARE) to improve patients' adherence to health behaviors and medication management. iCARE was identified to be highly acceptable, useful, and easy to use among individuals with a diagnosis of CHD. Trial Registration: Chinese Clinical Trial Registry ChiCTR-INR-16010242; https://tinyurl.com/2p8bkrew ",
doi="10.2196/26439",
url="https://mhealth.jmir.org/2021/12/e26439",
url="http://www.ncbi.nlm.nih.gov/pubmed/34898449"
}


@Article{info:doi/10.2196/32587,
author="Stewart, Callum
and Ranjan, Yatharth
and Conde, Pauline
and Rashid, Zulqarnain
and Sankesara, Heet
and Bai, Xi
and Dobson, B. Richard J.
and Folarin, A. Amos",
title="Investigating the Use of Digital Health Technology to Monitor COVID-19 and Its Effects: Protocol for an Observational Study (Covid Collab Study)",
journal="JMIR Res Protoc",
year="2021",
month="Dec",
day="8",
volume="10",
number="12",
pages="e32587",
keywords="mobile health",
keywords="COVID-19",
keywords="digital health",
keywords="smartphone",
keywords="wearable devices",
keywords="mental health",
keywords="wearable",
keywords="data",
keywords="crowdsourced",
keywords="monitoring",
keywords="surveillance",
keywords="observational",
keywords="feasibility",
keywords="infectious disease",
keywords="recovery",
keywords="mobile phone",
abstract="Background: The ubiquity of mobile phones and increasing use of wearable fitness trackers offer a wide-ranging window into people's health and well-being. There are clear advantages in using remote monitoring technologies to gain an insight into health, particularly under the shadow of the COVID-19 pandemic. Objective: Covid Collab is a crowdsourced study that was set up to investigate the feasibility of identifying, monitoring, and understanding the stratification of SARS-CoV-2 infection and recovery through remote monitoring technologies. Additionally, we will assess the impacts of the COVID-19 pandemic and associated social measures on people's behavior, physical health, and mental well-being. Methods: Participants will remotely enroll in the study through the Mass Science app to donate historic and prospective mobile phone data, fitness tracking wearable data, and regular COVID-19--related and mental health--related survey data. The data collection period will cover a continuous period (ie, both before and after any reported infections), so that comparisons to a participant's own baseline can be made. We plan to carry out analyses in several areas, which will cover symptomatology; risk factors; the machine learning--based classification of illness; and trajectories of recovery, mental well-being, and activity. Results: As of June 2021, there are over 17,000 participants---largely from the United Kingdom---and enrollment is ongoing. Conclusions: This paper introduces a crowdsourced study that will include remotely enrolled participants to record mobile health data throughout the COVID-19 pandemic. The data collected may help researchers investigate a variety of areas, including COVID-19 progression; mental well-being during the pandemic; and the adherence of remote, digitally enrolled participants. International Registered Report Identifier (IRRID): DERR1-10.2196/32587 ",
doi="10.2196/32587",
url="https://www.researchprotocols.org/2021/12/e32587",
url="http://www.ncbi.nlm.nih.gov/pubmed/34784292"
}


@Article{info:doi/10.2196/26185,
author="Dorsch, P. Michael
and Farris, B. Karen
and Rowell, E. Brigid
and Hummel, L. Scott
and Koelling, M. Todd",
title="The Effects of the ManageHF4Life Mobile App on Patients With Chronic Heart Failure: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Dec",
day="7",
volume="9",
number="12",
pages="e26185",
keywords="mHealth",
keywords="remote monitoring",
keywords="self-management",
keywords="self-care",
keywords="heart failure",
keywords="medical therapy",
keywords="mobile app",
abstract="Background: The successful management of heart failure (HF) involves guideline-based medical therapy as well as self-management behavior. As a result, the management of HF is moving toward a proactive real-time technological model of assisting patients with monitoring and self-management. Objective: The aim of this paper was to evaluate the efficacy of enhanced self-management via a mobile app intervention on health-related quality of life, self-management, and HF readmissions. Methods: A single-center randomized controlled trial was performed. Participants older than 45 years and admitted for acute decompensated HF or recently discharged in the past 4 weeks were included. The intervention group (``app group'') used a mobile app, and the intervention prompted daily self-monitoring and promoted self-management. The control group (``no-app group'') received usual care. The primary outcome was the change in Minnesota Living with Heart Failure Questionnaire (MLHFQ) score from baseline to 6 and 12 weeks. Secondary outcomes were the Self-Care Heart Failure Index (SCHFI) questionnaire score and recurrent HF admissions. Results: A total of 83 participants were enrolled and completed all baseline assessments. Baseline characteristics were similar between the groups except for the prevalence of ischemic HF. The app group had a reduced MLHFQ at 6 weeks (mean 37.5, SD 3.5 vs mean 48.2, SD 3.7; P=.04) but not at 12 weeks (mean 44.2, SD 4 vs mean 45.9, SD 4; P=.78), compared to the no-app group. There was no effect of the app on the SCHFI at 6 or 12 weeks. The time to first HF readmission was not statistically different between the app group and the no-app group (app group 11/42, 26\% vs no-app group 12/41, 29\%; hazard ratio 0.89, 95\% CI 0.39-2.02; P=.78) over 12 weeks. Conclusions: The adaptive mobile app intervention, which focused on promoting self-monitoring and self-management, improved the MLHFQ at 6 weeks but did not sustain its effects at 12 weeks. No effect was seen on HF self-management measured by self-report. Further research is needed to enhance engagement in the app for a longer period and to determine if the app can reduce HF readmissions in a larger study. Trial Registration: ClinicalTrials.gov NCT03149510; https://clinicaltrials.gov/ct2/show/NCT03149510 ",
doi="10.2196/26185",
url="https://mhealth.jmir.org/2021/12/e26185",
url="http://www.ncbi.nlm.nih.gov/pubmed/34878990"
}


@Article{info:doi/10.2196/17959,
author="Beerthuizen, Thijs
and Rikkers-Mutsaerts, M. E. R. V.
and Snoeck-Stroband, B. Jiska
and Sont, K. Jacob",
title="The Role of Education, Monitoring, and Symptom Perception in Internet-Based Self-management Among Adolescents With Asthma: Secondary Analysis of a Randomized Controlled Trial",
journal="JMIR Pediatr Parent",
year="2021",
month="Dec",
day="7",
volume="4",
number="4",
pages="e17959",
keywords="web-based monitoring",
keywords="internet self-management",
keywords="adolescents",
keywords="asthma",
keywords="education",
keywords="perception",
abstract="Background: Internet-based self-management programs improve asthma control and the asthma-related quality of life in adults and adolescents. The components of self-management programs include education and the web-based self-monitoring of symptoms; the latter requires adequate perception in order to timely adjust lifestyle or medication or to contact a care provider. Objective: We aimed to test the hypothesis that adherence to education and web-based monitoring and adequate symptom perception are important determinants for the improvement of asthma control in self-management programs. Methods: We conducted a subgroup analysis of the intervention group of a randomized controlled trial, which included adolescents who participated in the internet-based self-management arm. We assessed the impacts that attendance in education sessions, the frequency of web-based monitoring, and the level of perception had on changes in asthma control (Asthma Control Questionnaire [ACQ]) and asthma-related quality of life (Pediatric Asthma Quality of Life Questionnaire) from baseline to 12 months after intervention. Results: Adolescents who attended education sessions had significant and clinically relevant improvements in asthma control (ACQ score difference: ?0.6; P=.03) and exhibited a nonsignificant trend of improvement in asthma-related quality of life (Pediatric Asthma Quality of Life Questionnaire score difference: ?0.45; P=.15) when compared to those who did not adhere to education. Frequent monitoring alone did not improve asthma control (P=.07) and quality of life (P=.44) significantly, but its combination with education did result in improved ACQ scores (difference: ?0.88; P=.02). There were no significant differences in outcomes between normoperceivers and hypoperceivers. Conclusions: Education, especially in combination with frequent web-based monitoring, is an important determinant for the 1-year outcomes of asthma control in internet-based self-management programs for adolescents with partly controlled and uncontrolled asthma; however, we could not establish the effect of symptom perception. This study provides important knowledge on the effects of asthma education and monitoring in daily life. ",
doi="10.2196/17959",
url="https://pediatrics.jmir.org/2021/4/e17959",
url="http://www.ncbi.nlm.nih.gov/pubmed/34879001"
}


@Article{info:doi/10.2196/29563,
author="Moshontz, Hannah
and Colmenares, J. Alejandra
and Fronk, E. Gaylen
and Sant'Ana, J. Sarah
and Wyant, Kendra
and Wanta, E. Susan
and Maus, Adam
and Gustafson Jr, H. David
and Shah, Dhavan
and Curtin, J. John",
title="Prospective Prediction of Lapses in Opioid Use Disorder: Protocol for a Personal Sensing Study",
journal="JMIR Res Protoc",
year="2021",
month="Dec",
day="7",
volume="10",
number="12",
pages="e29563",
keywords="digital therapeutics",
keywords="risk prediction",
keywords="opioid lapse",
keywords="mobile phone",
abstract="Background: Successful long-term recovery from opioid use disorder (OUD) requires continuous lapse risk monitoring and appropriate use and adaptation of recovery-supportive behaviors as lapse risk changes. Available treatments often fail to support long-term recovery by failing to account for the dynamic nature of long-term recovery. Objective: The aim of this protocol paper is to describe research that aims to develop a highly contextualized lapse risk prediction model that forecasts the ongoing probability of lapse. Methods: The participants will include 480 US adults in their first year of recovery from OUD. Participants will report lapses and provide data relevant to lapse risk for a year with a digital therapeutic smartphone app through both self-report and passive personal sensing methods (eg, cellular communications and geolocation). The lapse risk prediction model will be developed using contemporary rigorous machine learning methods that optimize prediction in new data. Results: The National Institute of Drug Abuse funded this project (R01DA047315) on July 18, 2019 with a funding period from August 1, 2019 to June 30, 2024. The University of Wisconsin-Madison Health Sciences Institutional Review Board approved this project on July 9, 2019. Pilot enrollment began on April 16, 2021. Full enrollment began in September 2021. Conclusions: The model that will be developed in this project could support long-term recovery from OUD---for example, by enabling just-in-time interventions within digital therapeutics. International Registered Report Identifier (IRRID): DERR1-10.2196/29563 ",
doi="10.2196/29563",
url="https://www.researchprotocols.org/2021/12/e29563",
url="http://www.ncbi.nlm.nih.gov/pubmed/34559061"
}


@Article{info:doi/10.2196/28242,
author="Bughin, Fran{\c{c}}ois
and Bui, Gaspard
and Ayoub, Bronia
and Blervaque, Leo
and Saey, Didier
and Avignon, Antoine
and Brun, Fr{\'e}d{\'e}ric Jean
and Molinari, Nicolas
and Pomies, Pascal
and Mercier, Jacques
and Gouzi, Fares
and Hayot, Maurice",
title="Impact of a Mobile Telerehabilitation Solution on Metabolic Health Outcomes and Rehabilitation Adherence in Patients With Obesity: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Dec",
day="6",
volume="9",
number="12",
pages="e28242",
keywords="telerehabilitation",
keywords="mHealth",
keywords="rehabilitation",
keywords="obesity",
keywords="mobile phone",
abstract="Background: Obesity is a major public health issue. Combining exercise training, nutrition, and therapeutic education in metabolic rehabilitation (MR) is recommended for obesity management. However, evidence from randomized controlled studies is lacking. In addition, MR is associated with poor patient adherence. Mobile health devices improve access to MR components. Objective: The aim of this study is to compare the changes in body composition, anthropometric parameters, exercise capacity, and quality of life (QOL) within 12 weeks of patients in the telerehabilitation (TR) program to those of usual care patients with obesity. Methods: This was a parallel-design randomized controlled study. In total, 50 patients with obesity (BMI>30 kg/m{\texttwosuperior}) were included in a TR group (TRG) or a usual care group (UCG) for 12 weeks. Patients underwent biometric impedance analyses, metabolic exercise tests, actimetry, and QOL and satisfaction questionnaires. The primary outcome was the change in fat mass at 12 weeks from baseline. Secondary outcomes were changes in body weight, metabolic parameters, exercise capacity, QOL, patients' adhesion, and satisfaction. Results: A total of 49 patients completed the study. No significant group {\texttimes} time interaction was found for fat mass (TRG: mean 1.7 kg, SD 2.6 kg; UCG: mean 1.2 kg, SD 2.4 kg; P=.48). Compared with the UCG, TRG patients tended to significantly improve their waist to hip ratios (TRG: ?0.01 kg, SD 0.04; UCG: +0.01 kg, SD 0.06; P=.07) and improved QOL physical impact (TRG: +21.8, SD 43.6; UCG: ?1.2, SD 15.4; P=.005). Significant time effects were observed for body composition, 6-minute walk test distance, exercise metabolism, sedentary time, and QOL. Adherence (95\%) and satisfaction in the TRG were good. Conclusions: In adults with obesity, the TR program was not superior to usual care for improving body composition. However, TR was able to deliver full multidisciplinary rehabilitation to patients with obesity and improve some health outcomes. Given the patients' adherence and satisfaction, pragmatic programs should consider mobile health devices to improve access to MR. Further studies are warranted to further establish the benefits that TR has over usual care. Trial Registration: ClinicalTrials.gov NCT03396666; http://clinicaltrials.gov/ct2/show/NCT03396666 ",
doi="10.2196/28242",
url="https://mhealth.jmir.org/2021/12/e28242",
url="http://www.ncbi.nlm.nih.gov/pubmed/34874887"
}


@Article{info:doi/10.2196/31271,
author="Janvrin, Lynn Miranda
and Korona-Bailey, Jessica
and Koehlmoos, P{\'e}rez Tracey",
title="Re-examining COVID-19 Self-Reported Symptom Tracking Programs in the United States: Updated Framework Synthesis",
journal="JMIR Form Res",
year="2021",
month="Dec",
day="6",
volume="5",
number="12",
pages="e31271",
keywords="COVID-19",
keywords="coronavirus",
keywords="framework analysis",
keywords="information resources",
keywords="monitoring",
keywords="patient-reported outcome measures",
keywords="self-reported",
keywords="surveillance",
keywords="symptom tracking",
keywords="synthesis",
keywords="digital health",
abstract="Background: Early in the pandemic, in 2020, Koehlmoos et al completed a framework synthesis of currently available self-reported symptom tracking programs for COVID-19. This framework described relevant programs, partners and affiliates, funding, responses, platform, and intended audience, among other considerations. Objective: This study seeks to update the existing framework with the aim of identifying developments in the landscape and highlighting how programs have adapted to changes in pandemic response. Methods: Our team developed a framework to collate information on current COVID-19 self-reported symptom tracking programs using the ``best-fit'' framework synthesis approach. All programs from the previous study were included to document changes. New programs were discovered using a Google search for target keywords. The time frame for the search for programs ranged from March 1, 2021, to May 6, 2021. Results: We screened 33 programs, of which 8 were included in our final framework synthesis. We identified multiple common data elements, including demographic information such as race, age, gender, and affiliation (all were associated with universities, medical schools, or schools of public health). Dissimilarities included questions regarding vaccination status, vaccine hesitancy, adherence to social distancing, COVID-19 testing, and mental health. Conclusions: At this time, the future of self-reported symptom tracking for COVID-19 is unclear. Some sources have speculated that COVID-19 may become a yearly occurrence much like the flu, and if so, the data that these programs generate is still valuable. However, it is unclear whether the public will maintain the same level of interest in reporting their symptoms on a regular basis if the prevalence of COVID-19 becomes more common. ",
doi="10.2196/31271",
url="https://formative.jmir.org/2021/12/e31271",
url="http://www.ncbi.nlm.nih.gov/pubmed/34792469"
}


@Article{info:doi/10.2196/28782,
author="van Barneveld, Esther
and Lim, Arianne
and van Hanegem, Nehalennia
and Vork, Lisa
and Herrewegh, Alexandra
and van Poll, Mikal
and Manders, Jessica
and van Osch, Frits
and Spaans, Wilbert
and van Koeveringe, Gommert
and Vrijens, Desiree
and Kruimel, Joanna
and Bongers, Marlies
and Leue, Carsten",
title="Patient-Reported Outcome Measure for Real-time Symptom Assessment in Women With Endometriosis: Focus Group Study",
journal="JMIR Form Res",
year="2021",
month="Dec",
day="3",
volume="5",
number="12",
pages="e28782",
keywords="endometriosis",
keywords="pelvic pain",
keywords="positive affect",
keywords="negative affect",
keywords="patient-reported outcome measure",
keywords="focus groups",
keywords="experience sampling method",
keywords="momentary symptom assessment",
keywords="mobile phone",
abstract="Background: Symptoms related to endometriosis have a significant impact on the quality of life, and symptoms often recur. The experience sampling method (ESM), a digital questioning method characterized by randomly repeated momentary assessments, has several advantages over traditionally used measurements, including the ability to assess the temporal relationship between variables such as physical, mental, and social factors. Objective: The aim of this study is to develop an ESM tool for patients with endometriosis to accurately measure symptoms and their course over time, allowing for personalized treatment and adequate monitoring of treatment efficacy in individual patients. Methods: On the basis of international guidelines, items from validated questionnaires were selected through a literature review and during focus groups and multidisciplinary expert meetings. Data analysis was conducted using ATLAS.ti (ATLAS.ti Scientific Software Development GmbH). The feasibility and usability of the newly developed momentary assessment tool were tested for 28 consecutive days in 5 patients with endometriosis-related pain symptoms. Results: Momentary assessment items contained questions concerning endometriosis symptoms, general somatic symptoms, psychological symptoms, contextual information, and the use of food and medication. A morning questionnaire on sleep and sexuality was included. In a pilot study, the patients considered the tool easy to use but time consuming. The average compliance rate of momentary assessments was 37.8\% (106/280), with the highest completion rate during the first week (39/70, 56\%). Therefore, it is advisable to use the ESM for a maximum of 7 days. Conclusions: A new digital tool for endometriosis symptom assessment was developed using the ESM, which may help overcome the limitations of current retrospective questionnaires. After validation and testing, future studies will be planned to evaluate the use of this tool in a clinical setting in order to propose a personalized treatment plan for women with endometriosis. ",
doi="10.2196/28782",
url="https://formative.jmir.org/2021/12/e28782",
url="http://www.ncbi.nlm.nih.gov/pubmed/34870608"
}


@Article{info:doi/10.2196/29071,
author="Steele Gray, Carolyn
and Chau, Edward
and Tahsin, Farah
and Harvey, Sarah
and Loganathan, Mayura
and McKinstry, Brian
and Mercer, W. Stewart
and Nie, Xin Jason
and Palen, E. Ted
and Ramsay, Tim
and Thavorn, Kednapa
and Upshur, Ross
and Wodchis, P. Walter",
title="Assessing the Implementation and Effectiveness of the Electronic Patient-Reported Outcome Tool for Older Adults With Complex Care Needs: Mixed Methods Study",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="2",
volume="23",
number="12",
pages="e29071",
keywords="older adults",
keywords="goal-oriented care",
keywords="quality of life",
keywords="self-management",
keywords="primary care",
keywords="eHealth",
keywords="pragmatic trial",
keywords="mobile phone",
abstract="Background: Goal-oriented care is being adopted to deliver person-centered primary care to older adults with multimorbidity and complex care needs. Although this model holds promise, its implementation remains a challenge. Digital health solutions may enable processes to improve adoption; however, they require evaluation to determine feasibility and impact. Objective: This study aims to evaluate the implementation and effectiveness of the electronic Patient-Reported Outcome (ePRO) mobile app and portal system, designed to enable goal-oriented care delivery in interprofessional primary care practices. The research questions driving this study are as follows: Does ePRO improve quality of life and self-management in older adults with complex needs? What mechanisms are likely driving observed outcomes? Methods: A multimethod, pragmatic randomized controlled trial using a stepped-wedge design and ethnographic case studies was conducted over a 15-month period in 6 comprehensive primary care practices across Ontario with a target enrollment of 176 patients. The 6 practices were randomized into either early (3-month control period; 12-month intervention) or late (6-month control period; 9-month intervention) groups. The primary outcome measure of interest was the Assessment of Quality of Life-4D (AQoL-4D). Data were collected at baseline and at 3 monthly intervals for the duration of the trial. Ethnographic data included observations and interviews with patients and providers at the midpoint and end of the intervention. Outcome data were analyzed using linear models conducted at the individual level, accounting for cluster effects at the practice level, and ethnographic data were analyzed using qualitative description and framework analysis methods. Results: Recruitment challenges resulted in fewer sites and participants than expected; of the 176 target, only 142 (80.6\%) patients were identified as eligible to participate because of lower-than-expected provider participation and fewer-than-expected patients willing to participate or perceived as ready to engage in goal-setting. Of the 142 patients approached, 45 (32\%) participated. Patients set a variety of goals related to self-management, mental health, social health, and overall well-being. Owing to underpowering, the impact of ePRO on quality of life could not be definitively assessed; however, the intervention group, ePRO plus usual care (mean 15.28, SD 18.60) demonstrated a nonsignificant decrease in quality of life (t24=?1.20; P=.24) when compared with usual care only (mean 21.76, SD 2.17). The ethnographic data reveal a complex implementation process in which the meaningfulness (or coherence) of the technology to individuals' lives and work acted as a key driver of adoption and tool appraisal. Conclusions: This trial experienced many unexpected and significant implementation challenges related to recruitment and engagement. Future studies could be improved through better alignment of the research methods and intervention to the complex and diverse clinical settings, dynamic goal-oriented care process, and readiness of provider and patient participants. Trial Registration: ClinicalTrials.gov NCT02917954; https://clinicaltrials.gov/ct2/show/NCT02917954 ",
doi="10.2196/29071",
url="https://www.jmir.org/2021/12/e29071",
url="http://www.ncbi.nlm.nih.gov/pubmed/34860675"
}


@Article{info:doi/10.2196/27024,
author="Mosa, Mohammad Abu Saleh
and Rana, Zaman Md Kamruz
and Islam, Humayera
and Hossain, Mosharraf A. K. M.
and Yoo, Illhoi",
title="A Smartphone-Based Decision Support Tool for Predicting Patients at Risk of Chemotherapy-Induced Nausea and Vomiting: Retrospective Study on App Development Using Decision Tree Induction",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Dec",
day="2",
volume="9",
number="12",
pages="e27024",
keywords="chemotherapy",
keywords="CINV risk factors",
keywords="data mining",
keywords="prediction",
keywords="decision trees",
keywords="clinical decision support",
keywords="smartphone app",
abstract="Background: Chemotherapy-induced nausea and vomiting (CINV) are the two most frightful and unpleasant side effects of chemotherapy. CINV is accountable for poor treatment outcomes, treatment failure, or even death. It can affect patients' overall quality of life, leading to many social, economic, and clinical consequences. Objective: This study compared the performances of different data mining models for predicting the risk of CINV among the patients and developed a smartphone app for clinical decision support to recommend the risk of CINV at the point of care. Methods: Data were collected by retrospective record review from the electronic medical records used at the University of Missouri Ellis Fischel Cancer Center. Patients who received chemotherapy and standard antiemetics at the oncology outpatient service from June 1, 2010, to July 31, 2012, were included in the study. There were six independent data sets of patients based on emetogenicity (low, moderate, and high) and two phases of CINV (acute and delayed). A total of 14 risk factors of CINV were chosen for data mining. For our study, we used five popular data mining algorithms: (1) naive Bayes algorithm, (2) logistic regression classifier, (3) neural network, (4) support vector machine (using sequential minimal optimization), and (5) decision tree. Performance measures, such as accuracy, sensitivity, and specificity with 10-fold cross-validation, were used for model comparisons. A smartphone app called CINV Risk Prediction Application was developed using the ResearchKit in iOS utilizing the decision tree algorithm, which conforms to the criteria of explainable, usable, and actionable artificial intelligence. The app was created using both the bulk questionnaire approach and the adaptive approach. Results: The decision tree performed well in both phases of high emetogenic chemotherapies, with a significant margin compared to the other algorithms. The accuracy measure for the six patient groups ranged from 79.3\% to 94.8\%. The app was developed using the results from the decision tree because of its consistent performance and simple, explainable nature. The bulk questionnaire approach asks 14 questions in the smartphone app, while the adaptive approach can determine questions based on the previous questions' answers. The adaptive approach saves time and can be beneficial when used at the point of care. Conclusions: This study solved a real clinical problem, and the solution can be used for personalized and precise evidence-based CINV management, leading to a better life quality for patients and reduced health care costs. ",
doi="10.2196/27024",
url="https://mhealth.jmir.org/2021/12/e27024",
url="http://www.ncbi.nlm.nih.gov/pubmed/34860677"
}


@Article{info:doi/10.2196/31985,
author="Cruz-Mart{\'i}nez, Rafael Roberto
and Wentzel, Jobke
and Bente, Elise Britt
and Sanderman, Robbert
and van Gemert-Pijnen, EWC Julia",
title="Toward the Value Sensitive Design of eHealth Technologies to Support Self-management of Cardiovascular Diseases: Content Analysis",
journal="JMIR Cardio",
year="2021",
month="Dec",
day="1",
volume="5",
number="2",
pages="e31985",
keywords="eHealth",
keywords="self-management",
keywords="self-care",
keywords="cardiovascular diseases",
keywords="value sensitive design",
keywords="values",
keywords="content analysis",
abstract="Background: eHealth can revolutionize the way self-management support is offered to chronically ill individuals such as those with a cardiovascular disease (CVD). However, patients' fluctuating motivation to actually perform self-management is an important factor for which to account. Tailoring and personalizing eHealth to fit with the values of individuals promises to be an effective motivational strategy. Nevertheless, how specific eHealth technologies and design features could potentially contribute to values of individuals with a CVD has not been explicitly studied before. Objective: This study sought to connect a set of empirically validated, health-related values of individuals with a CVD with existing eHealth technologies and their design features. The study searched for potential connections between design features and values with the goal to advance knowledge about how eHealth technologies can actually be more meaningful and motivating for end users. Methods: Undertaking a technical investigation that fits with the value sensitive design framework, a content analysis of existing eHealth technologies was conducted. We matched 11 empirically validated values of CVD patients with 70 design features from 10 eHealth technologies that were previously identified in a systematic review. The analysis consisted mainly of a deductive coding stage performed independently by 3 members of the study team. In addition, researchers and developers of 6 of the 10 reviewed technologies provided input about potential feature-value connections. Results: In total, 98 connections were made between eHealth design features and patient values. This meant that some design features could contribute to multiple values. Importantly, some values were more often addressed than others. CVD patients' values most often addressed were related to (1) having or maintaining a healthy lifestyle, (2) having an overview of personal health data, (3) having reliable information and advice, (4) having extrinsic motivators to accomplish goals or health-related activities, and (5) receiving personalized care. In contrast, values less often addressed concerned (6) perceiving low thresholds to access health care, (7) receiving social support, (8) preserving a sense of autonomy over life, and (9) not feeling fear, anxiety, or insecurity about health. Last, 2 largely unaddressed values were related to (10) having confidence and self-efficacy in the treatment or ability to achieve goals and (11) desiring to be seen as a person rather than a patient. Conclusions: Positively, existing eHealth technologies could be connected with CVD patients' values, largely through design features that relate to educational support, self-monitoring support, behavior change support, feedback, and motivational incentives. Other design features such as reminders, prompts or cues, peer-based or expert-based human support, and general system personalization were also connected with values but in narrower ways. In future studies, the inferred feature-value connections must be validated with empirical data from individuals with a CVD or similar chronic conditions. ",
doi="10.2196/31985",
url="https://cardio.jmir.org/2021/2/e31985",
url="http://www.ncbi.nlm.nih.gov/pubmed/34855608"
}


@Article{info:doi/10.2196/28678,
author="Mayo-Gamble, L. Tilicia
and Quasie-Woode, Delores
and Cunningham-Erves, Jennifer
and Rollins, Margo
and Schlundt, David
and Bonnet, Kemberlee
and Murry, McBride Velma",
title="Preferences for Using a Mobile App in Sickle Cell Disease Self-management: Descriptive Qualitative Study",
journal="JMIR Form Res",
year="2021",
month="Nov",
day="30",
volume="5",
number="11",
pages="e28678",
keywords="sickle cell disease",
keywords="digital technology",
keywords="rural",
keywords="mHealth app",
keywords="patient-centered technology",
keywords="mobile health",
keywords="health outcomes",
keywords="hematology",
keywords="mobile phone",
abstract="Background: Individuals with sickle cell disease (SCD) and their caregivers may benefit from technology-based resources to improve disease self-management. Objective: This study explores the preferences regarding a mobile health (mHealth) app to facilitate self-management in adults with SCD and their caregivers living in urban and rural communities. Methods: Five community listening sessions were conducted in 2 urban and rural communities among adults with SCD and their caregivers (N=43). Each session comprised 4 to 15 participants. Participants were asked questions on methods of finding information about SCD self-care, satisfaction with current methods for finding SCD management information, support for SCD management, important features for development of an mHealth app, and areas of benefit for using an mHealth app for SCD self-management. An inductive-deductive content analysis approach was implemented to identify the critical themes. Results: Seven critical themes emerged, including the current methods for receiving self-management information, desired information, recommendations for communicating sickle cell self-management information, challenges of disease management, types of support received for disease management, barriers to and facilitators of using an mHealth app, and feature preferences for an mHealth app. In addition, we found that the participants were receptive to using mHealth apps in SCD self-management. Conclusions: This study expands our knowledge on the use of mHealth technology to reduce information access barriers pertaining to SCD. The findings can be used to develop a patient-centered, user-friendly mHealth app to facilitate disease self-management, thus increasing access to resources for families of patients with SCD residing in rural communities. ",
doi="10.2196/28678",
url="https://formative.jmir.org/2021/11/e28678",
url="http://www.ncbi.nlm.nih.gov/pubmed/34851295"
}


@Article{info:doi/10.2196/22931,
author="Ghods, Alireza
and Shahrokni, Armin
and Ghasemzadeh, Hassan
and Cook, Diane",
title="Remote Monitoring of the Performance Status and Burden of Symptoms of Patients With Gastrointestinal Cancer Via a Consumer-Based Activity Tracker: Quantitative Cohort Study",
journal="JMIR Cancer",
year="2021",
month="Nov",
day="26",
volume="7",
number="4",
pages="e22931",
keywords="step count",
keywords="performance status",
keywords="symptom",
keywords="wearable",
keywords="activity tracker",
keywords="gastrointestinal cancer",
keywords="monitoring",
keywords="cancer",
keywords="gastrointestinal",
keywords="burden",
abstract="Background: The number of older patients with gastrointestinal cancer is increasing due to an aging global population. Minimizing reliance on an in-clinic patient performance status test to determine a patient's prognosis and course of treatment can improve resource utilization. Further, current performance status measurements cannot capture patients' constant changes. These measurements also rely on self-reports, which are subjective and subject to bias. Real-time monitoring of patients' activities may allow for a more accurate assessment of patients' performance status while minimizing resource utilization. Objective: This study investigates the validity of consumer-based activity trackers for monitoring the performance status of patients with gastrointestinal cancer. Methods: A total of 27 consenting patients (63\% male, median age 58 years) wore a consumer-based activity tracker 7 days before chemotherapy and 14 days after receiving their first treatment. The provider assessed patients using the Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scale and Memorial Symptom Assessment Scale-Short Form (MSAS-SF) before and after chemotherapy visits. The statistical correlations between ECOG-PS and MSAS-SF scores and patients' daily step counts were assessed. Results: The daily step counts yielded the highest correlation with the patients' ECOG-PS scores after chemotherapy (P<.001). The patients with higher ECOG-PS scores experienced a higher fluctuation in their step counts. The patients who walked more prechemotherapy (mean 6071 steps per day) and postchemotherapy (mean 5930 steps per day) had a lower MSAS-SF score (lower burden of symptoms) compared to patients who walked less prechemotherapy (mean 5205 steps per day) and postchemotherapy (mean 4437 steps per day). Conclusions: This study demonstrates the feasibility of using inexpensive, consumer-based activity trackers for the remote monitoring of performance status in the gastrointestinal cancer population. The findings need to be validated in a larger population for generalizability. ",
doi="10.2196/22931",
url="https://cancer.jmir.org/2021/4/e22931",
url="http://www.ncbi.nlm.nih.gov/pubmed/34842527"
}


@Article{info:doi/10.2196/28259,
author="Artanian, Veronica
and Ware, Patrick
and Rac, E. Valeria
and Ross, J. Heather
and Seto, Emily",
title="Experiences and Perceptions of Patients and Providers Participating in Remote Titration of Heart Failure Medication Facilitated by Telemonitoring: Qualitative Study",
journal="JMIR Cardio",
year="2021",
month="Nov",
day="25",
volume="5",
number="2",
pages="e28259",
keywords="telemonitoring",
keywords="remote",
keywords="titration",
keywords="monitoring",
keywords="mHealth",
keywords="heart failure",
keywords="qualitative",
keywords="mobile phone",
abstract="Background: Guideline-directed medical therapy (GDMT), optimized to target doses, improves health outcomes in patients with heart failure. However, GDMT remains underused, with <25\% of patients receiving target doses in clinical practice. A randomized controlled trial was conducted at the Peter Munk Cardiac Centre in Toronto to compare a remote GDMT titration intervention with standard in-office titration. This randomized controlled trial found that remote titration increased the proportion of patients who achieved optimal GDMT doses, decreased the time to dose optimization, and reduced the number of essential clinic visits. This paper presents findings from the qualitative component of the mixed methods study, which evaluated the implementation of the remote titration intervention. Objective: The objective of the qualitative component is to assess the perceptions and experiences of clinicians and patients with heart failure who participated in the remote titration intervention to identify factors that affected the implementation of the intervention. Methods: We conducted semistructured interviews with clinicians (n=5) and patients (n=11) who participated in the remote titration intervention. Questions probed the experiences of the participants to identify factors that can serve as barriers and facilitators to its implementation. Conventional content analysis was first used to analyze the interviews and gain direct information based on the participants' unique perspectives. Subsequently, the generated themes were delineated and mapped following a multilevel framework. Results: Patients and clinicians indicated that the intervention was easy to use, integrated well into their routines, and removed practical barriers to titration. Key implementation facilitators from the patients' perspective included the reduction in clinic visits and daily monitoring of their condition, whereas clinicians emphasized the benefits of rapid drug titration and efficient patient management. Key implementation barriers included the resources necessary to support the intervention and lack of physician remuneration. Conclusions: This study presents results from a real-world implementation assessment of remote titration facilitated by telemonitoring. It is among the first to provide insight into the perception of the remote titration process by clinicians and patients. Our findings indicate that the relative advantages that remote titration presents over standard care strongly appeal to both clinicians and patients. However, to ensure uptake and adherence, it is important to ensure that suitable patients are enrolled and the impact on the physicians' workload is minimized. The implementation of remote titration is now more critical than ever, as it can help provide access to care for patients during times when physical distancing is required. Trial Registration: ClinicalTrials.gov NCT04205513; https://clinicaltrials.gov/ct2/show/NCT04205513 International Registered Report Identifier (IRRID): RR2-10.2196/19705 ",
doi="10.2196/28259",
url="https://cardio.jmir.org/2021/2/e28259",
url="http://www.ncbi.nlm.nih.gov/pubmed/34842546"
}


@Article{info:doi/10.2196/30495,
author="Shewchuk, Brittany
and Green, A. Lee
and Barber, Tanya
and Miller, Jean
and Teare, Sylvia
and Campbell-Scherer, Denise
and Mrklas, J. Kelly
and Li, C. Linda
and Marlett, Nancy
and Wasylak, Tracy
and Lopatina, Elena
and McCaughey, Deirdre
and Marshall, A. Deborah",
title="Patients' Use of Mobile Health for Self-management of Knee Osteoarthritis: Results of a 6-Week Pilot Study",
journal="JMIR Form Res",
year="2021",
month="Nov",
day="25",
volume="5",
number="11",
pages="e30495",
keywords="mobile health",
keywords="mHealth",
keywords="app",
keywords="self-management",
keywords="osteoarthritis",
abstract="Background: In a previous study, a prototype mobile health (mHealth) app was co-designed with patients, family physicians, and researchers to enhance self-management and optimize conservative management for patients with mild to moderate knee osteoarthritis (OA). Objective: This study aims to evaluate the overall usability, quality, and effectiveness of the mHealth app prototype for aiding knee OA self-management from the perspectives of patients with OA and health care providers (HCPs). Methods: Using methods triangulation of qualitative and quantitative data, we conducted a pilot evaluation of an mHealth app prototype that was codeveloped with patients and HCPs. We recruited adult patients aged ?20 years with early knee OA (n=18) who experienced knee pain on most days of the month at any time in the past and HCPs (n=7) to participate. In the qualitative assessment, patient and HCP perspectives were elicited on the likeability and usefulness of app features and functionalities and the perceived impact of the app on patient-HCP communication. The quantitative assessment involved evaluating the app using usability, quality, and effectiveness metrics. Patient baseline assessments included a semistructured interview and survey to gather demographics and assess the quality of life (European Quality-of-Life 5-Dimension 5-Level Questionnaire [EQ-5D-5L]) and patient activation (patient activation measure [PAM]). Following the 6-week usability trial period, a follow-up survey assessed patients' perceptions of app usability and quality and longitudinal changes in quality of life and patient activation. Semistructured interviews and surveys were also conducted with HCPs (n=7) at baseline to evaluate the usability and quality of the app prototype. Results: Interviews with patients and HCPs revealed overall positive impressions of the app prototype features and functionalities related to likeability and usefulness. Between the baseline and follow-up patient assessments, the mean EQ-5D-5L scores improved from 0.77 to 0.67 (P=.04), and PAM scores increased from 80.4 to 87.9 (P=.01). Following the 6-week evaluation, patients reported a mean System Usability Scale (SUS) score of 57.8, indicating marginal acceptability according to SUS cutoffs. The mean number of goals set during the usability period was 2.47 (SD 3.08), and the mean number of activities completed for knee OA self-management during the study period was 22.2 (SD 17.8). Spearman rank correlation (rs) calculations revealed that the follow-up PAM scores were weakly correlated (rs=?0.32) with the number of goals achieved and the number (rs=0.19) of activities performed during the 6-week usability period. HCPs reported a mean SUS score of 39.1, indicating unacceptable usability. Conclusions: This evidence-based and patient-centered app prototype represents a potential use of mHealth for improving outcomes and enhancing conservative care by promoting patient activation and patient-HCP communication regarding OA management. However, future iterations of the app prototype are required to address the limitations related to usability and quality. ",
doi="10.2196/30495",
url="https://formative.jmir.org/2021/11/e30495",
url="http://www.ncbi.nlm.nih.gov/pubmed/34842526"
}


@Article{info:doi/10.2196/31678,
author="Beckers, B. Abraham
and Snijkers, W. Johanna T.
and Weerts, M. Zsa Zsa R.
and Vork, Lisa
and Klaassen, Tim
and Smeets, M. Fabienne G.
and Masclee, M. Ad A.
and Keszthelyi, Daniel",
title="Digital Instruments for Reporting of Gastrointestinal Symptoms in Clinical Trials: Comparison of End-of-Day Diaries Versus the Experience Sampling Method",
journal="JMIR Form Res",
year="2021",
month="Nov",
day="24",
volume="5",
number="11",
pages="e31678",
keywords="irritable bowel syndrome",
keywords="functional dyspepsia",
keywords="digital diary",
keywords="experience sampling method",
keywords="smartphone app",
keywords="mobile phone application",
keywords="mHealth",
keywords="eHealth",
keywords="compliance",
keywords="patient-reported outcome measures",
abstract="Background: Questionnaires are necessary tools for assessing symptoms of disorders of the brain-gut interaction in clinical trials. We previously reported on the excellent adherence to a smartphone app used as symptom diary in a randomized clinical trial on irritable bowel syndrome (IBS). Other sampling methods, such as the experience sampling method (ESM), are better equipped to measure symptom variability over time and provide useful information regarding possible symptom triggers, and they are free of ecological and recall bias. The high frequency of measurements, however, could limit the feasibility of ESM in clinical trials. Objective: This study aimed to compare the adherence rates of a smartphone-based end-of-day diary and ESM for symptom assessment in IBS and functional dyspepsia (FD). Methods: Data from 4 separate studies were included. Patients with IBS participated in a randomized controlled trial, which involved a smartphone end-of-day diary for a 2+8-week (pretreatment + treatment) period, and an observational study in which patients completed ESM assessments using a smartphone app for 1 week. Patients with FD participated in a randomized controlled trial, which involved a smartphone end-of-day diary for a 2+12-week (pretreatment + treatment) period, and an observational study in which patients completed ESM assessments using a smartphone app for 1 week. Adherence rates were compared between these 2 symptom sampling methods. Results: In total, 25 patients with IBS and 15 patients with FD were included. Overall adherence rates for the end-of-day diaries were significantly higher than those for ESM (IBS: 92.7\% vs 69.8\%, FD: 90.1\% vs 61.4\%, respectively). Conclusions: This study demonstrates excellent adherence rates for smartphone app--based end-of-day diaries as used in 2 separate clinical trials. Overall adherence rates for ESM were significantly lower, rendering it more suitable for intermittent sampling periods rather than continuous sampling during longer clinical trials. ",
doi="10.2196/31678",
url="https://formative.jmir.org/2021/11/e31678",
url="http://www.ncbi.nlm.nih.gov/pubmed/34821561"
}


@Article{info:doi/10.2196/28204,
author="Motahari-Nezhad, Hossein
and P{\'e}ntek, M{\'a}rta
and Gul{\'a}csi, L{\'a}szl{\'o}
and Zrubka, Zsombor",
title="Outcomes of Digital Biomarker--Based Interventions: Protocol for a Systematic Review of Systematic Reviews",
journal="JMIR Res Protoc",
year="2021",
month="Nov",
day="24",
volume="10",
number="11",
pages="e28204",
keywords="digital biomarker",
keywords="outcome",
keywords="systematic review",
keywords="meta-analysis",
keywords="digital health",
keywords="mobile health",
keywords="Grading of Recommendations, Assessment, Development and Evaluation",
keywords="AMSTAR-2",
keywords="review",
keywords="biomarkers",
keywords="clinical outcome",
keywords="interventions",
keywords="wearables",
keywords="portables",
keywords="digestables",
keywords="implants",
abstract="Background: Digital biomarkers?are?defined?as objective, quantifiable, physiological, and behavioral data that are collected and measured using?digital?devices such as portables, wearables, implantables, or digestibles. For their widespread adoption in publicly financed health care systems, it is important to understand how their benefits translate into improved patient outcomes, which is essential for demonstrating their value. Objective: The paper presents the protocol for a systematic review that aims to assess the quality and strength of the evidence reported in systematic reviews regarding the impact of digital biomarkers on clinical outcomes compared to interventions without digital biomarkers. Methods: A comprehensive search for reviews from 2019 to 2020 will be conducted in PubMed and the Cochrane Library using keywords related to digital biomarkers and a filter for systematic reviews. Original full-text English publications of systematic reviews comparing clinical outcomes of interventions with and without digital biomarkers via meta-analysis will be included. The AMSTAR-2 tool will be used to assess the methodological quality of these reviews. To assess the quality of evidence, we will evaluate the systematic reviews using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool. To detect the possible presence of reporting bias, we will determine whether a protocol was published prior to the start of the studies. A qualitative summary of the results by digital biomarker technology and outcomes will be provided. Results: This protocol was submitted before data collection. Search, screening, and data extraction will commence in December 2021 in accordance with the published protocol. Conclusions: Our study will provide a comprehensive summary of the highest level of evidence available on digital biomarker interventions, providing practical guidance for health care providers. Our results will help identify clinical areas in which the use of digital biomarkers has led to favorable clinical outcomes. In addition, our findings will highlight areas of evidence gaps where the clinical benefits of digital biomarkers have not yet been demonstrated. International Registered Report Identifier (IRRID): PRR1-10.2196/28204 ",
doi="10.2196/28204",
url="https://www.researchprotocols.org/2021/11/e28204",
url="http://www.ncbi.nlm.nih.gov/pubmed/34821568"
}


@Article{info:doi/10.2196/31966,
author="Lo, Jonathon
and Ballurkar, Kieran
and Fox, Simonie
and Tynan, Kate
and Luu, Nghiep
and Boyer, Michael
and Murali-Ganesh, Raghav",
title="A Digital Coaching Intervention for Cancer Survivors With Job Loss: Retrospective Study",
journal="JMIR Cancer",
year="2021",
month="Nov",
day="23",
volume="7",
number="4",
pages="e31966",
keywords="cancer survivors",
keywords="employment",
keywords="absenteeism",
keywords="mobile app",
keywords="software",
keywords="return to work",
abstract="Background: Returning to work is a key unmet need for working-age cancer survivors. Objective: This study sought to evaluate return-to-work outcomes of a multidisciplinary intervention provided as routine employee support. Methods: In a retrospective cohort analysis, patients with cancer and more than 3 months of absence from work were provided with an intervention consisting of digital resources and calls with a health coach. Propensity score matching was used to define a similar cohort of cancer patients absent from work, who were not offered the coaching intervention. The return-to-work rate as a percentage of all participants and secondary outcomes, such as the rate of death, were measured. The median time to return to work was compared between the cohorts using the Kaplan-Meier method. Results: A total of 220 participants were enrolled in the intervention, of which 125 met the criteria for analysis. The median follow-up from cancer diagnosis was 79 weeks (IQR 60-106 weeks). In the matched control group, 22 (17.6\%) participants returned to work compared with 38 (30.4\%) in the intervention group (P=.02). Additionally, 19 (15.2\%) matched controls died prior to claim closure compared with 13 (10.4\%) in the intervention group (P=.26). The Kaplan-Meier estimated median time for the first 15\% of the cohort to return to work was 87.1 weeks (95\% CI 60.0-109.1 weeks) for the matched control group compared with 70.6 weeks (95\% CI 52.6-79.6 weeks; P=.08) for the intervention group. Conclusions: Patients receiving a remotely delivered coaching program in a real-world setting returned to work at a higher frequency than did control participants receiving usual care. ",
doi="10.2196/31966",
url="https://cancer.jmir.org/2021/4/e31966",
url="http://www.ncbi.nlm.nih.gov/pubmed/34710853"
}


@Article{info:doi/10.2196/32306,
author="Jonathan, K. Geneva
and Dopke, A. Cynthia
and Michaels, Tania
and Martin, R. Clair
and Ryan, Chloe
and McBride, Alyssa
and Babington, Pamela
and Goulding, H. Evan",
title="A Smartphone-Based Self-Management Intervention for Individuals with Bipolar Disorder (LiveWell): Qualitative Study on User Experiences of the Behavior Change Process",
journal="JMIR Ment Health",
year="2021",
month="Nov",
day="22",
volume="8",
number="11",
pages="e32306",
keywords="behavioral intervention technology",
keywords="mHealth",
keywords="bipolar disorder",
keywords="depression",
keywords="illness management",
keywords="smartphone",
keywords="behavior change",
keywords="early warning signs",
keywords="self-management",
keywords="qualitative",
keywords="behavior",
keywords="intervention",
keywords="management",
keywords="user experience",
keywords="perception",
keywords="utilization",
abstract="Background: Bipolar disorder is a severe mental illness characterized by recurrent episodes of depressed, elevated, and mixed mood states. The addition of psychotherapy to pharmacological management can decrease symptoms, lower relapse rates, and improve quality of life; however, access to psychotherapy is limited. Mental health technologies such as smartphone apps are being studied as a means to increase access to and enhance the effectiveness of adjunctive psychotherapies for bipolar disorder. Individuals with bipolar disorder find this intervention format acceptable, but our understanding of how people utilize and integrate these tools into their behavior change and maintenance processes remains limited. Objective: The objective of this study was to explore how individuals with bipolar disorder perceive and utilize a smartphone intervention for health behavior change and maintenance. Methods: Individuals with bipolar disorder were recruited via flyers placed at university-affiliated and private outpatient mental health practices to participate in a pilot study of LiveWell, a smartphone-based self-management intervention. At the end of the study, all participants completed in-depth qualitative exit interviews. The behavior change framework developed to organize the intervention design was used to deductively code behavioral targets and determinants involved in target engagement. Inductive coding was used to identify themes not captured by this framework. Results: In terms of behavioral targets, participants emphasized the importance of managing mood episode--related signs and symptoms. They also discussed the importance of maintaining regular routines, sleep duration, and medication adherence. Participants emphasized that receiving support from a coach as well as seeking and receiving assistance from family, friends, and providers were important for managing behavioral targets and staying well. In terms of determinants, participants stressed the important role of monitoring for their behavior change and maintenance efforts. Monitoring facilitated self-awareness and reflection, which was considered valuable for staying well. Some participants also felt that the intervention facilitated learning information necessary for managing bipolar disorder but others felt that the information provided was too basic. Conclusions: In addition to addressing acceptability, satisfaction, and engagement, a person-based design of mental health technologies can be used to understand how people experience the impact of these technologies on their behavior change and maintenance efforts. This understanding may then be used to guide ongoing intervention development. The participants' perceptions aligned with the intervention's primary behavioral targets and use of a monitoring tool as a core intervention feature. Participant feedback further indicates that developing additional content and tools to address building and engaging social support may be an important avenue for improving LiveWell. A comprehensive behavior change framework to understand participant perceptions of their behavior change and maintenance efforts may help facilitate ongoing intervention development. ",
doi="10.2196/32306",
url="https://mental.jmir.org/2021/11/e32306",
url="http://www.ncbi.nlm.nih.gov/pubmed/34813488"
}


@Article{info:doi/10.2196/27674,
author="B{\"o}ttcher, Sebastian
and Bruno, Elisa
and Manyakov, V. Nikolay
and Epitashvili, Nino
and Claes, Kasper
and Glasstetter, Martin
and Thorpe, Sarah
and Lees, Simon
and D{\"u}mpelmann, Matthias
and Van Laerhoven, Kristof
and Richardson, P. Mark
and Schulze-Bonhage, Andreas
and ",
title="Detecting Tonic-Clonic Seizures in Multimodal Biosignal Data From Wearables: Methodology Design and Validation",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Nov",
day="19",
volume="9",
number="11",
pages="e27674",
keywords="wearables",
keywords="epilepsy",
keywords="seizure detection",
keywords="multimodal data",
keywords="mHealth",
keywords="mobile health",
keywords="digital health",
keywords="eHealth",
abstract="Background: Video electroencephalography recordings, routinely used in epilepsy monitoring units, are the gold standard for monitoring epileptic seizures. However, monitoring is also needed in the day-to-day lives of people with epilepsy, where video electroencephalography is not feasible. Wearables could fill this gap by providing patients with an accurate log of their seizures. Objective: Although there are already systems available that provide promising results for the detection of tonic-clonic seizures (TCSs), research in this area is often limited to detection from 1 biosignal modality or only during the night when the patient is in bed. The aim of this study is to provide evidence that supervised machine learning can detect TCSs from multimodal data in a new data set during daytime and nighttime. Methods: An extensive data set of biosignals from a multimodal watch worn by people with epilepsy was recorded during their stay in the epilepsy monitoring unit at 2 European clinical sites. From a larger data set of 243 enrolled participants, those who had data recorded during TCSs were selected, amounting to 10 participants with 21 TCSs. Accelerometry and electrodermal activity recorded by the wearable device were used for analysis, and seizure manifestation was annotated in detail by clinical experts. Ten accelerometry and 3 electrodermal activity features were calculated for sliding windows of variable size across the data. A gradient tree boosting algorithm was used for seizure detection, and the optimal parameter combination was determined in a leave-one-participant-out cross-validation on a training set of 10 seizures from 8 participants. The model was then evaluated on an out-of-sample test set of 11 seizures from the remaining 2 participants. To assess specificity, we additionally analyzed data from up to 29 participants without TCSs during the model evaluation. Results: In the leave-one-participant-out cross-validation, the model optimized for sensitivity could detect all 10 seizures with a false alarm rate of 0.46 per day in 17.3 days of data. In a test set of 11 out-of-sample TCSs, amounting to 8.3 days of data, the model could detect 10 seizures and produced no false positives. Increasing the test set to include data from 28 more participants without additional TCSs resulted in a false alarm rate of 0.19 per day in 78 days of wearable data. Conclusions: We show that a gradient tree boosting machine can robustly detect TCSs from multimodal wearable data in an original data set and that even with very limited training data, supervised machine learning can achieve a high sensitivity and low false-positive rate. This methodology may offer a promising way to approach wearable-based nonconvulsive seizure detection. ",
doi="10.2196/27674",
url="https://mhealth.jmir.org/2021/11/e27674",
url="http://www.ncbi.nlm.nih.gov/pubmed/34806993"
}


@Article{info:doi/10.2196/30394,
author="Woelfle, Tim
and Pless, Silvan
and Wiencierz, Andrea
and Kappos, Ludwig
and Naegelin, Yvonne
and Lorscheider, Johannes",
title="Practice Effects of Mobile Tests of Cognition, Dexterity, and Mobility on Patients With Multiple Sclerosis: Data Analysis of a Smartphone-Based Observational Study",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="18",
volume="23",
number="11",
pages="e30394",
keywords="multiple sclerosis",
keywords="digital biomarkers",
keywords="practice effects",
keywords="learning effects",
keywords="learning curves",
keywords="nonlinear mixed models",
keywords="quantile regression",
keywords="information processing speed",
keywords="symbol digit modalities test",
keywords="smartphones",
keywords="wearable electronic devices",
keywords="mobile phones",
abstract="Background: Smartphones and their built-in sensors allow for measuring functions in disease-related domains through mobile tests. This could improve disease characterization and monitoring, and could potentially support treatment decisions for multiple sclerosis (MS), a multifaceted chronic neurological disease with highly variable clinical manifestations. Practice effects can complicate the interpretation of both improvement over time by potentially exaggerating treatment effects and stability by masking deterioration. Objective: The aim of this study is to identify short-term learning and long-term practice effects in 6 active tests for cognition, dexterity, and mobility in user-scheduled, high-frequency smartphone-based testing. Methods: We analyzed data from 264 people with self-declared MS with a minimum of 5 weeks of follow-up and at least 5 repetitions per test in the Floodlight Open study, a self-enrollment study accessible by smartphone owners from 16 countries. The collected data are openly available to scientists. Using regression and bounded growth mixed models, we characterized practice effects for the following tests: electronic Symbol Digit Modalities Test (e-SDMT) for cognition; Finger Pinching and Draw a Shape for dexterity; and Two Minute Walk, U-Turn, and Static Balance for mobility. Results: Strong practice effects were found for e-SDMT (n=4824 trials), Finger Pinching (n=19,650), and Draw a Shape (n=19,019) with modeled boundary improvements of 40.8\% (39.9\%-41.6\%), 86.2\% (83.6\%-88.7\%), and 23.1\% (20.9\%-25.2\%) over baseline, respectively. Half of the practice effect was reached after 11 repetitions for e-SDMT, 28 repetitions for Finger Pinching, and 17 repetitions for Draw a Shape; 90\% was reached after 35, 94, and 56 repetitions, respectively. Although baseline performance levels were highly variable across participants, no significant differences between the short-term learning effects in low performers (5th and 25th percentile), median performers, and high performers (75th and 95th percentile) were found for e-SDMT up to the fifth trial ($\beta$=1.50-2.00). Only small differences were observed for Finger Pinching ($\beta$=1.25-2.5). For U-Turn (n=15,051) and Static Balance (n=16,797), only short-term learning effects could be observed, which ceased after a maximum of 5 trials. For Two Minute Walk (n=14,393), neither short-term learning nor long-term practice effects were observed. Conclusions: Smartphone-based tests are promising for monitoring the disease trajectories of MS and other chronic neurological diseases. Our findings suggest that strong long-term practice effects in cognitive and dexterity functions have to be accounted for to identify disease-related changes in these domains, especially in the context of personalized health and in studies without a comparator arm. In contrast, changes in mobility may be more easily interpreted because of the absence of long-term practice effects, even though short-term learning effects might have to be considered. ",
doi="10.2196/30394",
url="https://www.jmir.org/2021/11/e30394",
url="http://www.ncbi.nlm.nih.gov/pubmed/34792480"
}


@Article{info:doi/10.2196/30572,
author="Jessen, Stian
and Mirkovic, Jelena
and Halvorsen Brendmo, Elanor
and Solberg Nes, Lise",
title="Evaluating a Strengths-Based mHealth Tool (MyStrengths): Explorative Feasibility Trial",
journal="JMIR Form Res",
year="2021",
month="Nov",
day="17",
volume="5",
number="11",
pages="e30572",
keywords="mHealth",
keywords="personal strengths",
keywords="gameful design",
keywords="gamification",
keywords="user engagement",
keywords="explorative",
keywords="feasibility",
keywords="usefulness",
keywords="usability",
keywords="design",
keywords="self-management",
keywords="chronic illness",
abstract="Background: As the number of people living with chronic illnesses increases, providing wide-reaching and easy-to-use support tools is becoming increasingly important. Supporting people in this group to recognize and use more of their personal strengths has the potential to improve their quality of life. With this in mind, we have developed the MyStrengths app prototype, a gamefully designed app aimed at aiding users in both identifying their strengths and using these strengths more actively in their daily life. Objective: The goal of this study was to evaluate the user-reported feasibility and usefulness of the MyStrengths app. The study additionally aimed to explore whether the use of MyStrengths could be associated with selected psychosocial outcomes. Methods: A 31-day explorative feasibility trial with a pretest-posttest design and an optional end of study interview was conducted. Data collection included system-use log data, demographic information, pre-- and post--psychosocial measures (ie, strengths use, self-efficacy, health-related quality of life, depression), user experience measures (ie, usability, engagement, flow), and interview data. Results: In total, 34 people with at least 1 chronic condition were enrolled in the study, with 26 participants (mean age 48 years, range 29-62 years; 1 male) completing the trial. Among these individuals, 18 were also interviewed posttrial. Participants used the MyStrengths app an average of 6 days during the trial period, with 54\% (14/26) using the app over a period of at least 19 days. In total, 8738 unique app actions were registered. Of the psychosocial outcome measures, only 1 subscale, general health in the RAND 36-Item Health Survey, yielded significant pre- and posttest changes. Posttrial interviews showed that the number of participants who considered the MyStrengths app to be useful, somewhat useful, or not useful was evenly distributed across 3 groups. However, every participant did voice support for the strengths approach. All participants were able to identify a multitude of personal strengths using the MyStrengths app. Most participants that reported it to be useful had little or no previous experience with the personal strengths approach. A multitude of users welcomed the gameful design choices, particularly the rolling die feature, suggesting strengths exercises, activities that use a specific strength, were well received. Conclusions: Although the reported usefulness and feedback from use varied, most participants were favorable to the strengths-focused approach to care and support. Consequently, low-threshold and wide-reaching mobile health tools that use a strengths-focused approach, such as MyStrengths, hold the potential to support people living with chronic illness  in performing self-management and achieving mastery of their life. ",
doi="10.2196/30572",
url="https://formative.jmir.org/2021/11/e30572",
url="http://www.ncbi.nlm.nih.gov/pubmed/34787580"
}


@Article{info:doi/10.2196/29128,
author="van Oirschot, Pim
and Heerings, Marco
and Wendrich, Karine
and den Teuling, Bram
and Dorssers, Frank
and van Ee, Ren{\'e}
and Martens, Bart Marijn
and Jongen, Joseph Peter",
title="A Two-Minute Walking Test With a Smartphone App for Persons With Multiple Sclerosis: Validation Study",
journal="JMIR Form Res",
year="2021",
month="Nov",
day="17",
volume="5",
number="11",
pages="e29128",
keywords="multiple sclerosis",
keywords="relapsing remitting",
keywords="mobility",
keywords="mobile phone",
keywords="2-Minute Walking Test",
abstract="Background: Walking disturbances are a common dysfunction in persons with multiple sclerosis (MS). The 2-Minute Walking Test (2MWT) is widely used to quantify walking speed. We implemented a smartphone-based 2MWT (s2MWT) in MS sherpa, an app for persons with MS. When performing the s2MWT, users of the app are instructed to walk as fast as safely possible for 2 minutes in the open air, while the app records their movement and calculates the distance walked. Objective: The aim of this study is to investigate the concurrent validity and test-retest reliability of the MS sherpa s2MWT. Methods: We performed a validation study on 25 persons with relapsing-remitting MS and 79 healthy control (HC) participants. In the HC group, 21 participants were matched to the persons with MS based on age, gender, and education and these followed the same assessment schedule as the persons with MS (the HC-matched group), whereas 58 participants had a less intense assessment schedule to determine reference values (the HC-normative group). Intraclass correlation coefficients (ICCs) were determined between the distance measured by the s2MWT and the distance measured using distance markers on the pavement during these s2MWT assessments. ICCs were also determined for test-retest reliability and derived from 10 smartphone tests per study participant, with 3 days in between each test. We interviewed 7 study participants with MS regarding their experiences with the s2MWT. Results: In total, 755 s2MWTs were completed. The adherence rate for the persons with MS and the participants in the HC-matched group was 92.4\% (425/460). The calculated distance walked on the s2MWT was, on average, 8.43 m or 5\% (SD 18.9 m or 11\%) higher than the distance measured using distance markers (n=43). An ICC of 0.817 was found for the concurrent validity of the s2MWT in the combined analysis of persons with MS and HC participants. Average ICCs of 9 test-retest reliability analyses of the s2MWT for persons with MS and the participants in the HC-matched group were 0.648 (SD 0.150) and 0.600 (SD 0.090), respectively, whereas the average ICC of 2 test-retest reliability analyses of the s2MWT for the participants in the HC-normative group was 0.700 (SD 0.029).?The interviewed study participants found the s2MWT easy to perform, but they also expressed that the test results can be confronting and that a pressure to reach a certain distance can be experienced. Conclusions: The high correlation between s2MWT distance and the conventional 2MWT distance indicates a good concurrent validity. Similarly, high correlations underpin a good test-retest reliability of the s2MWT. We conclude that the s2MWT can be used to measure the distance that the persons with MS walk in 2 minutes outdoors near their home, from which both clinical studies and clinical practice can benefit. ",
doi="10.2196/29128",
url="https://formative.jmir.org/2021/11/e29128",
url="http://www.ncbi.nlm.nih.gov/pubmed/34787581"
}


@Article{info:doi/10.2196/31037,
author="Yakovchenko, Vera
and McInnes, Keith D.
and Petrakis, Ann Beth
and Gillespie, Chris
and Lipschitz, M. Jessica
and McCullough, B. Megan
and Richardson, Lorilei
and Vetter, Brian
and Hogan, P. Timothy",
title="Implementing Automated Text Messaging for Patient Self-management in the Veterans Health Administration: Qualitative Study Applying the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability Framework",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Nov",
day="15",
volume="9",
number="11",
pages="e31037",
keywords="implementation science",
keywords="implementation facilitation",
keywords="texting",
keywords="veterans",
keywords="eHealth",
keywords="self-management",
keywords="digital health",
keywords="digital medicine",
abstract="Background: The Veterans Health Administration (VHA) is deploying an automated texting system (aTS) to support patient self-management. Objective: We conducted a qualitative evaluation to examine factors influencing national rollout of the aTS, guided by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework, which is intended to support the evaluation of novel technologies. Methods: Semistructured interviews were conducted with 33 staff and 38 patients who were early adopters of the aTS. Data were analyzed following deductive and inductive approaches using a priori codes and emergent coding based on the NASSS. Results: We identified themes across NASSS domains: (1) Condition: The aTS was considered relevant for a range of patient needs; however, perceptions of patient suitability were guided by texting experience and clinical complexity rather than potential benefits. (2) Technology: Onboarding of the aTS presented difficulty and the staff had different opinions on incorporating patient-generated data into care planning. (3) Value: Supply-side value relied on the flexibility of the aTS and its impact on staff workload whereas demand-side value was driven by patient perceptions of the psychological and behavioral impacts of the aTS. (4) Adopters: Limited clarity on staff roles and responsibilities presented challenges in incorporating the aTS into clinical processes. (5) Organization: Staff were willing to try the aTS; however, perceptions of leadership support and clinic readiness hindered usage. (6) Wider system: Staff focused on enhancing aTS interoperability with the electronic medical record. (7) Embedding and adaptation over time: The interplay of aTS versatility, patient and staff demands, and broader societal changes in preferences for communicating health information facilitated aTS implementation. Conclusions: VHA's new aTS has the potential to further engage patients and expand the reach of VHA care; however, patients and staff require additional support to adopt, implement, and sustain the aTS. The NASSS highlighted how the aTS can be better embedded into current practices, which patients might benefit most from its functionality, and which aspects of aTS messages are most relevant to self-management. Trial Registration: ClinicalTrials.gov NCT03898349; https://clinicaltrials.gov/ct2/show/NCT03898349 ",
doi="10.2196/31037",
url="https://mhealth.jmir.org/2021/11/e31037",
url="http://www.ncbi.nlm.nih.gov/pubmed/34779779"
}


@Article{info:doi/10.2196/30332,
author="Leese, Jenny
and MacDonald, Graham
and Backman, L. Catherine
and Townsend, Anne
and Nimmon, Laura
and Li, C. Linda",
title="Experiences of Wearable Technology by Persons with Knee Osteoarthritis Participating in a Physical Activity Counseling Intervention: Qualitative Study Using a Relational Ethics Lens",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Nov",
day="12",
volume="9",
number="11",
pages="e30332",
keywords="relational ethics",
keywords="physical activity",
keywords="wearable",
keywords="arthritis",
keywords="qualitative",
abstract="Background: Current evidence indicates physical activity wearables could support persons with knee osteoarthritis (OA) to be more physically active. However, recent evidence also identifies some persons with arthritis experience guilt or worry while using a wearable if they are not as active as they feel they should be. Questions remain around how persons with knee OA experience benefits or downsides using a wearable in their everyday lives. Better understanding is needed if wearables are to be incorporated in arthritis self-management in ethically aware ways. Objective: Using an ethics lens, we aimed to describe a range of experiences from persons with knee OA who used a wearable during a physical activity counseling intervention study. Methods: This is a secondary analysis of qualitative interviews nested within a randomized controlled trial. Guided by phenomenography, we explored the experiences of persons with knee OA following participation in a physical activity counseling intervention that involved using a Fitbit Flex and biweekly phone calls with a study physiotherapist (PT) in an 8-week period. Benefits or downsides experienced in participants' relationships with themselves or the study PT when using the wearable were identified using a relational ethics lens. Results: Interviews with 21 participants (12 females and 9 males) aged 40 to 82 years were analyzed. Education levels ranged from high school graduates (4/21, 19\%) to bachelor's degrees or above (11/21, 52\%). We identified 3 categories of description: (1) participants experienced their wearable as a motivating or nagging influence to be more active, depending on how freely they were able to make autonomous choices about physical activity in their everyday lives; (2) some participants felt a sense of accomplishment from seeing progress in their wearable data, which fueled their motivation; (3) for some participants, sharing wearable data helped to build mutual trust in their relationship with the study PT. However, they also expressed there was potential for sharing wearable data to undermine this trust, particularly if this data was inaccurate. Conclusions: Findings provide an early glimpse into positive and negative emotional impacts of using a wearable that can be experienced by participants with knee OA when participating in a randomized controlled trial to support physical activity. To our knowledge, this is the first qualitative study that uses a relational ethics lens to explore how persons with arthritis experienced changes in their relationship with a health professional when using a wearable during research participation. ",
doi="10.2196/30332",
url="https://mhealth.jmir.org/2021/11/e30332",
url="http://www.ncbi.nlm.nih.gov/pubmed/34766912"
}


@Article{info:doi/10.2196/28874,
author="Laursen, Lund Sidsel
and Helweg-J{\o}rgensen, Stig
and Langergaard, Astrid
and S{\o}ndergaard, Jesper
and S{\o}rensen, Storgaard Sabrina
and Mathiasen, Kim
and Lichtenstein, Beck Mia
and Ehlers, Holger Lars",
title="Mobile Diary App Versus Paper-Based Diary Cards for Patients With Borderline Personality Disorder: Economic Evaluation",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="11",
volume="23",
number="11",
pages="e28874",
keywords="borderline personality disorder",
keywords="dialectical behavior therapy",
keywords="mobile app",
keywords="psychotherapy",
keywords="cost-consequence",
keywords="mHealth",
keywords="mobile phone",
abstract="Background: The cost-effectiveness of using a mobile diary app as an adjunct in dialectical behavior therapy (DBT) in patients with borderline personality disorder is unknown. Objective: This study aims to perform an economic evaluation of a mobile diary app compared with paper-based diary cards in DBT treatment for patients with borderline personality disorder in a psychiatric outpatient facility. Methods: This study was conducted alongside a pragmatic, multicenter, randomized controlled trial. The participants were recruited at 5 Danish psychiatric outpatient facilities and were randomized to register the emotions, urges, and skills used in a mobile diary app or on paper-based diary cards. The participants in both groups received DBT delivered by the therapists. A cost-consequence analysis with a time horizon of 12 months was performed. Consequences included quality-adjusted life years (QALYs), depression severity, borderline severity, suicidal behavior, health care use, treatment compliance, and system usability. All relevant costs were included. Focus group interviews were conducted with patients, therapists, researchers, and industry representatives to discuss the potential advantages and disadvantages of using a mobile diary app. Results: A total of 78 participants were included in the analysis. An insignificantly higher number of participants in the paper group dropped out before the start of treatment (P=.07). Of those starting treatment, participants in the app group had an average of 37.1 (SE 27.55) more days of treatment and recorded an average of 3.16 (SE 5.10) more skills per week than participants in the paper group. Participants in both groups had a QALY gain and a decrease in depression severity, borderline severity, and suicidal behavior. Significant differences were found in favor of the paper group for both QALY gain (adjusted difference ?0.054; SE 0.03) and reduction in depression severity (adjusted difference ?1.11; SE 1.57). The between-group difference in total costs ranged from US \$107.37 to US \$322.10 per participant during the 12 months. The use of services in the health care sector was similar across both time points and groups (difference: psychiatric hospitalization <5 and <5; general practice ?1.32; SE 3.68 and 2.02; SE 3.19). Overall, the patients showed high acceptability and considered the app as being easy to use. Therapists worried about potential negative influences on the therapist-patient interaction from new work tasks accompanying the introduction of the new technology but pointed at innovation potential from digital database registrations. Conclusions: This study suggests both positive and negative consequences of mobile diary apps as adjuncts to DBT compared with paper diary cards. More research is needed to draw conclusions regarding its cost-effectiveness. Trial Registration: ClinicalTrials.gov NCT03191565; http://clinicaltrials.gov/ct2/show/NCT03191565 International Registered Report Identifier (IRRID): RR2-10.2196/17737 ",
doi="10.2196/28874",
url="https://www.jmir.org/2021/11/e28874",
url="http://www.ncbi.nlm.nih.gov/pubmed/34762057"
}


@Article{info:doi/10.2196/30435,
author="Dhinagaran, Ardhithy Dhakshenya
and Sathish, Thirunavukkarasu
and Kowatsch, Tobias
and Griva, Konstadina
and Best, Donovan James
and Tudor Car, Lorainne",
title="Public Perceptions of Diabetes, Healthy Living, and Conversational Agents in Singapore: Needs Assessment",
journal="JMIR Form Res",
year="2021",
month="Nov",
day="11",
volume="5",
number="11",
pages="e30435",
keywords="conversational agents",
keywords="chatbots",
keywords="diabetes",
keywords="prediabetes",
keywords="healthy lifestyle change",
keywords="mobile phone",
abstract="Background: The incidence of chronic diseases such as type 2 diabetes is increasing in countries worldwide, including Singapore. Health professional--delivered healthy lifestyle interventions have been shown to prevent type 2 diabetes. However, ongoing personalized guidance from health professionals is not feasible or affordable at the population level. Novel digital interventions delivered using mobile technology, such as conversational agents, are a potential alternative for the delivery of healthy lifestyle change behavioral interventions to the public. Objective: We explored perceptions and experiences of Singaporeans on healthy living, diabetes, and mobile health (mHealth) interventions (apps and conversational agents). This study was conducted to help inform the design and development of a conversational agent focusing on healthy lifestyle changes. Methods: This qualitative study was conducted in August and September 2019. A total of 20 participants were recruited from relevant healthy living Facebook pages and groups. Semistructured interviews were conducted in person or over the telephone using an interview guide. Interviews were transcribed and analyzed in parallel by 2 researchers using Burnard's method, a structured approach for thematic content analysis. Results: The collected data were organized into 4 main themes: use of conversational agents, ubiquity of smartphone apps, understanding of diabetes, and barriers and facilitators to a healthy living in Singapore. Most participants used health-related mobile apps as well as conversational agents unrelated to health care. They provided diverse suggestions for future conversational agent-delivered interventions. Participants also highlighted several knowledge gaps in relation to diabetes and healthy living. Regarding barriers to healthy living, participants mentioned frequent dining out, high stress levels, lack of work-life balance, and lack of free time to engage in physical activity. In contrast, discipline, preplanning, and sticking to a routine were important for enabling a healthy lifestyle. Conclusions: Participants in this study commonly used mHealth interventions and provided important insights into their knowledge gaps and needs in relation to changes in healthy lifestyle behaviors. Future digital interventions such as conversational agents focusing on healthy lifestyle and diabetes prevention should aim to address the barriers highlighted in our study and motivate individuals to adopt healthy lifestyle behavior. ",
doi="10.2196/30435",
url="https://formative.jmir.org/2021/11/e30435",
url="http://www.ncbi.nlm.nih.gov/pubmed/34762053"
}


@Article{info:doi/10.2196/27779,
author="Klimis, Harry
and Nothman, Joel
and Lu, Di
and Sun, Chao
and Cheung, Wah N.
and Redfern, Julie
and Thiagalingam, Aravinda
and Chow, K. Clara",
title="Text Message Analysis Using Machine Learning to Assess Predictors of Engagement With Mobile Health Chronic Disease Prevention Programs: Content Analysis",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Nov",
day="10",
volume="9",
number="11",
pages="e27779",
keywords="mHealth",
keywords="machine learning",
keywords="chronic disease",
keywords="cardiovascular",
keywords="text messaging",
keywords="SMS",
keywords="digital health",
keywords="mobile phone",
keywords="engagement",
keywords="prevention",
abstract="Background: SMS text messages as a form of mobile health are increasingly being used to support individuals with chronic diseases in novel ways that leverage the mobility and capabilities of mobile phones. However, there are knowledge gaps in mobile health, including how to maximize engagement. Objective: This study aims to categorize program SMS text messages and participant replies using machine learning (ML) and to examine whether message characteristics are associated with premature program stopping and engagement. Methods: We assessed communication logs from SMS text message--based chronic disease prevention studies that encouraged 1-way (SupportMe/ITM) and 2-way (TEXTMEDS [Text Messages to Improve Medication Adherence and Secondary Prevention]) communication. Outgoing messages were manually categorized into 5 message intents (informative, instructional, motivational, supportive, and notification) and replies into 7 groups (stop, thanks, questions, reporting healthy, reporting struggle, general comment, and other). Grid search with 10-fold cross-validation was implemented to identify the best-performing ML models and evaluated using nested cross-validation. Regression models with interaction terms were used to compare the association of message intent with premature program stopping and engagement (replied at least 3 times and did not prematurely stop) in SupportMe/ITM and TEXTMEDS. Results: We analyzed 1550 messages and 4071 participant replies. Approximately 5.49\% (145/2642) of participants responded with stop, and 11.7\% (309/2642) of participants were engaged. Our optimal ML model correctly classified program message intent with 76.6\% (95\% CI 63.5\%-89.8\%) and replies with 77.8\% (95\% CI 74.1\%-81.4\%) balanced accuracy (average area under the curve was 0.95 and 0.96, respectively). Overall, supportive (odds ratio [OR] 0.53, 95\% CI 0.35-0.81) messages were associated with reduced chance of stopping, as were informative messages in SupportMe/ITM (OR 0.35, 95\% CI 0.20-0.60) but not in TEXTMEDS (for interaction, P<.001). Notification messages were associated with a higher chance of stopping in SupportMe/ITM (OR 5.76, 95\% CI 3.66-9.06) but not TEXTMEDS (for interaction, P=.01). Overall, informative (OR 1.76, 95\% CI 1.46-2.12) and instructional (OR 1.47, 95\% CI 1.21-1.80) messages were associated with higher engagement but not motivational messages (OR 1.18, 95\% CI 0.82-1.70; P=.37). For supportive messages, the association with engagement was opposite with SupportMe/ITM (OR 1.77, 95\% CI 1.21-2.58) compared with TEXTMEDS (OR 0.77, 95\% CI 0.60-0.98; for interaction, P<.001). Notification messages were associated with reduced engagement in SupportMe/ITM (OR 0.07, 95\% CI 0.05-0.10) and TEXTMEDS (OR 0.28, 95\% CI 0.20-0.39); however, the strength of the association was greater in SupportMe/ITM (for interaction P<.001). Conclusions: ML models enable monitoring and detailed characterization of program messages and participant replies. Outgoing message intent may influence premature program stopping and engagement, although the strength and direction of association appear to vary by program type. Future studies will need to examine whether modifying message characteristics can optimize engagement and whether this leads to behavior change. ",
doi="10.2196/27779",
url="https://mhealth.jmir.org/2021/11/e27779",
url="http://www.ncbi.nlm.nih.gov/pubmed/34757324"
}


@Article{info:doi/10.2196/27087,
author="Soulard, Julie
and Vaillant, Jacques
and Baillet, Athan
and Gaudin, Philippe
and Vuillerme, Nicolas",
title="Gait and Axial Spondyloarthritis: Comparative Gait Analysis Study Using Foot-Worn Inertial Sensors",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Nov",
day="9",
volume="9",
number="11",
pages="e27087",
keywords="ankylosing spondylitis",
keywords="spondyloarthritis",
keywords="gait",
keywords="locomotion",
keywords="pain",
keywords="mobility",
keywords="spatiotemporal",
keywords="digital health",
keywords="sensors",
abstract="Background: Axial spondyloarthritis (axSpA) can lead to spinal mobility restrictions associated with restricted lower limb ranges of motion, thoracic kyphosis, spinopelvic ankylosis, or decrease in muscle strength. It is well known that these factors can have consequences on spatiotemporal gait parameters during walking. However, no study has assessed spatiotemporal gait parameters in patients with axSpA. Divergent results have been obtained in the studies assessing spatiotemporal gait parameters in ankylosing spondylitis, a subgroup of axSpA, which could be partly explained by self-reported pain intensity scores at time of assessment. Inertial measurement units (IMUs) are increasingly popular and may facilitate gait assessment in clinical practice. Objective: This study compared spatiotemporal gait parameters assessed with foot-worn IMUs in patients with axSpA and matched healthy individuals without and with pain intensity score as a covariate. Methods: A total of 30 patients with axSpA and 30 age- and sex-matched healthy controls performed a 10-m walk test at comfortable speed. Various spatiotemporal gait parameters were computed from foot-worn inertial sensors including gait speed in ms--1 (mean walking velocity), cadence in steps/minute (number of steps in a minute), stride length in m (distance between 2 consecutive footprints of the same foot on the ground), swing time in percentage (portion of the cycle during which the foot is in the air), stance time in percentage (portion of the cycle during which part of the foot touches the ground), and double support time in percentage (portion of the cycle where both feet touch the ground). Results: Age, height, and weight were not significantly different between groups. Self-reported pain intensity was significantly higher in patients with axSpA than healthy controls (P<.001). Independent sample t tests indicated that patients with axSpA presented lower gait speed (P<.001) and cadence (P=.004), shorter stride length (P<.001) and swing time (P<.001), and longer double support time (P<.001) and stance time (P<.001) than healthy controls. When using pain intensity as a covariate, spatiotemporal gait parameters were still significant with patients with axSpA exhibiting lower gait speed (P<.001), shorter stride length (P=.001) and swing time (P<.001), and longer double support time (P<.001) and stance time (P<.001) than matched healthy controls. Interestingly, there were no longer statistically significant between-group differences observed for the cadence (P=.17). Conclusions: Gait was significantly altered in patients with axSpA with reduced speed, cadence, stride length, and swing time and increased double support and stance time. Taken together, these changes in spatiotemporal gait parameters could be interpreted as the adoption of a so-called cautious gait pattern in patients with axSpA. Among factors that may influence gait in patients with axSpA, patient self-reported pain intensity could play a role. Finally, IMUs allowed computation of spatiotemporal gait parameters and are usable to assess gait in patients with axSpA in clinical routine. Trial Registration: ClinicalTrials.gov NCT03761212; https://clinicaltrials.gov/ct2/show/NCT03761212 International Registered Report Identifier (IRRID): RR2-10.1007/s00296-019-04396-4  ",
doi="10.2196/27087",
url="https://mhealth.jmir.org/2021/11/e27087",
url="http://www.ncbi.nlm.nih.gov/pubmed/34751663"
}


@Article{info:doi/10.2196/28634,
author="Herkert, Cyrille
and Graat-Verboom, Lidwien
and Gilsing-Fernhout, Judith
and Schols, Manon
and Kemps, Clemens Hareld Marijn",
title="Home-Based Exercise Program for Patients With Combined Advanced Chronic Cardiac and Pulmonary Diseases: Exploratory Study",
journal="JMIR Form Res",
year="2021",
month="Nov",
day="9",
volume="5",
number="11",
pages="e28634",
keywords="home-based exercise",
keywords="cardiac diseases",
keywords="pulmonary diseases",
keywords="comorbidities",
keywords="elderly",
abstract="Background: As chronic cardiac and pulmonary diseases often coexist, there is a need for combined physical home-based rehabilitation programs, specifically addressing older patients with advanced disease stages. Objective: The primary aim of this study is to evaluate the completion and adherence rates of an 8-week, home-based exercise program for patients with advanced cardiopulmonary disease. The secondary end points include patient satisfaction; adverse events; and program efficacy in terms of change in functional capacity, level of dyspnea, and health-related quality of life. Methods: The participants received a goal-oriented, home-based exercise program, and they used a wrist-worn activity tracker to record their exercise sessions. Activity tracker data were made visible on a digital platform, which was also equipped with several other features such as short instruction videos on how to perform specific exercises. The participants received weekly coaching by a physiotherapist and an occupational therapist through video communication. Results: In all, 10 patients with advanced combined cardiopulmonary disease participated (median age 71, IQR 63-75 years), and 50\% (5/10) were men. Of the 10 participants, 9 (90\%) completed the 8-week program. Median adherence to the exercise prescription was 75\% (IQR 37\%-88\%), but it declined significantly when the program was divided into 2-week periods (first 2 weeks: 86\%, IQR 51\%-100\%, and final 2 weeks: 57\%, IQR 8\%-75\%; P=.03). The participants were highly satisfied with the program (Client Satisfaction Questionnaire: median score 29, IQR 26-32, and Purpose-Designed Questionnaire: median score 103, IQR 92-108); however, of the 9 participants, 4 (44\%) experienced technical issues. The Patient-Specific Complaints Instrument scores declined, indicating functional improvement (from median 7.5, IQR 6.1-8.9, to median 5.7, IQR 3.8-6.7; P=.01). Other program efficacy metrics showed a trend toward improvement. Conclusions: Home-based cardiopulmonary telerehabilitation for patients with severe combined cardiopulmonary disease is feasible in terms of high completion and satisfaction rates. Nevertheless, a decrease in adherence during the program was observed, and some of the participants reported difficulties with the technology, indicating the importance of the integration of behavior change techniques, using appropriate technology. Trial Registration: Netherlands Trial Register NL9182; https://www.trialregister.nl/trial/9182 ",
doi="10.2196/28634",
url="https://formative.jmir.org/2021/11/e28634",
url="http://www.ncbi.nlm.nih.gov/pubmed/34751655"
}


@Article{info:doi/10.2196/29044,
author="Radhakrishnan, Kavita
and Julien, Christine
and Baranowski, Tom
and O'Hair, Matthew
and Lee, Grace
and Sagna De Main, Atami
and Allen, Catherine
and Viswanathan, Bindu
and Thomaz, Edison
and Kim, Miyong",
title="Feasibility of a Sensor-Controlled Digital Game for Heart Failure Self-management: Randomized Controlled Trial",
journal="JMIR Serious Games",
year="2021",
month="Nov",
day="8",
volume="9",
number="4",
pages="e29044",
keywords="heart failure",
keywords="digital game",
keywords="sensor",
keywords="self-management",
keywords="older adults",
keywords="weight monitoring",
keywords="physical activity",
keywords="behaviors",
keywords="mobile phone",
abstract="Background: Poor self-management of heart failure (HF) contributes to devastating health consequences. Our innovative sensor-controlled digital game (SCDG) integrates data from sensors to trigger game rewards, progress, and feedback based on the real-time behaviors of individuals with HF. Objective: The aim of this study is to compare daily weight monitoring and physical activity behavior adherence by older adults using an SCDG intervention versus a sensors-only intervention in a feasibility randomized controlled trial. Methods: English-speaking adults with HF aged 55 years or older who owned a smartphone and could walk unassisted were recruited from Texas and Oklahoma from November 2019 to August 2020. Both groups were given activity trackers and smart weighing scales to track behaviors for 12 weeks. The feasibility outcomes of recruitment, retention, intervention engagement, and satisfaction were assessed. In addition to daily weight monitoring and physical activity adherence, the participants' knowledge, functional status, quality of life, self-reported HF behaviors, motivation to engage in behaviors, and HF-related hospitalization were also compared between the groups at baseline and at 6, 12, and 24 weeks. Results: A total of 38 participants with HF---intervention group (IG; 19/38, 50\%) and control group (CG; 19/38, 50\%)---were enrolled in the study. Of the 38 participants, 18 (47\%) were women, 18 (47\%) were aged 65 years or older, 21 (55\%) had been hospitalized with HF in the past 6 months, and 29 (76\%) were White. Furthermore, of these 38 participants, 31 (82\%)---IG (15/19, 79\%) and CG (16/19, 84\%)---had both weight monitoring and physical activity data at the end of 12 weeks, and 27 (71\%)---IG (14/19, 74\%) and CG (13/19, 68\%)---participated in follow-up assessments at 24 weeks. For the IG participants who installed the SCDG app (15/19, 79\%), the number of days each player opened the game app was strongly associated with the number of days the player engaged in weight monitoring (r=0.72; P=.04) and the number of days with physical activity step data (r=0.9; P<.001). The IG participants who completed the satisfaction survey (13/19, 68\%) reported that the SCDG was easy to use. Trends of improvement in daily weight monitoring and physical activity in the IG, as well as within-group improvements in HF functional status, quality of life, knowledge, self-efficacy, and HF hospitalization in both groups, were observed in this feasibility trial. Conclusions: Playing an SCDG on smartphones was feasible and acceptable for older adults with HF for motivating daily weight monitoring and physical activity. A larger efficacy trial of the SCDG intervention will be needed to validate trends of improvement in daily weight monitoring and physical activity behaviors. Trial Registration: ClinicalTrials.gov NCT03947983; https://clinicaltrials.gov/ct2/show/NCT03947983 ",
doi="10.2196/29044",
url="https://games.jmir.org/2021/4/e29044",
url="http://www.ncbi.nlm.nih.gov/pubmed/34747701"
}


@Article{info:doi/10.2196/29788,
author="Kim, Ben
and Ghasemi, Peyman
and Stolee, Paul
and Lee, Joon",
title="Clinicians and Older Adults' Perceptions of the Utility of Patient-Generated Health Data in Caring for Older Adults: Exploratory Mixed Methods Study",
journal="JMIR Aging",
year="2021",
month="Nov",
day="5",
volume="4",
number="4",
pages="e29788",
keywords="mobile health",
keywords="mHealth",
keywords="older adults",
keywords="wearables",
keywords="patient generated health data",
keywords="chronic disease management",
keywords="home care",
keywords="self-care",
keywords="activities of daily living",
keywords="sleep",
abstract="Background: Many people are motivated to self-track their health and optimize their well-being through mobile health apps and wearable devices. The diversity and complexity of these systems have evolved over time, resulting in a large amount of data referred to as patient-generated health data (PGHD), which has recently emerged as a useful set of data elements in health care systems around the world. Despite the increased interest in PGHD, clinicians and older adults' perceptions of PGHD are poorly understood. In particular, although some clinician barriers to using PGHD have been identified, such as concerns about data quality, ease of use, reliability, privacy, and regulatory issues, little is known from the perspectives of older adults. Objective: This study aims to explore the similarities and differences in the perceptions of older adults and clinicians with regard to how various types of PGHD can be used to care for older adults. Methods: A mixed methods study was conducted to explore clinicians and older adults' perceptions of PGHD. Focus groups were conducted with older adults and health care providers from the Greater Toronto area and the Kitchener-Waterloo region. The participants were asked to discuss their perceptions of PGHD, including facilitators and barriers. A questionnaire aimed at exploring the perceived usefulness of a range of different PGHD was also embedded in the study design. Focus group interviews were transcribed for thematic analysis, whereas the questionnaire results were analyzed using descriptive statistics. Results: Of the 9 participants, 4 (44\%) were clinicians (average age 38.3 years, SD 7 years), and 5 (56\%) were older adults (average age 81.0 years, SD 9.1 years). Four main themes were identified from the focus group interviews: influence of PGHD on patient-provider trust, reliability of PGHD, meaningful use of PGHD and PGHD-based decision support systems, and perceived clinical benefits and intrusiveness of PGHD. The questionnaire results were significantly correlated with the frequency of PGHD mentioned in the focus group interviews (r=0.42; P=.03) and demonstrated that older adults and clinicians perceived blood glucose, step count, physical activity, sleep, blood pressure, and stress level as the most useful data for managing health and delivering high-quality care. Conclusions: This embedded mixed methods study generated several important findings about older adults and clinicians' perceptions and perceived usefulness of a range of PGHD. Owing to the exploratory nature of this study, further research is needed to understand the concerns about data privacy, potential negative impact on the trust between older adults and clinicians, data quality and quantity, and usability of PGHD-related technologies for older adults. ",
doi="10.2196/29788",
url="https://aging.jmir.org/2021/4/e29788",
url="http://www.ncbi.nlm.nih.gov/pubmed/34738913"
}


@Article{info:doi/10.2196/24110,
author="ter Stal, Silke
and Sloots, Joanne
and Ramlal, Aniel
and op den Akker, Harm
and Lenferink, Anke
and Tabak, Monique",
title="An Embodied Conversational Agent in an eHealth Self-management Intervention for Chronic Obstructive Pulmonary Disease and Chronic Heart Failure: Exploratory Study in a Real-life Setting",
journal="JMIR Hum Factors",
year="2021",
month="Nov",
day="4",
volume="8",
number="4",
pages="e24110",
keywords="embodied conversational agent",
keywords="eHealth",
keywords="self-management",
keywords="design",
keywords="daily life evaluation",
abstract="Background: Embodied conversational agents (ECAs) have the potential to stimulate actual use of eHealth apps. An ECA's design influences the user's perception during short interactions, but daily life evaluations of ECAs in health care are scarce. Objective: This is an exploratory, long-term study on the design of ECAs for eHealth. The study investigates how patients perceive the design of the ECA over time with regard to the ECA's characteristics (friendliness, trustworthiness, involvement, expertise, and authority), small talk interaction, and likeliness of following the agent's advice. Methods: We developed an ECA within an eHealth self-management intervention for patients with both chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF), which we offered for 4 months. Patients rated 5 agent characteristics and likeliness of following the agent's advice before use and after 3 and 9 weeks of use. The amount of patients' small talk interaction was assessed by log data. Lastly, individual semistructured interviews were used to triangulate results. Results: Eleven patients (7 male and 4 female) with COPD and CHF participated (median age 70 years). Patients' perceptions of the agent characteristics did not change over time (P>.05 for all characteristics) and only 1 participant finished all small talk dialogues. After 3 weeks of use, the patients were less likely to follow the agent's advice (P=.01). The agent's messages were perceived as nonpersonalized and the feedback as inappropriate, affecting the agent's perceived reliability. Conclusions: This exploratory study provides first insights into ECA design for eHealth. The first impression of an ECA's design seems to remain during long-term use. To investigate future added value of ECAs in eHealth, perceived reliability should be improved by managing users' expectations of the ECA's capabilities and creating ECA designs fitting individual needs. Trial Registration: Netherlands Trial Register NL6480; https://www.trialregister.nl/trial/6480 ",
doi="10.2196/24110",
url="https://humanfactors.jmir.org/2021/4/e24110",
url="http://www.ncbi.nlm.nih.gov/pubmed/34734824"
}


@Article{info:doi/10.2196/26556,
author="Alwashmi, F. Meshari
and Mugford, Gerald
and Vokey, Brett
and Abu-Ashour, Waseem
and Hawboldt, John",
title="Effectiveness of the BreatheSuite Device in Assessing the Technique of Metered-Dose Inhalers: Validation Study",
journal="JMIR Biomed Eng",
year="2021",
month="Nov",
day="3",
volume="6",
number="4",
pages="e26556",
keywords="digital health",
keywords="asthma",
keywords="smartphone",
keywords="mHealth",
keywords="mobile health",
keywords="effective",
keywords="observational",
keywords="treatment",
keywords="chronic obstructive pulmonary disease",
keywords="inhaler",
keywords="app",
abstract="Background: The majority of medications used in treating asthma and chronic obstructive pulmonary disease (COPD) are taken through metered-dose inhalers (MDIs). Studies have reported that most patients demonstrate poor inhaler technique, which has resulted in poor disease control. Digital Health applications have the potential to improve the technique and adherence of inhaled medications. Objective: This study aimed to validate the effectiveness of the BreatheSuite MDI device in assessing the technique of taking a dose via an MDI. Methods: The study was a validation study. Thirty participants who self-reported a diagnosis of asthma or COPD were recruited from community pharmacies in Newfoundland and Labrador, Canada. Participants used a BreatheSuite MDI device attached to a placebo MDI and resembled taking 3 doses. Pharmacists used a scoring sheet to evaluate the technique of using the MDI. An independent researcher compared the results of the pharmacist's scoring sheet with the results of the BreatheSuite device. Results: This study found that the BreatheSuite MDI can objectively detect several errors in the MDI technique. The data recorded by the BreatheSuite MDI device showed that all participants performed at least one error in using the MDI. The BreatheSuite device captured approximately 40\% (143/360) more errors compared to observation alone. The distribution of participants who performed errors in MDI steps as recorded by BreatheSuite compared to errors reported by observation alone were as follows: shaking before actuation, 33.3\% (30/90) versus 25.5\% (23/90); upright orientation of the inhaler during actuation, 66.7\% (60/90) versus 18.87\% (17/90); coordination (actuating after the start of inhalation), 76.6\% (69/90) versus 35.5\% (32/90); and duration of inspiration, 96.7\% (87/90) versus 34.4\% (31/90). Conclusions: The BreatheSuite MDI can objectively detect several errors in the MDI technique, which were missed by observation alone. It has the potential to enhance treatment outcomes among patients with chronic lung diseases. ",
doi="10.2196/26556",
url="https://biomedeng.jmir.org/2021/4/e26556"
}


@Article{info:doi/10.2196/30674,
author="Diaz-Skeete, Maria Yohanca
and McQuaid, David
and Akinosun, Samuel Adewale
and Ekerete, Idongesit
and Carragher, Natacha
and Carragher, Lucia",
title="Analysis of Apps With a Medication List Functionality for Older Adults With Heart Failure Using the Mobile App Rating Scale and the IMS Institute for Healthcare Informatics Functionality Score: Evaluation Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Nov",
day="2",
volume="9",
number="11",
pages="e30674",
keywords="mobile app",
keywords="mHealth",
keywords="medication app",
keywords="heart failure",
keywords="Mobile App Rating Scale",
abstract="Background: Managing the care of older adults with heart failure (HF) largely centers on medication management. Because of frequent medication or dosing changes, an app that supports these older adults in keeping an up-to-date list of medications could be advantageous. During the COVID-19 pandemic, HF outpatient consultations are taking place virtually or by telephone. An app with the capability to share a patient's medication list with health care professionals before consultation could support clinical efficiency, for example, by reducing consultation time. However, the influence of apps on maintaining an up-to-date medication history for older adults with HF in Ireland remains largely unexplored. Objective: The aims of this review are twofold: to review apps with a medication list functionality and to assess the quality of the apps included in the review using the Mobile App Rating Scale (MARS) and the IMS Institute for Healthcare Informatics functionality scale. Methods: A systematic search of apps was conducted in June 2019 using the Google Play Store and iTunes App Store. The MARS was used independently by 4 researchers to assess the quality of the apps using an Android phone and an iPad. Apps were also evaluated using the IMS Institute for Healthcare Informatics functionality score. Results: Google Play and iTunes App store searches identified 483 potential apps (292 from Google Play and 191 from iTunes App stores). A total of 6 apps (3 across both stores) met the inclusion criteria. Of the 6 apps, 4 achieved an acceptable MARS score (3/5). The Medisafe app had the highest overall MARS score (4/5), and the Medication List \& Medical Records app had the lowest overall score (2.5/5). On average, the apps had 8 functions based on the IMS functionality criteria (range 5-11). A total of 2 apps achieved the maximum score for number of features (11 features) according to the IMS Institute for Healthcare Informatics functionality score, and 2 scored the lowest (5 features). Peer-reviewed publications were identified for 3 of the apps. Conclusions: The quality of current apps with medication list functionality varies according to their technical aspects. Most of the apps reviewed have an acceptable MARS objective quality (ie, the overall quality of an app). However, subjective quality (ie, satisfaction with the apps) was poor. Only 3 apps are based on scientific evidence and have been tested previously. A total of 2 apps featured all the IMS Institute for Healthcare Informatics functionalities, and half did not provide clear instructions on how to enter medication data, did not display vital parameter data in an easy-to-understand format, and did not guide users on how or when to take their medication. ",
doi="10.2196/30674",
url="https://mhealth.jmir.org/2021/11/e30674",
url="http://www.ncbi.nlm.nih.gov/pubmed/34726613"
}


@Article{info:doi/10.2196/29727,
author="Sushko, Katelyn
and Wang, Rui Qi
and Tschirhart Menezes, Holly
and Fitzpatrick-Lewis, Donna
and Sherifali, Diana",
title="Patient-Reported Benefits and Limitations of Mobile Health Technologies for Diabetes in Pregnancy: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2021",
month="Oct",
day="29",
volume="10",
number="10",
pages="e29727",
keywords="diabetes",
keywords="pregnancy",
keywords="type 1 diabetes",
keywords="type 2 diabetes",
keywords="gestational diabetes mellitus",
keywords="mobile health",
keywords="mHealth",
keywords="virtual care",
keywords="scoping review",
abstract="Background: For women with pre-existing and gestational diabetes mellitus, pregnancy involves specialized and intensive medical care to improve maternal and infant outcomes. Medical management for patients with diabetes in pregnancy typically occurs via frequent face-to-face outpatient appointments. Barriers to face-to-face care during the COVID-19 pandemic have signaled the need for high-quality, patient-centered virtual health care modalities, such as mobile health (mHealth). Objective: The objective of the proposed scoping review is to identify the patient-reported benefits and limitations of mHealth technology among women with diabetes in pregnancy. We also aim to determine how the women's experiences align with the best practice standards for patient-centered communication. Methods: Arksey and O'Malley's framework for conducting scoping reviews with refinements by Levac et al will be used to guide the conduct of this scoping review. Relevant studies will be identified through comprehensive database searches of MEDLINE, Embase, Emcare, and PsycINFO. Following database searches, studies will be screened for eligibility at the title, abstract, and full-text level by two independent reviewers, with the inclusion of a third reviewer if required to reach consensus. Data charting of included studies will be conducted by one reviewer using a standardized data extraction form and verified independently by a second reviewer. Synthesis of results will be guided by Thomas and Harden's ``Methods for the Thematic Synthesis of Qualitative Research in Systematic Reviews.'' Results: As of August 2020, we have carried out the qualitative searches in the electronic databases MEDLINE, Embase, Emcare, and PsycINFO (Ovid interface) for a combined total of 8207 articles. Next, we plan to conduct the quantitative searches in the electronic databases MEDLINE, Embase, and Emcare (Ovid interface). We also plan to review the reference lists of relevant studies to identify additional eligible studies. Conclusions: With the results of this review, we hope to describe the patient-reported benefits and limitations of mHealth technology for women with diabetes in pregnancy. Furthermore, we aim to determine how women's experiences align with the best practice standards for patient-centered communication. Ultimately, our review can provide valuable information for guideline developers, policy makers, and clinicians related to mobile technologies to support virtual care delivery for women with diabetes in pregnancy. International Registered Report Identifier (IRRID): PRR1-10.2196/29727 ",
doi="10.2196/29727",
url="https://www.researchprotocols.org/2021/10/e29727",
url="http://www.ncbi.nlm.nih.gov/pubmed/34714251"
}


@Article{info:doi/10.2196/27131,
author="Sekandi, Nabbuye Juliet
and Kasiita, Vicent
and Onuoha, Amara Nicole
and Zalwango, Sarah
and Nakkonde, Damalie
and Kaawa-Mafigiri, David
and Turinawe, Julius
and Kakaire, Robert
and Davis-Olwell, Paula
and Atuyambe, Lynn
and Buregyeya, Esther",
title="Stakeholders' Perceptions of Benefits of and Barriers to Using Video-Observed Treatment for Monitoring Patients With Tuberculosis in Uganda: Exploratory Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Oct",
day="27",
volume="9",
number="10",
pages="e27131",
keywords="tuberculosis",
keywords="adherence",
keywords="mHealth",
keywords="video directly observed therapy",
keywords="Uganda",
keywords="mobile phone",
abstract="Background: Nonadherence to treatment remains a barrier to tuberculosis (TB) control. Directly observed therapy (DOT) is the standard for monitoring adherence to TB treatment worldwide, but its implementation is challenging, especially in resource-limited settings. DOT is labor-intensive and inconvenient to both patients and health care workers. Video DOT (VDOT) is a novel patient-centered alternative that uses mobile technology to observe patients taking medication remotely. However, the perceptions and acceptability of potential end users have not been evaluated in Africa. Objective: This study explores stakeholders' acceptability of, as well as perceptions of potential benefits of and barriers to, using VDOT to inform a pilot study for monitoring patients with TB in urban Uganda. Methods: An exploratory, qualitative, cross-sectional study with an exit survey was conducted in Kampala, Uganda, from April to May 2018. We conducted 5 focus group discussions, each comprising 6 participants. Groups included patients with TB (n=2 groups; male and female), health care providers (n=1), caregivers (n=1), and community DOT volunteer workers (n=1). The questions that captured perceived benefits and barriers were guided by domains adopted from the Technology Acceptance Model. These included perceived usefulness, ease of use, and intent to use technology. Eligible participants were aged ?18 years and provided written informed consent. For patients with TB, we included only those who had completed at least 2 months of treatment to minimize the likelihood of infection. A purposive sample of patients, caregivers, health care providers, and community DOT workers was recruited at 4 TB clinics in Kampala. Trained interviewers conducted unstructured interviews that were audio-recorded, transcribed, and analyzed using inductive content analysis to generate emerging themes. Results: The average age of participants was 34.5 (SD 10.7) years. VDOT was acceptable to most participants on a scale of 1 to 10. Of the participants, 70\% (21/30) perceived it as highly acceptable, with scores ?8, whereas 30\% (9/30) scored between 5 and 7. Emergent themes on perceived benefits of VDOT were facilitation of easy adherence monitoring, timely follow-up on missed doses, patient-provider communication, and saving time and money because of minimal travel to meet in person. Perceived barriers included limited technology usability skills, inadequate cellular connectivity, internet access, availability of electricity, cost of the smartphone, and use of the internet. Some female patients raised concerns about the disruption of their domestic work routines to record videos. The impact of VDOT on privacy and confidentiality emerged as both a perceived benefit and barrier. Conclusions: VDOT was acceptable and perceived as beneficial by most study participants, despite potential technical and cost barriers. Mixed perceptions emerged about the impact of VDOT on privacy and confidentiality. Future efforts should focus on training users, ensuring adequate technical infrastructure, assuring privacy, and performing comparative cost analyses in the local context. ",
doi="10.2196/27131",
url="https://mhealth.jmir.org/2021/10/e27131",
url="http://www.ncbi.nlm.nih.gov/pubmed/34704961"
}


@Article{info:doi/10.2196/28149,
author="Domogalla, Lena
and Beck, Alena
and Schulze-Hagen, Theresa
and Herr, Raphael
and Benecke, Johannes
and Schmieder, Astrid",
title="Impact of an eHealth Smartphone App on the Mental Health of Patients With Psoriasis: Prospective Randomized Controlled Intervention Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Oct",
day="25",
volume="9",
number="10",
pages="e28149",
keywords="psoriasis",
keywords="eHealth",
keywords="mHealth",
keywords="telemedicine",
keywords="teledermatology",
keywords="patient educational program",
keywords="disease management",
keywords="smartphone app",
keywords="mental health",
keywords="mobile phone",
abstract="Background: Psoriasis has a negative impact on patients' physical and mental health and can lead to anxiety and depression. Disease management strategies, including educational programs and eHealth devices, have been shown to improve health care for several chronic diseases. However, such disease management strategies are lacking in the routine care of patients with psoriasis. Objective: This study aims to study the impact of a novel intervention that combines an educational program with a disease management smartphone app on the mental health of patients with psoriasis. Methods: Patients with psoriasis in the intervention group received an educational program; attended visits on weeks 0, 12, 24, 36, and 60; and had access to the study app. Patients in the control group only attended the visits. The primary endpoint was a significant reduction of scores on the Hospital Anxiety and Depression Scale (HADS). Secondary end points were reductions in Dermatology Life Quality Index score, Psoriasis Area and Severity Index score, pruritus, and pain, as well as improvements in mood and daily activities. In addition, modulating effects of sex, age, disease duration, and app use frequency were evaluated. Results: A total of 107 patients were included in the study and randomized into the control group (53/107, 49.5\%) or intervention group (54/107, 50.5\%). Approximately 71.9\% (77/107) of the patients completed the study. A significant reduction in HADS-Depression (HADS-D) in the intervention group was found at weeks 12 (P=.04) and 24 (P=.005) but not at weeks 36 (P=.12) and 60 (P=.32). Patient stratification according to app use frequency showed a significant improvement in HADS-D score at weeks 36 (P=.004) and 60 (P=.04) and in HADS-Anxiety (HADS-A) score at weeks 36 (P=.04) and 60 (P=.05) in the group using the app less than once every 5 weeks. However, in patients using the app more than once every 5 weeks, no significant reduction in HADS-D (P=.84) or HADS-A (P=.20) score was observed over the 60-week study period compared with that observed in patients in the control group. All findings were independent of sex, age, and disease duration. Conclusions: These findings support the use of a disease management smartphone app as a valid tool to achieve long-term improvement in the mental health of patients with psoriasis if it is not used too frequently. Further studies are needed to analyze the newly observed influence of app use frequency. Trial Registration: Deutsches Register Klinischer Studien DRKS00020755; https://tinyurl.com/nyzjyvvk ",
doi="10.2196/28149",
url="https://mhealth.jmir.org/2021/10/e28149",
url="http://www.ncbi.nlm.nih.gov/pubmed/34431478"
}


@Article{info:doi/10.2196/29933,
author="Santala, E. Onni
and Halonen, Jari
and Martikainen, Susanna
and J{\"a}ntti, Helena
and Rissanen, T. Tuomas
and Tarvainen, P. Mika
and Laitinen, P. Tomi
and Laitinen, M. Tiina
and V{\"a}liaho, Eemu-Samuli
and Hartikainen, K. Juha E.
and Martikainen, J. Tero
and Lipponen, A. Jukka",
title="Automatic Mobile Health Arrhythmia Monitoring for the Detection of Atrial Fibrillation: Prospective Feasibility, Accuracy, and User Experience Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Oct",
day="22",
volume="9",
number="10",
pages="e29933",
keywords="atrial fibrillation",
keywords="ECG",
keywords="algorithm",
keywords="stroke",
keywords="mHealth",
keywords="user experience",
keywords="Awario analysis Service",
keywords="Suunto Movesense",
keywords="cardiology",
keywords="digital health",
keywords="mobile health",
keywords="wearable device",
keywords="heart belt",
keywords="arrhythmia monitor",
keywords="heart monitor",
abstract="Background: Atrial fibrillation (AF) is the most common tachyarrhythmia and associated with a risk of stroke. The detection and diagnosis of AF represent a major clinical challenge due to AF's asymptomatic and intermittent nature. Novel consumer-grade mobile health (mHealth) products with automatic arrhythmia detection could be an option for long-term electrocardiogram (ECG)-based rhythm monitoring and AF detection. Objective: We evaluated the feasibility and accuracy of a wearable automated mHealth arrhythmia monitoring system, including a consumer-grade, single-lead heart rate belt ECG device (heart belt), a mobile phone application, and a cloud service with an artificial intelligence (AI) arrhythmia detection algorithm for AF detection. The specific aim of this proof-of-concept study was to test the feasibility of the entire sequence of operations from ECG recording to AI arrhythmia analysis and ultimately to final AF detection. Methods: Patients (n=159) with an AF (n=73) or sinus rhythm (n=86) were recruited from the emergency department. A single-lead heart belt ECG was recorded for 24 hours. Simultaneously registered 3-lead ECGs (Holter) served as the gold standard for the final rhythm diagnostics and as a reference device in a user experience survey with patients over 65 years of age (high-risk group). Results: The heart belt provided a high-quality ECG recording for visual interpretation resulting in 100\% accuracy, sensitivity, and specificity of AF detection. The accuracy of AF detection with the automatic AI arrhythmia detection from the heart belt ECG recording was also high (97.5\%), and the sensitivity and specificity were 100\% and 95.4\%, respectively. The correlation between the automatic estimated AF burden and the true AF burden from Holter recording was >0.99 with a mean burden error of 0.05 (SD 0.26) hours. The heart belt demonstrated good user experience and did not significantly interfere with the patient's daily activities. The patients preferred the heart belt over Holter ECG for rhythm monitoring (85/110, 77\% heart belt vs 77/109, 71\% Holter, P=.049). Conclusions: A consumer-grade, single-lead ECG heart belt provided good-quality ECG for rhythm diagnosis. The mHealth arrhythmia monitoring system, consisting of heart-belt ECG, a mobile phone application, and an automated AF detection achieved AF detection with high accuracy, sensitivity, and specificity. In addition, the mHealth arrhythmia monitoring system showed good user experience. Trial Registration: ClinicalTrials.gov NCT03507335; https://clinicaltrials.gov/ct2/show/NCT03507335 ",
doi="10.2196/29933",
url="https://mhealth.jmir.org/2021/10/e29933",
url="http://www.ncbi.nlm.nih.gov/pubmed/34677135"
}


@Article{info:doi/10.2196/33252,
author="Bente, E. Britt
and Wentzel, Jobke
and Groeneveld, GH Rik
and IJzerman, VH Ren{\'e}e
and de Buisonj{\'e}, R. David
and Breeman, D. Linda
and Janssen, R. Veronica
and Kraaijenhagen, Roderik
and Pieterse, E. Marcel
and Evers, WM Andrea
and van Gemert-Pijnen, EWC Julia",
title="Values of Importance to Patients With Cardiovascular Disease as a Foundation for eHealth Design and Evaluation: Mixed Methods Study",
journal="JMIR Cardio",
year="2021",
month="Oct",
day="22",
volume="5",
number="2",
pages="e33252",
keywords="patient values",
keywords="health behavior",
keywords="lifestyle",
keywords="mobile app",
keywords="user-centered design",
keywords="eHealth",
keywords="cardiovascular disease",
keywords="behavior",
keywords="app",
keywords="design",
keywords="cardiovascular",
keywords="evaluation",
keywords="platform",
keywords="support",
keywords="intervention",
abstract="Background: eHealth interventions are developed to support and facilitate patients with lifestyle changes and self-care tasks after being diagnosed with a cardiovascular disease (CVD). Creating long-lasting effects on lifestyle change and health outcomes with eHealth interventions is challenging and requires good understanding of patient values. Objective: The aim of the study was to identify values of importance to patients with CVD to aid in designing a technological lifestyle platform. Methods: A mixed method?design was applied,?combining?data from usability testing?with an additional online survey study, to validate?the outcomes of the usability tests. Results: A total of 11 relevant patient values were identified, including the need for security, support, not wanting to feel anxious, tailoring of treatment, and personalized, accessible care. The validation survey shows that all values but one (value 9: To have extrinsic motivation to accomplish goals or activities [related to health/lifestyle]) were regarded as important/very important. A rating of very unimportant or unimportant was given by less than 2\% of the respondents (value 1: 4/641, 0.6\%; value 2: 10/641, 1.6\%; value 3: 9/641, 1.4\%; value 4: 5/641, 0.8\%; value 5: 10/641, 1.6\%; value 6: 4/641, 0.6\%; value 7: 10/639, 1.6\%; value 8: 4/639, 0.6\%; value 10: 3/636, 0.5\%; value 11: 4/636, 0.6\%) to all values except but one (value 9: 56/636, 8.8\%). Conclusions: There is a high consensus among patients regarding the identified values reflecting goals and themes central to their lives, while living with or managing their CVD. The identified values can serve as a foundation for future research to translate and integrate these values into the design of the eHealth technology. This may call for prioritization of values, as not all values can be met equally. ",
doi="10.2196/33252",
url="https://cardio.jmir.org/2021/2/e33252",
url="http://www.ncbi.nlm.nih.gov/pubmed/34677130"
}


@Article{info:doi/10.2196/26816,
author="Murray, R. Kevin
and Foroutan, Farid
and Amadio, M. Jennifer
and Posada, Duero Juan
and Kozuszko, Stella
and Duhamel, Joseph
and Tsang, Katherine
and Farkouh, E. Michael
and McDonald, Michael
and Billia, Filio
and Barber, Edward
and Hershman, G. Steven
and Bhat, Mamatha
and Tinckam, J. Kathryn
and Ross, J. Heather
and McIntosh, Christopher
and Moayedi, Yasbanoo",
title="Remote Mobile Outpatient Monitoring in Transplant (Reboot) 2.0: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Oct",
day="22",
volume="10",
number="10",
pages="e26816",
keywords="mobile health",
keywords="telemonitoring, transplantation",
keywords="wearable sensors",
keywords="solid organ transplant",
abstract="Background: The number of solid organ transplants in Canada has increased 33\% over the past decade. Hospital readmissions are common within the first year after transplant and are linked to increased morbidity and mortality. Nearly half of these admissions to the hospital appear to be preventable. Mobile health (mHealth) technologies hold promise to reduce admission to the hospital and improve patient outcomes, as they allow real-time monitoring and timely clinical intervention. Objective: This study aims to determine whether an innovative mHealth intervention can reduce hospital readmission and unscheduled visits to the emergency department or transplant clinic. Our second objective is to assess the use of clinical and continuous ambulatory physiologic data to develop machine learning algorithms to predict the risk of infection, organ rejection, and early mortality in adult heart, kidney, and liver transplant recipients. Methods: Remote Mobile Outpatient Monitoring in Transplant (Reboot) 2.0 is a two-phased single-center study to be conducted at the University Health Network in Toronto, Canada. Phase one will consist of a 1-year concealed randomized controlled trial of 400 adult heart, kidney, and liver transplant recipients. Participants will be randomized to receive either personalized communication using an mHealth app in addition to standard of care phone communication (intervention group) or standard of care communication only (control group). In phase two, the prior collected data set will be used to develop machine learning algorithms to identify early markers of rejection, infection, and graft dysfunction posttransplantation. The primary outcome will be a composite of any unscheduled hospital admission, visits to the emergency department or transplant clinic, following discharge from the index admission. Secondary outcomes will include patient-reported outcomes using validated self-administered questionnaires, 1-year graft survival rate, 1-year patient survival rate, and the number of standard of care phone voice messages. Results: At the time of this paper's completion, no results are available. Conclusions: Building from previous work, this project will aim to leverage an innovative mHealth app to improve outcomes and reduce hospital readmission in adult solid organ transplant recipients. Additionally, the development of machine learning algorithms to better predict adverse health outcomes will allow for personalized medicine to tailor clinician-patient interactions and mitigate the health care burden of a growing patient population. Trial Registration: ClinicalTrials.gov NCT04721288; https://www.clinicaltrials.gov/ct2/show/NCT04721288 International Registered Report Identifier (IRRID): PRR1-10.2196/26816 ",
doi="10.2196/26816",
url="https://www.researchprotocols.org/2021/10/e26816",
url="http://www.ncbi.nlm.nih.gov/pubmed/34528885"
}


@Article{info:doi/10.2196/27263,
author="Middleton, Timothy
and Constantino, Maria
and McGill, Margaret
and D'Souza, Mario
and Twigg, M. Stephen
and Wu, Ted
and Thiagalingam, Aravinda
and Chow, Clara
and Wong, Jencia",
title="An Enhanced SMS Text Message--Based Support and Reminder Program for Young Adults With Type 2 Diabetes (TEXT2U): Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="21",
volume="23",
number="10",
pages="e27263",
keywords="young-onset type 2 diabetes",
keywords="SMS",
keywords="clinic attendance",
keywords="engagement",
keywords="diabetes",
keywords="digital health",
keywords="mobile health",
keywords="adolescents",
abstract="Background: Clinic attendance, metabolic control, engagement in self-management, and psychological health are suboptimal in young-onset (age of onset <40 years) type 2 diabetes. Objective: We examined the effectiveness of an enhanced SMS text message--based support and reminder program in improving clinic attendance, metabolic control, engagement in self-management, and psychological health in young-onset type 2 diabetes. Methods: A 12-month, parallel-arm, randomized controlled trial comparing an enhanced, semipersonalized SMS text message--based intervention (incorporating 1-8 supportive and/or informative text messages per month) against standard care was conducted in a specialized clinic for young adult type 2 diabetes. The primary outcome was maintenance of 100\% attendance at scheduled quarterly clinical appointments. Secondary outcomes included (1) metabolic indices, (2) pathology and self-monitored blood glucose (SMBG) data availability, and (3) psychosocial well-being. Results: A total of 40 participants were randomized, and 32 completed their 12-month study visit. The average participant age was 32.7 (SD 5.1) years, 50\% (20/40) were male, and baseline glycated hemoglobin A1c (HbA1c) was 7.3\% (SD 1.9\%) (56 mmol/mol, SD 20). A higher proportion of the intervention group achieved 100\% attendance (12/21, 57\%, vs 5/19, 26\%, for the control group); Kaplan-Meier analysis demonstrated significantly greater cumulative attendance in the intervention group (P=.04). There were no between-group differences in HbA1c, BMI, lipids, or availability of pathology and SMBG data. Odds of recording an improvement in the Diabetes Empowerment Scale--Short Form score were higher in the intervention group at 6 months (odds ratio [OR] 4.3, 95\% CI 1.1-17), with attenuation of this effect at study end (OR 3.1, 95\% CI 0.9-11). Program acceptability was high; >90\% of participants would recommend the program to new patients. Conclusions: An enhanced SMS text message--based support and reminder program doubled scheduled clinic attendance rates for patients with young-onset type 2 diabetes. The program was highly acceptable and provided early support for patient empowerment but had no significant effect on measures of metabolic control or self-management. Trial Registration: Australian and New Zealand Clinical Trials Registry (ACTRN12618000479202); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373579 ",
doi="10.2196/27263",
url="https://www.jmir.org/2021/10/e27263",
url="http://www.ncbi.nlm.nih.gov/pubmed/34524102"
}


@Article{info:doi/10.2196/28124,
author="Haglo, H{\aa}vard
and Wang, Eivind
and Berg, Kristian Ole
and Hoff, Jan
and Helgerud, Jan",
title="Smartphone-Assisted High-Intensity Interval Training in Inflammatory Rheumatic Disease Patients: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Oct",
day="21",
volume="9",
number="10",
pages="e28124",
keywords="VO2max",
keywords="maximal oxygen uptake",
keywords="mobile app",
keywords="cardiovascular health",
keywords="quality of life",
keywords="endurance training",
abstract="Background: Patients with inflammatory rheumatic diseases (IRDs) experience disease-related barriers to physical training. Compared with the general population, IRD patients are reported to have reduced maximal oxygen uptake (VO2max) and physical activity levels. Supervised high-intensity interval training (HIIT) is documented to counteract the reduced VO2max and poor cardiovascular health associated with IRDs. However, supervised HIIT is resource demanding. Objective: This study sought to investigate if self-administered 4{\texttimes}4-min HIIT guided by a smartphone app (Myworkout GO) could yield similar HIIT-induced effects as standard 4{\texttimes}4-min HIIT performed under the guidance and supervision of health care professionals. The effects studied were on VO2max and health-related quality of life (HRQoL). Methods: Forty patients (33 female patients, mean age 48 years, SD 12 years; 7 male patients, mean age 52 years, SD 11 years) diagnosed with rheumatoid arthritis, spondyloarthritis, or systemic lupus erythematosus were randomized to a supervised group (SG) or an app group (AG). Both groups were instructed to perform 4{\texttimes}4-min intervals with a rate of perceived exertion of 16 to 17, corresponding to 85\% to 95\% of the maximal heart rate, twice a week for 10 weeks. Treadmill VO2max and HRQoL measured using RAND-36 were assessed before and after the exercise period. Results: VO2max increased (P<.001) in both groups after 10 weeks of HIIT, with improvements of 3.6 (SD 1.3) mL/kg/min in the SG and 3.7 (SD 1.5) mL/kg/min in the AG. This was accompanied by increases in oxygen pulse in both groups (P<.001), with no between-group differences apparent for either measure. Improvements in the HRQoL dimensions of bodily pain, vitality, and social functioning were observed for both groups (P<.001 to P=.04). Again, no between-group differences were detected. Conclusions: High-intensity 4{\texttimes}4-min interval training increased VO2max and HRQoL, contributing to patients' reduced cardiovascular disease risk, improved health and performance, and enhanced quality of life. Similar improvements were observed following HIIT when IRD patients were guided using perceived exertion by health care professionals or the training was self-administered and guided by the app Myworkout GO. Utilization of the app may help reduce the cost of HIIT as a treatment strategy in this patient population. Trial Registration: ClinicalTrials.gov NCT04649528; https://clinicaltrials.gov/ct2/show/NCT04649528 ",
doi="10.2196/28124",
url="https://mhealth.jmir.org/2021/10/e28124",
url="http://www.ncbi.nlm.nih.gov/pubmed/34673536"
}


@Article{info:doi/10.2196/26233,
author="Payne Riches, Sarah
and Piernas, Carmen
and Aveyard, Paul
and Sheppard, P. James
and Rayner, Mike
and Albury, Charlotte
and Jebb, A. Susan",
title="A Mobile Health Salt Reduction Intervention for People With Hypertension: Results of a Feasibility Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Oct",
day="21",
volume="9",
number="10",
pages="e26233",
keywords="salt reduction",
keywords="behavior change",
keywords="mobile health",
keywords="mHealth",
keywords="smartphone app",
keywords="mobile phone",
abstract="Background: A high-salt diet is a risk factor for hypertension and cardiovascular disease; therefore, reducing dietary salt intake is a key part of prevention strategies. There are few effective salt reduction interventions suitable for delivery in the primary care setting, where the majority of the management and diagnosis of hypertension occurs. Objective: The aim of this study is to assess the feasibility of a complex behavioral intervention to lower salt intake in people with elevated blood pressure and test the trial procedures for a randomized controlled trial to investigate the intervention's effectiveness. Methods: This feasibility study was an unblinded, randomized controlled trial of a mobile health intervention for salt reduction versus an advice leaflet (control). The intervention was developed using the Behavior Change Wheel and comprised individualized, brief advice from a health care professional with the use of the SaltSwap app. Participants with an elevated blood pressure recorded in the clinic were recruited through primary care practices in the United Kingdom. Primary outcomes assessed the feasibility of progression to a larger trial, including follow-up attendance, fidelity of intervention delivery, and app use. Secondary outcomes were objectively assessed using changes in salt intake (measured via 24-hour urine collection), salt content of purchased foods, and blood pressure. Qualitative outcomes were assessed using the think-aloud method, and the process outcomes were evaluated. Results: A total of 47 participants were randomized. All progression criteria were met: follow-up attendance (45/47, 96\%), intervention fidelity (25/31, 81\%), and app use (27/31, 87\%). There was no evidence that the intervention significantly reduced the salt content of purchased foods, salt intake, or blood pressure; however, this feasibility study was not powered to detect changes in secondary outcomes. Process and qualitative outcomes demonstrated that the trial design was feasible and the intervention was acceptable to both individuals and practitioners and positively influenced salt intake behaviors. Conclusions: The intervention was acceptable and feasible to deliver within primary care; the trial procedures were practicable, and there was sufficient signal of potential efficacy to change salt intake. With some improvements to the intervention app, a larger trial to assess intervention effectiveness for reducing salt intake and blood pressure is warranted. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 20910962; https://www.isrctn.com/ISRCTN20910962 ",
doi="10.2196/26233",
url="https://mhealth.jmir.org/2021/10/e26233",
url="http://www.ncbi.nlm.nih.gov/pubmed/34673535"
}


@Article{info:doi/10.2196/29218,
author="Oppelaar, C. Martinus
and van den Wijngaart, S. Lara
and Merkus, M. Peter J. F.
and Croonen, A. Ellen
and Hugen, C. Cindy A.
and Brouwer, L. Marianne
and Boehmer, M. Annemie L.
and Roukema, Jolt",
title="It Is Not Just the FEV1 That Matters, but the Personal Goals We Reach Along the Way: Qualitative, Multicenter, Prospective, Observational Study",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="20",
volume="23",
number="10",
pages="e29218",
keywords="eHealth",
keywords="asthma",
keywords="pediatrics",
keywords="telemonitoring",
keywords="lung function tests",
keywords="lung function",
keywords="spirometry",
keywords="home monitoring",
keywords="mHealth",
keywords="app",
keywords="smartphone",
keywords="asthma control",
keywords="child",
keywords="outpatients",
keywords="remote consultations",
keywords="quality improvement",
keywords="patient care management",
keywords="telemetry",
keywords="application",
keywords="FEV1",
keywords="pulmonary care",
abstract="Background: The COVID-19 pandemic has boosted the use of forced expiratory volume in 1 second (FEV1) telemonitoring in pediatric asthma, but a consensus on its most efficient and effective implementation is still lacking. To find answers, it is important to study how such an intervention is perceived, experienced, and used by both patients and health care professionals (HCPs). Objective: The aim of this study was to provide perspectives on how FEV1 home monitoring should be used in pediatric asthma. Methods: This is a qualitative, multicenter, prospective, observational study which included patients with asthma aged 6-16 and HCPs. Primary outcomes were results of 2 surveys that were sent to all participants at study start and after 3-4 months. Secondary outcomes consisted of FEV1 device usage during 4 months after receiving the FEV1 device. Results: A total of 39 participants (26 patients and 13 HCPs) were included in this study. Survey response rates were 97\% (38/39) at the start and 87\% (34/39) at the end of the study. Both patients and HCPs were receptive toward online FEV1 home monitoring and found it contributive to asthma control, self-management, and disease perception. The main concerns were about reliability of the FEV1 device and validity of home-performed lung function maneuvers. FEV1 devices were used with a median frequency of 7.5 (IQR 3.3-25.5) during the 4-month study period. Conclusions: Patients and HCPs are receptive toward online FEV1 home monitoring. Frequency of measurements varied largely among individuals, yet perceived benefits remained similar. This emphasizes that online FEV1 home monitoring strategies should be used as a means to reach individual goals, rather than being a goal on their own. ",
doi="10.2196/29218",
url="https://www.jmir.org/2021/10/e29218",
url="http://www.ncbi.nlm.nih.gov/pubmed/34668868"
}


@Article{info:doi/10.2196/22567,
author="Phanareth, Klaus
and Dam, Laura Astrid
and Hansen, C. Martin A. B.
and Lindskrog, Signe
and Vingtoft, S{\o}ren
and Kayser, Lars",
title="Revealing the Nature of Chronic Obstructive Pulmonary Disease Using Self-tracking and Analysis of Contact Patterns: Longitudinal Study",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="19",
volume="23",
number="10",
pages="e22567",
keywords="COPD",
keywords="exacerbations",
keywords="patient-reported outcomes",
keywords="Epital Care Model",
keywords="early interventions",
abstract="Background: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death and is characterized by a progressive loss of pulmonary function over time with intermittent episodes of exacerbations. Rapid and proactive interventions may reduce the burden of the condition for the patients. Telehealth solutions involving self-tracking of vital parameters such as pulmonary function, oxygen saturation, heart rate, and temperature with synchronous communication of health data may become a powerful solution as they enable health care professionals to react with a proactive and adequate response. We have taken this idea to the next level in the Epital Care Model and organized a person-centered technology-assisted ecosystem to provide health services to COPD patients. Objective: The objective is to reveal the nature of COPD by combining technology with a person-centered design aimed to benefit from interactions based on patient-reported outcome data and to assess the needed kind of contacts to best treat exacerbations. We wanted to know the following: (1) What are the incidences of mild, moderate, and severe exacerbations in a mixed population of COPD patients? (2) What are the courses of mild, moderate, and severe exacerbations? And (3) How is the activity and pattern of contacts with health professionals related to the participant conditions? Methods: Participants were recruited by convenience sampling from November 2013 to December 2015. The participants' sex, age, forced expiratory volume during the first second, pulse rate, and oxygen saturation were registered at entry. During the study, we registered number of days, number of exacerbations, and number of contact notes coded into care and treatment notes. Each participant was classified according to GOLD I-IV and risk factor group A-D. Participants reported their clinical status using a tablet by answering 4 questions and sending 3 semiautomated measurements. Results: Of the 87 participants, 11 were in risk factor group A, 24 in B, 13 in C, and 39 in D. The number of observed days was 31,801 days with 12,470 measurements, 1397 care notes, and 1704 treatment notes. A total of 254 exacerbations were treated and only 18 caused hospitalization. Those in risk factor group D had the highest number of hospitalizations (16), exacerbations (151), and contacts (1910). The initial contacts during the first month declined within 3 months to one-third for care contacts and one-half for treatment contacts and reached a plateau after 4 months. Conclusions: The majority of COPD patients in risk factor group D can be managed virtually, and only 13\% of those with severe exacerbations required hospitalization. Contact to the health care professionals decreases markedly within the first months after enrollment. These results provide a new and detailed insight into the course of COPD. We propose a resilience index for virtual clinical management making it easier to compare results across settings. ",
doi="10.2196/22567",
url="https://www.jmir.org/2021/10/e22567",
url="http://www.ncbi.nlm.nih.gov/pubmed/34665151"
}


@Article{info:doi/10.2196/24072,
author="Turino, Cecilia
and Ben{\'i}tez, D. Ivan
and Rafael-Palou, Xavier
and Mayoral, Ana
and Lopera, Alejandro
and Pascual, Lydia
and Vaca, Rafaela
and Cortijo, Anunciaci{\'o}n
and Moncus{\'i}-Moix, Anna
and Dalmases, Mireia
and Vargiu, Eloisa
and Blanco, Jordi
and Barb{\'e}, Ferran
and de Batlle, Jordi",
title="Management and Treatment of Patients With Obstructive Sleep Apnea Using an Intelligent Monitoring System Based on Machine Learning Aiming to Improve Continuous Positive Airway Pressure Treatment Compliance: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="18",
volume="23",
number="10",
pages="e24072",
keywords="obstructive sleep apnea",
keywords="continuous positive airway pressure",
keywords="patient compliance",
keywords="remote monitoring",
keywords="machine learning",
abstract="Background: Continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnea (OSA), but treatment compliance is often unsatisfactory. Objective: The aim of this study was to assess the effectiveness and cost-effectiveness of an intelligent monitoring system for improving CPAP compliance. Methods: This is a prospective, open label, parallel, randomized controlled trial including 60 newly diagnosed patients with OSA requiring CPAP (Apnea--Hypopnea Index [AHI] >15) from Lleida, Spain. Participants were randomized (1:1) to standard management or the MiSAOS intelligent monitoring system, involving (1) early compliance detection, thus providing measures of patient's CPAP compliance from the very first days of usage; (2) machine learning--based prediction of midterm future CPAP compliance; and (3) rule-based recommendations for the patient (app) and care team. Clinical and anthropometric variables, daytime sleepiness, and quality of life were recorded at baseline and after 6 months, together with patient's compliance, satisfaction, and health care costs. Results: Randomized patients had a mean age of 57 (SD 11) years, mean AHI of 50 (SD 27), and 13\% (8/60) were women. Patients in the intervention arm had a mean (95\% CI) of 1.14 (0.04-2.23) hours/day higher adjusted CPAP compliance than controls (P=.047). Patients' satisfaction was excellent in both arms, and up to 88\% (15/17) of intervention patients reported willingness to keep using the MiSAOS app in the future. No significant differences were found in costs (control: mean {\texteuro}90.2 (SD 53.14) (US \$105.76 [SD 62.31]); intervention: mean {\texteuro}96.2 (SD 62.13) (US \$112.70 [SD 72.85]); P=.70; {\texteuro}1=US \$1.17 was considered throughout). Overall costs combined with results on compliance demonstrated cost-effectiveness in a bootstrap-based simulation analysis. Conclusions: A machine learning--based intelligent monitoring system increased daily compliance, reported excellent patient satisfaction similar to that reported in usual care, and did not incur in a substantial increase in costs, thus proving cost-effectiveness. This study supports the implementation of intelligent eHealth frameworks for the management of patients with CPAP-treated OSA and confirms the value of patients' empowerment in the management of chronic diseases. Trial Registration: ClinicalTrials.gov NCT03116958; https://clinicaltrials.gov/ct2/show/NCT03116958 ",
doi="10.2196/24072",
url="https://www.jmir.org/2021/10/e24072",
url="http://www.ncbi.nlm.nih.gov/pubmed/34661550"
}


@Article{info:doi/10.2196/32298,
author="Shea, Benjamin
and Bakre, Shivani
and Carano, Keaton
and Scharen, Jared
and Langheier, Jason
and Hu, A. Emily",
title="Changes in Glycemic Control Among Individuals With Diabetes Who Used a Personalized Digital Nutrition Platform: Longitudinal Study",
journal="JMIR Diabetes",
year="2021",
month="Oct",
day="18",
volume="6",
number="4",
pages="e32298",
keywords="diabetes",
keywords="hyperglycemia",
keywords="hemoglobin A1c",
keywords="HbA1c",
keywords="blood glucose",
keywords="digital health",
keywords="nutrition",
keywords="meal planning",
keywords="food environment",
keywords="food ordering",
keywords="food purchasing",
keywords="platform",
keywords="longitudinal",
keywords="characteristic",
keywords="diet",
keywords="education",
abstract="Background: Diabetes-related costs are the highest across all chronic conditions in the United States, with type 2 diabetes accounting for up to 95\% of all cases of diabetes. A healthy diet is strongly associated with lowering glycated hemoglobin A1c (HbA1c) levels among individuals with diabetes, which can help curtail other health complications. Digital health platforms can offer critical support for improving diet and glycemic control among individuals with diabetes. Less is known about the characteristics of people with diabetes who use digital health platforms (specifically, a platform that integrates personalized healthy meal plans and food ordering) and changes in their HbA1c levels. Objective: The aim of this study is to characterize Foodsmart users with diabetes and evaluate the longitudinal impact of Foodsmart---a personalized digital nutrition platform with meal planning, food ordering, and nutrition education features---on changes in HbA1c levels. Methods: We retrospectively analyzed data collected from 643 adults with at least two self-reported HbA1c entries in the Foodsmart platform between January 2016 and June 2021. Participants self-reported their HbA1c levels, height, weight, health conditions, and diet in a 53-item food frequency questionnaire. Diabetes was defined as HbA1c ?6.5\%. We analyzed distributions of characteristics by baseline diabetes status and examined the association of characteristics with the likelihood of having diabetes at baseline. To evaluate the change in HbA1c levels among Foodsmart users, we calculated mean changes (absolute and percent) in HbA1c among participants with diabetes and by length of follow-up. We also compared changes in HbA1c and weight between participants with diabetes at baseline who achieved a normal HbA1c level and those who did not. Results: We found that 43.5\% (280/643) of the participants with at least two HbA1c level entries had diabetes at baseline. Participants with diabetes at baseline were more likely to be male, have a higher weight and BMI, report high blood pressure, and have a poorer diet in comparison to participants without diabetes. Using a multivariable logistic regression model, we found that being male and obese were statistically significantly associated with baseline diabetes. Among participants with diabetes at baseline, HbA1c was reduced, on average, by 0.46\%. In addition, 21.4\% (60/280) of participants with diabetes achieved a normal HbA1c level (<6.5\%) in their last HbA1c level entry; this percentage increased with longer follow-up time (39\% [7/18] at >24 months). In a sensitivity analysis, users with an HbA1c ?7.0\% at baseline had an average absolute change of --0.62\% and 31.2\% (62/199) of these participants achieved HbA1c levels of less than 7.0\%. Conclusions: This study assessed characteristics of individuals enrolled on the Foodsmart platform with HbA1c levels and found that users with diabetes had lower HbA1c levels over time and a sizable percentage of participants were successful in achieving normal levels. ",
doi="10.2196/32298",
url="https://diabetes.jmir.org/2021/4/e32298",
url="http://www.ncbi.nlm.nih.gov/pubmed/34661545"
}


@Article{info:doi/10.2196/27720,
author="Seiler, Amber
and Biundo, Eliana
and Di Bacco, Marco
and Rosemas, Sarah
and Nicolle, Emmanuelle
and Lanctin, David
and Hennion, Juliette
and de Melis, Mirko
and Van Heel, Laura",
title="Clinic Time Required for Remote and In-Person Management of Patients With Cardiac Devices: Time and Motion Workflow Evaluation",
journal="JMIR Cardio",
year="2021",
month="Oct",
day="15",
volume="5",
number="2",
pages="e27720",
keywords="cardiac implantable electronic devices",
keywords="remote monitoring",
keywords="patient management",
keywords="clinic efficiency",
keywords="digital health",
keywords="mobile phone",
abstract="Background: The number of patients with cardiac implantable electronic device (CIED) is increasing, creating a substantial workload for device clinics. Objective: This study aims to characterize the workflow and quantify clinic staff time requirements for managing patients with CIEDs. Methods: A time and motion workflow evaluation was performed in 11 US and European CIEDs clinics. Workflow tasks were repeatedly timed during 1 business week of observation at each clinic; these observations included all device models and manufacturers. The mean cumulative staff time required to review a remote device transmission and an in-person clinic visit were calculated, including all necessary clinical and administrative tasks. The annual staff time to manage a patient with a CIED was modeled using CIED transmission volumes, clinical guidelines, and the published literature. Results: A total of 276 in-person clinic visits and 2173 remote monitoring activities were observed. Mean staff time required per remote transmission ranged from 9.4 to 13.5 minutes for therapeutic devices (pacemaker, implantable cardioverter-defibrillator, and cardiac resynchronization therapy) and from 11.3 to 12.9 minutes for diagnostic devices such as insertable cardiac monitors (ICMs). Mean staff time per in-person visit ranged from 37.8 to 51.0 and from 39.9 to 45.8 minutes for therapeutic devices and ICMs, respectively. Including all remote and in-person follow-ups, the estimated annual time to manage a patient with a CIED ranged from 1.6 to 2.4 hours for therapeutic devices and from 7.7 to 9.3 hours for ICMs. Conclusions: The CIED patient management workflow is complex and requires significant staff time. Understanding process steps and time requirements informs the implementation of efficiency improvements, including remote solutions. Future research should examine heterogeneity in patient management processes to identify the most efficient workflow. ",
doi="10.2196/27720",
url="https://cardio.jmir.org/2021/2/e27720",
url="http://www.ncbi.nlm.nih.gov/pubmed/34156344"
}


@Article{info:doi/10.2196/29739,
author="Shetty, B. Vinutha
and Soon, K. Wayne H.
and Roberts, G. Alison
and Fried, Leanne
and Roby, C. Heather
and Smith, J. Grant
and Fournier, A. Paul
and Jones, W. Timothy
and Davis, A. Elizabeth",
title="A Novel Mobile Health App to Educate and Empower Young People With Type 1 Diabetes to Exercise Safely: Prospective Single-Arm Mixed Methods Pilot Study",
journal="JMIR Diabetes",
year="2021",
month="Oct",
day="14",
volume="6",
number="4",
pages="e29739",
keywords="mobile health app",
keywords="exercise",
keywords="acT1ve",
keywords="type 1 diabetes",
keywords="young people",
keywords="blood glucose level",
abstract="Background: Empowering young people with type 1 diabetes (T1D) to manage their blood glucose levels during exercise is a complex challenge faced by health care professionals due to the unpredictable nature of exercise and its effect on blood glucose levels. Mobile health (mHealth) apps would be useful as a decision-support aid to effectively contextualize a blood glucose result and take appropriate action to optimize glucose levels during and after exercise. A novel mHealth app acT1ve was recently developed, based on expert consensus exercise guidelines, to provide real-time support for young people with T1D during exercise. Objective: Our aim was to pilot acT1ve in a free-living setting to assess its acceptability and functionality, and gather feedback on the user experience before testing it in a larger clinical trial. Methods: A prospective single-arm mixed method design was used. Ten participants with T1D (mean age 17.7 years, SD 4.2 years; mean HbA1c, 54 mmol/mol, SD 5.5 mmol/mol [7.1\%, SD 0.5\%]) had acT1ve installed on their phones, and were asked to use the app to guide their exercise management for 6 weeks. At the end of 6 weeks, participants completed both a semistructured interview and the user Mobile Application Rating Scale (uMARS). All semistructured interviews were transcribed. Thematic analysis was conducted whereby interview transcripts were independently analyzed by 2 researchers to uncover important and relevant themes. The uMARS was scored for 4 quality subscales (engagement, functionality, esthetics, and information), and a total quality score was obtained from the weighted average of the 4 subscales. Scores for the 4 objective subscales were determined by the mean score of each of its individual questions. The perceived impact and subjective quality of acT1ve for each participant were calculated by averaging the scores of their related questions, but were not considered in the total quality score. All scores have a maximal possible value of 5, and they are presented as medians, IQRs, and ranges. Results: The main themes arising from the interview analysis were ``increased knowledge,'' ``increased confidence to exercise,'' and ``suitability'' for people who were less engaged in exercise. The uMARS scores for acT1ve were high (out of 5) for its total quality (median 4.3, IQR 4.2-4.6), engagement (median 3.9, IQR 3.6-4.2), functionality (median 4.8, IQR 4.5-4.8), information (median 4.6, IQR 4.5-4.8), esthetics (median 4.3, IQR 4.0-4.7), subjective quality (median 4.0, IQR 3.8-4.2), and perceived impact (median 4.3, IQR 3.6-4.5). Conclusions: The acT1ve app is functional and acceptable, with a high user satisfaction. The efficacy and safety of this app will be tested in a randomized controlled trial in the next phase of this study. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001414101; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378373 ",
doi="10.2196/29739",
url="https://diabetes.jmir.org/2021/4/e29739",
url="http://www.ncbi.nlm.nih.gov/pubmed/34647896"
}


@Article{info:doi/10.2196/24865,
author="Cruz, da Fl{\'a}via Oliveira de Almeida Marques
and Faria, Tostes Edison
and Ghobad, Cardelino Pabblo
and Alves, Mano Leandro Yukio
and Reis, dos Paula Elaine Diniz",
title="A Mobile App (AMOR Mama) for Women With Breast Cancer Undergoing Radiation Therapy: Functionality and Usability Study",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="13",
volume="23",
number="10",
pages="e24865",
keywords="mobile applications",
keywords="health education",
keywords="nursing care",
keywords="oncology nursing",
keywords="educational technology",
keywords="breast neoplasms",
keywords="radiation therapy",
abstract="Background: Mobile apps targeting women with breast cancer can facilitate access to information, improve well-being, and record reports of treatment-related symptoms. However, it is important to confirm the benefits of these apps before they are used as a tool in clinical care. Objective: The aim of this study was to evaluate the functionality and the usability of a mobile app created to guide and monitor patients with breast cancer undergoing radiation therapy. Methods: The evaluation process of the mobile app was performed in 2 steps with 8 professionals, including nurses, physician, medical physicists, and communication networks engineer. The first step was the focus group, which allowed obtaining suggestions proposed by the participants regarding the improvement of the mobile app. The second step was the individual filling in of an evaluation tool to obtain objective measures about the mobile app. A minimum concordance index of 80\% was considered to ensure the adequacy of the material. Results: After the mobile app was evaluated by 8 professionals, only 1 item of the evaluation tool, that is, concerning the potentiality of the app to be used by users of different educational levels, obtained a concordance index <80\%. Conclusions: The mobile app titled ``AMOR Mama'' was considered suitable, which suggests its contribution to an educational health technology to guide and monitor patients with breast cancer undergoing radiation therapy. More studies with this target population should be carried out to assess the performance and quality of the mobile app during its use. ",
doi="10.2196/24865",
url="https://www.jmir.org/2021/10/e24865",
url="http://www.ncbi.nlm.nih.gov/pubmed/34643531"
}


@Article{info:doi/10.2196/25163,
author="Stollfuss, Barbara
and Richter, Manuel
and Dr{\"o}mann, Daniel
and Klose, Hans
and Schwaiblmair, Martin
and Gruenig, Ekkehard
and Ewert, Ralf
and Kirchner, C. Martin
and Kleinjung, Frank
and Irrgang, Valeska
and Mueller, Christian",
title="Digital Tracking of Physical Activity, Heart Rate, and Inhalation Behavior in Patients With Pulmonary Arterial Hypertension Treated With Inhaled Iloprost: Observational Study (VENTASTEP)",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="8",
volume="23",
number="10",
pages="e25163",
keywords="6-minute walk distance",
keywords="6MWD",
keywords="Breelib",
keywords="daily physical activity",
keywords="digital monitoring",
keywords="health-related quality of life",
keywords="iloprost",
keywords="Ventavis",
keywords="inhalation behavior",
keywords="mobile phone",
keywords="pulmonary arterial hypertension",
keywords="PAH",
keywords="sleeping behavior",
keywords="behavior",
keywords="sleep",
keywords="monitoring",
keywords="physical activity",
keywords="heart",
keywords="cardiology",
abstract="Background: Pulmonary arterial hypertension restricts the ability of patients to perform routine physical activities. As part of pulmonary arterial hypertension treatment, inhaled iloprost can be administered via a nebulizer that tracks inhalation behavior. Pulmonary arterial hypertension treatment is guided by intermittent clinical measurements, such as 6-minute walk distance, assessed during regular physician visits. Continuous digital monitoring of physical activity may facilitate more complete assessment of the impact of pulmonary arterial hypertension on daily life. Physical activity tracking with a wearable has not yet been assessed with simultaneous tracking of pulmonary arterial hypertension medication intake. Objective: We aimed to digitally track the physical parameters of patients with pulmonary arterial hypertension who were starting treatment with iloprost using a Breelib nebulizer. The primary objective was to investigate correlations between changes in digital physical activity measures and changes in traditional clinical measures and health-related quality of life over 3 months. Secondary objectives were to evaluate inhalation behavior, adverse events, and changes in heart rate and sleep quality. Methods: We conducted a prospective, multicenter observational study of adults with pulmonary arterial hypertension in World Health Organization functional class III who were adding inhaled iloprost to existing pulmonary arterial hypertension therapy. Daily distance walked, step count, number of standing-up events, heart rate, and 6-minute walk distance were digitally captured using smartwatch (Apple Watch Series 2) and smartphone (iPhone 6S) apps during a 3-month observation period (which began when iloprost treatment began). Before and at the end of the observation period (within 2 weeks), we also evaluated 6-minute walk distance, Borg dyspnea, functional class, B-type natriuretic peptide (or N-terminal pro--B-type natriuretic peptide) levels, health-related quality of life (EQ-5D questionnaire), and sleep quality (Pittsburgh Sleep Quality Index). Results: Of 31 patients, 18 were included in the full analysis (observation period: median 91.5 days, IQR 88.0 to 92.0). Changes from baseline in traditional and digital 6-minute walk distance were moderately correlated (r=0.57). Physical activity (daily distance walked: median 0.4  km, IQR --0.2 to 1.9; daily step count: median 591, IQR ?509 to 2413) and clinical measures (traditional 6-minute walk distance: median 26 m, IQR 0 to 40) changed concordantly from baseline to the end of the observation period. Health-related quality of life showed little change. Total sleep score and resting heart rate slightly decreased. Distance walked and step count showed short-term increases after each iloprost inhalation. No new safety signals were identified (safety analysis set: n=30). Conclusions: Our results suggest that despite challenges, parallel monitoring of physical activity, heart rate, and iloprost inhalation is feasible in patients with pulmonary arterial hypertension and may complement traditional measures in guiding treatment; however, the sample size of this study limits generalizability. Trial Registration: ClinicalTrials.gov NCT03293407; https://clinicaltrials.gov/ct2/show/NCT03293407 International Registered Report Identifier (IRRID): RR2-10.2196/12144 ",
doi="10.2196/25163",
url="https://www.jmir.org/2021/10/e25163",
url="http://www.ncbi.nlm.nih.gov/pubmed/34623313"
}


@Article{info:doi/10.2196/32444,
author="Chen, Hung-Chang
and Tzeng, Shin-Shi
and Hsiao, Yen-Chang
and Chen, Ruei-Feng
and Hung, Erh-Chien
and Lee, K. Oscar",
title="Smartphone-Based Artificial Intelligence--Assisted Prediction for Eyelid Measurements: Algorithm Development and Observational Validation Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Oct",
day="8",
volume="9",
number="10",
pages="e32444",
keywords="artificial intelligence",
keywords="AI",
keywords="deep learning",
keywords="margin reflex distance 1",
keywords="margin reflex distance 2",
keywords="levator muscle function",
keywords="smartphone",
keywords="measurement",
keywords="eye",
keywords="prediction",
keywords="processing",
keywords="limit",
keywords="image",
keywords="algorithm",
keywords="observational",
abstract="Background: Margin reflex distance 1 (MRD1), margin reflex distance 2 (MRD2), and levator muscle function (LF) are crucial metrics for ptosis evaluation and management. However, manual measurements of MRD1, MRD2, and LF are time-consuming, subjective, and prone to human error. Smartphone-based artificial intelligence (AI) image processing is a potential solution to overcome these limitations. Objective: We propose the first smartphone-based AI-assisted image processing algorithm for MRD1, MRD2, and LF measurements. Methods: This observational study included 822 eyes of 411 volunteers aged over 18 years from August 1, 2020, to April 30, 2021. Six orbital photographs (bilateral primary gaze, up-gaze, and down-gaze) were taken using a smartphone (iPhone 11 Pro Max). The gold-standard measurements and normalized eye photographs were obtained from these orbital photographs and compiled using AI-assisted software to create MRD1, MRD2, and LF models. Results: The Pearson correlation coefficients between the gold-standard measurements and the predicted values obtained with the MRD1 and MRD2 models were excellent (r=0.91 and 0.88, respectively) and that obtained with the LF model was good (r=0.73). The intraclass correlation coefficient demonstrated excellent agreement between the gold-standard measurements and the values predicted by the MRD1 and MRD2 models (0.90 and 0.84, respectively), and substantial agreement with the LF model (0.69). The mean absolute errors were 0.35 mm, 0.37 mm, and 1.06 mm for the MRD1, MRD2, and LF models, respectively. The 95\% limits of agreement were --0.94 to 0.94 mm for the MRD1 model, --0.92 to 1.03 mm for the MRD2 model, and --0.63 to 2.53 mm for the LF model. Conclusions: We developed the first smartphone-based AI-assisted image processing algorithm for eyelid measurements. MRD1, MRD2, and LF measures can be taken in a quick, objective, and convenient manner. Furthermore, by using a smartphone, the examiner can check these measurements anywhere and at any time, which facilitates data collection. ",
doi="10.2196/32444",
url="https://mhealth.jmir.org/2021/10/e32444",
url="http://www.ncbi.nlm.nih.gov/pubmed/34538776"
}


@Article{info:doi/10.2196/28873,
author="Ranjan, Yatharth
and Althobiani, Malik
and Jacob, Joseph
and Orini, Michele
and Dobson, JB Richard
and Porter, Joanna
and Hurst, John
and Folarin, A. Amos",
title="Remote Assessment of Lung Disease and Impact on Physical and Mental Health (RALPMH): Protocol for a Prospective Observational Study",
journal="JMIR Res Protoc",
year="2021",
month="Oct",
day="7",
volume="10",
number="10",
pages="e28873",
keywords="mHealth",
keywords="COVID-19",
keywords="mobile health",
keywords="remote monitoring",
keywords="wearables",
keywords="internet of things",
keywords="lung diseases",
keywords="respiratory health",
keywords="mental health",
keywords="cardiopulmonary diseases",
abstract="Background: Chronic lung disorders like chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF) are characterized by exacerbations. They are unpleasant for patients and sometimes severe enough to cause hospital admission and death. Moreover, due to the COVID-19 pandemic, vulnerable populations with these disorders are at high risk, and their routine care cannot be done properly. Remote monitoring offers a low cost and safe solution for gaining visibility into the health of people in their daily lives, making it useful for vulnerable populations. Objective: The primary objective is to assess the feasibility and acceptability of remote monitoring using wearables and mobile phones in patients with pulmonary diseases. The secondary objective is to provide power calculations for future studies centered around understanding the number of exacerbations according to sample size and duration. Methods: Twenty participants will be recruited in each of three cohorts (COPD, IPF, and posthospitalization COVID). Data collection will be done remotely using the RADAR-Base (Remote Assessment of Disease And Relapse) mobile health (mHealth) platform for different devices, including Garmin wearable devices and smart spirometers, mobile app questionnaires, surveys, and finger pulse oximeters. Passive data include wearable-derived continuous heart rate, oxygen saturation, respiration rate, activity, and sleep. Active data include disease-specific patient-reported outcome measures, mental health questionnaires, and symptom tracking to track disease trajectory. Analyses will assess the feasibility of lung disorder remote monitoring (including data quality, data completeness, system usability, and system acceptability). We will attempt to explore disease trajectory, patient stratification, and identification of acute clinical events such as exacerbations. A key aspect is understanding the potential of real-time data collection. We will simulate an intervention to acquire responses at the time of the event to assess model performance for exacerbation identification. Results: The Remote Assessment of Lung Disease and Impact on Physical and Mental Health (RALPMH) study provides a unique opportunity to assess the use of remote monitoring in the evaluation of lung disorders. The study started in the middle of June 2021. The data collection apparatus, questionnaires, and wearable integrations were setup and tested by the clinical teams prior to the start of recruitment. While recruitment is ongoing, real-time exacerbation identification models are currently being constructed. The models will be pretrained daily on data of previous days, but the inference will be run in real time. Conclusions: The RALPMH study will provide a reference infrastructure for remote monitoring of lung diseases. It specifically involves information regarding the feasibility and acceptability of remote monitoring and the potential of real-time data collection and analysis in the context of chronic lung disorders. It will help plan and inform decisions in future studies in the area of respiratory health. Trial Registration: ISRCTN Registry ISRCTN16275601; https://www.isrctn.com/ISRCTN16275601 International Registered Report Identifier (IRRID): PRR1-10.2196/28873 ",
doi="10.2196/28873",
url="https://www.researchprotocols.org/2021/10/e28873",
url="http://www.ncbi.nlm.nih.gov/pubmed/34319235"
}


@Article{info:doi/10.2196/30444,
author="De Ridder, David
and Loizeau, Jutta Andrea
and Sandoval, Luis Jos{\'e}
and Ehrler, Fr{\'e}d{\'e}ric
and Perrier, Myriam
and Ritch, Albert
and Violot, Guillemette
and Santolini, Marc
and Greshake Tzovaras, Bastian
and Stringhini, Silvia
and Kaiser, Laurent
and Pradeau, Jean-Fran{\c{c}}ois
and Joost, St{\'e}phane
and Guessous, Idris",
title="Detection of Spatiotemporal Clusters of COVID-19--Associated Symptoms and Prevention Using a Participatory Surveillance App: Protocol for the @choum Study",
journal="JMIR Res Protoc",
year="2021",
month="Oct",
day="6",
volume="10",
number="10",
pages="e30444",
keywords="participatory surveillance",
keywords="infectious disease",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="space-time clustering",
keywords="digital health",
keywords="mobile app",
keywords="mHealth",
keywords="epidemiology",
keywords="surveillance",
keywords="digital surveillance",
keywords="public health",
abstract="Background: The early detection of clusters of infectious diseases such as the SARS-CoV-2--related COVID-19 disease can promote timely testing recommendation compliance and help to prevent disease outbreaks. Prior research revealed the potential of COVID-19 participatory syndromic surveillance systems to complement traditional surveillance systems. However, most existing systems did not integrate geographic information at a local scale, which could improve the management of the SARS-CoV-2 pandemic. Objective: The aim of this study is to detect active and emerging spatiotemporal clusters of COVID-19--associated symptoms, and to examine (a posteriori) the association between the clusters' characteristics and sociodemographic and environmental determinants. Methods: This report presents the methodology and development of the @choum (English: ``achoo'') study, evaluating an epidemiological digital surveillance tool to detect and prevent clusters of individuals (target sample size, N=5000), aged 18 years or above, with COVID-19--associated symptoms living and/or working in the canton of Geneva, Switzerland. The tool is a 5-minute survey integrated into a free and secure mobile app (CoronApp-HUG). Participants are enrolled through a comprehensive communication campaign conducted throughout the 12-month data collection phase. Participants register to the tool by providing electronic informed consent and nonsensitive information (gender, age, geographically masked addresses). Symptomatic participants can then report COVID-19--associated symptoms at their onset (eg, symptoms type, test date) by tapping on the @choum button. Those who have not yet been tested are offered the possibility to be informed on their cluster status (information returned by daily automated clustering analysis). At each participation step, participants are redirected to the official COVID-19 recommendations websites. Geospatial clustering analyses are performed using the modified space-time density-based spatial clustering of applications with noise (MST-DBSCAN) algorithm. Results: The study began on September 1, 2020, and will be completed on February 28, 2022. Multiple tests performed at various time points throughout the 5-month preparation phase have helped to improve the tool's user experience and the accuracy of the clustering analyses. A 1-month pilot study performed among 38 pharmacists working in 7 Geneva-based pharmacies confirmed the proper functioning of the tool. Since the tool's launch to the entire population of Geneva on February 11, 2021, data are being collected and clusters are being carefully monitored. The primary study outcomes are expected to be published in mid-2022. Conclusions: The @choum study evaluates an innovative participatory epidemiological digital surveillance tool to detect and prevent clusters of COVID-19--associated symptoms. @choum collects precise geographic information while protecting the user's privacy by using geomasking methods. By providing an evidence base to inform citizens and local authorities on areas potentially facing a high COVID-19 burden, the tool supports the targeted allocation of public health resources and promotes testing. International Registered Report Identifier (IRRID): DERR1-10.2196/30444 ",
doi="10.2196/30444",
url="https://www.researchprotocols.org/2021/10/e30444",
url="http://www.ncbi.nlm.nih.gov/pubmed/34449403"
}


@Article{info:doi/10.2196/30871,
author="Seberger, S. John
and Patil, Sameer",
title="Post-COVID Public Health Surveillance and Privacy Expectations in the United States: Scenario-Based Interview Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Oct",
day="5",
volume="9",
number="10",
pages="e30871",
keywords="COVID-19",
keywords="pandemic-tracking apps",
keywords="privacy concerns",
keywords="infrastructure",
keywords="health surveillance",
keywords="scenario",
keywords="interview",
keywords="thematic analysis",
abstract="Background: Smartphone-based apps designed and deployed to mitigate the COVID-19 pandemic may become infrastructure for postpandemic public health surveillance in the United States. Through the lenses of privacy concerns and user expectations of digital pandemic mitigation techniques, we identified possible long-term sociotechnical implications of such an infrastructure. Objective: We explored how people in the United States perceive the possible routinization of pandemic tracking apps for public health surveillance in general. Our interdisciplinary analysis focused on the interplay between privacy concerns, data practices of surveillance capitalism, and trust in health care providers. We conducted this analysis to achieve a richer understanding of the sociotechnical issues raised by the deployment and use of technology for pandemic mitigation. Methods: We conducted scenario-based, semistructured interviews (n=19) with adults in the United States. The interviews focused on how people perceive the short- and long-term privacy concerns associated with a fictional smart thermometer app deployed to mitigate the ``outbreak of a contagious disease.'' In order to elicit future-oriented discussions, the scenario indicated that the app would continue functioning ``after the disease outbreak has dissipated.'' We analyzed interview transcripts using reflexive thematic analysis. Results: In the context of pandemic mitigation technology, including app-based tracking, people perceive a core trade-off between public health and personal privacy. People tend to rationalize this trade-off by invoking the concept of ``the greater good.'' The interplay between the trade-off and rationalization forms the core of sociotechnical issues that pandemic mitigation technologies raise. Participants routinely expected that data collected through apps related to public health would be shared with unknown third parties for the financial gain of the app makers. This expectation suggests a perceived alignment between an app-based infrastructure for public health surveillance and the broader economics of surveillance capitalism. Our results highlight unintended and unexpected sociotechnical impacts of routinizing app-based tracking on postpandemic life, which are rationalized by invoking a nebulous concept of the greater good. Conclusions: While technologies such as app-based tracking could be useful for pandemic mitigation and preparedness, the routinization of such apps as a form of public health surveillance may have broader, unintentional sociotechnical implications for individuals and the societies in which they live. Although technology has the potential to increase the efficacy of pandemic mitigation, it exists within a broader network of sociotechnical concerns. Therefore, it is necessary to consider the long-term implications of pandemic mitigation technologies beyond the immediate needs of addressing the COVID-19 pandemic. Potential negative consequences include the erosion of patient trust in health care systems and providers, grounded in concerns about privacy violations and overly broad surveillance. ",
doi="10.2196/30871",
url="https://mhealth.jmir.org/2021/10/e30871",
url="http://www.ncbi.nlm.nih.gov/pubmed/34519667"
}


@Article{info:doi/10.2196/26125,
author="Tobias, Guy
and Sgan-Cohen, Harold
and Spanier, B. Assaf
and Mann, Jonathan",
title="Perceptions and Attitudes Toward the Use of a Mobile Health App for Remote Monitoring of Gingivitis and Willingness to Pay for Mobile Health Apps (Part 3): Mixed Methods Study",
journal="JMIR Form Res",
year="2021",
month="Oct",
day="5",
volume="5",
number="10",
pages="e26125",
keywords="mHealth",
keywords="public health",
keywords="oral health promotion",
keywords="gum health",
keywords="willingness to pay",
keywords="willingness to use",
keywords="willingness",
keywords="perception",
keywords="attitude",
keywords="mouth",
keywords="oral health",
keywords="dentist",
keywords="app",
keywords="monitoring",
keywords="mixed method",
abstract="Background: Gum infection, known as gingivitis, is a global issue. Gingivitis does not cause pain; however, if left untreated, it can worsen, leading to bad breath, bleeding gums, and even tooth loss, as the problem spreads to the underlying structures anchoring the teeth in the jaws. The asymptomatic nature of gingivitis leads people to postpone dental appointments until clinical signs are obvious or pain is evident. The COVID-19 pandemic has necessitated social distancing, which has caused many people to postpone dental visits and neglect gingival health. iGAM is a dental mobile health (mHealth) app that remotely monitors gum health, and an observational study demonstrated the ability of iGAM to reduce gingivitis. We found that a weekly dental selfie using the iGAM app reduced the signs of gingivitis and promoted oral health in a home-based setting. Objective: The aim of this mixed methods study is to assess perceptions, attitudes, willingness to pay, and willingness to use an mHealth app. Methods: The first qualitative phase of the study included eight semistructured interviews, and the second quantitative phase included data collected from responses to 121 questionnaires. Results: There was a consensus among all interviewees that apps dealing with health-related issues (mHealth apps) can improve health. Three themes emerged from the interviews: the iGAM app is capable of improving health, the lack of use of medical apps, and a contradiction between the objective state of health and the self-definition of being healthy. Participants were grouped according to how they responded to the question about whether they believed that mHealth apps could improve their health. Participants who believed that mHealth apps can enhance health (mean 1.96, SD 1.01) had a higher willingness to pay for the service (depending on price) than those who did not believe in app efficacy (mean 1.31, SD 0.87; t119=?2417; P=.02). A significant positive correlation was found between the amount a participant was willing to pay and the benefits offered by the app (rs=0.185; P=.04). Conclusions: Potential mHealth users will be willing to pay for app use depending on their perception of the app's ability to help them personally, provided they define themselves as currently unhealthy. ",
doi="10.2196/26125",
url="https://formative.jmir.org/2021/10/e26125",
url="http://www.ncbi.nlm.nih.gov/pubmed/34609320"
}


@Article{info:doi/10.2196/24005,
author="Spitzer, A. Kerry
and Heineman, Brent
and Jewell, Marcella
and Moran, Michael
and Lindenauer, K. Peter",
title="Evaluation of the Acceptability of a Proposed, Instagram-Based, Randomized Controlled Trial for People With Asthma: Survey Study",
journal="JMIR Form Res",
year="2021",
month="Sep",
day="30",
volume="5",
number="9",
pages="e24005",
keywords="asthma",
keywords="social media",
keywords="Instagram",
keywords="social support",
keywords="digital storytelling",
keywords="young adult",
abstract="Background: Asthma is a chronic lung disease that affects nearly 25 million individuals in the United States. More research is needed into the potential for health care providers to leverage existing social media platforms to improve healthy behaviors and support individuals living with chronic health conditions. Objective: In this study, we assessed the willingness of Instagram users with poorly controlled asthma to participate in a pilot randomized controlled trial that will use Instagram as a means of providing social and informational support. In addition, we explored the potential for adapting the principles of photovoice and digital storytelling to Instagram. Methods: We conducted a survey study of Instagram users aged 18-40 years with poorly controlled asthma in the United States. Results: Over 3 weeks of recruitment, 457 individuals completed the presurvey screener; 347 (75.9\%) were excluded and 110 (24.1\%) were eligible and agreed to participate in the study. Of the 110 individuals, 82 (74.5\%) completed the study survey. The mean age of the respondents was 21 (SD 5.3) years. Among respondents, 56\% (46/82) were female, 65\% (53/82) were non-Hispanic White, and 72\% (59/82) had at least some college education. The majority of respondents (67/82, 82\%) indicated that they would be willing to participate in the proposed study. Conclusions: Among young adult Instagram users with asthma, there is substantial interest in participating in a pilot randomized controlled trial that will use Instagram to connect participants with peers and a health coach to share information about self-management of asthma and build social connection. ",
doi="10.2196/24005",
url="https://formative.jmir.org/2021/9/e24005",
url="http://www.ncbi.nlm.nih.gov/pubmed/34591019"
}


@Article{info:doi/10.2196/27787,
author="Thurman, Whitney
and Semwal, Monika
and Moczygemba, R. Leticia
and Hilbelink, Mark",
title="Smartphone Technology to Empower People Experiencing Homelessness: Secondary Analysis        ",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="29",
volume="23",
number="9",
pages="e27787",
keywords="homelessness",
keywords="self-management",
keywords="smartphone technology",
keywords="social needs",
keywords="mobile phone",
abstract="Background: In the United States, the number of people experiencing homelessness has continually increased over the last 3 years. Homelessness is associated with poor health, and people experiencing homelessness are often burdened with high rates of chronic and mental health conditions, functional limitations, and cognitive impairment. Despite the high burden of chronic illness and functional limitations, there is limited literature exploring self-management among homeless populations. Objective: This study aims to investigate how access to smartphone technology facilitates self-management, including the attainment of social needs within the context of homelessness. Methods: A secondary analysis of 33 exit interviews from 2 feasibility studies related to mobile health interventions among people experiencing homelessness was conducted. Iterative thematic analysis was used to identify themes representative of participants' experiences using smartphone technology. Results: Collectively, participants revealed not only how the context of homelessness constrained their ability to engage in activities necessary to self-manage health and meet social needs but also how consistent and predictable access to the tools available through a smartphone changed their behaviors and outlook. The global theme of empowered by technology was identified and defined as how having a smartphone with a plan for unlimited text, calling, data, and transportation allowed participants to navigate homelessness and facilitated self-management. Conclusions: People experiencing homelessness used the tools on a smartphone to make decisions, take action, solve problems, and use the resources---skills necessary for fulfilling tasks required for effective self-management. Further, consistent access to smartphone technology and transportation empowered participants to meet the requirements for the attainment of social needs. ",
doi="10.2196/27787",
url="https://www.jmir.org/2021/9/e27787",
url="http://www.ncbi.nlm.nih.gov/pubmed/34586073"
}


@Article{info:doi/10.2196/26744,
author="Auener, L. Stefan
and Remers, P. Toine E.
and van Dulmen, A. Simone
and Westert, P. Gert
and Kool, B. Rudolf
and Jeurissen, T. Patrick P.",
title="The Effect of Noninvasive Telemonitoring for Chronic Heart Failure on Health Care Utilization: Systematic Review",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="29",
volume="23",
number="9",
pages="e26744",
keywords="heart failure",
keywords="telemonitoring",
keywords="remote monitoring",
keywords="health care utilization",
keywords="eHealth",
abstract="Background: Chronic heart failure accounts for approximately 1\%-2\% of health care expenditures in most developed countries. These costs are primarily driven by hospitalizations and comorbidities. Telemonitoring has been proposed to reduce the number of hospitalizations and decrease the cost of treatment for patients with heart failure. However, the effects of telemonitoring on health care utilization remain unclear. Objective: This systematic review aims to study the effect of telemonitoring programs on health care utilization and costs in patients with chronic heart failure. We assess the effect of telemonitoring on hospitalizations, emergency department visits, length of stay, hospital days, nonemergency department visits, and health care costs. Methods: We searched PubMed, Embase, and Web of Science for randomized controlled trials and nonrandomized studies on noninvasive telemonitoring and health care utilization. We included studies published between January 2010 and August 2020. For each study, we extracted the reported data on the effect of telemonitoring on health care utilization. We used P<.05 and CIs not including 1.00 to determine whether the effect was statistically significant. Results: We included 16 randomized controlled trials and 13 nonrandomized studies. Inclusion criteria, population characteristics, and outcome measures differed among the included studies. Most studies showed no effect of telemonitoring on health care utilization. The number of hospitalizations was significantly reduced in 38\% (9/24) of studies, whereas emergency department visits were reduced in 13\% (1/8) of studies. An increase in nonemergency department visits (6/9, 67\% of studies) was reported. Health care costs showed ambiguous results, with 3 studies reporting an increase in health care costs, 3 studies reporting a reduction, and 4 studies reporting no significant differences. Health care cost reductions were realized through a reduction in hospitalizations, whereas increases were caused by the high costs of the telemonitoring program or increased health care utilization. Conclusions: Most telemonitoring programs do not show clear effects on health care utilization measures, except for an increase in nonemergency outpatient department visits. This may be an unwarranted side effect rather than a prerequisite for effective telemonitoring. The consequences of telemonitoring on nonemergency outpatient visits should receive more attention from regulators, payers, and providers. This review further demonstrates the high clinical and methodological heterogeneity of telemonitoring programs. This should be taken into account in future meta-analyses aimed at identifying the effective components of telemonitoring programs. ",
doi="10.2196/26744",
url="https://www.jmir.org/2021/9/e26744",
url="http://www.ncbi.nlm.nih.gov/pubmed/34586072"
}


@Article{info:doi/10.2196/25630,
author="Wu, Dan
and An, Jiye
and Yu, Ping
and Lin, Hui
and Ma, Li
and Duan, Huilong
and Deng, Ning",
title="Patterns for Patient Engagement with the Hypertension Management and Effects of Electronic Health Care Provider Follow-up on These Patterns: Cluster Analysis",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="28",
volume="23",
number="9",
pages="e25630",
keywords="hypertension",
keywords="health care services",
keywords="mHealth",
keywords="patient engagement",
keywords="electronic follow-up",
keywords="cluster analysis",
abstract="Background: Hypertension is a long-term medical condition. Electronic and mobile health care services can help patients to self-manage this condition. However, not all management is effective, possibly due to different levels of patient engagement (PE) with health care services. Health care provider follow-up is an intervention to promote PE and blood pressure (BP) control. Objective: This study aimed to discover and characterize patterns of PE with a hypertension self-management app, investigate the effects of health care provider follow-up on PE, and identify the follow-up effects on BP in each PE pattern. Methods: PE was represented as the number of days that a patient recorded self-measured BP per week. The study period was the first 4 weeks for a patient to engage in the hypertension management service. K-means algorithm was used to group patients by PE. There was compliance follow-up, regular follow-up, and abnormal follow-up in management. The follow-up effect was calculated by the change in PE (CPE) and the change in systolic blood pressure (CSBP, SBP) before and after each follow-up. Chi-square tests and z scores were used to ascertain the distribution of gender, age, education level, SBP, and the number of follow-ups in each cluster. The follow-up effect was identified by analysis of variances. Once a significant effect was detected, Bonferroni multiple comparisons were further conducted to identify the difference between 2 clusters. Results: Patients were grouped into 4 clusters according to PE: (1) PE started low and dropped even lower (PELL), (2) PE started high and remained high (PEHH), (3) PE started high and dropped to low (PEHL), and (4) PE started low and rose to high (PELH). Significantly more patients over 60 years old were found in the PEHH cluster (P?.05). Abnormal follow-up was significantly less frequent (P?.05) in the PELL cluster. Compliance follow-up and regular follow-up can improve PE. In the clusters of PEHH and PELH, the improvement in PE in the first 3 weeks and the decrease in SBP in all 4 weeks were significant after follow-up. The SBP of the clusters of PELL and PELH decreased more (--6.1 mmHg and --8.4 mmHg) after follow-up in the first week. Conclusions: Four distinct PE patterns were identified for patients engaging in the hypertension self-management app. Patients aged over 60 years had higher PE in terms of recording self-measured BP using the app. Once SBP reduced, patients with low PE tended to stop using the app, and a continued decline in PE occurred simultaneously with the increase in SBP. The duration and depth of the effect of health care provider follow-up were more significant in patients with high or increased engagement after follow-up. ",
doi="10.2196/25630",
url="https://www.jmir.org/2021/9/e25630",
url="http://www.ncbi.nlm.nih.gov/pubmed/34581680"
}


@Article{info:doi/10.2196/20520,
author="Chew, Elaine Chu Shan
and Davis, Courtney
and Lim, Ethel Jie Kai
and Lim, Micheal Chee Meng
and Tan, Henny Yi Zhen
and Oh, Yin Jean
and Rajasegaran, Kumudhini
and Chia, Michael Yong Hwa
and Finkelstein, Andrew Eric",
title="Use of a Mobile Lifestyle Intervention App as an Early Intervention for Adolescents With Obesity: Single-Cohort Study",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="28",
volume="23",
number="9",
pages="e20520",
keywords="pediatric obesity",
keywords="mobile health",
keywords="apps",
keywords="health behavior",
keywords="mHealth",
keywords="obesity",
keywords="adolescent",
keywords="lifestyle",
keywords="well-being",
keywords="mobile phone",
abstract="Background: Effective, resource-efficient treatment is urgently needed to address the high rates of pediatric and adolescent obesity. This need has been accelerated by the COVID-19 pandemic. The use of a mobile health tool as an early intervention before a clinic-based multidisciplinary weight management program could be an effective treatment strategy that is appropriate during a pandemic. Objective: This study aims to assess the effectiveness of and adolescent engagement with a mobile app--based lifestyle intervention program as an early intervention before enrollment in a clinic-based multidisciplinary weight management program. Methods: This prospective single-cohort study involved adolescents, aged 10-16 years, who were overweight and obese (defined as BMI percentile above the 85th percentile). Participants used the mobile Kurbo app as an early intervention before enrolling in a clinic-based multidisciplinary weight management program. Kurbo's health coaches provided weekly individual coaching informed by a model of supportive accountability via video chat, and participants self-monitored their health behavior. The implementation of Kurbo as an early intervention was evaluated using the reach, effectiveness, adoption, implementation, and maintenance framework by reach (number who consented to participate out of all patients approached), implementation (Kurbo engagement and evaluation), and effectiveness as measured by the primary outcome of the BMI z-score at 3 months. Secondary outcome measures included changes in body fat percentage, nutrition and physical activity levels, and quality of life at 3 months. Maintenance was defined as the outcome measures at 6-month follow-up. Results: Of the 73 adolescents who were approached for enrollment, 40 (55\%) of adolescents were recruited. The mean age was 13.8 (SD 1.7) years, and the mean BMI z-score was 2.07 (SD 0.30). In the multiethnic Asian sample, 83\% (33/40) of the participants had household incomes below the national median. Kurbo engagement was high, with 83\% (33/40) of participants completing at least 7 coaching sessions. In total, 78\% (18/23) of participants rated the app as good to excellent and 70\% (16/23) stated that they would recommend it to others. There were no statistically significant changes in BMI z-scores at 3 months (P=.19) or 6 months (P=.27). Participants showed statistically significant improvements in measured body fat percentage, self-reported quality of life, and self-reported caloric intake from the 3-day food diaries at 3 and 6 months. Conclusions: The use of Kurbo before enrollment in an outpatient multidisciplinary clinical care intervention is a feasible strategy to expand the reach of adolescent obesity management services to a low-income and racially diverse population. Although there was no significant change in BMI z-scores, the use of Kurbo as an early intervention could help to improve quality of life and reduce body fat percentage and total caloric intake. ",
doi="10.2196/20520",
url="https://www.jmir.org/2021/9/e20520",
url="http://www.ncbi.nlm.nih.gov/pubmed/34581672"
}


@Article{info:doi/10.2196/26361,
author="Shade, Marcia
and Rector, Kyle
and Kupzyk, Kevin",
title="Voice Assistant Reminders and the Latency of Scheduled Medication Use in Older Adults With Pain: Descriptive Feasibility Study",
journal="JMIR Form Res",
year="2021",
month="Sep",
day="28",
volume="5",
number="9",
pages="e26361",
keywords="adherence",
keywords="pain medications",
keywords="older adults",
keywords="reminders",
keywords="mHealth",
keywords="voice assistants",
abstract="Background: Pain is difficult to manage in older adults. It has been recommended that pain management in older adults should include both nonpharmacologic and pharmacologic strategies. Unfortunately, nonadherence to pain medication is more prevalent than nonadherence to any other chronic disease treatment. Technology-based reminders have some benefit for medication adherence, but adherence behavior outcomes have mostly been verified by self-reports. Objective: We aimed to describe objective medication adherence and the latency of medication use after a voice assistant reminder prompted participants to take pain medications for chronic pain. Methods: A total of 15 older adults created a voice assistant reminder for taking scheduled pain medications. A subsample of 5 participants were randomly selected to participate in a feasibility study, in which a medication event monitoring system for pain medications was used to validate medication adherence as a health outcome. Data on the subsample's self-assessed pain intensity, pain interference, concerns and necessity beliefs about pain medications, self-confidence in managing pain, and medication implementation adherence were analyzed. Results: In the 5 participants who used the medication event monitoring system, the overall latency between voice assistant reminder deployment and the medication event (ie, medication bottle cap opening) was 55 minutes. The absolute latency (before or after the reminder) varied among the participants. The shortest average time taken to open the cap after the reminder was 17 minutes, and the longest was 4.5 hours. Of the 168 voice assistant reminders for scheduled pain medications, 25 (14.6\%) resulted in the opening of MEMS caps within 5 minutes of the reminder, and 107 (63.7\%) resulted in the opening of MEMS caps within 30 minutes of the reminder. Conclusions: Voice assistant reminders may help cue patients to take scheduled medications, but the timing of medication use may vary. The timing of medication use may influence treatment effectiveness. Tracking the absolute latency time of medication use may be a helpful method for assessing medication adherence. Medication event monitoring may provide additional insight into medication implementation adherence during the implementation of mobile health interventions. ",
doi="10.2196/26361",
url="https://formative.jmir.org/2021/9/e26361",
url="http://www.ncbi.nlm.nih.gov/pubmed/34581677"
}


@Article{info:doi/10.2196/27535,
author="Anan, Tomomi
and Kajiki, Shigeyuki
and Oka, Hiroyuki
and Fujii, Tomoko
and Kawamata, Kayo
and Mori, Koji
and Matsudaira, Ko",
title="Effects of an Artificial Intelligence--Assisted Health Program on Workers With Neck/Shoulder Pain/Stiffness and Low Back Pain: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Sep",
day="24",
volume="9",
number="9",
pages="e27535",
keywords="neck pain",
keywords="shoulder pain",
keywords="shoulder stiffness",
keywords="low back pain",
keywords="musculoskeletal symptoms",
keywords="digital intervention",
keywords="mobile app",
keywords="mHealth",
keywords="eHealth",
keywords="digital health",
keywords="mobile phone",
abstract="Background: Musculoskeletal symptoms such as neck and shoulder pain/stiffness and low back pain are common health problems in the working population. They are the leading causes of presenteeism (employees being physically present at work but unable to be fully engaged). Recently, digital interventions have begun to be used to manage health but their effectiveness has not yet been fully verified, and adherence to such programs is always a problem. Objective: This study aimed to evaluate the improvements in musculoskeletal symptoms in workers with neck/shoulder stiffness/pain and low back pain after the use of an exercise-based artificial intelligence (AI)--assisted interactive health promotion system that operates through a mobile messaging app (the AI-assisted health program). We expected that this program would support participants' adherence to exercises. Methods: We conducted a two-armed, randomized, controlled, and unblinded trial in workers with either neck/shoulder stiffness/pain or low back pain or both. We recruited participants with these symptoms through email notifications. The intervention group received the AI-assisted health program, in which the chatbot sent messages to users with the exercise instructions at a fixed time every day through the smartphone's chatting app (LINE) for 12 weeks. The program was fully automated. The control group continued with their usual care routines. We assessed the subjective severity of the neck and shoulder pain/stiffness and low back pain of the participants by using a scoring scale of 1 to 5 for both the intervention group and the control group at baseline and after 12 weeks of intervention by using a web-based form. We used a logistic regression model to calculate the odds ratios (ORs) of the intervention group to achieve to reduce pain scores with those of the control group, and the ORs of the subjective assessment of the improvement of the symptoms compared to the intervention and control groups, which were performed using Stata software (version 16, StataCorp LLC). Results: We analyzed 48 participants in the intervention group and 46 participants in the control group. The adherence rate was 92\% (44/48) during the intervention. The participants in the intervention group showed significant improvements in the severity of the neck/shoulder pain/stiffness and low back pain compared to those in the control group (OR 6.36, 95\% CI 2.57-15.73; P<.001). Based on the subjective assessment of the improvement of the pain/stiffness at 12 weeks, 36 (75\%) out of 48 participants in the intervention group and 3 (7\%) out of 46 participants in the control group showed improvements (improved, slightly improved) (OR 43.00, 95\% CI 11.25-164.28; P<.001). Conclusions: This study shows that the short exercises provided by the AI-assisted health program improved both neck/shoulder pain/stiffness and low back pain in 12 weeks. Further studies are needed to identify the elements contributing to the successful outcome of the AI-assisted health program. Trial Registration: University hospital Medical Information Network-Clinical Trials Registry (UMIN-CTR) 000033894; https://upload.umin.ac.jp/cgi-open-bin/ctr\_e/ctr\_view.cgi?recptno=R000038307. ",
doi="10.2196/27535",
url="https://mhealth.jmir.org/2021/9/e27535",
url="http://www.ncbi.nlm.nih.gov/pubmed/34559054"
}


@Article{info:doi/10.2196/29928,
author="Bae, Jang-Whan
and Woo, Seoung-Il
and Lee, Joongyub
and Park, Sang-Don
and Kwon, Woo Sung
and Choi, Huan Seong
and Yoon, Gwang-Seok
and Kim, Mi-Sook
and Hwang, Seung-Sik
and Lee, Kyung Won",
title="mHealth Interventions for Lifestyle and Risk Factor Modification in Coronary Heart Disease: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Sep",
day="24",
volume="9",
number="9",
pages="e29928",
keywords="coronary heart disease",
keywords="prevention",
keywords="lifestyle modification",
keywords="mobile health",
keywords="text message",
keywords="mHealth",
abstract="Background: Self-management of lifestyle and cardiovascular disease risk factors is challenging in older patients with coronary heart disease (CHD). SMS text messaging could be a potential support tool for self-management and the most affordable and accessible method through a mobile phone. High-quality evidence had been lacking, and previous studies evaluated the effects of SMS text messaging on the subjective measures of short-term outcomes. Recently, a large-sized randomized controlled trial in Australia reported promising findings on the objective measures upon 6-month follow-up. However, an examination of the effectiveness of such interventions in an Asian population with unique demographic characteristics would be worthwhile. Objective: This study examined the effectiveness of a 1-way SMS text messaging program to modify the lifestyle and cardiovascular disease risk factors of patients who underwent the first percutaneous coronary intervention (PCI). Methods: A parallel, single-blinded, 1:1 random allocation clinical trial was conducted with 879 patients treated through PCI. They were recruited during hospital admission from April 2017 to May 2020 at 2 university hospitals in the Republic of Korea. In addition to standard care, the intervention group received access to a supporting website and 4 SMS text messages per week for 6 months regarding a healthy diet, physical activity, smoking cessation, and cardiovascular health. Random allocation upon study enrollment and SMS text messaging after hospital discharge were performed automatically using a computer program. The coprimary outcomes were low-density-lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP), and BMI. The secondary outcomes were change in lifestyle and adherence to the recommended health behaviors. Results: Of the eligible population, 440 and 439 patients who underwent PCI were assigned to the intervention and control groups, respectively. The 1-way SMS text messaging program significantly enhanced physical activity (P=.02), healthy diet (P<.01), and medication adherence (P<.04) among patients with CHD. Hence, more people were likely to control their cardiovascular disease risk factors per the recommendations. The intervention group was more likely to control all 5 risk factors by 62\% (relative risk 1.62, 95\% CI 1.05-2.50) per the recommendations. On the other hand, physiological measures of the primary outcomes, including LDL-C levels, SBP, and BMI, were not significant. Most participants found the SMS text messaging program useful and helpful in motivating lifestyle changes. Conclusions: Lifestyle-focused SMS text messages were effective in the self-management of a healthy diet, exercise, and medication adherence, but their influence on the physiological measures was not significant. One-way SMS text messages can be used as an affordable adjuvant method for lifestyle modification to help prevent the recurrence of cardiovascular disease. Trial Registration: Clinical Research Information Service (CRiS) KCT0005087; https://cris.nih.go.kr/cris/search/detailSearch.do/19282 ",
doi="10.2196/29928",
url="https://mhealth.jmir.org/2021/9/e29928",
url="http://www.ncbi.nlm.nih.gov/pubmed/34559058"
}


@Article{info:doi/10.2196/25922,
author="Moskowitz, Tedlie Judith
and Addington, L. Elizabeth
and Shiu, Eva
and Bassett, M. Sarah
and Schuette, Stephanie
and Kwok, Ian
and Freedman, E. Melanie
and Leykin, Yan
and Saslow, R. Laura
and Cohn, A. Michael
and Cheung, O. Elaine",
title="Facilitator Contact, Discussion Boards, and Virtual Badges as Adherence Enhancements to a Web-Based, Self-guided, Positive Psychological Intervention for Depression: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="22",
volume="23",
number="9",
pages="e25922",
keywords="mHealth",
keywords="adherence",
keywords="depression",
keywords="discussion board",
keywords="gamification",
keywords="positive psychological intervention",
keywords="mobile phone",
abstract="Background: Adherence to self-guided interventions tends to be very low, especially in people with depression. Prior studies have demonstrated that enhancements may increase adherence, but little is known about the efficacy of various enhancements in comparison to, or in combination with, one another. Objective: The aim of our study is to test whether 3 enhancements---facilitator contact (FC), an online discussion board, and virtual badges (VB)---alone, or in combination, improve adherence to a self-guided, web-based intervention for depression. We also examined whether age, gender, race, ethnicity, comfort with technology, or baseline depression predicted adherence or moderated the effects that each enhancement had on adherence. Methods: Participants were recruited through web-based sources and, after completing at least 4 out of 7 daily emotion reports, were sequentially assigned to 1 of 9 conditions---the intervention alone; the intervention plus 1, 2, or all 3 enhancements; or an emotion reporting control condition. The intervention was a positive psychological program consisting of 8 skills that specifically targeted positive emotions, and it was delivered over 5 weeks in a self-guided, web-based format. We operationalized adherence as the number of skills accessed. Results: A total of 602 participants were enrolled in this study. Participants accessed, on average, 5.61 (SD 2.76) of 8 skills. The total number of enhancements participants received (0-3) did not predict the number of skills accessed. Participants who were assigned to the VB+FC condition accessed significantly more skills than those in the intervention only conditions. Furthermore, participants in arms that received the combination of both the VB and FC enhancements (VB+FC and VB+FC+online discussion board) accessed a greater number of skills relative to the number of skills accessed by participants who received either VB or FC without the other. Moderation analyses revealed that the receipt of VB (vs no VB) predicted higher adherence among participants with moderately severe depression at baseline. Conclusions: The results suggested that the VB+FC combination significantly increased the number of skills accessed in a self-guided, web-based intervention for elevated depression. We have provided suggestions for refinements to these enhancements, which may further improve adherence. Trial Registration: ClinicalTrials.gov NCT02861755; http://clinicaltrials.gov/ct2/show/NCT02861755 ",
doi="10.2196/25922",
url="https://www.jmir.org/2021/9/e25922",
url="http://www.ncbi.nlm.nih.gov/pubmed/34550076"
}


@Article{info:doi/10.2196/24527,
author="Tam, Lon Hon
and Wong, Ling Eliza Mi
and Cheung, Kin
and Chung, Fung Siu",
title="Effectiveness of Text Messaging Interventions on Blood Pressure Control Among Patients With Hypertension: Systematic Review of Randomized Controlled Trials",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Sep",
day="22",
volume="9",
number="9",
pages="e24527",
keywords="text messaging",
keywords="hypertension",
keywords="blood pressure",
keywords="mHealth",
keywords="meta-analysis",
abstract="Background: Controlling blood pressure (BP) is an international health concern, and high BP is a major contributor to cardiovascular disease mortality. Evidence has shown that educational interventions directed at patients potentially improve BP control and adherence to medications and lifestyle modifications. In addition, a text messaging intervention has a potential effect on BP control; however, the dosage of a text messaging intervention has not been determined in previous reviews, resulting in difficult application in practice. Objective: This review aimed to identify the effectiveness of a text messaging intervention on hypertension management with a specific focus on the dosage of text messaging and the type of additional interventions with text messaging. Methods: A systematic review was conducted and reported on in accordance with PRISMA guideline. Participants were aged 18 years and older and diagnosed with primary hypertension. The included studies used text messaging as a component of the intervention. We searched for randomized controlled trials published until June 30, 2020, from the following health-related electronic databases: Embase, Medline, CINAHL Complete, PsycINFO, and Scopus. Data were extracted for qualitative synthesis and meta-analysis. The Physiotherapy Evidence Database Scale was used to assess the methodological quality of each study, and the quality of the included studies was assessed independently by two authors. Results: Twelve studies met the inclusion criteria. The overall methodological quality was fair (mean score 5.75). The frequency of text message delivery varied from daily to biweekly. Health education was identified in 4 studies as an additional intervention with text messaging. The overall results showed that the text messaging intervention significantly reduced systolic BP (SBP) but not diastolic BP (DBP). There was no significant difference in BP reduction between studies that lasted 6 months or less and those that lasted more than 7 months. Seven studies that lasted 6 months or less involving 1428 patients with hypertension were pooled for further meta-analysis. Text messages delivered at a lower frequency (once per week or less) had a small effect on SBP reduction (effect size 0.35, P<.01) and DBP reduction (effect size 0.28, P=.01). In addition, the use of a text messaging intervention halved the odds of uncontrolled BP among patients with hypertension in 6 months (odds ratio 0.46, P=.02). Conclusions: This review found that a text messaging intervention was effective in BP control. One-way text messaging delivered in a weekly manner was suggested to be effective and required fewer resources. Future studies should use different forms of text message and be integrated into other interventions to improve adherence behaviors and BP control among patients with hypertension. ",
doi="10.2196/24527",
url="https://mhealth.jmir.org/2021/9/e24527",
url="http://www.ncbi.nlm.nih.gov/pubmed/34550078"
}


@Article{info:doi/10.2196/27447,
author="Kim, Sunyoung
and Park, Yunoh
and Ackerman, K. Matthew",
title="Designing an Indoor Air Quality Monitoring App for Asthma Management in Children: User-Centered Design Approach",
journal="JMIR Form Res",
year="2021",
month="Sep",
day="22",
volume="5",
number="9",
pages="e27447",
keywords="asthma",
keywords="children",
keywords="indoor air quality",
keywords="mobile app",
keywords="smartphone",
keywords="user-centered design",
abstract="Background: Indoor air pollution is a well-known risk factor that triggers and exacerbates asthma, the most common pediatric chronic disease. Using a mobile app to monitor indoor air quality could be promising in engaging children in keeping their indoor air quality clean and healthy as secondary environmental prevention for asthma management. However, no app is available to allow children to monitor, assess, and improve their indoor air quality. Objective: This study aims to design a mobile app that encourages children to monitor indoor air quality and track their asthma conditions through a user-centered, iterative design approach. Methods: We reviewed existing apps for indoor air quality monitoring or asthma management for children and conducted two sets of semistructured interviews with 12 children with asthma. We then iteratively created prototypes and evaluated and revised them. Results: Participants raised a series of outstanding questions on the prototype features and content that described their needs and perspectives, which informed the final designs. Following the identified requirements and recommendations, we developed two versions of the app: AirBuddy for presenting concrete information for indoor air quality and AirPet for gamifying the practice of monitoring indoor air quality. Conclusions: By following an iterative, user-centered design process, we developed two versions of an app to encourage children with asthma to monitor indoor air quality and track their asthma condition. The user-centered design approach revealed two crucial aspects that require deeper consideration when creating a child-friendly app, including balancing brevity and expressivity and considering the longitudinal effects of gamification. As a next step, we plan to conduct a longitudinal deployment study to evaluate the real-world effects of our apps. ",
doi="10.2196/27447",
url="https://formative.jmir.org/2021/9/e27447",
url="http://www.ncbi.nlm.nih.gov/pubmed/34550080"
}


@Article{info:doi/10.2196/28524,
author="Hauth, Franziska
and Gehler, Barbara
and Nie{\ss}, Michael Andreas
and Fischer, Katharina
and Toepell, Andreas
and Heinrich, Vanessa
and Roesel, Inka
and Peter, Andreas
and Renovanz, Mirjam
and Hartkopf, Andreas
and Stengel, Andreas
and Zips, Daniel
and Gani, Cihan",
title="An Activity Tracker--Guided Physical Activity Program for Patients Undergoing Radiotherapy: Protocol for a Prospective Phase III Trial (OnkoFit I and II Trials)",
journal="JMIR Res Protoc",
year="2021",
month="Sep",
day="22",
volume="10",
number="9",
pages="e28524",
keywords="cancer",
keywords="fatigue",
keywords="physical activity",
keywords="quality of life",
keywords="activity tracker",
keywords="exercise program",
keywords="radiotherapy",
keywords="digital health",
abstract="Background: The positive impact that physical activity has on patients with cancer has been shown in several studies over recent years. However, supervised physical activity programs have several limitations, including costs and availability. Therefore, our study proposes a novel approach for the implementation of a patient-executed, activity tracker--guided exercise program to bridge this gap. Objective: Our trial aims to investigate the impact that an activity tracker--guided, patient-executed exercise program for patients undergoing radiotherapy has on cancer-related fatigue, health-related quality of life, and preoperative health status. Methods: Patients receiving postoperative radiotherapy for breast cancer (OnkoFit I trial) or neoadjuvant, definitive, or postoperative treatment for other types of solid tumors (OnkoFit II trial) will be randomized (1:1:1) into 3-arm studies. Target accrual is 201 patients in each trial (50 patients per year). After providing informed consent, patients will be randomized into a standard care arm (arm A) or 1 of 2 interventional arms (arms B and C). Patients in arms B and C will wear an activity tracker and record their daily step count in a diary. Patients in arm C will receive personalized weekly targets for their physical activity. No further instructions will be given to patients in arm B. The target daily step goals for patients in arm C will be adjusted weekly and will be increased by 10\% of the average daily step count of the past week until they reach a maximum of 6000 steps per day. Patients in arm A will not be provided with an activity tracker. The primary end point of the OnkoFit I trial is cancer-related fatigue at 3 months after the completion of radiotherapy. This will be measured by the Functional Assessment of Chronic Illness Therapy-Fatigue questionnaire. For the OnkoFit II trial, the primary end point is the overall quality of life, which will be assessed with the Functional Assessment of Cancer Therapy-General sum score at 6 months after treatment to allow for recovery after possible surgery. In parallel, blood samples from before, during, and after treatment will be collected in order to assess inflammatory markers. Results: Recruitment for both trials started on August 1, 2020, and to date, 49 and 12 patients have been included in the OnkoFit I and OnkoFit II trials, respectively. Both trials were approved by the institutional review board prior to their initiation. Conclusions: The OnkoFit trials test an innovative, personalized approach for the implementation of an activity tracker--guided training program for patients with cancer during radiotherapy. The program requires only a limited amount of resources. Trial Registration: ClinicalTrials.gov NCT04506476; https://clinicaltrials.gov/ct2/show/NCT04506476. ClinicalTrials.gov NCT04517019; https://clinicaltrials.gov/ct2/show/NCT04517019. International Registered Report Identifier (IRRID): DERR1-10.2196/28524 ",
doi="10.2196/28524",
url="https://www.researchprotocols.org/2021/9/e28524",
url="http://www.ncbi.nlm.nih.gov/pubmed/34550079"
}


@Article{info:doi/10.2196/25878,
author="Wessels, J. Nienke
and Loohuis, M. Anne M.
and van der Worp, Henk
and Abbenhuis, Linde
and Dekker, Janny
and Berger, Y. Marjolein
and van Gemert-Pijnen, C. Julia E. W.
and Blanker, H. Marco",
title="Barriers and Facilitators Associated With App-Based Treatment for Female Urinary Incontinence: Mixed Methods Evaluation",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Sep",
day="17",
volume="9",
number="9",
pages="e25878",
keywords="mHealth",
keywords="female",
keywords="mixed methods",
keywords="primary health care",
keywords="urinary incontinence",
abstract="Background: App-based treatment for urinary incontinence is a proven effective and cost-effective alternative to care as usual, but successful implementation requires that we identify and address the barriers and facilitators associated with app use. Objective: The goal of the research was to explore the factors influencing app-based treatment for urinary incontinence and identify which barriers or facilitators are associated with treatment success or failure. Methods: We used a sequential explanatory mixed methods design to connect the results of a randomized controlled trial with data from semistructured interviews. This previous RCT had shown the noninferiority of app-based treatment compared with care as usual for urinary incontinence over 4 months. Participants who reported success or failure with app-based treatment, as measured by the change in International Consultation on Incontinence Modular Questionnaire Urinary Incontinence Short Form symptom score, were selected for telephone interview by purposive sampling (n=17). This study reports mainly on the qualitative component of our mixed methods study. Qualitative analyses were conducted in two ways. First, we analyzed the qualitative data of all interviewed participants and discussed the relationships between the main themes. Second, the experiences between the success (n=9) and failure group (n=8) were compared and contrasted to explore factors that were positively or negatively associated with the quantitative effect of app-based treatment. These factors were then interpreted as barriers to and facilitators of successful app-based treatment. Results: Four interrelated themes were identified as affecting the app based treatment effect: adherence, personal factors, app factors, and awareness. Qualitative analyses of the relationships between the themes showed that adherence-related factors directly influenced treatment effect in both a positive and negative matter. In turn, adherence was also positively and negatively influenced by the other 3 themes. Additionally, awareness was positively influenced by the treatment effect. Within these themes, several factors were identified that acted as barriers (eg, unrealistic expectation of time investment and interfering personal circumstances), facilitators (eg, strict integration of exercises and prior pelvic floor muscle therapy), or both (eg, personality traits and increased awareness of symptoms). Conclusions: This study shows that the effect of app-based treatment for urinary incontinence is mainly influenced by adherence, which in turn is affected by personal factors, app-based factors, and awareness. The identified factors could function as both facilitators and barriers depending on the user and interaction with other themes. Insight into these facilitators and barriers could lead to improved implementation and increased treatment effectiveness by targeting women most likely to benefit and through further development of the app. International Registered Report Identifier (IRRID): RR2-10.1002/nau.23507 ",
doi="10.2196/25878",
url="https://mhealth.jmir.org/2021/9/e25878",
url="http://www.ncbi.nlm.nih.gov/pubmed/34533466"
}


@Article{info:doi/10.2196/24955,
author="Tobias, Guy
and Spanier, B. Assaf",
title="Using an mHealth App (iGAM) to Reduce Gingivitis Remotely (Part 2): Prospective Observational Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Sep",
day="16",
volume="9",
number="9",
pages="e24955",
keywords="mHealth",
keywords="public health",
keywords="oral health promotion",
keywords="gum health",
keywords="COVID-19",
abstract="Background: Gingivitis is a nonpainful, inflammatory condition that can be managed at home. Left untreated, gingivitis can lead to tooth loss. Periodic dental examinations are important for early diagnosis and treatment of gum diseases. To contain the spread of the coronavirus, governments, including in Israel, have restricted movements of their citizens which might have caused routine dental checkups to be postponed. Objective: This study aimed to examine the ability of a mobile health app, iGAM, to reduce gingivitis, and to determine the most effective interval between photograph submissions. Methods: A prospective observational cohort study with 160 unpaid participants divided into 2 equal groups using the iGAM app was performed. The intervention group photographed their gums weekly for 8 weeks. The wait-list control group photographed their gums at the time of recruitment and 8 weeks later. After photo submission, the participants received the same message ``we recommended that you read the information in the app regarding oral hygiene habits.'' A single-blinded researcher examined all the images and scored them according to the Modified Gingival Index (MGI). Results: The average age of the intervention group was 26.77 (SD 7.43) and 28.53 (SD 10.44) for the wait-list control group. Most participants were male (intervention group: 56/75,74.7\%; wait-list control group: 34/51, 66.7\%) and described themselves as ``secular''; most were ``single'' non-smokers (intervention group: 56/75, 74.7\%; wait-list control group: 40/51, 78.4\%), and did not take medications (intervention group: 64/75, 85.3\%; wait-list control group: 40/51, 78.4\%). A total of 126 subjects completed the study. A statistically significant difference (P<.001) was found in the dependent variable (MGI). Improvements in gingival health were noted over time, and the average gingivitis scores were significantly lower in the intervention group (mean 1.16, SD 1.18) than in the wait-list control group (mean 2.16, SD 1.49) after 8 weeks. Those with more recent dental visits had a lower MGI (P=.04). No association was found between knowledge and behavior. Most participants were familiar with the recommendations for maintaining oral health, yet they only performed some of them. Conclusions: A dental selfie taken once a week using an mobile health app (iGAM) reduced the signs of gingivitis and promoted oral health. Selfies taken less frequently yielded poorer results. During the current pandemic, where social distancing recommendations may be causing people to avoid dental clinics, this app can remotely promote gum health. ",
doi="10.2196/24955",
url="https://mhealth.jmir.org/2021/9/e24955",
url="http://www.ncbi.nlm.nih.gov/pubmed/34528897"
}


@Article{info:doi/10.2196/27576,
author="Yu, Jing
and Wu, Jiayi
and Huang, Ou
and Chen, Xiaosong
and Shen, Kunwei",
title="A Smartphone-Based App to Improve Adjuvant Treatment Adherence to Multidisciplinary Decisions in Patients With Early-Stage Breast Cancer: Observational Study",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="16",
volume="23",
number="9",
pages="e27576",
keywords="breast cancer",
keywords="adherence",
keywords="multidisciplinary treatment",
keywords="adjuvant treatment",
keywords="smartphone-based app",
keywords="mobile phone",
abstract="Background: Multidisciplinary treatment (MDT) and adjuvant therapy are associated with improved survival rates in breast cancer. However, nonadherence to MDT decisions is common in patients. We developed a smartphone-based app that can facilitate the full-course management of patients after surgery. Objective: This study aims to investigate the influence factors of treatment nonadherence and to determine whether this smartphone-based app can improve the compliance rate with MDTs. Methods: Patients who had received a diagnosis of invasive breast cancer and had undergone MDT between March 2013 and May 2019 were included. Patients were classified into 3 groups: Pre-App cohort (November 2017, before the launch of the app); App nonused, cohort (after November 2017 but not using the app); and App used cohort (after November 2017 and using the app). Univariate and multivariate analyses were performed to identify the factors related to MDT adherence. Compliance with specific adjuvant treatments, including chemotherapy, radiotherapy, endocrine therapy, and targeted therapy, was also evaluated. Results: A total of 4475 patients were included, with Pre-App, App nonused, and App used cohorts comprising 2966 (66.28\%), 861 (19.24\%), and 648 (14.48\%) patients, respectively. Overall, 15.53\% (695/4475) patients did not receive MDT recommendations; the noncompliance rate ranged from 27.4\% (75/273) in 2013 to 8.8\% (44/500) in 2019. Multivariate analysis demonstrated that app use was independently associated with adherence to adjuvant treatment. Compared with the patients in the Pre-App cohort, patients in the App used cohort were less likely to deviate from MDT recommendations (odds ratio [OR] 0.61, 95\% CI 0.43-0.87; P=.007); no significant difference was found in the App nonused cohort (P=.77). Moreover, app use decreased the noncompliance rate for adjuvant chemotherapy (OR 0.41, 95\% CI 0.27-0.65; P<.001) and radiotherapy (OR 0.49, 95\% CI 0.25-0.96; P=.04), but not for anti-HER2 therapy (P=.76) or endocrine therapy (P=.39). Conclusions: This smartphone-based app can increase MDT adherence in patients undergoing adjuvant therapy; this was more obvious for adjuvant chemotherapy and radiotherapy. ",
doi="10.2196/27576",
url="https://www.jmir.org/2021/9/e27576",
url="http://www.ncbi.nlm.nih.gov/pubmed/34528890"
}


@Article{info:doi/10.2196/31621,
author="Tully, Louise
and Sorensen, Jan
and O'Malley, Grace",
title="Pediatric Weight Management Through mHealth Compared to Face-to-Face Care: Cost Analysis of a Randomized Control Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Sep",
day="14",
volume="9",
number="9",
pages="e31621",
keywords="childhood obesity",
keywords="pediatric weight management",
keywords="economic evaluation",
keywords="digital health",
keywords="telemedicine",
keywords="mHealth",
abstract="Background: Mobile health (mHealth) may improve pediatric weight management capacity and the geographical reach of services, and overcome barriers to attending physical appointments using ubiquitous devices such as smartphones and tablets. This field remains an emerging research area with some evidence of its effectiveness; however, there is a scarcity of literature describing economic evaluations of mHealth interventions. Objective: We aimed to assess the economic viability of using an mHealth approach as an alternative to standard multidisciplinary care by evaluating the direct costs incurred within treatment arms during a noninferiority randomized controlled trial (RCT). Methods: A digitally delivered (via a smartphone app) maintenance phase of a pediatric weight management program was developed iteratively with patients and families using evidence-based approaches. We undertook a microcosting exercise and budget impact analysis to assess the costs of delivery from the perspective of the publicly funded health care system. Resource use was analyzed alongside the RCT, and we estimated the costs associated with the staff time and resources for service delivery per participant. Results: In total, 109 adolescents participated in the trial, and 84 participants completed the trial (25 withdrew from the trial). We estimated the mean direct cost per adolescent attending usual care at {\texteuro}142 (SD 23.7), whereas the cost per adolescent in the mHealth group was {\texteuro}722 (SD 221.1), with variations depending on the number of weeks of treatment completion. The conversion rate for the reference year 2013 was \$1={\texteuro}0.7525. The costs incurred for those who withdrew from the study ranged from {\texteuro}35 to {\texteuro}681, depending on the point of dropout and study arm. The main driver of the costs in the mHealth arm was the need for health professional monitoring and support for patients on a weekly basis. The budget impact for offering the mHealth intervention to all newly referred patients in a 1-year period was estimated at {\texteuro}59,046 using the assessed approach. Conclusions: This mHealth approach was substantially more expensive than usual care, although modifications to the intervention may offer opportunities to reduce the mHealth costs. The need for monitoring and support from health care professionals (HCPs) was not eliminated using this delivery model. Further research is needed to explore the cost-effectiveness and economic impact on families and from a wider societal perspective. Trial Registration: ClinicalTrials.gov NCT01804855; https://clinicaltrials.gov/ct2/show/NCT01804855 ",
doi="10.2196/31621",
url="https://mhealth.jmir.org/2021/9/e31621",
url="http://www.ncbi.nlm.nih.gov/pubmed/34519665"
}


@Article{info:doi/10.2196/23916,
author="Holtz, Bree
and Mitchell, M. Katharine
and Holmstrom, J. Amanda
and Cotten, R. Shelia
and Dunneback, K. Julie
and Jimenez-Vega, Jose
and Ellis, A. Deborah
and Wood, A. Michael",
title="An mHealth-Based Intervention for Adolescents With Type 1 Diabetes and Their Parents: Pilot Feasibility and Efficacy Single-Arm Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Sep",
day="14",
volume="9",
number="9",
pages="e23916",
keywords="mobile health (mHealth)",
keywords="adolescents",
keywords="type 1 diabetes",
keywords="mobile phone",
keywords="parent-adolescent",
keywords="chronic disease",
keywords="feasibility",
keywords="diabetes management",
abstract="Background: Type 1 diabetes (T1D) affects more than 165,000 individuals younger than 20 years in the United States of America. The transition from parent management to parent-child team management, with the child taking on increased levels of self-care, can be stressful and is associated with a deterioration in self-management behaviors. Therefore, a mobile app intervention, MyT1DHero, was designed to facilitate diabetes-specific positive parent-adolescent communication and improve diabetes-related outcomes. The MyT1DHero intervention links an adolescent with T1D and their parent through 2 separate app interfaces and is designed to promote positive communication regarding T1D management. Objective: The aim of this pilot study was to determine (1) the initial efficacy of the MyT1DHero intervention in improving diabetes outcomes in adolescents, specifically the hemoglobin A1c (HbA1c) levels, diabetes care adherence, and quality of life, and (2) the adolescents' overall satisfaction with this intervention. Methods: This pilot study included 30 adolescent-parent pairs who used the MyT1DHero app in a 12-week single-arm clinical trial. Participants were recruited from the local pediatric endocrinology subspecialty clinic via snowball sampling. HbA1c levels, diabetes care adherence, quality of life, family conflict, and satisfaction levels were measured and analyzed using paired sample two-sided t tests and linear regression analyses. Results: The final analysis included 25 families. The mean age of the adolescents was 12.28 (SD 1.62) years. Half of the participants (13/25) reported a diabetes diagnosis of less than 5 years. After 12 weeks of the intervention, diabetes care adherence significantly improved (before the study: mean 3.87 [SD 0.59]; after the study: mean 4.19 [SD 0.65]; t21=--2.52, P=.02, d=0.52) as did quality of life (before the study: mean 4.02 [SD 0.84]; after the study: mean 4.27 [SD 0.73]; t24=2.48, P=.01, d=0.32). HbA1c levels (before the study: mean 8.94 [SD 1.46]; after the study: mean 8.87 [SD 1.29]; t24=0.67, P=.51, d=0.04) and family conflict (before the study: mean 2.45 [SD 0.55]; after the study: mean 2.61 [SD 0.45]; t23=0.55, P=.14, d=0.32) changed in the hypothesized direction, but the change was not significant. However, higher use of the mobile app was associated with more improvement in HbA1c levels (F1,20=9.74, P<.005; R2=0.33). Overall, the adolescents were satisfied with the app intervention. Conclusions: In a 12-week pilot study of the mobile app intervention designed to facilitate parent-adolescent communication for improving diabetes outcomes, significant benefits were demonstrated in self-care adherence and quality of life. A randomized controlled trial with a longer intervention is needed to replicate these findings and to determine the stability of the intervention effects. Trial Registration: ClinicalTrials.gov NCT03436628; https://clinicaltrials.gov/ct2/show/NCT03436628 ",
doi="10.2196/23916",
url="https://mhealth.jmir.org/2021/9/e23916",
url="http://www.ncbi.nlm.nih.gov/pubmed/34519670"
}


@Article{info:doi/10.2196/28796,
author="Sarasmita, Ary Made
and Larasanty, Febryana Luh Putu
and Kuo, Li-Na
and Cheng, Kuei-Ju
and Chen, Hsiang-Yin",
title="A Computer-Based Interactive Narrative and a Serious Game for Children With Asthma: Development and Content Validity Analysis",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="13",
volume="23",
number="9",
pages="e28796",
keywords="asthma",
keywords="computer",
keywords="children",
keywords="interactive narrative",
keywords="serious game",
keywords="digital education",
keywords="mobile phone",
abstract="Background: Nonadherence to medications, failure to prevent exposure to asthma triggers, lack of knowledge about using medications, and fixed mindsets contribute to poor asthma control in children. Digital learning could provide a new strategy for improving health-related outcomes in children with asthma. Objective: The aim of this study is to develop and design a digital educational program, titled Module of Inhaler and Asthma Triggers for Children (MIRACLE), for Indonesian children with asthma. The program comprises an interactive narrative and a serious game. It was proposed to increase the understanding of asthma self-management, instruct on proper inhaler techniques, improve asthma control, and promote a growth mindset for children with asthma. Methods: Two phases of research were conducted to develop the program. In the first phase, a literature search and two rounds of the Delphi technique were conducted to obtain agreement from an expert panel regarding elements of asthma self-management and the design of interactive narratives and a serious game. The expert panel item statements were evaluated using the content validity index (CVI). In the second phase, the SERES framework, Norma Engaging Multimedia Design, and Psychological Theory of Growth Mindset were applied to create a storyline, learn objectives, and game challenges. Results: In the first phase, 40 experts were invited to participate in Delphi round 1. Forty responses were collected to generate 38 item statements that consisted of part 1, elements of asthma self-management (25 items), and part 2, design of an interactive narrative and a serious game (13 items); 38 experts were involved in Delphi round 2. In total, 24 statements in part 1 and 13 items in part 2 had item-CVI values >0.80. The average CVI was 0.9, which was considered acceptable. Four narrative plots and five game sessions were developed during the second phase. Challenges with the scenario, scoring, and feedback on asthma difficulties were designed to promote a growth mindset for learners. Conclusions: We developed a culture-specific, computer-based asthma program containing an interactive narrative and a serious game to deliver asthma self-management and promote a growth mindset among Indonesian children. ",
doi="10.2196/28796",
url="https://www.jmir.org/2021/9/e28796",
url="http://www.ncbi.nlm.nih.gov/pubmed/34515641"
}


@Article{info:doi/10.2196/26608,
author="Sahandi Far, Mehran
and Eickhoff, B. Simon
and Goni, Maria
and Dukart, Juergen",
title="Exploring Test-Retest Reliability and Longitudinal Stability of Digital Biomarkers for Parkinson Disease in the m-Power Data Set: Cohort Study",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="13",
volume="23",
number="9",
pages="e26608",
keywords="health sciences",
keywords="medical research",
keywords="biomarkers",
keywords="diagnostic markers",
keywords="neurological disorders",
keywords="Parkinson disease",
keywords="mobile phone",
abstract="Background: Digital biomarkers (DB), as captured using sensors embedded in modern smart devices, are a promising technology for home-based sign and symptom monitoring in Parkinson disease (PD). Objective: Despite extensive application in recent studies, test-retest reliability and longitudinal stability of DB have not been well addressed in this context. We utilized the large-scale m-Power data set to establish the test-retest reliability and longitudinal stability of gait, balance, voice, and tapping tasks in an unsupervised and self-administered daily life setting in patients with PD and healthy controls (HC). Methods: Intraclass correlation coefficients were computed to estimate the test-retest reliability of features that also differentiate between patients with PD and healthy volunteers. In addition, we tested for longitudinal stability of DB measures in PD and HC, as well as for their sensitivity to PD medication effects. Results: Among the features differing between PD and HC, only a few tapping and voice features had good to excellent test-retest reliabilities and medium to large effect sizes. All other features performed poorly in this respect. Only a few features were sensitive to medication effects. The longitudinal analyses revealed significant alterations over time across a variety of features and in particular for the tapping task. Conclusions: These results indicate the need for further development of more standardized, sensitive, and reliable DB for application in self-administered remote studies in patients with PD. Motivational, learning, and other confounders may cause variations in performance that need to be considered in DB longitudinal applications. ",
doi="10.2196/26608",
url="https://www.jmir.org/2021/9/e26608",
url="http://www.ncbi.nlm.nih.gov/pubmed/34515645"
}


@Article{info:doi/10.2196/28378,
author="Chen, Chih-Hao
and Lin, Haley Heng-Yu
and Wang, Mao-Che
and Chu, Yuan-Chia
and Chang, Chun-Yu
and Huang, Chii-Yuan
and Cheng, Yen-Fu",
title="Diagnostic Accuracy of Smartphone-Based Audiometry for Hearing Loss Detection: Meta-analysis",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Sep",
day="10",
volume="9",
number="9",
pages="e28378",
keywords="audiometry",
keywords="hearing loss",
keywords="hearing test",
keywords="mhealth",
keywords="mobile health",
keywords="digital health",
keywords="meta-analysis",
keywords="mobile phone",
keywords="smartphone diagnostic test accuracy",
abstract="Background: Hearing loss is one of the most common disabilities worldwide and affects both individual and public health. Pure tone audiometry (PTA) is the gold standard for hearing assessment, but it is often not available in many settings, given its high cost and demand for human resources. Smartphone-based audiometry may be equally effective and can improve access to adequate hearing evaluations. Objective: The aim of this systematic review is to synthesize the current evidence of the role of smartphone-based audiometry in hearing assessments and further explore the factors that influence its diagnostic accuracy. Methods: Five databases---PubMed, Embase, Cochrane Library, Web of Science, and Scopus---were queried to identify original studies that examined the diagnostic accuracy of hearing loss measurement using smartphone-based devices with conventional PTA as a reference test. A bivariate random-effects meta-analysis was performed to estimate the pooled sensitivity and specificity. The factors associated with diagnostic accuracy were identified using a bivariate meta-regression model. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Results: In all, 25 studies with a total of 4470 patients were included in the meta-analysis. The overall sensitivity, specificity, and area under the receiver operating characteristic curve for smartphone-based audiometry were 89\% (95\% CI 83\%-93\%), 93\% (95\% CI 87\%-97\%), and 0.96 (95\% CI 0.93-0.97), respectively; the corresponding values for the smartphone-based speech recognition test were 91\% (95\% CI 86\%-94\%), 88\% (95\% CI 75\%-94\%), and 0.93 (95\% CI 0.90-0.95), respectively. Meta-regression analysis revealed that patient age, equipment used, and the presence of soundproof booths were significantly related to diagnostic accuracy. Conclusions: We have presented comprehensive evidence regarding the effectiveness of smartphone-based tests in diagnosing hearing loss. Smartphone-based audiometry may serve as an accurate and accessible approach to hearing evaluations, especially in settings where conventional PTA is unavailable. ",
doi="10.2196/28378",
url="https://mhealth.jmir.org/2021/9/e28378/",
url="http://www.ncbi.nlm.nih.gov/pubmed/34515644"
}


@Article{info:doi/10.2196/31129,
author="Han, Changho
and Song, Youngjae
and Lim, Hong-Seok
and Tae, Yunwon
and Jang, Jong-Hwan
and Lee, Tak Byeong
and Lee, Yeha
and Bae, Woong
and Yoon, Dukyong",
title="Automated Detection of Acute Myocardial Infarction Using Asynchronous Electrocardiogram Signals---Preview of Implementing Artificial Intelligence With Multichannel Electrocardiographs Obtained From Smartwatches: Retrospective Study",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="10",
volume="23",
number="9",
pages="e31129",
keywords="wearables",
keywords="smartwatches",
keywords="asynchronous electrocardiogram",
keywords="artificial intelligence",
keywords="deep learning",
keywords="automatic diagnosis",
keywords="myocardial infarction",
keywords="timely diagnosis",
keywords="machine learning",
keywords="digital health",
keywords="cardiac health",
keywords="cardiology",
abstract="Background: When using a smartwatch to obtain electrocardiogram (ECG) signals from multiple leads, the device has to be placed on different parts of the body sequentially. The ECG signals measured from different leads are asynchronous. Artificial intelligence (AI) models for asynchronous ECG signals have barely been explored. Objective: We aimed to develop an AI model for detecting acute myocardial infarction using asynchronous ECGs and compare its performance with that of the automatic ECG interpretations provided by a commercial ECG analysis software. We sought to evaluate the feasibility of implementing multiple lead--based AI-enabled ECG algorithms on smartwatches. Moreover, we aimed to determine the optimal number of leads for sufficient diagnostic power. Methods: We extracted ECGs recorded within 24 hours from each visit to the emergency room of Ajou University Medical Center between June 1994 and January 2018 from patients aged 20 years or older. The ECGs were labeled on the basis of whether a diagnostic code corresponding to acute myocardial infarction was entered. We derived asynchronous ECG lead sets from standard 12-lead ECG reports and simulated a situation similar to the sequential recording of ECG leads via smartwatches. We constructed an AI model based on residual networks and self-attention mechanisms by randomly masking each lead channel during the training phase and then testing the model using various targeting lead sets with the remaining lead channels masked. Results: The performance of lead sets with 3 or more leads compared favorably with that of the automatic ECG interpretations provided by a commercial ECG analysis software, with 8.1\%-13.9\% gain in sensitivity when the specificity was matched. Our results indicate that multiple lead-based AI-enabled ECG algorithms can be implemented on smartwatches. Model performance generally increased as the number of leads increased (12-lead sets: area under the receiver operating characteristic curve [AUROC] 0.880; 4-lead sets: AUROC 0.858, SD 0.008; 3-lead sets: AUROC 0.845, SD 0.011; 2-lead sets: AUROC 0.813, SD 0.018; single-lead sets: AUROC 0.768, SD 0.001). Considering the short amount of time needed to measure additional leads, measuring at least 3 leads---ideally more than 4 leads---is necessary for minimizing the risk of failing to detect acute myocardial infarction occurring in a certain spatial location or direction. Conclusions: By developing an AI model for detecting acute myocardial infarction with asynchronous ECG lead sets, we demonstrated the feasibility of multiple lead-based AI-enabled ECG algorithms on smartwatches for automated diagnosis of cardiac disorders. We also demonstrated the necessity of measuring at least 3 leads for accurate detection. Our results can be used as reference for the development of other AI models using sequentially measured asynchronous ECG leads via smartwatches for detecting various cardiac disorders. ",
doi="10.2196/31129",
url="https://www.jmir.org/2021/9/e31129",
url="http://www.ncbi.nlm.nih.gov/pubmed/34505839"
}


@Article{info:doi/10.2196/26434,
author="Salim, Hani
and Lee, Yein Ping
and Sharif-Ghazali, Sazlina
and Cheong, Theng Ai
and Wong, Jasmine
and Young, Ingrid
and Pinnock, Hilary
and ",
title="Developing an Asthma Self-management Intervention Through a Web-Based Design Workshop for People With Limited Health Literacy: User-Centered Design Approach",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="9",
volume="23",
number="9",
pages="e26434",
keywords="asthma",
keywords="self-management",
keywords="design sprint",
keywords="health literacy",
keywords="mobile phone",
abstract="Background: Technology, including mobile apps, has the potential to support self-management of long-term conditions and can be tailored to enhance adoption. We developed an app to support asthma self-management among people with limited health literacy in a web-based workshop (to ensure physical distancing during the COVID-19 pandemic). Objective: The aim of this study is to develop and test a prototype asthma self-management mobile app tailored to the needs of people with limited health literacy through a web-based workshop. Methods: We recruited participants from a primary care center in Malaysia. We adapted a design sprint methodology to a web-based workshop in five stages over 1 week. Patients with asthma and limited health literacy provided insights into real-life self-management issues in stage 1, which informed mobile app development in stages 2-4. We recruited additional patients to test the prototype in stage 5 using a qualitative research design. Participants gave feedback through a concurrent thinking-aloud process moderated by a researcher. Each interview lasted approximately 1 hour. Screen recordings of app browsing activities were performed. Interviews were audio-recorded and analyzed using a thematic approach to identify utility and usability issues. Results: The stakeholder discussion identified four themes: individual, family, friends, and society and system levels. Five patients tested the prototype. Participants described 4 ways in which the app influenced or supported self-management (utility): offering information, providing access to an asthma action plan, motivating control of asthma through support for medication adherence, and supporting behavior change through a reward system. Specific usability issues addressed navigation, comprehension, and layout. Conclusions: This study proved that it was possible to adapt the design sprint workshop to a web-based format with the added advantage that it allowed the development and the testing process to be done efficiently through various programs. The resultant app incorporated advice from stakeholders, including sources for information about asthma, medication and appointment reminders, accessible asthma action plans, and sources for social support. The app is now ready to move to feasibility testing. ",
doi="10.2196/26434",
url="https://www.jmir.org/2021/9/e26434",
url="http://www.ncbi.nlm.nih.gov/pubmed/34499039"
}


@Article{info:doi/10.2196/27985,
author="Cheung, Ting Yin
and Lam, Hong Pok
and Lam, Tai-Ning Teddy
and Lam, Wai Henry Hon
and Li, Kong Chi",
title="Technology Acceptance Among Patients With Hemophilia in Hong Kong and Their Expectations of a Mobile Health App to Promote Self-management: Survey Study",
journal="JMIR Form Res",
year="2021",
month="Sep",
day="9",
volume="5",
number="9",
pages="e27985",
keywords="mobile health",
keywords="mHealth",
keywords="patients",
keywords="expectations",
keywords="hemophilia",
keywords="chronic diseases",
keywords="rare diseases",
keywords="self-management",
abstract="Background: The lifelong management of hemophilia is demanding and complex. In July 2019, we published a review in the Journal of Medical Internet Research, summarizing telehealth interventions that facilitate monitoring of bleeding events and promoting the appropriate use of clotting factors among patients with hemophilia. This work has led to the development of a community program that aims to harness technology to promote self-management among patients with hemophilia in Hong Kong. Objective: Before the inception of this program, we conducted a cross-sectional survey to evaluate the patients' level of technology acceptance and identify their expectations of the use of mobile technology for self-management of hemophilia. Methods: In total, 56 participants (75\% adult patients and 25\% parents of pediatric patients; 87.5\% with moderate to severe disease) were recruited from a local nongovernmental organization that serves patients with hemophilia. They rated their perceived confidence and acceptance in using the new mobile technology (score 1 to 5 for each item, with a higher score indicating better acceptance) using a structured questionnaire (adapted from the Technology Acceptance Model). They also identified the top features that they perceived to be the most important components of a mobile app for the self-management of hemophilia. The Mann--Whitney U test was used to compare technology acceptance scores across subgroups of different clinical and socioeconomic characteristics. Results: In general, the participants considered themselves skilled in using mobile apps (mean 4.3, 95\% CI 4.1-4.5). They were willing to learn to use the new mobile app to organize their bleeding records (mean 4.0, 95\% CI 3.7-4.3) and to manage their health (mean 4.2, 95\% CI 4.1-4.5). Participants who lived in public housing (a surrogate marker for lower socioeconomic status in Hong Kong) reported lower technology acceptance than those who lived in private housing (P=.04). The most important features identified by the participants concerned documenting of infusion logs (n=49, 87.5\%), bleeding events (n=48, 85.7\%), and the secure delivery of the bleeding information to health care professionals (n=40, 71.4\%). Conclusions: It is encouraging to infer that patients with hemophilia in Hong Kong are receptive to the use of mobile health technology. The findings of this survey are applicable in designing the key features of a patient-centered, multimodal program harnessing mobile technology to promote self-management among patients with hemophilia. Future studies should evaluate participants' acceptability and perceived usability of the mobile app via user metrics and assess clinical and humanistic outcomes of this program. ",
doi="10.2196/27985",
url="https://formative.jmir.org/2021/9/e27985",
url="http://www.ncbi.nlm.nih.gov/pubmed/34499034"
}


@Article{info:doi/10.2196/28391,
author="Skovlund, Eik S{\o}ren
and Nicolucci, Antonio
and Balk-M{\o}ller, Nina
and Berthelsen, B. Dorthe
and Gl{\"u}mer, Charlotte
and Perrild, Hans
and Kj{\ae}r, Pernille
and N{\o}rgaard, Mellergaard Lise
and Troelsen, Havb{\ae}k Lise
and Pietraszek, Anna
and Hessler, Danielle
and Kaplan, Sherrie
and Ejskj{\ae}r, Niels",
title="Perceived Benefits, Barriers, and Facilitators of a Digital Patient-Reported Outcomes Tool for Routine Diabetes Care: Protocol for a National, Multicenter, Mixed Methods Implementation Study",
journal="JMIR Res Protoc",
year="2021",
month="Sep",
day="3",
volume="10",
number="9",
pages="e28391",
keywords="diabetes",
keywords="type 1 diabetes",
keywords="type 2 diabetes",
keywords="multisector care",
keywords="digital health",
keywords="patient-reported outcomes",
keywords="patient-centered care",
keywords="internet-administered",
keywords="feasibility",
keywords="mixed-method research",
keywords="mobile phone",
abstract="Background: There is growing evidence that digital patient-reported outcome (PRO) questionnaires and PRO-based decision support tools may help improve the active engagement of people with diabetes in self-care, thereby improving the quality of care. However, many barriers still exist for the real-world effectiveness and implementation of such PRO tools in routine care. Furthermore, limited research has evaluated the acceptability, feasibility, and benefits of such tools across different health care settings. Objective: This study aims to evaluate the acceptability, feasibility, and perceived benefits of the Danish digital PRO diabetes tool in different health care settings in Denmark and to determine the factors affecting its implementation. Furthermore, the study evaluates the psychometric characteristics of the Danish PRO Diabetes Questionnaire and the validity of the scoring algorithms for dialogue support. The objective of this study is to guide the ongoing optimization of the PRO diabetes tool, its implementation, and the design of future randomized controlled effectiveness studies. Methods: We designed a multicenter, mixed methods, single-arm acceptability-feasibility implementation study protocol to contribute to the real-world pilot test of a new digital PRO diabetes tool in routine diabetes care. The use of the tool involves two main steps. First, the people with diabetes will complete a digital PRO Diabetes Questionnaire in the days before a routine diabetes visit. Second, the health care professional (HCP) will use a digital PRO tool to review the PRO results together with the people with diabetes during the visit. The PRO diabetes tool is designed to encourage and support people to take an active role for the people with diabetes in their own care and to expedite the delivery of person-centered, collaborative, and coordinated care. Results: A multicenter pilot study protocol and psychometrically designed digital data collection tools for evaluation were developed and deployed as part of a national evaluation of a new digital PRO diabetes intervention. A total of 598 people with diabetes and 34 HCPs completed the study protocol by April 1, 2021. Conclusions: A large-scale, mixed methods, multicenter study for evaluating the use of the nationally developed PRO Diabetes Questionnaire in routine care across all health care sectors in Denmark by using the RE-AIM (Reach, Efficacy, Adoption, Implementation and Maintenance) model as a framework has been designed and is ongoing. This study is expected to provide new important and detailed information about the real-world acceptability, perceived relevance, and benefits of the PRO diabetes tool among a large heterogeneous population of people with diabetes in Denmark and HCPs in different care settings. The results will be used to further improve the PRO tool, design implementation facilitation support strategies, and design future controlled effectiveness studies. International Registered Report Identifier (IRRID): DERR1-10.2196/28391 ",
doi="10.2196/28391",
url="https://www.researchprotocols.org/2021/9/e28391",
url="http://www.ncbi.nlm.nih.gov/pubmed/34477563"
}


@Article{info:doi/10.2196/28320,
author="Colomina, Jordi
and Drudis, Reis
and Torra, Montserrat
and Pallis{\'o}, Francesc
and Massip, Mireia
and Vargiu, Eloisa
and Nadal, Nuria
and Fuentes, Araceli
and Ortega Bravo, Marta
and Miralles, Felip
and Barb{\'e}, Ferran
and Torres, Gerard
and de Batlle, Jordi
and ",
title="Implementing mHealth-Enabled Integrated Care for Complex Chronic Patients With Osteoarthritis Undergoing Primary Hip or Knee Arthroplasty: Prospective, Two-Arm, Parallel Trial",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="2",
volume="23",
number="9",
pages="e28320",
keywords="mHealth",
keywords="osteoarthritis",
keywords="arthroplasty",
keywords="health plan implementation",
keywords="chronic disease",
keywords="mobile phone",
abstract="Background: Osteoarthritis is a disabling condition that is often associated with other comorbidities. Total hip or knee arthroplasty is an effective surgical treatment for osteoarthritis when indicated, but comorbidities can impair their results by increasing complications and social and economic costs. Integrated care (IC) models supported by eHealth can increase efficiency through defragmentation of care and promote patient-centeredness. Objective: This study aims to assess the effectiveness and cost-effectiveness of implementing a mobile health (mHealth)--enabled IC model for complex chronic patients undergoing primary total hip or knee arthroplasty. Methods: As part of the Horizon 2020 Personalized Connected Care for Complex Chronic Patients (CONNECARE) project, a prospective, pragmatic, two-arm, parallel implementation trial was conducted in the rural region of Lleida, Catalonia, Spain. For 3 months, complex chronic patients undergoing total hip or knee arthroplasty and their caregivers received the combined benefits of the CONNECARE organizational IC model and the eHealth platform supporting it, consisting of a patient self-management app, a set of integrated sensors, and a web-based platform connecting professionals from different settings, or usual care (UC). We assessed changes in health status (12-item short-form survey [SF-12]), unplanned visits and admissions during a 6-month follow-up, and the incremental cost-effectiveness ratio. Results: A total of 29 patients were recruited for the mHealth-enabled IC arm, and 30 patients were recruited for the UC arm. Both groups were statistically comparable for baseline characteristics, such as age; sex; type of arthroplasty; and Charlson index, American Society of Anesthesiologists classification, Barthel index, Hospital Anxiety and Depression scale, Western Ontario and McMaster Universities Osteoarthritis Index, and Pfeiffer mental status questionnaire scores. Patients in both groups had significant increases in the SF-12 physical domain and total SF-12 score, but differences in differences between the groups were not statistically significant. IC patients had 50\% fewer unplanned visits (P=.006). Only 1 hospital admission was recorded during the follow-up (UC arm). The IC program generated savings in different cost scenarios, and the incremental cost-effectiveness ratio demonstrated cost-effectiveness. Conclusions: Chronic patients undergoing hip or knee arthroplasty can benefit from the implementation of patient-centered mHealth-enabled IC models aimed at empowering patients and facilitating transitions from specialized hospital care to primary care. Such models can reduce unplanned contacts with the health system and reduce overall health costs, proving to be cost-effective. Overall, our findings support the notion of system-wide cross-organizational care pathways supported by mHealth as a successful way to implement IC for patients undergoing elective surgery. ",
doi="10.2196/28320",
url="https://www.jmir.org/2021/9/e28320",
url="http://www.ncbi.nlm.nih.gov/pubmed/34473068"
}


@Article{info:doi/10.2196/27662,
author="Kim, Aram
and Yun, Jung Seo
and Sung, Kwan-Sik
and Kim, Yeonju
and Jo, Young Ju
and Cho, Hanseul
and Park, Kyudong
and Oh, Byung-Mo
and Seo, Gil Han",
title="Exercise Management Using a Mobile App in Patients With Parkinsonism: Prospective, Open-Label, Single-Arm Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Aug",
day="31",
volume="9",
number="8",
pages="e27662",
keywords="Parkinsonian disorders",
keywords="exercise",
keywords="mobile apps",
keywords="mhealth",
keywords="Parkinson",
abstract="Background: Patients with parkinsonism have higher inactivity levels than the general population, and this results in increased comorbidities. Although exercise has benefits for motor function and quality of life (QOL) in patients with parkinsonism, these patients face many barriers to exercise participation, such as lack of motivation, fatigue, depression, and time constraints. Recently, the use of mobile apps has been highlighted as a remote exercise management strategy for patients with chronic diseases. Objective: This study aimed to evaluate the effects of home-based exercise management with a customized mobile app on the exercise amount, physical activity, and QOL of patients with parkinsonism. Methods: This was a prospective, open-label, single-arm pilot study. The therapist installed the app in the smartphones of the participants and educated them on how to use the app. The therapist developed an individualized multimodal exercise program that consisted of stretching, strengthening, aerobic, balance and coordination, and oral-motor and vocal exercises. Participants were encouraged to engage in an 8-week home-based exercise program delivered through a customized app. The alarm notifications of the app provided reminders to exercise regularly at home. The primary outcome was the exercise amount. The secondary outcomes were assessed using the International Physical Activity Questionnaire (IPAQ), Parkinson's Disease Questionnaire-39 (PDQ-39), and Geriatric Depression Scale (GDS). The usability of the customized app was assessed using a self-report questionnaire. Results: A total of 21 participants with parkinsonism completed the intervention and assessment between September and December 2020 (mean age: 72 years; women: 17/21, 81\%; men: 4/21, 19\%). The participants reported a significant increase in the total amount of exercise (baseline: mean 343.33, SD 206.70 min/week; 8-week follow-up: mean 693.10, SD 373.45 min/week; P<.001) and in the amount of each exercise component, including stretching, strengthening, balance and coordination, and oral-motor and vocal exercise after 8 weeks. Analysis of the secondary outcomes revealed significant improvements in the IPAQ (P=.006), PDQ-39 (P=.02), and GDS (P=.04) scores. The usability of the program with the mobile app was verified based on the positive responses such as ``intention to use'' and ``role expectation for rehabilitation.'' Conclusions: Exercise management with a customized mobile app may be beneficial for improving exercise adherence, physical activity levels, depression management, and QOL in patients with parkinsonism. This remotely supervised technology-based, reinforcing, and multimodal exercise management strategy is recommended for use in patients with parkinsonism. In addition, this program proved useful as an alternative exercise management strategy during the COVID-19 pandemic when patients with Parkinson disease were less physically active than before and showed aggravation of symptoms. However, additional clinical trials are needed to evaluate the efficacy of this exercise program in a large population and to confirm its disease-modifying effects. ",
doi="10.2196/27662",
url="https://mhealth.jmir.org/2021/8/e27662",
url="http://www.ncbi.nlm.nih.gov/pubmed/34463635"
}


@Article{info:doi/10.2196/21088,
author="Keum, Jiyoung
and Chung, Jae Moon
and Kim, Youngin
and Ko, Hyunyoung
and Sung, Je Min
and Jo, Hyun Jung
and Park, Youp Jeong
and Bang, Seungmin
and Park, Woo Seung
and Song, Young Si
and Lee, Seung Hee",
title="Usefulness of Smartphone Apps for Improving Nutritional Status of Pancreatic Cancer Patients: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Aug",
day="31",
volume="9",
number="8",
pages="e21088",
keywords="pancreatic ductal adenocarcinoma",
keywords="mobile app",
keywords="nutritional support",
keywords="quality of life",
keywords="chemotherapy",
abstract="Background: Approximately 80\% of pancreatic ductal adenocarcinoma (PDAC) patients suffer from anorexia, weight loss, and asthenia. Most PDAC patients receive chemotherapy, which often worsens their nutritional status owing to the adverse effects of chemotherapy. Malnutrition of PDAC patients is known to be associated with poor prognosis; therefore, nutritional management during chemotherapy is a key factor influencing the outcome of the treatment. Mobile apps have the potential to provide readily accessible nutritional support for patients with PDAC. Objective: We aimed to evaluate the efficacy of a mobile app--based program, Noom, in patients receiving chemotherapy for PDAC. Methods: We prospectively enrolled 40 patients who were newly diagnosed with unresectable PDAC from a single university-affiliated hospital in South Korea, and randomly assigned them into a Noom user group (n=20) and a non-Noom user group (n=20). The 12-week in-app interventions included meal and physical activity logging as well as nutritional education feedback from dietitians. The non-Noom user group did not receive any nutrition intervention. The primary outcomes were the changes in the nutritional status and quality of life (QoL) from the baseline to 12 weeks. The secondary outcomes included the changes in the skeletal muscle index (SMI) from the baseline to 12 weeks. The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30) and the Patient-Generated Subjective Global Assessment (PG-SGA) were used as paper questionnaires to assess the QoL and nutritional status of the patients. Intention-to-treat and per-protocol analyses were conducted. Regarding the study data collection time points, we assessed the nutritional status and QoL at the baseline (T0), and at 4 (T1), 8 (T2), and 12 (T3) weeks. Abdominal computed tomography (CT) imaging was conducted at the baseline and after 8 weeks for tumor response and SMI evaluation. The skeletal muscle area (cm2) was calculated using routine CT images. The cross-sectional areas (cm2) of the L3 skeletal muscles were analyzed. Results: Between February 2017 and January 2018, 48 patients were assessed for eligibility. Totally 40 patients with pancreatic cancer were included by random allocation. Only 17 participants in the Noom user group and 16 in the non-Noom user group completed all follow-ups. All the study participants showed a significant improvement in the nutritional status according to the PG-SGA score regardless of Noom app usage. Noom users showed statistically significant improvements on the global health status (GHS) and QoL scales compared to non-Noom users, based on the EORTC QLQ (P=.004). The SMI decreased in both groups during chemotherapy (Noom users, 49.08{\textpm}12.27 cm2/m2 to 46.08{\textpm}10.55 cm2/m2; non-Noom users, 50.60{\textpm}9.05 cm2/m2 to 42.97{\textpm}8.12 cm2/m2). The decrement was higher in the non-Noom user group than in the Noom user group, but it was not statistically significant (-13.96\% vs. -3.27\%; P=.11). Conclusions: This pilot study demonstrates that a mobile app--based approach is beneficial for nutritional and psychological support for PDAC patients receiving chemotherapy. Trial Registration: ClinicalTrials.gov NCT04109495; https://clinicaltrials.gov/ct2/show/NCT04109495. ",
doi="10.2196/21088",
url="https://mhealth.jmir.org/2021/8/e21088",
url="http://www.ncbi.nlm.nih.gov/pubmed/34463630"
}


@Article{info:doi/10.2196/17431,
author="Sneha, Sweta
and Thalla, Srivarun
and Rischie, Ishaan
and Shahriar, Hossain",
title="Health Internet Technology for Chronic Conditions: Review of Diabetes Management Apps",
journal="JMIR Diabetes",
year="2021",
month="Aug",
day="31",
volume="6",
number="3",
pages="e17431",
keywords="chronic disease",
keywords="diabetes",
keywords="blood glucose",
keywords="diabetes management",
keywords="mHealth disease apps",
keywords="diabetes apps",
keywords="best Apple diabetes apps",
abstract="Background: Mobile health (mHealth) smartphone apps have shown promise in the self-management of chronic disease. In today's oversaturated health app market, selection criteria that consumers are employing to choose mHealth apps for disease self-management are of paramount importance. App quality is critical in monitoring disease controls but is often linked to consumer popularity rather than clinical recommendations of effectiveness in disease management. Management of key disease variances can be performed through these apps to increase patient engagement in disease self-management. This paper provides a comprehensive review of features found in mHealth apps frequently used in the self- management of diabetes. Objective: The purpose of this study was to review features of frequently used and high consumer-rated mHealth apps used in the self-management of diabetes. This study aimed to highlight key features of consumer-favored mHealth apps used in the self-management of diabetes. Methods: A 2-fold approach was adopted involving the Apple iOS store and the Google search engine. The primary search was conducted on the Apple iOS store using the term ``diabetes apps'' (device used: Apple iPad). The top 5 most frequently used mHealth apps were identified and rated by the number of consumer reviews, app ratings, and the presence of key diabetes management features, such as dietary blood glucose, A1C, insulin, physical activity, and prescription medication. A subsequent Google search was conducted using the search term ``best Apple diabetes apps.'' The top 3 search results---``Healthline,'' ``Everyday Health,'' and ``Diabetes Apps--American Diabetes Association''---were explored. Results: In total, 12 mHealth apps were reviewed due to their appearing across 4 evaluated sources. Only 1 health app---Glucose Buddy Diabetes Tracker---appeared as the most frequently used within the Apple iOS store and across the other 3 sources. The OneTouch Reveal app ranked first on the list in the iOS store with 39,000 consumer reviews and a rating of 4.7 out of 5.0 stars but only appeared in 1 of the other 3 sources. Blood glucose tracking was present across all apps, but other disease management features varied in type with at least 3 of the 5 key features being present across the 12 reviewed apps. Subscription cost and integration needs were present in the apps which could impact consumers' decision to select apps. Although mobile app preference was assessed and defined by the number of consumer reviews and star ratings, there were no scientific standards used in the selection and ranking of the health apps within this study. Conclusions: mHealth apps have shown promise in chronic disease management, but a surge in development of these nonregulated health solutions points to a need for regulation, standardization, and quality control. A governing body of health IT professionals, clinicians, policymakers, payors, and patients could be beneficial in defining health app standards for effective chronic disease management. Variabilities in features, cost, and other aspects of management could be reduced by regulatory uniformity, which would increase patient engagement and improve disease outcomes. ",
doi="10.2196/17431",
url="https://diabetes.jmir.org/2021/3/e17431",
url="http://www.ncbi.nlm.nih.gov/pubmed/34463627"
}


@Article{info:doi/10.2196/29061,
author="Arutyunov, P. Gregory
and Arutyunov, G. Alexander
and Ageev, T. Fail
and Fofanova, V. Tatiana",
title="Digital Technology Tools to Examine Patient Adherence to a Prescription-Only Omega-3 Polyunsaturated Fatty Acid Therapy To Mitigate Cardiovascular Risk: Protocol for a Prospective Observational Study and Preliminary Demographic Analysis",
journal="JMIR Res Protoc",
year="2021",
month="Aug",
day="30",
volume="10",
number="8",
pages="e29061",
keywords="omega-3-acid ethyl esters",
keywords="myocardial infarction",
keywords="hypertriglyceridemia",
keywords="adherence",
keywords="compliance",
keywords="persistence",
keywords="mHealth",
keywords="eHealth",
keywords="patient-reported outcomes",
abstract="Background: Sustained adherence and persistence with prescription medications is considered essential to achieve maximal treatment benefit for patients with major chronic, noncommunicable diseases such as hyperlipidemia and lipid-associated cardiovascular disease. It is widely documented, however, that many patients with these conditions have poor long-term adherence to their treatments. The population of Russia is affected by poor adherence in the same ways as populations elsewhere and continues to have high rates of cardiovascular disease. Objective: The purpose of this study was to examine patient adherence to a prescription-only preparation of highly purified omega-3 polyunsaturated fatty acids (1.2 to 1 eicosapentaenoic acid to docosahexaenoic ratio, 90\% purity) in a large sample of patients at risk for cardiovascular diseases using digital technology to monitor patient behavior and as an outreach facility for patient education and engagement. Methods: We conducted a 6-month prospective observational study (DIAPAsOn) at >100 centers in the Russian Federation. A bespoke electronic data capture and patient engagement system were developed with a well-established Russian technology supplier that enables information obtained during clinic visits to be supplemented by remote patient self-reporting. Other aspects of the program included raising patients' awareness about their condition via educational materials available in personal patient accounts in the electronic system. Results: From an initial cohort of 3000 patients, a safety population of 2572 patients (age: mean 60 years) with an equal proportion of men and women has been characterized. There was widespread concomitant cardiovascular pathology and commensurate use of multiple classes of cardiovascular medication, notably lipid-modifying and antihypertensive drugs. The program was completed by 1975 patients, of whom 780 were prescribed highly purified omega-3 polyunsaturated fatty acid supplements for secondary prevention after myocardial infarction and 1195 were prescribed highly purified omega-3 polyunsaturated fatty acid supplements for hypertriglyceridemia. Data collection and analysis have been completed. Conclusions: DIAPAsOn will provide insights into patient adherence with prescription-grade omega-3 polyunsaturated fatty acid therapy and perspectives on the role of mobile technology in monitoring and encouraging adherence to therapy. ",
doi="10.2196/29061",
url="https://www.researchprotocols.org/2021/8/e29061",
url="http://www.ncbi.nlm.nih.gov/pubmed/34459746"
}


@Article{info:doi/10.2196/28974,
author="Nazarian, Scarlet
and Lam, Kyle
and Darzi, Ara
and Ashrafian, Hutan",
title="Diagnostic Accuracy of Smartwatches for the Detection of Cardiac Arrhythmia: Systematic Review and Meta-analysis",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="27",
volume="23",
number="8",
pages="e28974",
keywords="wearables",
keywords="smartwatch",
keywords="cardiac arrhythmia",
keywords="atrial fibrillation",
keywords="cardiology",
keywords="mHealth",
keywords="wearable devices",
keywords="screening",
keywords="diagnostics",
keywords="accuracy",
abstract="Background: Significant morbidity, mortality, and financial burden are associated with cardiac rhythm abnormalities. Conventional investigative tools are often unsuccessful in detecting cardiac arrhythmias because of their episodic nature. Smartwatches have gained popularity in recent years as a health tool for the detection of cardiac rhythms. Objective: This study aims to systematically review and meta-analyze the diagnostic accuracy of smartwatches in the detection of cardiac arrhythmias. Methods: A systematic literature search of the Embase, MEDLINE, and Cochrane Library databases was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify studies reporting the use of a smartwatch for the detection of cardiac arrhythmia. Summary estimates of sensitivity, specificity, and area under the curve were attempted using a bivariate model for the diagnostic meta-analysis. Studies were examined for quality using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Results: A total of 18 studies examining atrial fibrillation detection, bradyarrhythmias and tachyarrhythmias, and premature contractions were analyzed, measuring diagnostic accuracy in 424,371 subjects in total. The signals analyzed by smartwatches were based on photoplethysmography. The overall sensitivity, specificity, and accuracy of smartwatches for detecting cardiac arrhythmias were 100\% (95\% CI 0.99-1.00), 95\% (95\% CI 0.93-0.97), and 97\% (95\% CI 0.96-0.99), respectively. The pooled positive predictive value and negative predictive value for detecting cardiac arrhythmias were 85\% (95\% CI 0.79-0.90) and 100\% (95\% CI 1.0-1.0), respectively. Conclusions: This review demonstrates the evolving field of digital disease detection. The current diagnostic accuracy of smartwatch technology for the detection of cardiac arrhythmias is high. Although the innovative drive of digital devices in health care will continue to gain momentum toward screening, the process of accurate evidence accrual and regulatory standards ready to accept their introduction is strongly needed. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020213237; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=213237. ",
doi="10.2196/28974",
url="https://www.jmir.org/2021/8/e28974",
url="http://www.ncbi.nlm.nih.gov/pubmed/34448706"
}


@Article{info:doi/10.2196/28695,
author="Yang, Kyungmi
and Oh, Dongryul
and Noh, Myoung Jae
and Yoon, Gyul Han
and Sun, Jong-Mu
and Kim, Kwan Hong
and Zo, Ill Jae
and Shim, Mog Young
and Ko, Hyunyoung
and Lee, Jungeun
and Kim, Youngin",
title="Feasibility of an Interactive Health Coaching Mobile App to Prevent Malnutrition and Muscle Loss in Esophageal Cancer Patients Receiving Neoadjuvant Concurrent Chemoradiotherapy: Prospective Pilot Study",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="27",
volume="23",
number="8",
pages="e28695",
keywords="esophageal cancer",
keywords="malnutrition",
keywords="muscle loss",
keywords="sarcopenia",
keywords="mobile app",
keywords="mHealth",
abstract="Background: Excessive muscle loss is an important prognostic factor in esophageal cancer patients undergoing neoadjuvant chemoradiotherapy (NACRT), as reported in our previous research. Objective: In this pilot study, we prospectively tested the feasibility of a health coaching mobile app for preventing malnutrition and muscle loss in this patient population. Methods: Between July 2019 and May 2020, we enrolled 38 male patients with esophageal cancer scheduled for NACRT. For 8 weeks from the start of radiotherapy (RT), the patients used Noom, a health coaching mobile app that interactively provided online advice about food intake, exercise, and weight changes. The skeletal muscle index (SMI) measured based on computed tomography and nutrition-related laboratory markers were assessed before and after RT. We evaluated the changes in the SMI, nutrition, and inflammatory factors between the patient group that used the mobile app (mHealth group) and our previous study cohort (usual care group). Additionally, we analyzed the factors associated with walk steps recorded in the app. Results: Two patients dropped out of the study (no app usage; treatment changed to a definitive aim). The use (or activation) of the app was noted in approximately 70\% (25/36) of the patients until the end of the trial. Compared to the 1:2 matched usual care group by propensity scores balanced with their age, primary tumor location, tumor stage, pre-RT BMI, and pre-RT SMI level, 30 operable patients showed less aggravation of the prognostic nutritional index (PNI) (--6.7 vs --9.8; P=.04). However, there was no significant difference in the SMI change or the number of patients with excessive muscle loss (?SMI/50 days >10\%). In patients with excessive muscle loss, the walk steps significantly decreased in the last 4 weeks compared to those in the first 4 weeks. Age affected the absolute number of walk steps (P=.01), whereas pre-RT sarcopenia was related to the recovery of the reduced walk steps (P=.03). Conclusions: For esophageal cancer patients receiving NACRT, a health care mobile app helped nutritional self-care with less decrease in the PNI, although it did not prevent excessive muscle loss. An individualized care model with proper exercise as well as nutritional support may be required to reduce muscle loss and malnutrition. ",
doi="10.2196/28695",
url="https://www.jmir.org/2021/8/e28695",
url="http://www.ncbi.nlm.nih.gov/pubmed/34448714"
}


@Article{info:doi/10.2196/23425,
author="Ksi??czyk, Marcin
and D?bska-Koz?owska, Agnieszka
and Warcho?, Izabela
and Lubi?ski, Andrzej",
title="Enhancing Healthcare Access--Smartphone Apps in Arrhythmia Screening: Viewpoint",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Aug",
day="27",
volume="9",
number="8",
pages="e23425",
keywords="arrhythmia screening",
keywords="atrial fibrillation",
keywords="mobile electrocardiography",
keywords="mobile health",
keywords="phonocardiography",
keywords="photoplethysmography",
keywords="seismocardiography",
keywords="stroke prevention",
doi="10.2196/23425",
url="https://mhealth.jmir.org/2021/8/e23425",
url="http://www.ncbi.nlm.nih.gov/pubmed/34448723"
}


@Article{info:doi/10.2196/22909,
author="Haggenm{\"u}ller, Sarah
and Krieghoff-Henning, Eva
and Jutzi, Tanja
and Trapp, Nicole
and Kiehl, Lennard
and Utikal, Sven Jochen
and Fabian, Sascha
and Brinker, Josef Titus",
title="Digital Natives' Preferences on Mobile Artificial Intelligence Apps for Skin Cancer Diagnostics: Survey Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Aug",
day="27",
volume="9",
number="8",
pages="e22909",
keywords="artificial intelligence",
keywords="skin cancer",
keywords="skin cancer screening",
keywords="diagnostics",
keywords="digital natives",
keywords="acceptance",
keywords="concerns",
keywords="preferences",
keywords="online survey",
abstract="Background: Artificial intelligence (AI) has shown potential to improve diagnostics of various diseases, especially for early detection of skin cancer. Studies have yet to investigate the clear application of AI technology in clinical practice or determine the added value for younger user groups. Translation of AI-based diagnostic tools can only be successful if they are accepted by potential users. Young adults as digital natives may offer the greatest potential for successful implementation of AI into clinical practice, while at the same time, representing the future generation of skin cancer screening participants. Objective: We conducted an anonymous online survey to examine how and to what extent individuals are willing to accept AI-based mobile apps for skin cancer diagnostics. We evaluated preferences and relative influences of concerns, with a focus on younger age groups. Methods: We recruited participants below 35 years of age using three social media channels---Facebook, LinkedIn, and Xing. Descriptive analysis and statistical tests were performed to evaluate participants' attitudes toward mobile apps for skin examination. We integrated an adaptive choice-based conjoint to assess participants' preferences. We evaluated potential concerns using maximum difference scaling. Results: We included 728 participants in the analysis. The majority of participants (66.5\%, 484/728; 95\% CI 0.631-0.699) expressed a positive attitude toward the use of AI-based apps. In particular, participants residing in big cities or small towns (P=.02) and individuals that were familiar with the use of health or fitness apps (P=.02) were significantly more open to mobile diagnostic systems. Hierarchical Bayes estimation of the preferences of participants with a positive attitude (n=484) revealed that the use of mobile apps as an assistance system was preferred. Participants ruled out app versions with an accuracy of ?65\%, apps using data storage without encryption, and systems that did not provide background information about the decision-making process. However, participants did not mind their data being used anonymously for research purposes, nor did they object to the inclusion of clinical patient information in the decision-making process. Maximum difference scaling analysis for the negative-minded participant group (n=244) showed that data security, insufficient trust in the app, and lack of personal interaction represented the dominant concerns with respect to app use. Conclusions: The majority of potential future users below 35 years of age were ready to accept AI-based diagnostic solutions for early detection of skin cancer. However, for translation into clinical practice, the participants' demands for increased transparency and explainability of AI-based tools seem to be critical. Altogether, digital natives between 18 and 24 years and between 25 and 34 years of age expressed similar preferences and concerns when compared both to each other and to results obtained by previous studies that included other age groups. ",
doi="10.2196/22909",
url="https://mhealth.jmir.org/2021/8/e22909",
url="http://www.ncbi.nlm.nih.gov/pubmed/34448722"
}


@Article{info:doi/10.2196/14552,
author="Morsa, Maxime
and Perrin, Am{\'e}lie
and David, Val{\'e}rie
and Rault, Gilles
and Le Roux, Enora
and Alberti, Corinne
and Gagnayre, R{\'e}mi
and Pougheon Bertrand, Dominique",
title="Use of Home-Based Connected Devices in Patients With Cystic Fibrosis for the Early Detection and Treatment of Pulmonary Exacerbations: Protocol for a Qualitative Study",
journal="JMIR Res Protoc",
year="2021",
month="Aug",
day="18",
volume="10",
number="8",
pages="e14552",
keywords="cystic fibrosis",
keywords="pulmonary exacerbation",
keywords="connected devices",
keywords="patient education",
keywords="self-management",
abstract="Background: Early detection of pulmonary exacerbations (PEx) in patients with cystic fibrosis (CF) is important to quickly trigger treatment and reduce respiratory damage. We hypothesized that using home-based and wearable connected devices (CDs) and educating patients to react in case of abnormal variations in a set of parameters would allow patients to detect and manage their PEx early with their care team. Objective: This qualitative study aimed to assess the feasibility and appropriate conditions of a new PEx management process from the users' point of view by analyzing the experience of patients and of CF center teams regarding the education program, the use of CDs, and the relationship between the patient and the care team during PEx management. Methods: We have been conducting a multicenter pilot study involving 36 patients with CF aged ?12 years. The intervention was divided into 3 phases. In phase 1 (3 months), patients were equipped with CDs, and their parameters were collected on 3 nonconsecutive days each week. Phase 2 involved the development of a ``React to PEx'' educational program aimed at providing patients with a personalized action plan. A training session to the educational program was organized for the physicians. Physicians then determined the patients' personalized alert thresholds by reviewing the data collected during phase 1 and their patients' clinical history. In phase 3 (12 months), patients were educated by the physician during a clinic visit, and their action plan for reacting in timely fashion to their PEx signs was defined. Education and action plans were revised during clinic visits. At the end of the project, the patients' experience was collected during semistructured interviews with a researcher as part of the qualitative study. The experience of CF teams was collected during focus groups using a semistructured guide once all their patients had finished the study. The interviews and focus groups were recorded and transcribed verbatim to be analyzed. Data from educational sessions were collected throughout the educational program to be put into perspective with the learnings reported by patients. Analyses are being led by 2 researchers using NVivo (QSR International). Results: The study received the favorable reception of the Committee for the Protection of Persons (CPP NORTH WEST III) on June 10, 2017 (\#2017-A00723-50). Out of the 36 patients included in phase 1, 27 were educated and entered phase 3. We completed collection of all data from the patients and care providers. Qualitative analysis will provide a better understanding of users' experience on the conditions of data collection, how useful CDs are for detecting PEx, how useful the PEx action plan is for reacting quickly, what patients learned about PEx management, and the conditions for this PEx management to be sustainable in routine care. Conclusions: This study will open new perspectives for further research into the implementation of an optimal PEx care process in the organization of care teams in order to support patient self-management. Trial Registration: ClinicalTrials.gov NCT03304028; https://clinicaltrials.gov/ct2/show/results/NCT03304028 International Registered Report Identifier (IRRID): DERR1-10.2196/14552 ",
doi="10.2196/14552",
url="https://www.researchprotocols.org/2021/8/e14552",
url="http://www.ncbi.nlm.nih.gov/pubmed/34406124"
}


@Article{info:doi/10.2196/31061,
author="Kawai, Yuki
and Sankoda, Akiko
and Waki, Kayo
and Miyake, Kana
and Hayashi, Aki
and Mieno, Makiko
and Wakui, Hiromichi
and Tsurutani, Yuya
and Saito, Jun
and Hirawa, Nobuhito
and Yamakawa, Tadashi
and Komiya, Shiro
and Isogawa, Akihiro
and Satoh, Shinobu
and Minami, Taichi
and Osada, Uru
and Iwamoto, Tamio
and Takano, Tatsuro
and Terauchi, Yasuo
and Tamura, Kouichi
and Yamauchi, Toshimasa
and Kadowaki, Takashi
and Nangaku, Masaomi
and Kashihara, Naoki
and Ohe, Kazuhiko",
title="Efficacy of the Self-management Support System DialBetesPlus for Diabetic Kidney Disease: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Aug",
day="17",
volume="10",
number="8",
pages="e31061",
keywords="diabetic kidney disease",
keywords="microalbuminuria",
keywords="albuminuria",
keywords="diabetes mellitus",
keywords="self-management support system",
keywords="mHealth",
keywords="randomized controlled trial",
keywords="diabetes",
keywords="kidney",
keywords="chronic disease",
keywords="support",
keywords="self-management",
keywords="efficacy",
keywords="protocol",
keywords="therapy",
keywords="intervention",
keywords="self-care",
keywords="behavior",
abstract="Background: Diabetic kidney disease (DKD) is one of the main complications of type 2 diabetes mellitus (T2DM). DKD is a known risk factor for end-stage renal disease, cardiovascular disease, and all-cause death. Effective intervention for early-stage DKD is vital to slowing down the progression of kidney disease and improve prognoses. Mobile health (mHealth) is reportedly effective in supporting patients' self-care and improving glycemic control, but the impact of mHealth on DKD has yet to be shown. Objective: The purpose of this study is to evaluate the efficacy of standard therapy with the addition of a self-management support system, DialBetesPlus, in patients with DKD and microalbuminuria. Methods: This study is a prospective, randomized, open-label, multicenter clinical trial. The target population consists of 160 patients diagnosed with T2DM accompanied by microalbuminuria. We randomly assigned the patients to 2 groups---the intervention group using DialBetesPlus in addition to conventional therapy and the control group using conventional therapy alone. DialBetesPlus is a smartphone application that supports patients' self-management of T2DM. The study period was 12 months, with a follow-up survey at 18 months. The primary outcome was a change in albuminuria levels at 12 months. Secondary outcomes included changes in physical parameters, blood test results (glycemic control, renal function, and lipid metabolism), lifestyle habits, self-management scores, medication therapy, and quality of life. Results: The study was approved in April 2018. We began recruiting patients in July 2018 and completed recruiting in August 2019. The final 18-month follow-up was conducted in March 2021. We recruited 159 patients and randomly allocated 70 into the intervention group and 61 into the control group, with 28 exclusions due to withdrawal of consent, refusal to continue, or ineligibility. The first results are expected to be available in 2021. Conclusions: This is the first randomized controlled trial assessing the efficacy of mHealth on early-stage DKD. We expect that albuminuria levels will decrease significantly in the intervention group due to improved glycemic control with ameliorated self-care behaviors. Trial Registration: UMIN-CTR UMIN000033261; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr\_view.cgi?recptno=R000037924 International Registered Report Identifier (IRRID): DERR1-10.2196/31061 ",
doi="10.2196/31061",
url="https://www.researchprotocols.org/2021/8/e31061",
url="http://www.ncbi.nlm.nih.gov/pubmed/34402802"
}


@Article{info:doi/10.2196/24555,
author="Zhang, Lu
and McLeod, L. Howard
and Liu, Ke-Ke
and Liu, Wen-Hui
and Huang, Hang-Xing
and Huang, Ya-Min
and Sun, Shu-Sen
and Chen, Xiao-Ping
and Chen, Yao
and Liu, Fang-Zhou
and Xiao, Jian",
title="Effect of Physician-Pharmacist Participation in the Management of Ambulatory Cancer Pain Through a Digital Health Platform: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Aug",
day="16",
volume="9",
number="8",
pages="e24555",
keywords="cancer pain",
keywords="self-management",
keywords="ambulatory setting",
keywords="digital health",
keywords="physician-pharmacist",
abstract="Background: Self-management of ambulatory cancer pain is full of challenges. Motivated by the need for better pain management, we developed a WeChat-supported platform, Medication Housekeeper (MediHK), to enhance communication, optimize outcomes, and promote self-management in the home setting. Objective: We conducted a randomized controlled trial to assess whether the joint physician-pharmacist team through MediHK would provide better self-management of ambulatory patients with cancer pain. Methods: Patients were randomly assigned to either an intervention group or control group. During the 4-week study period, the pharmacist would send 24-hour pain diaries daily, adverse drug reaction (ADR) forms every 3 days, and the Brief Pain Inventory form every 15 days to patients in the intervention group via MediHK. If a patient needed a change in drug/dosage or treatment of an ADR after the comprehensive review, the pharmacist would propose pharmacological interventions to the attending physician, who was then responsible for prescribing or adjusting pain medications. If no adjustments were needed, the pharmacist provided appropriate targeted education based on knowledge deficits. Patients in the control group received conventional care and did not receive reminders to fill out the forms. However, if the control group patients filled out a form via MediHK, the pain management team would review and respond in the same way as for the intervention group. The primary outcomes included pain intensity and pain interference in daily life. Secondary outcomes included patient-reported outcome measures, medication adherence, ADRs, and rehospitalization rates. Results: A total of 100 patients were included, with 51 (51\%) in the intervention group and 49 (49\%) in the control group. The worst pain scores, least pain scores, and average pain scores in the intervention group and the control group were statistically different, with median values of 4 (IQR 3-7) vs 7 (IQR 6-8; P=.001), 1 (IQR 0-2) vs 2 (IQR 1-3; P=.02), and 2 (IQR 2-4) vs 4 (IQR 3-5; P=.001), respectively, at the end of the study. The pain interference on patients' general activity, mood, relationships with others, and interests was reduced, but the difference was not statistically significant compared with the control group (Ps=.10-.76). The medication adherence rate increased from 43\% to 63\% in the intervention group, compared with an increase of 33\% to 51\% in the control group (P<.001). The overall number of ADRs increased at 4 weeks, and more ADRs were monitored in the intervention group (P=.003). Rehospitalization rates were similar between the 2 groups. Conclusions: The joint physician-pharmacist team operating through MediHK improved pain management. This study supports the feasibility of integrating the internet into the self-management of cancer pain. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900023075; https://www.chictr.org.cn/showproj.aspx?proj=36901 ",
doi="10.2196/24555",
url="https://mhealth.jmir.org/2021/8/e24555",
url="http://www.ncbi.nlm.nih.gov/pubmed/34398796"
}


@Article{info:doi/10.2196/24214,
author="Pald{\'a}n, Katrin
and Steinmetz, Martin
and Simanovski, Jan
and Rammos, Christos
and Ullrich, Greta
and J{\'a}nosi, Alexander Rolf
and Moebus, Susanne
and Rassaf, Tienush
and Lortz, Julia",
title="Supervised Exercise Therapy Using Mobile Health Technology in Patients With Peripheral Arterial Disease: Pilot Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Aug",
day="16",
volume="9",
number="8",
pages="e24214",
keywords="peripheral arterial disease",
keywords="mHealth",
keywords="supervised exercise therapy",
keywords="motivation",
keywords="artery",
keywords="exercise",
keywords="mobile applications",
keywords="lifestyle",
keywords="well-being",
abstract="Background: Mobile health interventions are intended to support complex health care needs in chronic diseases digitally, but they are mainly targeted at general health improvement and neglect disease-specific requirements. Therefore, we designed TrackPAD, a smartphone app to support supervised exercise training in patients with peripheral arterial disease. Objective: This pilot study aimed to evaluate changes in the 6-minute walking distance (meters) as a primary outcome measure. The secondary outcome measures included changes in physical activity and assessing the patients' peripheral arterial disease--related quality of life. Methods: This was a pilot two-arm, single-blinded, randomized controlled trial. Patients with symptomatic PAD (Fontaine stage IIa/b) and access to smartphones were eligible. Eligible participants were randomly assigned to the study, with the control group stratified by the distance covered in the 6-minute walking test using the TENALEA software. Participants randomized to the intervention group received usual care and the mobile intervention (TrackPAD) for the follow-up period of 3 months, whereas participants randomized to the control group received routine care only. TrackPAD records the frequency and duration of training sessions and pain levels using manual user input. Clinical outcome data were collected at the baseline and after 3 months via validated tools (the 6-minute walk test and self-reported quality of life). The usability and quality of the app were determined using the Mobile Application Rating Scale user version. Results: The intervention group (n=19) increased their mean 6-minute walking distance (83 meters, SD 72.2), while the control group (n=20) decreased their mean distance after 3 months of follow-up (--38.8 meters, SD 53.7; P=.01). The peripheral arterial disease--related quality of life increased significantly in terms of ``symptom perception'' and ``limitations in physical functioning.'' Users' feedback showed increased motivation and a changed attitude toward performing supervised exercise training. Conclusions: Besides the rating providing a valuable support tool for the user group, the mobile intervention TrackPAD was linked to a change in prognosis-relevant outcome measures combined with enhanced coping with the disease. The influence of mobile interventions on long-term prognosis must be evaluated in the future. Trial Registration: ClinicalTrials.gov NCT04947228; https://clinicaltrials.gov/ct2/show/NCT04947228 ",
doi="10.2196/24214",
url="https://mhealth.jmir.org/2021/8/e24214",
url="http://www.ncbi.nlm.nih.gov/pubmed/34398800"
}


@Article{info:doi/10.2196/26300,
author="Imeri, Hyllore
and Desselle, Shane
and Hetemi, Dardan
and Hoti, Kreshnik",
title="Mobile Electronic Devices as Means of Facilitating Patient Activation and Health Professional Empowerment Related to Information Seeking on Chronic Conditions and Medications: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Aug",
day="11",
volume="9",
number="8",
pages="e26300",
keywords="patient activation",
keywords="mobile electronic devices",
keywords="health professionals",
keywords="chronic conditions",
keywords="medications",
abstract="Background: Patient activation has an impact on the management of patients' health, clinical outcomes, and treatment costs. Mobile electronic devices (MEDs) have shown the potential to engage patients in wellness behavior. Furthermore, the potentially positive role of MEDs is evident in supporting health professionals in their practice. Objective: This study aims to explore the impact of MEDs on patient activation to search for information on chronic conditions and medications and the impact of MEDs on the empowerment of health professionals or future health professionals. Methods: We conducted 6 focus groups---2 with health sciences students, 2 with health professionals, and 2 with hospitalized patients with chronic conditions. A protocol comprising eight questions was used to guide discussions. Audio-recorded data were transcribed verbatim and analyzed thematically; a ranking system was used to analyze the relevance of identified themes and subthemes, using a coding system depicted by the + symbol, to indicate different relevance levels. Results: Our results suggest that MEDs can positively affect patient activation to search for chronic conditions and medication information by facilitating patients' information-seeking behavior. Key drivers leading to patients' activation to seek information related to chronic conditions and medications through MEDs were the accessibility and abundance of available and detailed information, reduced search time, information updates, and convenience in finding information at any time and place. The lack of accurate information in one's native language, access to incorrect information, and limited access to the internet were key obstacles to seeking information related to chronic conditions and medications via MEDs. In addition, findings of this study suggest that MEDs in general and mobile apps, in particular, may have a positive impact on the work routine of health care professionals as they enable them to make quicker decisions by accessing the required information faster, thus improving practice efficiency. Furthermore, the appropriate usage of MEDs by patients for seeking information about their chronic conditions and medications may positively impact the physician-patient relationship. All focus groups recognized the questionable reliability of health information on the internet and its potential negative effects on patients. Therefore, our findings suggest the need for an additional role of health professionals in assisting patients in using MEDs to search for health and medication information, such as providing reliable websites and mobile apps where patients can safely search for health-related information on the web. Conclusions: The use of MEDs may help activate patients to seek chronic conditions and medication-related information, potentially leading to better management of their chronic conditions and medications. Our findings also highlight the positive impact MEDs may have on empowering health professionals in their practice and the need for health professionals to help patients through specific education that addresses MEDs utilization for chronic conditions and medication information seeking. ",
doi="10.2196/26300",
url="https://mhealth.jmir.org/2021/8/e26300",
url="http://www.ncbi.nlm.nih.gov/pubmed/34383686"
}


@Article{info:doi/10.2196/28139,
author="Schmaderer, Myra
and Miller, N. Jennifer
and Mollard, Elizabeth",
title="Experiences of Using a Self-management Mobile App Among Individuals With Heart Failure: Qualitative Study",
journal="JMIR Nursing",
year="2021",
month="Aug",
day="9",
volume="4",
number="3",
pages="e28139",
keywords="mHealth",
keywords="eHealth",
keywords="mobile applications",
keywords="patient experiences",
keywords="patient perceptions",
keywords="self-management",
keywords="self-care",
keywords="heart failure",
keywords="congestive heart failure",
keywords="heart decompensation",
abstract="Background: Interventions that focus on the self-management of heart failure are vital to promoting health in patients with heart failure. Mobile health (mHealth) apps are becoming more integrated into practice to promote self-management strategies for chronic diseases, optimize care delivery, and reduce health disparities. Objective: The purpose of this study was to explore the experience of using a self-management mHealth intervention in individuals with heart failure to inform a future mHealth intervention study. Methods: This study used a qualitative descriptive design. Participants were enrolled in the intervention groups of a larger parent study using a mobile app related to self-management of heart failure. The purposive, convenient, criterion-based sample for this qualitative analysis comprised 10 patients who responded to phone calls and were willing to be interviewed. Inclusion criteria for the parent study were adults who were hospitalized at Nebraska Medical Center with a primary diagnosis and an episode of acute decompensated heart failure; discharged to home without services such as home health care; had access to a mobile phone; and were able to speak, hear, and understand English. Results: Study participants were middle-aged (mean age 55.8, SD 12 years; range 36-73 years). They had completed a mean of 13.5 (SD 2.2) years (range 11-17 years) of education. Of the 10 participants, 6 (60\%) were male. Half of them (5/10, 50\%) were New York Heart Association Classification Class III patients and the other half were Class IV patients. The intervention revealed four self-management themes, including (1) I didn't realize, and now I know; (2) It feels good to focus on my health; (3) I am the leader of my health care team; and (4) My health is improving. Conclusions: Participants who used a self-management mHealth app intervention for heart failure reported an overall positive experience. Their statements were organized into four major themes. The education provided during the study increased self-awareness and promoted self-management of their heart failure. The mHealth app supported patient empowerment, resulting in better heart failure management and improved quality of life. Participants advocated for themselves by becoming the leader of their health, especially when communicating with their health care team. Finally, the mHealth app was used by the participants as a self-management tool to assist in symptom management and improve their overall health. Future research should study symptom evaluation, medication tracking, and possibly serve as a health provider communication platform to empower individuals to be leaders in their chronic disease management. ",
doi="10.2196/28139",
url="https://nursing.jmir.org/2021/3/e28139",
url="http://www.ncbi.nlm.nih.gov/pubmed/34406966"
}


@Article{info:doi/10.2196/27466,
author="Ganti, Venu
and Carek, M. Andrew
and Jung, Hewon
and Srivatsa, V. Adith
and Cherry, Deborah
and Johnson, Neicey Levather
and Inan, T. Omer",
title="Enabling Wearable Pulse Transit Time-Based Blood Pressure Estimation for Medically Underserved Areas and Health Equity: Comprehensive Evaluation Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Aug",
day="2",
volume="9",
number="8",
pages="e27466",
keywords="wearable sensing",
keywords="pulse transit time",
keywords="cuffless blood pressure",
keywords="noninvasive blood pressure estimation",
keywords="health equity",
keywords="mobile phone",
abstract="Background: Noninvasive and cuffless approaches to monitor blood pressure (BP), in light of their convenience and accuracy, have paved the way toward remote screening and management of hypertension. However, existing noninvasive methodologies, which operate on mechanical, electrical, and optical sensing modalities, have not been thoroughly evaluated in demographically and racially diverse populations. Thus, the potential accuracy of these technologies in populations where they could have the greatest impact has not been sufficiently addressed. This presents challenges in clinical translation due to concerns about perpetuating existing health disparities. Objective: In this paper, we aim to present findings on the feasibility of a cuffless, wrist-worn, pulse transit time (PTT)--based device for monitoring BP in a diverse population. Methods: We recruited a diverse population through a collaborative effort with a nonprofit organization working with medically underserved areas in Georgia. We used our custom, multimodal, wrist-worn device to measure the PTT through seismocardiography, as the proximal timing reference, and photoplethysmography, as the distal timing reference. In addition, we created a novel data-driven beat-selection algorithm to reduce noise and improve the robustness of the method. We compared the wearable PTT measurements with those from a finger-cuff continuous BP device over the course of several perturbations used to modulate BP. Results: Our PTT-based wrist-worn device accurately monitored diastolic blood pressure (DBP) and mean arterial pressure (MAP) in a diverse population (N=44 participants) with a mean absolute difference of 2.90 mm Hg and 3.39 mm Hg for DBP and MAP, respectively, after calibration. Meanwhile, the mean absolute difference of our systolic BP estimation was 5.36 mm Hg, a grade B classification based on the Institute for Electronics and Electrical Engineers standard. We have further demonstrated the ability of our device to capture the commonly observed demographic differences in underlying arterial stiffness. Conclusions: Accurate DBP and MAP estimation, along with grade B systolic BP estimation, using a convenient wearable device can empower users and facilitate remote BP monitoring in medically underserved areas, thus providing widespread hypertension screening and management for health equity. ",
doi="10.2196/27466",
url="https://mhealth.jmir.org/2021/8/e27466",
url="http://www.ncbi.nlm.nih.gov/pubmed/34338646"
}


@Article{info:doi/10.2196/26149,
author="Zhang, Jia
and Mihai, Carina
and T{\"u}shaus, Laura
and Scebba, Gaetano
and Distler, Oliver
and Karlen, Walter",
title="Wound Image Quality From a Mobile Health Tool for Home-Based Chronic Wound Management With Real-Time Quality Feedback: Randomized Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jul",
day="30",
volume="9",
number="7",
pages="e26149",
keywords="data quality",
keywords="remote assessment",
keywords="digital ulcers",
keywords="scleroderma",
keywords="mobile app",
keywords="digital health",
keywords="ehealth",
keywords="mhealth",
keywords="telemedicine",
keywords="teledermatology",
abstract="Background: Travel to clinics for chronic wound management is burdensome to patients. Remote assessment and management of wounds using mobile and telehealth approaches can reduce this burden and improve patient outcomes. An essential step in wound documentation is the capture of wound images, but poor image quality can have a negative influence on the reliability of the assessment. To date, no study has investigated the quality of remotely acquired wound images and whether these are suitable for wound self-management and telemedical interpretation of wound status. Objective: Our goal was to develop a mobile health (mHealth) tool for the remote self-assessment of digital ulcers (DUs) in patients with systemic sclerosis (SSc). We aimed to define and validate objective measures for assessing the image quality, evaluate whether an automated feedback feature based on real-time assessment of image quality improves the overall quality of acquired wound images, and evaluate the feasibility of deploying the mHealth tool for home-based chronic wound self-monitoring by patients with SSc. Methods: We developed an mHealth tool composed of a wound imaging and management app, a custom color reference sticker, and a smartphone holder. We introduced 2 objective image quality parameters based on the sharpness and presence of the color checker to assess the quality of the image during acquisition and enable a quality feedback mechanism in an advanced version of the app. We randomly assigned patients with SSc and DU to the 2 device groups (basic and feedback) to self-document their DU at home over 8 weeks. The color checker detection ratio (CCDR) and color checker sharpness (CCS) were compared between the 2 groups. We evaluated the feasibility of the mHealth tool by analyzing the usability feedback from questionnaires, user behavior and timings, and the overall quality of the wound images. Results: A total of 21 patients were enrolled, of which 15 patients were included in the image quality analysis. The average CCDR was 0.96 (191/199) in the feedback group and 0.86 (158/183) in the basic group. The feedback group showed significantly higher (P<.001) CCS compared to the basic group. The usability questionnaire results showed that the majority of patients were satisfied with the tool, but could benefit from disease-specific adaptations. The median assessment duration was <50 seconds in all patients, indicating the mHealth tool was efficient to use and could be integrated into the daily routine of patients. Conclusions: We developed an mHealth tool that enables patients with SSc to acquire good-quality DU images and demonstrated that it is feasible to deploy such an app in this patient group. The feedback mechanism improved the overall image quality. The introduced technical solutions consist of a further step towards reliable and trustworthy digital health for home-based self-management of wounds. ",
doi="10.2196/26149",
url="https://mhealth.jmir.org/2021/7/e26149",
url="http://www.ncbi.nlm.nih.gov/pubmed/34328440"
}


@Article{info:doi/10.2196/25548,
author="Bermon, Anderson
and Uribe, Fernanda Ana
and P{\'e}rez-Rivero, Fernanda Paula
and Prieto-Merino, David
and Saaibi, Federico Jose
and Silva, Arturo Federico
and Canon, Ivonne Diana
and Castillo-Gonzalez, Melissa Karol
and C{\'a}ceres-Rivera, Isabel Diana
and Guio, Elizabeth
and Meneses-Castillo, Janneth Karen
and Castillo-Meza, Alberto
and Atkins, Louise
and Horne, Robert
and Murray, Elizabeth
and Serrano, Cecilia Norma
and Free, Caroline
and Casas, Pablo Juan
and Perel, Pablo",
title="Efficacy and Safety of Text Messages Targeting Adherence to Cardiovascular Medications in Secondary Prevention: TXT2HEART Colombia Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jul",
day="28",
volume="9",
number="7",
pages="e25548",
keywords="randomized controlled trial",
keywords="Colombia",
keywords="text messaging",
keywords="cardiovascular disease",
keywords="secondary prevention",
abstract="Background: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality worldwide, with a prevalence of approximately 100 million patients. There is evidence that antiplatelet agents and antihypertensive medications could reduce the risk of new vascular events in this population; however, treatment adherence is very low. An SMS text messaging intervention was recently developed based on behavior change techniques to increase adherence to pharmacological treatment among patients with a history of ASCVD. Objective: This study aims to evaluate the efficacy and safety of an SMS text messaging intervention to improve adherence to cardiovascular medications in patients with ASCVD. Methods: A randomized controlled clinical trial for patients with a prior diagnosis of cardiovascular events, such as acute myocardial infarction, unstable angina, cerebrovascular disease, or peripheral artery disease, in one center in Colombia was conducted. Patients randomized to the intervention arm were assigned to receive SMS text messages daily for the first 4 weeks, 5 SMS text messages on week 5, 3 SMS text messages each in weeks 6 and 7, and 1 SMS text message weekly from week 8 until week 52. In contrast, patients in the control arm received a monthly SMS text message reminding them of the next study appointment and the importance of the study, requesting information about changes in their phone number, and thanking them for participating in the study. The primary endpoint was the change in low-density lipoprotein cholesterol (LDL-C) levels, whereas the secondary endpoints were the changes in thromboxane B2 levels, heart rate, systolic and diastolic blood pressure, medication adherence, cardiac and noncardiac mortality, and hospitalization. Linear regression analyses and bivariate tests were performed. Results: Of the 930 randomized patients, 805 (86.5\%) completed follow-up and were analyzed for the primary endpoint. There was no evidence that the intervention changed the primary outcome (LDL-C levels; P=.41) or any of the secondary outcomes evaluated (all P>.05). There was also no evidence that the intervention was associated with adverse events. Conclusions: In this study, there was no evidence that a behavior modification intervention delivered by SMS text messaging improved LDL-C levels, blood pressure levels, or adherence at 12 months. More research is needed to evaluate whether different SMS text messaging strategies, including personalized messages and different timings, are effective; future studies should include mixed methods to better understand why, for whom, and in which context (eg, health system or social environment) SMS text messaging interventions work (or not) to improve adherence in patients with ASCVD. Trial Registration: ClinicalTrials.gov NCT03098186; https://clinicaltrials.gov/ct2/show/NCT03098186 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-028017 ",
doi="10.2196/25548",
url="https://mhealth.jmir.org/2021/7/e25548",
url="http://www.ncbi.nlm.nih.gov/pubmed/34319247"
}


@Article{info:doi/10.2196/29463,
author="Kumwichar, Ponlagrit
and Chongsuvivatwong, Virasakdi
and Prappre, Tagoon",
title="Development of a Video-Observed Therapy System to Improve Monitoring of Tuberculosis Treatment in Thailand: Mixed-Methods Study",
journal="JMIR Form Res",
year="2021",
month="Jul",
day="27",
volume="5",
number="7",
pages="e29463",
keywords="app",
keywords="mixed-methods analysis",
keywords="remote monitoring",
keywords="therapy",
keywords="tuberculosis",
keywords="user experience",
keywords="video directly observed therapy",
keywords="video-enhanced therapy",
keywords="video-observed therapy",
abstract="Background: Directly observed therapy programs for monitoring tuberculosis (TB) treatment in Thailand are unsustainable, especially during the COVID-19 pandemic. The current video-observed therapy (VOT) system, the Thai VOT (TH VOT), was developed to replace the directly observed therapy program. Objective: This study aimed to describe the VOT system design and identify the potential for system improvements. Methods: This pilot study was conducted in Na Yong district, a small district in Trang province, south of Thailand. The TH VOT system consists of a smartphone app for patients, a secured web-based platform for staff, items used, and standard operating procedures. There were three groups of users: observers who were TB staff, healthy volunteers as simulated patients, and patients with active TB. All participants were trained to follow the standard operating procedures. After 2-week usage, VOT session records were analyzed to measure the compliance of the patients and observers. The User Experience Questionnaire was used to lead the participant users to focus on 6 standard dimensions of usability, and was supplemented with an in-depth interview to identify potential system improvements from users' experience. Results: Only 2 of 16 patients with currently active TB had a usable smartphone. Sixty of 70 drug-taking sessions among 2 patients and 3 simulated patients in 2 weeks were recorded and uploaded. Only 37 sessions were inspected by the observers within 24 hours. All participants needed a proper notification system. An audit system was also requested. Conclusions: Before upscaling, the cost of smartphone lending, audit management, and notification systems should be elucidated. ",
doi="10.2196/29463",
url="https://formative.jmir.org/2021/7/e29463",
url="http://www.ncbi.nlm.nih.gov/pubmed/34313602"
}


@Article{info:doi/10.2196/24308,
author="Domin, Alex
and Spruijt-Metz, Donna
and Theisen, Daniel
and Ouzzahra, Yacine
and V{\"o}gele, Claus",
title="Smartphone-Based Interventions for Physical Activity Promotion: Scoping Review of the Evidence Over the Last 10 Years",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jul",
day="21",
volume="9",
number="7",
pages="e24308",
keywords="scoping review",
keywords="smartphone application",
keywords="physical activity",
keywords="behavior change",
keywords="mobile health",
keywords="research design",
keywords="mHealth",
keywords="adolescents",
keywords="adults",
keywords="BCT",
keywords="mobile phonescoping review",
keywords="mobile phone",
abstract="Background: Several reviews of mobile health (mHealth) physical activity (PA) interventions suggest their beneficial effects on behavior change in adolescents and adults. Owing to the ubiquitous presence of smartphones, their use in mHealth PA interventions seems obvious; nevertheless, there are gaps in the literature on the evaluation reporting processes and best practices of such interventions. Objective: The primary objective of this review is to analyze the development and evaluation trajectory of smartphone-based mHealth PA interventions and to review systematic theory- and evidence-based practices and methods that are implemented along this trajectory. The secondary objective is to identify the range of evidence (both quantitative and qualitative) available on smartphone-based mHealth PA interventions to provide a comprehensive tabular and narrative review of the available literature in terms of its nature, features, and volume. Methods: We conducted a scoping review of qualitative and quantitative studies examining smartphone-based PA interventions published between 2008 and 2018. In line with scoping review guidelines, studies were not rejected based on their research design or quality. This review, therefore, includes experimental and descriptive studies, as well as reviews addressing smartphone-based mHealth interventions aimed at promoting PA in all age groups (with a subanalysis conducted for adolescents). Two groups of studies were additionally included: reviews or content analyses of PA trackers and meta-analyses exploring behavior change techniques and their efficacy. Results: Included articles (N=148) were categorized into 10 groups: commercial smartphone app content analyses, smartphone-based intervention review studies, activity tracker content analyses, activity tracker review studies, meta-analyses of PA intervention studies, smartphone-based intervention studies, qualitative formative studies, app development descriptive studies, qualitative follow-up studies, and other related articles. Only 24 articles targeted children or adolescents (age range: 5-19 years). There is no agreed evaluation framework or taxonomy to code or report smartphone-based PA interventions. Researchers did not state the coding method, used various evaluation frameworks, or used different versions of behavior change technique taxonomies. In addition, there is no consensus on the best behavior change theory or model that should be used in smartphone-based interventions for PA promotion. Commonly reported systematic practices and methods have been successfully identified. They include PA recommendations, trial designs (randomized controlled trials, experimental trials, and rapid design trials), mixed methods data collection (surveys, questionnaires, interviews, and focus group discussions), scales to assess app quality, and industry-recognized reporting guidelines. Conclusions: Smartphone-based mHealth interventions aimed at promoting PA showed promising results for behavior change. Although there is a plethora of published studies on the adult target group, the number of studies and consequently the evidence base for adolescents is limited. Overall, the efficacy of smartphone-based mHealth PA interventions can be considerably improved through a more systematic approach of developing, reporting, and coding of the interventions. ",
doi="10.2196/24308",
url="https://mhealth.jmir.org/2021/7/e24308",
url="http://www.ncbi.nlm.nih.gov/pubmed/34287209"
}


@Article{info:doi/10.2196/20650,
author="Song, Ting
and Yu, Ping
and Bliokas, Vida
and Probst, Yasmine
and Peoples, E. Gregory
and Qian, Siyu
and Houston, Lauren
and Perez, Pascal
and Amirghasemi, Mehrdad
and Cui, Tingru
and Hitige, Rathnayaka Nadeesha Pathiraja
and Smith, Anne Natalie",
title="A Clinician-Led, Experience-Based Co-Design Approach for Developing mHealth Services to Support the Patient Self-management of Chronic Conditions: Development Study and Design Case",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jul",
day="20",
volume="9",
number="7",
pages="e20650",
keywords="mHealth",
keywords="smartphone",
keywords="mobile apps",
keywords="chronic disease",
keywords="surgery",
keywords="obesity",
keywords="theory",
keywords="community-based participatory research",
keywords="mobile phone",
abstract="Background: Despite the increasing use of mobile health (mHealth) services, such as mHealth apps or SMS text messaging services, that support the patient self-management of chronic conditions, many existing mHealth services lack theoretical guidance. In addition, although often the target audience for requirement acquisition at the initial mHealth app design stage, it is a common challenge for them to fully conceptualize their needs for mHealth services that help self-manage chronic conditions. Objective: This study proposes a novel co-design approach with the initial requirements for mHealth services proposed by clinicians based on their experiences in guiding patients to self-manage chronic conditions. A design case is presented to illustrate our innovative approach to designing an mHealth app that supports the self-management of patients with obesity in their preparation for elective surgery. Methods: We adopted a clinician-led co-design approach. The co-design approach consisted of the following four cyclic phases: understanding user needs, identifying an applicable underlying theory, integrating the theory into the prototype design, and evaluating and refining the prototype mHealth services with patients. Expert panel discussions, a literature review, intervention mapping, and patient focus group discussions were conducted in these four phases. Results: In stage 1, the expert panel proposed the following three common user needs: motivational, educational, and supportive needs. In stage 2, the team selected the Social Cognitive Theory to guide the app design. In stage 3, the team designed and developed the key functions of the mHealth app, including automatic push notifications; web-based resources; goal setting and monitoring; and interactive health-related exchanges that encourage physical activity, healthy eating, psychological preparation, and a positive outlook for elective surgery. Push notifications were designed in response to a patient's risk level, as informed by the person's response to a baseline health survey. In stage 4, the prototype mHealth app was used to capture further requirements from patients in the two focus group discussions. Focus group participants affirmed the potential benefits of the app and suggested more requirements for the function, presentation, and personalization needs. The app was improved based on these suggestions. Conclusions: This study reports an innovative co-design approach that was used to leverage the clinical experiences of clinicians to produce the initial prototype app and the approach taken to allow patients to effectively voice their needs and expectations for the mHealth app in a focus group discussion. This approach can be generalized to the design of any mHealth service that aims to support the patient self-management of chronic conditions. ",
doi="10.2196/20650",
url="https://mhealth.jmir.org/2021/7/e20650",
url="http://www.ncbi.nlm.nih.gov/pubmed/34283030"
}


@Article{info:doi/10.2196/24127,
author="Hui, Yan Chi
and McKinstry, Brian
and Fulton, Olivia
and Buchner, Mark
and Pinnock, Hilary",
title="Patients' and Clinicians' Perceived Trust in Internet-of-Things Systems to Support Asthma Self-management: Qualitative Interview Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jul",
day="16",
volume="9",
number="7",
pages="e24127",
keywords="asthma",
keywords="self-management",
keywords="telehealth",
keywords="internet-of-thing",
keywords="trust",
abstract="Background: Asthma affects 235 million people worldwide. Supported self-management, including an action plan agreed with clinicians, improves asthma outcomes. Internet-of-things (IoT) systems with artificial intelligence (AI) can provide customized support for a range of self-management functions, but trust is vital to encourage patients' adoption of such systems. Many models for understanding trust exist, some explicitly designed for eHealth, but no studies have used these models to explore trust in the context of using IoT systems to support asthma self-management. Objective: In this study, we aim to use the McKnight model to explore the functionality, helpfulness, and reliability domains of patients' and clinicians' trust in IoT systems to deliver the 14 components of self-management support defined by the PRISMS (Practical Reviews in Self-Management Support) taxonomy. Methods: We used think-aloud techniques in semistructured interviews to explore the views of patients and clinicians. Patients were recruited from research registers and social media and purposively sampled to include a range of ages, genders, action plan ownership, asthma duration, hospital admissions, and experience with mobile apps. Clinicians (primary, secondary, and community-based) were recruited from professional networks. Interviews were transcribed verbatim, and thematic analysis was used to explore perceptions of the functionality, helpfulness, and reliability of IoT features to support components of supported self-management. Results: A total of 12 patients and 12 clinicians were interviewed. Regarding perceived functionality, most patients considered that an IoT system had functionality that could support a broad range of self-management tasks. They wanted a system to provide customized advice involving AI. With regard to perceived helpfulness, they considered that IoT systems could usefully provide integrated support for a number of recognized components of self-management support. In terms of perceived reliability, they believed they could rely on the system to log their asthma condition and provide preset action plan advice triggered by their logs. However, they were less confident that the system could operate continuously and without errors in providing advice. They were not confident that AI could generate new advice or reach diagnostic conclusions without the interpretation of their trusted clinicians. Clinicians wanted clinical evidence before trusting the system. Conclusions: IoT systems including AI were regarded as offering potentially helpful functionality in mediating the action plans developed with a trusted clinician, although our technologically adept participants were not yet ready to trust AI to generate novel advice. Research is needed to ensure that technological capability does not outstrip the trust of individuals using it. ",
doi="10.2196/24127",
url="https://mhealth.jmir.org/2021/7/e24127",
url="http://www.ncbi.nlm.nih.gov/pubmed/34269684"
}


@Article{info:doi/10.2196/23227,
author="Tu, Yu-Zhen
and Chang, Ya-Ting
and Chiou, Hung-Yi
and Lai, Ken",
title="The Effects of Continuous Usage of a Diabetes Management App on Glycemic Control in Real-world Clinical Practice: Retrospective Analysis",
journal="J Med Internet Res",
year="2021",
month="Jul",
day="15",
volume="23",
number="7",
pages="e23227",
keywords="app",
keywords="diabetes care",
keywords="diabetes",
keywords="digital intervention",
keywords="digital therapeutics",
keywords="glycemic control",
keywords="mobile app",
keywords="mHealth",
keywords="real-world data",
keywords="therapy",
abstract="Background: The efficacy of digital technology in improving diabetes management has typically been demonstrated through studies such as randomized controlled trials, which have reported a steeper reduction in hemoglobin A1c (HbA1c) values for patients who adopted a digital solution. However, evidence from real-world clinical practice is still limited. Objective: This study aimed to evaluate the effectiveness of digital interventions by tracking HbA1c improvements over 1 year in real-world clinical settings. Methods: Patients used the Health2Sync mobile app to track self-measured outcomes and communicate with health care professionals (HCPs). HCPs used the web-based Patient Management Platform to monitor patient data, view test results from clinical laboratories, and communicate with patients. Patients who have been onboarded for at least 13 months and have consecutive HbA1c findings for 5 quarters were included in the analysis. They were then stratified into 3 groups (high, mid, and low retention) based on their level of use of Health2Sync in the first 6 months of onboarding. A mixed model was built to compare the slopes of the rate of reduction in HbA1c among the groups. In addition, these patients' retention on the app from the seventh to the 12th month was verified through multiple comparisons. Results: A sample of 2036 users was included in the analysis. With the mixed model coefficient estimates, we found that app users had significant HbA1c percentage reductions as the passed quarter count increased (t=--9.869; P<.001), and that effectiveness increased in the high (t=--5.173) and mid retention (t=--6.620) groups as the interaction effects were significantly negative compared to that in the low retention group (P<.001) in the passed quarter count. The low retention group also had the highest average HbA1c value at the end of 13 months (high: 7.01\%, SD 1.02\%; mid: 6.99\%, SD 1.00\%; low: 7.17\%, SD 1.14\%) (Bonferroni correction: high vs low, P=.07; mid vs low, P=.02; high vs mid, P>.99). The level of use of the app remained consistent in the seventh to the 12th month after onboarding (high: 5.23 [SD 1.37] months, mid: 2.43 [SD 1.68] months, low: 0.41 [SD 0.97] months) (P<.001). Conclusions: Our analysis shows that continuous usage of the diabetes management app is associated with better glycemic control in real-world clinical practice. Further studies are required to reveal the efficacy for specific diabetes types and to observe effects beyond 1 year. ",
doi="10.2196/23227",
url="https://www.jmir.org/2021/7/e23227",
url="http://www.ncbi.nlm.nih.gov/pubmed/34264192"
}


@Article{info:doi/10.2196/28664,
author="Fonseka, N. Lakshan
and Woo, KP Benjamin",
title="Consumer Wearables and the Integration of New Objective Measures in Oncology: Patient and Provider Perspectives",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jul",
day="15",
volume="9",
number="7",
pages="e28664",
keywords="consumer",
keywords="wearables",
keywords="smartwatch",
keywords="cancer",
keywords="oncology",
keywords="chemotherapy",
keywords="apps",
doi="10.2196/28664",
url="https://mhealth.jmir.org/2021/7/e28664",
url="http://www.ncbi.nlm.nih.gov/pubmed/34264191"
}


@Article{info:doi/10.2196/27234,
author="Song, Yuqing
and Chen, Hong",
title="Evaluating Chinese Mobile Health Apps for Ankylosing Spondylitis Management: Systematic App Search",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jul",
day="14",
volume="9",
number="7",
pages="e27234",
keywords="ankylosing spondylitis",
keywords="app",
keywords="eHealth",
keywords="mHealth",
keywords="smartphone",
keywords="mobile phone",
abstract="Background: Patients with ankylosing spondylitis (AS), a chronic systematic inflammatory disease, require long-term treatment and management. Mobile health (mHealth) apps can deliver health services through mobile devices, facilitate long-term disease management, support patient--health care provider communication, and enable patients to engage in disease management. There are some apps targeted at patients with AS, but the feature and quality of these apps have not been systematically examined. Objective: The aim of this study was to identify existing, publicly available Chinese mHealth apps for AS management and to evaluate their features and quality. Methods: We systematically searched potential apps for AS management on the Apple and Huawei App Stores, using 4 search terms: ankylosing spondylitis, spondyloarthritis, rheumatic disease, and arthritis. Apps were included if they were in the Chinese language, targeted at patients with AS, could be downloaded and run on Android and/or iOS operating systems, and incorporated elements of disease management and/or patient education. We excluded apps that were not for patient use, not relevant to AS, or had not been updated since 2018. Apps that met the inclusion criteria were downloaded for final analysis. We formulated a list of app quality measures from and consistent with international guidelines for mHealth apps and AS management to evaluate the features and quality of the included app. The user version of the Mobile App Rating Scale (uMARS) was also used to rate the apps' quality. Results: Of the 354 apps screened, 5 met the inclusion criteria and were included in our analysis. All apps were free, and most apps (4/5, 80\%) had a privacy policy. Of the 5 apps, 1 (20\%) involved medical professionals in the development process, 2 (40\%) were developed by companies, and 2 (40\%) were developed by medical institutions. All apps provided educational information about AS. Around half of the apps had functions like a basic information record (ie, users can input gender, age, disease history, etc) (n=3, 60\%), patient--health care provider (and patient-patient) communication (n=2, 40\%), symptom tracking (n=2, 40\%), and information sharing (n=3, 60\%). Only 1 (20\%) app provided comprehensive functions that adhered to international guidelines for AS management and mHealth apps. The overall uMARS scores ranged from 2.7 to 4.2; only 1 app, with an overall uMARS score of 4.2, was considered as a high-quality app. Conclusions: Most apps lacked comprehensive functions for AS management. One high-quality app provided comprehensive functions to help patients manage their conditions. This study assessed and summarized the features and quality of the apps but did not evaluate their efficacy. Future studies should evaluate the feasibility and efficacy of these apps. International guidelines and regulations for the design, development, validation, and implementation of mHealth apps are needed in the future. Meanwhile, health care providers, patients with AS, and app developers should collaborate to develop high-quality, evidence-based apps that take into account patients' needs and health care professionals' perspectives. ",
doi="10.2196/27234",
url="https://mhealth.jmir.org/2021/7/e27234",
url="http://www.ncbi.nlm.nih.gov/pubmed/34259644"
}


@Article{info:doi/10.2196/24553,
author="Rouzaud Laborde, Charlotte
and Cenko, Erta
and Mardini, T. Mamoun
and Nerella, Subhash
and Kheirkhahan, Matin
and Ranka, Sanjay
and Fillingim, B. Roger
and Corbett, B. Duane
and Weber, Eric
and Rashidi, Parisa
and Manini, Todd",
title="Satisfaction, Usability, and Compliance With the Use of Smartwatches for Ecological Momentary Assessment of Knee Osteoarthritis Symptoms in Older Adults: Usability Study",
journal="JMIR Aging",
year="2021",
month="Jul",
day="14",
volume="4",
number="3",
pages="e24553",
keywords="ehealth",
keywords="mobile health",
keywords="ecological momentary assessment",
keywords="real-time online assessment and mobility monitor",
keywords="ROAMM",
keywords="older adults",
keywords="compliance",
keywords="personal satisfaction",
keywords="usability",
keywords="smartwatch",
keywords="knee osteoarthritis",
keywords="pain",
keywords="fatigue",
keywords="wearable electronic device",
keywords="mobile application",
abstract="Background: Smartwatches enable physicians to monitor symptoms in patients with knee osteoarthritis, their behavior, and their environment. Older adults experience fluctuations in their pain and related symptoms (mood, fatigue, and sleep quality) that smartwatches are ideally suited to capture remotely in a convenient manner. Objective: The aim of this study was to evaluate satisfaction, usability, and compliance using the real-time, online assessment and mobility monitoring (ROAMM) mobile app designed for smartwatches for individuals with knee osteoarthritis. Methods: Participants (N=28; mean age 73.2, SD 5.5 years; 70\% female) with reported knee osteoarthritis were asked to wear a smartwatch with the ROAMM app installed. They were prompted to report their prior night's sleep quality in the morning, followed by ecological momentary assessments (EMAs) of their pain, fatigue, mood, and activity in the morning, afternoon, and evening. Satisfaction, comfort, and usability were evaluated using a standardized questionnaire. Compliance with regard to answering EMAs was calculated after excluding time when the watch was not being worn for technical reasons (eg, while charging). Results: A majority of participants reported that the text displayed was large enough to read (22/26, 85\%), and all participants found it easy to enter ratings using the smartwatch. Approximately half of the participants found the smartwatch to be comfortable (14/26, 54\%) and would consider wearing it as their personal watch (11/24, 46\%). Most participants were satisfied with its battery charging system (20/26, 77\%). A majority of participants (19/26, 73\%) expressed their willingness to use the ROAMM app for a 1-year research study. The overall EMA compliance rate was 83\% (2505/3036 responses). The compliance rate was lower among those not regularly wearing a wristwatch (10/26, 88\% vs 16/26, 71\%) and among those who found the text too small to read (4/26, 86\% vs 22/26, 60\%). Conclusions: Older adults with knee osteoarthritis positively rated the ROAMM smartwatch app and were generally satisfied with the device. The high compliance rates coupled with the willingness to participate in a long-term study suggest that the ROAMM app is a viable approach to remotely collecting health symptoms and behaviors for both research and clinical endeavors. ",
doi="10.2196/24553",
url="https://aging.jmir.org/2021/3/e24553",
url="http://www.ncbi.nlm.nih.gov/pubmed/34259638"
}


@Article{info:doi/10.2196/26670,
author="Song, Ting
and Deng, Ning
and Cui, Tingru
and Qian, Siyu
and Liu, Fang
and Guan, Yingping
and Yu, Ping",
title="Measuring Success of Patients' Continuous Use of Mobile Health Services for Self-management of Chronic Conditions: Model Development and Validation",
journal="J Med Internet Res",
year="2021",
month="Jul",
day="13",
volume="23",
number="7",
pages="e26670",
keywords="mobile health",
keywords="service",
keywords="smartphone",
keywords="mobile application",
keywords="continuous use",
keywords="high blood pressure",
keywords="chronic disease",
keywords="PLS",
abstract="Background: Mobile health services are gradually being introduced to support patients' self-management of chronic conditions. The success of these services is contingent upon patients' continuous use of them. Objective: This study aims to develop a model to measure the success of patients' continuous use of mobile health services for the self-management of chronic conditions. Methods: The proposed model was derived from the information systems continuance model and the information systems success model. This model contains 7 theoretical constructs: information quality, system quality, service quality, perceived usefulness, user satisfaction, perceived health status, and continuous use intention. A web-based questionnaire survey instrument was developed to test the model. The survey was conducted to collect data from 129 patients who used a mobile health app for hypertension management from 2017 to 2019. The questionnaire items were derived from validated instruments and were measured using a 5-point Likert scale. The partial least squares modelling method was used to test the theoretical model. Results: The model accounted for 58.5\% of the variance in perceived usefulness (R2=0.585), 52.3\% of the variance in user satisfaction (R2=0.523), and 41.4\% of the variance in patients' intention to make continuous use of mobile health services (R2=0.414). The continuous use intention was significantly influenced by their perceived health status ($\beta$=.195, P=.03), perceived usefulness ($\beta$=.307, P=.004), and user satisfaction ($\beta$=.254, P=.04) with the mobile health service. Information quality ($\beta$=.235, P=.005), system quality ($\beta$=.192, P=.02), and service quality ($\beta$=.494, P<.001) had a significantly positive influence on perceived usefulness but not on user satisfaction. Perceived usefulness had a significantly positive influence on user satisfaction ($\beta$=.664, P<.001). In a result opposite to the original hypothesis, perceived health status did not negatively influence patients' intention to continue using the mobile health service but showed a significantly positive correlation. Conclusions: This study developed a theoretical model to predict and explain patients' continuous use of mobile health services for self-management of chronic conditions and empirically tested the model. Perceived usefulness, user satisfaction, and health status contributed to patients' intention to make continuous use of mobile health services for self-managing their chronic conditions. ",
doi="10.2196/26670",
url="https://www.jmir.org/2021/7/e26670",
url="http://www.ncbi.nlm.nih.gov/pubmed/34255685"
}


@Article{info:doi/10.2196/27156,
author="Scheibe, Madlen
and Lang, Caroline
and Druschke, Diana
and Arnold, Katrin
and Luntz, Edwin
and Schmitt, Jochen
and Holthoff-Detto, Vjera",
title="Independent Use of a Home-Based Telemonitoring App by Older Patients With Multimorbidity and Mild Cognitive Impairment: Qualitative Study",
journal="JMIR Hum Factors",
year="2021",
month="Jul",
day="12",
volume="8",
number="3",
pages="e27156",
keywords="telemedicine",
keywords="aged",
keywords="multimorbidity",
keywords="dementia",
keywords="patient acceptance of health care",
keywords="health care quality, access, and evaluation",
keywords="qualitative research",
abstract="Background: The management of multimorbidity is complex and patients have a high burden of disease. When symptoms of dementia also appear, it becomes even more difficult for patients to cope with their everyday lives and manage their diseases. Home-based telemonitoring may support older patients with multimorbidity and mild cognitive impairment (MCI) in their regular monitoring and self-management. However, to date, there has been no investigation into whether patients with MCI are able to operate a telemonitoring app independently to manage their own diseases. This question has become even more important during the current COVID-19 pandemic to maintain high-quality medical care for this patient group. Objective: We examined the following research questions: (1) How do patients with MCI assess the usability of the telemonitoring app? (2) How do patients with MCI assess the range of functions offered by the telemonitoring app? (3) Was there an additional benefit for the patients with MCI in using the telemonitoring app? (4) Were patients with MCI able to use the telemonitoring app independently and without restrictions? (5) To what extent does previous experience with smartphones, tablets, or computers influence the perceived ease of use of the telemonitoring app? Methods: We performed a formative evaluation of a telemonitoring app. Therefore, we carried out a qualitative study and conducted guided interviews. All interviews were audio-recorded, transcribed verbatim, and analyzed using the Mayring method of structured content analysis. Results: Twelve patients (8 women, 4 men) were interviewed; they had an average age of 78.7 years (SD 5.6) and an average Mini-Mental State Examination score of 24.5 (SD 1.6). The interviews lasted between 17 and 75 minutes (mean 41.8 minutes, SD 19.4). Nine patients reported that the telemonitoring app was easy to use. All respondents assessed the range of functions as good or adequate. Desired functionalities mainly included more innovative and varied educational material, better fit of the telemonitoring app for specific needs of patients with MCI, and a more individually tailored content. Ten of the 12 patients stated that the telemonitoring app had an additional benefit for them. Most frequently reported benefits included increased feeling of security, appreciation of regular monitoring of vital parameters, and increased independence due to telemonitoring. Eight patients were able to operate the app independently. Participants found the app easy to use regardless of whether they had prior experience with smartphones, tablets, or computers. Conclusions: The majority of examined patients with MCI were capable of operating the telemonitoring app independently. Crucial components in attaining independent use were comprehensive personal support from the start of use and appropriate design features. This study provides initial evidence that patients with MCI could increasingly be considered as a relevant user group of telemonitoring apps. ",
doi="10.2196/27156",
url="https://humanfactors.jmir.org/2021/3/e27156",
url="http://www.ncbi.nlm.nih.gov/pubmed/34255664"
}


@Article{info:doi/10.2196/25820,
author="Ang, Han Ian Yi
and Tan, Quan Kyle Xin
and Tan, Clive
and Tan, Hoon Chiew
and Kwek, Ming James Wei
and Tay, Joanne
and Toh, Anne Sue",
title="A Personalized Mobile Health Program for Type 2 Diabetes During the COVID-19 Pandemic: Single-Group Pre--Post Study",
journal="JMIR Diabetes",
year="2021",
month="Jul",
day="9",
volume="6",
number="3",
pages="e25820",
keywords="type 2 diabetes",
keywords="prediabetic state",
keywords="text messaging",
keywords="mobile applications",
keywords="glycated hemoglobin A",
keywords="HbA1c",
keywords="blood glucose",
keywords="body mass index",
keywords="mHealth",
keywords="COVID-19",
keywords="diabetes",
keywords="intervention",
keywords="self-management",
keywords="chronic disease",
keywords="outcome",
abstract="Background: With increasing type 2 diabetes prevalence, there is a need for effective programs that support diabetes management and improve type 2 diabetes outcomes. Mobile health (mHealth) interventions have shown promising results. With advances in wearable sensors and improved integration, mHealth programs could become more accessible and personalized. Objective: The study aimed to evaluate the feasibility, acceptability, and effectiveness of a personalized mHealth-anchored intervention program in improving glycemic control and enhancing care experience in diabetes management. The program was coincidentally implemented during the national-level lockdown for COVID-19 in Singapore, allowing for a timely study of the use of mHealth for chronic disease management. Methods: Patients with type 2 diabetes or prediabetes were enrolled from the Singapore Armed Forces and offered a 3-month intervention program in addition to the usual care they received. The program was standardized to include (1) in-person initial consultation with a clinical dietitian; (2) in-person review with a diabetes specialist doctor; (3) 1 continuous glucose monitoring device; (4) access to the mobile app for dietary intake and physical activity tracking, and communication via messaging with the dietitian and doctor; and (5) context-sensitive digital health coaching over the mobile app. Medical support was rendered to the patients on an as-needed basis when they required advice on adjustment of medications. Measurements of weight, height, and glycated hemoglobin A1c (HbA1c) were conducted at 2 in-person visits at the start and end of the program. At the end of the program, patients were asked to complete a short acceptability feedback survey to understand the motivation for joining the program, their satisfaction, and suggestions for improvement. Results: Over a 4-week recruitment period, 130 individuals were screened, the enrollment target of 30 patients was met, and 21 patients completed the program and were included in the final analyses; 9 patients were lost to follow-up (full data were not available for the final analyses). There were no differences in the baseline characteristics between patients who were included and excluded from the final analyses (age category: P=.23; gender: P=.21; ethnicity: P>.99; diabetes status category: P=.52, medication adjustment category: P=.65; HbA1c category: P=.69; BMI: P>.99). The 21 patients who completed the study rated a mean of 9.0 out of 10 on the Likert scale for both satisfaction questions. For the Yes-No question on benefit of the program, all of the patients selected ``Yes.'' Mean HbA1c decreased from 7.6\% to 7.0\% (P=.004). There were no severe hypoglycemia events (glucose level <3.0 mmol/L) reported. Mean weight decreased from 76.8 kg to 73.9 kg (P<.001), a mean decrease of 3.5\% from baseline weight. Mean BMI decreased from 27.8 kg/m2 to 26.7 kg/m2 (P<.001). Conclusions: The personalized mHealth program was feasible, acceptable, and produced significant reductions in HbA1c (P=.004) and body weight (P<.001) in individuals with type 2 diabetes. Such mHealth programs could overcome challenges posed to chronic disease management by COVID-19, including disruptions to in-person health care access. ",
doi="10.2196/25820",
url="https://diabetes.jmir.org/2021/3/e25820",
url="http://www.ncbi.nlm.nih.gov/pubmed/34111018"
}


@Article{info:doi/10.2196/26401,
author="Raffaelli, Bianca
and Mecklenburg, Jasper
and Overeem, Hendrik Lucas
and Scholler, Simon
and Dahlem, A. Markus
and Kurth, Tobias
and Oliveira Gon{\c{c}}alves, Sofia Ana
and Reuter, Uwe
and Neeb, Lars",
title="Determining the Evolution of Headache Among Regular Users of a Daily Electronic Diary via a Smartphone App: Observational Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jul",
day="7",
volume="9",
number="7",
pages="e26401",
keywords="headache",
keywords="migraine",
keywords="mobile app",
keywords="headache app",
keywords="electronic diary",
keywords="app",
keywords="pain",
keywords="frequency",
keywords="intensity",
abstract="Background: Smartphone-based apps represent a major development in health care management. Specifically in headache care, the use of electronic headache diaries via apps has become increasingly popular. In contrast to the soaring volume of available data, scientific use of these data resources is sparse. Objective: In this analysis, we aimed to assess changes in headache and migraine frequency, headache and migraine intensity, and use of acute medication among people who showed daily use of the headache diary as implemented in the freely available basic version of the German commercial app, M-sense. Methods: The basic version of M-sense comprises an electronic headache diary, documentation of lifestyle factors with a possible impact on headaches, and evaluation of headache patterns. This analysis included all M-sense users who had entered data into the app on a daily basis for at least 7 months. Results: We analyzed data from 1545 users. Mean MHD decreased from 9.42 (SD 5.81) at baseline to 6.39 (SD 5.09) after 6 months (P<.001; 95\% CI 2.80-3.25). MMD, AMD, and migraine intensity were also significantly reduced. Similar results were found in 985 users with episodic migraine and in 126 users with chronic migraine. Conclusions: Among regular users of an electronic headache diary, headache and migraine frequency, in addition to other headache characteristics, improved over time. The use of an electronic headache diary may support standard headache care. ",
doi="10.2196/26401",
url="https://mhealth.jmir.org/2021/7/e26401",
url="http://www.ncbi.nlm.nih.gov/pubmed/34255716"
}


@Article{info:doi/10.2196/27502,
author="Chen, Ciao-Sin
and Kim, Judith
and Garg, Noemi
and Guntupalli, Harsha
and Jagsi, Reshma
and Griggs, J. Jennifer
and Sabel, Michael
and Dorsch, P. Michael
and Callaghan, C. Brian
and Hertz, L. Daniel",
title="Chemotherapy-Induced Peripheral Neuropathy Detection via a Smartphone App: Cross-sectional Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jul",
day="5",
volume="9",
number="7",
pages="e27502",
keywords="chemotherapy-induced peripheral neuropathy",
keywords="smartphone",
keywords="mobile health",
keywords="gait",
keywords="balance",
keywords="9-Hole Peg Test",
abstract="Background: Severe chemotherapy-induced peripheral neuropathy (CIPN) can cause long-term dysfunction of the hands and feet, interfere with activities of daily living, and diminish the quality of life. Monitoring to identify CIPN and adjust treatment before it progressing to a life-altering severity relies on patients self-reporting subjective symptoms to their clinical team. Objective assessment is not a standard component of CIPN monitoring due to the requirement for specially trained health care professionals and equipment. Smartphone apps have the potential to conveniently collect both subjective and objective CIPN data directly from patients, which could improve CIPN monitoring. Objective: The objective of this cross-sectional pilot study was to assess the feasibility of functional CIPN assessment via a smartphone app in patients with cancer that have received neurotoxic chemotherapy. Methods: A total of 26 patients who had completed neurotoxic chemotherapy were enrolled and classified as CIPN cases (n=17) or controls (n=9) based on self-report symptoms. All participants completed CIPN assessments within the NeuroDetect app a single time, including patient-reported surveys (CIPN20 [European Organization for Research and Treatment of Cancer Quality of Life Questionnaire for Chemotherapy-induced Peripheral Neuropathy 20-item scale] and PRO-CTCAE [Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events]) and functional assessments (Gait and Balance and 9-Hole Peg Test). Functional assessment data were decomposed into features. The primary analysis was done to identify features indicative of the difference between CIPN cases and controls using partial least squares analyses. Exploratory analyses were performed to test if any features were associated with specific symptom subtypes or patient-reported survey scores. Patient interviews were also conducted to understand the challenges they experienced with the app. Results: Comparisons between CIPN cases and controls indicate that CIPN cases had shorter step length (P=.007), unique swaying acceleration patterns during a walking task, and shorter hand moving distance in the dominant hands during a manual dexterity task (variable importance in projection scores ?2). Exploratory analyses showed similar signatures associated with symptoms subtypes, CIPN20, and PRO-CTCAE. The interview results showed that some patients had difficulties due to technical issues, which indicated a need for additional training or oversight during the initial app download. Conclusions: Our results supported the feasibility of remote CIPN assessment via a smartphone app and suggested that functional assessments may indicate CIPN manifestations in the hands and feet. Additional work is needed to determine which functional assessments are most indicative of CIPN and could be used for CIPN monitoring within clinical care. ",
doi="10.2196/27502",
url="https://mhealth.jmir.org/2021/7/e27502",
url="http://www.ncbi.nlm.nih.gov/pubmed/36260403"
}


@Article{info:doi/10.2196/29561,
author="Cislo, Christine
and Clingan, Caroline
and Gilley, Kristen
and Rozwadowski, Michelle
and Gainsburg, Izzy
and Bradley, Christina
and Barabas, Jenny
and Sandford, Erin
and Olesnavich, Mary
and Tyler, Jonathan
and Mayer, Caleb
and DeMoss, Matthew
and Flora, Christopher
and Forger, B. Daniel
and Cunningham, Lee Julia
and Tewari, Muneesh
and Choi, Won Sung",
title="Monitoring Beliefs and Physiological Measures Using Wearable Sensors and Smartphone Technology Among Students at Risk of COVID-19: Protocol for a mHealth Study",
journal="JMIR Res Protoc",
year="2021",
month="Jun",
day="24",
volume="10",
number="6",
pages="e29561",
keywords="college students",
keywords="COVID-19",
keywords="global pandemic",
keywords="mental health",
keywords="mHealth",
keywords="pandemic",
keywords="risk monitoring",
keywords="wearable sensors",
keywords="well-being",
abstract="Background: The COVID-19 pandemic has significantly impacted lives and greatly affected the mental health and public safety of an already vulnerable population---college students. Social distancing and isolation measures have presented challenges to students' mental health. mHealth apps and wearable sensors may help monitor students at risk of COVID-19 and support their mental well-being. Objective: This study aimed to monitor students at risk of COVID-19 by using a wearable sensor and a smartphone-based survey. Methods: We conducted a prospective study on undergraduate and graduate students at a public university in the Midwest United States. Students were instructed to download the Fitbit, Social Rhythms, and Roadmap 2.0 apps onto their personal smartphone devices (Android or iOS). Subjects consented to provide up to 10 saliva samples during the study period. Surveys were administered through the Roadmap 2.0 app at five timepoints: at baseline, 1 month later, 2 months later, 3 months later, and at study completion. The surveys gathered information regarding demographics, COVID-19 diagnoses and symptoms, and mental health resilience, with the aim of documenting the impact of COVID-19 on the college student population. Results: This study enrolled 2158 college students between September 2020 and January 2021. Subjects are currently being followed-up for 1 academic year. Data collection and analysis are currently underway. Conclusions: This study examined student health and well-being during the COVID-19 pandemic and assessed the feasibility of using a wearable sensor and a survey in a college student population, which may inform the role of our mHealth tools in assessing student health and well-being. Finally, using data derived from a wearable sensor, biospecimen collection, and self-reported COVID-19 diagnosis, our results may provide key data toward the development of a model for the early prediction and detection of COVID-19. Trial Registration: ClinicalTrials.gov NCT04766788; https://clinicaltrials.gov/ct2/show/NCT04766788 International Registered Report Identifier (IRRID): DERR1-10.2196/29561 ",
doi="10.2196/29561",
url="https://www.researchprotocols.org/2021/6/e29561/"
}


@Article{info:doi/10.2196/25522,
author="Song, Ting
and Liu, Fang
and Deng, Ning
and Qian, Siyu
and Cui, Tingru
and Guan, Yingping
and Arnolda, Leonard
and Zhang, Zhenyu
and Yu, Ping",
title="A Comprehensive 6A Framework for Improving Patient Self-Management of Hypertension Using mHealth Services: Qualitative Thematic Analysis",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="21",
volume="23",
number="6",
pages="e25522",
keywords="patient experience",
keywords="mHealth",
keywords="mobile phone",
keywords="mobile app",
keywords="intervention",
keywords="self-management",
keywords="high blood pressure",
keywords="chronic disease management",
keywords="qualitative research",
abstract="Background: Hypertension affects over 15\% of the world's population and is a significant global public health and socioeconomic challenge. Mobile health (mHealth) services have been increasingly introduced to support hypertensive patients to improve their self-management behaviors, such as adherence to pharmacotherapy and lifestyle modifications. Objective: This study aims to explore patients' perceptions of mHealth services and the mechanisms by which the services support them to self-manage their hypertension. Methods: A semistructured, in-depth interview study was conducted with 22 outpatients of the General Hospital of Ningxia Medical University from March to May 2019. In 2015, the hospital introduced an mHealth service to support community-dwelling outpatients with self-management of hypertension. Content analysis was conducted by following a grounded theory approach for inductive thematic extraction. Constant comparison and categorization classified the first-level codes with similar meanings into higher-level themes. Results: The patient-perceived mechanisms by which the mHealth service supported their self-management of hypertension were summarized as 6A: access, assessment, assistance, awareness, ability, and activation. With the portability of mobile phones and digitization of information, the mHealth service provided outpatients with easy access to assess their vital signs and self-management behaviors. The assessment results gave the patients real-time awareness of their health conditions and self-management performance, which activated their self-management behaviors. The mHealth service also gave outpatients access to assistance, which included health education and self-management reminders. Both types of assistance could also be activated by abnormal assessment results, that is, uncontrolled or deteriorating blood pressure values, discomfort symptoms, or not using the service for a long period. With its scalable use to handle any possible information and services, the mHealth service provided outpatients with educational materials to learn at their own pace. This led to an improvement in self-management awareness and ability, again activating their self-management behaviors. The patients would like to see further improvements in the service to provide more useful, personalized information and reliable services. Conclusions: The mHealth service extended the traditional hypertension care model beyond the hospital and clinician's office. It provided outpatients with easy access to otherwise inaccessible hypertension management services. This led to process improvement for outpatients to access health assessment and health care assistance and improved their awareness and self-management ability, which activated their hypertension self-management behaviors. Future studies can apply the 6A framework to guide the design, implementation, and evaluation of mHealth services for outpatients to self-manage chronic conditions. ",
doi="10.2196/25522",
url="https://www.jmir.org/2021/6/e25522",
url="http://www.ncbi.nlm.nih.gov/pubmed/34152272"
}


@Article{info:doi/10.2196/25482,
author="Feusner, D. Jamie
and Mohideen, Reza
and Smith, Stephen
and Patanam, Ilyas
and Vaitla, Anil
and Lam, Christopher
and Massi, Michelle
and Leow, Alex",
title="Semantic Linkages of Obsessions From an International Obsessive-Compulsive Disorder Mobile App Data Set: Big Data Analytics Study",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="21",
volume="23",
number="6",
pages="e25482",
keywords="OCD",
keywords="natural language processing",
keywords="clinical subtypes",
keywords="semantic",
keywords="word embedding",
keywords="clustering",
abstract="Background: Obsessive-compulsive disorder (OCD) is characterized by recurrent intrusive thoughts, urges, or images (obsessions) and repetitive physical or mental behaviors (compulsions). Previous factor analytic and clustering studies suggest the presence of three or four subtypes of OCD symptoms. However, these studies have relied on predefined symptom checklists, which are limited in breadth and may be biased toward researchers' previous conceptualizations of OCD. Objective: In this study, we examine a large data set of freely reported obsession symptoms obtained from an OCD mobile app as an alternative to uncovering potential OCD subtypes. From this, we examine data-driven clusters of obsessions based on their latent semantic relationships in the English language using word embeddings. Methods: We extracted free-text entry words describing obsessions in a large sample of users of a mobile app, NOCD. Semantic vector space modeling was applied using the Global Vectors for Word Representation algorithm. A domain-specific extension, Mittens, was also applied to enhance the corpus with OCD-specific words. The resulting representations provided linear substructures of the word vector in a 100-dimensional space. We applied principal component analysis to the 100-dimensional vector representation of the most frequent words, followed by k-means clustering to obtain clusters of related words. Results: We obtained 7001 unique words representing obsessions from 25,369 individuals. Heuristics for determining the optimal number of clusters pointed to a three-cluster solution for grouping subtypes of OCD. The first had themes relating to relationship and just-right; the second had themes relating to doubt and checking; and the third had themes relating to contamination, somatic, physical harm, and sexual harm. All three clusters showed close semantic relationships with each other in the central area of convergence, with themes relating to harm. An equal-sized split-sample analysis across individuals and a split-sample analysis over time both showed overall stable cluster solutions. Words in the third cluster were the most frequently occurring words, followed by words in the first cluster. Conclusions: The clustering of naturally acquired obsessional words resulted in three major groupings of semantic themes, which partially overlapped with predefined checklists from previous studies. Furthermore, the closeness of the overall embedded relationships across clusters and their central convergence on harm suggests that, at least at the level of self-reported obsessional thoughts, most obsessions have close semantic relationships. Harm to self or others may be an underlying organizing theme across many obsessions. Notably, relationship-themed words, not previously included in factor-analytic studies, clustered with just-right words. These novel insights have potential implications for understanding how an apparent multitude of obsessional symptoms are connected by underlying themes. This observation could aid exposure-based treatment approaches and could be used as a conceptual framework for future research. ",
doi="10.2196/25482",
url="https://www.jmir.org/2021/6/e25482",
url="http://www.ncbi.nlm.nih.gov/pubmed/33892466"
}


@Article{info:doi/10.2196/24981,
author="Martin, Megan
and Patterson, Jonathan
and Allison, Matt
and O'Connor, B. Blakely
and Patel, Dhiren",
title="The Influence of Baseline Hemoglobin A1c on Digital Health Coaching Outcomes in Adults With Type 2 Diabetes: Real-World Retrospective Cohort Study",
journal="JMIR Diabetes",
year="2021",
month="Jun",
day="16",
volume="6",
number="2",
pages="e24981",
keywords="type 2 diabetes",
keywords="mobile health",
keywords="digital health coaching",
keywords="digital therapy",
keywords="diabetes support program",
keywords="hemoglobin A1c",
keywords="body mass index",
keywords="diabetes distress",
abstract="Background: Digital health coaching is an increasingly common diabetes self-management support strategy for individuals with type 2 diabetes and has been linked to positive mental and physical health outcomes. However, the relationship between baseline risk and outcomes is yet to be evaluated in a real-world setting. Objective: The purpose of this real-world study was to evaluate trends in digital health coaching outcomes by baseline hemoglobin A1c (HbA1c) to better understand which populations may experience the greatest clinical and psychosocial benefit. Methods: A retrospective cohort study design was used to evaluate program effect in a convenience sample of participants in a 12-week digital health coaching program administered by Pack Health. Participants were referred through their health care provider, payer, or employer. The program included patient-centered lifestyle counseling and psychosocial support delivered via telephone, text, and/or email. Self-reported HbA1c and weight were collected at baseline and completion. Physical and mental health were assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health Short Form and the Diabetes Distress Scale-2. Changes in HbA1c, weight, BMI, and physical and mental health were analyzed within three participant cohorts stratified by baseline HbA1c level. Results: Participants with complete HbA1c data sets (n=226) were included in the analysis. The sample population was 71.7\% (162/226) female, with 61.5\% (139/226) identifying as white and 34.1\% (77/226) as black. Most participants (184/226, 81.4\%) reported a baseline HbA1c ?7\%, and 20.3\% (46/226) were classified as high risk (HbA1c >9\%). Across HbA1c cohorts, the mean baseline BMI was 35.83 (SD 7.79), and the moderate-risk cohort (7\% ? HbA1c ? 9\%) reported the highest mean value (36.6, SD 7.79). At 12 weeks, patients reported a significant decrease in HbAlc, and high-risk participants reduced their levels by the greatest margin (2.28 points; P<.001). Across cohorts, BMI improved by 0.82 (P<.001), with the moderate-risk cohort showing the greatest reduction (?0.88; P<.001). Overall, participants reported significant improvements for PROMIS scores, with the greatest change occurring in the high-risk cohort for whom physical health improved 3.84 points (P<.001) and mental health improved 3.3 points (P<.001). However, the lowest-risk cohort showed the greatest improvements in diabetes distress (?0.76; P=.005). Conclusions: Acknowledging the limitations in this real-world study design, the results reported here suggest that adults with type 2 diabetes with a high baseline HbA1c or high BMI may benefit the most from patient-centered digital health coaching programs when compared to their lower risk counterparts. While all participants improved in physical and mental health categories, participants with high HbA1c experienced the greatest HbA1c reduction and individuals with the highest baseline BMI lost the most weight. These results may be used to inform referrals for patients who are more likely to benefit from digital health coaching. ",
doi="10.2196/24981",
url="https://diabetes.jmir.org/2021/2/e24981",
url="http://www.ncbi.nlm.nih.gov/pubmed/34010804"
}


@Article{info:doi/10.2196/27823,
author="Polsky, Michael
and Moraveji, Neema",
title="Early Identification of COVID-19 Infection Using Remote Cardiorespiratory Monitoring: Three Case Reports",
journal="Interact J Med Res",
year="2021",
month="Jun",
day="16",
volume="10",
number="2",
pages="e27823",
keywords="COVID-19",
keywords="remote patient monitoring",
keywords="wearable sensors",
keywords="monitoring",
keywords="case study",
keywords="preidentification",
keywords="lung",
keywords="data collection",
keywords="respiration",
keywords="prediction",
abstract="Background: The adoption of remote patient monitoring (RPM) in routine medical care requires increased understanding of the physiologic changes accompanying disease development and the proactive interventions that will improve outcomes. Objective: The aim of this study is to present three case reports that highlight the capability of RPM to enable early identification of viral infection with COVID-19 in patients with chronic respiratory disease. Methods: Patients at a large pulmonary practice who were enrolled in a respiratory RPM program and who had contracted COVID-19 were identified. The RPM system (Spire Health) contains three components: (1) Health Tags (Spire Health), undergarment waistband-adhered physiologic monitors that include a respiratory rate sensor; (2) an app on a smartphone; and (3) a web dashboard for use by respiratory therapists. The physiologic data of 9 patients with COVID out of 1000 patients who were enrolled for monitoring were retrospectively reviewed, and 3 instances were identified where the RPM system had notified clinicians of physiologic deviation due to the viral infection. Results: Physiologic deviations from respective patient baselines occurred during infection onset and, although the infection manifested differently in each case, were identified by the RPM system. In the first case, the patient was symptomatic; in the second case, the patient was presymptomatic; and in the third case, the patient varied from asymptomatic to mildly symptomatic. Conclusions: RPM systems intended for long-term use and that use patient-specific baselines can highlight physiologic changes early in the course of acute disease, such as COVID-19 infection. These cases demonstrate opportunities for earlier diagnosis, treatment, and isolation. This study supports the need for further research into how RPM can be effectively integrated into clinical practice. ",
doi="10.2196/27823",
url="https://www.i-jmr.org/2021/2/e27823",
url="http://www.ncbi.nlm.nih.gov/pubmed/34086588"
}


@Article{info:doi/10.2196/25151,
author="Maharaj, Alita
and Lim, David
and Murphy, Rinki
and Serlachius, Anna",
title="Comparing Two Commercially Available Diabetes Apps to Explore Challenges in User Engagement: Randomized Controlled Feasibility Study",
journal="JMIR Form Res",
year="2021",
month="Jun",
day="16",
volume="5",
number="6",
pages="e25151",
keywords="type 2 diabetes",
keywords="mobile apps",
keywords="diabetes",
keywords="self-management",
keywords="user engagement",
keywords="app",
keywords="mHealth",
keywords="randomized controlled trial",
keywords="intervention",
keywords="efficacy",
abstract="Background: Diabetes apps represent a promising addition to face-to-face self-management interventions, which can be time and resource intensive. However, few randomized controlled trials have evaluated the efficacy of diabetes apps, in particular as a stand-alone intervention without additional clinical support. Objective: We used a feasibility randomized trial design to investigate differences in user engagement between 2 commercially available apps (free versions of Glucose Buddy and mySugr) over 2 weeks in adults with type 2 diabetes. Feasibility was assessed based on recruitment uptake, adherence to the diabetes apps, and follow-up rates. We also hypothesized that the diabetes app mySugr would demonstrate higher user engagement at follow-up due to its use of gamification. We also predicted higher user engagement would be associated with improved self-care behaviors and illness beliefs. Methods: Adults with type 2 diabetes attending outpatient diabetes clinics in Auckland were recruited and randomized (1:1 without blinding) to use either the Glucose Buddy or mySugr diabetes apps. User engagement, self-care behaviors, and illness beliefs were measured 2 weeks after baseline. Spearman rank correlations, Mann-Whitney tests, and Wilcoxon signed-rank tests were used to explore associations between the outcome measures and to investigate possible changes between and within groups. Six participants were interviewed to further explore acceptability and usability. Results: In total, 58 participants (29 per group) completed the 2-week follow-up, of whom only 38 reported using the apps (Glucose Buddy: n=20; mySugr: n=18). Both groups reported low engagement (Glucose Buddy: median 4 days; mySugr: median 6.5 days; P=.06; use for both groups: median 10 minutes). No changes were observed in self-care or illness beliefs in either group. Out of the self-care behaviors, only blood glucose testing was significantly associated with minutes of app use (P=.02). The interviews suggested that although both apps were deemed acceptable, they were generally viewed as time-consuming and too complicated to use. Conclusions: Low engagement with both Glucose Buddy and mySugr reflect the challenges associated with engaging users with diabetes apps. Due to low engagement and loss to follow-up, the changes in outcome measures should be interpreted with caution. The results highlight the need for more clinical support as well as involvement from end users and behavior change specialists in order to incorporate evidence-based behavior change techniques to motivate and provide value to users. Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12618000424202; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374671 ",
doi="10.2196/25151",
url="https://formative.jmir.org/2021/6/e25151",
url="http://www.ncbi.nlm.nih.gov/pubmed/34132640"
}


@Article{info:doi/10.2196/26991,
author="Stampe, Kathrine
and Kishik, Sharon
and M{\"u}ller, Dueholm Sune",
title="Mobile Health in Chronic Disease Management and Patient Empowerment: Exploratory Qualitative Investigation Into Patient-Physician Consultations",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="15",
volume="23",
number="6",
pages="e26991",
keywords="compliance",
keywords="empowerment",
keywords="mHealth",
keywords="patient-physician consultation",
keywords="power",
abstract="Background: Chronic diseases often present severe consequences for those affected. The management and treatment of chronic diseases largely depend on patients' lifestyle choices and how they cope with the disease in their everyday lives. Accordingly, the ability of patients to self-manage diseases is a highly relevant topic. In relation to self-management, studies refer to patient empowerment as strengthening patients' voices and enabling them to assert control over their health and treatment. Mobile health (mHealth) provides cost-efficient means to support self-management and foster empowerment. Objective: There is a scarcity of research investigating how mHealth affects patient empowerment during patient-physician consultations. The objective of this study is to address this knowledge gap by investigating how mHealth affects consultations and patient empowerment. Methods: We relied on data from an ethnographic field study of 6 children and adolescents diagnosed with juvenile idiopathic arthritis. We analyzed 6 patient-physician consultations and drew on Michel Foucault's concepts of power and power technology. Results: Our results suggest that the use of mHealth constitutes practices that structure the consultations around deviations and noncompliant patient behavior. Our analysis shows how mHealth is used to discipline patients and correct their behavior. We argue that the use of mHealth during consultations may unintentionally lead to relevant aspects of patients' lives related to the disease being ignored; thus, inadvertently, patients' voices may be silenced. Conclusions: Our results show that concrete uses of mHealth may conflict with extant literature on empowerment, which emphasizes the importance of strengthening the patients' voices and enabling patients to take more control of their health and treatment. We contribute to the state-of-the-art knowledge by showing that the use of mHealth may have unintended consequences that do not lead to empowerment. Our analysis underscores the need for further research to investigate how mHealth impacts patient empowerment during consultations. ",
doi="10.2196/26991",
url="https://www.jmir.org/2021/6/e26991",
url="http://www.ncbi.nlm.nih.gov/pubmed/34128817"
}


@Article{info:doi/10.2196/27475,
author="Fulford, Daniel
and Gard, E. David
and Mueser, T. Kim
and Mote, Jasmine
and Gill, Kathryn
and Leung, Lawrence
and Mow, Jessica",
title="Preliminary Outcomes of an Ecological Momentary Intervention for Social Functioning in Schizophrenia: Pre-Post Study of the Motivation and Skills Support App",
journal="JMIR Ment Health",
year="2021",
month="Jun",
day="15",
volume="8",
number="6",
pages="e27475",
keywords="schizophrenia",
keywords="psychosis",
keywords="social functioning",
keywords="social skills",
keywords="motivation",
keywords="mHealth",
keywords="smartphone",
keywords="mobile phone",
abstract="Background: People with schizophrenia and other serious mental illnesses often lack access to evidence-based interventions, particularly interventions that target meaningful recovery outcomes such as social functioning and quality of life. Mobile technologies, including smartphone apps, have the potential to provide scalable support that places elements of evidence-based interventions at the palm of patients' hands. Objective: We aim to develop a smartphone app---called Motivation and Skills Support---to provide targeted social goal support (eg, making new friends and improving existing relationships) for people with schizophrenia enrolled in a stand-alone open trial. Methods: In this paper, we presented preliminary outcomes of 31 participants who used the Motivation and Skills Support app for 8 weeks, including social functioning pre- to postintervention, and momentary reports of treatment targets (eg, social motivation and appraisals) during the intervention. Results: The findings suggest that the intervention improved self-reported social functioning from baseline to treatment termination, particularly in female participants. Gains were not maintained at the 3-month follow-up. Furthermore, increased social functioning was predicted by momentary reports of social appraisals, including perceived social competence and the extent to which social interactions were worth the effort. Conclusions: The implications of these findings and future directions for addressing social functioning in schizophrenia using mobile technology have been discussed. Trial Registration: ClinicalTrials.gov NCT03404219; https://clinicaltrials.gov/ct2/show/NCT03404219 ",
doi="10.2196/27475",
url="https://mental.jmir.org/2021/6/e27475",
url="http://www.ncbi.nlm.nih.gov/pubmed/34128812"
}


@Article{info:doi/10.2196/26095,
author="Chen, Mingrong
and Wu, Tingting
and Lv, Meina
and Chen, Chunmei
and Fang, Zongwei
and Zeng, Zhiwei
and Qian, Jiafen
and Jiang, Shaojun
and Chen, Wenjun
and Zhang, Jinhua",
title="Efficacy of Mobile Health in Patients With Low Back Pain: Systematic Review and Meta-analysis of Randomized Controlled Trials",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jun",
day="11",
volume="9",
number="6",
pages="e26095",
keywords="mobile health",
keywords="mHealth",
keywords="low back pain",
keywords="meta-analysis",
keywords="pain intensity",
keywords="disability",
abstract="Background: Low back pain is one of the most common health problems and a main cause of disability, which imposes a great burden on patients. Mobile health (mHealth) affects many aspects of people's lives, and it has progressed rapidly, showing promise as an effective intervention for patients with low back pain. However, the efficacy of mHealth interventions for patients with low back pain remains unclear; thus, further exploration is necessary. Objective: The purpose of this study was to evaluate the efficacy of mHealth interventions in patients with low back pain compared to usual care. Methods: This was a systematic review and meta-analysis of randomized controlled trials designed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) statement standard. We searched for studies published in English before October 2020 in the PubMed, EMBASE, Web of Science, and Cochrane Library databases. Two researchers independently scanned the literature, extracted data, and assessed the methodological quality of the included studies. Bias risks were assessed using the Cochrane Collaboration tool. We used RevMan 5.4 software to perform the meta-analysis. Results: A total of 9 studies with 792 participants met the inclusion criteria. The simultaneous use of mHealth and usual care showed a better reduction in pain intensity than usual care alone, as measured by the numeric rating scale (mean difference [MD] --0.85, 95\% CI --1.29 to --0.40; P<.001), and larger efficacy in reducing disability, as measured by the Rolland-Morris Disability Questionnaire (MD --1.54, 95\% CI --2.35 to --0.73; P<.001). Subgroup analyses showed that compared with usual care, mHealth using telephone calls significantly reduced pain intensity (MD --1.12, 95\% CI --1.71 to --0.53; P<.001) and disability score (MD --1.68, 95\% CI --2.74 to --0.63; P<.001). However, without the use of telephone calls, mHealth had no obvious advantage over usual care in improving pain intensity (MD --0.48, 95\% CI --1.16 to 0.20; P=.16) and the disability score (MD --0.41, 95\% CI --1.88 to 1.05; P=.58). The group that received a more sensitive feedback intervention showed a significantly reduced disability score (MD --4.30, 95\% CI --6.95 to --1.69; P=.001). Conclusions: The use of simultaneous mHealth and usual care interventions has better efficacy than usual care alone in reducing pain intensity and disability in patients with low back pain. Moreover, the results of subgroup analysis revealed that mHealth using telephone calls might play a positive role in improving pain intensity and disability in patients with low back pain. ",
doi="10.2196/26095",
url="https://mhealth.jmir.org/2021/6/e26095",
url="http://www.ncbi.nlm.nih.gov/pubmed/34114965"
}


@Article{info:doi/10.2196/25958,
author="Lauffenburger, C. Julie
and Barlev, A. Renee
and Sears, S. Ellen
and Keller, A. Punam
and McDonnell, E. Marie
and Yom-Tov, Elad
and Fontanet, P. Constance
and Hanken, Kaitlin
and Haff, Nancy
and Choudhry, K. Niteesh",
title="Preferences for mHealth Technology and Text Messaging Communication in Patients With Type 2 Diabetes: Qualitative Interview Study",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="11",
volume="23",
number="6",
pages="e25958",
keywords="diabetes",
keywords="technology",
keywords="mobile health",
keywords="medication adherence",
keywords="mobile phone",
abstract="Background: Individuals with diabetes need regular support to help them manage their diabetes on their own, ideally delivered via mechanisms that they already use, such as their mobile phones. One reason for the modest effectiveness of prior technology-based interventions may be that the patient perspective has been insufficiently incorporated. Objective: This study aims to understand patients' preferences for mobile health (mHealth) technology and how that technology can be integrated into patients' routines, especially with regard to medication use. Methods: We conducted semistructured qualitative individual interviews with patients with type 2 diabetes from an urban health care system to elicit and explore their perspectives on diabetes medication--taking behaviors, daily patterns of using mobile technology, use of mHealth technology for diabetes care, acceptability of text messages to support medication adherence, and preferred framing of information within text messages to support diabetes care. The interviews were digitally recorded and transcribed. The data were analyzed using codes developed by the study team to generate themes, with representative quotations selected as illustrations. Results: We conducted interviews with 20 participants, of whom 12 (60\%) were female and 9 (45\%) were White; in addition, the participants' mean glycated hemoglobin A1c control was 7.8 (SD 1.1). Overall, 5 key themes were identified: patients try to incorporate cues into their routines to help them with consistent medication taking; many patients leverage some form of technology as a cue to support adherence to medication taking and diabetes self-management behaviors; patients value simplicity and integration of technology solutions used for diabetes care, managing medications, and communicating with health care providers; some patients express reluctance to rely on mobile technology for these diabetes care behaviors; and patients believe they prefer positively framed communication, but communication preferences are highly individualized. Conclusions: The participants expressed some hesitation about using mobile technology in supporting diabetes self-management but have largely incorporated it or are open to incorporating it as a cue to make medication taking more automatic and less burdensome. When using technology to support diabetes self-management, participants exhibited individualized preferences, but overall, they preferred simple and positively framed communication. mHealth interventions may be improved by focusing on integrating them easily into daily routines and increasing the customization of content. ",
doi="10.2196/25958",
url="https://www.jmir.org/2021/6/e25958",
url="http://www.ncbi.nlm.nih.gov/pubmed/34114964"
}


@Article{info:doi/10.2196/25021,
author="Willems, H. Sofie
and Rao, Jyotsna
and Bhambere, Sailee
and Patel, Dipu
and Biggins, Yvonne
and Guite, W. Jessica",
title="Digital Solutions to Alleviate the Burden on Health Systems During a Public Health Care Crisis: COVID-19 as an Opportunity",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jun",
day="11",
volume="9",
number="6",
pages="e25021",
keywords="coronavirus",
keywords="digital health",
keywords="multiplatform",
keywords="chat",
keywords="symptom tracking",
keywords="well-being",
keywords="COVID-19",
keywords="online platform",
keywords="symptom",
keywords="monitoring",
keywords="follow-up",
doi="10.2196/25021",
url="https://mhealth.jmir.org/2021/6/e25021",
url="http://www.ncbi.nlm.nih.gov/pubmed/34033575"
}


@Article{info:doi/10.2196/25069,
author="Poort, Hanneke
and Ryan, Annelise
and MacDougall, Katelyn
and Malinowski, Paige
and MacDonald, Anna
and Markin, Zach
and Pirl, William
and Greer, Joseph
and Fasciano, Karen",
title="Feasibility and Acceptability of a Mobile Phone App Intervention for Coping With Cancer as a Young Adult: Pilot Trial and Thematic Analysis",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="11",
volume="23",
number="6",
pages="e25069",
keywords="mobile phone",
keywords="mobile phone application",
keywords="cancer",
keywords="feasibility",
abstract="Background: Many young adult patients do not receive adequate psychosocial services to help them cope with cancer. Objective: This study aims to assess the feasibility and acceptability of a smartphone app (iaya) intervention that was designed to create an engaged community of young adult patients and help them learn emotional coping skills. Methods: For this single-group pilot trial, 25 young adult patients aged 18-39 years who were receiving active cancer treatment were asked to use the iaya app for 12 weeks. To collect app use data, we used Mixpanel, an analytics platform for apps. Feasibility was assessed through rates of app sessions and the number of coping exercises engaged, and intervention acceptability was evaluated by using an app usability questionnaire and through qualitative interviews at study completion. We collected patient-reported outcome data at baseline and at week 12 to explore self-efficacy for coping with cancer, self-efficacy for managing emotions, perceived emotional support, and quality of life. Results: Baseline patient-reported outcome data indicated that participants scored relatively low on perceived emotional support but reasonably high on self-efficacy for coping with cancer and managing emotions as well as quality of life. Participants had a mean of 13 app sessions (SD 14) and 2 coping exercises (SD 3.83) in 12 weeks. Only 9\% (2/23) of participants met our combined feasibility definition of ?10 app sessions and ?3 coping skills from different categories. The participants' mean usability score was 73.7\% (SD 10.84), which exceeded our predefined threshold of ?70\%, and qualitative feedback was generally positive. Conclusions: Although perceived acceptable by patients, the iaya smartphone app did not meet the a priori feasibility criteria as a stand-alone app intervention. Future studies should screen participants for unmet coping needs and consider integrating the app as part of psychosocial care for young adult patients. ",
doi="10.2196/25069",
url="https://www.jmir.org/2021/6/e25069",
url="http://www.ncbi.nlm.nih.gov/pubmed/34114957"
}


@Article{info:doi/10.2196/24116,
author="Lv, Meina
and Wu, Tingting
and Jiang, Shaojun
and Chen, Wenjun
and Zhang, Jinhua",
title="Effects of Telemedicine and mHealth on Systolic Blood Pressure Management in Stroke Patients: Systematic Review and Meta-Analysis of Randomized Controlled Trials",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jun",
day="11",
volume="9",
number="6",
pages="e24116",
keywords="stroke",
keywords="systolic blood pressure",
keywords="mHealth",
keywords="telemedicine",
keywords="meta-analysis",
keywords="self-management",
abstract="Background: Stroke is a common, harmful disease with high recurrence and mortality rates. Uncontrolled blood pressure is an important and changeable risk factor for stroke recurrence. Telemedicine and mobile health (mHealth) interventions may have the potential to facilitate the control of blood pressure among stroke survivors, but their effect has not been established. Objective: This systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to estimate the effects of telemedicine and mHealth interventions on the control of systolic blood pressure among stroke survivors. Methods: The research literature published up to June 28, 2020, and consisting of RCTs related to telemedicine and mHealth interventions was searched in PubMed, EMBASE, Web of Science, and the Cochrane Library. The Cochrane risk of bias tool (RoB 2.0) was used to evaluate the quality of the studies. The Cochran Q test and I2 statistic were used to assess heterogeneity. Data were meta-analyzed using a random-effects model. Mean difference (MD) with 95\% CI and 95\% prediction interval (PI) were calculated. Results: In total, 9 RCTs with a total sample size of 1583 stroke survivors met the inclusion criteria. Compared with the usual care, telemedicine and mHealth had a significantly greater impact on the control of systolic blood pressure (MD --5.49; 95\% CI --7.87 to --3.10; P<.001; 95\% PI --10.46 to --0.51). A subgroup analysis showed that the intervention mode of telephone plus SMS text messaging (MD --9.09; 95\% CI --12.71 to --5.46; P<.001) or only telephone (MD --4.34; 95\% CI --6.55 to --2.13; P<.001; 95\% PI --7.24 to --1.45) had a greater impact on the control of systolic blood pressure than usual care. Among the stroke survivors with an intervention interval ?1 week (MD --6.51; 95\% CI --9.36 to --3.66; P<.001; 95\% PI --12.91 to --0.10) or a baseline systolic blood pressure ?140 mm Hg (MD --6.15; 95\% CI --9.44 to --2.86; P<.001; 95\% PI --13.55 to 1.26), the control of systolic blood pressure using telemedicine and mHealth was better than that of usual care. Conclusions: In general, telemedicine and mHealth reduced the systolic blood pressure of stroke survivors by an average of 5.49 mm Hg compared with usual care. Telemedicine and mHealth are a relatively new intervention mode with potential applications for the control of systolic blood pressure among stroke survivors, especially those with hypertensive stroke. ",
doi="10.2196/24116",
url="https://mhealth.jmir.org/2021/6/e24116",
url="http://www.ncbi.nlm.nih.gov/pubmed/34114961"
}


@Article{info:doi/10.2196/21728,
author="Houchen-Wolloff, Linzy
and Orme, Mark
and Barradell, Amy
and Clinch, Lisa
and Chaplin, Emma
and Gardiner, Nikki
and Singh, J. Sally",
title="Web-Based Self-management Program (SPACE for COPD) for Individuals Hospitalized With an Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Nonrandomized Feasibility Trial of Acceptability",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jun",
day="11",
volume="9",
number="6",
pages="e21728",
keywords="COPD",
keywords="telehealth",
keywords="digital health",
keywords="internet",
keywords="rehabilitation",
keywords="quantitative",
keywords="qualitative",
keywords="exercise",
abstract="Background: Hospital admissions due to the acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are costly for individuals and health services. Pulmonary rehabilitation (PR) is known to reduce hospital readmissions when delivered after hospitalization, but the uptake and completion of PR following hospitalization remains poor (<10\% of those eligible in the UK audit data). A web-based platform of the SPACE (Self-management Program of Activity Coping and Education) for COPD (chronic obstructive pulmonary disease) has previously shown promising results in patients with stable COPD but has not been tested following an AECOPD. Objective: This study aims to assess the feasibility and acceptability of a web-based self-management program. Methods: A nonrandomized feasibility study for patients with confirmed AECOPD who were deemed web literate was conducted. All patients consented during their hospitalization and received access to the website following discharge in addition to usual care. The program aims to facilitate patients to better understand and manage their condition through education and home-based exercises. Participants were asked to complete the Bristol COPD Knowledge Questionnaire at baseline and after 6 months. A total of 14 participants were also interviewed (n=8 completers; n=6 noncompleters) regarding their experiences with the web-based program and trial. The interviews were analyzed using thematic analysis. Results: In total, 2080 patients were screened for eligibility, of which 100 patients (age: mean 71.2 years, SD 9.3 years; male: 55/100, 55\%; forced expiratory volume in 1 second/forced vital capacity ratio: mean 0.46, SD 0.14; pack-years: mean 50.2, SD 31.0; current smokers: 35/100, 35\%) were recruited (4.8\% of those screened). The main reason for ineligibility was a lack of web literacy (1366/1980, 68.98\%). In total, 18\% (18/100) of patients had completed the web program by 6 months, with others still registered in the program (27/100, 27\%), and more than half did not register (55/100, 55\%). There was a mean change in Bristol COPD Knowledge Questionnaire scores at 6 months of 7.8 (SD 10.2) points. Qualitative interviews identified three main themes: preparing for, engagement with, and benefits of the study and program. A total of 57\% (57/100) accepted a referral to PR on discharge and 19\% (19/100) had completed the program after 6 months. Conclusions: On the basis of the challenges of recruiting, retaining, and engaging participants in a web-based self-management program, it is not a feasible approach to roll out widely. This study acknowledges that this is a challenging time for patients with an AECOPD to engage in exercise and self-management education. However, for patients who were able to engage in such an intervention, the completion rate of PR was double the previous audit estimates from the United Kingdom, disease knowledge improved, and the intervention was of value to patients. Trial Registration: ISRCTN Registry 13081008; https://www.isrctn.com/ISRCTN13081008 ",
doi="10.2196/21728",
url="https://mhealth.jmir.org/2021/6/e21728",
url="http://www.ncbi.nlm.nih.gov/pubmed/34114960"
}


@Article{info:doi/10.2196/24687,
author="Milani, Richard
and Chava, Pavan
and Wilt, Jonathan
and Entwisle, Jonathan
and Karam, Susan
and Burton, Jeffrey
and Blonde, Lawrence",
title="Improving Management of Type 2 Diabetes Using Home-Based Telemonitoring: Cohort Study",
journal="JMIR Diabetes",
year="2021",
month="Jun",
day="10",
volume="6",
number="2",
pages="e24687",
keywords="diabetes",
keywords="digital health",
keywords="ehealth",
keywords="digital medicine",
keywords="connected devices",
abstract="Background: Diabetes is present in 10.5\% of the US population and accounts for 14.3\% of all office-based physician visits made by adults. Despite this established office-based approach, the disease and its adverse outcomes including glycemic control and clinical events tend to worsen over time. Available home technology now provides accurate, reliable data that can be transmitted directly to the electronic medical record. Objective: This study aims to evaluate the impact of a virtual, home-based diabetes management program on clinical measures of diabetes control compared to usual care. Methods: We evaluated glycemic control and other diabetes-related measures after 1 year in 763 patients with type 2 diabetes enrolled into a home-based digital medicine diabetes program and compared them to 794 patients matched for age, sex, race, BMI, hemoglobin A1c (HbA1c), creatinine, estimated glomerular filtration rate, and insulin use in a usual care group after 1 year. Digital medicine patients completed questionnaires online, received medication management and lifestyle recommendations from a clinical pharmacist or advanced practice provider and a health coach, and were asked to submit blood glucose readings using a commercially available Bluetooth-enabled glucose meter that transmitted data directly to the electronic medical record. Results: After 1 year, usual care patients demonstrated no significant changes in HbA1c (mean 7.3, SE 1.7 to mean 7.3, SE 1.6; P=.41) or changes in the proportion of patients with HbA1c?9.0 (n=117, 15\% to n=113, 14\%; P=.51). Digital medicine patients demonstrated improvements in HbA1c (mean 7.3, SE 1.5 to mean 6.9, SE 1.2; P<.001) and significant changes in the proportion of patients with HbA1c?9.0 (n=107, 14\% to n=49, 6\%; P<.001), diabetes distress (n=198, 26\% to n=122, 16\%; P<.001), and hypoglycemic episodes (n=313, 41.1\% to n=91, 11.9\%; P<.001). Conclusions: A digital diabetes program is associated with significant improvement in glycemic control and other diabetes measures. The use of a virtual health intervention using connected devices was widely accepted across a broad range of ethnic diversity, ages, and levels of health literacy. ",
doi="10.2196/24687",
url="https://diabetes.jmir.org/2021/2/e24687",
url="http://www.ncbi.nlm.nih.gov/pubmed/34110298"
}


@Article{info:doi/10.2196/27102,
author="Osmanlliu, Esli
and Rafie, Edmond
and B{\'e}dard, Sylvain
and Paquette, Jesseca
and Gore, Genevieve
and Pomey, Marie-Pascale",
title="Considerations for the Design and Implementation of COVID-19 Contact Tracing Apps: Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jun",
day="9",
volume="9",
number="6",
pages="e27102",
keywords="COVID-19",
keywords="contact tracing",
keywords="exposure notification",
keywords="app",
keywords="design",
keywords="implementation",
keywords="participatory",
keywords="eHealth",
keywords="surveillance",
keywords="monitoring",
keywords="review",
abstract="Background: Given the magnitude and speed of SARS-CoV-2 transmission, achieving timely and effective manual contact tracing has been a challenging task. Early in the pandemic, contact tracing apps generated substantial enthusiasm due to their potential for automating tracing and reducing transmission rates while enabling targeted confinement strategies. However, although surveys demonstrate public interest in using such apps, their actual uptake remains limited. Their social acceptability is challenged by issues around privacy, fairness, and effectiveness, among other concerns. Objective: This study aims to examine the extent to which design and implementation considerations for contact tracing apps are detailed in the available literature, focusing on aspects related to participatory and responsible eHealth innovation, and synthesize recommendations that support the development of successful COVID-19 contact tracing apps and related eHealth technologies. Methods: Searches were performed on five databases, and articles were selected based on eligibility criteria. Papers pertaining to the design, implementation, or acceptability of contact tracing apps were included. Articles published since 2019, written in English or French, and for which the full articles were available were considered eligible for analysis. To assess the scope of the knowledge found in the current literature, we used three complementary frameworks: (1) the Holistic Framework to Improve the Uptake and Impact of eHealth Technologies, (2) the Montreal model, and (3) the Responsible Innovation in Health Assessment Tool. Results: A total of 63 articles qualified for the final analysis. Less than half of the selected articles cited the need for a participatory process (n=25, 40\%), which nonetheless was the most frequently referenced item of the Framework to Improve the Uptake and Impact of eHealth Technologies. Regarding the Montreal model, stakeholder consultation was the most frequently described level of engagement in the development of contact tracing apps (n=24, 38\%), while collaboration and partnership were cited the least (n=2, 3\%). As for the Responsible Innovation in Health framework, all the articles (n=63, 100\%) addressed population health, whereas only 2\% (n=1) covered environmental considerations. Conclusions: Most studies lacked fundamental aspects of eHealth development and implementation. Our results demonstrate that stakeholders of COVID-19 contact tracing apps lack important information to be able to critically appraise this eHealth innovation. This may have contributed to the modest uptake of contact tracing apps worldwide. We make evidence-informed recommendations regarding data management, communication, stakeholder engagement, user experience, and implementation strategies for the successful and responsible development of contact tracing apps. ",
doi="10.2196/27102",
url="https://mhealth.jmir.org/2021/6/e27102",
url="http://www.ncbi.nlm.nih.gov/pubmed/34038376"
}


@Article{info:doi/10.2196/27496,
author="Bilger, Marcel
and Koong, Leng Agnes Ying
and Phoon, Yun Ian Kwong
and Tan, Chuan Ngiap
and Bahadin, Juliana
and Bairavi, Joann
and Batcagan-Abueg, M. Ada Portia
and Finkelstein, A. Eric",
title="Wireless Home Blood Pressure Monitoring System With Automatic Outcome-Based Feedback and Financial Incentives to Improve Blood Pressure in People With Hypertension: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Jun",
day="9",
volume="10",
number="6",
pages="e27496",
keywords="telemedicine",
keywords="home blood pressure monitoring",
keywords="behavior change",
keywords="hypertension",
keywords="financial incentive",
keywords="medication adherence",
keywords="remote titration",
abstract="Background: Hypertension is prevalent in Singapore and is a major risk factor for cardiovascular morbidity and mortality and increased health care costs. Strategies to lower blood pressure include lifestyle modifications and home blood pressure monitoring. Nonetheless, adherence to home blood pressure monitoring remains low. This protocol details an algorithm for remote management of primary care patients with hypertension. Objective: The objective of this study was to determine whether wireless home blood pressure monitoring with or without financial incentives is more effective at reducing systolic blood pressure than nonwireless home blood pressure monitoring (usual care). Methods: This study was designed as a randomized controlled open-label superiority study. A sample size of 224 was required to detect differences of 10 mmHg in average systolic blood pressure. Participants were to be randomized, in the ratio of 2:3:3, into 1 of 3 parallel study arms :(1) usual care, (2) wireless home blood pressure monitoring, and (3) wireless home blood pressure monitoring with financial incentives. The primary outcome was the mean change in systolic blood pressure at month 6. The secondary outcomes were the mean reduction in diastolic blood pressure, cost of financial incentives, time taken for the intervention, adherence to home blood pressure monitoring, effectiveness of the framing of financial incentives in decreasing nonadherence to blood pressure self-monitoring and the adherence to antihypertensive medication at month 6. Results: This study was approved by SingHealth Centralised Institutional Review Board and registered. Between January 24, 2018 and July 10, 2018, 42 participants (18.75\% of the required sample size) were enrolled, and 33 participants completed the month 6 assessment by January 31, 2019. Conclusions: Due to unforeseen events, the study was stopped prematurely; therefore, no results are available. Depending on the blood pressure information received from the patients, the algorithm can trigger immediate blood pressure advice (eg, Accident and Emergency department visit advice for extremely high blood pressure), weekly feedback on blood pressure monitoring, medication titration, or skipping of routine follow-ups. The inclusion of financial incentives framed as health capital provides a novel idea on how to promote adherence to remote monitoring, and ultimately, improve chronic disease management. Trial Registration: ClinicalTrials.gov NCT 03368417; https://clinicaltrials.gov/ct2/show/NCT03368417 International Registered Report Identifier (IRRID): DERR1-10.2196/27496 ",
doi="10.2196/27496",
url="https://www.researchprotocols.org/2021/6/e27496",
url="http://www.ncbi.nlm.nih.gov/pubmed/34106085"
}


@Article{info:doi/10.2196/20330,
author="Odukoya, Ololade Oluwakemi
and Ohazurike, Chidumga
and Akanbi, Maxwell
and O'Dwyer, C. Linda
and Isikekpei, Brenda
and Kuteyi, Ewemade
and Ameh, O. Idaomeh
and Osadiaye, Olanlesi
and Adebayo, Khadijat
and Usinoma, Adewunmi
and Adewole, Ajoke
and Odunukwe, Nkiruka
and Okuyemi, Kola
and Kengne, Pascal Andre",
title="mHealth Interventions for Treatment Adherence and Outcomes of Care for Cardiometabolic Disease Among Adults Living With HIV: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jun",
day="9",
volume="9",
number="6",
pages="e20330",
keywords="mHealth",
keywords="HIV",
keywords="cardiometabolic disease",
keywords="text messaging",
keywords="mobile",
keywords="systematic review",
keywords="telephone calls",
keywords="wearable devices",
keywords="smartphones",
keywords="desktop",
keywords="web-based",
keywords="mobile apps",
abstract="Background: The success of antiretroviral therapy has led to an increase in life expectancy and an associated rise in the risk of cardiometabolic diseases (CMDs) among people living with HIV. Objective: Our aim was to conduct a systematic review to synthesize the existing literature on the patterns of use and effects of mobile health (mHealth) interventions for improving treatment adherence and outcomes of care for CMD among people living with HIV. Methods: A systematic search of multiple databases, including PubMed-MEDLINE, Embase, CINAHL, Scopus, Web of Science, African Journals online, ClinicalTrials.gov, and the World Health Organization Global Index Medicus of peer-reviewed articles, was conducted with no date or language restrictions. Unpublished reports on mHealth interventions for treatment adherence and outcomes of care for CMD among adults living with HIV were also included in this review. Studies were included if they had at least 1 component that used an mHealth intervention to address treatment adherence or 1 or more of the stated outcomes of care for CMD among people living with HIV. Results: Our search strategy yielded 1148 unique records. In total, 10 articles met the inclusion criteria and were included in this review. Of the 10 studies, only 4 had published results. The categories of mHealth interventions ranged from short messaging, telephone calls, and wearable devices to smartphone and desktop web-based mobile apps. Across the different categories of interventions, there were no clear patterns in terms of consistency in the use of a particular intervention, as most studies (9/10, 90\%) assessed a combination of mHealth interventions. Short messaging and telephone calls were however the most common interventions. Half of the studies (5/10, 50\%) reported on outcomes that were indirectly linked to CMD, and none of them provided reliable evidence for evaluating the effectiveness of mHealth interventions for treatment adherence and outcomes of care for CMD among people living with HIV. Conclusions: Due to the limited number of studies and the heterogeneity of interventions and outcome measures in the studies, no definitive conclusions could be drawn on the patterns of use and effects of mHealth interventions for treatment adherence and outcomes of care for CMD among people living with HIV. We therefore recommend that future trials should focus on standardized outcomes for CMD. We also suggest that future studies should consider having a longer follow-up period in order to determine the long-term effects of mHealth interventions on CMD outcomes for people living with HIV. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42018086940; https://www.crd.york.ac.uk/prospero/display\_record.php?ID=CRD42018086940 ",
doi="10.2196/20330",
url="https://mhealth.jmir.org/2021/6/e20330",
url="http://www.ncbi.nlm.nih.gov/pubmed/34106075"
}


@Article{info:doi/10.2196/24952,
author="Maddison, Ralph
and Jiang, Yannan
and Stewart, Ralph
and Scott, Tony
and Kerr, Andrew
and Whittaker, Robyn
and Benatar, Jocelyn
and Rolleston, Anna
and Estabrooks, Paul
and Dale, Leila",
title="An Intervention to Improve Medication Adherence in People With Heart Disease (Text4HeartII): Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jun",
day="9",
volume="9",
number="6",
pages="e24952",
keywords="cardiovascular disease",
keywords="self-management",
keywords="text messaging",
keywords="risk factors",
abstract="Background: Mobile health technologies have the potential to improve the reach and delivery of interventions for promoting long-term secondary prevention of coronary heart disease. Objective: This study aims to determine the effectiveness of an SMS text messaging intervention (Text4HeartII) for improving adherence to medication and lifestyle changes over and above usual care in people with coronary heart disease at 24 and 52 weeks. Methods: A two-arm, parallel, randomized controlled trial was conducted in New Zealand. Participants with a recent acute coronary syndrome were randomized to receive usual cardiac services alone (control, n=153) or a 24-week SMS text message program for supporting self-management plus usual cardiac services (n=153). The primary outcome was adherence to medication at 24 weeks, defined as a medication possession ratio of 80\% or more for aspirin, statin, and antihypertensive therapy. Secondary outcomes included medication possession ratio at 52 weeks, self-reported medication adherence, adherence to healthy lifestyle behaviors, and health-related quality of life at 24 and 52 weeks. Results: Participants were predominantly male (113/306, 80.3\%) and European New Zealanders (210/306, 68.6\%), with a mean age of 61 years (SD 11 years). Groups were comparable at baseline. National hospitalization and pharmacy dispensing recordswere available for all participants; 92\% (282/306, 92.1\%) of participants completed a 24-week questionnaire and 95.1\% (291/306) of participants completed a 52-week questionnaire. Adherence with 3 medication classes were lower in the intervention group than in the control group (87/153, 56.8\% vs 105/153, 68.6\%, odds ratio 0.60, 95\% CI 0.38-0.96; P=.03) and 52 weeks (104/153, 67.9\% vs 83/153, 54.2\%; odds ratio 0.56, 95\% CI 0.35-0.89; P=.01). Self-reported medication adherence scores showed the same trend at 52 weeks (mean difference 0.3; 95\% CI 0.01-0.59; P=.04). Moreover, self-reported adherence to health-related behaviors was similar between groups. Conclusions: Text4HeartII did not improve dispensed medication or adherence to a favorable lifestyle over and above usual care. This finding contrasts with previous studies and highlights that the benefits of text interventions may depend on the context in which they are used. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616000422426; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370398. International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-2468-z ",
doi="10.2196/24952",
url="https://mhealth.jmir.org/2021/6/e24952",
url="http://www.ncbi.nlm.nih.gov/pubmed/34106081"
}


@Article{info:doi/10.2196/26605,
author="Huang, Ching-Chang
and Chen, Ying-Hsien
and Hung, Chi-Sheng
and Lee, Jen-Kuang
and Hsu, Tse-Pin
and Wu, Hui-Wen
and Chuang, Pao-Yu
and Chen, Ming-Fong
and Ho, Yi-Lwun",
title="The Association Between Short-term Exposure to Ambient Air Pollution and Patient-Level Home Blood Pressure Among Patients With Chronic Cardiovascular Diseases in a Web-Based Synchronous Telehealth Care Program: Retrospective Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Jun",
day="8",
volume="7",
number="6",
pages="e26605",
keywords="ambient air pollution",
keywords="blood pressure",
keywords="cardiovascular disease",
keywords="chronic disease",
keywords="climate",
keywords="home blood pressure",
keywords="particulate matter",
keywords="pollution",
keywords="remote monitoring",
keywords="telehealth care",
keywords="telemonitoring",
keywords="weather",
abstract="Background: The association between short-term exposure to ambient air pollution and blood pressure has been inconsistent, as reported in the literature. Objective: This study aimed to investigate the relationship between short-term ambient air pollution exposure and patient-level home blood pressure (HBP). Methods: Patients with chronic cardiovascular diseases from a telehealth care program at a university-affiliated hospital were enrolled as the study population. HBP was measured by patients or their caregivers. Hourly meteorological data (including temperature, relative humidity, wind speed, and rainfall) and ambient air pollution monitoring data (including CO, NO2, particulate matter with a diameter of <10 {\textmu}m, particulate matter with a diameter of <2.5 {\textmu}m, and SO2) during the same time period were obtained from the Central Weather Bureau and the Environmental Protection Administration in Taiwan, respectively. A stepwise multivariate repeated generalized estimating equation model was used to assess the significant factors for predicting systolic and diastolic blood pressure (SBP and DBP). Results: A total of 253 patients and 110,715 HBP measurements were evaluated in this study. On multivariate analysis, demographic, clinical, meteorological factors, and air pollutants significantly affected the HBP (both SBP and DBP). All 5 air pollutants evaluated in this study showed a significant, nonlinear association with both home SBP and DBP. Compared with demographic and clinical factors, environmental factors (meteorological factors and air pollutants) played a minor yet significant role in the regulation of HBP. Conclusions: Short-term exposure to ambient air pollution significantly affects HBP in patients with chronic cardiovascular disease. ",
doi="10.2196/26605",
url="https://publichealth.jmir.org/2021/6/e26605",
url="http://www.ncbi.nlm.nih.gov/pubmed/34100764"
}


@Article{info:doi/10.2196/29242,
author="Haque, M. Munirul
and Rabbani, Masud
and Dipal, Das Dipranjan
and Zarif, Islam Md Ishrak
and Iqbal, Anik
and Schwichtenberg, Amy
and Bansal, Naveen
and Soron, Rashid Tanjir
and Ahmed, Ishtiaque Syed
and Ahamed, Iqbal Sheikh",
title="Informing Developmental Milestone Achievement for Children With Autism: Machine Learning Approach",
journal="JMIR Med Inform",
year="2021",
month="Jun",
day="8",
volume="9",
number="6",
pages="e29242",
keywords="autism spectrum disorders",
keywords="machine learning",
keywords="digital health",
keywords="mobile health",
keywords="mhealth",
keywords="predictive modeling",
keywords="milestone parameters",
keywords="Autism and Developmental Disabilities Monitoring (ADDM)",
keywords="early intervention",
abstract="Background: Care for children with autism spectrum disorder (ASD) can be challenging for families and medical care systems. This is especially true in low- and- middle-income countries such as Bangladesh. To improve family--practitioner communication and developmental monitoring of children with ASD, mCARE (Mobile-Based Care for Children with Autism Spectrum Disorder Using Remote Experience Sampling Method) was developed. Within this study, mCARE was used to track child milestone achievement and family sociodemographic assets to inform mCARE feasibility/scalability and family asset--informed practitioner recommendations. Objective: The objectives of this paper are threefold. First, it documents how mCARE can be used to monitor child milestone achievement. Second, it demonstrates how advanced machine learning models can inform our understanding of milestone achievement in children with ASD. Third, it describes family/child sociodemographic factors that are associated with earlier milestone achievement in children with ASD (across 5 machine learning models). Methods: Using mCARE-collected data, this study assessed milestone achievement in 300 children with ASD from Bangladesh. In this study, we used 4 supervised machine learning algorithms (decision tree, logistic regression, K-nearest neighbor [KNN], and artificial neural network [ANN]) and 1 unsupervised machine learning algorithm (K-means clustering) to build models of milestone achievement based on family/child sociodemographic details. For analyses, the sample was randomly divided in half to train the machine learning models and then their accuracy was estimated based on the other half of the sample. Each model was specified for the following milestones: Brushes teeth, Asks to use the toilet, Urinates in the toilet or potty, and Buttons large buttons. Results: This study aimed to find a suitable machine learning algorithm for milestone prediction/achievement for children with ASD using family/child sociodemographic characteristics. For Brushes teeth, the 3 supervised machine learning models met or exceeded an accuracy of 95\% with logistic regression, KNN, and ANN as the most robust sociodemographic predictors. For Asks to use toilet, 84.00\% accuracy was achieved with the KNN and ANN models. For these models, the family sociodemographic predictors of ``family expenditure'' and ``parents' age'' accounted for most of the model variability. The last 2 parameters, Urinates in toilet or potty and Buttons large buttons, had an accuracy of 91.00\% and 76.00\%, respectively, in ANN. Overall, the ANN had a higher accuracy (above {\textasciitilde}80\% on average) among the other algorithms for all the parameters. Across the models and milestones, ``family expenditure,'' ``family size/type,'' ``living places,'' and ``parent's age and occupation'' were the most influential family/child sociodemographic factors. Conclusions: mCARE was successfully deployed in a low- and middle-income country (ie, Bangladesh), providing parents and care practitioners a mechanism to share detailed information on child milestones achievement. Using advanced modeling techniques this study demonstrates how family/child sociodemographic elements can inform child milestone achievement. Specifically, families with fewer sociodemographic resources reported later milestone attainment. Developmental science theories highlight how family/systems can directly influence child development and this study provides a clear link between family resources and child developmental progress. Clinical implications for this work could include supporting the larger family system to improve child milestone achievement. ",
doi="10.2196/29242",
url="https://medinform.jmir.org/2021/6/e29242",
url="http://www.ncbi.nlm.nih.gov/pubmed/33984830"
}


@Article{info:doi/10.2196/28882,
author="Trettin, Bettina
and Danbj{\o}rg, Boe Dorthe
and Andersen, Flemming
and Feldman, Steven
and Agerskov, Hanne",
title="An mHealth App to Support Patients With Psoriasis in Relation to Follow-up Consultations: Qualitative Study",
journal="JMIR Dermatol",
year="2021",
month="Jun",
day="8",
volume="4",
number="1",
pages="e28882",
keywords="psoriasis",
keywords="teledermatology",
keywords="qualitative",
keywords="video consultations",
keywords="app",
keywords="participatory design",
keywords="mHealth",
keywords="telehealth",
keywords="patient-physician relationship",
keywords="dermatology",
abstract="Background: Teledermatology has the potential to help deliver health care by transforming the relationship between patients and health care professionals (HCPs), shifting the power of consultation so that patients can become more informed, assertive, and involved in their care. Mobile health (mHealth) is a promising and reliable tool for the long-term management of patients with psoriasis on systemic treatment. In an attempt to facilitate a more patient-centered approach in clinical practice, we designed and developed an mHealth solution to support patients with self-management and empowerment. Objective: The aim of this study is to explore the experiences and perceptions of patients and health care professionals of using an mHealth solution that was developed using a participatory design approach. Methods: This was an exploratory qualitative study. Data were collected through semistructured interviews with patients and focus group interviews with HCPs. Results: All participants found it easy to use the mHealth solution, and the patients found it convenient. Patients' reflexivity was improved because they could prepare ahead of consultations. Video consultations provided patients with a degree of freedom in their everyday lives, with not having to attend in-person visits. Among the HCPs, there were concerns regarding their medical responsibilities, as they could not assess the patients' skin as they used to. The mHealth solution required new workflows and procedures that were not part of the existing consultation routines. Conclusions: The mHealth solution can strengthen the relationship between HCPs and patients and facilitate patients to become more active in their care. Alignment and structure in relation to the selection of eligible patient candidates for being offered the mHealth solution could reduce social health inequalities. In addition, video consultations changed HCPs' work practice, necessitating new types of skills to communicate with patients. ",
doi="10.2196/28882",
url="https://derma.jmir.org/2021/1/e28882",
url="http://www.ncbi.nlm.nih.gov/pubmed/37632803"
}


@Article{info:doi/10.2196/16304,
author="Mascheroni, Alessandro
and Choe, Kyoung Eun
and Luo, Yuhan
and Marazza, Michele
and Ferlito, Clara
and Caverzasio, Serena
and Mezzanotte, Francesco
and Kaelin-Lang, Alain
and Faraci, Francesca
and Puiatti, Alessandro
and Ratti, Luca Pietro",
title="The SleepFit Tablet Application for Home-Based Clinical Data Collection in Parkinson Disease: User-Centric Development and Usability Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jun",
day="8",
volume="9",
number="6",
pages="e16304",
keywords="Parkinson disease",
keywords="ecological momentary assessment",
keywords="finger-tapping test",
keywords="subjective scales",
keywords="sleep diaries",
keywords="tablet application",
keywords="home-based system",
abstract="Background: Parkinson disease (PD) is a common, multifaceted neurodegenerative disorder profoundly impacting patients' autonomy and quality of life. Assessment in real-life conditions of subjective symptoms and objective metrics of mobility and nonmotor symptoms such as sleep disturbance is strongly advocated. This information would critically guide the adaptation of antiparkinsonian medications and nonpharmacological interventions. Moreover, since the spread of the COVID-19 pandemic, health care practices are being reshaped toward a more home-based care. New technologies could play a pivotal role in this new approach to clinical care. Nevertheless, devices and information technology tools might be unhandy for PD patients, thus dramatically limiting their widespread employment. Objective: The goals of the research were development and usability evaluation of an application, SleepFit, for ecological momentary assessment of objective and subjective clinical metrics at PD patients' homes, and as a remote tool for researchers to monitor patients and integrate and manage data. Methods: An iterative and user-centric strategy was employed for the development of SleepFit. The core structure of SleepFit consists of (1) an electronic finger-tapping test; (2) motor, sleepiness, and emotional subjective scales; and (3) a sleep diary. Applicable design, ergonomic, and navigation principles have been applied while tailoring the application to the specific patient population. Three progressively enhanced versions of the application (alpha, v1.0, v2.0) were tested by a total of 56 patients with PD who were asked to perform multiple home assessments 4 times per day for 2 weeks. Patient compliance was calculated as the proportion of completed tasks out of the total number of expected tasks. Satisfaction on the latest version (v2.0) was evaluated as potential willingness to use SleepFit again after the end of the study. Results: From alpha to v1.0, SleepFit was improved in graphics, ergonomics, and navigation, with automated flows guiding the patients in performing tasks throughout the 24 hours, and real-time data collection and consultation were made possible thanks to a remote web portal. In v2.0, the kiosk-mode feature restricts the use of the tablet to the SleepFit application only, thus preventing users from accidentally exiting the application. A total of 52 (4 dropouts) patients were included in the analyses. Overall compliance (all versions) was 88.89\% (5707/6420). SleepFit was progressively enhanced and compliance increased from 87.86\% (2070/2356) to 89.92\% (2899/3224; P=.04). Among the patients who used v2.0, 96\% (25/26) declared they would use SleepFit again. Conclusions: SleepFit can be considered a state-of-the-art home-based system that increases compliance in PD patients, ensures high-quality data collection, and works as a handy tool for remote monitoring and data management in clinical research. Thanks to its user-friendliness and modular structure, it could be employed in other clinical studies with minimum adaptation efforts. Trial Registration: ClinicalTrials.gov NCT02723396; https://clinicaltrials.gov/ct2/show/NCT02723396 ",
doi="10.2196/16304",
url="https://mhealth.jmir.org/2021/6/e16304",
url="http://www.ncbi.nlm.nih.gov/pubmed/34100767"
}


@Article{info:doi/10.2196/26143,
author="Andersson, Ulrika
and Bengtsson, Ulrika
and Ranerup, Agneta
and Midl{\"o}v, Patrik
and Kjellgren, Karin",
title="Patients and Professionals as Partners in Hypertension Care: Qualitative Substudy of a Randomized Controlled Trial Using an Interactive Web-Based System Via Mobile Phone",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="3",
volume="23",
number="6",
pages="e26143",
keywords="eHealth",
keywords="digital health",
keywords="hypertension",
keywords="mobile phones",
keywords="patient-professional partnership",
keywords="person-centered care",
keywords="self-management",
abstract="Background: The use of technology has the potential to support the patient{\textasciiacute}s active participation regarding treatment of hypertension. This might lead to changes in the roles of the patient and health care professional and affect the partnership between them. Objective: The aim of this qualitative study was to explore the partnership between patients and health care professionals and the roles of patients and professionals in hypertension management when using an interactive web-based system for self-management of hypertension via the patient's own mobile phone. Methods: Focus group interviews were conducted with 22 patients and 15 professionals participating in a randomized controlled trial in Sweden aimed at lowering blood pressure (BP) using an interactive web-based system via mobile phones. The interviews were audiorecorded and transcribed and analyzed using thematic analysis. Results: Three themes were identified: the technology, the patient, and the professional. The technology enabled documentation of BP treatment, mainly for sharing knowledge between the patient and the professional. The patients gained increased knowledge of BP values and their relation to daily activities and treatment. They were able to narrate about their BP treatment and take a greater responsibility, inspired by new insights and motivation for lifestyle changes. Based on the patient's understanding of hypertension, professionals could use the system as an educational tool and some found new ways of communicating BP treatment with patients. Some reservations were raised about using the system, that it might be too time-consuming to function in clinical practice and that too much measuring could result in stress for the patient and an increased workload for the professionals. In addition, not all professionals and patients had adopted the instructions regarding the use of the system, resulting in less realization of its potential. Conclusions: The use of the system led to the patients taking on a more active role in their BP treatment, becoming more of an expert of their BP. When using the system as intended, the professionals experienced it as a useful resource for communication regarding BP and lifestyle. Patients and professionals described a consultation on more equal grounds. The use of technology in hypertension management can promote a constructive and person-centered partnership between patient and professional. However, implementation of a new way of working should bring benefits and not be considered a burden for the professionals. To establish a successful partnership, both the patient and the professional need to be motivated toward a new way of working. Trial Registration: ClinicalTrials.gov NCT03554382; https://clinicaltrials.gov/ct2/show/NCT03554382 ",
doi="10.2196/26143",
url="https://www.jmir.org/2021/6/e26143",
url="http://www.ncbi.nlm.nih.gov/pubmed/34081021"
}


@Article{info:doi/10.2196/25138,
author="Rodriguez-Le{\'o}n, Ciro
and Villalonga, Claudia
and Munoz-Torres, Manuel
and Ruiz, R. Jonatan
and Banos, Oresti",
title="Mobile and Wearable Technology for the Monitoring of Diabetes-Related Parameters: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jun",
day="3",
volume="9",
number="6",
pages="e25138",
keywords="diabetes",
keywords="monitoring",
keywords="passive sensing",
keywords="smartphone",
keywords="wearable",
keywords="mobile phone",
abstract="Background: Diabetes mellitus is a metabolic disorder that affects hundreds of millions of people worldwide and causes several million deaths every year. Such a dramatic scenario puts some pressure on administrations, care services, and the scientific community to seek novel solutions that may help control and deal effectively with this condition and its consequences. Objective: This study aims to review the literature on the use of modern mobile and wearable technology for monitoring parameters that condition the development or evolution of diabetes mellitus. Methods: A systematic review of articles published between January 2010 and July 2020 was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Manuscripts were identified through searching the databases Web of Science, Scopus, and PubMed as well as through hand searching. Manuscripts were included if they involved the measurement of diabetes-related parameters such as blood glucose level, performed physical activity, or feet condition via wearable or mobile devices. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. Results: The search yielded 1981 articles. A total of 26 publications met the eligibility criteria and were included in the review. Studies predominantly used wearable devices to monitor diabetes-related parameters. The accelerometer was by far the most used sensor, followed by the glucose monitor and heart rate monitor. Most studies applied some type of processing to the collected data, mainly consisting of statistical analysis or machine learning for activity recognition, finding associations among health outcomes, and diagnosing conditions related to diabetes. Few studies have focused on type 2 diabetes, even when this is the most prevalent type and the only preventable one. None of the studies focused on common diabetes complications. Clinical trials were fairly limited or nonexistent in most of the studies, with a common lack of detail about cohorts and case selection, comparability, and outcomes. Explicit endorsement by ethics committees or review boards was missing in most studies. Privacy or security issues were seldom addressed, and even if they were addressed, they were addressed at a rather insufficient level. Conclusions: The use of mobile and wearable devices for the monitoring of diabetes-related parameters shows early promise. Its development can benefit patients with diabetes, health care professionals, and researchers. However, this field is still in its early stages. Future work must pay special attention to privacy and security issues, the use of new emerging sensor technologies, the combination of mobile and clinical data, and the development of validated clinical trials. ",
doi="10.2196/25138",
url="https://mhealth.jmir.org/2021/6/e25138",
url="http://www.ncbi.nlm.nih.gov/pubmed/34081010"
}


@Article{info:doi/10.2196/27027,
author="Ray, Katherine Mary
and McMichael, Alana
and Rivera-Santana, Maria
and Noel, Jacob
and Hershey, Tamara",
title="Technological Ecological Momentary Assessment Tools to Study Type 1 Diabetes in Youth: Viewpoint of Methodologies",
journal="JMIR Diabetes",
year="2021",
month="Jun",
day="3",
volume="6",
number="2",
pages="e27027",
keywords="ecological momentary assessment",
keywords="continuous glucose monitoring",
keywords="actigraphy",
keywords="accelerometer",
keywords="ambulatory blood pressure monitoring",
keywords="personal digital assistant",
keywords="mobile phone",
keywords="smartphone",
keywords="mHealth",
doi="10.2196/27027",
url="https://diabetes.jmir.org/2021/2/e27027",
url="http://www.ncbi.nlm.nih.gov/pubmed/34081017"
}


@Article{info:doi/10.2196/24509,
author="Ho, Kendall
and Novak Lauscher, Helen
and Cordeiro, Jennifer
and Hawkins, Nathaniel
and Scheuermeyer, Frank
and Mitton, Craig
and Wong, Hubert
and McGavin, Colleen
and Ross, Dianne
and Apantaku, Glory
and Karim, Ehsan Mohammad
and Bhullar, Amrit
and Abu-Laban, Riyad
and Nixon, Suzanne
and Smith, Tyler",
title="Testing the Feasibility of Sensor-Based Home Health Monitoring (TEC4Home) to Support the Convalescence of Patients With Heart Failure: Pre--Post Study",
journal="JMIR Form Res",
year="2021",
month="Jun",
day="3",
volume="5",
number="6",
pages="e24509",
keywords="telemonitoring",
keywords="heart failure",
keywords="home health monitoring",
keywords="technology",
keywords="telehealth",
keywords="emergency care",
keywords="community care",
keywords="emergency department",
keywords="quality of life",
keywords="self-efficacy",
abstract="Background: Patients with heart failure (HF) can be affected by disabling symptoms and low quality of life. Furthermore, they may frequently need to visit the emergency department or be hospitalized due to their condition deteriorating. Home telemonitoring can play a role in tracking symptoms, reducing hospital visits, and improving quality of life. Objective: Our objective was to conduct a feasibility study of a home health monitoring (HHM) solution for patients with HF in British Columbia, Canada, to prepare for conducting a randomized controlled trial. Methods: Patients with HF were recruited from 3 urban hospitals and provided with HHM technology for 60 days of monitoring postdischarge. Participants were asked to monitor their weight, blood pressure, and heart rate and to answer symptomology questions via Bluetooth sensors and a tablet computer each day. A monitoring nurse received this data and monitored the patient's condition. In our evaluation, the primary outcome was the combination of unscheduled emergency department revisits of discharged participants or death within 90 days. Secondary outcomes included 90-day hospital readmissions, patient quality of life (as measured by Veterans Rand 12-Item Health Survey and Kansas City Cardiomyopathy Scale), self-efficacy (as measured by European Heart Failure Self-Care Behaviour Scale 9), end-user experience, and health system cost-effectiveness including cost reduction and hospital bed capacity. In this feasibility study, we also tested the recruitment strategy, clinical protocols, evaluation framework, and data collection methods. Results: Seventy participants were enrolled into this trial. Participant engagement to monitoring was measured at 94\% (N=70; ie, data submitted 56/60 days on average). Our evaluation framework allowed us to collect sound data, which also showed encouraging trends: a 79\% reduction of emergency department revisits post monitoring, an 87\% reduction in hospital readmissions, and a 60\% reduction in the median hospital length of stay (n=36). Cost of hospitalization for participants decreased by 71\%, and emergency department visit costs decreased by 58\% (n=30). Overall health system costs for our participants showed a 56\% reduction post monitoring (n=30). HF-specific quality of life (Kansas City Cardiomyopathy Scale) scores showed a significant increase of 101\% (n=35) post monitoring (P<.001). General quality of life (Veterans Rand 12-Item Health Survey) improved by 19\% (n=35) on the mental component score (P<.001) and 19\% (n=35) on the physical component score (P=.02). Self-efficacy improved by 6\% (n=35). Interviews with participants revealed that they were satisfied overall with the monitoring program and its usability, and participants reported being more engaged, educated, and involved in their self-management. Conclusions: Results from this small-sample feasibility study suggested that our HHM intervention can be beneficial in supporting patients post discharge. Additionally, key insights from the trial allowed us to refine our methods and procedures, such as shifting our recruitment methods to in-patient wards and increasing our scope of data collection. Although these findings are promising, a more rigorous trial design is required to test the true efficacy of the intervention. The results from this feasibility trial will inform our next step as we proceed with a randomized controlled trial across British Columbia. Trial Registration: ClinicalTrials.gov NCT03439384; https://clinicaltrials.gov/ct2/show/NCT03439384 ",
doi="10.2196/24509",
url="https://formative.jmir.org/2021/6/e24509",
url="http://www.ncbi.nlm.nih.gov/pubmed/34081015"
}


@Article{info:doi/10.2196/18167,
author="Salari, Raheleh
and R Niakan Kalhori, Sharareh
and GhaziSaeedi, Marjan
and Jeddi, Marjan
and Nazari, Mahin
and Fatehi, Farhad",
title="Mobile-Based and Cloud-Based System for Self-management of People With Type 2 Diabetes: Development and Usability Evaluation",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="2",
volume="23",
number="6",
pages="e18167",
keywords="type 2 diabetes",
keywords="mobile health",
keywords="mHealth",
keywords="mobile app, self-management",
keywords="behavior change",
abstract="Background: As the use of smartphones and mobile apps is increasing, mobile health (mHealth) can be used as a cost-effective option to provide behavioral interventions aimed at educating and promoting self-management for chronic diseases such as diabetes. Although many mobile software apps have been developed for this purpose, they usually lack a theoretical foundation and do not follow the guidelines suggested for evidence-based practice. Therefore, this study aimed to develop a theory-based self-management app for people with type 2 diabetes and provide an app based on a needs assessment analysis. Objective: This paper describes the development and usability evaluation of a cloud-based and mobile-based diabetes self-management app designed to help people with diabetes change their health behavior and also enable remote monitoring by health care providers. Methods: The development of this mHealth solution comprises 3 phases. Phase I: feature extraction of the Android apps that had a user rating of 4 stars or more and review of papers related to mHealth for diabetes self-management were performed followed by seeking expert opinions about the extracted features to determine the essential features of the app. Phase II: design and implementation included selecting which behavioral change and structural theories were to be applied the app and design of the website. Phase III: evaluation of the usability and user experience of the mobile app by people with diabetes and the portal by health care providers using the User Experience Questionnaire. Results: The developed mobile app includes modules that support several features. A person's data were entered or collected and viewed in the form of graphs and tables. The theoretical foundation of behavioral intervention is the transtheoretical model. Users were able to receive customized messages based on the behavioral change preparation stage using the Kreuter algorithm. The clinician's portal was used by health care providers to monitor the patients. The results of the usability evaluation revealed overall user satisfaction with the app. Conclusions: Mobile- and cloud-based systems may be an effective tool for facilitating the modification of self-management of chronic care. The results of this study showed that the usability of mobile- and cloud-based systems can be satisfactory and promising. Given that the study used a behavioral model, assessment of the effectiveness of behavior change over time requires further research with long-term follow-up. ",
doi="10.2196/18167",
url="https://www.jmir.org/2021/6/e18167",
url="http://www.ncbi.nlm.nih.gov/pubmed/34076579"
}


@Article{info:doi/10.2196/22970,
author="Ormel, Ilja
and Onu, C. Charles
and Magalhaes, Mona
and Tang, Terence
and Hughes, B. John
and Law, Susan",
title="Using a Mobile App--Based Video Recommender System of Patient Narratives to Prepare Women for Breast Cancer Surgery: Development and Usability Study Informed by Qualitative Data",
journal="JMIR Form Res",
year="2021",
month="Jun",
day="2",
volume="5",
number="6",
pages="e22970",
keywords="qualitative research",
keywords="illness narratives",
keywords="experiential information",
keywords="breast cancer",
keywords="surgery",
keywords="tailored information",
keywords="recommender system",
keywords="patient information and communication",
keywords="mobile app",
keywords="mobile phone",
abstract="Background: Women diagnosed with breast cancer are often bombarded with information. Such information overload can lead to misunderstandings and hamper women's capacity for making informed decisions about their care. For women with breast cancer, this uncertainty is particularly severe in the period before surgery. Personalized narratives about others' experiences can help patients better understand the disease course, the quality and type of care to be expected, the clinical decision-making processes, and the strategies for coping. Existing resources and eHealth apps rarely include experiential information, and no tools exist that tailor information for individual preferences and needs---offering the right information at the right time and in the right format. Combining high-quality experiential evidence with novel technical approaches may contribute to patient-centered solutions in this area. Objective: This study aims to design and seek preliminary feedback on a mobile app that will improve information access about surgery for patients with breast cancer, by drawing on a qualitative collection of personal narratives from a diverse sample of Canadian women and using video and audio recordings or audio recordings from the Canadian Health Experiences Research Network. Methods: In a previous study, we conducted in-depth interviews with 35 Canadian women and used video and audio recordings or audio recordings to collect stories about the lived experiences of breast cancer. The participants highlighted the need for more specific information between diagnosis and surgery that was relevant to their personal situations and preferences. They also wanted to learn from other women's experiences. We worked with patients, clinicians, and informatics experts to develop a mobile app that provides access to tailored experiential information relevant to women's personal situations and preferences. We completed focus groups and qualitative interviews, conducted a further analysis of the original qualitative data, designed novel software using artificial intelligence, and sought preliminary feedback from users on a new app via focus groups and a survey. Results: The secondary analysis of the breast cancer narratives revealed key themes and their interconnections relevant to the experience of surgery, including preparation, treatment decisions, aftercare, reconstruction, prostheses, lumpectomy and mastectomy, and complications. These themes informed the development of the structure and content of the app. We developed a recommender system within the app by using content matching (user and speaker profiles and user interests and video content) and collaborative filtering to identify clips marked as relevant by the user and by similar users. A 2-minute animated introductory video for users was developed. Pilot testing revealed generally positive responses regarding the content and value of this type of e-tool. Conclusions: Developing reliable, evidence-based tools and apps that are based on diverse collections of people's experiences of illness offers a novel approach to help manage the plethora of information that women face after a diagnosis of breast cancer. ",
doi="10.2196/22970",
url="https://formative.jmir.org/2021/6/e22970",
url="http://www.ncbi.nlm.nih.gov/pubmed/34076582"
}


@Article{info:doi/10.2196/19536,
author="Dani{\"e}ls, M. Naomi E.
and Hochstenbach, J. Laura M.
and van Zelst, Catherine
and van Bokhoven, A. Marloes
and Delespaul, G. Philippe A. E.
and Beurskens, M. Anna J. H.",
title="Factors That Influence the Use of Electronic Diaries in Health Care: Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jun",
day="1",
volume="9",
number="6",
pages="e19536",
keywords="compliance",
keywords="delivery of health care",
keywords="diary",
keywords="ecological momentary assessment",
keywords="intention",
keywords="motivation",
keywords="scoping review",
abstract="Background: A large number of people suffer from psychosocial or physical problems. Adequate strategies to alleviate needs are scarce or lacking. Symptom variation can offer insights into personal profiles of coping and resilience (detailed functional analyses). Hence, diaries are used to report mood and behavior occurring in daily life. To reduce inaccuracies, biases, and noncompliance with paper diaries, a shift to electronic diaries has occurred. Although these diaries are increasingly used in health care, information is lacking about what determines their use. Objective: The aim of this study was to map the existing empirical knowledge and gaps concerning factors that influence the use of electronic diaries, defined as repeated recording of psychosocial or physical data lasting at least one week using a smartphone or a computer, in health care. Methods: A scoping review of the literature published between January 2000 and December 2018 was conducted using queries in PubMed and PsycInfo databases. English or Dutch publications based on empirical data about factors that influence the use of electronic diaries for psychosocial or physical purposes in health care were included. Both databases were screened, and findings were summarized using a directed content analysis organized by the Consolidated Framework for Implementation Research (CFIR). Results: Out of 3170 articles, 22 studies were selected for qualitative synthesis. Eleven themes were determined in the CFIR categories of intervention, user characteristics, and process. No information was found for the CFIR categories inner (eg, organizational resources, innovation climate) and outer (eg, external policies and incentives, pressure from competitors) settings. Reminders, attractive designs, tailored and clear data visualizations (intervention), smartphone experience, and intrinsic motivation to change behavior (user characteristics) could influence the use of electronic diaries. During the implementation process, attention should be paid to both theoretical and practical training. Conclusions: Design aspects, user characteristics, and training and instructions determine the use of electronic diaries in health care. It is remarkable that there were no empirical data about factors related to embedding electronic diaries in daily clinical practice. More research is needed to better understand influencing factors for optimal electronic diary use. ",
doi="10.2196/19536",
url="https://mhealth.jmir.org/2021/6/e19536",
url="http://www.ncbi.nlm.nih.gov/pubmed/34061036"
}


@Article{info:doi/10.2196/17858,
author="Fakih El Khoury, Cosette
and Crutzen, Rik
and Schols, MGA Jos
and Halfens, JG Ruud
and Karavetian, Mirey",
title="Adequate Management of Phosphorus in Patients Undergoing Hemodialysis Using a Dietary Smartphone App: Prospective Pilot Study",
journal="JMIR Form Res",
year="2021",
month="Jun",
day="1",
volume="5",
number="6",
pages="e17858",
keywords="renal diet",
keywords="mhealth",
keywords="dietary app",
abstract="Background: The renal diet is complex and requires alterations of the diet and careful monitoring of various nutrients. Elevated serum phosphorus is common among patients undergoing hemodialysis, and it is associated with many complications. Smartphone technology could be used to support both dietitians and patients by providing a source of accessible and reliable information. Objective: The aim of this pilot is to assess the potential efficacy of an intervention using the educational and self-monitoring mobile app KELA.AE on the phosphorous management in hemodialysis patients. Results will be used to improve both the app and a planned, rigorous large-scale trial intended to assess app efficacy. Methods: This is a prospective pilot study performed at the hemodialysis unit of Al Qassimi Hospital (Emirate of Sharjah, United Arab Emirates). All patients were assessed for eligibility and, based on inclusion criteria, considered for enrollment. Participants met with a dietitian once a week and used the mobile app regularly for 2 weeks. Outcomes (knowledge, self-reported nonadherence, dietary intake, anthropometry, and biochemical data) were measured. This pilot is reported as per guidelines for nonrandomized pilot and feasibility studies and in line with the CONSORT (Consolidated Standards of Reporting Trials) 2010 checklist for reporting pilot or feasibility trials. Results: Of 26 subjects, 23 successfully completed the pilot. Patient dietary knowledge about phosphorous management improved from 51.4\% (SD 13.9) to 68.1\% (SD 13.3) after intervention with a large effect size (d=1.22, 95\% CI 0.59 to 1.85). Dietary protein intake increased from a mean of 0.9 g/kg (SD 0.3) per day to a mean of 1.3 g/kg (SD 0.5) per day with a large effect size (d=1.07, 95\% CI 0.45 to 1.69). Phosphorus to protein ratio dropped from a mean of 18.4 mg/g protein to 13.5 mg/g protein with a large effect size (d=0.83, 95\% CI 0.22 to 1.43). There was no evidence of change in phosphorous intake, self-reported nonadherence, and serum phosphorus. Conclusions: The findings of this prospective pilot reveal the potential efficacy of a smartphone app as a supportive nutrition education tool for phosphorus management in patients undergoing hemodialysis. This pilot study showed that the KELA.AE app has the potential to improve knowledge and dietary choices. A rigorous randomized controlled trial should be performed to evaluate the efficacy, assessing app use of a long-term intervention. ",
doi="10.2196/17858",
url="https://formative.jmir.org/2021/6/e17858",
url="http://www.ncbi.nlm.nih.gov/pubmed/34061034"
}


@Article{info:doi/10.2196/25713,
author="Gios, Lorenzo
and Crema Falceri, Giulia
and Micocci, Stefano
and Patil, Luigi
and Testa, Sara
and Sforzin, Simona
and Turra, Ettore
and Conforti, Diego
and Malfatti, Giulia
and Moz, Monica
and Nicolini, Andrea
and Guarda, Paolo
and Bacchiega, Alessandro
and Mion, Carlo
and Marchesoni, Michele
and Maimone, Rosa
and Molini, Benedetto Pietro
and Zanella, Alberto
and Osmani, Venet
and Mayora-Ibarra, Oscar
and Forti, Stefano",
title="Use of eHealth Platforms and Apps to Support Monitoring and Management of Home-Quarantined Patients With COVID-19 in the Province of Trento, Italy: App Development and Implementation",
journal="JMIR Form Res",
year="2021",
month="May",
day="31",
volume="5",
number="5",
pages="e25713",
keywords="telemedicine",
keywords="telemonitoring",
keywords="quarantine management",
keywords="COVID-19",
keywords="connected care",
abstract="Background: Italy was the first country to largely experience the COVID-19 epidemic among other Western countries during the so-called first wave of the COVID-19 pandemic. Proper management of an increasing number of home-quarantined individuals created a significant challenge for health care authorities and professionals. This was especially true when considering the importance of remote surveillance to detect signs of disease progression and consequently regulate access to hospitals and intensive care units on a priority basis. Objective: In this paper, we report on an initiative promoted to cope with the first wave of the COVID-19 epidemic in the Spring/Summer of 2020, in the Autonomous Province of Trento, Italy. A purposefully built app named TreCovid19 was designed to provide dedicated health care staff with a ready-to-use tool for remotely monitoring patients with progressive symptoms of COVID-19, who were home-quarantined during the first wave of the epidemic, and to focus on those patients who, based on their self-reported clinical data, required a quick response from health care professionals. Methods: TreCovid19 was rapidly developed to facilitate the monitoring of a selected number of home-quarantined patients with COVID-19 during the very first epidemic wave. The app was built on top of an existing eHealth platform, already in use by the local health authority to provide home care, with the following functionalities: (1) to securely collect and link demographic and clinical information related to the patients and (2) to provide a two-way communication between a multidisciplinary health care team and home-quarantined patients. The system supported patients to self-assess their condition and update the multidisciplinary team on their health status. The system was used between March and June 2020 in the province of Trento. Results: A dedicated multidisciplinary group of health care professionals adopted the platform over a period of approximately 3 months (from March-end to June 2020) to monitor a total of 170 patients with confirmed COVID-19 during home quarantine. All patients used the system until the end of the initiative. The TreCovid19 system has provided useful insights of possible viability and impact of a technological--organizational asset to manage a potentially critical workload for the health care staff involved in the periodic monitoring of a relevant number of quarantined patients, notwithstanding its limitations given the rapid implementation of the whole initiative. Conclusions: The technological and organizational model adopted in response to the COVID-19 pandemic was developed and finalized in a relatively short period during the initial few weeks of the epidemic. The system successfully supported the health care staff involved in the periodic monitoring of an increasing number of home-quarantined patients and provided valuable data in terms of disease surveillance. ",
doi="10.2196/25713",
url="https://formative.jmir.org/2021/5/e25713",
url="http://www.ncbi.nlm.nih.gov/pubmed/33909586"
}


@Article{info:doi/10.2196/22489,
author="Alzamanan, Zaied Mohsen
and Lim, Kheng-Seang
and Akmar Ismail, Maizatul
and Abdul Ghani, Norjihan",
title="Self-Management Apps for People With Epilepsy: Systematic Analysis",
journal="JMIR Mhealth Uhealth",
year="2021",
month="May",
day="28",
volume="9",
number="5",
pages="e22489",
keywords="mobile health",
keywords="epilepsy",
keywords="self-management",
keywords="smartphone",
abstract="Background: Patients with epilepsy (PWEs) are motivated to manage and cope with their disorder themselves (ie, self-management [SM] is encouraged). Mobile health (mHealth) apps have multiple features that have a huge potential to improve SM of individuals with chronic disorders such as epilepsy. Objective: This study aimed to review all freely available apps related to the SM of PWEs and to determine the SM domains covered in these apps. Methods: We performed a search of apps on Google Play and App Store using the keywords ``epilepsy'' or ``seizures'' from May to August 2018. Apps were included if they were free and in English language. We excluded apps with installation-related issues and not related to epilepsy self-management (eSM). Results: A total of 22 eSM apps were identified in our search: 6 of these run only on iOS, 7 only on Android, and 9 run on both operating systems. Of the 11 domains of SM, seizure tracking and seizure response features were covered by most apps (n=22 and n=19, respectively), followed by treatment management (n=17) and medication adherence (n=15). Three apps (Epilepsy Journal, Epilepsy Tool Kit, and EpiDiary) were installed more than 10,000 times, with features focused specifically on a few domains (treatment management, medication adherence, health care communication, and seizure tracking). Two apps (Young Epilepsy and E-Epilepsy Inclusion) covered more than 6 SM domains but both had lower installation rates (5000+ and 100+, respectively). Conclusions: Both Android and iOS mHealth apps are available to improve SM in epilepsy, but the installation rate of most apps remains low. The SM features of these apps were different from one another, making it difficult to recommend a single app that completely fulfills the needs of PWEs. The common features of the apps evaluated included seizure tracking and seizure response. To improve the efficacy and availability of these apps, we propose the following: (1) involve the stakeholders, such as physicians, pharmacists, and PWEs, during the development of mHealth apps; (2) assess the efficacy and acceptance of the apps objectively by performing a usability analysis; and (3) promote the apps so that they benefit more PWEs. ",
doi="10.2196/22489",
url="https://mhealth.jmir.org/2021/5/e22489",
url="http://www.ncbi.nlm.nih.gov/pubmed/34047709"
}


@Article{info:doi/10.2196/26110,
author="Karim, Lynn Jalisa
and Talhouk, Aline",
title="Person-Generated Health Data in Women's Health: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="28",
volume="10",
number="5",
pages="e26110",
keywords="digital health",
keywords="women's health",
keywords="mobile health",
keywords="health app",
keywords="wearables",
keywords="femtech",
keywords="self-tracking",
keywords="personalized health",
keywords="person-generated health data",
keywords="patient-generated health data",
keywords="scoping review",
abstract="Background: Due to their ability to collect person-generated health data, digital tools and connected health devices may hold great utility in disease prevention, chronic disease self-monitoring and self-tracking, as well as in tailoring information and educational content to fit individual needs. Facilitators and barriers to the use of digital health technologies vary across demographics, including sex. The ``femtech'' market is growing rapidly, and women are some of the largest adopters of digital health technologies. Objective: This paper aims to provide the background and methods for conducting a scoping review on the use of person-generated health data from connected devices in women's health. The objectives of the scoping review are to identify the various contexts of digital technologies in women's health and to consolidate women's views on the usability and acceptability of the devices. Methods: Searches were conducted in the following databases: Medline, Embase, APA PsycInfo, CINAHL Complete, and Web of Science Core Collection. We included articles from January 2015 to February 2020. Screening of articles was done independently by at least two authors in two stages. Data charting is being conducted in duplicate. Results will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. Results: Our search identified 9102 articles after deduplication. As of November 2020, the full-text screening stage is almost complete and data charting is in progress. The scoping review is expected to be completed by Fall 2021. Conclusions: This scoping review will broadly map the literature regarding the contexts and acceptability of digital health tools for women. The results from this review will be useful in guiding future digital health and women's health research. International Registered Report Identifier (IRRID): DERR1-10.2196/26110 ",
doi="10.2196/26110",
url="https://www.researchprotocols.org/2021/5/e26110",
url="http://www.ncbi.nlm.nih.gov/pubmed/34047708"
}


@Article{info:doi/10.2196/22513,
author="Fonner, A. Virginia
and Kennedy, Samuel
and Desai, Rohan
and Eichberg, Christie
and Martin, Lisa
and Meissner, G. Eric",
title="Patient-Provider Text Messaging and Video Calling Among Case-Managed Patients Living With HIV: Formative Acceptability and Feasibility Study",
journal="JMIR Form Res",
year="2021",
month="May",
day="27",
volume="5",
number="5",
pages="e22513",
keywords="HIV",
keywords="mHealth",
keywords="text messaging",
keywords="video calling",
keywords="implementation science",
keywords="mobile phone",
abstract="Background: Patient-provider communication is critical for engaging and retaining people living with HIV in care, especially among medically case-managed patients in need of service coordination and adherence support. Expanding patient-provider communication channels to include mobile health modalities, such as text messaging and video calling, has the potential to facilitate communication and ultimately improve clinical outcomes. However, the implementation of these communication modalities in clinical settings has not been well characterized. Objective: The purpose of this study is to understand patient and provider perspectives on the acceptability of and preferences for using text messaging and video calling as a means of communication; perceived factors relevant to adoption, appropriateness, and feasibility; and organizational perspectives on implementation within an HIV clinic in South Carolina. Methods: We conducted 26 semistructured in-depth interviews among patients receiving case management services (n=12) and clinic providers (n=14) using interview guides and content analysis informed by the Proctor taxonomy of implementation outcomes and the Consolidated Framework for Implementation Research. Participants were purposefully sampled to obtain maximum variation in terms of age and gender for patients and clinic roles for providers. The data were analyzed using quantitative and qualitative content analyses. Results: Most patients (11/12, 92\%) and providers (12/14, 86\%) agreed that they should have the capacity to text message and/or video call each other. Although consensus was not reached, most preferred using a secure messaging app rather than standard text messaging because of the enhanced security features. Perceived benefits to adoption included the added convenience of text messaging, and potential barriers included the cost and access of smartphone-based technology for patients. From an organizational perspective, some providers were concerned that offering text messaging could lead to unreasonable expectations of instant access and increased workload. Conclusions: Patients and providers perceived text messaging and video calling as acceptable, appropriate, and feasible and felt that these expanded modes of communication could help meet patients' needs while being safe and not excessively burdensome. Although patients and providers mostly agreed on implementation barriers and facilitators, several differences emerged. Taking both perspectives into account when using implementation frameworks is critical for expanding mobile health--based communication, especially as implementation requires active participation from providers and patients. ",
doi="10.2196/22513",
url="https://formative.jmir.org/2021/5/e22513",
url="http://www.ncbi.nlm.nih.gov/pubmed/34042596"
}


@Article{info:doi/10.2196/26643,
author="Gross, Christoph
and Schachner, Theresa
and Hasl, Andrea
and Kohlbrenner, Dario
and Clarenbach, F. Christian
and Wangenheim, V. Forian
and Kowatsch, Tobias",
title="Personalization of Conversational Agent-Patient Interaction Styles for Chronic Disease Management: Two Consecutive Cross-sectional Questionnaire Studies",
journal="J Med Internet Res",
year="2021",
month="May",
day="26",
volume="23",
number="5",
pages="e26643",
keywords="conversational agents",
keywords="chatbots",
keywords="human-computer interaction",
keywords="physician-patient interaction styles",
keywords="deliberative interaction",
keywords="paternalistic interaction",
keywords="digital health",
keywords="chronic conditions",
keywords="disease management",
keywords="COPD",
keywords="chronic obstructive pulmonary disease",
abstract="Background: Conversational agents (CAs) for chronic disease management are receiving increasing attention in academia and the industry. However, long-term adherence to CAs is still a challenge and needs to be explored. Personalization of CAs has the potential to improve long-term adherence and, with it, user satisfaction, task efficiency, perceived benefits, and intended behavior change. Research on personalized CAs has already addressed different aspects, such as personalized recommendations and anthropomorphic cues. However, detailed information on interaction styles between patients and CAs in the role of medical health care professionals is scant. Such interaction styles play essential roles for patient satisfaction, treatment adherence, and outcome, as has been shown for physician-patient interactions. Currently, it is not clear (1) whether chronically ill patients prefer a CA with a paternalistic, informative, interpretive, or deliberative interaction style, and (2) which factors influence these preferences. Objective: We aimed to investigate the preferences of chronically ill patients for CA-delivered interaction styles. Methods: We conducted two studies. The first study included a paper-based approach and explored the preferences of chronic obstructive pulmonary disease (COPD) patients for paternalistic, informative, interpretive, and deliberative CA-delivered interaction styles. Based on these results, a second study assessed the effects of the paternalistic and deliberative interaction styles on the relationship quality between the CA and patients via hierarchical multiple linear regression analyses in an online experiment with COPD patients. Patients' sociodemographic and disease-specific characteristics served as moderator variables. Results: Study 1 with 117 COPD patients revealed a preference for the deliberative (50/117) and informative (34/117) interaction styles across demographic characteristics. All patients who preferred the paternalistic style over the other interaction styles had more severe COPD (three patients, Global Initiative for Chronic Obstructive Lung Disease class 3 or 4). In Study 2 with 123 newly recruited COPD patients, younger participants and participants with a less recent COPD diagnosis scored higher on interaction-related outcomes when interacting with a CA that delivered the deliberative interaction style (interaction between age and CA type: relationship quality: b=?0.77, 95\% CI ?1.37 to ?0.18; intention to continue interaction: b=?0.49, 95\% CI ?0.97 to ?0.01; working alliance attachment bond: b=?0.65, 95\% CI ?1.26 to ?0.04; working alliance goal agreement: b=?0.59, 95\% CI ?1.18 to ?0.01; interaction between recency of COPD diagnosis and CA type: working alliance goal agreement: b=0.57, 95\% CI 0.01 to 1.13). Conclusions: Our results indicate that age and a patient's personal disease experience inform which CA interaction style the patient should be paired with to achieve increased interaction-related outcomes with the CA. These results allow the design of personalized health care CAs with the goal to increase long-term adherence to health-promoting behavior. ",
doi="10.2196/26643",
url="https://www.jmir.org/2021/5/e26643",
url="http://www.ncbi.nlm.nih.gov/pubmed/33913814"
}


@Article{info:doi/10.2196/21668,
author="Park, Rang Yu
and Kim, Hyery
and Park, Ae Ji
and Ahn, Hyun Sang
and Chang, Seyun
and Shin, Won Jae
and Kim, Myeongchan
and Lee, Jae-Ho",
title="Comparative Analysis of Single and Combined Antipyretics Using Patient-Generated Health Data: Retrospective Observational Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="May",
day="26",
volume="9",
number="5",
pages="e21668",
keywords="combination antipyretics",
keywords="fever management",
keywords="patient-generated health data",
keywords="comparative analysis",
keywords="mHealth",
keywords="apps",
keywords="fever",
abstract="Background: Fever is one of the most common symptoms in children and is the physiological response of the human immune system to external pathogens. However, effectiveness studies of single and combined antipyretic therapy are relatively few due to lack of data. In this study, we used large-scale patient-generated health data from mobile apps to compare antipyretic affects between single and combination antipyretics. Objective: We aimed to establish combination patterns of antipyretics and compare antipyretic affects between single and combination antipyretics using large-scale patient-generated health data from mobile apps. Methods: This study was conducted using medical records of feverish children from July 2015 to June 2017 using the Fever Coach mobile app. In total, 3,584,748 temperature records and 1,076,002 antipyretic records of 104,337 children were analyzed. Antipyretic efficacy was measured by the mean difference in the area under the temperature change curve from baseline for 6 hours, 8 hours, 10 hours, and 12 hours after antipyretic administration in children with a body temperature of ?38.0 {\textcelcius} between single and combination groups. Results: The single antipyretic and combination groups comprised 152,017 and 54,842 cases, respectively. Acetaminophen was the most commonly used single agent (60,929/152,017, 40.08\%), and acetaminophen plus dexibuprofen was the most common combination (28,065/54,842, 51.17\%). We observed inappropriate use, including triple combination (1205/206,859, 0.58\%) and use under 38 {\textcelcius} (11,361/206,859, 5.50\%). Combination antipyretic use increased with temperature; 23.82\% (33,379/140,160) of cases were given a combination treatment when 38 {\textcelcius} ? temperature < 39 {\textcelcius}, while 41.40\% (1517/3664) were given a combination treatment when 40 {\textcelcius} ? temperature. The absolute value of the area under the curve at each hour was significantly higher in the single group than in the combination group; this trend was consistently observed, regardless of the type of antipyretics. In particular, the delta fever during the first 6 hours between the two groups showed the highest difference. The combination showed the lowest delta fever among all cases. Conclusions: Antipyretics combination patterns were analyzed using large-scale data. Approximately 75\% of febrile cases used single antipyretics, mostly acetaminophen, but combination usage became more frequent as temperature increased. However, combination antipyretics did not show definite advantages over single antipyretics in defervescence, regardless of the combination. Single antipyretics are effective in reducing fever and relieving discomfort in febrile children. ",
doi="10.2196/21668",
url="https://mhealth.jmir.org/2021/5/e21668",
url="http://www.ncbi.nlm.nih.gov/pubmed/34037528"
}


@Article{info:doi/10.2196/27271,
author="Larimer, Karen
and Wegerich, Stephan
and Splan, Joel
and Chestek, David
and Prendergast, Heather
and Vanden Hoek, Terry",
title="Personalized Analytics and a Wearable Biosensor Platform for Early Detection of COVID-19 Decompensation (DeCODe): Protocol for the Development of the COVID-19 Decompensation Index",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="26",
volume="10",
number="5",
pages="e27271",
keywords="analytic",
keywords="artificial intelligence",
keywords="biomarker",
keywords="cloud",
keywords="COVID-19",
keywords="decompensation",
keywords="detection",
keywords="development",
keywords="index",
keywords="monitoring",
keywords="outcome",
keywords="remote monitoring",
keywords="symptom validation",
keywords="wearable",
abstract="Background: During the COVID-19 pandemic, novel digital health technologies have the potential to improve our understanding of SARS-CoV-2 and COVID-19, improve care delivery, and produce better health outcomes. The National Institutes of Health called on digital health leaders to contribute to a high-quality data repository that will support researchers to make discoveries that are otherwise not possible with small, limited data sets. Objective: To this end, we seek to develop a COVID-19 digital biomarker for early detection of physiological exacerbation or decompensation. We propose the development and validation of a COVID-19 decompensation Index (CDI) in a 2-phase study that builds on existing wearable biosensor-derived analytics generated by physIQ's end-to-end cloud platform for continuous physiological monitoring with wearable biosensors. This effort serves to achieve two primary objectives: (1) to collect adequate data to help develop the CDI and (2) to collect rich deidentified clinical data correlating with outcomes and symptoms related to COVID-19 progression. Our secondary objectives include evaluation of the feasibility and usability of pinpointIQ, a digital platform through which data are gathered, analyzed, and displayed. Methods: This is a prospective, nonrandomized, open-label, 2-phase study. Phase I will involve data collection for the digital data hub of the National Institutes of Health as well as data to support the preliminary development of the CDI. Phase II will involve data collection for the hub and contribute to continued refinement and validation of the CDI. While this study will focus on the development of a CDI, the digital platform will also be evaluated for feasibility and usability while clinicians deliver care to continuously monitored patients enrolled in the study. Results: Our target CDI will be a binary classifier trained to distinguish participants with and those without decompensation. The primary performance metric for CDI will be the area under the receiver operating characteristic curve with a minimum performance criterion of ?0.75 ($\alpha$=.05; power [1--$\beta$]=0.80). Furthermore, we will determine the sex or gender and race or ethnicity of the participants, which would account for differences in the CDI performance, as well as the lead time---time to predict decompensation---and its relationship with the ultimate disease severity based on the World Health Organization COVID-19 ordinal scale. Conclusions: Using machine learning techniques on a large data set of patients with COVID-19 could provide valuable insights into the pathophysiology of COVID-19 and a digital biomarker for COVID-19 decompensation. Through this study, we intend to develop a tool that can uniquely reflect physiological data of a diverse population and contribute to high-quality data that will help researchers better understand COVID-19. Trial Registration: ClinicalTrials.gov NCT04575532; https://www.clinicaltrials.gov/ct2/show/NCT04575532 International Registered Report Identifier (IRRID): DERR1-10.2196/27271 ",
doi="10.2196/27271",
url="https://www.researchprotocols.org/2021/5/e27271",
url="http://www.ncbi.nlm.nih.gov/pubmed/33949966"
}


@Article{info:doi/10.2196/22881,
author="Tian, Ying
and Zhang, Suhan
and Huang, Feiling
and Ma, Liangkun",
title="Comparing the Efficacies of Telemedicine and Standard Prenatal Care on Blood Glucose Control in Women With Gestational Diabetes Mellitus: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="May",
day="25",
volume="9",
number="5",
pages="e22881",
keywords="gestational diabetes mellitus",
keywords="blood glucose",
keywords="mhealth",
keywords="health education",
keywords="lifestyle management",
abstract="Background: Gestational diabetes mellitus (GDM) can usually be well controlled by health education and lifestyle management, resulting in better pregnancy outcomes. However, standard clinical prenatal care, which consists of clinic visits every 2 weeks, may not provide sufficient management for women with GDM. Telemedicine demonstrates a potential to fill this gap. Objective: The objective of this study was to investigate whether health education and lifestyle management delivered through a WeChat group chat was more effective in controlling blood glucose (BG) than standard clinical prenatal care among women with GDM. Methods: In this multicenter randomized controlled trial, women with GDM diagnosed by an oral glucose tolerance test between 23 and 30 (+6) gestational weeks were randomized to a WeChat group chat--based BG management group or a routine clinical prenatal care group. The primary outcome was the change in the glycemic qualification rate during the follow-up period in both groups. The secondary outcomes were pregnancy outcomes. Results: A total of 309 women with GDM participated in the trial, with 162 women randomized to the control group and 147 to the intervention group. No significant differences in baseline characteristics were found between the control and intervention groups. Participants were further divided into 4 groups according to gestational weeks at enrollment for further analysis. The glycemic qualification rate of the intervention group was higher than that of the control group at nearly all time points in Groups 1 to 3, among which 3 time points reached statistical significance: Group 1 at T3 (54.8\% vs 83.3\%) and Group 2 at T3 (62.5\% vs 80.0\%) and T7 (75.0\% vs 100\%). The glycemic qualification rate gradually increased as gestational weeks progressed in both groups, regardless of the intervention method. None of the pregnancy outcomes measured, including delivery mode, premature rupture of the membranes, preterm birth, infant's birth weight, and postpartum hemorrhage, were significantly different between the control and intervention groups. Conclusions: This multicenter randomized controlled trial that assessed women with noninsulin-dependent GDM demonstrated that additional instant messaging platforms, such as WeChat, used for health education and lifestyle intervention in China tend to be more effective for BG control than standard clinical prenatal care alone. Trial Registration: ClinicalTrials.gov NCT03748576; https://clinicaltrials.gov/ct2/show/NCT03748576 ",
doi="10.2196/22881",
url="https://mhealth.jmir.org/2021/5/e22881",
url="http://www.ncbi.nlm.nih.gov/pubmed/33783365"
}


@Article{info:doi/10.2196/26442,
author="J{\'a}come, Cristina
and Almeida, Rute
and Pereira, Margarida Ana
and Amaral, Rita
and Mendes, Sandra
and Alves-Correia, Magna
and Vidal, Carmen
and L{\'o}pez Freire, Sara
and M{\'e}ndez Brea, Paula
and Ara{\'u}jo, Lu{\'i}s
and Couto, Mariana
and Antol{\'i}n-Am{\'e}rigo, Dar{\'i}o
and de la Hoz Caballer, Bel{\'e}n
and Barra Castro, Alicia
and Gonzalez-De-Olano, David
and Todo Bom, Ana
and Azevedo, Jo{\~a}o
and Leiria Pinto, Paula
and Pinto, Nicole
and Castro Neves, Ana
and Palhinha, Ana
and Todo Bom, Filipa
and Costa, Alberto
and Chaves Loureiro, Cl{\'a}udia
and Maia Santos, Lilia
and Arrobas, Ana
and Val{\'e}rio, Margarida
and Cardoso, Jo{\~a}o
and Emiliano, Madalena
and Gerardo, Rita
and Cidrais Rodrigues, Carlos Jos{\'e}
and Oliveira, Georgeta
and Carvalho, Joana
and Mendes, Ana
and Lozoya, Carlos
and Santos, Natacha
and Menezes, Fernando
and Gomes, Ricardo
and C{\^a}mara, Rita
and Rodrigues Alves, Rodrigo
and Moreira, Sofia Ana
and Bordalo, Diana
and Alves, Carlos
and Ferreira, Alberto Jos{\'e}
and Lopes, Cristina
and Silva, Diana
and Vasconcelos, Jo{\~a}o Maria
and Teixeira, Fernanda Maria
and Ferreira-Magalh{\~a}es, Manuel
and Taborda-Barata, Lu{\'i}s
and C{\'a}lix, Jos{\'e} Maria
and Alves, Adelaide
and Almeida Fonseca, Jo{\~a}o",
title="Feasibility and Acceptability of an Asthma App to Monitor Medication Adherence: Mixed Methods Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="May",
day="25",
volume="9",
number="5",
pages="e26442",
keywords="mHealth",
keywords="smartphone",
keywords="technology assessment",
keywords="medication adherence",
keywords="self-management",
keywords="gamification",
keywords="patient participation",
abstract="Background: Poor medication adherence is a major challenge in asthma, and objective assessment of inhaler adherence is needed. The InspirerMundi app aims to monitor adherence while providing a positive experience through gamification and social support. Objective: This study aimed to evaluate the feasibility and acceptability of the InspirerMundi app to monitor medication adherence in adolescents and adults with persistent asthma (treated with daily inhaled medication). Methods: A 1-month mixed method multicenter observational study was conducted in 26 secondary care centers from Portugal and Spain. During an initial face-to-face visit, physicians reported patients' asthma therapeutic plan in a structured questionnaire. During the visits, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients registered the intake (inhaler, blister, or other drug formulation) by using the image-based medication detection tool. At 1 month, patients were interviewed by phone, and app satisfaction was assessed on a 1 (low) to 5 (high) scale. Patients were also asked to point out the most and least preferred app features and make suggestions for future app improvements. Results: A total of 107 patients (median 27 [P25-P75 14-40] years) were invited, 92.5\% (99/107) installed the app, and 73.8\% (79/107) completed the 1-month interview. Patients interacted with the app a median of 9 (P25-P75 1-24) days. At least one medication was registered in the app by 78\% (77/99) of patients. A total of 53\% (52/99) of participants registered all prescribed inhalers, and 34\% (34/99) registered the complete asthma therapeutic plan. Median medication adherence was 75\% (P25-P75 25\%-90\%) for inhalers and 82\% (P25-P75 50\%-94\%) for other drug formulations. Patients were globally satisfied with the app, with 75\% (59/79) scoring ?4,; adherence monitoring, symptom monitoring, and gamification features being the most highly scored components; and the medication detection tool among the lowest scored. A total of 53\% (42/79) of the patients stated that the app had motivated them to improve adherence to inhaled medication and 77\% (61/79) would recommend the app to other patients. Patient feedback was reflected in 4 major themes: medication-related features (67/79, 85\%), gamification and social network (33/79, 42\%), symptom monitoring and physician communication (21/79, 27\%), and other aspects (16/79, 20\%). Conclusions: The InspirerMundi app was feasible and acceptable to monitor medication adherence in patients with asthma. Based on patient feedback and to increase the registering of medications, the therapeutic plan registration and medication detection tool were redesigned. Our results highlight the importance of patient participation to produce a patient-centered and engaging mHealth asthma app. ",
doi="10.2196/26442",
url="https://mhealth.jmir.org/2021/5/e26442",
url="http://www.ncbi.nlm.nih.gov/pubmed/34032576"
}


@Article{info:doi/10.2196/24190,
author="Al-Arkee, Shahd
and Mason, Julie
and Lane, A. Deirdre
and Fabritz, Larissa
and Chua, Winnie
and Haque, Sayeed M.
and Jalal, Zahraa",
title="Mobile Apps to Improve Medication Adherence in Cardiovascular Disease: Systematic Review and Meta-analysis",
journal="J Med Internet Res",
year="2021",
month="May",
day="25",
volume="23",
number="5",
pages="e24190",
keywords="mobile health care applications",
keywords="medication adherence",
keywords="cardiovascular disease",
keywords="systematic review",
keywords="mobile phone",
abstract="Background: Adherence rates of preventative medication for cardiovascular disease (CVD) have been reported as 57\%, and approximately 9\% of all CVD events in Europe are attributable to poor medication adherence. Mobile health technologies, particularly mobile apps, have the potential to improve medication adherence and clinical outcomes. Objective: The objective of this study is to assess the effects of mobile health care apps on medication adherence and health-related outcomes in patients with CVD. This study also evaluates apps' functionality and usability and the involvement of health care professionals in their use. Methods: Electronic databases (MEDLINE [Ovid], PubMed Central, Cochrane Library, CINAHL Plus, PsycINFO [Ovid], Embase [Ovid], and Google Scholar) were searched for randomized controlled trials (RCTs) to investigate app-based interventions aimed at improving medication adherence in patients with CVD. RCTs published in English from inception to January 2020 were reviewed. The Cochrane risk of bias tool was used to assess the included studies. Meta-analysis was performed for clinical outcomes and medication adherence, with meta-regression analysis used to evaluate the impact of app intervention duration on medication adherence. Results: This study included 16 RCTs published within the last 6 years. In total, 12 RCTs reported medication adherence as the primary outcome, which is the most commonly self-reported adherence. The duration of the interventions ranged from 1 to 12 months, and sample sizes ranged from 24 to 412. Medication adherence rates showed statistically significant improvements in 9 RCTs when compared with the control, and meta-analysis of the 6 RCTs reporting continuous data showed a significant overall effect in favor of the app intervention (mean difference 0.90, 95\% CI 0.03-1.78) with a high statistical heterogeneity (I2=93.32\%). Moreover, 9 RCTs assessed clinical outcomes and reported an improvement in systolic blood pressure, diastolic blood pressure, total cholesterol, and low-density lipoprotein cholesterol levels in the intervention arm. Meta-analysis of these clinical outcomes from 6 RCTs favored app interventions, but none were significant. In the 7 trials evaluating app usability, all were found to be acceptable. There was a great variation in the app characteristics. A total of 10 RCTs involved health care professionals, mainly physicians and nurses, in the app-based interventions. The apps had mixed functionality: 2 used education, 7 delivered reminders, and 7 provided reminders in combination with educational support. Conclusions: Apps tended to increase medication adherence, but interventions varied widely in design, content, and delivery. Apps have an acceptable degree of usability; yet the app characteristics conferring usability and effectiveness are ill-defined. Future large-scale studies should focus on identifying the essential active components of successful apps. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019121385; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=121385 ",
doi="10.2196/24190",
url="https://www.jmir.org/2021/5/e24190",
url="http://www.ncbi.nlm.nih.gov/pubmed/34032583"
}


@Article{info:doi/10.2196/26402,
author="Montazeri, Maryam
and Multmeier, Jan
and Novorol, Claire
and Upadhyay, Shubhanan
and Wicks, Paul
and Gilbert, Stephen",
title="Optimization of Patient Flow in Urgent Care Centers Using a Digital Tool for Recording Patient Symptoms and History: Simulation Study",
journal="JMIR Form Res",
year="2021",
month="May",
day="21",
volume="5",
number="5",
pages="e26402",
keywords="symptom assessment app",
keywords="discrete event simulation",
keywords="health care system",
keywords="patient flow modeling",
keywords="patient flow",
keywords="simulation",
keywords="urgent care",
keywords="waiting times",
abstract="Background: Crowding can negatively affect patient and staff experience, and consequently the performance of health care facilities. Crowding can potentially be eased through streamlining and the reduction of duplication in patient history-taking through the use of a digital symptom-taking app. Objective: We simulated the introduction of a digital symptom-taking app on patient flow. We hypothesized that waiting times and crowding in an urgent care center (UCC) could be reduced, and that this would be more efficient than simply adding more staff. Methods: A discrete-event approach was used to simulate patient flow in a UCC during a 4-hour time frame. The baseline scenario was a small UCC with 2 triage nurses, 2 doctors, 1 treatment/examination nurse, and 1 discharge administrator in service. We simulated 33 scenarios with different staff numbers or different potential time savings through the app. We explored average queue length, waiting time, idle time, and staff utilization for each scenario. Results: Discrete-event simulation showed that even a few minutes saved through patient app-based self-history recording during triage could result in significantly increased efficiency. A modest estimated time saving per patient of 2.5 minutes decreased the average patient wait time for triage by 26.17\%, whereas a time saving of 5 minutes led to a 54.88\% reduction in patient wait times. Alternatively, adding an additional triage nurse was less efficient, as the additional staff were only required at the busiest times. Conclusions: Small time savings in the history-taking process have potential to result in substantial reductions in total patient waiting time for triage nurses, with likely effects of reduced patient anxiety, staff anxiety, and improved patient care. Patient self-history recording could be carried out at home or in the waiting room via a check-in kiosk or a portable tablet computer. This formative simulation study has potential to impact service provision and approaches to digitalization at scale. ",
doi="10.2196/26402",
url="https://formative.jmir.org/2021/5/e26402",
url="http://www.ncbi.nlm.nih.gov/pubmed/34018963"
}


@Article{info:doi/10.2196/26716,
author="Santa Maria, Diane
and Lightfoot, Marguerita
and Nyamathi, Adey
and Businelle, Michael
and Paul, Mary
and Quadri, Yasmeen
and Padhye, Nikhil
and Jones, Jennifer
and Calvo Armijo, Margarita",
title="A Nurse Case Management HIV Prevention Intervention (Come As You Are) for Youth Experiencing Homelessness: Protocol for a Randomized Wait-list Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="21",
volume="10",
number="5",
pages="e26716",
keywords="HIV prevention",
keywords="nurse case management",
keywords="motivational interviewing",
keywords="homelessness",
keywords="youth",
keywords="just-in-time-adaptive intervention",
keywords="ecological momentary assessment",
abstract="Background: Youth experiencing homelessness are more likely than housed youth to experience premature death, suicide, drug overdose, pregnancy, substance use, and mental illness. Yet while youth experiencing homelessness are 6 to 12 times more likely to become infected with HIV than housed youth, with HIV prevalence as high as 16\%, many do not access the prevention services they need. Despite adversities, youth experiencing homelessness are interested in health promotion programs, can be recruited and retained in interventions and research studies, and demonstrate improved outcomes when programs are tailored and relevant to them. Objective: The study aims to compare the efficacy of a nurse case management HIV prevention and care intervention, titled Come As You Are, with that of usual care among youth experiencing homelessness aged 16 to 25 years. Methods: The study is designed as a 2-armed randomized wait-list controlled trial. Participants (n=450) will be recruited and followed up for 9 months after the intervention for a total study period of 12 months. Come As You Are combines nurse case management with a smartphone-based daily ecological momentary assessment to develop participant-driven HIV prevention behavioral goals that can be monitored in real-time. Youth in the city of Houston, Texas will be recruited from drop-in centers, shelters, street outreach programs, youth-serving organizations, and clinics. Results: Institutional review board approval (Committee for the Protection of Human Subjects, University of Texas Health Science Center at Houston) was obtained in November 2018. The first participant was enrolled in November 2019. Data collection is ongoing. To date, 123 participants have consented to participate in the study, 89 have been enrolled, and 15 have completed their final follow-up. Conclusions: There is a paucity of HIV prevention research regarding youth experiencing homelessness. Novel and scalable interventions that address the full continuum of behavioral and biomedical HIV prevention are needed. This study will determine whether a personalized and mobile HIV prevention approach can reduce HIV risk among a hard-to-reach, transient population of youth at high risk. International Registered Report Identifier (IRRID): DERR1-10.2196/26716 ",
doi="10.2196/26716",
url="https://www.researchprotocols.org/2021/5/e26716",
url="http://www.ncbi.nlm.nih.gov/pubmed/34018967"
}


@Article{info:doi/10.2196/28164,
author="Kleinert, Stefan
and Bartz-Bazzanella, Peter
and von der Decken, Cay
and Knitza, Johannes
and Witte, Torsten
and Fekete, P. S{\'a}ndor
and Konitzny, Matthias
and Zink, Alexander
and Gauler, Georg
and Wurth, Patrick
and Aries, Peer
and Karberg, Kirsten
and Kuhn, Christoph
and Schuch, Florian
and Sp{\"a}thling-Mestekemper, Susanna
and Vorbr{\"u}ggen, Wolfgang
and Englbrecht, Matthias
and Welcker, Martin
and ",
title="A Real-World Rheumatology Registry and Research Consortium: The German RheumaDatenRhePort (RHADAR) Registry",
journal="J Med Internet Res",
year="2021",
month="May",
day="20",
volume="23",
number="5",
pages="e28164",
keywords="registry",
keywords="rheumatology",
keywords="real-world data",
keywords="symptom checker",
keywords="patient-reported outcomes",
doi="10.2196/28164",
url="https://www.jmir.org/2021/5/e28164",
url="http://www.ncbi.nlm.nih.gov/pubmed/34014170"
}


@Article{info:doi/10.2196/26152,
author="Hunt, Melissa
and Miguez, Sofia
and Dukas, Benji
and Onwude, Obinna
and White, Sarah",
title="Efficacy of Zemedy, a Mobile Digital Therapeutic for the Self-management of Irritable Bowel Syndrome: Crossover Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="May",
day="20",
volume="9",
number="5",
pages="e26152",
keywords="digital health",
keywords="irritable bowel syndrome",
keywords="cognitive behavioral therapy",
keywords="CBT",
keywords="efficacy",
keywords="mHealth",
keywords="self-management",
keywords="IBS",
keywords="randomized controlled trial",
keywords="app",
abstract="Background: Patients with irritable bowel syndrome (IBS) experience abdominal pain, altered bowel habits, and defecation-related anxiety, which can result in reduced productivity and impaired health-related quality of life (HRQL). Cognitive behavioral therapy (CBT) has been shown to reduce symptoms of IBS and to improve HRQL, but access to qualified therapists is limited. Smartphone-based digital therapeutic interventions have potential to increase access to guided CBT at scale, but require careful study to assess their benefits and risks. Objective: The aim of this study was to test the efficacy of a novel app, Zemedy, as a mobile digital therapeutic that delivers a comprehensive CBT program to individuals with IBS. Methods: This was a crossover randomized controlled trial. Participants were recruited online and randomly allocated to either immediate treatment (n=62) or waitlist control (n=59) groups. The Zemedy app consists of 8 modules focusing on psychoeducation, relaxation training, exercise, the cognitive model of stress management, applying CBT to IBS symptoms, reducing avoidance through exposure therapy, behavioral experiments, and information about diet.  Users interact with a chatbot that presents the information and encourages specific plans, homework, and exercises. The treatment was fully automated, with no therapist involvement or communication.  At baseline and after 8 weeks, participants were asked to complete the battery of primary (Irritable Bowel Syndrome Quality of Life [IBS-QOL], Gastrointestinal Symptom Rating Scale [GSRS]) and secondary (Fear of Food Questionnaire [FFQ], Visceral Sensitivity Index [VSI], Gastrointestinal Cognition Questionnaire [GI-COG], Depression Anxiety Stress Scale [DASS], and Patient Health Questionnaire-9 [PHQ-9]) outcome measures. Waitlist controls were then offered the opportunity to crossover to treatment. All participants were assessed once more at 3 months posttreatment. Results: Both intention-to-treat and completer analyses at posttreatment revealed significant improvement for the immediate treatment group compared to the waitlist control group on both primary and secondary outcome measures. Gains were generally maintained at 3 months posttreatment. Scores on the GSRS, IBS-QoL, GI-COG, VSI, and FFQ all improved significantly more in the treatment group (F1,79=20.49, P<.001, Cohen d=1.01; F1,79=20.12, P<.001, d=1.25; F1,79=34.71, P<.001, d=1.47; F1,79=18.7, P<.001, d=1.07; and F1,79=12.13, P=.001, d=0.62, respectively). Depression improved significantly as measured by the PHQ-9 (F1,79=10.5, P=.002, d=1.07), and the DASS Depression (F1,79=6.03, P=.02, d=.83) and Stress (F1,79=4.47, P=.04, d=0.65) subscales in the completer analysis but not in the intention-to-treat analysis. The impact of treatment on HRQL was mediated by reductions in catastrophizing and visceral sensitivity. Conclusions: Despite its relatively benign physical profile, IBS can be an extraordinarily debilitating condition. Zemedy is an effective modality to deliver CBT for individuals with IBS, and could increase accessibility of this evidence-based treatment. Trial Registration: ClinicalTrials.gov NCT04170686; https://www.clinicaltrials.gov/ct2/show/NCT04170686 ",
doi="10.2196/26152",
url="https://mhealth.jmir.org/2021/5/e26152",
url="http://www.ncbi.nlm.nih.gov/pubmed/33872182"
}


@Article{info:doi/10.2196/24907,
author="Franzmair, Julian
and Diesner-Treiber, C. Susanne
and Voitl, M. Julian J.
and Voitl, Peter",
title="Effective German and English Language mHealth Apps for Self-management of Bronchial Asthma in Children and Adolescents: Comparison Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="May",
day="19",
volume="9",
number="5",
pages="e24907",
keywords="asthma",
keywords="apps",
keywords="mobile health",
keywords="self-management",
keywords="recommended apps",
keywords="German",
keywords="English",
keywords="mobile phone",
abstract="Background: Mobile health (mHealth) apps hold great potential for asthma self-management. Data on the suitability of asthma apps intended for children are insufficient, and the availability of German language apps is still inadequate compared with English language apps. Objective: This study aims to identify functional asthma apps for children in German and to compare them with English language apps. In line with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the Google Play Store and Apple App Store are systematically searched to preselect the most efficient apps, which are then compared according to a self-compiled criteria catalog. Methods: Both app stores were screened for the term asthma. Following a PRISMA preselection process, the apps that met the inclusion criteria (ie, available free of charge, German or English language, and suitable for children) were rated by 3 independent persons following a criteria catalog consisting of 9 categories, some conceived for this purpose (availability, child-friendly, learning factor, and range of functions) and some adopted from existing validated catalogs (functionality and design, ease of use, potential for improving asthma self-management, fun factor and incentives, and information management and medical accuracy). The highest rated apps in German and English were compared. Results: A total of 403 apps were identified on the Google Play Store and the Apple App Store. Finally, 24 apps that met the inclusion criteria were analyzed. In the first step of the quality assessment, only 4 available German language asthma apps were compared with 20 English language asthma apps. The 4 German language apps were then compared with the 4 highest rated English language apps. All selected apps, independent of the language, were comparable in the following categories: availability, functionality and design, ease of use, and information management and medical accuracy. The English language apps scored significantly higher in the following categories: potential for improving self-management, child-friendly, fun factor, learning factor, and range of function. English language apps (mean total points 34.164, SD 1.09) performed significantly better than German language asthma apps (mean total points 22.91, SD 2.898; P=.003). The best rated English language app was Kiss my asthma (36/42 points), whereas the best rated German language app Kata achieved only 27.33 points. Conclusions: The recommended English language apps are Kiss my asthma, AsthmaXcel, AsthmaAustralia, and Ask Me, AsthMe!, whereas the only recommended German language app is Kata. The use of apps plays an increasingly important role in patients' lives and in the medical field, making mHealth a staple in the future of asthma treatment plans. Although validated recommendations on rating mHealth apps have been published, it remains a challenging task for physicians and patients to choose a suitable app for each case, especially in non--English-speaking countries. ",
doi="10.2196/24907",
url="https://mhealth.jmir.org/2021/5/e24907",
url="http://www.ncbi.nlm.nih.gov/pubmed/34009134"
}


@Article{info:doi/10.2196/25969,
author="Magee, Reece Michael
and McNeilage, Gray Amy
and Avery, Nicholas
and Glare, Paul
and Ashton-James, Elizabeth Claire",
title="mHealth Interventions to Support Prescription Opioid Tapering in Patients With Chronic Pain: Qualitative Study of Patients' Perspectives",
journal="JMIR Form Res",
year="2021",
month="May",
day="18",
volume="5",
number="5",
pages="e25969",
keywords="prescription opioids",
keywords="chronic noncancer pain",
keywords="tapering",
keywords="digital health",
keywords="support",
keywords="mobile health technology",
keywords="SMS",
keywords="mobile phone",
abstract="Background: Patients with chronic pain who are tapering prescription opioids report a need for greater support for coping with symptoms of pain and withdrawal. Mobile health (mHealth) technologies (SMS text messaging-- or app-based) have the potential to provide patients with educational, emotional, and motivational support for opioid tapering beyond what is offered by their health care provider. However, it is not known whether patients with chronic pain who are tapering opioids would be willing or able to engage with technology-based support. Objective: This study aims to examine patients' use of mobile technologies in health care, interest in using mHealth support, preferences for the form and content of mHealth support, and potential barriers to and facilitators of engagement with mHealth support for opioid tapering. Methods: A total of 21 patients (11 women and 10 men; age range 29-83 years) with chronic noncancer pain on long-term opioid therapy who had recently initiated a voluntary opioid taper were recruited from primary and tertiary care clinics in metropolitan and regional Australia for a larger study of patients' experiences of opioid tapering. Participants had been taking prescription opioids for a mean duration of 13 (SD 9.6; range 0.25-30) years at the time of the study. Survey items characterized participants' typical mobile phone use and level of interest in mobile technology--based support for opioid tapering. Semistructured interviews further explored patients' use of mobile technologies and their interest in, preferences for, and perspectives on potential barriers to and facilitators of engagement with mHealth support for opioid tapering. Two researchers collaborated to conduct a thematic analysis of the interview data. Results: All participants reported owning and using a mobile phone, and most (17/21, 81\%) participants reported using mobile apps. The majority of participants expressed interest in SMS text messaging--based (17/21, 81\%) and app-based (15/21, 71\%) support for opioid tapering. Participants expected that messages delivering both informational and socioemotional support would be helpful. Participants expected that access to technology, mobile reception, internet connectivity, vision impairment, and low self-efficacy for using apps may be barriers to user engagement. Patients expected that continuity of care from their health care provider, flexible message dosing, responsivity, and familiarity with pain self-management strategies would increase user engagement. Conclusions: The results of this study indicate that patients with chronic noncancer pain may be willing to engage with SMS text messaging--based and app-based mHealth interventions to support opioid tapering. However, the feasibility and acceptability of these interventions may depend on how patients' preferences for functionality, content, and design are addressed. ",
doi="10.2196/25969",
url="https://formative.jmir.org/2021/5/e25969",
url="http://www.ncbi.nlm.nih.gov/pubmed/34003133"
}


@Article{info:doi/10.2196/24530,
author="Ross, S. Emily
and Sakakibara, M. Brodie
and Mackay, H. Martha
and Whitehurst, T. David G.
and Singer, Joel
and Toma, Mustafa
and Corbett, K. Kitty
and Van Spall, C. Harriette G.
and Rutherford, Kimberly
and Gheorghiu, Bobby
and Code, Jillianne
and Lear, A. Scott",
title="The Use of SMS Text Messaging to Improve the Hospital-to-Community Transition in Patients With Acute Coronary Syndrome (Txt2Prevent): Results From a Pilot Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="May",
day="14",
volume="9",
number="5",
pages="e24530",
keywords="SMS text messaging",
keywords="mHealth",
keywords="acute coronary syndrome",
keywords="cardiovascular disease",
abstract="Background: Acute coronary syndrome (ACS) is a leading cause of hospital admission in North America. Many patients with ACS experience challenges after discharge that impact their clinical outcomes and psychosocial well-being. SMS text messaging has the potential to provide support to patients during this postdischarge period. Objective: This study pilot tested a 60-day SMS text messaging intervention (Txt2Prevent) for patients with ACS. The primary objective was to compare self-management domains between usual care and usual care plus Txt2Prevent. The secondary objectives were to compare medication adherence, health-related quality of life, self-efficacy, and health care resource use between groups. The third objective was to assess the feasibility of the study protocol and the acceptability of the intervention. Methods: This was a randomized controlled trial with blinding of outcome assessors. We recruited 76 patients with ACS from St. Paul's Hospital in Vancouver, Canada, and randomized them to 1 of 2 groups within 7 days of discharge. The Txt2Prevent program included automated 1-way SMS text messages about follow-up care, self-management, and healthy living. Data were collected during the index admission and at 60 days after randomization. The primary outcome was measured with the Health Education Impact Questionnaire (heiQ). Other outcomes included the EQ-5D-5L, EQ-5D-5L Visual Analog Scale, a modified Sullivan Cardiac Self-Efficacy Scale, and Morisky Medication Adherence Scale scores, and self-reported health care resource use. Analyses of covariance were used to test the effect of group assignment on follow-up scores (controlling for baseline) and were considered exploratory in nature. Feasibility was assessed with descriptive characteristics of the study protocol. Acceptability was assessed with 2 survey questions and semistructured interviews. Results: There were no statistically significant differences between the groups for the heiQ domains (adjusted mean difference [Txt2Prevent minus usual care] for each domain---Health-directed activity: --0.13, 95\% CI --0.39 to 0.13, P=.31; Positive and active engagement in life: 0.03, 95\% CI --0.19 to 0.25, P=.76; Emotional distress: 0.04, 95\% CI --0.22 to 0.29, P=.77; Self-monitoring and insight: --0.14, 95\% CI --0.33 to 0.05, P=.15; Constructive attitudes and approaches: --0.10, 95\% CI --0.36 to 0.17, P=.47; Skill technique and acquisition: 0.05, 95\% CI --0.18 to 0.27, P=.69; Social integration and support: --0.12, 95\% CI --0.34 to 0.10, P=.27; and Health services navigation: --0.05, 95\% CI --0.29 to 0.19, P=.69). For the secondary outcomes, there were no statistically significant differences in adjusted analyses except in 1 self-efficacy domain (Total plus), where the Txt2Prevent group had lower scores (mean difference --0.36, 95\% CI --0.66 to --0.50, P=.03). The study protocol was feasible, but recruitment took longer than expected. Over 90\% (29/31 [94\%]) of participants reported they were satisfied with the program. Conclusions: The Txt2Prevent study was feasible to implement; however, although exploratory, there were no differences between the 2 groups in adjusted analyses except for 1 self-efficacy domain. As the intervention appeared acceptable, there is potential in using SMS text messages in this context. The design of the intervention may need to be reconsidered to have more impact on outcome measures. Trial Registration: ClinicalTrials.gov NCT02336919; https://clinicaltrials.gov/ct2/show/NCT02336919 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.6968 ",
doi="10.2196/24530",
url="https://mhealth.jmir.org/2021/5/e24530",
url="http://www.ncbi.nlm.nih.gov/pubmed/33988519"
}


@Article{info:doi/10.2196/25316,
author="Lopes, Filipa
and Rodrigues, M{\'a}rio
and Silva, G. Anabela",
title="User-Centered Development of a Mobile App for Biopsychosocial Pain Assessment in Adults: Usability, Reliability, and Validity Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="May",
day="14",
volume="9",
number="5",
pages="e25316",
keywords="pain assessment",
keywords="mobile app",
keywords="validity",
keywords="reliability",
keywords="usability",
keywords="mHealth",
keywords="pain",
keywords="user-centered design",
abstract="Background: Pain-related mobile apps targeting pain assessment commonly limit pain assessment to pain behaviors and physiological aspects. However, current guidelines state that pain assessment should follow the biopsychosocial model, clearly addressing biological, psychological, and social aspects of the pain experience. Existing reviews also highlight that pain specialists and end users are not commonly involved in the development process of mobile apps for pain assessment, negatively affecting the quality of the available apps. Objective: This study aimed to develop a mobile app for pain assessment (AvaliaDor) and assess its usability, validity, reliability, and measurement error in a sample of real patients with chronic pain recruited from a physiotherapy clinic. Methods: This study was divided into 2 phases: phase 1---development of the AvaliaDor app; and phase 2---assessment of the apps' usability, reliability, measurement error, and validity. AvaliaDor was developed (phase 1) based on the literature and the recommendations of physiotherapists and patients with pain in cycles of evaluation, inclusion of recommendations, and reevaluation until no further changes were required. The final version of the app was then tested in patients with musculoskeletal pain attending a private physiotherapy practice (phase 2) who were asked to use the app twice on 2 consecutive days for reliability purposes. In addition, participants had to complete a set of paper-based scales (Brief Pain Inventory, painDETECT, Pain Catastrophizing Scale, and Tampa Scale for Kinesiophobia), which were used to assess the validity (criterion validity and hypothesis testing) of the app, and the Post-Study System Usability Questionnaire was used to assess its usability. Results: The development process (phase 1) included 5 physiotherapists external to the research team and 5 patients with musculoskeletal pain, and it resulted in the creation of an app named AvaliaDor, which includes an assessment of pain intensity, location, and phenotype; associated disability; and the issues of pain catastrophizing and fear of movement. A total of 52 patients with pain (mean age 50.12 years, SD 11.71 years; 39 females) participated in phase 2 and used the app twice. The Pearson correlation coefficient between the scores on the paper-based scales and the app ranged between 0.81 and 0.93 for criterion validity and between 0.41 and 0.59 for hypothesis testing. Test-retest reliability was moderate to good (intraclass correlation coefficient between 0.67 and 0.90) and the score for usability was 1.16 (SD 0.27), indicating good usability. Conclusions: A mobile app named AvaliaDor was developed to assess the intensity, location, and phenotype of pain; associated disability; and the issues of pain catastrophizing and fear of movement in a user-centered design process. The app was shown to be usable, valid, and reliable for assessing pain from a biopsychosocial perspective in a heterogeneous group of patients with pain. Future work can explore the long-term use of AvaliaDor in clinical contexts and its advantages for the assessment and management of patients with pain. ",
doi="10.2196/25316",
url="https://mhealth.jmir.org/2021/5/e25316",
url="http://www.ncbi.nlm.nih.gov/pubmed/33988515"
}


@Article{info:doi/10.2196/29014,
author="Badawy, M. Sherif
and Abebe, Z. Kaleab
and Reichman, A. Charlotte
and Checo, Grace
and Hamm, E. Megan
and Stinson, Jennifer
and Lalloo, Chitra
and Carroll, Patrick
and Saraf, L. Santosh
and Gordeuk, R. Victor
and Desai, Payal
and Shah, Nirmish
and Liles, Darla
and Trimnell, Cassandra
and Jonassaint, R. Charles",
title="Comparing the Effectiveness of Education Versus Digital Cognitive Behavioral Therapy for Adults With Sickle Cell Disease: Protocol for the Cognitive Behavioral Therapy and Real-time Pain Management Intervention for Sickle Cell via Mobile Applications (CaRISMA) Study",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="14",
volume="10",
number="5",
pages="e29014",
keywords="sickle cell anemia",
keywords="sickle cell disease",
keywords="pain",
keywords="depression",
keywords="depressive symptoms",
keywords="quality of life",
keywords="digital",
keywords="mHealth",
keywords="eHealth",
keywords="CBT",
keywords="cognitive behavioral therapy",
keywords="education",
keywords="mobile phone",
abstract="Background: Patients with sickle cell disease (SCD) experience significant medical and psychological stressors that affect their mental health, well-being, and disease outcomes. Digital cognitive behavioral therapy (CBT) has been used in other patient populations and has demonstrated clinical benefits. Although evidence-based, nonpharmacological interventions for pain management are widely used in other populations, these treatments have not been well studied in SCD. Currently, there are no adequately powered large-scale clinical trials to evaluate the effectiveness and dissemination potential of behavioral pain management for adults with SCD. Furthermore, some important details regarding behavioral therapies in SCD remain unclear---in particular, what works best for whom and when. Objective: Our primary goal is to compare the effectiveness of two smartphone--delivered programs for reducing SCD pain symptoms: digital CBT versus pain and SCD education (Education). Our secondary goal is to assess whether baseline depression symptoms moderate the effect of interventions on pain outcomes. We hypothesize that digital CBT will confer greater benefits on pain outcomes and depressive symptoms at 6 months and a greater reduction in health care use (eg, opioid prescriptions or refills or acute care visits) over 12 months. Methods: The CaRISMA (Cognitive Behavioral Therapy and Real-time Pain Management Intervention for Sickle Cell via Mobile Applications) study is a multisite comparative effectiveness trial funded by the Patient-Centered Outcomes Research Institute. CaRISMA is conducted at six clinical academic sites, in partnership with four community-based organizations. CaRISMA will evaluate the effectiveness of two 12-week health coach--supported digital health programs with a total of 350 participants in two groups: CBT (n=175) and Education (n=175). Participants will complete a series of questionnaires at baseline and at 3, 6, and 12 months. The primary outcome will be the change in pain interference between the study arms. We will also evaluate changes in pain intensity, depressive symptoms, other patient-reported outcomes, and health care use as secondary outcomes. We have 80\% power to detect a difference of 0.37 SDs between study arms on 6-month changes in the outcomes with 15\% expected attrition at 6 months. An exploratory analysis will examine whether baseline depression symptoms moderate the effect of the intervention on pain interference. Results: This study will be conducted from March 2021 through February 2022, with results expected to be available in February 2023. Conclusions: Patients with SCD experience significant disease burden, psychosocial stress, and impairment of their quality of life. CaRISMA proposes to leverage digital technology and overcome barriers to the routine use of behavioral treatments for pain and depressive symptoms in the treatment of adults with SCD. The study will provide data on the comparative effectiveness of digital CBT and Education approaches and evaluate the potential for implementing evidence-based behavioral interventions to manage SCD pain. Trial Registration: ClinicalTrials.gov NCT04419168; https://clinicaltrials.gov/ct2/show/NCT04419168. International Registered Report Identifier (IRRID): PRR1-10.2196/29014 ",
doi="10.2196/29014",
url="https://www.researchprotocols.org/2021/5/e29014",
url="http://www.ncbi.nlm.nih.gov/pubmed/33988517"
}


@Article{info:doi/10.2196/21831,
author="Liu, Yongmei
and Jiang, Fei
and Lin, Peiyang",
title="Influence Mechanism of the Affordances of Chronic Disease Management Apps on Continuance Intention: Questionnaire Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="May",
day="13",
volume="9",
number="5",
pages="e21831",
keywords="health empowerment",
keywords="perceived affordances",
keywords="uses and gratifications",
keywords="S-O-R framework",
keywords="continuance intention",
keywords="chronic disease management app",
abstract="Background: Mobile health apps are becoming increasingly popular, and they provide opportunities for effective health management. Existing chronic disease management (CDM) apps cannot meet users' practical and urgent needs, and user adhesion is poor. Few studies, however, have investigated the factors that influence the continuance intention of CDM app users. Objective: Starting from the affordances of CDM apps, this study aimed to analyze how such apps can influence continuance intention through the role of health empowerment. Methods: Adopting a stimulus-organism-response framework, an antecedent model was established for continuance intention from the perspective of perceived affordances, uses and gratifications theory, and health empowerment. Perceived affordances were used as the ``stimulus,'' users' gratifications and health empowerment were used as the ``organism,'' and continuance intention was used as the ``response.'' Data were collected online through a well-known questionnaire survey platform in China, and 323 valid questionnaires were obtained. The theoretical model was tested using structural equation modeling. Results: Perceived connection affordances were found to have significant positive effects on social interactivity gratification (t717=6.201, P<.001) and informativeness gratification (t717=5.068, P<.001). Perceived utilitarian affordances had significant positive effects on informativeness gratification (t717=7.029, P<.001), technology gratification (t717=8.404, P<.001), and function gratification (t717=9.812, P<.001). Perceived hedonic affordances had significant positive effects on function gratification (t717=5.305, P<.001) and enjoyment gratification (t717=13.768, P<.001). Five gratifications (t717=2.767, P=.005; t717=4.632, P<.001; t717=7.608, P<.001; t717=2.496, P=.012; t717=5.088, P<.001) had significant positive effects on health empowerment. Social interactivity gratification, informativeness gratification, and function gratification had significant positive effects on continuance intention. Technology gratification and enjoyment gratification did not have a significant effect on continuance intention. Health empowerment had a significant positive effect on continuance intention. Health empowerment and gratifications play mediating roles in the influence of affordances on continuance intention. Conclusions: Health empowerment and gratifications of users' needs are effective ways to promote continuance intention. The gratifications of users' needs can realize health empowerment and then inspire continuance intention. Affordances are key antecedents that affect gratifications of users' needs, health empowerment, and continuance intention. ",
doi="10.2196/21831",
url="https://mhealth.jmir.org/2021/5/e21831",
url="http://www.ncbi.nlm.nih.gov/pubmed/33983126"
}


@Article{info:doi/10.2196/26096,
author="Holl{\"a}nder-Mieritz, Cecilie
and Vogelius, R. Ivan
and Kristensen, A. Claus
and Green, Allan
and Rindum, L. Judith
and Pappot, Helle",
title="Using Biometric Sensor Data to Monitor Cancer Patients During Radiotherapy: Protocol for the OncoWatch Feasibility Study",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="13",
volume="10",
number="5",
pages="e26096",
keywords="biometric sensor technology",
keywords="cancer",
keywords="head and neck cancer",
keywords="home monitoring",
keywords="patient-generated health data",
keywords="radiotherapy",
keywords="sensor",
keywords="smartwatch",
abstract="Background: Patients with head and neck cancer (HNC) experience severe side effects during radiotherapy (RT). Ongoing technological advances in wearable biometric sensors allow for the collection of objective data (eg, physical activity and heart rate), which might, in the future, help detect and counter side effects before they become severe. A smartwatch such as the Apple Watch allows for objective data monitoring outside the hospital with minimal effort from the patient. To determine whether such tools can be implemented in the oncological setting, feasibility studies are needed. Objective: This protocol describes the design of the OncoWatch 1.0 feasibility study that assesses the adherence of patients with HNC to an Apple Watch during RT. Methods: A prospective, single-cohort trial will be conducted at the Department of Oncology, Rigshospitalet (Copenhagen, Denmark). Patients aged ?18 years intended for primary or postoperative curatively intended RT for HNC will be recruited. Consenting patients will be asked to wear an Apple Watch on the wrist during and until 2 weeks after RT. The study will include 10 patients. Data on adherence, data acquisition, and biometric data will be collected. Demographic data, objective toxicity scores, and hospitalizations will be documented. Results: The primary outcome is to determine if it is feasible for the patients to wear a smartwatch continuously (minimum 12 hours/day) during RT. Furthermore, we will explore how the heart rate and physical activity change over the treatment course. Conclusions: The study will assess the feasibility of using the Apple Watch for home monitoring of patients with HNC. Our findings may provide novel insights into the patient's activity levels and variations in heart rate during the treatment course. The knowledge obtained from this study will be essential for further investigating how biometric data can be used as part of symptom monitoring for patients with HNC. Trial Registration: ClinicalTrials.gov NCT04613232; https://clinicaltrials.gov/ct2/show/NCT04613232 International Registered Report Identifier (IRRID): PRR1-10.2196/26096 ",
doi="10.2196/26096",
url="https://www.researchprotocols.org/2021/5/e26096",
url="http://www.ncbi.nlm.nih.gov/pubmed/33983123"
}


@Article{info:doi/10.2196/29562,
author="Clingan, A. Caroline
and Dittakavi, Manasa
and Rozwadowski, Michelle
and Gilley, N. Kristen
and Cislo, R. Christine
and Barabas, Jenny
and Sandford, Erin
and Olesnavich, Mary
and Flora, Christopher
and Tyler, Jonathan
and Mayer, Caleb
and Stoneman, Emily
and Braun, Thomas
and Forger, B. Daniel
and Tewari, Muneesh
and Choi, Won Sung",
title="Monitoring Health Care Workers at Risk for COVID-19 Using Wearable Sensors and Smartphone Technology: Protocol for an Observational mHealth Study",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="12",
volume="10",
number="5",
pages="e29562",
keywords="mobile health",
keywords="app",
keywords="mHealth",
keywords="wearable",
keywords="sensor",
keywords="COVID-19",
keywords="health care worker",
keywords="frontline worker",
keywords="smartphone",
keywords="digital health",
abstract="Background: Health care workers (HCWs) have been working on the front lines of the COVID-19 pandemic with high risks of viral exposure, infection, and transmission. Standard COVID-19 testing is insufficient to protect HCWs from these risks and prevent the spread of disease. Continuous monitoring of physiological data with wearable sensors, self-monitoring of symptoms, and asymptomatic COVID-19 testing may aid in the early detection of COVID-19 in HCWs and may help reduce further transmission among HCWs, patients, and families. Objective: By using wearable sensors, smartphone-based symptom logging, and biospecimens, this project aims to assist HCWs in self-monitoring COVID-19. Methods: We conducted a prospective, longitudinal study of HCWs at a single institution. The study duration was 1 year, wherein participants were instructed on the continuous use of two wearable sensors (Fitbit Charge 3 smartwatch and TempTraq temperature patches) for up to 30 days. Participants consented to provide biospecimens (ie, nasal swabs, saliva swabs, and blood) for up to 1 year from study entry. Using a smartphone app called Roadmap 2.0, participants entered a daily mood score, submitted daily COVID-19 symptoms, and completed demographic and health-related quality of life surveys at study entry and 30 days later. Semistructured qualitative interviews were also conducted at the end of the 30-day period, following completion of daily mood and symptoms reporting as well as continuous wearable sensor use. Results: A total of 226 HCWs were enrolled between April 28 and December 7, 2020. The last participant completed the 30-day study procedures on January 16, 2021. Data collection will continue through January 2023, and data analyses are ongoing. Conclusions: Using wearable sensors, smartphone-based symptom logging and survey completion, and biospecimen collections, this study will potentially provide data on the prevalence of COVID-19 infection among HCWs at a single institution. The study will also assess the feasibility of leveraging wearable sensors and self-monitoring of symptoms in an HCW population. Trial Registration: ClinicalTrials.gov NCT04756869; https://clinicaltrials.gov/ct2/show/NCT04756869 International Registered Report Identifier (IRRID): DERR1-10.2196/29562 ",
doi="10.2196/29562",
url="https://www.researchprotocols.org/2021/5/e29562",
url="http://www.ncbi.nlm.nih.gov/pubmed/33945497"
}


@Article{info:doi/10.2196/24520,
author="Machen, Leah
and Handley, A. Margaret
and Powe, Neil
and Tuot, Delphine",
title="Engagement With a Health Information Technology--Augmented Self-Management Support Program in a Population With Limited English Proficiency: Observational Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="May",
day="11",
volume="9",
number="5",
pages="e24520",
keywords="automated telehealth intervention",
keywords="limited English proficiency",
keywords="mHealth",
keywords="language problems",
keywords="telehealth",
keywords="SMS",
keywords="text message",
abstract="Background: Limited English proficiency (LEP) is an important driver of health disparities. Many successful patient-level interventions to prevent chronic disease progression and complications have used automated telephone self-management support, which relies on patient activation and communication to achieve improved health outcomes. It is not clear whether these interventions are similarly applicable to patients with LEP compared to patients with English proficiency. Objective: The objectives of this study were as follows: (1) To examine the impact of LEP on patient engagement (primary outcome) with a 12-month language-concordant self-management program that included automated telephone self-management support, designed for patients with chronic kidney disease (CKD). (2) To assess the impact of LEP on change in systolic blood pressure (SBP) and albuminuria (secondary outcomes) resulting from the self-management program. Methods: This was a secondary analysis of the Kidney Awareness Registry and Education (KARE) pilot trial (NCT01530958) which was funded by the National Institutes of Health in August 2011, approved by the University of California Institutional Review Board in October 2011 (No. 11-07399), and executed between 2013 and 2015. Multivariable logistic and linear models were used to examine various facets of patient engagement with the CKD self-management support program by LEP status. Patient engagement was defined by patient's use of educational materials, completion of a health coaching action plan, and degree of participation with automated telephone self-management support. Changes in SBP and albuminuria at 12 months by LEP status were determined using multivariable linear mixed models. Results: Of 137 study participants, 53 (38.7\%) reported LEP, of which 45 (85\%) were Spanish speaking and 8 (15\%) Cantonese speaking. While patients with LEP and English proficiency similarly used the program's educational materials (85\% [17/20] vs 88\% [30/34], P=.69) and completed an action plan (81\% [22/27] vs 74\% [35/47], P=.49), those with LEP engaged more with the automated telephone self-management support component. Average call completion was 66\% among patients with LEP compared with 57\% among those with English proficiency; patients with LEP requested more health coach telephone calls (P=.08) and had a significantly longer average automated call duration (3.3 [SD 1.4] min vs 2.2 [1.1 min], P<.001), indicating higher patient engagement. Patients with LEP randomized to self-management support had a larger, though nonstatistically significant (P=.74), change in SBP (--4.5 mmHg; 95\% CI --9.4 to 0.3) and albuminuria (--72.4 mg/dL; 95\% CI --208.9 to 64.1) compared with patients with English proficiency randomized to self-management support (--2.1 mmHg; 95\% CI --8.6 to 4.3 and --11.1 mg/dL; 95\% CI --166.9 to 144.7). Conclusions: Patients with LEP with CKD were equally or more engaged with a language-concordant, culturally appropriate telehealth intervention compared with their English-speaking counterparts. Augmented telehealth may be useful in mitigating communication barriers among patients with LEP. Trial Registration: ClinicalTrials.gov NCT01530958; https://clinicaltrials.gov/ct2/show/NCT01530958 ",
doi="10.2196/24520",
url="https://mhealth.jmir.org/2021/5/e24520",
url="http://www.ncbi.nlm.nih.gov/pubmed/33973868"
}


@Article{info:doi/10.2196/25503,
author="Sezgin, Emre
and Noritz, Garey
and Lin, Simon
and Huang, Yungui",
title="Feasibility of a Voice-Enabled Medical Diary App (SpeakHealth) for Caregivers of Children With Special Health Care Needs and Health Care Providers: Mixed Methods Study",
journal="JMIR Form Res",
year="2021",
month="May",
day="11",
volume="5",
number="5",
pages="e25503",
keywords="children with special health care needs",
keywords="care management",
keywords="care coordination",
keywords="voice-enabled mobile app",
keywords="health information technology",
keywords="voice assistant",
keywords="voice interaction",
keywords="mobile phone",
abstract="Background: Children with special health care needs (CSHCN) require more than the usual care management and coordination efforts from caregivers and health care providers (HCPs). Health information and communication technologies can potentially facilitate these efforts to increase the quality of care received by CSHCN. Objective: In this study, we aim to assess the feasibility of a voice-enabled medical diary app (SpeakHealth) by investigating its potential use among caregivers and HCPs. Methods: Following a mixed methods approach, caregivers of CSHCN were interviewed (n=10) and surveyed (n=86) about their care management and communication technology use. Only interviewed participants were introduced to the SpeakHealth app prototype, and they tested the app during the interview session. In addition, we interviewed complex care HCPs (n=15) to understand their perception of the value of a home medical diary such as the SpeakHealth app. Quantitative data were analyzed using descriptive statistics and correlational analyses. Theoretical thematic analysis was used to analyze qualitative data. Results: The survey results indicated a positive attitude toward voice-enabled technology and features; however, there was no strong correlation among the measured items. The caregivers identified communication, information sharing, tracking medication, and appointments as fairly and highly important features of the app. Qualitative analysis revealed the following two overarching themes: enablers and barriers in care communication and enablers and barriers in communication technologies. The subthemes included parent roles, care communication technologies, and challenges. HCPs found the SpeakHealth app to be a promising tool for timely information collection that could be available for sharing information with the health system. Overall, the findings demonstrated a variety of needs and challenges for caregivers of CSHCN and opportunities for voice-enabled, interactive medical diary apps in care management and coordination. Caregivers fundamentally look for better information sharing and communication with HCPs. Health care and communication technologies can potentially improve care communication and coordination in addressing the patient and caregiver needs. Conclusions: The perspectives of caregivers and providers suggested both benefits and challenges in using the SpeakHealth app for medical note-taking and tracking health events at home. Our findings could inform researchers and developers about the potential development and use of a voice-enabled medical diary app. ",
doi="10.2196/25503",
url="https://formative.jmir.org/2021/5/e25503",
url="http://www.ncbi.nlm.nih.gov/pubmed/33865233"
}


@Article{info:doi/10.2196/26673,
author="Trettin, Bettina
and Danbj{\o}rg, Boe Dorthe
and Andersen, Flemming
and Feldman, Steven
and Agerskov, Hanne",
title="Development of an mHealth App for Patients With Psoriasis Undergoing Biological Treatment: Participatory Design Study",
journal="JMIR Dermatol",
year="2021",
month="May",
day="10",
volume="4",
number="1",
pages="e26673",
keywords="mHealth",
keywords="psoriasis",
keywords="biologics",
keywords="participatory design",
keywords="teledermatology",
keywords="mobile phone",
abstract="Background: In Denmark, patients with psoriasis undergoing biological treatment have regular follow-ups, typically every 3 months. This may pose a challenge for patients who live far away from the hospital. Mobile health (mHealth) is a promising and reliable tool for the long-term management of patients with psoriasis undergoing biological treatment because the disease course can be properly monitored. Despite recent developments in mHealth, the full potential of teledermatology remains to be tapped by newer, more attractive forms of services focused on patients' needs. Objective: This study aims to design and develop an mHealth app to support the self-management of patients with psoriasis using a participatory design. Methods: Using participatory design, we conducted 1 future workshop, 4 mock-up workshops, and 1 prototype test with patients and health care professionals to co-design a prototype. The process was iterative to ensure that all stakeholders would provide input into the design and outcome; this approach enabled continuous revision of the prototype until an acceptable solution was agreed upon. Data were analyzed according to the steps---plan, act, observe, and reflect---in the methodology of participatory design. Results: Health care professionals and patients emphasized the importance of a more patient-centered approach, focusing on the communication and maintenance of relationships. Patients perceived consultations to be impersonal and repetitive and wanted the opportunity to contribute to the agenda while attending a consultation. Patients also stated they would prefer not to attend visits in person every 3 months. On the basis of these findings, we designed an mHealth app that could replace in-person visits and support patients at in-person visits. Video consultations, self-monitoring, and registration of patient-reported outcome data were embedded in the app. Conclusions: Using participatory design facilitated mutual learning and democratic processes that gave end users a significant influence over the solution. Despite the advantages of using participatory design in developing mHealth solutions, organizational conditions may still represent a barrier to the optimization of solutions. ",
doi="10.2196/26673",
url="https://derma.jmir.org/2021/1/e26673",
url="http://www.ncbi.nlm.nih.gov/pubmed/37632817"
}


@Article{info:doi/10.2196/28668,
author="Petrocchi, Serena
and Filipponi, Chiara
and Montagna, Giacomo
and Bonollo, Marta
and Pagani, Olivia
and Meani, Francesco",
title="A Breast Cancer Smartphone App to Navigate the Breast Cancer Journey: Mixed Methods Study",
journal="JMIR Form Res",
year="2021",
month="May",
day="10",
volume="5",
number="5",
pages="e28668",
keywords="breast cancer",
keywords="decision-making process",
keywords="breast cancer patient",
keywords="smartphone app",
keywords="empowerment",
keywords="breast cancer journey",
keywords="mobile app",
abstract="Background: Several mobile apps have been designed for patients with a diagnosis of cancer. Unfortunately, despite the promising potential and impressive spread, their effectiveness often remains unclear. Most mobile apps are developed without any medical professional involvement and quality evidence-based assessment. Furthermore, they are often implemented in clinical care before any research is performed to confirm usability, appreciation, and clinical benefits for patients. Objective: We aimed to develop a new smartphone app (Centro di Senologia della Svizzera Italiana [CSSI]) specifically designed by breast care specialists and patients together to help breast cancer patients better understand and organize their journey through the diagnosis and treatment of cancer. We describe the development of the app and present assessments to evaluate its feasibility, usefulness, and capability to improve patient empowerment. Methods: A mixed method study with brief longitudinal quantitative data collection and subsequent qualitative semistructured interviews was designed. Twenty breast cancer patients participated in the study (mean age 51 years, SD 10 years). The usability of the app, the user experience, and empowerment were measured after 1 month. The semistructured interviews measured the utility of the app and the necessary improvements. Results: The app received good responses from the patients in terms of positive perception of the purpose of the app (7/20, 35\%), organizing the cure path and being aware of the steps in cancer management (5/20, 25\%), facilitating doctor-patient communication (4/20, 20\%), and having detailed information about the resources offered by the hospital (2/20, 10\%). Correlation and regression analyses showed that user experience increased the level of empowerment of patients (B=0.31, 95\% CI 0.22-0.69; P=.009). The interviews suggested the need to constantly keep the app updated and to synchronize it with the hospital's electronic agenda, and carefully selecting the best time to offer the tool to final users was considered crucial. Conclusions: Despite the very small number of participants in this study, the findings demonstrate the potential of the app and support a fully powered trial to evaluate the empowering effect of the mobile health app. More data will be gathered with an improved version of the app in the second phase involving a larger study sample. ",
doi="10.2196/28668",
url="https://formative.jmir.org/2021/5/e28668",
url="http://www.ncbi.nlm.nih.gov/pubmed/33970120"
}


@Article{info:doi/10.2196/26468,
author="Lin, Shu-Han Donna
and Lee, Jen-Kuang",
title="Mobile Health--Based Thermometer for Monitoring Wound Healing After Endovascular Therapy in Patients With Chronic Foot Ulcer: Prospective Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="May",
day="7",
volume="9",
number="5",
pages="e26468",
keywords="temperature",
keywords="peripheral artery disease",
keywords="endovascular therapy",
keywords="mHealth",
keywords="app",
keywords="foot",
keywords="therapy",
keywords="wound",
keywords="thermometer",
keywords="monitoring",
keywords="ulcer",
keywords="artery",
keywords="prospective",
keywords="cohort",
keywords="healing",
abstract="Background: Foot temperature may increase after endovascular therapy, but the relationship between foot temperature and wound healing is unclear. Objective: This study was performed to evaluate the feasibility of a mobile health (mHealth)--based thermometer for foot temperature monitoring in patients with chronic foot ulcer before and after endovascular therapy and to determine the association between temperature change and wound healing time. Methods: This was a prospective cohort study. Patients who had a chronic foot ulcer (>3 months) and underwent endovascular therapy between July 2019 and December 2019 were included. The participants received standard medical care and endovascular therapy for revascularization. The mHealth-based thermometer, composed of 4 temperature-sensing chips, was put on the foot before and after endovascular therapy. Data from the chips were transferred to an associated mobile phone app via Bluetooth. Wound healing time was estimated using the Kaplan-Meier method, and the associations between baseline characteristics and clinical outcomes were evaluated using a Cox proportional hazard model. Results: A total of 163 patients with chronic foot ulcer who underwent endovascular therapy were enrolled and followed up until wound healing was complete or for 180 days. The mean foot temperature before endovascular therapy was 30.6 (SD 2.8 {\textdegree}C). Foot temperature increased significantly (mean 32.1 {\textdegree}C, SD 2.8 {\textdegree}C; P=.01) after the procedure. Wound healing time was significantly different in the Kaplan-Meier curves of the patient group with temperature changes ?2 {\textdegree}C and the group with temperature changes ?2 {\textdegree}C (log-rank P<.001). A foot temperature increase ?2 {\textdegree}C after endovascular therapy was associated with increased wound healing in univariate analysis (hazard ratio [HR] 1.78, 95\% CI 1.24-2.76, P=.02), and the association remained significant in multivariate analysis (HR 1.69, 95\% CI 1.21-2.67, P=.03). Conclusions: The mHealth-based thermometer was feasible and useful for foot temperature monitoring, which may provide health care professionals with a new endpoint for endovascular therapy. Foot temperature increases ?2 {\textdegree}C after endovascular therapy were associated with faster wound healing in patients with chronic foot ulcer. Further studies are needed, however, to confirm these findings. ",
doi="10.2196/26468",
url="https://mhealth.jmir.org/2021/5/e26468",
url="http://www.ncbi.nlm.nih.gov/pubmed/33960955"
}


@Article{info:doi/10.2196/25011,
author="Altmann, Patrick
and Hinterberger, Werner
and Leutmezer, Fritz
and Ponleitner, Markus
and Monschein, Tobias
and Zrzavy, Tobias
and Zulehner, Gudrun
and Kornek, Barbara
and Lanzenberger, Rupert
and Berek, Klaus
and Rommer, Stefan Paulus
and Berger, Thomas
and Bsteh, Gabriel",
title="The Smartphone App haMSter for Tracking Patient-Reported Outcomes in People With Multiple Sclerosis: Protocol for a Pilot Study",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="7",
volume="10",
number="5",
pages="e25011",
keywords="mHealth",
keywords="mobile health",
keywords="remote monitoring",
keywords="patient-reported outcomes",
keywords="multiple sclerosis",
keywords="telemedicine",
abstract="Background: Treatment and monitoring decisions in people with multiple sclerosis (MS) are based commonly on clinician-reported outcomes. These reflect physical and radiological disease activity and are the most relevant endpoints in clinical trials. Over the past few years, the number of studies evaluating so-called patient-reported outcomes (PROs) has been increasing. PROs are reports from patients concerning their own health perception. They are typically obtained by means of questionnaires and aim to quantify symptoms such as fatigue, depression, and sexual dysfunction. The emergence of PROs has made a tremendous contribution to understanding the individual impact of disease in people with MS and their health-related quality of life. However, the assessment of PROs consumes resources, including time and personnel. Thus, useful ways to conveniently introduce PROs into clinical practice are needed. Objective: We aim to provide a rationale and pilot study protocol for a mobile health (mHealth) solution named ``haMSter'' that allows for remote monitoring of PROs in people with MS. Methods: The core function of haMSter is to provide three scientifically validated PRO questionnaires relevant to MS for patients to fill out at home once a month. Thereby, longitudinal and remote documentation of PROs is enabled. A scoring algorithm graphically plots PRO scores over time and makes them available at the next visit. Results: The pilot study is currently ongoing and will evaluate adherence to this mHealth solution in 50 patients over a period of 6 months. Results from the haMSter pilot study are expected in 2021. Conclusions: haMSter is a novel mHealth-based solution for modern PRO research, which may constitute the first step in achieving the ability to integrate PROs in clinical practice. This allows for a more problem-oriented approach in monitoring visits, which addresses patient needs and ultimately saves time. Trial Registration: ClinicalTrials.gov NCT04555863; https://clinicaltrials.gov/ct2/show/NCT04555863 International Registered Report Identifier (IRRID): DERR1-10.2196/25011 ",
doi="10.2196/25011",
url="https://www.researchprotocols.org/2021/5/e25011",
url="http://www.ncbi.nlm.nih.gov/pubmed/33960949"
}


@Article{info:doi/10.2196/16156,
author="Peltola, Kristiina Maria
and Poikonen-Saksela, Paula
and Mattson, Johanna
and Parkkari, Timo",
title="A Novel Digital Patient-Reported Outcome Platform (Noona) for Clinical Use in Patients With Cancer: Pilot Study Assessing Suitability",
journal="JMIR Form Res",
year="2021",
month="May",
day="6",
volume="5",
number="5",
pages="e16156",
keywords="electronic patient-reported outcome",
keywords="adverse events",
keywords="patients with cancer",
abstract="Background: As the incidence of cancer is on the rise, there is a need to develop modern communication tools between patients and the medical personnel. Electronic patient-reported outcome (ePRO) measures increase the safety of cancer treatments and may have an impact on treatment outcome as well. ePRO may also provide a cost-efficient way to organize follow-up for patients with cancer. Noona is an internet-based system for patients to self-report symptoms and adverse events of cancer treatments from home via a computer or a smart device (eg, smartphone, tablet). Objective: In this pilot study, we assessed the suitability of a novel ePRO application (Noona) for patients with cancer, nurses, and doctors at the Helsinki University Hospital, Finland. Methods: The study included 44 patients with cancer (different solid tumor types) and 17 health care professionals (nurses or medical doctors). Patients were either operated or received systemic treatment or radiotherapy. Patients reported their symptoms to the medical staff via Noona. In addition, patients and clinicians answered a questionnaire, based on which Noona's suitability for clinical use was evaluated in terms of usability (ease of use, operability, and learnability), reliability (subjective opinion of the participant), and incidence of harmful events reported by the participants. Results: A total of 41/44 (93\%) patients and 15/17 (88\%) professionals reported that the program was easy or quite easy to use; 38/44 (86\%) patients and 11/17 (65\%) professionals found Noona reliable, and 38/44 (86\%) patients and 10/17 (59\%) professionals would recommend Noona to other patients or their colleagues. No harmful incidences caused by the use of Noona were reported by the patients; however, 1 harmful incidence was reported by one of the professionals. Conclusions: The majority of the participants felt that Noona appeared reliable and it was easy to use. Noona seems to be a useful tool for monitoring patient's symptoms during cancer therapy. Future studies will determine the impact of this ePRO platform in routine clinical practice. ",
doi="10.2196/16156",
url="https://formative.jmir.org/2021/5/e16156",
url="http://www.ncbi.nlm.nih.gov/pubmed/33955841"
}


@Article{info:doi/10.2196/22591,
author="Wu, Chia-Tung
and Li, Guo-Hung
and Huang, Chun-Ta
and Cheng, Yu-Chieh
and Chen, Chi-Hsien
and Chien, Jung-Yien
and Kuo, Ping-Hung
and Kuo, Lu-Cheng
and Lai, Feipei",
title="Acute Exacerbation of a Chronic Obstructive Pulmonary Disease Prediction System Using Wearable Device Data, Machine Learning, and Deep Learning: Development and Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="May",
day="6",
volume="9",
number="5",
pages="e22591",
keywords="chronic obstructive pulmonary disease",
keywords="clinical decision support systems",
keywords="health risk assessment",
keywords="wearable device",
abstract="Background: The World Health Organization has projected that by 2030, chronic obstructive pulmonary disease (COPD) will be the third-leading cause of mortality and the seventh-leading cause of morbidity worldwide. Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with an accelerated decline in lung function, diminished quality of life, and higher mortality. Accurate early detection of acute exacerbations will enable early management and reduce mortality. Objective: The aim of this study was to develop a prediction system using lifestyle data, environmental factors, and patient symptoms for the early detection of AECOPD in the upcoming 7 days. Methods: This prospective study was performed at National Taiwan University Hospital. Patients with COPD that did not have a pacemaker and were not pregnant were invited for enrollment. Data on lifestyle, temperature, humidity, and fine particulate matter were collected using wearable devices (Fitbit Versa), a home air quality--sensing device (EDIMAX Airbox), and a smartphone app. AECOPD episodes were evaluated via standardized questionnaires. With these input features, we evaluated the prediction performance of machine learning models, including random forest, decision trees, k-nearest neighbor, linear discriminant analysis, and adaptive boosting, and a deep neural network model. Results: The continuous real-time monitoring of lifestyle and indoor environment factors was implemented by integrating home air quality--sensing devices, a smartphone app, and wearable devices. All data from 67 COPD patients were collected prospectively during a mean 4-month follow-up period, resulting in the detection of 25 AECOPD episodes. For 7-day AECOPD prediction, the proposed AECOPD predictive model achieved an accuracy of 92.1\%, sensitivity of 94\%, and specificity of 90.4\%. Receiver operating characteristic curve analysis showed that the area under the curve of the model in predicting AECOPD was greater than 0.9. The most important variables in the model were daily steps walked, stairs climbed, and daily distance moved. Conclusions: Using wearable devices, home air quality--sensing devices, a smartphone app, and supervised prediction algorithms, we achieved excellent power to predict whether a patient would experience AECOPD within the upcoming 7 days. The AECOPD prediction system provided an effective way to collect lifestyle and environmental data, and yielded reliable predictions of future AECOPD events. Compared with previous studies, we have comprehensively improved the performance of the AECOPD prediction model by adding objective lifestyle and environmental data. This model could yield more accurate prediction results for COPD patients than using only questionnaire data. ",
doi="10.2196/22591",
url="https://mhealth.jmir.org/2021/5/e22591",
url="http://www.ncbi.nlm.nih.gov/pubmed/33955840"
}


@Article{info:doi/10.2196/26240,
author="Iqbal, Mujtaba Fahad
and Joshi, Meera
and Khan, Sadia
and Ashrafian, Hutan
and Darzi, Ara",
title="Implementation of Wearable Sensors and Digital Alerting Systems in Secondary Care: Protocol for a Real-World Prospective Study Evaluating Clinical Outcomes",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="4",
volume="10",
number="5",
pages="e26240",
keywords="remote sensing technology",
keywords="clinical trial",
keywords="patient deterioration",
keywords="monitoring",
keywords="ambulatory",
keywords="wearable",
abstract="Background: Advancements in wearable sensors have caused a resurgence in their use, particularly because their miniaturization offers ambulatory advantages while performing continuous vital sign monitoring. Digital alerts can be generated following early recognition of clinical deterioration through breaches of set parameter thresholds, permitting earlier intervention. However, a systematic real-world evaluation of these alerting systems has yet to be conducted, and their efficacy remains unknown. Objective: The aim of this study is to implement wearable sensors and digital alerting systems in acute general wards to evaluate the resultant clinical outcomes. Methods: Participants on acute general wards will be screened and recruited into a trial with a pre-post implementation design. In the preimplementation phase, the SensiumVitals monitoring system, which continuously measures temperature, heart, and respiratory rates, will be used for monitoring alongside usual care. In the postimplementation phase, alerts will be generated from the SensiumVitals system when pre-established thresholds for vital parameters have been crossed, requiring acknowledgement from health care staff; subsequent clinical outcomes will be analyzed. Results: Enrolment is currently underway, having started in September 2017, and is anticipated to end shortly. Data analysis is expected to be completed in 2021. Conclusions: This study will offer insight into the implementation of digital health technologies within a health care trust and aims to describe the effectiveness of wearable sensors for ambulatory continuous monitoring and digital alerts on clinical outcomes in acute general ward settings. Trial Registration: ClinicalTrials.gov NCT04638738; https://clinicaltrials.gov/ct2/show/NCT04638738. International Registered Report Identifier (IRRID): DERR1-10.2196/26240 ",
doi="10.2196/26240",
url="https://www.researchprotocols.org/2021/5/e26240",
url="http://www.ncbi.nlm.nih.gov/pubmed/33944790"
}


@Article{info:doi/10.2196/25672,
author="Marklund, Sarah
and Tistad, Malin
and Lundell, Sara
and {\"O}strand, Lina
and S{\"o}rlin, Ann
and Bostr{\"o}m, Carina
and Wadell, Karin
and Nyberg, Andre",
title="Experiences and Factors Affecting Usage of an eHealth Tool for Self-Management Among People With Chronic Obstructive Pulmonary Disease: Qualitative Study",
journal="J Med Internet Res",
year="2021",
month="Apr",
day="30",
volume="23",
number="4",
pages="e25672",
keywords="COPD",
keywords="qualitative content analysis",
keywords="eHealth",
keywords="self-management",
keywords="primary care",
keywords="chronic disease",
abstract="Background: Self-management strategies are regarded as highly prioritized in chronic obstructive pulmonary disease (COPD) treatment guidelines. However, individual and structural barriers lead to a staggering amount of people with COPD that are not offered support for such strategies, and new approaches are urgently needed to circumvent these barriers. A promising way of delivering health services such as support for self-management strategies is the use of eHealth tools. However, there is a lack of knowledge about the usage of, and factors affecting the use of, eHealth tools over time in people with COPD. Objective: This study aimed, among people with COPD, to explore and describe the experiences of an eHealth tool over time and factors that might affect usage. Methods: The eHealth tool included information on evidence-based self-management treatment for people with COPD, including texts, pictures, videos as well as interactive components such as a step registration function with automatized feedback. In addition to the latter, automated notifications of new content and pedometers were used as triggers to increase usage. After having access to the tool for 3 months, 16 individuals (12 women) with COPD were individually interviewed. At 12 months' access to the tool, 7 (5 women) of the previous 16 individuals accepted a second individual interview. Data were analyzed using qualitative content analysis. User frequency was considered in the analysis, and participants were divided into users and nonusers/seldom users depending on the number of logins and minutes of usage per month. Results: Three main categories, namely, ambiguous impact, basic conditions for usage, and approaching capability emerged from the analysis, which, together with their subcategories, reflect the participants' experiences of using the eHealth tool. Nonusers/seldom users (median 1.5 logins and 1.78 minutes spent on the site per month) reported low motivation, a higher need for technical support, a negative view about the disease and self-management, and had problematic health literacy as measured by the Communicative and Critical Health Literacy Scale (median [range] 154 [5-2102]). Users (median 10 logins and 43 minutes per month) felt comfortable with information technology (IT) tools, had a positive view on triggers, and had sufficient health literacy (median [range] 5 [5-1400]). Benefits including behavior changes were mainly expressed after 12 months had passed and mainly among users. Conclusions: Findings of this study indicate that the level of motivation, comfortability with IT tools, and the level of health literacy seem to affect usage of an eHealth tool over time. Besides, regarding behavioral changes, gaining benefits from the eHealth tool seems reserved for the users and specifically after 12 months, thus suggesting that eHealth tools can be suitable media for supporting COPD-specific self-management skills, although not for everyone or at all times. These novel findings are of importance when designing new eHealth tools as well as when deciding on whether or not an eHealth tool might be appropriate to use if the goal is to support self-management among people with COPD. Trial Registration: ClinicalTrials.gov NCT02696187; https://clinicaltrials.gov/ct2/show/NCT02696187 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2017-016851 ",
doi="10.2196/25672",
url="https://www.jmir.org/2021/4/e25672",
url="http://www.ncbi.nlm.nih.gov/pubmed/33929327"
}


@Article{info:doi/10.2196/19163,
author="Cohn, F. Wendy
and Canan, E. Chelsea
and Knight, Sarah
and Waldman, Lena Ava
and Dillingham, Rebecca
and Ingersoll, Karen
and Schexnayder, Julie
and Flickinger, E. Tabor",
title="An Implementation Strategy to Expand Mobile Health Use in HIV Care Settings: Rapid Evaluation Study Using the Consolidated Framework for Implementation Research",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Apr",
day="28",
volume="9",
number="4",
pages="e19163",
keywords="mHealth",
keywords="smartphone",
keywords="mobile health",
keywords="implementation strategy",
keywords="implementation science",
keywords="Consolidated Framework for Implementation Research",
keywords="HIV care engagement",
keywords="viral suppression",
abstract="Background: Mobile health (mHealth) apps can provide support to people living with a chronic disease by offering resources for communication, self-management, and social support. PositiveLinks (PL) is a clinic-deployed mHealth app designed to improve the health of people with HIV. In a pilot study, PL users experienced considerable improvements in care engagement and viral load suppression. To promote its expansion to other HIV clinics, we developed an implementation strategy consisting of training resources and on-demand program support. Objective: The objective of our study was to conduct an interim analysis of the barriers and facilitators to PL implementation at early adopting sites to guide optimization of our implementation strategy. Methods: Semistructured interviews with stakeholders at PL expansion sites were conducted. Analysis of interviews identified facilitators and barriers that were mapped to 22 constructs of the Consolidated Framework for Implementation Research (CFIR). The purpose of the analysis was to identify the facilitators and barriers to PL implementation in order to adapt the PL implementation strategy. Four Ryan White HIV clinics were included. Interviews were conducted with one health care provider, two clinic managers, and five individuals who coordinated site PL activities. Results: Ten common facilitators and eight common barriers were identified. Facilitators to PL implementation included PL's fit with patient and clinic needs, PL training resources, and sites' early engagement with their information technology personnel. Most barriers were specific to mHealth, including access to Wi-Fi networks, maintaining patient smartphone access, patient privacy concerns, and lack of clarity on how to obtain approvals for mHealth use. Conclusions: The CFIR is a useful framework for evaluating mHealth interventions. Although PL training resources were viewed favorably, we identified important barriers to PL implementation in a sample of Ryan White clinics. This enabled our team to expand guidance on identifying information technology stakeholders and procuring and managing mobile resources. Ongoing evaluation results continue to inform improvements to the PL implementation strategy, facilitating PL access for future expansion sites. ",
doi="10.2196/19163",
url="https://mhealth.jmir.org/2021/4/e19163",
url="http://www.ncbi.nlm.nih.gov/pubmed/33908893"
}


@Article{info:doi/10.2196/27975,
author="Low, A. Carissa
and Li, Meng
and Vega, Julio
and Durica, C. Krina
and Ferreira, Denzil
and Tam, Vernissia
and Hogg, Melissa
and Zeh III, Herbert
and Doryab, Afsaneh
and Dey, K. Anind",
title="Digital Biomarkers of Symptom Burden Self-Reported by Perioperative Patients Undergoing Pancreatic Surgery: Prospective Longitudinal Study",
journal="JMIR Cancer",
year="2021",
month="Apr",
day="27",
volume="7",
number="2",
pages="e27975",
keywords="mobile sensing",
keywords="symptom",
keywords="cancer",
keywords="surgery",
keywords="wearable device",
keywords="smartphone",
keywords="mobile phone",
abstract="Background: Cancer treatments can cause a variety of symptoms that impair quality of life and functioning but are frequently missed by clinicians. Smartphone and wearable sensors may capture behavioral and physiological changes indicative of symptom burden, enabling passive and remote real-time monitoring of fluctuating symptoms Objective: The aim of this study was to examine whether smartphone and Fitbit data could be used to estimate daily symptom burden before and after pancreatic surgery. Methods: A total of 44 patients scheduled for pancreatic surgery participated in this prospective longitudinal study and provided sufficient sensor and self-reported symptom data for analyses. Participants collected smartphone sensor and Fitbit data and completed daily symptom ratings starting at least two weeks before surgery, throughout their inpatient recovery, and for up to 60 days after postoperative discharge. Day-level behavioral features reflecting mobility and activity patterns, sleep, screen time, heart rate, and communication were extracted from raw smartphone and Fitbit data and used to classify the next day as high or low symptom burden, adjusted for each individual's typical level of reported symptoms. In addition to the overall symptom burden, we examined pain, fatigue, and diarrhea specifically. Results: Models using light gradient boosting machine (LightGBM) were able to correctly predict whether the next day would be a high symptom day with 73.5\% accuracy, surpassing baseline models. The most important sensor features for discriminating high symptom days were related to physical activity bouts, sleep, heart rate, and location. LightGBM models predicting next-day diarrhea (79.0\% accuracy), fatigue (75.8\% accuracy), and pain (79.6\% accuracy) performed similarly. Conclusions: Results suggest that digital biomarkers may be useful in predicting patient-reported symptom burden before and after cancer surgery. Although model performance in this small sample may not be adequate for clinical implementation, findings support the feasibility of collecting mobile sensor data from older patients who are acutely ill as well as the potential clinical value of mobile sensing for passive monitoring of patients with cancer and suggest that data from devices that many patients already own and use may be useful in detecting worsening perioperative symptoms and triggering just-in-time symptom management interventions. ",
doi="10.2196/27975",
url="https://cancer.jmir.org/2021/2/e27975",
url="http://www.ncbi.nlm.nih.gov/pubmed/33904822"
}


@Article{info:doi/10.2196/26038,
author="Alneyadi, Mahra
and Drissi, Nidal
and Almeqbaali, Mariam
and Ouhbi, Sofia",
title="Biofeedback-Based Connected Mental Health Interventions for Anxiety: Systematic Literature Review",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Apr",
day="22",
volume="9",
number="4",
pages="e26038",
keywords="anxiety",
keywords="biofeedback",
keywords="systematic literature review",
keywords="mental health",
keywords="eHealth",
keywords="mHealth",
keywords="connected health",
keywords="digital health",
abstract="Background: Connected mental health, which refers to the use of technology for mental health care and technology-based therapeutic solutions, has become an established field of research. Biofeedback is one of the approaches used in connected mental health solutions, which is mainly based on the analysis of physiological indicators for the assessment and management of the psychological state. Biofeedback is recommended by many therapists and has been used for conditions including depression, insomnia, and anxiety. Anxiety is associated with several physiological symptoms, including muscle tension and breathing issues, which makes the inclusion of biofeedback useful for anxiety detection and management. Objective: The aim of this study was to identify interventions using biofeedback as a part of their process for anxiety management and investigate their perceived effectiveness. Methods: A systematic literature review of publications presenting empirically evaluated biofeedback-based interventions for anxiety was conducted. The systematic literature review was based on publications retrieved from IEEE Digital Library, PubMed, ScienceDirect, and Scopus. A preliminary selection of papers was identified, examined, and filtered to include only relevant publications. Studies in the final selection were classified and analyzed to extract the modalities of use of biofeedback in the identified interventions, the types of physiological data that were collected and analyzed and the sensors used to collect them. Processes and outcomes of the empirical evaluations were also extracted. Results: After final selection, 13 publications presenting different interventions were investigated. The interventions addressed either primarily anxiety disorders or anxiety associated with health issues such as migraine, Parkinson disease, and rheumatology. Solutions combined biofeedback with other techniques including virtual reality, music therapy, games, and relaxation practices and used different sensors including cardiovascular belts, wrist sensors, or stretch sensors to collect physiological data such as heart rate, respiration indicators, and movement information. The interventions targeted different cohorts including children, students, and patients. Overall, outcomes from the empirical evaluations yielded positive results and emphasized the effectiveness of connected mental health solutions using biofeedback for anxiety; however, certain unfavorable outcomes, such as interventions not having an effect on anxiety and patients' preferring traditional therapy, were reported in studies addressing patients with specific physical health issues. Conclusions: The use of biofeedback in connected mental health interventions for the treatment and management of anxiety allows better screening and understanding of both psychological and physiological patient information, as well as of the association between the two. The inclusion of biofeedback could improve the outcome of interventions and boost their effectiveness; however, when used with patients suffering from certain physical health issues, suitability investigations are needed. ",
doi="10.2196/26038",
url="https://mhealth.jmir.org/2021/4/e26038",
url="http://www.ncbi.nlm.nih.gov/pubmed/33792548"
}


@Article{info:doi/10.2196/24743,
author="Houlding, Elizabeth
and Mate, V. Kedar K.
and Engler, Kim
and Ortiz-Paredes, David
and Pomey, Marie-Pascale
and Cox, Joseph
and Hijal, Tarek
and Lebouch{\'e}, Bertrand",
title="Barriers to Use of Remote Monitoring Technologies Used to Support Patients With COVID-19: Rapid Review",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Apr",
day="20",
volume="9",
number="4",
pages="e24743",
keywords="remote monitoring",
keywords="technology",
keywords="COVID-19, telehealth",
keywords="asynchronous technology",
keywords="synchronous technology",
keywords="mHealth",
keywords="monitoring",
keywords="review",
keywords="barrier",
keywords="benefit",
keywords="equity",
abstract="Background: The COVID-19 pandemic has acted as a catalyst for the development and adoption of a broad range of remote monitoring technologies (RMTs) in health care delivery. It is important to demonstrate how these technologies were implemented during the early stages of this pandemic to identify their application and barriers to adoption, particularly among vulnerable populations. Objective: The purpose of this knowledge synthesis was to present the range of RMTs used in delivering care to patients with COVID-19 and to identify perceived benefits of and barriers to their use. The review placed a special emphasis on health equity considerations. Methods: A rapid review of published research was conducted using Embase, MEDLINE, and QxMD for records published from the inception of COVID-19 (December 2019) to July 6, 2020. Synthesis involved content analysis of reported benefits of and barriers to the use of RMTs when delivering health care to patients with COVID-19, in addition to health equity considerations. Results: Of 491 records identified, 48 publications that described 35 distinct RMTs were included in this review. RMTs included use of existing technologies (eg, videoconferencing) and development of new ones that have COVID-19--specific applications. Content analysis of perceived benefits generated 34 distinct codes describing advantages of RMTs, mapped to 10 themes overall. Further, 52 distinct codes describing barriers to use of RMTs were mapped to 18 themes. Prominent themes associated with perceived benefits included a lower burden of care (eg, for hospitals, health care practitioners; 28 records), reduced infection risk (n=33), and support for vulnerable populations (n=14). Prominent themes reflecting barriers to use of RMTs included equity-related barriers (eg, affordability of technology for users, poor internet connectivity, poor health literacy; n=16), the need for quality ``best practice'' guidelines for use of RMTs in clinical care (n=12), and the need for additional resources to develop and support new technologies (n=11). Overall, 23 of 48 records commented on equity characteristics that stratify health opportunities and outcomes, including general characteristics that vary over time (eg, age, comorbidities; n=17), place of residence (n=11), and socioeconomic status (n=7). Conclusions: Results of this rapid review highlight the breadth of RMTs being used to monitor and inform treatment of COVID-19, the potential benefits of using these technologies, and existing barriers to their use. Results can be used to prioritize further efforts in the implementation of RMTs (eg, developing ``best practice'' guidelines for use of RMTs and generating strategies to improve equitable access for marginalized populations). ",
doi="10.2196/24743",
url="https://mhealth.jmir.org/2021/4/e24743",
url="http://www.ncbi.nlm.nih.gov/pubmed/33769943"
}


@Article{info:doi/10.2196/19564,
author="Palotai, Miklos
and Wallack, Max
and Kujbus, Gergo
and Dalnoki, Adam
and Guttmann, Charles",
title="Usability of a Mobile App for Real-Time Assessment of Fatigue and Related Symptoms in Patients With Multiple Sclerosis: Observational Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Apr",
day="16",
volume="9",
number="4",
pages="e19564",
keywords="multiple sclerosis",
keywords="fatigue",
keywords="depression",
keywords="mobile application",
keywords="mobile phone",
keywords="real-time assessment",
abstract="Background: Although fatigue is one of the most debilitating symptoms in patients with multiple sclerosis (MS), its pathogenesis is not well understood. Neurogenic, inflammatory, endocrine, and metabolic mechanisms have been proposed. Taking into account the temporal dynamics and comorbid mood symptoms of fatigue may help differentiate fatigue phenotypes. These phenotypes may reflect different pathogeneses and may respond to different mechanism-specific treatments. Although several tools have been developed to assess various symptoms (including fatigue), monitor clinical status, or improve the perceived level of fatigue in patients with MS, options for a detailed, real-time assessment of MS-related fatigue and relevant comorbidities are still limited. Objective: This study aims to present a novel mobile app specifically designed to differentiate fatigue phenotypes using circadian symptom monitoring and state-of-the-art characterization of MS-related fatigue and its related symptoms. We also aim to report the first findings regarding patient compliance and the relationship between compliance and patient characteristics, including MS disease severity. Methods: After developing the app, we used it in a prospective study designed to investigate the brain magnetic resonance imaging correlates of MS-related fatigue. In total, 64 patients with MS were recruited into this study and asked to use the app over a 2-week period. The app features the following modules: Visual Analogue Scales (VASs) to assess circadian changes in fatigue, depression, anxiety, and pain; daily sleep diaries (SLDs) to assess sleep habits and quality; and 10 one-time questionnaires to assess fatigue, depression, anxiety, sleepiness, physical activity, and motivation, as well as several other one-time questionnaires that were created to assess those relevant aspects of fatigue that were not captured by existing fatigue questionnaires. The app prompts subjects to assess their symptoms multiple times a day and enables real-time symptom monitoring through a web-accessible portal. Results: Of 64 patients, 56 (88\%) used the app, of which 51 (91\%) completed all one-time questionnaires and 47 (84\%) completed all one-time questionnaires, VASs, and SLDs. Patients reported no issues with the usage of the app, and there were no technical issues with our web-based data collection system. The relapsing-remitting MS to secondary-progressive MS ratio was significantly higher in patients who completed all one-time questionnaires, VASs, and SLDs than in those who completed all one-time questionnaires but not all VASs and SLDs (P=.01). No other significant differences in demographics, fatigue, or disease severity were observed between the degrees of compliance. Conclusions: The app can be used with reasonable compliance across patients with relapsing-remitting and secondary-progressive MS irrespective of demographics, fatigue, or disease severity. ",
doi="10.2196/19564",
url="https://mhealth.jmir.org/2021/4/e19564",
url="http://www.ncbi.nlm.nih.gov/pubmed/33861208"
}


@Article{info:doi/10.2196/25496,
author="Kumar, Ravindra
and Das, Aparup",
title="The Potential of mHealth as a Game Changer for the Management of Sickle Cell Disease in India",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Apr",
day="13",
volume="9",
number="4",
pages="e25496",
keywords="sickle cell disease",
keywords="drug adherence",
keywords="mHealth",
keywords="India",
doi="10.2196/25496",
url="https://mhealth.jmir.org/2021/4/e25496",
url="http://www.ncbi.nlm.nih.gov/pubmed/33847598"
}


@Article{info:doi/10.2196/24271,
author="Bakogiannis, Constantinos
and Tsarouchas, Anastasios
and Mouselimis, Dimitrios
and Lazaridis, Charalampos
and Theofillogianakos, K. Efstratios
and Billis, Antonios
and Tzikas, Stergios
and Fragakis, Nikolaos
and Bamidis, D. Panagiotis
and Papadopoulos, E. Christodoulos
and Vassilikos, P. Vassilios",
title="A Patient-Oriented App (ThessHF) to Improve Self-Care Quality in Heart Failure: From Evidence-Based Design to Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Apr",
day="13",
volume="9",
number="4",
pages="e24271",
keywords="mHealth",
keywords="heart failure",
keywords="smartphone app",
keywords="self-care",
keywords="COVID-19",
keywords="patients",
keywords="caregivers",
abstract="Background: Heart failure (HF) remains a major public health challenge, while HF self-care is particularly challenging. Mobile health (mHealth)--based interventions taking advantage of smartphone technology have shown particular promise in increasing the quality of self-care among these patients, and in turn improving the outcomes of their disease. Objective: The objective of this study was to co-develop with physicians, patients with HF, and their caregivers a patient-oriented mHealth app, perform usability assessment, and investigate its effect on the quality of life of patients with HF and rate of hospitalizations in a pilot study. Methods: The development of an mHealth app (The Hellenic Educational Self-care and Support Heart Failure app [ThessHF app]) was evidence based, including features based on previous clinically tested mHealth interventions and selected by a panel of HF expert physicians and discussed with patients with HF. At the end of alpha development, the app was rated by mHealth experts with the Mobile Application Rating Scale (MARS). The beta version was tested by patients with HF, who rated its design and content by means of the Post-Study System Usability Questionnaire (PSSUQ). Subsequently, a prospective pilot study (THESS-HF [THe Effect of a Specialized Smartphone app on Heart Failure patients' quality of self-care, quality of life and hospitalization rate]) was performed to investigate the effect of app use on patients with HF over a 3-month follow-up period. The primary endpoint was patients' quality of life, which was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the 5-level EQ-5D version (EQ-5D-5L). The secondary endpoints were the European Heart Failure Self-care Behavior Scale (EHFScBS) score and the hospitalization rate. Results: A systematic review of mHealth-based HF interventions and expert panel suggestions yielded 18 separate app features, most of which were incorporated into the ThessHF app. A total of 14 patients and 5 mHealth experts evaluated the app. The results demonstrated a very good user experience (overall PSSUQ score 2.37 [SD 0.63], where 1 is the best, and a median MARS score of 4.55/5). Finally, 30 patients (male: n=26, 87\%) participated in the THESS-HF pilot study (mean age 68.7 [SD 12.4] years). A significant increase in the quality of self-care was noted according to the EHFScBS, which increased by 4.4\% (SD 7.2\%) (P=.002). The mean quality of life increased nonsignificantly after 3 months according to both KCCQ (mean increase 5.8 [SD 15] points, P=.054) and EQ-5D-5L (mean increase 5.6\% [SD 15.6\%], P=.06) scores. The hospitalization rate for the follow-up duration was 3\%. Conclusions: The need for telehealth services and remote self-care management in HF is of vital importance, especially in periods such as the COVID-19 pandemic. We developed a user-friendly mHealth app to promote remote self-care support in HF. In this pilot study, the use of the ThessHF app was associated with an increase in the quality of self-care. A future multicenter study will investigate the effect of the app use on long-term outcomes in patients with HF. ",
doi="10.2196/24271",
url="https://mhealth.jmir.org/2021/4/e24271",
url="http://www.ncbi.nlm.nih.gov/pubmed/33847599"
}


@Article{info:doi/10.2196/24604,
author="Zhang, Yuezhou
and Folarin, A. Amos
and Sun, Shaoxiong
and Cummins, Nicholas
and Bendayan, Rebecca
and Ranjan, Yatharth
and Rashid, Zulqarnain
and Conde, Pauline
and Stewart, Callum
and Laiou, Petroula
and Matcham, Faith
and White, M. Katie
and Lamers, Femke
and Siddi, Sara
and Simblett, Sara
and Myin-Germeys, Inez
and Rintala, Aki
and Wykes, Til
and Haro, Maria Josep
and Penninx, WJH Brenda
and Narayan, A. Vaibhav
and Hotopf, Matthew
and Dobson, JB Richard
and ",
title="Relationship Between Major Depression Symptom Severity and Sleep Collected Using a Wristband Wearable Device: Multicenter Longitudinal Observational Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Apr",
day="12",
volume="9",
number="4",
pages="e24604",
keywords="mobile health (mHealth)",
keywords="mental health",
keywords="depression",
keywords="sleep",
keywords="wearable device",
keywords="monitoring",
abstract="Background: Sleep problems tend to vary according to the course of the disorder in individuals with mental health problems. Research in mental health has associated sleep pathologies with depression. However, the gold standard for sleep assessment, polysomnography (PSG), is not suitable for long-term, continuous monitoring of daily sleep, and methods such as sleep diaries rely on subjective recall, which is qualitative and inaccurate. Wearable devices, on the other hand, provide a low-cost and convenient means to monitor sleep in home settings. Objective: The main aim of this study was to devise and extract sleep features from data collected using a wearable device and analyze their associations with depressive symptom severity and sleep quality as measured by the self-assessed Patient Health Questionnaire 8-item (PHQ-8). Methods: Daily sleep data were collected passively by Fitbit wristband devices, and depressive symptom severity was self-reported every 2 weeks by the PHQ-8. The data used in this paper included 2812 PHQ-8 records from 368 participants recruited from 3 study sites in the Netherlands, Spain, and the United Kingdom. We extracted 18 sleep features from Fitbit data that describe participant sleep in the following 5 aspects: sleep architecture, sleep stability, sleep quality, insomnia, and hypersomnia. Linear mixed regression models were used to explore associations between sleep features and depressive symptom severity. The z score was used to evaluate the significance of the coefficient of each feature. Results: We tested our models on the entire dataset and separately on the data of 3 different study sites. We identified 14 sleep features that were significantly (P<.05) associated with the PHQ-8 score on the entire dataset, among them awake time percentage (z=5.45, P<.001), awakening times (z=5.53, P<.001), insomnia (z=4.55, P<.001), mean sleep offset time (z=6.19, P<.001), and hypersomnia (z=5.30, P<.001) were the top 5 features ranked by z score statistics. Associations between sleep features and PHQ-8 scores varied across different sites, possibly due to differences in the populations. We observed that many of our findings were consistent with previous studies, which used other measurements to assess sleep, such as PSG and sleep questionnaires. Conclusions: We demonstrated that several derived sleep features extracted from consumer wearable devices show potential for the remote measurement of sleep as biomarkers of depression in real-world settings. These findings may provide the basis for the development of clinical tools to passively monitor disease state and trajectory, with minimal burden on the participant. ",
doi="10.2196/24604",
url="https://mhealth.jmir.org/2021/4/e24604",
url="http://www.ncbi.nlm.nih.gov/pubmed/33843591"
}


@Article{info:doi/10.2196/25513,
author="Thornton, Louise
and Gardner, Anne Lauren
and Osman, Bridie
and Green, Olivia
and Champion, Elizabeth Katrina
and Bryant, Zachary
and Teesson, Maree
and Kay-Lambkin, Frances
and Chapman, Cath
and ",
title="A Multiple Health Behavior Change, Self-Monitoring Mobile App for Adolescents: Development and Usability Study of the Health4Life App",
journal="JMIR Form Res",
year="2021",
month="Apr",
day="12",
volume="5",
number="4",
pages="e25513",
keywords="mHealth",
keywords="mobile phone",
keywords="chronic disease",
keywords="adolescents",
keywords="health promotion",
abstract="Background: The link between chronic diseases and the Big 6 lifestyle risk behaviors (ie, poor diet, physical inactivity, smoking, alcohol use, sedentary recreational screen time, and poor sleep) is well established. It is critical to target these lifestyle risk behaviors, as they often co-occur and emerge in adolescence. Smartphones have become an integral part of everyday life, and many adolescents already use mobile apps to monitor their lifestyle behaviors and improve their health. Smartphones may be a valuable platform for engaging adolescents with interventions to prevent key chronic disease risk behaviors. Objective: The aim of this paper is to describe the development, usability, and acceptability of the Health4Life app, a self-monitoring smartphone app for adolescents that concurrently targets the Big 6 lifestyle behaviors. Methods: The development of the Health4Life app was an iterative process conducted in collaboration with adolescents and experts. The development process consisted of three stages: scoping the literature; end user consultations, which included a web-based survey (N=815; mean age 13.89, SD 0.89 years) and a focus group (N=12) among adolescents; and app development and beta testing. Following this development work, 232 adolescents were asked to rate the usability and acceptability of the app. Results: The process resulted in a self-monitoring smartphone app that allows adolescent users to track and set goals for the Big 6 health behaviors, using in-app rewards and notifications to enhance engagement. The overall adolescent feedback was positive in terms of user-friendly design, content, relevance, and helpfulness. Commonly identified areas for improvement were to increase interactive features and display recorded health behaviors differently to improve interpretability. Conclusions: The Health4Life app is a co-designed, self-monitoring smartphone app for adolescents that concurrently targets the Big 6 lifestyle behaviors. Adolescents rated the app as highly acceptable and usable. The app has the potential to efficiently and effectively modify important risk factors for chronic disease among young people and is currently being evaluated in a world-first trial of 6640 secondary school students in 71 schools across Australia. ",
doi="10.2196/25513",
url="https://formative.jmir.org/2021/4/e25513",
url="http://www.ncbi.nlm.nih.gov/pubmed/33843590"
}


@Article{info:doi/10.2196/26167,
author="Yang, Yun Tien
and Huang, Li
and Malwade, Shwetambara
and Hsu, Chien-Yi
and Chen, Ching Yang",
title="Diagnostic Accuracy of Ambulatory Devices in Detecting Atrial Fibrillation: Systematic Review and Meta-analysis",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Apr",
day="9",
volume="9",
number="4",
pages="e26167",
keywords="atrial fibrillation",
keywords="ambulatory devices",
keywords="electrocardiogram",
keywords="photoplethysmography",
keywords="diagnostic accuracy",
keywords="ubiquitous health",
keywords="mobile health",
keywords="technology",
keywords="ambulatory device",
abstract="Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide. Early diagnosis of AF is crucial for preventing AF-related morbidity, mortality, and economic burden, yet the detection of the disease remains challenging. The 12-lead electrocardiogram (ECG) is the gold standard for the diagnosis of AF. Because of technological advances, ambulatory devices may serve as convenient screening tools for AF. Objective: The objective of this review was to investigate the diagnostic accuracy of 2 relatively new technologies used in ambulatory devices, non-12-lead ECG and photoplethysmography (PPG), in detecting AF. We performed a meta-analysis to evaluate the diagnostic accuracy of non-12-lead ECG and PPG compared to the reference standard, 12-lead ECG. We also conducted a subgroup analysis to assess the impact of study design and participant recruitment on diagnostic accuracy. Methods: This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. MEDLINE and EMBASE were systematically searched for articles published from January 1, 2015 to January 23, 2021. A bivariate model was used to pool estimates of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and area under the summary receiver operating curve (SROC) as the main diagnostic measures. Study quality was evaluated using the quality assessment of diagnostic accuracy studies (QUADAS-2) tool. Results: Our search resulted in 16 studies using either non-12-lead ECG or PPG for detecting AF, comprising 3217 participants and 7623 assessments. The pooled estimates of sensitivity, specificity, PLR, NLR, and diagnostic odds ratio for the detection of AF were 89.7\% (95\% CI 83.2\%-93.9\%), 95.7\% (95\% CI 92.0\%-97.7\%), 20.64 (95\% CI 10.10-42.15), 0.11 (95\% CI 0.06-0.19), and 224.75 (95\% CI 70.10-720.56), respectively, for the automatic interpretation of non-12-lead ECG measurements and 94.7\% (95\% CI 93.3\%-95.8\%), 97.6\% (95\% CI 94.5\%-99.0\%), 35.51 (95\% CI 18.19-69.31), 0.05 (95\% CI 0.04-0.07), and 730.79 (95\% CI 309.33-1726.49), respectively, for the automatic interpretation of PPG measurements. Conclusions: Both non-12-lead ECG and PPG offered high diagnostic accuracies for AF. Detection employing automatic analysis techniques may serve as a useful preliminary screening tool before administering a gold standard test, which generally requires competent physician analyses. Subgroup analysis indicated variations of sensitivity and specificity between studies that recruited low-risk and high-risk populations, warranting future validity tests in the general population. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020179937; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=179937 ",
doi="10.2196/26167",
url="https://mhealth.jmir.org/2021/4/e26167",
url="http://www.ncbi.nlm.nih.gov/pubmed/33835039"
}


@Article{info:doi/10.2196/16806,
author="Hasan, Kamrul Md
and Aziz, Hasanul Md
and Zarif, Islam Md Ishrak
and Hasan, Mahmudul
and Hashem, MMA
and Guha, Shion
and Love, R. Richard
and Ahamed, Sheikh",
title="Noninvasive Hemoglobin Level Prediction in a Mobile Phone Environment: State of the Art Review and Recommendations",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Apr",
day="8",
volume="9",
number="4",
pages="e16806",
keywords="noninvasive hemoglobin",
keywords="smartphone-based hemoglobin",
keywords="hemoglobin level from image and video",
abstract="Background: There is worldwide demand for an affordable hemoglobin measurement solution, which is a particularly urgent need in developing countries. The smartphone, which is the most penetrated device in both rich and resource-constrained areas, would be a suitable choice to build this solution. Consideration of a smartphone-based hemoglobin measurement tool is compelling because of the possibilities for an affordable, portable, and reliable point-of-care tool by leveraging the camera capacity, computing power, and lighting sources of the smartphone. However, several smartphone-based hemoglobin measurement techniques have encountered significant challenges with respect to data collection methods, sensor selection, signal analysis processes, and machine-learning algorithms. Therefore, a comprehensive analysis of invasive, minimally invasive, and noninvasive methods is required to recommend a hemoglobin measurement process using a smartphone device. Objective: In this study, we analyzed existing invasive, minimally invasive, and noninvasive approaches for blood hemoglobin level measurement with the goal of recommending data collection techniques, signal extraction processes, feature calculation strategies, theoretical foundation, and machine-learning algorithms for developing a noninvasive hemoglobin level estimation point-of-care tool using a smartphone. Methods: We explored research papers related to invasive, minimally invasive, and noninvasive hemoglobin level measurement processes. We investigated the challenges and opportunities of each technique. We compared the variation in data collection sites, biosignal processing techniques, theoretical foundations, photoplethysmogram (PPG) signal and features extraction process, machine-learning algorithms, and prediction models to calculate hemoglobin levels. This analysis was then used to recommend realistic approaches to build a smartphone-based point-of-care tool for hemoglobin measurement in a noninvasive manner. Results: The fingertip area is one of the best data collection sites from the body, followed by the lower eye conjunctival area. Near-infrared (NIR) light-emitting diode (LED) light with wavelengths of 850 nm, 940 nm, and 1070 nm were identified as potential light sources to receive a hemoglobin response from living tissue. PPG signals from fingertip videos, captured under various light sources, can provide critical physiological clues. The features of PPG signals captured under 1070 nm and 850 nm NIR LED are considered to be the best signal combinations following a dual-wavelength theoretical foundation. For error metrics presentation, we recommend the mean absolute percentage error, mean squared error, correlation coefficient, and Bland-Altman plot. Conclusions: We addressed the challenges of developing an affordable, portable, and reliable point-of-care tool for hemoglobin measurement using a smartphone. Leveraging the smartphone's camera capacity, computing power, and lighting sources, we define specific recommendations for practical point-of-care solution development. We further provide recommendations to resolve several long-standing research questions, including how to capture a signal using a smartphone camera, select the best body site for signal collection, and overcome noise issues in the smartphone-captured signal. We also describe the process of extracting a signal's features after capturing the signal based on fundamental theory. The list of machine-learning algorithms provided will be useful for processing PPG features. These recommendations should be valuable for future investigators seeking to build a reliable and affordable hemoglobin prediction model using a smartphone. ",
doi="10.2196/16806",
url="https://mhealth.jmir.org/2021/4/e16806",
url="http://www.ncbi.nlm.nih.gov/pubmed/33830065"
}


@Article{info:doi/10.2196/24461,
author="Beerten, Gabri{\"e}l Simon
and Proesmans, Tine
and Vaes, Bert",
title="A Heart Rate Monitoring App (FibriCheck) for Atrial Fibrillation in General Practice: Pilot Usability Study",
journal="JMIR Form Res",
year="2021",
month="Apr",
day="7",
volume="5",
number="4",
pages="e24461",
keywords="atrial fibrillation",
keywords="smartphone app",
keywords="FibriCheck",
keywords="primary care",
abstract="Background: Atrial fibrillation (AF) is a major risk factor for stroke. The current opportunistic screening procedure consists of pulse palpation and an electrocardiogram when an irregular rhythm is found. Smartphone apps that measure heart rhythm could be useful in increasing the detection of AF in a primary care setting. Objective: We conducted a pilot study with the smartphone app FibriCheck to assess whether the introduction of such an app is feasible. Methods: Four general practices across Flanders provided patient data for the study. Inclusion criteria for participants were aged 65 or older and a CHARGE-AF score of at least 10\%. We excluded patients with known AF or a pacemaker. Participants were asked to measure at least twice a day with FibriCheck (for at least 14 days). They were provided the 36-Item Short Form Survey (SF-36) questionnaire both before and after the study, as well as different surveys concerning their user experience and general perception of technology. Results: There were 92 participants (36 women and 56 men). The study population was relatively homogenous concerning risk factors and medication use at baseline. During the study period, 5/86 (6\%) participants were found to have AF (6 dropouts). The average study period was 23 days and the average number of measurements per day was 2.1. Patient compliance was variable, but high. On the whole, there were no appreciable changes in quality of life. The overall user experience and satisfaction were very high. Conclusions: FibriCheck is a relatively easy-to-use smartphone app to complement AF screening in primary care. Its implementation in this setting is certainly achievable, and one can expect high rates of patient compliance. Based on these results, a planned cluster randomized trial will be going ahead. Trial Registration: ClinicalTrials.gov NCT03509493; https://clinicaltrials.gov/ct2/show/NCT03509493 ",
doi="10.2196/24461",
url="https://formative.jmir.org/2021/4/e24461",
url="http://www.ncbi.nlm.nih.gov/pubmed/33825692"
}


@Article{info:doi/10.2196/23280,
author="McCreesh-Toselli, Siobhan
and Torline, John
and Gouse, Hetta
and Robbins, N. Reuben
and Mellins, A. Claude
and Remien, H. Robert
and Rowe, Jessica
and Peton, Neshaan
and Rabie, Stephan
and Joska, A. John",
title="Staff Perceptions of Preimplementation Barriers and Facilitators to a Mobile Health Antiretroviral Therapy Adherence Counseling Intervention in South Africa: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Apr",
day="6",
volume="9",
number="4",
pages="e23280",
keywords="HIV/AIDS",
keywords="antiretroviral treatment",
keywords="low-resource settings",
keywords="mHealth",
keywords="Masivukeni",
keywords="Consolidated Framework for Implementation Research",
keywords="implementation research",
keywords="lay antiretroviral therapy adherence counselors",
keywords="mobile phone",
abstract="Background: South Africa adopted a universal test and treatment program for HIV infection in 2015. The standard of care that people living with HIV receive consists of 3 sessions of readiness counseling delivered by lay counselors (LCs). In the largest antiretroviral therapy (ART) program worldwide, effective and early HIV and ART education and support are key for ensuring ART adoption, adherence, and retention in care. Having LCs to deliver readiness counseling allows for the wide task-sharing of this critical activity but carries the risks of loss of standardization, incomplete content delivery, and inadequate monitoring and supervision. Systems for ensuring that a minimum standard of readiness counseling is delivered to the growing number of people living with HIV are essential in the care cascade. In resource-constrained, high-burden settings, mobile health (mHealth) apps may potentially offer solutions to these treatment gaps by providing content structure and delivery records.  Objective: This study aims to explore, at a large Cape Town--based nonprofit HIV care organization, the staff's perceived preimplementation barriers and facilitators of an mHealth intervention (Masivukeni) developed as a structured app for ART readiness counseling.  Methods: Masivukeni is a laptop-based app that incorporates written content, graphics, short video materials, and participant activities. In total, 20 participants were included in this study. To explore how an mHealth intervention might be adopted across different staff levels within the organization, we conducted 7 semistructured interviews (participants: 7/20, 35\%) and 3 focus groups (participants in 2 focus groups: 4/20, 20\%; participants in 1 focus group: 3/20, 15\%) among LCs, supervisors, and their managers. In total, 20 participants were included in this study. Interviews lasted approximately 60 minutes, and focus groups ranged from 90 to 120 minutes. The Consolidated Framework for Implementation Research was used to explore the perceived implementation barriers and facilitators of the Masivukeni mHealth intervention.  Results: Several potential facilitators of Masivukeni were identified. Multimedia and visual elements were generally regarded as aids in content delivery. The interactive learning components were notably helpful, whereas facilitated updates to the adherence curriculum were important to facilitators and managers. The potential to capture administrative information regarding LC delivery and client logging was regarded as an attractive feature. Barriers to implementation included security risks and equipment costs, the high volume of clients to be counseled, and variable computer literacy among LCs. There was uncertainty about the app's appeal to older clients.  Conclusions: mHealth apps, such as Masivukeni, were perceived as being well placed to address some of the needs of those who deliver ART adherence counseling in South Africa. However, the successful implementation of mHealth apps appeared to be dependent on overcoming certain barriers in this setting. ",
doi="10.2196/23280",
url="https://mhealth.jmir.org/2021/4/e23280",
url="http://www.ncbi.nlm.nih.gov/pubmed/33821806"
}


@Article{info:doi/10.2196/19439,
author="Wadensten, Towe
and Nystr{\"o}m, Emma
and Franz{\'e}n, Karin
and Lindam, Anna
and Wasteson, Elisabet
and Samuelsson, Eva",
title="A Mobile App for Self-management of Urgency and Mixed Urinary Incontinence in Women: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Apr",
day="5",
volume="23",
number="4",
pages="e19439",
keywords="eHealth",
keywords="mHealth",
keywords="urinary incontinence",
keywords="urgency urinary incontinence",
keywords="mixed urinary incontinence",
keywords="self-management",
keywords="mobile app",
keywords="smartphone app",
keywords="women",
abstract="Background: Many women experience urgency (UUI) and mixed (MUI) urinary incontinence but commonly hesitate to seek care. Treatment access and self-management for these conditions can be supported through eHealth approaches. Objective: This study aimed to investigate the efficacy of the mobile app T{\"a}t II for self-management of UUI and MUI in women. Methods: This randomized controlled trial included women ?18 years old with UUI or MUI and ?2 leakages per week. Those with red-flag symptoms were excluded. Participants were recruited via analog and digital advertisements and screened for initial selection through a web-based questionnaire. Data were collected using another questionnaire and a 2-day bladder diary. A telephone interview confirmed the symptom diagnosis. Participants were randomized (1:1) to receive access to a treatment app (including pelvic floor muscle training, bladder training, psychoeducation, lifestyle advice, tailored advice, exercise log, reinforcement messages, and reminders) or an information app (control group), with no external treatment guidance provided. The primary outcome was incontinence symptoms at the 15-week follow-up, measured using the International Consultation on Incontinence Questionnaire (ICIQ)?Urinary Incontinence Short Form (ICIQ-UI SF). Urgency symptoms were assessed using the ICIQ?Overactive Bladder Module (ICIQ-OAB) and quality of life using the ICIQ?Lower Urinary Tract Symptoms Quality of Life Module (ICIQ-LUTSqol). Incontinence episode frequency (IEF) was calculated per bladder diary entries. Improvement was measured using the Patient's Global Impression of Improvement. All outcomes were self-reported. Cure was defined as no leakages per the bladder diary. Intention-to-treat analysis was performed. Results: Between April 2017 and March 2018, 123 women (mean age 58.3, SD 9.6 years) were randomized to the treatment (n=60, 2 lost to follow-up) or information (n=63) group. Of these, 35 (28\%) women had UUI, and 88 (72\%) had MUI. Mean ICIQ-UI SF score at follow-up was lower in the treatment group than in the information group (estimated difference ?3.1, 95\% CI ?4.8 to ?1.3). The estimated between-group difference was ?1.8 (95\% CI ?2.8 to ?0.99) for mean ICIQ-OAB score and ?6.3 (95\% CI ?10.5 to ?2.1) for the mean ICIQ-LUTSqol score at follow-up. IEF reduction from baseline to follow-up was greater in the treatment group (?10.5, IQR ?17.5 to ?3.5) than in the information group (P<.001). Improvement was reported by 87\% (52/60) of treatment group participants and by 30\% (19/63) of information group participants. The cure rate was 32\% in the treatment group, and 6\% in the information group (odds ratio 5.4, 95\% CI 1.9-15.6; P=.002). About 67\% (40/60) of the treatment group participants used the app more than thrice a week. Conclusions: The treatment app was effective for improving urgency and mixed incontinence in women. When self-management is appropriate, this app may be a good alternative to pharmacological treatment or other conservative management, thus increasing access to care. Trial Registration: ClinicalTrials.gov NCT03097549; https://clinicaltrials.gov/ct2/show/NCT03097549 ",
doi="10.2196/19439",
url="https://www.jmir.org/2021/4/e19439",
url="http://www.ncbi.nlm.nih.gov/pubmed/33818395"
}


@Article{info:doi/10.2196/24374,
author="Braune, Katarina
and Boss, Karina
and Schmidt-Herzel, Jessica
and Gajewska, Anna Katarzyna
and Thieffry, Axel
and Schulze, Lilian
and Posern, Barbara
and Raile, Klemens",
title="Shaping Workflows in Digital and Remote Diabetes Care During the COVID-19 Pandemic via Service Design: Prospective, Longitudinal, Open-label Feasibility Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Apr",
day="5",
volume="9",
number="4",
pages="e24374",
keywords="telemedicine",
keywords="telehealth",
keywords="remote care",
keywords="digital care",
keywords="type 1 diabetes",
keywords="pediatric diabetes",
keywords="open source",
keywords="service design",
keywords="digital health",
keywords="COVID-19",
keywords="diabetes",
keywords="workflow",
abstract="Background: The COVID-19 pandemic poses new challenges to health care providers and the delivery of continuous care. Although many diabetes technologies, such as insulin pumps and continuous glucose monitors, have been established, the data from these devices are rarely assessed. Furthermore, telemedicine has not been sufficiently integrated into clinical workflows. Objective: We sought to remotely support children with type 1 diabetes and their caregivers, enhance the clinical outcomes and quality of life of children with diabetes, increase multiple stakeholders' engagement with digital care via a participatory approach, evaluate the feasibility of using an interoperable open-source platform in a university hospital setting, and analyze the success factors and barriers of transitioning from conventional care to digital care. Methods: Service design methods were used to adapt clinical workflows. Remote consultations were performed on a monthly and on-demand basis. Diabetes device data were uploaded from patients' homes to an open-source platform. Clinical and patient-reported outcomes were assessed before, during, and after the COVID-19 lockdown period in Germany. Results: A total of 28 children with type 1 diabetes and their caregivers enrolled in this study and completed 6 months of remote visits. Of these 28 participants, 16 (57\%) also opted to attend at least one of their regular visits remotely. After 3 months of remote visits, participants' time in range (P=.001) and time in hyperglycemia (P=.004) significantly improved, and their time in hypoglycemia did not increase. These improvements were maintained during the COVID-19 lockdown period (ie, between months 3 and 6 of this study). Participants' psychosocial health improved after 6 months. Conclusions: Remote consultations and commonly shared data access can improve the clinical outcomes and quality of life of children with type 1 diabetes, even during challenging circumstances. A service design approach helped with the delivery of comprehensive and holistic solutions that accounted for the needs of multiple stakeholders. Our findings can inform the future integration of digital tools into clinical care during and beyond the pandemic. Trial Registration: German Clinical Trials Register DRKS00016170; https://tinyurl.com/skz4wdk5 ",
doi="10.2196/24374",
url="https://mhealth.jmir.org/2021/4/e24374",
url="http://www.ncbi.nlm.nih.gov/pubmed/33571104"
}


@Article{info:doi/10.2196/22603,
author="van Noort, J. Esther M.
and Claessens, Danny
and Moor, C. Catharina
and Berg, Den Carlijn A. L. Van
and Kasteleyn, J. Marise
and in 't Veen, M. Johannes C. C.
and Van Schayck, P. Onno C.
and Chavannes, H. Niels",
title="Online Tool for the Assessment of the Burden of COVID-19 in Patients: Development Study",
journal="JMIR Form Res",
year="2021",
month="Mar",
day="31",
volume="5",
number="3",
pages="e22603",
keywords="COVID-19",
keywords="patient-reported outcomes",
keywords="ABCoV tool",
keywords="monitoring",
keywords="patient outcome",
keywords="long-term impact",
keywords="tool",
keywords="assessment",
keywords="online patient platform",
abstract="Background: The impact of COVID-19 has been felt worldwide, yet we are still unsure about its full impact. One of the gaps in our current knowledge relates to the long-term mental and physical impact of the infection on affected individuals. The COVID-19 pandemic hit the Netherlands at the end of February 2020, resulting in over 900,000 people testing positive for the virus, over 24,000 hospitalizations, and over 13,000 deaths by the end of January 2021. Although many patients recover from the acute phase of the disease, experience with other virus outbreaks has raised concerns regarding possible late sequelae of the infection. Objective: This study aims to develop an online tool to assess the long-term burden of COVID-19 in patients. Methods: In this paper, we describe the process of development, assessment, programming, implementation, and use of this new tool: the assessment of burden of COVID-19 (ABCoV) tool. This new tool is based on the well-validated assessment of burden of chronic obstructive pulmonary disease tool. Results: As of January 2021, the new ABCoV tool has been used in an online patient platform by more than 2100 self-registered patients and another 400 patients in a hospital setting, resulting in over 2500 patients. These patients have submitted the ABCoV questionnaire 3926 times. Among the self-registered patients who agreed to have their data analyzed (n=1898), the number of females was high (n=1153, 60.7\%), many were medically diagnosed with COVID-19 (n=892, 47.0\%), and many were relatively young with only 7.4\% (n=141) being older than 60 years. Of all patients that actually used the tool (n=1517), almost one-quarter (n=356, 23.5\%) used the tool twice, and only a small group (n=76, 5.0\%) used the tool 6 times. Conclusions: This new ABCoV tool has been broadly and repeatedly used, and may provide insight into the perceived burden of disease, provide direction for personalized aftercare for people post COVID-19, and help us to be prepared for possible future recurrences. ",
doi="10.2196/22603",
url="https://formative.jmir.org/2021/3/e22603",
url="http://www.ncbi.nlm.nih.gov/pubmed/33729982"
}


@Article{info:doi/10.2196/18460,
author="Chi, Yuan
and Velardo, Carmelo
and Allen, Julie
and Robinson, Stephanie
and Riga, Evgenia
and Judge, David
and Tarassenko, Lionel
and Farmer, J. Andrew",
title="System Architecture for ``Support Through Mobile Messaging and Digital Health Technology for Diabetes'' (SuMMiT-D): Design and Performance in Pilot and Randomized Controlled Feasibility Studies",
journal="JMIR Form Res",
year="2021",
month="Mar",
day="26",
volume="5",
number="3",
pages="e18460",
keywords="type 2 diabetes",
keywords="short message service",
keywords="health-related behavior",
keywords="mobile health",
keywords="mHealth",
keywords="mobile phone",
abstract="Background: Diabetes is a highly prevalent long-term condition with high morbidity and mortality rates. People with diabetes commonly worry about their diabetes medicines and do not always take them regularly as prescribed. This can lead to poor diabetes control. The Support Through Mobile Messaging and Digital Health Technology for Diabetes (SuMMiT-D) study aims to deliver brief messages as tailored interventions to support people with type 2 diabetes in better use of their diabetes medicines and to improve treatment adherence and health outcomes. Objective: This paper describes the overall architecture of a tailored intervention delivery system used in the pilot and randomized controlled feasibility studies of SuMMiT-D and reports its performance. Methods: The SuMMiT-D system includes several platforms and resources to recruit participants and deliver messages as tailored interventions. Its core component is called the clinical system and is responsible for interacting with the participants by receiving and sending SMS text messages from and to them. The personalization and tailoring of brief messages for each participant is based on a list of built-in commands that they can use. Results: For the pilot study, a total of 48 participants were recruited; they had a median age of 64 years (first quartile, third quartile [Q1, Q3: 54.5, 69]). For the feasibility study, a total of 209 participants were recruited and randomly assigned to either the control or intervention group; they had a median age of 65 years (Q1, Q3: 56, 71), with 41.1\% (86/209) being female. The participants used the SuMMiT-D system for up to 6 months (26 weeks) and had a wide range of different interactions with the SuMMiT-D system while tailored interventions were being delivered. For both studies, we had low withdrawal rates: only 4.2\% and 5.3\% for the pilot and feasibility studies, respectively. Conclusions: A system was developed to successfully deliver brief messages as tailored health interventions to more than 250 people with type 2 diabetes via SMS text messages. On the basis of the low withdrawal rates and positive feedback received, it can be inferred that the SuMMiT-D system is robust, user-friendly, useful, and positive for most participants. From the two studies, we found that online recruitment was more efficient than recruitment via postal mail; a regular SMS text reminder (eg, every 4 weeks) can potentially increase the participants' interactions with the system. Trial Registration: ISRCTN Registry ISRCTN13404264; http://www.isrctn.com/ISRCTN13404264 ",
doi="10.2196/18460",
url="https://formative.jmir.org/2021/3/e18460",
url="http://www.ncbi.nlm.nih.gov/pubmed/33769299"
}


@Article{info:doi/10.2196/17908,
author="Krishnakumar, Arjun
and Verma, Ritika
and Chawla, Rajeev
and Sosale, Aravind
and Saboo, Banshi
and Joshi, Shilpa
and Shaikh, Maaz
and Shah, Abhishek
and Kolwankar, Siddhesh
and Mattoo, Vinod",
title="Evaluating Glycemic Control in Patients of South Asian Origin With Type 2 Diabetes Using a Digital Therapeutic Platform: Analysis of Real-World Data",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="25",
volume="23",
number="3",
pages="e17908",
keywords="digital therapeutics",
keywords="type 2 diabetes",
keywords="behavior change",
keywords="diabetes self-management",
keywords="lifestyle intervention",
keywords="mobile phone",
abstract="Background: Digital therapeutics are evidence-based therapeutic interventions driven by high-quality software programs for the treatment, prevention, or management of a medical disorder or disease. Many studies in the western population have shown the effectiveness of mobile app--based digital therapeutics for improving glycemic control in patients with type 2 diabetes (T2D). However, few studies have assessed similar outcomes in the South Asian population. Objective: This study aims to investigate the real-world effectiveness of the Wellthy CARE digital therapeutic for improving glycemic control among the South Asian population of Indian origin. Methods: We analyzed deidentified data from 102 patients with T2D from India enrolled in a 16-week structured self-management program delivered using the Wellthy CARE mobile app. Patients recorded their meals, weight, physical activity, and blood sugar in the app, and they received lessons on self-care behaviors (healthy eating, being active, monitoring, medication adherence, problem solving, healthy coping, and reducing risks); feedback provided by an artificial intelligence--powered chatbot; and periodic interactions with certified diabetes educators via voice calls and chats. The primary outcome of the program was a change in glycated hemoglobin A1c (HbA1c). Secondary outcomes included the difference between preintervention and postintervention fasting blood glucose (FBG) and postprandial blood glucose (PPBG) levels; changes in BMI and weight at the completion of 16 weeks; and the association between program engagement and the changes in HbA1c, FBG, and PPBG levels. Results: At the end of 16 weeks, the average change in HbA1c was --0.49\% (n=102; 95\% CI ?0.73 to 0.25; P<.001). Of all the patients, 63.7\% (65/102) had improved HbA1c levels, with a mean change of ?1.16\% (n=65; 95\% CI ?1.40 to ?0.92; P<.001). The mean preintervention and postintervention FBG levels were 145 mg/dL (n=51; 95\% CI 135-155) and 134 mg/dL (n=51; 95\% CI 122-146; P=.02) and PPBG levels were 188 mg/dL (n=51; 95\% CI 172-203) and 166 mg/dL (n=51; 95\% CI 153-180; P=.03), respectively. The mean changes in BMI and weight were --0.47 kg/m2 (n=59; 95\% CI ?0.22 to ?0.71; P<.001) and --1.32 kg (n=59; 95\% CI ?0.63 to ?2.01; P<.001), respectively. There was a stepwise decrease in HbA1c, FBG, and PPBG levels as the program engagement increased. Patients in the highest tertile of program engagement had a significantly higher reduction in HbA1c (?0.84\% vs ?0.06\%; P=.02), FBG (?21.4 mg/dL vs ?0.18 mg/dL; P=.02), and PPBG levels (?22.03 mg/dL vs 2.35 mg/dL; P=.002) than those in the lowest tertile. Conclusions: The use of the Wellthy CARE digital therapeutic for patients with T2D showed a significant reduction in the levels of HbA1c, FBG, and PPBG after 16 weeks. A higher level of participation showed improved glycemic control, suggesting the potential of the Wellthy CARE platform for better management of the disease. ",
doi="10.2196/17908",
url="https://www.jmir.org/2021/3/e17908",
url="http://www.ncbi.nlm.nih.gov/pubmed/33764306"
}


@Article{info:doi/10.2196/23475,
author="Eberle, Claudia
and Stichling, Stefanie
and L{\"o}hnert, Maxine",
title="Diabetology 4.0: Scoping Review of Novel Insights and Possibilities Offered by Digitalization",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="24",
volume="23",
number="3",
pages="e23475",
keywords="diabetes mellitus",
keywords="telemedicine",
keywords="mobile apps",
keywords="electronic health records",
keywords="digital technology",
keywords="eHealth",
keywords="mobile phone",
abstract="Background: The increasing prevalence of diabetes mellitus and associated morbidity worldwide justifies the need to create new approaches and strategies for diabetes therapy. Therefore, the ongoing digitalization offers novel opportunities in this field. Objective: The aim of this study is to provide an updated overview of available technologies, possibilities, and novel insights into diabetes therapy 4.0. Methods: A scoping review was carried out, and a literature search was performed using electronic databases (MEDLINE [PubMed], Cochrane Library, Embase, CINAHL, and Web of Science). The results were categorized according to the type of technology presented. Results: Different types of technology (eg, glucose monitoring systems, insulin pens, insulin pumps, closed-loop systems, mobile health apps, telemedicine, and electronic medical records) may help to improve diabetes treatment. These improvements primarily affect glycemic control. However, they may also help in increasing the autonomy and quality of life of people who are diagnosed with diabetes mellitus. Conclusions: Diabetes technologies have developed rapidly over the last few years and offer novel insights into diabetes therapy and a chance to improve and individualize diabetes treatment. Challenges that need to be addressed in the following years relate to data security, interoperability, and the development of standards. ",
doi="10.2196/23475",
url="https://www.jmir.org/2021/3/e23475",
url="http://www.ncbi.nlm.nih.gov/pubmed/33759789"
}


@Article{info:doi/10.2196/24062,
author="Morse, S. Robert
and Lambden, Kaley
and Quinn, Erin
and Ngoma, Twalib
and Mushi, Beatrice
and Ho, Xian Yun
and Ngoma, Mamsau
and Mahuna, Habiba
and Sagan, B. Sarah
and Mmari, Joshua
and Miesfeldt, Susan",
title="A Mobile App to Improve Symptom Control and Information Exchange Among Specialists and Local Health Workers Treating Tanzanian Cancer Patients: Human-Centered Design Approach",
journal="JMIR Cancer",
year="2021",
month="Mar",
day="23",
volume="7",
number="1",
pages="e24062",
keywords="mobile health",
keywords="mHealth",
keywords="user-centered design",
keywords="palliative care",
keywords="pain",
keywords="cancer",
keywords="sub-Saharan Africa",
keywords="mobile phone",
abstract="Background: Improving access to end-of-life symptom control interventions among cancer patients is a public health priority in Tanzania, and innovative community-based solutions are needed. Mobile health technology holds promise; however, existing resources are limited, and outpatient access to palliative care specialists is poor. A mobile platform that extends palliative care specialist access via shared care with community-based local health workers (LHWs) and provides remote support for pain and other symptom management can address this care gap. Objective: The aim of this study is to design and develop mobile-Palliative Care Link (mPCL), a web and mobile app to support outpatient symptom assessment and care coordination and control, with a focus on pain. Methods: A human-centered iterative design framework was used to develop the mPCL prototype for use by Tanzanian palliative care specialists (physicians and nurses trained in palliative care), poor-prognosis cancer patients and their lay caregivers (patients and caregivers), and LHWs. Central to mPCL is the validated African Palliative Care Outcome Scale (POS), which was adapted for automated, twice-weekly collection of quality of life--focused patient and caregiver responses and timely review, reaction, and tracking by specialists and LHWs. Prototype usability testing sessions were conducted in person with 21 key informants representing target end users. Sessions consisted of direct observations and qualitative and quantitative feedback on app ease of use and recommendations for improvement. Results were applied to optimize the prototype for subsequent real-world testing. Early pilot testing was conducted by deploying the app among 10 patients and caregivers, randomized to mPCL use versus phone-contact POS collection, and then gathering specialist and study team feedback to further optimize the prototype for a broader randomized field study to examine the app's effectiveness in symptom control among cancer patients. Results: mPCL functionalities include the ability to create and update a synoptic clinical record, regular real-time symptom assessment, patient or caregiver and care team communication and care coordination, symptom-focused educational resources, and ready access to emergency phone contact with a care team member. Results from the usability and pilot testing demonstrated that all users were able to successfully navigate the app, and feedback suggests that mPCL has clinical utility. User-informed recommendations included further improvement in app navigation, simplification of patient and caregiver components and language, and delineation of user roles. Conclusions: We designed, built, and tested a usable, functional mobile app prototype that supports outpatient palliative care for Tanzanian patients with cancer. mPCL is expressly designed to facilitate coordinated care via customized interfaces supporting core users---patients or caregivers, LHWs, and members of the palliative care team---and their respective roles. Future work is needed to demonstrate the effectiveness and sustainability of mPCL to remotely support the symptom control needs of Tanzanian cancer patients, particularly in harder-to-reach areas. ",
doi="10.2196/24062",
url="https://cancer.jmir.org/2021/1/e24062",
url="http://www.ncbi.nlm.nih.gov/pubmed/33755022"
}


@Article{info:doi/10.2196/25309,
author="Biondi, Andrea
and Laiou, Petroula
and Bruno, Elisa
and Viana, F. Pedro
and Schreuder, Martijn
and Hart, William
and Nurse, Ewan
and Pal, K. Deb
and Richardson, P. Mark",
title="Remote and Long-Term Self-Monitoring of Electroencephalographic and Noninvasive Measurable Variables at Home in Patients With Epilepsy (EEG@HOME): Protocol for an Observational Study",
journal="JMIR Res Protoc",
year="2021",
month="Mar",
day="19",
volume="10",
number="3",
pages="e25309",
keywords="epilepsy",
keywords="EEG",
keywords="electroencephalography",
keywords="brain ictogenicity",
keywords="wearables",
keywords="seizure prediction",
keywords="brain",
keywords="seizures",
keywords="mobile technology",
abstract="Background: Epileptic seizures are spontaneous events that severely affect the lives of patients due to their recurrence and unpredictability. The integration of new wearable and mobile technologies to collect electroencephalographic (EEG) and extracerebral signals in a portable system might be the solution to prospectively identify times of seizure occurrence or propensity. The performances of several seizure detection devices have been assessed by validated studies, and patient perspectives on wearables have been explored to better match their needs. Despite this, there is a major gap in the literature on long-term, real-life acceptability and performance of mobile technology essential to managing chronic disorders such as epilepsy. Objective: EEG@HOME is an observational, nonrandomized, noninterventional study that aims to develop a new feasible procedure that allows people with epilepsy to independently, continuously, and safely acquire noninvasive variables at home. The data collected will be analyzed to develop a general model to predict periods of increased seizure risk. Methods: A total of 12 adults with a diagnosis of pharmaco-resistant epilepsy and at least 20 seizures per year will be recruited at King's College Hospital, London. Participants will be asked to self-apply an easy and portable EEG recording system (ANT Neuro) to record scalp EEG at home twice daily. From each serial EEG recording, brain network ictogenicity (BNI), a new biomarker of the propensity of the brain to develop seizures, will be extracted. A noninvasive wrist-worn device (Fitbit Charge 3; Fitbit Inc) will be used to collect non-EEG biosignals (heart rate, sleep quality index, and steps), and a smartphone app (Seer app; Seer Medical) will be used to collect data related to seizure occurrence, medication taken, sleep quality, stress, and mood. All data will be collected continuously for 6 months. Standardized questionnaires (the Post-Study System Usability Questionnaire and System Usability Scale) will be completed to assess the acceptability and feasibility of the procedure. BNI, continuous wrist-worn sensor biosignals, and electronic survey data will be correlated with seizure occurrence as reported in the diary to investigate their potential values as biomarkers of seizure risk. Results: The EEG@HOME project received funding from Epilepsy Research UK in 2018 and was approved by the Bromley Research Ethics Committee in March 2020. The first participants were enrolled in October 2020, and we expect to publish the first results by the end of 2022. Conclusions: With the EEG@HOME study, we aim to take advantage of new advances in remote monitoring technology, including self-applied EEG, to investigate the feasibility of long-term disease self-monitoring. Further, we hope our study will bring new insights into noninvasively collected personalized risk factors of seizure occurrence and seizure propensity that may help to mitigate one of the most difficult aspects of refractory epilepsy: the unpredictability of seizure occurrence. International Registered Report Identifier (IRRID): PRR1-10.2196/25309 ",
doi="10.2196/25309",
url="https://www.researchprotocols.org/2021/3/e25309",
url="http://www.ncbi.nlm.nih.gov/pubmed/33739290"
}


@Article{info:doi/10.2196/21116,
author="McDiarmid, Sarah
and Harvie, Michelle
and Johnson, Rhona
and Vyas, Avni
and Aglan, Azza
and Moran, Jacqui
and Ruane, Helen
and Hulme, Amanda
and Sellers, Katharine
and Issa, Basil",
title="Intermittent Versus Continuous Low-Energy Diet in Patients With Type 2 Diabetes: Protocol for a Pilot Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Mar",
day="19",
volume="10",
number="3",
pages="e21116",
keywords="type 2 diabetes",
keywords="diabetes",
keywords="diabetic diet",
keywords="low-energy diet",
keywords="low calorie diet",
keywords="intermittent energy restriction",
keywords="intermittent fasting",
keywords="diabetes remission",
keywords="smartphone",
keywords="mobile phone",
keywords="mHealth",
keywords="mobile health",
abstract="Background: Intensive face-to-face weight loss programs using continuous low-energy diets (CLEDs) providing approximately 800 kcal per day (3347 kJ per day) can produce significant weight loss and remission from type 2 diabetes (T2D). Intermittent low-energy diets (ILEDs) and remotely delivered programs could be viable alternatives that may support patient choice and adherence. Objective: This paper describes the protocol of a pilot randomized controlled trial to test the feasibility and potential efficacy of remotely supported isocaloric ILED and CLED programs among patients with overweight and obesity and T2D. Methods: A total of 79 participants were recruited from primary care, two National Health Service hospital trusts, and a voluntary T2D research register in the United Kingdom. The participants were randomized to a remotely delivered ILED (n=39) or CLED (n=40). The active weight loss phase of CLED involved 8 weeks of Optifast 820 kcal/3430 kJ formula diet, followed by 4 weeks of food reintroduction. The active weight loss phase of ILED (n=39) comprised 2 days of Optifast 820 kcal/3430 kJ diet and 5 days of a portion-controlled Mediterranean diet for 28 weeks. Both groups were asked to complete 56 Optifast 820 kcal/3430 kJ days during their active weight loss phase with an equivalent energy deficit. The diets were isocaloric for the remainder of the 12 months. CLED participants were asked to follow a portion-controlled Mediterranean diet 7 days per week. ILED followed 1-2 days per week of a food-based 820 kcal/3430 kJ diet and a portion-controlled Mediterranean diet for 5-6 days per week. Participants received high-frequency (weekly, fortnightly, or monthly depending on the stage of the trial) multidisciplinary remote support from a dietitian, nurse, exercise specialist, and psychologist via telephone or the Oviva smartphone app. The primary outcomes of the study were uptake, weight loss, and changes in glycated hemoglobin at 12 months. An outcome assessment of trial retention was retrospectively added. Secondary outcomes included an assessment of adherence and adverse events. A qualitative evaluation was undertaken via interviews with participants and health care professionals who delivered the intervention. Results: A total of 79 overweight or obese participants aged 18-75 years and diagnosed with T2D in the last 8 years were recruited to the Manchester Intermittent and Daily Diet Diabetes App Study (MIDDAS). Recruitment began in February 2018, and data collection was completed in February 2020. Data analysis began in June 2020, and the first results are expected to be submitted for publication in 2021. Conclusions: The outcomes of the MIDDAS study will inform the feasibility of remotely delivered ILED and CLED programs in clinical practice and the requirement for a larger-scale randomized controlled trial. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 15394285; http://www.isrctn.com/ISRCTN15394285 International Registered Report Identifier (IRRID): DERR1-10.2196/21116 ",
doi="10.2196/21116",
url="https://www.researchprotocols.org/2021/3/e21116",
url="http://www.ncbi.nlm.nih.gov/pubmed/33739297"
}


@Article{info:doi/10.2196/24667,
author="Teckie, Sewit
and Solomon, Jeffrey
and Kadapa, Karthik
and Sanchez, Keisy
and Orner, David
and Kraus, Dennis
and Kamdar, P. Dev
and Pereira, Lucio
and Frank, Douglas
and Diefenbach, Michael",
title="A Mobile Patient-Facing App for Tracking Patient-Reported Outcomes in Head and Neck Cancer Survivors: Single-Arm Feasibility Study",
journal="JMIR Form Res",
year="2021",
month="Mar",
day="19",
volume="5",
number="3",
pages="e24667",
keywords="mHealth",
keywords="ePROs",
keywords="head and neck cancer",
keywords="mobile phone",
abstract="Background: Patients with head and neck cancer (HNC) frequently experience disease-related symptoms and treatment adverse effects that impact their overall quality of life. Cancer-specific mobile health apps for patient-related outcomes allow patients to communicate with their clinicians and proactively track their symptoms, which have been shown to improve clinical management and disease outcomes. Objective: The purpose of this study was to evaluate the feasibility of LogPAL, a novel iPhone-based mobile health app designed to help HNC survivors track and manage their posttreatment symptoms. Methods: Patients who completed curative treatment for HNC in the preceding 24 months were recruited from 2 clinical sites within a single institution. Upon enrollment, participants completed a brief sociodemographic survey, downloaded the app onto their iPhone devices, and were asked to complete a series of biweekly questionnaires (based on the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events) via the app for an 8-week study period. The primary feasibility endpoints included retention (retaining >80\% of the enrolled participants for the duration of the study period), adherence (>50\% of the participants completing 100\% of the questionnaires over the study period), and usability (a mean system usability scale [SUS] score >68). Additional postintervention questions were collected to assess perceived usefulness, acceptance, and overall satisfaction. Results: Between January and October 2019, 38 participants were enrolled in the study. Three participants dropped out, and 3 were classified as nonusers. The remaining 32 (87\%) were eligible for analysis. Their mean age was 57.8 (SD 12.3) years (range 24-77 years, 81\% [26/32] male). Overall, 375 of 512 (73.2\%) questionnaires were completed, with 17 (53\%) of the 32 participants adherent. Participant-reported usability was acceptable; the mean SUS score was 71.9 (95\% CI 64.3-79.5) with high satisfaction of LogPAL usefulness and likelihood to recommend to other cancer survivors. Conclusions: This single-arm prospective pilot study showed that LogPAL is a feasible, regularly used, accepted app for HNC survivors, justifying a full-scale pilot. Based on the findings from this study, future iterations will aim to improve usability and test intervention efficacy. ",
doi="10.2196/24667",
url="https://formative.jmir.org/2021/3/e24667",
url="http://www.ncbi.nlm.nih.gov/pubmed/33739291"
}


@Article{info:doi/10.2196/24589,
author="Tokosi, Oluwaseyi Temitope
and Twum-Darko, Michael",
title="Mobile Health Crowdsensing (MHCS) Intervention on Chronic Disease Awareness: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2021",
month="Mar",
day="19",
volume="10",
number="3",
pages="e24589",
keywords="mHealth",
keywords="crowdsensing",
keywords="chronic diseases",
keywords="awareness",
keywords="mobile phone",
abstract="Background: Mobile health crowdsensing (MHCS) involves the use of mobile communication technologies to promote health by supporting health care practices (eg, health data collection, delivery of health care information, or patient observation and provision of care). MHCS technologies (eg, smartphones) have sensory capabilities, such as GPS, voice, light, and camera, to collect, analyze, and share user-centered data (explicit and implicit). The current literature indicates no scientific study related to MHCS interventions for chronic diseases. The proposed systematic review will examine the impact of MHCS interventions on chronic disease awareness. Objective: The objectives of this study are to identify and describe various MHCS intervention strategies applied to chronic disease awareness. Methods: Literature from various databases, such as MEDLINE, Embase, PsycINFO, CINAHL, and Cochrane Central Register of Controlled Trials, will be examined. Trial registers, reports, grey literature, and unpublished academic theses will also be included. All mobile technologies, such as cell phones, personal digital assistants, and tablets that have short message service, multimedia message service, video, and audio capabilities, will be included. MHCS will be the primary intervention strategy. The search strategy will include keywords such as mHealth, crowdsensing, and awareness among other medical subject heading terms. Articles published from January 1, 1945, to December 31, 2019, will be eligible for inclusion. The authors will independently screen and select studies, extract data, and assess the risk of bias, with discrepancies resolved by an independent party not involved in the study. The authors will assess statistical heterogeneity by examining the types of participants, interventions, study designs, and outcomes in each study, and pool studies judged to be statistically homogeneous. In the assessment of heterogeneity, a sensitivity analysis will be considered to explore statistical heterogeneity. Statistical heterogeneity will be investigated using the chi-square test of homogeneity on Cochrane Q test, and quantified using the I2 statistic. Results: The preliminary search query found 1 paper. Further literature search commenced in mid-March 2021 and is to be concluded in April 2021. The proposed systematic review protocol has been registered in PROSPERO (The International Prospective Register of Systematic Reviews; no. CRD42020161435). Furthermore, the use of search data extraction and capturing in Review Manager version 5.3 (Cochrane) commenced in January 2021 and ended in February 2021. Further literature search will begin in mid-March 2021 and will be concluded in April 2021. The final stages will include analyses and writing, which are anticipated to start and be completed in May 2021. Conclusions: The knowledge derived from this study will inform health care stakeholders---including researchers, policy makers, investors, health professionals, technologists, and engineers---of the impact of MHCS interventions on chronic disease awareness. International Registered Report Identifier (IRRID): PRR1-10.2196/24589 ",
doi="10.2196/24589",
url="https://www.researchprotocols.org/2021/3/e24589",
url="http://www.ncbi.nlm.nih.gov/pubmed/33739288"
}


@Article{info:doi/10.2196/19519,
author="Richardson, Julie
and Letts, Lori
and Sinclair, Susanne
and Chan, David
and Miller, Jordan
and Donnelly, Catherine
and Smith-Turchyn, Jenna
and Wojkowski, Sarah
and Gravesande, Janelle
and Loyola S{\'a}nchez, Adalberto",
title="Using a Web-Based App to Deliver Rehabilitation Strategies to Persons With Chronic Conditions: Development and Usability Study",
journal="JMIR Rehabil Assist Technol",
year="2021",
month="Mar",
day="18",
volume="8",
number="1",
pages="e19519",
keywords="rehabilitation",
keywords="physiotherapy",
keywords="occupational therapy",
keywords="self-management",
keywords="function",
keywords="web-based application",
keywords="usability",
keywords="user-centered design",
abstract="Background: The global rise in the incidence of chronic conditions and aging is associated with increased disability. Physiotherapists and occupational therapists can mitigate the resulting burden on the health care system with their expertise in optimizing function. Rehabilitation self-management strategies can assist people with chronic conditions to accept, adjust, and manage different aspects of their daily functioning. Interventions delivered using technology have the potential to increase the accessibility, availability, and affordability of rehabilitation self-management support and services. Objective: This study aims to describe the development and usability evaluation of iamable, a web-based app created to provide rehabilitation self-management support for people with chronic conditions. Methods: The development and evaluation of iamable were undertaken in several phases. We used user-centered design principles and an iterative process that included consultations with rehabilitation experts; developed a prototype; and conducted usability tests, heuristic evaluations, and a focus group analysis. Results: The iamable app was developed to provide rehabilitation self-management strategies in the areas of exercise, fall prevention, fatigue management, pain management, physical activity, and stress management. We engaged adults aged ?45 years with at least one chronic condition (N=11) in usability testing. They identified navigation and the understanding of instructions as the primary issues for end users. During the heuristic evaluation, clinicians (N=6) recommended that some areas of app content should be more succinct and that help should be more readily available. The focus group provided input to help guide clinical simulation testing, including strategies for selecting patients and overcoming barriers to implementation. Conclusions: We engaged end users and clinicians in the development and evaluation of the iamable app in an effort to create a web-based tool that was useful to therapists and their patients. By addressing usability issues, we were able to ensure that patients had access to rehabilitation strategies that could be used to help them better manage their health. Our app also provides therapists with a platform that they can trust to empower their patients to be more active in the management of chronic conditions. This paper provides a resource that can be used by others to develop and evaluate web-based health apps. ",
doi="10.2196/19519",
url="https://rehab.jmir.org/2021/1/e19519",
url="http://www.ncbi.nlm.nih.gov/pubmed/33734090"
}


@Article{info:doi/10.2196/24726,
author="van Buul, R. Amanda
and Derksen, Caroline
and Hoedemaker, Ouke
and van Dijk, Oscar
and Chavannes, H. Niels
and Kasteleyn, J. Marise",
title="eHealth Program to Reduce Hospitalizations Due to Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Retrospective Study",
journal="JMIR Form Res",
year="2021",
month="Mar",
day="18",
volume="5",
number="3",
pages="e24726",
keywords="COPD",
keywords="eHealth",
keywords="exacerbations",
keywords="hospitalizations",
keywords="mHealth",
abstract="Background: Hospitalization for acute exacerbation of chronic obstructive pulmonary disease (COPD) is associated with poor prognosis. eHealth interventions might improve outcomes and decrease costs. Objective: This study aimed to evaluate the effect of an eHealth program on COPD hospitalizations and exacerbations. Methods: This was a real-world study conducted from April 2018 to December 2019 in the Bravis Hospital, the Netherlands. An eHealth program (EmmaCOPD) was offered to COPD patients at risk of exacerbations. EmmaCOPD consisted of an app that used questionnaires (to monitor symptoms) and a step counter (to monitor the number of steps) to detect exacerbations. Patients and their buddies received feedback when their symptoms worsened or the number of steps declined. Generalized estimating equations were used to compare the number of days admitted to the hospital and the total number of exacerbations 12 months before and (max) 18 months after the start of EmmaCOPD. We additionally adjusted for the potential confounders of age, sex, COPD severity, and inhaled corticosteroid use. Results: The 29 included patients had a mean forced expiratory volume in 1 second of 45.5 (SD 17.7) \%predicted. In the year before the intervention, the median total number of exacerbations was 2.0 (IQR 2.0-3.0). The median number of hospitalized days was 8.0 days (IQR 6.0-16.5 days). Afterwards, there was a median 1.0 (IQR 0.0-2.0) exacerbation and 2.0 days (IQR 0.0-4.0 days) of hospitalization. After initiation of EmmaCOPD, both the number of hospitalized days and total number of exacerbations decreased significantly (incidence rate ratio 0.209, 95\% CI 0.116-0.382; incidence rate ratio 0.310, 95\% CI 0.219-0.438). Adjustment for confounders did not affect the results. Conclusions: The eHealth program seems to reduce the number of total exacerbations and number of days of hospitalization due to exacerbations of COPD. ",
doi="10.2196/24726",
url="https://formative.jmir.org/2021/3/e24726",
url="http://www.ncbi.nlm.nih.gov/pubmed/33734091"
}


@Article{info:doi/10.2196/26950,
author="Trojan, Andreas
and B{\"a}ttig, Basil
and Mannhart, Meinrad
and Seifert, Burkhardt
and Brauchbar, N. Mathis
and Egbring, Marco",
title="Effect of Collaborative Review of Electronic Patient-Reported Outcomes for Shared Reporting in Breast Cancer Patients: Descriptive Comparative Study",
journal="JMIR Cancer",
year="2021",
month="Mar",
day="17",
volume="7",
number="1",
pages="e26950",
keywords="cancer",
keywords="Consilium Care",
keywords="smartphone app",
keywords="eHealth",
keywords="electronic patient-reported outcomes",
keywords="Common Terminology Criteria for Adverse Events",
abstract="Background: Digital monitoring of treatment-related symptoms and self-reported patient outcomes is important for the quality of care among cancer patients. As mobile devices are ubiquitous nowadays, the collection of electronic patient-reported outcomes (ePROs) is gaining momentum. So far, data are lacking on the modalities that contribute to the quantity and quality of ePROs. Objective: The objective of our study was to compare the utilization of two versions of a subsequently employed mobile app for electronic monitoring of PROs and to test our hypothesis that a shared review of symptoms in patient-physician collaboration has an impact on the number of data entries. Methods: The Consilium Care app engages cancer patients to standardize reporting of well-being and treatment-related symptoms in outpatient settings. For descriptive comparison of the utilization of two slightly different app versions, data were obtained from an early breast cancer trial (version 1 of the app, n=86) and an ongoing study including patients with advanced disease (version 2 of the app, n=106). In both app versions, patients and doctors were allowed to share the information from data entries during consultations. Version 2 of the app, however, randomly selected symptoms that required a detailed and shared regular patient-doctor review in order to focus on the collection and appropriate interpretation regarding awareness and guidance for severity grading. The numbers and types of symptom entries, satisfaction with both app versions, and patients' perceived effects during consultations were included for analysis. Results: Symptom severity grading was performed according to the Common Terminology Criteria for Adverse Events (CTCAE) using a horizontal slider and was indicated in descriptive terminology in both apps, while a graphical display facilitated the illustration of symptom history charts. In total, 192 patients electronically reported 11,437 data entries on well-being and 33,380 data entries on individual symptoms. Overall, 628 (of 872 intended) requested patient-doctor symptom reviews were performed in version 2 of the app. Both the amount of data entries per patient and day for well-being (version 1 vs version 2: 0.3 vs 1.0; P<.001) and symptoms (version 1 vs version 2: 1.3 vs 1.9; P=.04) appeared significantly increased in version 2 of the app. Overall satisfaction with both app versions was high, although version 2 of the app was perceived to be more helpful in general. Conclusions: Version 2 of the app showed much better results than version 1 of the app. A request for collaborative patient-doctor symptom review is likely to affect the number of digital symptom data entries. This app shows high potential to improve the patient-doctor experience. Trial Registration: ClinicalTrials.gov NCT02004496; https://clinicaltrials.gov/ct2/show/NCT02004496 and ClinicalTrials.gov NCT03578731; https://clinicaltrials.gov/ct2/show/NCT03578731 ",
doi="10.2196/26950",
url="https://cancer.jmir.org/2021/1/e26950",
url="http://www.ncbi.nlm.nih.gov/pubmed/33729162"
}


@Article{info:doi/10.2196/24738,
author="Ammar, Nariman
and Bailey, E. James
and Davis, L. Robert
and Shaban-Nejad, Arash",
title="Using a Personal Health Library--Enabled mHealth Recommender System for Self-Management of Diabetes Among Underserved Populations: Use Case for Knowledge Graphs and Linked Data",
journal="JMIR Form Res",
year="2021",
month="Mar",
day="16",
volume="5",
number="3",
pages="e24738",
keywords="personal health library",
keywords="mobile health",
keywords="personal health knowledge graph",
keywords="patient-centered design",
keywords="personalized health",
keywords="recommender system",
keywords="observations of daily living",
keywords="Semantic Web",
keywords="privacy",
abstract="Background: Traditionally, digital health data management has been based on electronic health record (EHR) systems and has been handled primarily by centralized health providers. New mechanisms are needed to give patients more control over their digital health data. Personal health libraries (PHLs) provide a single point of secure access to patients' digital health data and enable the integration of knowledge stored in their digital health profiles with other sources of global knowledge. PHLs can help empower caregivers and health care providers to make informed decisions about patients' health by understanding medical events in the context of their lives. Objective: This paper reports the implementation of a mobile health digital intervention that incorporates both digital health data stored in patients' PHLs and other sources of contextual knowledge to deliver tailored recommendations for improving self-care behaviors in diabetic adults. Methods: We conducted a thematic assessment of patient functional and nonfunctional requirements that are missing from current EHRs based on evidence from the literature. We used the results to identify the technologies needed to address those requirements. We describe the technological infrastructures used to construct, manage, and integrate the types of knowledge stored in the PHL. We leverage the Social Linked Data (Solid) platform to design a fully decentralized and privacy-aware platform that supports interoperability and care integration. We provided an initial prototype design of a PHL and drafted a use case scenario that involves four actors to demonstrate how the proposed prototype can be used to address user requirements, including the construction and management of the PHL and its utilization for developing a mobile app that queries the knowledge stored and integrated into the PHL in a private and fully decentralized manner to provide better recommendations. Results: To showcase the main features of the mobile health app and the PHL, we mapped those features onto a framework comprising the user requirements identified in a use case scenario that features a preventive intervention from the diabetes self-management domain. Ongoing development of the app requires a formative evaluation study and a clinical trial to assess the impact of the digital intervention on patient-users. We provide synopses of both study protocols. Conclusions: The proposed PHL helps patients and their caregivers take a central role in making decisions regarding their health and equips their health care providers with informatics tools that support the collection and interpretation of the collected knowledge. By exposing the PHL functionality as an open service, we foster the development of third-party applications or services and provide motivational technological support in several projects crossing different domains of interest. ",
doi="10.2196/24738",
url="https://formative.jmir.org/2021/3/e24738",
url="http://www.ncbi.nlm.nih.gov/pubmed/33724197"
}


@Article{info:doi/10.2196/26320,
author="Koyama, Takafumi
and Sato, Shusuke
and Toriumi, Madoka
and Watanabe, Takuro
and Nimura, Akimoto
and Okawa, Atsushi
and Sugiura, Yuta
and Fujita, Koji",
title="A Screening Method Using Anomaly Detection on a Smartphone for Patients With Carpal Tunnel Syndrome: Diagnostic Case-Control Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Mar",
day="14",
volume="9",
number="3",
pages="e26320",
keywords="carpal tunnel syndrome",
keywords="anomaly detection",
keywords="machine learning",
keywords="smartphone",
keywords="screening",
keywords="thumb",
keywords="diagnostic",
keywords="data collection",
keywords="app",
keywords="algorithm",
abstract="Background: Carpal tunnel syndrome (CTS) is a medical condition caused by compression of the median nerve in the carpal tunnel due to aging or overuse of the hand. The symptoms include numbness of the fingers and atrophy of the thenar muscle. Thenar atrophy recovers slowly postoperatively; therefore, early diagnosis and surgery are important. While physical examinations and nerve conduction studies are used to diagnose CTS, problems with the diagnostic ability and equipment, respectively, exist. Despite research on a CTS-screening app that uses a tablet and machine learning, problems with the usage rate of tablets and data collection for machine learning remain. Objective: To make data collection for machine learning easier and more available, we developed a screening app for CTS using a smartphone and an anomaly detection algorithm, aiming to examine our system as a useful screening tool for CTS. Methods: In total, 36 participants were recruited, comprising 36 hands with CTS and 27 hands without CTS. Participants controlled the character in our app using their thumbs. We recorded the position of the thumbs and time; generated screening models that classified CTS and non-CTS using anomaly detection and an autoencoder; and calculated the sensitivity, specificity, and area under the curve (AUC). Results: Participants with and without CTS were classified with 94\% sensitivity, 67\% specificity, and an AUC of 0.86. When dividing the data by direction, the model with data in the same direction as the thumb opposition had the highest AUC of 0.99, 92\% sensitivity, and 100\% specificity. Conclusions: Our app could reveal the difficulty of thumb opposition for patients with CTS and screen for CTS with high sensitivity and specificity. The app is highly accessible because of the use of smartphones and can be easily enhanced by anomaly detection. ",
doi="10.2196/26320",
url="https://mhealth.jmir.org/2021/3/e26320",
url="http://www.ncbi.nlm.nih.gov/pubmed/33714936"
}


@Article{info:doi/10.2196/24638,
author="Cho, Youmin
and Zhang, Huiting
and Harris, Ruth Marcelline
and Gong, Yang
and Smith, Lavoie Ellen
and Jiang, Yun",
title="Acceptance and Use of Home-Based Electronic Symptom Self-Reporting Systems in Patients With Cancer: Systematic Review",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="12",
volume="23",
number="3",
pages="e24638",
keywords="symptom",
keywords="self report",
keywords="telemedicine",
keywords="technology",
keywords="internet",
keywords="mobile phone",
keywords="patient preference",
keywords="cancer",
keywords="patient-reported outcomes",
abstract="Background: Electronic symptom self-reporting systems (e-SRS) have been shown to improve symptoms and survival in patients with cancer. However, patient engagement in using e-SRS for voluntary symptom self-reporting is less optimal. Multiple factors can potentially affect patients' acceptance and engagement in using home-based e-SRS. However, such factors have not been fully explored in cancer populations. Objective: The aim of this study is to understand the acceptance and use of home-based e-SRS by patients with cancer and identify associated facilitators and barriers. Methods: PubMed, CINAHL, Scopus, and PsycINFO (January 2010 to March 2020) were searched using a combination of Medical Subject Headings (MeSH) terms and keywords such as symptom self-reporting, electronic/technology, cancer, and their synonyms. Included studies focused on the use of home-based e-SRS by patients with cancer and their families. Studies on patients' use of e-SRS in clinical settings only were excluded. Of the 3740 papers retrieved, 33 were included in the final review. Factors associated with patient acceptance and use of e-SRS were extracted and synthesized. Results: Most e-SRS were web based (22/33, 66\%) or mobile app based (9/33, 27\%). The e-SRS initial acceptance, represented by patient enrollment rates, ranged from 40\% (22/55) to 100\% (100/100). High e-SRS acceptance was rated by 69\% (59/85) to 77.6\% (337/434) of the patients after they used the system. The e-SRS use, measured by patients' response rates to questionnaires (ranging from 1596/3521, 45.33\% to 92\%) or system log-on rates (ranging from 4/12, 33\% to 99/100, 99\%), declined over time in general patterns. Few studies (n=7) reported e-SRS use beyond 6 months, with the response rates ranging from 62\% (40/64) to 85.1\% (541/636) and the log-on rates ranging from 63.6\% (103/162) to 77\% (49/64). The availability of compatible devices and technical support, interactive system features, information accessibility, privacy, questionnaire quality, patient physical/psychosocial status, and age were associated with patient acceptance and use of home-based e-SRS. Conclusions: Acceptance and use of home-based e-SRS by patients with cancer varied significantly across studies, as assessed by a variety of approaches. The lack of access to technology has remained a barrier to e-SRS adoption. Interactive system features and personalized questionnaires may increase patient engagement. More studies are needed to further understand patients' long-term use of home-based e-SRS behavior patterns to develop personalized interventions to support symptom self-management and self-reporting of patients with cancer for optimal health outcomes. ",
doi="10.2196/24638",
url="https://www.jmir.org/2021/3/e24638",
url="http://www.ncbi.nlm.nih.gov/pubmed/33709929"
}


@Article{info:doi/10.2196/22473,
author="White, M. Katie
and Ivan, Alina
and Williams, Ruth
and Galloway, B. James
and Norton, Sam
and Matcham, Faith",
title="Remote Measurement in Rheumatoid Arthritis: Qualitative Analysis of Patient Perspectives",
journal="JMIR Form Res",
year="2021",
month="Mar",
day="9",
volume="5",
number="3",
pages="e22473",
keywords="rheumatoid arthritis",
keywords="remote measurement technologies",
keywords="symptom assessment",
keywords="disease management",
keywords="smartphone",
keywords="qualitative research",
keywords="mobile phone",
abstract="Background: Rheumatoid arthritis (RA) is characterized by recurrent fluctuations in symptoms such as joint pain, swelling, and stiffness. Remote measurement technologies (RMTs) offer the opportunity to track symptoms continuously and in real time; therefore, they may provide a more accurate picture of RA disease activity as a complement to prescheduled general practitioner appointments. Previous research has shown patient interest in remote symptom tracking in RA and has provided evidence for its clinical validity. However, there is a lack of co-design in the current development of systems, and the features of RMTs that best promote optimal engagement remain unclear. Objective: This study represents the first in a series of work that aims to develop a multiparametric RMT system for symptom tracking in RA. The objective of this study is to determine the important outcomes for disease management in patients with RA and how these can be best captured via remote measurement. Methods: A total of 9 patients (aged 23-77 years; mean 55.78, SD 17.54) with RA were recruited from King's College Hospital to participate in two semistructured focus groups. Both focus group discussions were conducted by a facilitator and a lived-experience researcher. The sessions were recorded, transcribed, independently coded, and analyzed for themes. Results: Thematic analysis identified a total of four overarching themes: important symptoms and outcomes in RA, management of RA symptoms, views on the current health care system, and views on the use of RMTs in RA. Mobility and pain were key symptoms to consider for symptom tracking as well as symptom triggers. There is a general consensus that the ability to track fluctuations and transmit such data to clinicians would aid in individual symptom management and the effectiveness of clinical care. Suggestions for visually capturing symptom fluctuations in an app were proposed. Conclusions: The findings support previous work on the acceptability of RMT with RA disease management and address key outcomes for integration into a remote monitoring system for RA self-management and clinical care. Clear recommendations for RMT design are proposed. Future work will aim to take these recommendations into a user testing phase. ",
doi="10.2196/22473",
url="https://formative.jmir.org/2021/3/e22473",
url="http://www.ncbi.nlm.nih.gov/pubmed/33687333"
}


@Article{info:doi/10.2196/24365,
author="Bai, Ran
and Xiao, Le
and Guo, Yu
and Zhu, Xuequan
and Li, Nanxi
and Wang, Yashen
and Chen, Qinqin
and Feng, Lei
and Wang, Yinghua
and Yu, Xiangyi
and Wang, Chunxue
and Hu, Yongdong
and Liu, Zhandong
and Xie, Haiyong
and Wang, Gang",
title="Tracking and Monitoring Mood Stability of Patients With Major Depressive Disorder by Machine Learning Models Using Passive Digital Data: Prospective Naturalistic Multicenter Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Mar",
day="8",
volume="9",
number="3",
pages="e24365",
keywords="digital phenotype",
keywords="major depressive disorder",
keywords="machine learning",
keywords="mobile phone",
abstract="Background: Major depressive disorder (MDD) is a common mental illness characterized by persistent sadness and a loss of interest in activities. Using smartphones and wearable devices to monitor the mental condition of patients with MDD has been examined in several studies. However, few studies have used passively collected data to monitor mood changes over time. Objective: The aim of this study is to examine the feasibility of monitoring mood status and stability of patients with MDD using machine learning models trained by passively collected data, including phone use data, sleep data, and step count data. Methods: We constructed 950 data samples representing time spans during three consecutive Patient Health Questionnaire-9 assessments. Each data sample was labeled as Steady or Mood Swing, with subgroups Steady-remission, Steady-depressed, Mood Swing-drastic, and Mood Swing-moderate based on patients' Patient Health Questionnaire-9 scores from three visits. A total of 252 features were extracted, and 4 feature selection models were applied; 6 different combinations of types of data were experimented with using 6 different machine learning models. Results: A total of 334 participants with MDD were enrolled in this study. The highest average accuracy of classification between Steady and Mood Swing was 76.67\% (SD 8.47\%) and that of recall was 90.44\% (SD 6.93\%), with features from all types of data being used. Among the 6 combinations of types of data we experimented with, the overall best combination was using call logs, sleep data, step count data, and heart rate data. The accuracies of predicting between Steady-remission and Mood Swing-drastic, Steady-remission and Mood Swing-moderate, and Steady-depressed and Mood Swing-drastic were over 80\%, and the accuracy of predicting between Steady-depressed and Mood Swing-moderate and the overall Steady to Mood Swing classification accuracy were over 75\%. Comparing all 6 aforementioned combinations, we found that the overall prediction accuracies between Steady-remission and Mood Swing (drastic and moderate) are better than those between Steady-depressed and Mood Swing (drastic and moderate). Conclusions: Our proposed method could be used to monitor mood changes in patients with MDD with promising accuracy by using passively collected data, which can be used as a reference by doctors for adjusting treatment plans or for warning patients and their guardians of a relapse. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900021461; http://www.chictr.org.cn/showprojen.aspx?proj=36173 ",
doi="10.2196/24365",
url="https://mhealth.jmir.org/2021/3/e24365",
url="http://www.ncbi.nlm.nih.gov/pubmed/33683207"
}


@Article{info:doi/10.2196/24501,
author="Lu{\vs}trek, Mitja
and Bohanec, Marko
and Cavero Barca, Carlos
and Ciancarelli, Costanza Maria
and Clays, Els
and Dawodu, Adeyemo Amos
and Derboven, Jan
and De Smedt, Delphine
and Dovgan, Erik
and Lampe, Jure
and Marino, Flavia
and Mlakar, Miha
and Pioggia, Giovanni
and Puddu, Emilio Paolo
and Rodr{\'i}guez, Mario Juan
and Schiariti, Michele
and Slapni{\v c}ar, Ga{\vs}per
and Slegers, Karin
and Tartarisco, Gennaro
and Vali{\v c}, Jakob
and Vodopija, Aljo{\vs}a",
title="A Personal Health System for Self-Management of Congestive Heart Failure (HeartMan): Development, Technical Evaluation, and Proof-of-Concept Randomized Controlled Trial",
journal="JMIR Med Inform",
year="2021",
month="Mar",
day="5",
volume="9",
number="3",
pages="e24501",
keywords="congestive heart failure",
keywords="personal health system",
keywords="mobile application",
keywords="mobile phone",
keywords="wearable electronic devices",
keywords="decision support techniques",
keywords="psychological support",
keywords="human centered design",
abstract="Background: Congestive heart failure (CHF) is a disease that requires complex management involving multiple medications, exercise, and lifestyle changes. It mainly affects older patients with depression and anxiety, who commonly find management difficult. Existing mobile apps supporting the self-management of CHF have limited features and are inadequately validated. Objective: The HeartMan project aims to develop a personal health system that would comprehensively address CHF self-management by using sensing devices and artificial intelligence methods. This paper presents the design of the system and reports on the accuracy of its patient-monitoring methods, overall effectiveness, and patient perceptions. Methods: A mobile app was developed as the core of the HeartMan system, and the app was connected to a custom wristband and cloud services. The system features machine learning methods for patient monitoring: continuous blood pressure (BP) estimation, physical activity monitoring, and psychological profile recognition. These methods feed a decision support system that provides recommendations on physical health and psychological support. The system was designed using a human-centered methodology involving the patients throughout development. It was evaluated in a proof-of-concept trial with 56 patients. Results: Fairly high accuracy of the patient-monitoring methods was observed. The mean absolute error of BP estimation was 9.0 mm Hg for systolic BP and 7.0 mm Hg for diastolic BP. The accuracy of psychological profile detection was 88.6\%. The F-measure for physical activity recognition was 71\%. The proof-of-concept clinical trial in 56 patients showed that the HeartMan system significantly improved self-care behavior (P=.02), whereas depression and anxiety rates were significantly reduced (P<.001), as were perceived sexual problems (P=.01). According to the Unified Theory of Acceptance and Use of Technology questionnaire, a positive attitude toward HeartMan was seen among end users, resulting in increased awareness, self-monitoring, and empowerment. Conclusions: The HeartMan project combined a range of advanced technologies with human-centered design to develop a complex system that was shown to help patients with CHF. More psychological than physical benefits were observed. Trial Registration: ClinicalTrials.gov NCT03497871; https://clinicaltrials.gov/ct2/history/NCT03497871. International Registered Report Identifier (IRRID): RR2-10.1186/s12872-018-0921-2 ",
doi="10.2196/24501",
url="https://medinform.jmir.org/2021/3/e24501",
url="http://www.ncbi.nlm.nih.gov/pubmed/33666562"
}


@Article{info:doi/10.2196/26528,
author="Bhatia, Anuj
and Kara, Jamal
and Janmohamed, Tahir
and Prabhu, Atul
and Lebovic, Gerald
and Katz, Joel
and Clarke, Hance",
title="User Engagement and Clinical Impact of the Manage My Pain App in Patients With Chronic Pain: A Real-World, Multi-site Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Mar",
day="4",
volume="9",
number="3",
pages="e26528",
keywords="pain",
keywords="psychology",
keywords="patient-oriented research",
keywords="quality of life",
keywords="digital health",
keywords="chronic pain",
keywords="pain app",
keywords="virtual care",
keywords="mHealth",
keywords="pain management",
keywords="chronic disease management",
keywords="remote monitoring",
keywords="app",
keywords="engagement",
keywords="impact",
keywords="outcome",
abstract="Background: Chronic pain imposes a large burden on individuals and society. A patient-centric digital chronic pain management app called Manage My Pain (MMP) can be used to enhance communication between providers and patients and promote self-management. Objective: The purpose of this study was to evaluate the real-world engagement of patients in urban and rural settings in Ontario, Canada with the MMP app alongside their standard of care and assess the impact of its usage on clinical outcomes of pain and related mental health. Methods: A total of 246 participants with chronic pain at a rural and 2 urban pain clinics were recruited into this prospective, open-label, exploratory study that compared the use of MMP, a digital health app for pain that incorporates validated questionnaires and provides patients with summarized reports of their progress in combination with standard care (app group), against data entered on paper-based questionnaires (nonapp group). Participants completed validated questionnaires on anxiety, depression, pain catastrophizing, satisfaction, and daily opioid consumption up to 4.5 months after the initial visit (short-term follow-up) and between 4.5 and 7 months after the initial visit (long-term follow-up). Engagement and clinical outcomes were compared between participants in the two groups. Results: A total of 73.6\% (181/246) of the participants agreed to use the app, with 63.4\% (111/175) of them using it for at least one month. Individuals who used the app rated lower anxiety (reduction in Generalized Anxiety Disorder 7-item questionnaire score by 2.10 points, 95\% CI --3.96 to --0.24) at short-term follow-up and had a greater reduction in pain catastrophizing (reduction in Pain Catastrophizing Scale score by 5.23 points, 95\% CI --9.55 to --0.91) at long-term follow-up relative to patients with pain who did not engage with the MMP app. Conclusions: The use of MMP by patients with chronic pain is associated with engagement and improvements in self-reported anxiety and pain catastrophizing. Further research is required to understand factors that impact continued engagement and clinical outcomes in patients with chronic pain. Trial Registration: ClinicalTrials.gov NCT04762329; https://clinicaltrials.gov/ct2/show/NCT04762329 ",
doi="10.2196/26528",
url="https://mhealth.jmir.org/2021/3/e26528",
url="http://www.ncbi.nlm.nih.gov/pubmed/33661130"
}


@Article{info:doi/10.2196/20175,
author="Roux?de?B{\'e}zieux, Hector
and Bullard, James
and Kolterman, Orville
and Souza, Michael
and Perraudeau, Fanny",
title="Medical Food Assessment Using a Smartphone App With Continuous Glucose Monitoring Sensors: Proof-of-Concept Study",
journal="JMIR Form Res",
year="2021",
month="Mar",
day="4",
volume="5",
number="3",
pages="e20175",
keywords="clinical trials",
keywords="continuous glucose monitoring",
keywords="lifestyle modification",
keywords="mobile app",
keywords="telemedicine",
keywords="diabetes",
abstract="Background: Novel wearable biosensors, ubiquitous smartphone ownership, and telemedicine are converging to enable new paradigms of clinical research. A new generation of continuous glucose monitoring (CGM) devices provides access to clinical-grade measurement of interstitial glucose levels. Adoption of these sensors has become widespread for the management of type 1 diabetes and is accelerating in type 2 diabetes. In parallel, individuals are adopting health-related smartphone-based apps to monitor and manage care. Objective: We conducted a proof-of-concept study to investigate the potential of collecting robust, annotated, real-time clinical study measures of glucose levels without clinic visits. Methods: Self-administered meal-tolerance tests were conducted to assess the impact of a proprietary synbiotic medical food on glucose control in a 6-week, double-blind, placebo-controlled, 2{\texttimes}2 cross-over pilot study (n=6). The primary endpoint was incremental glucose measured using Abbott Freestyle Libre CGM devices associated with a smartphone app that provided a visual diet log. Results: All subjects completed the study and mastered CGM device usage. Over 40 days, 3000 data points on average per subject were collected across three sensors. No adverse events were recorded, and subjects reported general satisfaction with sensor management, the study product, and the smartphone app, with an average self-reported satisfaction score of 8.25/10. Despite a lack of sufficient power to achieve statistical significance, we demonstrated that we can detect meaningful changes in the postprandial glucose response in real-world settings, pointing to the merits of larger studies in the future. Conclusions: We have shown that CGM devices can provide a comprehensive picture of glucose control without clinic visits. CGM device usage in conjunction with our custom smartphone app can lower the participation burden for subjects while reducing study costs, and allows for robust integration of multiple valuable data types with glucose levels remotely. Trial Registration: ClinicalTrials.gov NCT04424888; http://clinicaltrials.gov/ct2/show/NCT04424888. ",
doi="10.2196/20175",
url="https://formative.jmir.org/2021/3/e20175",
url="http://www.ncbi.nlm.nih.gov/pubmed/33661120"
}


@Article{info:doi/10.2196/21061,
author="Akinosun, Samuel Adewale
and Polson, Rob
and Diaz - Skeete, Yohanca
and De Kock, Hendrikus Johannes
and Carragher, Lucia
and Leslie, Stephen
and Grindle, Mark
and Gorely, Trish",
title="Digital Technology Interventions for Risk Factor Modification in Patients With Cardiovascular Disease: Systematic Review and Meta-analysis",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Mar",
day="3",
volume="9",
number="3",
pages="e21061",
keywords="digital technologies",
keywords="mHealth",
keywords="eHealth",
keywords="risk factors",
keywords="cardiovascular diseases",
keywords="telehealth",
keywords="cardiac rehabilitation",
keywords="behavior",
keywords="systematic review",
keywords="meta-analysis",
keywords="mobile phone",
abstract="Background: Approximately 50\% of cardiovascular disease (CVD) cases are attributable to lifestyle risk factors. Despite widespread education, personal knowledge, and efficacy, many individuals fail to adequately modify these risk factors, even after a cardiovascular event. Digital technology interventions have been suggested as a viable equivalent and potential alternative to conventional cardiac rehabilitation care centers. However, little is known about the clinical effectiveness of these technologies in bringing about behavioral changes in patients with CVD at an individual level. Objective: The aim of this study is to identify and measure the effectiveness of digital technology (eg, mobile phones, the internet, software applications, wearables, etc) interventions in randomized controlled trials (RCTs) and determine which behavior change constructs are effective at achieving risk factor modification in patients with CVD. Methods: This study is a systematic review and meta-analysis of RCTs designed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) statement standard. Mixed data from studies extracted from selected research databases and filtered for RCTs only were analyzed using quantitative methods. Outcome hypothesis testing was set at 95\% CI and P=.05 for statistical significance. Results: Digital interventions were delivered using devices such as cell phones, smartphones, personal computers, and wearables coupled with technologies such as the internet, SMS, software applications, and mobile sensors. Behavioral change constructs such as cognition, follow-up, goal setting, record keeping, perceived benefit, persuasion, socialization, personalization, rewards and incentives, support, and self-management were used. The meta-analyzed effect estimates (mean difference [MD]; standard mean difference [SMD]; and risk ratio [RR]) calculated for outcomes showed benefits in total cholesterol SMD at ?0.29 [?0.44, ?0.15], P<.001; high-density lipoprotein SMD at --0.09 [--0.19, 0.00], P=.05; low-density lipoprotein SMD at ?0.18 [?0.33, ?0.04], P=.01; physical activity (PA) SMD at 0.23 [0.11, 0.36], P<.001; physical inactivity (sedentary) RR at 0.54 [0.39, 0.75], P<.001; and diet (food intake) RR at 0.79 [0.66, 0.94], P=.007. Initial effect estimates showed no significant benefit in body mass index (BMI) MD at ?0.37 [?1.20, 0.46], P=.38; diastolic blood pressure (BP) SMD at ?0.06 [?0.20, 0.08], P=.43; systolic BP SMD at ?0.03 [?0.18, 0.13], P=.74; Hemoglobin A1C blood sugar (HbA1c) RR at 1.04 [0.40, 2.70], P=.94; alcohol intake SMD at ?0.16 [?1.43, 1.10], P=.80; smoking RR at 0.87 [0.67, 1.13], P=.30; and medication adherence RR at 1.10 [1.00, 1.22], P=.06. Conclusions: Digital interventions may improve healthy behavioral factors (PA, healthy diet, and medication adherence) and are even more potent when used to treat multiple behavioral outcomes (eg, medication adherence plus). However, they did not appear to reduce unhealthy behavioral factors (smoking, alcohol intake, and unhealthy diet) and clinical outcomes (BMI, triglycerides, diastolic and systolic BP, and HbA1c). ",
doi="10.2196/21061",
url="https://mhealth.jmir.org/2021/3/e21061",
url="http://www.ncbi.nlm.nih.gov/pubmed/33656444"
}


@Article{info:doi/10.2196/25805,
author="Broome, Brantlee
and Madisetti, Mohan
and Prentice, Margaret
and Williams, Wong Kelli
and Kelechi, Teresa",
title="Food Allergy Symptom Self-Management With Technology (FASST) mHealth Intervention to Address Psychosocial Outcomes in Caregivers of Children With Newly Diagnosed Food Allergy: Protocol for a Pilot Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Mar",
day="3",
volume="10",
number="3",
pages="e25805",
keywords="caregiver well-being",
keywords="food allergy",
keywords="self-management",
keywords="mhealth, randomizes mixed trial",
keywords="caregiver",
keywords="well-being",
keywords="emergency room",
keywords="smartphone app",
keywords="smartphone",
keywords="children",
abstract="Background: Approximately 2.4 million children in the United States suffer from food-induced anaphylaxis, a condition that is annually responsible for over 200 deaths and 200,000 emergency room visits. As a result, caregivers of children newly diagnosed with severe and life-threatening food allergic reactions experience clinically significant symptoms of psychological distress, including fatigue, anxiety, depressed mood, social isolation, and substantially reduced quality of life. Despite this recognition, there is a lack of caregiver-centered self-management interventions to address these concerns. Objective: In this protocol, we propose to develop and conduct feasibility testing of a technology-enhanced, self-management, mobile health, smartphone app intervention called Food Allergy Symptom Self-Management with Technology for Caregivers (FASST) designed to meet the psychosocial health needs of caregivers of children with a new diagnosis of food allergy. Methods: This pilot study uses qualitative work (Phase I) to inform a 4-week longitudinal randomized controlled trial (Phase II). In Phase I, 10 caregivers of children (?18 years old) with established food allergy (?1 year from diagnosis) will participate in semistructured interviews to inform the development of the FASST app. In Phase II, 30 caregivers of children (?18 years old) with a newly diagnosed food allergy (?90 days from diagnosis) will be randomized 2:1 to receive the FASST intervention (n=20) or control condition (basic app with educational resources; n=10). Process measures include feasibility, caregiver acceptability, adherence, and satisfaction. Outcome measures include caregiver fatigue, anxiety, depression, sleep, self-efficacy, and quality of life measured at baseline, week 4, and 3 months post study completion. Results: Phase I study activities have been completed, and Phase II participant enrollment into the randomized controlled trial is expected to commence in 2021. Conclusions: With limited readily available resources at their disposal, the results from this study have the potential to provide caregivers of children with a newly diagnosed food allergy a tool to help them self-manage and mitigate negative psychosocial factors during a critical time period in the caregiving/condition trajectory. Trial Registration: ClinicalTrials.gov Identifier NCT04512924: https://clinicaltrials.gov/ct2/show/NCT04512924 International Registered Report Identifier (IRRID): DERR1-10.2196/25805 ",
doi="10.2196/25805",
url="https://www.researchprotocols.org/2021/3/e25805",
url="http://www.ncbi.nlm.nih.gov/pubmed/33656448"
}


@Article{info:doi/10.2196/23332,
author="Cao, Hua
and Jiang, Shaojun
and Lv, Meina
and Wu, Tingting
and Chen, Wenjun
and Zhang, Jinhua",
title="Effectiveness of the Alfalfa App in Warfarin Therapy Management for Patients Undergoing Venous Thrombosis Prevention and Treatment: Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Mar",
day="2",
volume="9",
number="3",
pages="e23332",
keywords="warfarin",
keywords="anticoagulation",
keywords="smartphone",
keywords="telemedicine",
keywords="app",
keywords="online",
keywords="offline",
keywords="bleeding",
keywords="INR",
keywords="TTR",
keywords="mobile phone",
abstract="Background: Over the years, the internet has enabled considerable progress in the management of chronic diseases, especially hypertension and diabetes. It also provides novel opportunities in online anticoagulation management. Nevertheless, there is insufficient evidence regarding the effectiveness of online anticoagulation management. Objective: This study explored the effectiveness and safety of warfarin management via the Alfalfa app, so as to provide evidence in support of anticoagulant management through online services. Methods: In this retrospective, observational cohort study, 824 patients were included. In the offline group, patients went to the hospital clinic for warfarin management. In the Alfalfa app group, patients reported the dose of warfarin, current international normalized ratio (INR) value, and other related information through the Alfalfa app. Physicians or pharmacists used the app to adjust the dose of warfarin and determined the time for the next blood INR testing. Patients completed INR testing by point-of-care at home or hospital. The primary outcome of the study was the percentage of time in therapeutic range (TTR). Secondary outcomes included minor and major bleeding events, thrombotic events, warfarin-related emergency department visits, hospital admissions, and high INR values. Results: The TTR and percentage of INR values in the range were significantly higher in the Alfalfa app group than in the offline group (79.35\% vs 52.38\%, P<.001; 3314/4282, 77.39\% vs 2005/4202, 47.72\%, P<.001, respectively). Patients managed via the Alfalfa app had lower rates of subtherapeutic (172/4282, 4.02\% vs 388/4202, 9.23\%; P<.001), supratherapeutic (487/4282, 11.37\% vs 882/4202, 20.99\%; P<.001), and extreme subtherapeutic INR values (290/4282, 6.77\% vs 910/4202, 21.66\%; P<.001). Additionally, the Alfalfa app group had lower incidences of major bleeding (2/425, 0.5\% vs 12/399, 3.0\%; P=.005), warfarin-related emergency department visits (13/425, 3.1\% vs 37/399, 9.3\%; P<.001), and hospital admissions (1/425, 0.2\% vs 12/399, 3.0\%; P=.001) compared with the offline group. However, the Alfalfa app group had a higher incidence of minor bleeding than the offline group (45/425, 10.6\% vs 20/399, 5.0\%; P=.003). There were similar incidences in extreme supratherapeutic INR values (19/4282, 0.44\% vs 17/4202, 0.40\%; P=.78) and thromboembolic events (1/425, 0.2\% vs 1/399, 0.3\%; P=.53) between the two groups. Conclusions: Warfarin management is superior via the Alfalfa app than via offline services in terms of major bleeding events, warfarin-related emergency department visits, and hospital admissions. ",
doi="10.2196/23332",
url="https://mhealth.jmir.org/2021/3/e23332",
url="http://www.ncbi.nlm.nih.gov/pubmed/33650976"
}


@Article{info:doi/10.2196/24322,
author="Almalki, Manal
and Giannicchi, Anna",
title="Health Apps for Combating COVID-19: Descriptive Review and Taxonomy",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Mar",
day="2",
volume="9",
number="3",
pages="e24322",
keywords="app",
keywords="COVID-19",
keywords="corona",
keywords="self-care",
keywords="personal tracking",
keywords="review",
keywords="mHealth",
keywords="track",
keywords="surveillance",
keywords="awareness",
keywords="exposure",
keywords="consumer health informatics",
abstract="Background: Mobile phone apps have been leveraged to combat the spread of COVID-19. However, little is known about these technologies' characteristics, technical features, and various applications in health care when responding to this public health crisis. The lack of understanding has led developers and governments to make poor choices about apps' designs, which resulted in creating less useful apps that are overall less appealing to consumers due to their technical flaws. Objective: This review aims to identify, analyze, and categorize health apps related to COVID-19 that are currently available for consumers in app stores; in particular, it focuses on exploring their key technical features and classifying the purposes that these apps were designed to serve. Methods: A review of health apps was conducted using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The Apple Store and Google Play were searched between April 20 and September 11, 2020. An app was included if it was dedicated for this disease and was listed under the health and medical categories in these app stores. The descriptions of these apps were extracted from the apps' web pages and thematically analyzed via open coding to identify both their key technical features and overall purpose. The characteristics of the included apps were summarized and presented with descriptive statistics. Results: Of the 298 health apps that were initially retrieved, 115 met the inclusion criteria. A total of 29 technical features were found in our sample of apps, which were then categorized into five key purposes of apps related to COVID-19. A total of 77 (67\%) apps were developed by governments or national authorities and for the purpose of promoting users to track their personal health (9/29, 31\%). Other purposes included raising awareness on how to combat COVID-19 (8/29, 27\%), managing exposure to COVID-19 (6/29, 20\%), monitoring health by health care professionals (5/29, 17\%), and conducting research studies (1/29, 3.5\%). Conclusions: This study provides an overview and taxonomy of the health apps currently available in the market to combat COVID-19 based on their differences in basic technical features and purpose. As most of the apps were provided by governments or national authorities, it indicates the essential role these apps have as tools in public health crisis management. By involving most of the population in self-tracking their personal health and providing them with the technology to self-assess, the role of these apps is deemed to be a key driver for a participatory approach to curtail the spread of COVID-19. Further effort is required from researchers to evaluate these apps' effectiveness and from governmental organizations to increase public awareness of these digital solutions. ",
doi="10.2196/24322",
url="https://mhealth.jmir.org/2021/3/e24322",
url="http://www.ncbi.nlm.nih.gov/pubmed/33626017"
}


@Article{info:doi/10.2196/24134,
author="Rafferty, J. Aaron
and Hall, Rick
and Johnston, S. Carol",
title="A Novel Mobile App (Heali) for Disease Treatment in Participants With Irritable Bowel Syndrome: Randomized Controlled Pilot Trial",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="2",
volume="23",
number="3",
pages="e24134",
keywords="irritable bowel syndrome",
keywords="artificial intelligence",
keywords="mobile app",
keywords="low FODMAP diet",
keywords="randomized controlled trial",
abstract="Background: A diet high in fermentable, oligo-, di-, monosaccharides and polyols (FODMAPs) has been shown to exacerbate symptoms of irritable bowel syndrome (IBS). Previous literature reports significant improvement in IBS symptoms with initiation of a low FODMAP diet (LFD) and monitored reintroduction. However, dietary adherence to the LFD is difficult, with patients stating that the information given by health care providers is often generalized and nonspecific, requiring them to search for supplementary information to fit their needs. Objective: The aim of our study was to determine whether Heali, a novel artificial intelligence dietary mobile app can improve adherence to the LFD, IBS symptom severity, and quality of life outcomes in adults with IBS or IBS-like symptoms over a 4-week period. Methods: Participants were randomized into 2 groups: the control group (CON), in which participants received educational materials, and the experimental group (APP), in which participants received access to the mobile app and educational materials. Over the course of this unblinded online trial, all participants completed a battery of 5 questionnaires at baseline and at the end of the trial to document IBS symptoms, quality of life, LFD knowledge, and LFD adherence. Results: We enrolled 58 participants in the study (29 in each group), and 25 participants completed the study in its entirety (11 and 14 for the CON and APP groups, respectively). Final, per-protocol analyses showed greater improvement in quality of life score for the APP group compared to the CON group (31.1 and 11.8, respectively; P=.04). Reduction in total IBS symptom severity score was 24\% greater for the APP group versus the CON group. Although this did not achieve significance (--170 vs --138 respectively; P=.37), the reduction in the subscore for bowel habit dissatisfaction was 2-fold greater for the APP group than for the CON group (P=.05). Conclusions: This initial study provides preliminary evidence that Heali may provide therapeutic benefit to its users, specifically improvements in quality of life and bowel habits. Although this study was underpowered, findings from this study warrant further research in a larger sample of participants to test the efficacy of Heali app use to improve outcomes for patients with IBS. Trial Registration: ClinicalTrials.gov NCT04256551; https://clinicaltrials.gov/ct2/show/NCT04256551 ",
doi="10.2196/24134",
url="https://www.jmir.org/2021/3/e24134",
url="http://www.ncbi.nlm.nih.gov/pubmed/33650977"
}


@Article{info:doi/10.2196/19239,
author="Chang, Leanne
and Chattopadhyay, Kaushik
and Li, Jialin
and Xu, Miao
and Li, Li",
title="Interplay of Support, Comparison, and Surveillance in Social Media Weight Management Interventions: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Mar",
day="1",
volume="9",
number="3",
pages="e19239",
keywords="obesity",
keywords="social comparison",
keywords="social media",
keywords="social support",
keywords="surveillance",
keywords="weight control",
abstract="Background: There has been a significant increase in the trend of using social media as a platform to deliver weight management interventions. This illustrates a need to develop a holistic understanding of doctor-patient communication and peer-to-peer communication in social media interventions and to determine their influences on weight management for people with overweight or obesity. Such studies will highlight how social media can be more effectively integrated into weight management programs to enhance individuals' short-term and long-term weight management behaviors. Objective: The aim of this study was to examine patients' experiences with doctor-patient communication and peer interactions in a social media--based (WeChat) weight management program, and to describe the interplay of three social influence factors---social support, social comparison, and surveillance---in their weight control practices. The program, designed and implemented by the research team located in a tertiary referral hospital in a southeastern province in China, included both diet and physical activity components that targeted people with overweight or obesity. Methods: We conducted in-depth interviews with 32 program participants of different ages (mean  35.6, SD 7.7 years), gender (18 women), duration of program membership (mean 1.4 years), and weight loss outcomes (54\% weight loss to 9\% weight gain). All interview data were audio-recorded, transcribed, and translated using the translation-backtranslation technique. Nvivo software was used to facilitate the coding process. Results: Results of thematic analysis indicated the distinct functions of professionally led support and peer support. Professional support was presented in the form of knowledge infusion, efficacy enhancement, and provision of timely feedback. Peer support fostered empathy and sense of belonging, and had a mutually reinforcing relationship with peer comparison and peer-based surveillance. Peer comparison enhanced motivation and positive competition. However, it also reinforced negative group norms, and resulted in downturns in reference standards and collective inactivity. Social media surveillance prompted participants' reactions to the gaze from medical professionals and peers that could be encouraging or inhibiting. Surveillance enhanced vigilance with weight control norms; however, its influence weakened when participants chose to fake weight data and turn off notifications. Findings from this study illustrated the interrelated and fluctuating influences of support, comparison, and surveillance. Conclusions: The interactive traits of social media eased the practices of social support and social comparison, and created new forms of surveillance. This study contributes to an in-depth understanding of social media influences on individuals' weight control behaviors. Practical implications of the study concern improved strategies for maintaining the positive dynamics of social media interactions and preventing negative resistance to surveillance technology. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900025861; http://www.chictr.org.cn/showprojen.aspx?proj=42497 ",
doi="10.2196/19239",
url="https://mhealth.jmir.org/2021/3/e19239",
url="http://www.ncbi.nlm.nih.gov/pubmed/33646130"
}


@Article{info:doi/10.2196/18224,
author="Barber-Gumbs, Tai
and Trolle Lagerros, Ylva
and Sena, M. Laura
and Gittelsohn, Joel
and Chang, W. Larry
and Zachary, W. Wayne
and Surkan, J. Pamela",
title="Perspectives From Underserved African Americans and Their Health Care Providers on the Development of a Diabetes Self-Management Smartphone App: Qualitative Exploratory Study",
journal="JMIR Form Res",
year="2021",
month="Feb",
day="26",
volume="5",
number="2",
pages="e18224",
keywords="diabetes",
keywords="mHealth",
keywords="type 2 diabetes mellitus",
keywords="diabetes self-management",
keywords="mobile app",
keywords="mobile phone",
abstract="Background: Type 2 diabetes mellitus (T2DM) affects approximately 10\% of the US population, disproportionately afflicting African Americans. Smartphone apps have emerged as promising tools to improve diabetes self-management, yet little is known about the use of this approach in low-income minority communities. Objective: The goal of the study was to explore which features of an app were prioritized for people with T2DM in a low-income African American community. Methods: Between February 2016 and May 2018, we conducted formative qualitative research with 78 participants to explore how a smartphone app could be used to improve diabetes self-management. Information was gathered on desired features, and app mock-ups were presented to receive comments and suggestions of improvements from smartphone users with prediabetes and T2DM, their friends and family members, and health care providers; data were collected from six interactive forums, one focus group, and 15 in-depth interviews. We carried out thematic data analysis using an inductive approach. Results: All three types of participants reported that difficulty with accessing health care was a main problem and suggested that an app could help address this. Participants also indicated that an app could provide information for diabetes education and self-management. Other suggestions included that the app should allow people with T2DM to log and track diabetes care--related behaviors and receive feedback on their progress in a way that would increase engagement in self-management among persons with T2DM. Conclusions: We identified educational and tracking smartphone features that can guide development of diabetes self-management apps for a low-income African American population. Considering those features in combination gives rise to opportunities for more advanced support, such as determining self-management recommendations based on data in users' logs. ",
doi="10.2196/18224",
url="https://formative.jmir.org/2021/2/e18224",
url="http://www.ncbi.nlm.nih.gov/pubmed/33635279"
}


@Article{info:doi/10.2196/21571,
author="Memon, Ali
and Lec, Patrick
and Lenis, Andrew
and Sharma, Vidit
and Wood, Erika
and Schade, George
and Brisbane, Wayne",
title="Relationship Between Mobile Digital Sensor Monitoring and Perioperative Outcomes: Systematic Review",
journal="JMIR Perioper Med",
year="2021",
month="Feb",
day="25",
volume="4",
number="1",
pages="e21571",
keywords="mobile sensors",
keywords="perioperative",
keywords="sensor monitoring",
keywords="perioperative outcomes",
abstract="Background: Monitoring surgical recovery has traditionally been confined to metrics measurable within the hospital and clinic setting. However, commercially available mobile sensors are now capable of extending measurements into a patient's home. As these sensors were developed for nonmedical applications, their clinical role has yet to be established. The aim of this systematic review is to evaluate the relationship between data generated by mobile sensors and postoperative outcomes. Objective: The objective of this study is to describe the current use of mobile sensors in the perioperative setting and the correlation between their data and clinical outcomes. Methods: A systematic search of EMBASE, MEDLINE, and Cochrane Library from inception until April 2019 was performed to identify studies of surgical patients monitored with mobile sensors. Sensors were considered if they collected patient metrics such as step count, temperature, or heart rate. Studies were included if patients underwent major surgery (?1 inpatient postoperative day), patients were monitored using mobile sensors in the perioperative period, and the study reported postoperative outcomes (ie, complications and hospital readmission). For studies including step count, a pooled analysis of the step count per postoperative day was calculated for the complication and noncomplication cohorts using mean and a random-effects linear model. The Grading of Recommendations, Assessment, Development, and Evaluation tool was used to assess study quality. Results: From 2209 abstracts, we identified 11 studies for review. Reviewed studies consisted of either prospective observational cohorts (n=10) or randomized controlled trials (n=1). Activity monitors were the most widely used sensors (n=10), with an additional study measuring temperature, respiratory rate, and heart rate (n=1). Low step count was associated with worse postoperative outcomes. A median step count of around 1000 steps per postoperative day was associated with adverse surgical outcomes. Within the studies, there was heterogeneity between the type of surgery and type of reported postoperative outcome. Conclusions: Despite significant heterogeneity in the type of surgery and sensors, low step count was associated with worse postoperative outcomes across surgical specialties. Further studies and standardization are needed to assess the role of mobile sensors in postoperative care, but a threshold of approximately 1000 steps per postoperative day warrants further investigation. ",
doi="10.2196/21571",
url="https://periop.jmir.org/2021/1/e21571",
url="http://www.ncbi.nlm.nih.gov/pubmed/33629966"
}


@Article{info:doi/10.2196/17590,
author="Ozkaynak, Mustafa
and Valdez, Rupa
and Hannah, Katia
and Woodhouse, Gina
and Klem, Patrick",
title="Understanding Gaps Between Daily Living and Clinical Settings in Chronic Disease Management: Qualitative Study",
journal="J Med Internet Res",
year="2021",
month="Feb",
day="25",
volume="23",
number="2",
pages="e17590",
keywords="health information systems",
keywords="workflow",
keywords="self-management",
keywords="activities of daily living",
keywords="mobile phone",
abstract="Background: Management of chronic conditions entails numerous activities in both clinical and daily living settings. Activities across these settings interact, creating a high potential for a gap to occur if there is an inconsistency or disconnect between controlled clinical settings and complex daily living environments. Objective: The aim of this study is to characterize gaps (from the patient's perspective) between health-related activities across home-based and clinical settings using anticoagulation treatment as an example. The causes, consequences, and mitigation strategies (reported by patients) were identified to understand these gaps. We conceptualized gaps as latent phenomena (ie, a break in continuity). Methods: Patients (n=39) and providers (n=4) from the anticoagulation clinic of an urban, western mountain health care system were recruited. Data were collected through primary interviews with patients, patient journaling with tablet computers, exit interviews with patients, and provider interviews. Data were analyzed qualitatively using a theory-driven approach and framework method of analysis. Results: The causes of gaps included clinician recommendations not fitting into patients' daily routines, recommendations not fitting into patients' living contexts, and information not transferred across settings. The consequences of these gaps included increased cognitive and physical workload on the patient, poor patient satisfaction, and compromised adherence to the therapy plan. We identified resources and strategies used to overcome these consequences as patient-generated strategies, routines, collaborative management, social environment, and tools and technologies. Conclusions: Understanding gaps, their consequences, and mitigating strategies can lead to the development of interventions that help narrow these gaps. Such interventions could take the form of collaborative health information technologies, novel patient and clinician education initiatives, and programs that strongly integrate health systems and community resources. Current technologies are insufficient to narrow the gaps between clinical and daily living settings due to the limited number and types of routines that are tracked. ",
doi="10.2196/17590",
url="https://www.jmir.org/2021/2/e17590",
url="http://www.ncbi.nlm.nih.gov/pubmed/33629657"
}


@Article{info:doi/10.2196/17573,
author="Lee, Min-Kyung
and Lee, Young Da
and Ahn, Hong-Yup
and Park, Cheol-Young",
title="A Novel User Utility Score for Diabetes Management Using Tailored Mobile Coaching: Secondary Analysis of a Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Feb",
day="24",
volume="9",
number="2",
pages="e17573",
keywords="type 2 diabetes",
keywords="mobile applications",
keywords="diabetes management",
keywords="patient engagement",
abstract="Background: Mobile health applications have been developed to support diabetes self-management, but their effectiveness could depend on patient engagement. Therefore, patient engagement must be examined through multifactorial tailored behavioral interventions from an individual perspective. Objective: This study aims to evaluate the usefulness of a novel user utility score (UUS) as a tool to measure patient engagement by using a mobile health application for diabetes management. Methods: We conducted a subanalysis of results from a 12-month randomized controlled trial of a tailored mobile coaching (TMC) system among insurance policyholders with type 2 diabetes. UUS was calculated as the sum of the scores for 4 major core components (range 0-8): frequency of self-monitoring blood glucose testing, dietary and exercise records, and message reading rate. We explored the association between UUS for the first 3 months and glycemic control over 12 months. In addition, we investigated the relationship of UUS with blood pressure, lipid profile, and self-report scales assessing diabetes self-management. Results: We divided 72 participants into 2 groups based on UUS for the first 3 months: UUS:0-4 (n=38) and UUS:5-8 (n=34). There was a significant between-group difference in glycated hemoglobin test (HbA1c) levels for the 12-months study period (P=.011). The HbA1c decrement at 12 months in the UUS:5-8 group was greater than that of the UUS:0-4 group [--0.92 (SD 1.24\%) vs --0.33 (SD 0.80\%); P=.049]. After adjusting for confounding factors, UUS was significantly associated with changes in HbA1c at 3, 6, and 12 months; the regression coefficients were --0.113 (SD 0.040; P=.006), --0.143 (SD 0.045; P=.002), and --0.136 (SD 0.052; P=.011), respectively. Change differences in other health outcomes between the 2 groups were not observed throughout a 12-month follow-up. Conclusions: UUS as a measure of patient engagement was associated with changes in HbA1c over the study period of the TMC system and could be used to predict improved glycemic control in diabetes self-management through mobile health interventions. Trial Registration: ClinicalTrial.gov NCT03033407; https://clinicaltrials.gov/ct2/show/NCT03033407 ",
doi="10.2196/17573",
url="https://mhealth.jmir.org/2021/2/e17573",
url="http://www.ncbi.nlm.nih.gov/pubmed/33625363"
}


@Article{info:doi/10.2196/26443,
author="Do Khac, Ariane
and Jourdan, Claire
and Fazilleau, Sylvain
and Palayer, Claire
and Laffont, Isabelle
and Dupeyron, Arnaud
and Verdun, St{\'e}phane
and Gelis, Anthony",
title="mHealth App for Pressure Ulcer Wound Assessment in Patients With Spinal Cord Injury: Clinical Validation Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Feb",
day="23",
volume="9",
number="2",
pages="e26443",
keywords="mobile app",
keywords="wound",
keywords="pressure ulcer",
keywords="assessment",
keywords="validity",
keywords="reliability",
keywords="app",
keywords="correlation",
keywords="access",
keywords="availability",
keywords="reproducibility",
abstract="Background: Clinical evaluation of a pressure ulcer is based on quantitative and qualitative evaluation. In clinical practice, acetate tracing is the standard technique used to measure wound surface area; however, it is difficult to use in daily practice (because of material availability, data storage issues, and time needed to calculate the surface area). Planimetry techniques developed with mobile health (mHealth) apps can be used to overcome these difficulties. Objective: The goal of this study was to evaluate the metrological properties of a free-access mHealth app, called imitoMeasure, to assess pressure ulcers. Methods: This was a noninterventional, validation study. We included patients with spinal cord injury presenting with a pressure ulcer, regardless of its stage or location. We performed wound measurements with a ruler, and we performed acetate tracing using a transparent dressing with a wound measurement grid. Wound evaluation via the mHealth app was conducted twice by the main investigator and also by a coinvestigator to determine validity, intrarater reproducibility, and interrater reproducibility. Bland-Altman plots and intraclass correlation coefficients were used to compute the minimal detectable change percentage. Results: Overall, 61 different pressure ulcers were included. The validity, intrarater reproducibility, and interrater reproducibility of the mHealth app vs acetate tracing (considered the method of reference) were good, with intraclass correlation coefficients of 0.97 (95\% CI 0.93-0.99), 0.99 (95\% CI 0.98-0.99), and 0.98 (95\% CI 0.96-0.99), respectively, and minimal detectable change percentages between 17\% and 35\%. Conclusions: The imitoMeasure app had good validity and reproducibility. It could be an alternative to standard wound assessment methods. Further studies on larger and more diverse wounds are needed. Trial Registration: ClinicalTrials.gov NCT04402398; http://clinicaltrials.gov/ct2/show/NCT04402398 ",
doi="10.2196/26443",
url="https://mhealth.jmir.org/2021/2/e26443",
url="http://www.ncbi.nlm.nih.gov/pubmed/33620327"
}


@Article{info:doi/10.2196/27109,
author="Stanger, Catherine
and Kowatsch, Tobias
and Xie, Haiyi
and Nahum-Shani, Inbal
and Lim-Liberty, Frances
and Anderson, Molly
and Santhanam, Prabhakaran
and Kaden, Sarah
and Rosenberg, Briana",
title="A Digital Health Intervention (SweetGoals) for Young Adults With Type 1 Diabetes: Protocol for a Factorial Randomized Trial",
journal="JMIR Res Protoc",
year="2021",
month="Feb",
day="23",
volume="10",
number="2",
pages="e27109",
keywords="type 1 diabetes",
keywords="mhealth",
keywords="incentives",
keywords="health coaching",
keywords="young adults",
abstract="Background: Many young adults with type 1 diabetes (T1D) struggle with the complex daily demands of adherence to their medical regimen and fail to achieve target range glycemic control. Few interventions, however, have been developed specifically for this age group. Objective: In this randomized trial, we will provide a mobile app (SweetGoals) to all participants as a ``core'' intervention. The app prompts participants to upload data from their diabetes devices weekly to a device-agnostic uploader (Glooko), automatically retrieves uploaded data, assesses daily and weekly self-management goals, and generates feedback messages about goal attainment. Further, the trial will test two unique intervention components: (1) incentives to promote consistent daily adherence to goals, and (2) web health coaching to teach effective problem solving focused on personalized barriers to self-management. We will use a novel digital direct-to-patient recruitment method and intervention delivery model that transcends the clinic. Methods: A 2x2 factorial randomized trial will be conducted with 300 young adults ages 19-25 with type 1 diabetes and (Hb)A1c ? 8.0\%. All participants will receive the SweetGoals app that tracks and provides feedback about two adherence targets: (a) daily glucose monitoring; and (b) mealtime behaviors. Participants will be randomized to the factorial combination of incentives and health coaching. The intervention will last 6 months. The primary outcome will be reduction in A1c. Secondary outcomes include self-regulation mechanisms in longitudinal mediation models and engagement metrics as a predictor of outcomes. Participants will complete 6- and 12-month follow-up assessments. We hypothesize greater sustained A1c improvements in participants who receive coaching and who receive incentives compared to those who do not receive those components. Results: Data collection is expected to be complete by February 2025. Analyses of primary and secondary outcomes are expected by December 2025. Conclusions: Successful completion of these aims will support dissemination and effectiveness studies of this intervention that seeks to improve glycemic control in this high-risk and understudied population of young adults with T1D. Trial Registration: ClinicalTrials.gov NCT04646473; https://clinicaltrials.gov/ct2/show/NCT04646473 International Registered Report Identifier (IRRID): PRR1-10.2196/27109 ",
doi="10.2196/27109",
url="https://www.researchprotocols.org/2021/2/e27109",
url="http://www.ncbi.nlm.nih.gov/pubmed/33620330"
}


@Article{info:doi/10.2196/23313,
author="Portenhauser, A. Alexandra
and Terhorst, Yannik
and Schultchen, Dana
and Sander, B. Lasse
and Denkinger, D. Michael
and Stach, Michael
and Waldherr, Natalie
and Dallmeier, Dhayana
and Baumeister, Harald
and Messner, Eva-Maria",
title="Mobile Apps for Older Adults: Systematic Search and Evaluation Within Online Stores",
journal="JMIR Aging",
year="2021",
month="Feb",
day="19",
volume="4",
number="1",
pages="e23313",
keywords="mHealth",
keywords="MARS",
keywords="MARS-G",
keywords="older adults",
keywords="mobile apps",
keywords="apps",
keywords="aging",
abstract="Background: Through the increasingly aging population, the health care system is confronted with various challenges such as expanding health care costs. To manage these challenges, mobile apps may represent a cost-effective and low-threshold approach to support older adults. Objective: This systematic review aimed to evaluate the quality, characteristics, as well as privacy and security measures of mobile apps for older adults in the European commercial app stores. Methods: In the European Google Play and App Store, a web crawler systematically searched for mobile apps for older adults. The identified mobile apps were evaluated by two independent reviewers using the German version of the Mobile Application Rating Scale. A correlation between the user star rating and overall rating was calculated. An exploratory regression analysis was conducted to determine whether the obligation to pay fees predicted overall quality. Results: In total, 83 of 1217 identified mobile apps were included in the analysis. Generally, the mobile apps for older adults were of moderate quality (mean 3.22 [SD 0.68]). Four mobile apps (5\%) were evidence-based; 49\% (41/83) had no security measures. The user star rating correlated significantly positively with the overall rating (r=.30, P=.01). Obligation to pay fees could not predict overall quality. Conclusions: There is an extensive quality range within mobile apps for older adults, indicating deficits in terms of information quality, data protection, and security precautions, as well as a lack of evidence-based approaches. Central databases are needed to identify high-quality mobile apps. ",
doi="10.2196/23313",
url="https://aging.jmir.org/2021/1/e23313",
url="http://www.ncbi.nlm.nih.gov/pubmed/33605884"
}


@Article{info:doi/10.2196/24030,
author="Fundoiano-Hershcovitz, Yifat
and Hirsch, Abigail
and Dar, Sharon
and Feniger, Eitan
and Goldstein, Pavel",
title="Role of Digital Engagement in Diabetes Care Beyond Measurement: Retrospective Cohort Study",
journal="JMIR Diabetes",
year="2021",
month="Feb",
day="18",
volume="6",
number="1",
pages="e24030",
keywords="blood glucose",
keywords="mHealth",
keywords="diabetes",
keywords="self-management",
keywords="digital engagement",
abstract="Background: The use of remote data capture for monitoring blood glucose and supporting digital apps is becoming the norm in diabetes care. One common goal of such apps is to increase user awareness and engagement with their day-to-day health-related behaviors (digital engagement) in order to improve diabetes outcomes. However, we lack a deep understanding of the complicated association between digital engagement and diabetes outcomes. Objective: This study investigated the association between digital engagement (operationalized as tagging of behaviors alongside glucose measurements) and the monthly average blood glucose level in persons with type 2 diabetes during the first year of managing their diabetes with a digital chronic disease management platform. We hypothesize that during the first 6 months, blood glucose levels will drop faster and further in patients with increased digital engagement and that difference in outcomes will persist for the remainder of the year. Finally, we hypothesize that disaggregated between- and within-person variabilities in digital engagement will predict individual-level changes in blood glucose levels. Methods: This retrospective real-world?analysis followed?998 people with type 2 diabetes who regularly tracked their blood glucose levels with the Dario digital therapeutics platform for chronic diseases.?Subjects included ``nontaggers'' (users who rarely or never used app features to notice and track mealtime, food, exercise, mood, and location, n=585) and ``taggers'' (users who used these features, n=413) representing increased digital engagement.?Within- and between-person variabilities in tagging behavior were disaggregated?to reveal the association between tagging behavior and blood glucose levels. The associations between an individual's tagging behavior in a given month and the monthly average blood glucose level in the following month were analyzed for quasicausal effects. A generalized mixed piecewise statistical framework was applied throughout. Results: Analysis revealed significant?improvement in?the monthly average?blood glucose?level during the first 6 months (t=?10.01, P<.001), which was maintained during?the following 6 months (t=?1.54, P=.12). Moreover, taggers demonstrated a significantly steeper improvement in the initial period relative to?nontaggers (t=2.15, P=.03). Additional findings included a within-user?quasicausal nonlinear link between tagging behavior and glucose control improvement?with?a 1-month lag. More specifically, increased tagging behavior in any given month resulted in a 43\% improvement in glucose levels in the next month up to a person-specific average in tagging intensity (t=?11.02, P<.001). Above that within-person mean level of digital engagement, glucose levels remained stable but did not show additional improvement with increased tagging (t=0.82, P=.41). When assessed alongside within-person effects, between-person changes in tagging behavior were not associated with changes in monthly average glucose levels (t=1.30, P=.20). Conclusions: This study sheds light on the source of the?association between user?engagement?with a diabetes tracking?app?and?the clinical condition, highlighting the importance of within-person changes?versus between-person differences.?Our findings underscore the need for and provide a basis for a personalized approach to digital health. ",
doi="10.2196/24030",
url="http://diabetes.jmir.org/2021/1/e24030/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33599618"
}


@Article{info:doi/10.2196/24607,
author="Aji, Melissa
and Gordon, Christopher
and Stratton, Elizabeth
and Calvo, A. Rafael
and Bartlett, Delwyn
and Grunstein, Ronald
and Glozier, Nick",
title="Framework for the Design Engineering and Clinical Implementation and Evaluation of mHealth Apps for Sleep Disturbance: Systematic Review",
journal="J Med Internet Res",
year="2021",
month="Feb",
day="17",
volume="23",
number="2",
pages="e24607",
keywords="mobile applications",
keywords="sleep",
keywords="insomnia",
keywords="internet-based intervention",
keywords="mHealth",
keywords="mobile health",
keywords="systematic review",
abstract="Background: Mobile health (mHealth) apps offer a scalable option for treating sleep disturbances at a population level. However, there is a lack of clarity about the development and evaluation of evidence-based mHealth apps. Objective: The aim of this systematic review was to provide evidence for the design engineering and clinical implementation and evaluation of mHealth apps for sleep disturbance. Methods: A systematic search of studies published from the inception of databases through February 2020 was conducted using 5 databases (MEDLINE, Embase, Cochrane Library, PsycINFO, and CINAHL). Results: A total of 6015 papers were identified using the search strategy. After screening, 15 papers were identified that examined the design engineering and clinical implementation and evaluation of 8 different mHealth apps for sleep disturbance. Most of these apps delivered cognitive behavioral therapy for insomnia (CBT-I, n=4) or modified CBT-I (n=2). Half of the apps (n=4) identified adopting user-centered design or multidisciplinary teams in their design approach. Only 3 papers described user and data privacy. End-user acceptability and engagement were the most frequently assessed implementation metrics. Only 1 app had available evidence assessing all 4 implementation metrics (ie, acceptability, engagement, usability, and adherence). Most apps were prototype versions (n=5), with few matured apps. A total of 6 apps had supporting papers that provided a quantitative evaluation of clinical outcomes, but only 1 app had a supporting, adequately powered randomized controlled trial. Conclusions: This is the first systematic review to synthesize and examine evidence for the design engineering and clinical implementation and evaluation of mHealth apps for sleep disturbance. The minimal number of apps with published evidence for design engineering and clinical implementation and evaluation contrasts starkly with the number of commercial sleep apps available. Moreover, there appears to be no standardization and consistency in the use of best practice design approaches and implementation assessments, along with very few rigorous efficacy evaluations. To facilitate the development of successful and evidence-based apps for sleep disturbance, we developed a high-level framework to guide researchers and app developers in the end-to-end process of app development and evaluation. ",
doi="10.2196/24607",
url="http://www.jmir.org/2021/2/e24607/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33595441"
}


@Article{info:doi/10.2196/25060,
author="Kowatsch, Tobias
and Schachner, Theresa
and Harperink, Samira
and Barata, Filipe
and Dittler, Ullrich
and Xiao, Grace
and Stanger, Catherine
and v Wangenheim, Florian
and Fleisch, Elgar
and Oswald, Helmut
and M{\"o}ller, Alexander",
title="Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study",
journal="J Med Internet Res",
year="2021",
month="Feb",
day="17",
volume="23",
number="2",
pages="e25060",
keywords="digital health intervention",
keywords="intervention design",
keywords="mHealth",
keywords="eHealth",
keywords="chatbot",
keywords="conversational agent",
keywords="chronic diseases",
keywords="asthma",
keywords="feasibility study",
abstract="Background: Successful management of chronic diseases requires a trustful collaboration between health care professionals, patients, and family members. Scalable conversational agents, designed to assist health care professionals, may play a significant role in supporting this collaboration in a scalable way by reaching out to the everyday lives of patients and their family members. However, to date, it remains unclear whether conversational agents, in such a role, would be accepted and whether they can support this multistakeholder collaboration. Objective: With asthma in children representing a relevant target of chronic disease management, this study had the following objectives: (1) to describe the design of MAX, a conversational agent--delivered asthma intervention that supports health care professionals targeting child-parent teams in their everyday lives; and (2) to assess the (a) reach of MAX, (b) conversational agent--patient working alliance, (c) acceptance of MAX, (d) intervention completion rate, (e) cognitive and behavioral outcomes, and (f) human effort and responsiveness of health care professionals in primary and secondary care settings. Methods: MAX was designed to increase cognitive skills (ie, knowledge about asthma) and behavioral skills (ie, inhalation technique) in 10-15-year-olds with asthma, and enables support by a health professional and a family member. To this end, three design goals guided the development: (1) to build a conversational agent--patient working alliance; (2) to offer hybrid (human- and conversational agent--supported) ubiquitous coaching; and (3) to provide an intervention with high experiential value. An interdisciplinary team of computer scientists, asthma experts, and young patients with their parents developed the intervention collaboratively. The conversational agent communicates with health care professionals via email, with patients via a mobile chat app, and with a family member via SMS text messaging. A single-arm feasibility study in primary and secondary care settings was performed to assess MAX. Results: Results indicated an overall positive evaluation of MAX with respect to its reach (49.5\%, 49/99 of recruited and eligible patient-family member teams participated), a strong patient-conversational agent working alliance, and high acceptance by all relevant stakeholders. Moreover, MAX led to improved cognitive and behavioral skills and an intervention completion rate of 75.5\%. Family members supported the patients in 269 out of 275 (97.8\%) coaching sessions. Most of the conversational turns (99.5\%) were conducted between patients and the conversational agent as opposed to between patients and health care professionals, thus indicating the scalability of MAX. In addition, it took health care professionals less than 4 minutes to assess the inhalation technique and 3 days to deliver related feedback to the patients. Several suggestions for improvement were made. Conclusions: This study provides the first evidence that conversational agents, designed as mediating social actors involving health care professionals, patients, and family members, are not only accepted in such a ``team player'' role but also show potential to improve health-relevant outcomes in chronic disease management. ",
doi="10.2196/25060",
url="http://www.jmir.org/2021/2/e25060/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33484114"
}


@Article{info:doi/10.2196/25655,
author="Clift, K. Ashley
and Le Lannou, Erwann
and Tighe, P. Christian
and Shah, S. Sachin
and Beatty, Matthew
and Hyv{\"a}rinen, Arsi
and Lane, J. Stephen
and Strauss, Tamir
and Dunn, D. Devin
and Lu, Jiahe
and Aral, Mert
and Vahdat, Dan
and Ponzo, Sonia
and Plans, David",
title="Development and Validation of Risk Scores for All-Cause Mortality for a Smartphone-Based ``General Health Score'' App: Prospective Cohort Study Using the UK Biobank",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Feb",
day="16",
volume="9",
number="2",
pages="e25655",
keywords="C-Score",
keywords="mortality",
keywords="risk score",
keywords="smartphone",
keywords="health score",
keywords="medical informatics",
keywords="public health",
keywords="mobile health",
keywords="development",
keywords="validation",
keywords="app",
keywords="prospective",
keywords="cohort",
keywords="machine learning",
abstract="Background: Given the established links between an individual's behaviors and lifestyle factors and potentially adverse health outcomes, univariate or simple multivariate health metrics and scores have been developed to quantify general health at a given point in time and estimate risk of negative future outcomes. However, these health metrics may be challenging for widespread use and are unlikely to be successful at capturing the broader determinants of health in the general population. Hence, there is a need for a multidimensional yet widely employable and accessible way to obtain a comprehensive health metric. Objective: The objective of the study was to develop and validate a novel, easily interpretable, points-based health score (``C-Score'') derived from metrics measurable using smartphone components and iterations thereof that utilize statistical modeling and machine learning (ML) approaches. Methods: A literature review was conducted to identify relevant predictor variables for inclusion in the first iteration of a points-based model. This was followed by a prospective cohort study in a UK Biobank population for the purposes of validating the C-Score and developing and comparatively validating variations of the score using statistical and ML models to assess the balance between expediency and ease of interpretability and model complexity. Primary and secondary outcome measures were discrimination of a points-based score for all-cause mortality within 10 years (Harrell c-statistic) and discrimination and calibration of Cox proportional hazards models and ML models that incorporate C-Score values (or raw data inputs) and other predictors to predict the risk of all-cause mortality within 10 years. Results: The study cohort comprised 420,560 individuals. During a cohort follow-up of 4,526,452 person-years, there were 16,188 deaths from any cause (3.85\%). The points-based model had good discrimination (c-statistic=0.66). There was a 31\% relative reduction in risk of all-cause mortality per decile of increasing C-Score (hazard ratio of 0.69, 95\% CI 0.663-0.675). A Cox model integrating age and C-Score had improved discrimination (8 percentage points; c-statistic=0.74) and good calibration. ML approaches did not offer improved discrimination over statistical modeling. Conclusions: The novel health metric (``C-Score'') has good predictive capabilities for all-cause mortality within 10 years. Embedding the C-Score within a smartphone app may represent a useful tool for democratized, individualized health risk prediction. A simple Cox model using C-Score and age balances parsimony and accuracy of risk predictions and could be used to produce absolute risk estimations for app users. ",
doi="10.2196/25655",
url="http://mhealth.jmir.org/2021/2/e25655/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33591285"
}


@Article{info:doi/10.2196/23687,
author="Forsyth, R. Jessica
and Chase, Hannah
and Roberts, W. Nia
and Armitage, C. Laura
and Farmer, J. Andrew",
title="Application of the National Institute for Health and Care Excellence Evidence Standards Framework for Digital Health Technologies in Assessing Mobile-Delivered Technologies for the Self-Management of Type 2 Diabetes Mellitus: Scoping Review",
journal="JMIR Diabetes",
year="2021",
month="Feb",
day="16",
volume="6",
number="1",
pages="e23687",
keywords="type 2 diabetes",
keywords="health technology",
keywords="self-management",
keywords="mobile health",
keywords="mobile applications",
keywords="guidelines",
abstract="Background: There is a growing role of digital health technologies (DHTs) in the management of chronic health conditions, specifically type 2 diabetes. It is increasingly important that health technologies meet the evidence standards for health care settings. In 2019, the National Institute for Health and Care Excellence (NICE) published the NICE Evidence Standards Framework for DHTs. This provides guidance for evaluating the effectiveness and economic value of DHTs in health care settings in the United Kingdom. Objective: The aim of this study is to assess whether scientific articles on DHTs for the self-management of type 2 diabetes mellitus report the evidence suggested for implementation in clinical practice, as described in the NICE Evidence Standards Framework for DHTs. Methods: We performed a scoping review of published articles and searched 5 databases to identify systematic reviews and primary studies of mobile device--delivered DHTs that provide self-management support for adults with type 2 diabetes mellitus. The evidence reported within articles was assessed against standards described in the NICE framework. Results: The database search yielded 715 systematic reviews, of which, 45 were relevant and together included 59 eligible primary studies. Within these, there were 39 unique technologies. Using the NICE framework, 13 technologies met best practice standards, 3 met minimum standards only, and 23 technologies did not meet minimum standards. Conclusions: On the assessment of peer-reviewed publications, over half of the identified DHTs did not appear to meet the minimum evidence standards recommended by the NICE framework. The most common reasons for studies of DHTs not meeting these evidence standards included the absence of a comparator group, no previous justification of sample size, no measurable improvement in condition-related outcomes, and a lack of statistical data analysis. This report provides information that will enable researchers and digital health developers to address these limitations when designing, delivering, and reporting digital health technology research in the future. ",
doi="10.2196/23687",
url="http://diabetes.jmir.org/2021/1/e23687/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33591278"
}


@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/10.2196/22229,
author="Byonanebye, Mirembe Dathan
and Nabaggala, S. Maria
and Naggirinya, Bwanika Agnes
and Lamorde, Mohammed
and Oseku, Elizabeth
and King, Rachel
and Owarwo, Noela
and Laker, Eva
and Orama, Richard
and Castelnuovo, Barbara
and Kiragga, Agnes
and Parkes-Ratanshi, Rosalind",
title="An Interactive Voice Response Software to Improve the Quality of Life of People Living With HIV in Uganda: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Feb",
day="11",
volume="9",
number="2",
pages="e22229",
keywords="mHealth",
keywords="HIV",
keywords="quality of life",
keywords="interactive voice response",
keywords="mobile health",
keywords="digital health",
abstract="Background: Following the successful scale-up of antiretroviral therapy (ART), the focus is now on ensuring good quality of life (QoL) and sustained viral suppression in people living with HIV. The access to mobile technology in the most burdened countries is increasing rapidly, and therefore, mobile health (mHealth) technologies could be leveraged to improve QoL in people living with HIV. However, data on the impact of mHealth tools on the QoL in people living with HIV are limited to the evaluation of SMS text messaging; these are infeasible in high-illiteracy settings. Objective: The primary and secondary outcomes were to determine the impact of interactive voice response (IVR) technology on Medical Outcomes Study HIV QoL scores and viral suppression at 12 months, respectively. Methods: Within the Call for Life study, ART-experienced and ART-na{\"i}ve people living with HIV commencing ART were randomized (1:1 ratio) to the control (no IVR support) or intervention arm (daily adherence and pre-appointment reminders, health information tips, and option to report symptoms). The software evaluated was Call for Life Uganda, an IVR technology that is based on the Mobile Technology for Community Health open-source software. Eligibility criteria for participation included access to a phone, fluency in local languages, and provision of consent. The differences in differences (DIDs) were computed, adjusting for baseline HIV RNA and CD4. Results: Overall, 600 participants (413 female, 68.8\%) were enrolled and followed-up for 12 months. In the intervention arm of 300 participants, 298 (99.3\%) opted for IVR and 2 (0.7\%) chose SMS text messaging as the mode of receiving reminders and health tips. At 12 months, there was no overall difference in the QoL between the intervention and control arms (DID=0.0; P=.99) or HIV RNA (DID=0.01; P=.94). At 12 months, 124 of the 256 (48.4\%) active participants had picked up at least 50\% of the calls. In the active intervention participants, high users (received >75\% of reminders) had overall higher QoL compared to low users (received <25\% of reminders) (92.2 versus 87.8, P=.02). Similarly, high users also had higher QoL scores in the mental health domain (93.1 versus 86.8, P=.008) and better appointment keeping. Similarly, participants with moderate use (51\%-75\%) had better viral suppression at 12 months (80/94, 85\% versus 11/19, 58\%, P=.006). Conclusions: Overall, there was high uptake and acceptability of the IVR tool. While we found no overall difference in the QoL and viral suppression between study arms, people living with HIV with higher usage of the tool showed greater improvements in QoL, viral suppression, and appointment keeping. With the declining resources available to HIV programs and the increasing number of people living with HIV accessing ART, IVR technology could be used to support patient care. The tool may be helpful in situations where physical consultations are infeasible, including the current COVID epidemic. Trial Registration: ClinicalTrials.gov NCT02953080; https://clinicaltrials.gov/ct2/show/NCT02953080 ",
doi="10.2196/22229",
url="https://mhealth.jmir.org/2021/2/e22229",
url="http://www.ncbi.nlm.nih.gov/pubmed/33570497"
}


@Article{info:doi/10.2196/24703,
author="Hrynyschyn, Robert
and Dockweiler, Christoph",
title="Effectiveness of Smartphone-Based Cognitive Behavioral Therapy Among Patients With Major Depression: Systematic Review of Health Implications",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Feb",
day="10",
volume="9",
number="2",
pages="e24703",
keywords="mobile health",
keywords="depression",
keywords="cognitive behavioral therapy",
keywords="systematic review",
keywords="mobile phone",
abstract="Background: Depression is often associated with rapid changes in mood and quality of life that persist for a period of 2 weeks. Despite medical innovations, there are problems in the provision of care. Long waiting times for treatment and high recurrence rates of depression cause enormous costs for health care systems. At the same time, comprehensive limitations in physical, psychological, and social dimensions are observed for patients with depression, which significantly reduce their quality of life. In addition to patient-specific limitations, undersupply and inappropriate health care have been determined. For this reason, new forms of care are discussed. Smartphone-based therapy is considered to have great potential due to its reach and easy accessibility. Low socioeconomic groups, which are always difficult to reach for public health interventions, can now be accessed due to the high dispersion of smartphones. There is still little information about the impact and mechanisms of smartphone-based therapy on depression. In a systematic literature review, the health implications of smartphone-based therapy were presented in comparison with standard care. Objective: The objective of this review was to identify and summarize the existing evidence regarding smartphone-based cognitive behavioral therapy for patients with depression and to present the health implications of smartphone-based cognitive behavioral therapy of considered endpoints. Methods: A systematic literature review was conducted to identify relevant studies by means of inclusion and exclusion criteria. For this purpose, the PubMed and Psyndex databases were systematically searched using a search syntax. The endpoints of depressive symptoms, depression-related anxiety, self-efficacy or self-esteem, and quality of life were analyzed. Identified studies were evaluated for study quality and risk of bias. After applying the inclusion and exclusion criteria, 8 studies were identified. Results: The studies examined in this review reported contradictory results regarding the investigated endpoints. In addition, due to clinical and methodological heterogeneity, it was difficult to derive evident results. All included studies reported effects on depressive symptoms. The other investigated endpoints were only reported by isolated studies. Only 50\% (4/8) of the studies reported effects on depression-related anxiety, self-efficacy or self-esteem, and quality of life. Conclusions: No clear implications of smartphone-based cognitive behavioral therapy could be established. Evidence for the treatment of depression using smartphone-based cognitive behavioral therapy is limited. Additional research projects are needed to demonstrate the effects of smartphone-based cognitive behavioral therapy in the context of evidence-based medicine and to enable its translation into standard care. Participatory technology development might help to address current problems in mobile health intervention studies. ",
doi="10.2196/24703",
url="http://mhealth.jmir.org/2021/2/e24703/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33565989"
}


@Article{info:doi/10.2196/23338,
author="Li, Jing
and Wei, Dong
and Liu, Shuyi
and Li, Mingxia
and Chen, Xi
and Chen, Li
and Wu, Yuelei
and Zhou, Wen
and Ouyang, Lingyun
and Tan, Cuixia
and Meng, Hongdao
and Tong, Nanwei",
title="Efficiency of an mHealth App and Chest-Wearable Remote Exercise Monitoring Intervention in Patients With Type 2 Diabetes: A Prospective, Multicenter Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Feb",
day="9",
volume="9",
number="2",
pages="e23338",
keywords="type 2 diabetes",
keywords="fitness app",
keywords="heart rate band",
keywords="exercise monitoring",
keywords="randomized controlled trial",
keywords="mobile phone",
abstract="Background: Exercise has been recommended as a cornerstone for diabetes management. Supervised exercise is more efficient than unsupervised exercise but is less convenient and accessible. Objective: We aimed to determine the efficiency of exercise using a fitness app and heart rate band to remotely monitor patients with type 2 diabetes in comparison with that of traditional exercise. Methods: Patients with type 2 diabetes without severe complications or comorbidities were recruited to participate in this multicenter randomized controlled trial and were allocated to either the intervention or control group (1:1 ratio). Participants in both groups were asked to engage in moderate to vigorous physical activity for at least 150 minutes per week; each participant was prescribed individualized exercises. Participants in the intervention group were asked to follow exercise videos on the app and to wear a chest band; heart rate, exercise duration, and exercise intensity were recorded by the app. Participants in the control group self-reported exercise intensity and duration. Cardiopulmonary endurance, body composition, blood glucose level, and insulin level were assessed before and after a 3-month exercise program. Results: Of the 101 participants who were enrolled, the majority of them (85/101, 84.2\%) completed the study. Both groups had similar baseline characteristics, with the exception that participants in the intervention group were slightly younger and less likely to have hypertension. Self-reported exercise duration was longer than app-recorded exercise duration (control: mean 214 minutes/week; intervention: mean 193 minutes/week); in addition, a higher proportion of participants in the control group (29/41, 71\%) than in the intervention group (18/44, 41\%) met the 150-minute target for moderate to vigorous physical activity. However, compared with the control group, the intervention group had a larger increase in cardiopulmonary endurance (mean difference --2.0 bpm [beats per minute] vs 1.0 bpm; P=.02) and a larger decrease in body fat percentage (mean difference --1.8\% vs --0.8\%; P=.01). There was no difference in hemoglobin A1c level reduction between the two groups, yet more participants in the intervention group stopped taking their antidiabetic drugs or had their dosages lowered by an endocrinologist, compared with those in the control group. There were no serious adverse events in either group. Conclusions: This was the first randomized controlled trial in China, to our knowledge, to test the efficiency of exercise using a fitness app and heart rate band to remotely monitor prescribed exercise in patients with type 2 diabetes. The findings of our study suggest that exercise programs may be more efficient if participants are remotely monitored with an app and heart rate band than if participants are not monitored. Trial Registration: Chinese Clinical Trial Register ChiCTR1800015963; http://www.chictr.org.cn/showprojen.aspx?proj=27080 ",
doi="10.2196/23338",
url="https://mhealth.jmir.org/2021/2/e23338",
url="http://www.ncbi.nlm.nih.gov/pubmed/33560244"
}


@Article{info:doi/10.2196/24177,
author="Alessa, Tourkiah
and S Hawley, Mark
and Alsulamy, Nouf
and de Witte, Luc",
title="Using a Commercially Available App for the Self-Management of Hypertension: Acceptance and Usability Study in Saudi Arabia",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Feb",
day="9",
volume="9",
number="2",
pages="e24177",
keywords="mHealth",
keywords="mobile phone",
keywords="hypertension",
keywords="usability",
keywords="acceptance",
keywords="user satisfaction",
abstract="Background: The use of smartphone apps to assist in the self-management of hypertension is becoming increasingly common, but few commercially available apps have the potential to be effective along with adequate security and privacy measures in place. In a previous study, we identified 5 apps that are potentially effective and safe, and based on the preferences of doctors and patients, one (Cora Health) was selected as the most suitable app for use in a Saudi context. However, there is currently no evidence of its usability and acceptance among potential users. Indeed, there has been little research into the usability and acceptance of hypertension apps in general, and less research considers this in the Gulf Region. Objective: This study aims to evaluate the acceptance and usability of the selected app in the Saudi context. Methods: This study used a mixed methods approach with 2 studies: a usability test involving patients in a controlled setting performing predefined tasks and a real-world usability study where patients used the app for 4 weeks. In the usability test, participants were asked to think aloud while performing the tasks, and an observer recorded the number of tasks they completed. At the end of the real-world pilot study, participants were interviewed, and the mHealth App Usability Questionnaire was completed. Descriptive statistics were used to analyze quantitative data, and thematic analysis was used to analyze qualitative data. Results: In total, 10 patients completed study 1. The study found that app usability was moderate and that participants needed some familiarization time before they could use the app proficiently. Some usability issues were revealed, related to app accessibility and navigation, and a few tasks remained uncompleted by most people. A total of 20 patients completed study 2, with a mean age of 51.6 (SD 11.7) years. Study 2 found that the app was generally acceptable and easy to use, with some similar usability issues identified. Participants stressed the importance of practice and training to use it more easily and proficiently. Participants had a good engagement level with 48\% retention at the end of study 2, with most participants' engagement being classed as meaningful. The most recorded data were blood pressure, followed by stress and medication, and the most accessed feature was viewing graphs of data trends. Conclusions: This study shows that a commercially available app can be usable and acceptable in the self-management of hypertension but also found a considerable number of possibilities for improvement, which needs to be considered in future app development. The results show that there is potential for a commercially available app to be used in large-scale studies of hypertension self-management if suggestions for improvements are addressed. ",
doi="10.2196/24177",
url="http://mhealth.jmir.org/2021/2/e24177/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33560237"
}


@Article{info:doi/10.2196/25122,
author="Zhang, Yiyu
and Liu, Chaoyuan
and Luo, Shuoming
and Huang, Jin
and Yang, Yuxin
and Ma, Xiao
and Li, Xia
and Zhou, Zhiguang",
title="Effectiveness of the Family Portal Function on the Lilly Connected Care Program (LCCP) for Patients With Type 2 Diabetes: Retrospective Cohort Study With Propensity Score Matching",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Feb",
day="5",
volume="9",
number="2",
pages="e25122",
keywords="diabetes management",
keywords="diabetes mellitus",
keywords="family support",
keywords="mobile app",
keywords="app",
keywords="self-management",
keywords="support",
keywords="online portal",
keywords="diabetes",
keywords="cohort",
abstract="Background: Diabetes is a major health concern worldwide. Family member engagement in diabetes self-management education programs can improve patients' diabetes management. However, there is limited evidence that the family portal on diabetes management apps is effective in the glycemic control of patients with diabetes. Objective: We aimed to evaluate the effectiveness of family support through the family portal function on Lilly Connected Care Program (LCCP) platform. Methods: This retrospective cohort study included patients with type 2 diabetes recruited to the LCCP platform from September 1, 2018, to August 31, 2019. Propensity score matching was used to match family (group A) and non--family (group B) portal use groups with similar baseline characteristics. The patients were followed up with for 12 weeks. The main objectives were differences in mean fasting blood glucose, proportion of patients achieving fasting blood glucose target <7mmol/L, mean postprandial blood glucose, proportion of patients achieving postprandial blood glucose target <10mmol/L, proportion of patients achieving both fasting blood glucose <7mmol/L and postprandial blood glucose <10mmol/L, self-monitoring of blood glucose frequency at week 12 and the number of diabetes education courses patients completed during the 12 weeks. Moreover, logistic regression analysis was used to explore the baseline factors which may be associated with the use of family portal, and odds ratios with 95\% confidence intervals were calculated. Results: A total of 6582 adult patients (aged ?18 years) with type 2 diabetes who were receiving insulin therapy were enrolled in the study. Overall, 6.1\% (402/6582) of the patients chose to engage their family members to use the family portal. Two groups of 394 patients were well-matched regarding baseline characteristics. After matching, mean fasting blood glucose and postprandial blood glucose at week 12 were significantly lower in group A than in group B (fasting blood glucose: 7.12 mmol/L, SD 1.70 vs 7.42 mmol/L, SD 1.88, respectively, P=.02; postprandial blood glucose: 8.56 mmol/L, SD 2.51 vs 9.10 mmol/L, SD 2.69, respectively, P=.002). When comparing group A to group B, the proportion of patients achieving both fasting blood glucose <7mmol and postprandial blood glucose <10mmol/L at week 12 (46.8\% vs 39.4\%, respectively, P=.04), self-monitoring of blood glucose frequency at week 12 (8.92 times per week, SD 6.77 vs 8.02 times per week, SD 5.97, respectively, P=.05) and number of diabetes education courses completed in 12 weeks (23.00, IQR9.00-38.00 vs 15.00, IQR 4.00-36.00, respectively, P<.001) was higher. Additionally, multivariate logistic regression analysis showed that higher age (OR=0.987, 95\% CI 0.978-0.996, P=.006) and higher baseline fasting blood glucose (OR=0.914, 95\% CI 0.859-0.972, P=.004) were correlated with less use of the family portal function, while increased baseline self-monitoring of blood glucose frequency (OR=1.022, 95\% CI 1.012-1.032], P<.001) as well as increased education courses (OR=1.026, 95\% CI 1.015-1.036, P<.001) were associated with more use of the family portal function. Conclusions: Family support through the LCCP family portal is effective for glycemic control and self-management behavior improvement in type 2 diabetes patients. ",
doi="10.2196/25122",
url="https://mhealth.jmir.org/2021/2/e25122",
url="http://www.ncbi.nlm.nih.gov/pubmed/33544081"
}


@Article{info:doi/10.2196/18404,
author="Guo, Huey-Ming Sophie
and Hsing, Hung-Chun
and Lin, Jiun-Lu
and Lee, Chun-Chuan",
title="Relationships Between Mobile eHealth Literacy, Diabetes Self-care, and Glycemic Outcomes in Taiwanese Patients With Type 2 Diabetes: Cross-sectional Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Feb",
day="5",
volume="9",
number="2",
pages="e18404",
keywords="mHealth literacy",
keywords="eHealth literacy",
keywords="diabetes mellitus",
keywords="self-care behavior",
keywords="glycemic outcomes",
abstract="Background: Understanding how people with diabetes seek online health information and use health applications is important to ensure these electronic tools are successfully supporting patient self-care. Furthermore, identifying the relationship between patient mobile eHealth literacy (mobile eHL) and diabetes outcomes can have far-reaching utility, for example, in the design of targeted interventions to address mobile eHL limitations. However, only limited studies have explored the impact of mobile eHL in a population with diabetes. Objective: This study aims to present data about online information-seeking behavior and mobile health (mHealth) app usage, investigate the factors related to mobile eHL in Taiwanese patients with type 2 diabetes, and flesh out the relationship between eHealth literacy (eHL), mobile health literacy (mHL), and health outcomes. Methods: Subjects were recruited from January 2017 to December 2017 in the outpatient departments of 3 hospitals in Taiwan. A total of 249 Taiwanese patients with diabetes voluntarily completed a cross-sectional survey assessing sociodemographic characteristics; diabetes status; knowledge and skills of computers, the internet, and mobile apps; mobile eHL; and patient outcomes (self-care behaviors, self-rated health, HbA1c). Structural equation modeling analyses examined the model fit of mobile eHL scores and the interrelationships between latent constructs and observable variables. Results: Of the 249 patients with diabetes, 67\% (164/249) reported they had searched for online diabetes information. The participants with smartphones had owned them for an average of 6.5 years and used them for an average of 4.5 (SD 3.81) hours per day. Only 1.6\% (4/249) of the patients used health apps. Some demographic factors affecting mobile eHL included age, education, and duration of type 2 diabetes. Mobile eHL was related to self-care behaviors as well as knowledge and skills of computers, the internet, and mobile technology, but only had a weak, indirect effect on self-rated health. The final model had adequate goodness-of-fit indexes: chi-square (83)=149.572, P<.001; comparative fit index (CFI)=0.925; root mean square of approximation (RMSEA)=0.057 (90\% CI 004-006); chi-square/df=1.082. Mobile eHL had a weak, indirect effect on self-rated health through the variables of knowledge with skills. Conclusions: Our study reveals that although people with diabetes who rated their health conditions as moderate were confident in using mobile eHealth and technology, few adopted these tools in their daily lives. The study found that mobile eHL had a direct effect on self-care behavior as well as knowledge and skills of computers, the internet, and mobile technology, and had an indirect effect on health outcomes (glycemic control and self-rated health status). Information about this population's experiences and the role mobile eHL plays in them can spur necessary mobile eHealth patient education. ",
doi="10.2196/18404",
url="https://mhealth.jmir.org/2021/2/e18404",
url="http://www.ncbi.nlm.nih.gov/pubmed/33544088"
}


@Article{info:doi/10.2196/21977,
author="Kooij, Laura
and Vos, E. Petra J.
and Dijkstra, Antoon
and van Harten, H. Wim",
title="Effectiveness of a Mobile Health and Self-Management App for High-Risk Patients With Chronic Obstructive Pulmonary Disease in Daily Clinical Practice: Mixed Methods Evaluation Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Feb",
day="4",
volume="9",
number="2",
pages="e21977",
keywords="chronic obstructive pulmonary disease",
keywords="mHealth",
keywords="self-management",
keywords="mobile app",
keywords="mobile phone",
abstract="Background: Mobile health and self-management interventions may positively affect behavioral change and reduce hospital admissions for patients with chronic obstructive pulmonary disease (COPD). However, not all patients qualify for these interventions, and systematic, comprehensive information on implementation- and compliance-related aspects of mobile self-management apps is lacking. Due to the tendency to target digital services to patients in stable phases of disease, it is especially relevant to focus on the use of these services in broad clinical practice for patients recently discharged from hospital. Objective: This study aims to evaluate the effects of a mobile health and self-management app in clinical practice for recently discharged patients with COPD on use of the app, self-management, expectations, and experiences (technology acceptance); patients' and nurses' satisfaction; and hospital readmissions. Methods: A prototype of the app was pilot tested with 6 patients with COPD. The COPD app consisted of an 8-week program including the Lung Attack Action Plan, education, medication overview, video consultation, and questionnaires (monitored by nurses). In the feasibility study, adult patients with physician-diagnosed COPD, access to a mobile device, and proficiency of the Dutch language were included from a large teaching hospital during hospital admission. Self-management (Partners in Health Scale), technology acceptance (Unified Theory Acceptance and Use of Technology model), and satisfaction were assessed using questionnaires at baseline, after 8 weeks, and 20 weeks. Use was assessed with log data, and readmission rates were extracted from the electronic medical record. Results: A total of 39 patients were included; 76.4\% (133/174) of patients had to be excluded from participation, and 48.9\% of those patients (65/133) were excluded because of lack of digital skills, access to a mobile device, or access to the internet. The COPD app was opened most often in the first week (median 6.0; IQR 3.5-10.0), but its use decreased over time. The self-management element knowledge and coping increased significantly over time (P=.04). The COPD app was rated on a scale of 1-10, with an average score by patients of 7.7 (SD 1.7) and by nurses of 6.3 (SD 1.2). Preliminary evidence about the readmission rate showed that 13\% (5/39) of patients were readmitted within 30 days; 31\% (12/39) of patients were readmitted within 20 weeks, compared with 14.1\% (48/340) and 21.8\% (74/340) in a preresearch cohort, respectively. Conclusions: The use of a mobile self-management app after hospital discharge seems to be feasible only for a small number of patients with COPD. Patients were satisfied with the service; however, use decreased over time, and only knowledge and coping changed significantly over time. Therefore, future research on digital self-management interventions in clinical practice should focus on including more difficult subgroups of target populations, a multidisciplinary approach, technology-related aspects (such as acceptability), and fine-tuning its adoption in clinical pathways. Trial Registration: Clinicaltrials.gov NCT04540562; https://clinicaltrials.gov/ct2/show/NCT04540562. ",
doi="10.2196/21977",
url="http://mhealth.jmir.org/2021/2/e21977/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33538699"
}


@Article{info:doi/10.2196/23548,
author="Bi, Junjie
and Yang, Wei
and Hao, Ping
and Zhao, Yongmei
and Wei, Dan
and Sun, Yipeng
and Lin, Yuhua
and Sun, Meng
and Chen, Xuan
and Luo, Xuming
and Li, Shanqun
and Zhang, Wei
and Wang, Xiongbiao",
title="WeChat as a Platform for Baduanjin Intervention in Patients With Stable Chronic Obstructive Pulmonary Disease in China: Retrospective Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Feb",
day="2",
volume="9",
number="2",
pages="e23548",
keywords="WeChat management",
keywords="chronic obstructive pulmonary disease",
keywords="Baduanjin rehabilitation",
abstract="Background: Pulmonary rehabilitation is a crucial part of the nonpharmacological treatment of stable chronic obstructive pulmonary disease (COPD), but management remains problematic. WeChat could serve as a useful tool in patient management. Baduanjin is a popular exercise in China that is usually applied in pulmonary rehabilitation, which has been confirmed to be effective in improving lung function and life quality. Objective: This study aimed to explore the efficiency of WeChat in the management of Baduanjin exercise in COPD patients. Methods: A total of 200 patients from the respiratory department of Putuo Hospital participated in the Baduanjin rehabilitation project from September 2018 to October 2019, and were randomly assigned to the WeChat and control groups and followed up using the WeChat platform or telephone for 12 weeks. The frequency of Baduanjin exercise, lung function (percentage of forced expiratory volume in 1 second predicted, FEV1\% predicted), and COPD assessment test (CAT) scores were collected and compared between the two groups. The number of message exchanges and a satisfaction survey on the WeChat platform were used to assess the feasibility of WeChat management outside the hospital. Results: The Baduanjin exercise frequency significantly differed between the control group and WeChat group (F=33.82, P<.001) and across various time points (F=214.87, P<.001). After the follow-up on WeChat, there were fewer patients not performing Baduanjin exercise. The FEV1\% predicted value significantly differed before and after Baduanjin exercise in the control group (Z=?3.686, P<.001) and the WeChat group (Z=?6.985, P<.001). A significant difference in the FEV1\% predicted value was observed after Baduanjin exercise between the two groups (Z=?3.679, P<.001). The CAT score significantly differed before and after Baduanjin exercise in the control group (Z=?4.937, P<.001) and the WeChat group (Z=?5.246, P<.001). A significant difference in the CAT score was observed after Baduanjin exercise between the two groups (Z=?5.246, P<.001). The number of completed Baduanjin exercises, lung function, and CAT scores in active patients were higher than those in nonactive patients. All satisfaction survey items were scored with more than 4 points. Among the items, the highest score (mean 4.54, SD 0.77) was for continued WeChat management, followed by the effective management of Baduanjin exercise (mean 4.46, SD 0.87). The patients in the WeChat group showed much higher enthusiasm for and compliance with Baduanjin exercise, resulting in better life quality and lung function. The patients were very satisfied with the WeChat management because of the obvious curative effect and home feeling. Conclusions: The WeChat platform provided a feasible, effective, and sustainable management plan for Baduanjin rehabilitation. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900028248; http://www.chictr.org.cn/showprojen.aspx?proj=46995 ",
doi="10.2196/23548",
url="https://mhealth.jmir.org/2021/2/e23548",
url="http://www.ncbi.nlm.nih.gov/pubmed/33528369"
}


@Article{info:doi/10.2196/23498,
author="Williams, Kelly
and Markwardt, Sarah
and Kearney, M. Shannon
and Karp, F. Jordan
and Kraemer, L. Kevin
and Park, J. Margaret
and Freund, Paul
and Watson, Andrew
and Schuster, James
and Beckjord, Ellen",
title="Addressing Implementation Challenges to Digital Care Delivery for Adults With Multiple Chronic Conditions: Stakeholder Feedback in a Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Feb",
day="1",
volume="9",
number="2",
pages="e23498",
keywords="telehealth tools",
keywords="smartphones",
keywords="remote patient monitoring",
keywords="care management",
keywords="mobile phone",
abstract="Background: Digital tools accessed via smartphones can promote chronic condition management, reduce disparities in health care and hospital readmissions, and improve quality of life. However, whether digital care strategies can be implemented successfully on a large scale with traditionally underserved populations remains uncertain. Objective: As part of a randomized trial comparing care delivery strategies for Medicaid and Medicare-Medicaid beneficiaries with multiple chronic conditions, our stakeholders identified implementation challenges, and we developed stakeholder-driven adaptions to improve a digitally delivered care management strategy (high-tech care). Methods: We used 4 mechanisms (study support log, Patient Partners Work Group log, case interview log, and implementation meeting minutes) to capture stakeholder feedback about technology-related challenges and solutions from 9 patient partners, 129 participants, and 32 care managers and used these data to develop and implement solutions. To assess the impact, we analyzed high-tech care exit surveys and intervention engagement outcomes (video visits and condition-specific text message check-ins sent at varying intervals) before and after each solution was implemented. Results: Challenges centered around 2 themes: difficulty using both smartphones and high-tech care components and difficulty using high-tech care components due to connectivity issues. To respond to the first theme's challenges, we devised 3 solutions: tech visits (eg, in-person technology support visits), tech packet (eg, participant-facing technology user guide), and tailored condition-specific text message check-ins. During the first 20 months of implementation, 73 participants received at least one tech visit. We observed a 15\% increase in video call completion for participants with data before and after the tech visit (n=25) and a 7\% increase in check-in completion for participants with data before and after the tech visit (n=59). Of the 379 participants given a tech packet, 179 completed care during this timeframe and were eligible for an exit survey. Of the survey respondents, 76\% (73/96) found the tech packet helpful and 64\% (62/96) actively used it during care. To support condition-specific text message check-in completion, we allowed for adaption of day and/or time of the text message with 31 participants changing the time they received check-ins and change in standard biometric settings with 13 physicians requesting personalized settings for participants. To respond to the second theme's challenges, tech visits or phone calls were made to demonstrate how to use a smartphone to connect or disconnect from the internet, to schedule video calls, or for condition-specific text message check-ins in a location with broadband/internet. Conclusions: Having structured stakeholder feedback mechanisms is key to identify challenges and solutions to digital care engagement. Creating flexible and scalable solutions to technology-related challenges will increase equity in accessing digital care and support more effective engagement of chronically ill populations in the use of these digital care tools. Trial Registration: ClinicalTrials.gov NCT03451630; https://clinicaltrials.gov/ct2/show/NCT03451630. ",
doi="10.2196/23498",
url="https://mhealth.jmir.org/2021/2/e23498",
url="http://www.ncbi.nlm.nih.gov/pubmed/33522981"
}


@Article{info:doi/10.2196/19413,
author="Rutland, B. Sarah
and Bergquist, Palmer Rikard
and Hager, Andreas
and Geurs, Robin
and Mims, Cathy
and Gutierrez, H. Hector
and Oates, R. Gabriela",
title="A Mobile Health Platform for Self-Management of Pediatric Cystic Fibrosis: Qualitative Study of Adaptation to Stakeholder Needs and Integration in Clinical Settings",
journal="JMIR Form Res",
year="2021",
month="Jan",
day="26",
volume="5",
number="1",
pages="e19413",
keywords="cystic fibrosis",
keywords="mHealth",
abstract="Background: Cystic fibrosis (CF) is an inherited chronic condition that requires extensive daily care and quarterly clinic visits with a multidisciplinary care team. The limited exchange of information outside of the quarterly clinic visits impedes optimal disease self-management, patient engagement, and shared decision making. Objective: The aim of this study is to adapt a mobile health (mHealth) app originally developed in Sweden to the needs of patients, families, and health care providers in a CF center in the United States and to test it as a platform for sharing patient-generated health data with the CF health care team. Methods: Focus groups with health care providers of patients with CF, adolescents with CF, and caregivers of children with CF were conducted to determine what modifications were necessary. Focus group data were analyzed using a thematic analysis, and emergent themes were ranked according to desirability and technical feasibility. The mHealth platform was then modified to meet the identified needs and preferences, and the flow of patient-generated health data to a secure Research Electronic Data Capture database was tested. Protocols for data management and clinical follow-up were also developed. Results: A total of 5 focus groups with 21 participants were conducted. Recommended modifications pertained to all functionalities of the mHealth platform, including tracking of symptoms, treatments, and activities of daily care; creating and organizing medication lists and setting up reminders; generating reports for the health care team; language and presentation; sharing and privacy; and settings and accounts. Overall, health care providers recommended changes to align the mHealth platform with US standards of care, people with CF and their caregivers requested more tracking functionalities, and both groups suggested the inclusion of a mental health tracker as well as more detailed response options and precise language. Beta testers of the modified platform reported issues related to translatability to US environment and various bugs. Conclusions: This study demonstrated the importance of identifying the needs and preferences of target users and stakeholders before adopting existing mHealth solutions. All relevant perspectives, including those of clinicians, patients, and caregivers, should be thoroughly considered to meet both end users' needs and evidence-based practice recommendations. ",
doi="10.2196/19413",
url="http://formative.jmir.org/2021/1/e19413/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33496667"
}


@Article{info:doi/10.2196/17537,
author="Batch, C. Bryan
and Spratt, E. Susan
and Blalock, V. Dan
and Benditz, Chad
and Weiss, Andi
and Dolor, J. Rowena
and Cho, H. Alex",
title="General Behavioral Engagement and Changes in Clinical and Cognitive Outcomes of Patients with Type 2 Diabetes Using the Time2Focus Mobile App for Diabetes Education: Pilot Evaluation",
journal="J Med Internet Res",
year="2021",
month="Jan",
day="20",
volume="23",
number="1",
pages="e17537",
keywords="mobile technology",
keywords="diabetes",
keywords="self management support",
keywords="self efficacy",
keywords="illness perception",
abstract="Background: Type 2 diabetes affects 30 million Americans, representing a significant cause of morbidity and mortality. Self-management support is an important component of chronic illness care and is a key pillar of the chronic care model. Face-to-face teaching and patient education materials suffer from being static or incompatible with mobile lifestyles. Digital apps provide a self-management support alternative that is convenient and scalable. Objective: This pilot study tested the real-world deployment of a self-guided mobile app for diabetes education (Time2Focus app; MicroMass Communications Inc, Cary, NC), which utilizes evidence-based content and gamification to deliver an interactive learning experience. Methods: Primary care providers were approached for permission to invite their patients to participate. Eligible patients were 18 to 89 years of age, had a diagnosis of type 2 diabetes, hemoglobin A1c (HbA1c) ?8\% and <12\% in the past 3 months, an active online patient portal account (tied to the electronic health record), and access to an iOS or Android smartphone. Interested patients were emailed a baseline survey, and once this was completed, were sent instructions for downloading the Time2Focus app. After completing all 12 levels, participants were sent a follow-up survey. The primary outcome was the change in HbA1c. Secondary outcomes included medication adherence, self-care activities, self-reporting of physical activities, diabetes self-efficacy, illness perceptions, diabetes distress scale, and users' engagement with and rating of the app. Results: Of 1355 potentially eligible patients screened, 201 were consented. Of these 201 patients, 101 (50.2\%) did not download the app. Of the 100 participants (49.8\%) who downloaded the app, 16 (16.0\%) completed 0 levels, 26 (26.0\%) completed 1 to 4 levels, 10 (10.0\%) completed 5 to 11 levels, and 48 (48.0\%) completed all 12 levels of the app and the follow-up survey. Those completing one or more levels had a mean pre/post-HbA1c change of --0.41\% (compared to --0.32\% among those who completed zero levels); however, the unadjusted two-tailed t test indicated no significant difference between the two groups (P=.73). Diabetes self-efficacy showed a large and significant increase during app usage for completers (mean change 1.28, P<.001, d=.83). Severity of illness perceptions showed a small but significant decrease during app usage for completers (mean change --0.51, P=.004, d=.43). Diabetes distress showed a small but significant decrease during app usage for completers (mean change --0.45, P=.006, d=.41). The net promoter score was 62.5, indicating that those who completed all levels of the app rated it highly and would recommend it to others. Conclusions: Participants who engaged in all 12 levels of the Time2Focus mobile app showed an improvement in diabetes self-efficacy and a decrease in severity of illness perceptions. The decrease in HbA1c observed in app users relative to nonusers during this limited pilot study was not statistically significant. However, uptake and application of lessons learned from self-management support may be delayed. Further research is needed to address how to increase engagement through self-management support and to investigate if follow up over a longer period demonstrates a significant change in outcomes such as HbA1c. ",
doi="10.2196/17537",
url="http://www.jmir.org/2021/1/e17537/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33470947"
}


@Article{info:doi/10.2196/14494,
author="Katzan, Irene
and Schuster, Andrew
and Kinzy, Tyler",
title="Physical Activity Monitoring Using a Fitbit Device in Ischemic Stroke Patients: Prospective Cohort Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jan",
day="19",
volume="9",
number="1",
pages="e14494",
keywords="physical activity",
keywords="accelerometer",
keywords="ischemic stroke",
keywords="step activity monitor",
abstract="Background: Continuous tracking of ambulatory activity in real-world settings using step activity monitors has many potential uses. However, feasibility, accuracy, and correlation with performance measures in stroke patients have not been well-established. Objective: The primary study objective was to determine adherence with wearing a consumer-grade step activity monitor, the Fitbit Charge HR, in home-going ischemic stroke patients during the first 90 days after hospital discharge. Secondary objectives were to (1) determine accuracy of step counts of the Fitbit Charge HR compared with a manual tally; (2) calculate correlations between the Fitbit step counts and the mobility performance scores at discharge and 30 days after stroke; (3) determine variability and change in weekly step counts over 90 days; and (4) evaluate patient experience with using the Fitbit Charge HR poststroke. Methods: A total of 15 participants with recent mild ischemic stroke wore a Fitbit Charge HR for 90 days after discharge and completed 3 mobility performance tests from the National Institutes of Health Toolbox at discharge and Day 30: (1) Standing Balance Test, (2) 2-Minute Walk Endurance Test, and (3) 4-Meter Walk Gait Speed Test. Accuracy of step activity monitors was assessed by calculating differences in steps recorded on the step activity monitor and a manual tally during 2-minute walk tests. Results: Participants had a mean age of 54 years and a median modified Rankin scale score of 1. Mean daily adherence with step activity monitor use was 83.6\%. Mean daily step count in the first week after discharge was 4376. Daily step counts increased slightly during the first 30 days after discharge (average increase of 52.5 steps/day; 95\% CI 32.2-71.8) and remained stable during the 30-90 day period after discharge. Mean step count difference between step activity monitor and manual tally was --4.8 steps (--1.8\%). Intraclass correlation coefficients for step counts and 2-minute walk, standing balance, and 4-meter gait speed at discharge were 0.41 (95\% CI --0.14 to 0.75), --0.12 (95\% CI --0.67 to 0.64), and 0.17 (95\% CI --0.46 to 0.66), respectively. Values were similarly poor at 30 days. Conclusions: The use of consumer-grade Fitbit Charge HR in patients with recent mild stroke is feasible with reasonable adherence and accuracy. There was poor correlation between step counts and gait speed, balance, and endurance. Further research is needed to evaluate the association between step counts and other outcomes relevant to patients, including patient-reported outcomes and measures of physical function. ",
doi="10.2196/14494",
url="http://mhealth.jmir.org/2021/1/e14494/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33464213"
}


@Article{info:doi/10.2196/23778,
author="Hwang, Hyunchan
and Bae, Sujin
and Hong, Sun Ji
and Han, Hyun Doug",
title="Comparing Effectiveness Between a Mobile App Program and Traditional Cognitive Behavior Therapy in Obsessive-Compulsive Disorder: Evaluation Study",
journal="JMIR Ment Health",
year="2021",
month="Jan",
day="19",
volume="8",
number="1",
pages="e23778",
keywords="obsessive-compulsive disorder",
keywords="exposure and response prevention",
keywords="cognitive behavior therapy",
keywords="cortico-striato-thalamo-cortical tract",
keywords="functional connectivity",
keywords="prevention",
keywords="cognitive",
keywords="mental illness",
keywords="behavior therapy",
abstract="Background: This study proposes a digital program for the treatment of mental illness that could increase motivation and improve learning outcomes for patients. Several studies have already applied this method by using an exposure and response prevention--inspired serious game to treat patients with obsessive-compulsive disorder (OCD). Objective: We hypothesized that a mobile cognitive behavior therapy (CBT) program would be as effective in treating OCD as traditional offline CBT. In addition, the treatment efficacy in response to mobile CBT for OCD might be associated with increased brain activity within the cortico-striato-thalamo-cortical (CSTC) tract. Methods: The digital CBT treatment program for OCD, OCfree, consists of 6 education sessions, 10 quests, and 7 casual games. Information was gathered from 27 patients with OCD (15 offline CBT and 12 OCfree CBT). During the 6-week intervention period, changes in clinical symptoms and brain function activity were analyzed. Results: There was no significant difference in the change in OCD symptoms and depressive symptoms between the two groups. However, the OCfree group showed greater improvement in anxiety symptoms compared to the offline CBT group. Both offline CBT and OCfree CBT increased the functional connectivity within the CSTC tract in all patients with OCD. However, CBT using OCfree showed greater changes in brain connectivity within the thalamus and insula, compared to offline CBT. Conclusions: OCfree, an OCD treatment app program, was effective in the treatment of drug-na{\"i}ve patients with OCD. The treatment effects of OCfree are associated with increased brain connectivity within the CSTC tract. Multisensory stimulation by education, quests, and games in OCfree increases the activity within the thalamus and insula in patients with OCD. ",
doi="10.2196/23778",
url="http://mental.jmir.org/2021/1/e23778/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33464208"
}


@Article{info:doi/10.2196/14774,
author="Su, Pen-Hua
and Yang, Chen
and Chao, Mei-Chyn
and Chiang, Chung-Lin",
title="Monitoring Adherence Rate to Growth Hormone Therapy and Growth Outcomes in Taiwanese Children Using Easypod Connect: Observational Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Jan",
day="15",
volume="4",
number="1",
pages="e14774",
keywords="growth hormone",
keywords="adherence",
keywords="easypod",
keywords="eHealth",
abstract="Background: Adherence to growth hormone therapy is difficult to detect reliably. Devices such as easypod have been developed for electronic recording of injections. The easypod connect observational study (ECOS) was an open-label, observational, multinational, phase IV study conducted in 24 countries around the world. The final results from ECOS in the Taiwanese cohort are reported in this paper. Objective: This study aimed to evaluate the adherence and long-term outcomes of growth hormone therapy in pediatric subjects using the easypod electromechanical device. Methods: Subjects (aged 2-18 years or >18 years without fusion of growth plates) who received Saizen (recombinant human growth hormone, somatropin) via the easypod device were enrolled in this study. The primary objective was to assess the level of adherence in subjects receiving Saizen via easypod. Results: In Taiwan, a total of 35 and 13 children fulfilled the criteria of full analysis set and complete analysis set, respectively. The mean (SD) age of the complete analysis set was 12.08 (2.72) years. All subjects were growth hormone--na{\"i}ve, with 38\% (5/13) females. The mean adherence rates of 13 subjects were 87.6\% at 3 months and 84.3\% at 6 months, that of 8 subjects was 81.0\% at 9 months, and that of 4 subjects was 91.6\% at 1 year. After 1 year of treatment, subjects had a median (Q1:Q3) change in height SD score of 0.30 (0.06:0.48), median height velocity of 6.50 (4.33:8.24) cm/year, and median change in height velocity SD score of 1.81 (--0.04:3.52). Conclusions: With the easypod device, patients with inadequate adherence and poor response to treatment can be identified. Adherence to growth hormone therapy administered via easypod was generally high in the first year of treatment but the adherence gradually decreased over time. Overall, growth outcomes after 1 year indicated a positive growth response to growth hormone treatment. Future efforts should be focused on personalized management of adherence by using the easypod system. ",
doi="10.2196/14774",
url="https://pediatrics.jmir.org/2021/1/e14774",
url="http://www.ncbi.nlm.nih.gov/pubmed/33448936"
}


@Article{info:doi/10.2196/22135,
author="de Batlle, Jordi
and Massip, Mireia
and Vargiu, Eloisa
and Nadal, Nuria
and Fuentes, Araceli
and Ortega Bravo, Marta
and Miralles, Felip
and Barb{\'e}, Ferran
and Torres, Gerard
and ",
title="Implementing Mobile Health--Enabled Integrated Care for Complex Chronic Patients: Intervention Effectiveness and Cost-Effectiveness Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jan",
day="14",
volume="9",
number="1",
pages="e22135",
keywords="chronic disease",
keywords="cost-benefit analysis",
keywords="delivery of health care, integrated",
keywords="mHealth",
keywords="eHealth",
keywords="quality of life",
abstract="Background: Integrated care can generate health and social care efficiencies through the defragmentation of care and adoption of patient-centered preventive models. eHealth can be a key enabling technology for integrated care. Objective: The aim of this study was to assess the effectiveness and cost-effectiveness of the implementation of a mobile health (mHealth)-enabled integrated care model for complex chronic patients. Methods: As part of the CONNECARE Horizon 2020 project, a prospective, pragmatic, two-arm, parallel implementation trial was held in a rural region of Catalonia, Spain. During 3 months, elderly patients with chronic obstructive pulmonary disease or heart failure and their carers experienced the combined benefits of the CONNECARE organizational integrated care model and the eHealth platform supporting it, consisting of a patient self-management app, a set of integrated sensors, and a web-based platform connecting professionals from different settings, or usual care. We assessed changes in health status with the 12-Item Short-Form Survey (SF-12), unplanned visits and admissions during a 6-month follow up, and the incremental cost-effectiveness ratio (ICER). Results: A total of 48 patients were included in the integrated care arm and 28 patients receiving usual care were included in the control arm (mean age 82 years, SD 7 years; mean Charlson index 7, SD 2). Integrated care patients showed a significant increase in the SF-12 physical domain with a mean change of +3.7 (SD 8.4) (P=.004) and total SF-12 score with a mean change of +5.8 (SD 12.8) (P=.003); however, the differences in differences between groups were not statistically significant. Integrated care patients had 57\% less unplanned visits (P=.004) and 50\% less hospital admissions related to their main chronic diseases (P=.32). The integrated care program generated savings in different cost scenarios and the ICER demonstrated the cost-effectiveness of the program. Conclusions: The implementation of a patient-centered mHealth-enabled integrated care model empowering the patient, and connecting primary, hospital, and social care professionals reduced unplanned contacts with the health system and health costs, and was cost-effective. These findings support the notion of system-wide cross-organizational care pathways supported by mHealth as a successful way to implement integrated care. ",
doi="10.2196/22135",
url="https://mhealth.jmir.org/2021/1/e22135",
url="http://www.ncbi.nlm.nih.gov/pubmed/33443486"
}


@Article{info:doi/10.2196/25507,
author="Laur, Violet Celia
and Agarwal, Payal
and Mukerji, Geetha
and Goulbourne, Elaine
and Baranek, Hayley
and Pus, Laura
and Bhatia, Sacha R.
and Martin, Danielle
and Bhattacharyya, Onil",
title="Building Health Services in a Rapidly Changing Landscape: Lessons in Adaptive Leadership and Pivots in a COVID-19 Remote Monitoring Program",
journal="J Med Internet Res",
year="2021",
month="Jan",
day="13",
volume="23",
number="1",
pages="e25507",
keywords="adaptive leadership",
keywords="pivots",
keywords="acute care",
keywords="COVID-19",
keywords="leadership",
keywords="remote monitoring",
keywords="monitoring",
keywords="health service",
keywords="framework",
doi="10.2196/25507",
url="http://www.jmir.org/2021/1/e25507/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33417588"
}


@Article{info:doi/10.2196/19609,
author="Mardini, T. Mamoun
and Nerella, Subhash
and Kheirkhahan, Matin
and Ranka, Sanjay
and Fillingim, B. Roger
and Hu, Yujie
and Corbett, B. Duane
and Cenko, Erta
and Weber, Eric
and Rashidi, Parisa
and Manini, M. Todd",
title="The Temporal Relationship Between Ecological Pain and Life-Space Mobility in Older Adults With Knee Osteoarthritis: A Smartwatch-Based Demonstration Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jan",
day="13",
volume="9",
number="1",
pages="e19609",
keywords="ecological momentary assessment",
keywords="smartwatch app",
keywords="life-space mobility",
keywords="pain",
keywords="knee osteoarthritis",
keywords="global positioning system",
abstract="Background: Older adults who experience pain are more likely to reduce their community and life-space mobility (ie, the usual range of places in an environment in which a person engages). However, there is significant day-to-day variability in pain experiences that offer unique insights into the consequences on life-space mobility, which are not well understood. This variability is complex and cannot be captured with traditional recall-based pain surveys. As a solution, ecological momentary assessments record repeated pain experiences throughout the day in the natural environment. Objective: The aim of this study was to examine the temporal association between ecological momentary assessments of pain and GPS metrics in older adults with symptomatic knee osteoarthritis by using a smartwatch platform called Real-time Online Assessment and Mobility Monitor. Methods: Participants (n=19, mean 73.1 years, SD 4.8; female: 13/19, 68\%; male: 6/19, 32\%) wore a smartwatch for a mean period of 13.16 days (SD 2.94). Participants were prompted in their natural environment about their pain intensity (range 0-10) at random time windows in the morning, afternoon, and evening. GPS coordinates were collected at 15-minute intervals and aggregated each day into excursion, ellipsoid, clustering, and trip frequency features. Pain intensity ratings were averaged across time windows for each day. A random effects model was used to investigate the within and between-person effects. Results: The daily mean pain intensities reported by participants ranged between 0 and 8 with 40\% reporting intensities ?2. The within-person associations between pain intensity and GPS features were more likely to be statistically significant than those observed between persons. Within-person pain intensity was significantly associated with excursion size, and others (excursion span, total distance, and ellipse major axis) showed a statistical trend (excursion span: P=.08; total distance: P=.07; ellipse major axis: P=.07). Each point increase in the mean pain intensity was associated with a 3.06 km decrease in excursion size, 2.89 km decrease in excursion span, 5.71 km decrease total distance travelled per day, 31.4 km2 decrease in ellipse area, 0.47 km decrease ellipse minor axis, and 3.64 km decrease in ellipse major axis. While not statistically significant, the point estimates for number of clusters (P=.73), frequency of trips (P=.81), and homestay (P=.15) were positively associated with pain intensity, and entropy (P=.99) was negatively associated with pain intensity. Conclusions: In this demonstration study, higher intensity knee pain in older adults was associated with lower life-space mobility. Results demonstrate that a custom-designed smartwatch platform is effective at simultaneously collecting rich information about ecological pain and life-space mobility. Such smart tools are expected to be important for remote health interventions that harness the variability in pain symptoms while understanding their impact on life-space mobility. ",
doi="10.2196/19609",
url="http://mhealth.jmir.org/2021/1/e19609/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33439135"
}


@Article{info:doi/10.2196/18587,
author="Ferrucci, Francesca
and Jorio, Manuele
and Marci, Stefano
and Bezenchek, Antonia
and Diella, Giulia
and Nulli, Cinzia
and Miranda, Ferdinando
and Castelli-Gattinara, Guido",
title="A Web-Based Application for Complex Health Care Populations: User-Centered Design Approach",
journal="JMIR Hum Factors",
year="2021",
month="Jan",
day="13",
volume="8",
number="1",
pages="e18587",
keywords="patient",
keywords="community participation",
keywords="eHealth",
keywords="patient-centered care",
keywords="user-centered design, comorbidity",
abstract="Background: Although eHealth technology makes it possible to improve the management of complex health care systems and follow up on chronic patients, it is not without challenges, thus requiring the development of efficient programs and graphic user interface (GUI) features. Similar information technology tools are crucial, as health care populations are going to have to endure social distancing measures in the forthcoming months and years. Objective: This study aims to provide adequate and personalized support to complex health care populations by developing a specific web-based mobile app. The app is designed around the patient and adapted to specific groups, for example, people with complex or rare diseases, autism, or disabilities (especially among children) as well as Alzheimer or senile dementia. The app's core features include the collection, labeling, analysis, and sorting of clinical data. Furthermore, it authorizes a network of people around the patient to securely access the data contained in his or her electronic health record. Methods: The application was designed according to the paradigms of patient-centered care and user-centered design (UCD). It considers the patient as the main empowered and motivating factor in the management of his or her well-being. Implementation was informed through a family needs and technology perception assessment. We used 3 interdisciplinary focus groups and 2 assessment surveys to study the contexts of app use, subpopulation management, and preferred functions. Finally, we developed an observational study involving 116 enrolled patients and 253 system users, followed by 2 feedback surveys to evaluate the performance and impact of the app. Results: In the validated general GUI, we developed 10 user profiles with different privacy settings. We tested 81 functions and studied a modular structure based on disease or medical area. This allowed us to identify replicable methods to be applied to module design. The observational study not only showed good family and community engagement but also revealed some limitations that need to be addressed. In total, 42 of 51 (82\%) patients described themselves as satisfied or very satisfied. Health care providers reported facilitated communication with colleagues and the need to support data quality. Conclusions: The experimented solution addressed some of the health system challenges mentioned by the World Health Organization: usability appears to be significantly improved when the GUI is designed according to patients' UCD mental models and when new media and medical literacy are promoted. This makes it possible to maximize the impact of eHealth products, thereby overcoming some crucial gaps reported in the literature. Two main features seemed to have potential benefit compared with other eHealth products: the modeling, within the app, of both the formal and informal health care support networks and the modular structure allowing for comorbidity management, both of which require further implementation. ",
doi="10.2196/18587",
url="http://humanfactors.jmir.org/2021/1/e18587/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33439146"
}


@Article{info:doi/10.2196/16785,
author="Mikolasek, Michael
and Witt, Margitta Claudia
and Barth, J{\"u}rgen",
title="Effects and Implementation of a Mindfulness and Relaxation App for Patients With Cancer: Mixed Methods Feasibility Study",
journal="JMIR Cancer",
year="2021",
month="Jan",
day="13",
volume="7",
number="1",
pages="e16785",
keywords="mobile app",
keywords="mobile phone",
keywords="mindfulness",
keywords="relaxation",
keywords="cancer",
keywords="qualitative research",
keywords="implementation science",
keywords="mHealth",
keywords="evaluation study",
keywords="patient compliance",
keywords="patient participation",
keywords="patient preference",
abstract="Background: Cancer diagnosis and cancer treatment can cause high levels of distress, which is often not sufficiently addressed in standard medical care. Therefore, a variety of supportive nonpharmacological treatments have been suggested to reduce distress in patients with cancer. However, not all patients use these interventions because of limited access or lack of awareness. To overcome these barriers, mobile health may be a promising way to deliver the respective supportive treatments. Objective: The aim of this study is to evaluate the effects and implementation of a mindfulness and relaxation app intervention for patients with cancer as well as patients' adherence to such an intervention. Methods: In this observational feasibility study with a mixed methods approach, patients with cancer were recruited through the web and through hospitals in Switzerland. All enrolled patients received access to a mindfulness and relaxation app. Patients completed self-reported outcomes (general health, health-related quality of life, anxiety, depression, distress, mindfulness, and fear of progression) at baseline and at weeks 4, 10, and 20. The frequency of app exercise usage was gathered directly through the app to assess the adherence of patients. In addition, we conducted interviews with 5 health professionals for their thoughts on the implementation of the app intervention in standard medical care. We analyzed patients' self-reported outcomes using linear mixed models (LMMs) and qualitative data with content analysis. Results: A total of 100 patients with cancer (74 female) with a mean age of 53.2 years (SD 11.6) participated in the study, of which 25 patients used the app regularly until week 20. LMM analyses revealed improvements in anxiety (P=.04), distress (P<.001), fatigue (P=.01), sleep disturbance (P=.02), quality of life (P=.03), and mindfulness (P<.001) over the course of 20 weeks. Further LMM analyses revealed a larger improvement in distress (P<.001), a moderate improvement in anxiety (P=.001), and a larger improvement in depression (P=.03) in patients with high levels of symptoms at baseline in the respective domains. The interviews revealed that the health professionals perceived the app as a helpful addition to standard care. They also made suggestions for improvements, which could facilitate the implementation of and adherence to such an app. Conclusions: This study indicates that a mindfulness and relaxation app for patients with cancer can be a feasible and effective way to deliver a self-care intervention, especially for highly distressed patients. Future studies should investigate if the appeal of the app can be increased with more content, and the effectiveness of such an intervention needs to be tested in a randomized controlled trial. ",
doi="10.2196/16785",
url="https://cancer.jmir.org/2021/1/e16785",
url="http://www.ncbi.nlm.nih.gov/pubmed/33439132"
}


@Article{info:doi/10.2196/16146,
author="Flors-Sidro, Javier Jos{\'e}
and Househ, Mowafa
and Abd-Alrazaq, Alaa
and Vidal-Alaball, Josep
and Fernandez-Luque, Luis
and Sanchez-Bocanegra, Luis Carlos",
title="Analysis of Diabetes Apps to Assess Privacy-Related Permissions: Systematic Search of Apps",
journal="JMIR Diabetes",
year="2021",
month="Jan",
day="13",
volume="6",
number="1",
pages="e16146",
keywords="diabetes mellitus",
keywords="privacy",
keywords="mobile apps",
keywords="dangerous permissions",
abstract="Background: Mobile health has become a major vehicle of support for people living with diabetes. Accordingly, the availability of mobile apps for diabetes has been steadily increasing. Most of the previous reviews of diabetes apps have focused on the apps' features and their alignment with clinical guidelines. However, there is a lack of knowledge on the actual compliance of diabetes apps with privacy and data security guidelines. Objective: The aim of this study was to assess the levels of privacy of mobile apps for diabetes to contribute to the raising of awareness of privacy issues for app users, developers, and governmental data protection regulators. Methods: We developed a semiautomatic app search module capable of retrieving Android apps' privacy-related information, particularly the dangerous permissions required by apps, with the aim of analyzing privacy aspects related to diabetes apps. Following the research selection criteria, the original 882 apps were narrowed down to 497 apps that were included in the analysis. Results: Approximately 60\% of the analyzed diabetes apps requested potentially dangerous permissions, which pose a significant risk to users' data privacy. In addition, 28.4\% (141/497) of the apps did not provide a website for their privacy policy. Moreover, it was found that 40.0\% (199/497) of the apps contained advertising, and some apps that claimed not to contain advertisements actually did. Ninety-five percent of the apps were free, and those belonging to the ``medical'' and ``health and fitness'' categories were the most popular. However, app users do not always realize that the free apps' business model is largely based on advertising and, consequently, on sharing or selling their private data, either directly or indirectly, to unknown third parties. Conclusions: The aforementioned findings confirm the necessity of educating patients and health care providers and raising their awareness regarding the privacy aspects of diabetes apps. Therefore, this research recommends properly and comprehensively training users, ensuring that governments and regulatory bodies enforce strict data protection laws, devising much tougher security policies and protocols in Android and in the Google Play Store, and implicating and supervising all stakeholders in the apps' development process. ",
doi="10.2196/16146",
url="http://diabetes.jmir.org/2021/1/e16146/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33439129"
}


@Article{info:doi/10.2196/24806,
author="Sj{\"o}berg, Veronica
and Westergren, Jens
and Monnier, Andreas
and Lo Martire, Riccardo
and Hagstr{\"o}mer, Maria
and {\"A}ng, Olov Bj{\"o}rn
and Vixner, Linda",
title="Wrist-Worn Activity Trackers in Laboratory and Free-Living Settings for Patients With Chronic Pain: Criterion Validity Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jan",
day="12",
volume="9",
number="1",
pages="e24806",
keywords="chronic pain",
keywords="energy expenditure",
keywords="heart rate",
keywords="physical activity",
keywords="step count",
keywords="validity",
keywords="wearable devices",
keywords="wearable",
keywords="pain",
keywords="rehabilitation",
abstract="Background: Physical activity is evidently a crucial part of the rehabilitation process for patients with chronic pain. Modern wrist-worn activity tracking devices seemingly have a great potential to provide objective feedback and assist in the adoption of healthy physical activity behavior by supplying data of energy expenditure expressed as metabolic equivalent of task units (MET). However, no studies of any wrist-worn activity tracking devices' have examined criterion validity in estimating energy expenditure, heart rate, or step count in patients with chronic pain. Objective: The aim was to determine the criterion validity of wrist-worn activity tracking devices for estimations of energy expenditure, heart rate, and step count in a controlled laboratory setting and free-living settings for patients with chronic pain. Methods: In this combined laboratory and field validation study, energy expenditure, heart rate, and step count were simultaneously estimated by a wrist-worn activity tracker (Fitbit Versa), indirect calorimetry (Jaeger Oxycon Pro), and a research-grade hip-worn accelerometer (ActiGraph GT3X) during treadmill walking at 3 speeds (3.0 km/h, 4.5 km/h, and 6.0 km/h) in the laboratory setting. Energy expenditure and step count were also estimated by the wrist-worn activity tracker in free-living settings for 72 hours. The criterion validity of each measure was determined using intraclass and Spearman correlation, Bland-Altman plots, and mean absolute percentage error. An analysis of variance was used to determine whether there were any significant systematic differences between estimations. Results: A total of 42 patients (age: 25-66 years; male: 10/42, 24\%; female: 32/42, 76\%), living with chronic pain (duration, in years: mean 9, SD 6.72) were included. At baseline, their mean pain intensity was 3.5 (SD 1.1) out of 6 (Multidimensional Pain Inventory, Swedish version). Results showed that the wrist-worn activity tracking device (Fitbit Versa) systematically overestimated energy expenditure when compared to the criterion standard (Jaeger Oxycon Pro) and the relative criterion standard (ActiGraph GT3X). Poor agreement and poor correlation were shown between Fitbit Versa and both Jaeger Oxycon Pro and ActiGraph GT3X for estimated energy expenditure at all treadmill speeds. Estimations of heart rate demonstrated poor to fair agreement during laboratory-based treadmill walks. For step count, the wrist-worn devices showed fair agreement and fair correlation at most treadmill speeds. In free-living settings; however, the agreement for step count between the wrist-worn device and waist-worn accelerometer was good, and the correlation was excellent. Conclusions: The wrist-worn device systematically overestimated energy expenditure and showed poor agreement and correlation compared to the criterion standard (Jaeger Oxycon Pro) and the relative criterion standard (ActiGraph GT3X), which needs to be considered when used clinically. Step count measured with a wrist-worn device, however, seemed to be a valid estimation, suggesting that future guidelines could include such variables in this group with chronic pain. ",
doi="10.2196/24806",
url="http://mhealth.jmir.org/2021/1/e24806/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33433391"
}


@Article{info:doi/10.2196/24333,
author="Goltermann, Janik
and Emden, Daniel
and Leehr, Johanna Elisabeth
and Dohm, Katharina
and Redlich, Ronny
and Dannlowski, Udo
and Hahn, Tim
and Opel, Nils",
title="Smartphone-Based Self-Reports of Depressive Symptoms Using the Remote Monitoring Application in Psychiatry (ReMAP): Interformat Validation Study",
journal="JMIR Ment Health",
year="2021",
month="Jan",
day="12",
volume="8",
number="1",
pages="e24333",
keywords="mobile monitoring",
keywords="smartphone",
keywords="digital biomarkers",
keywords="digital phenotyping",
keywords="course of illness",
keywords="psychometric quality",
keywords="mood disorders",
keywords="depression",
keywords="affective disorders",
keywords="mobile phone",
abstract="Background: Smartphone-based symptom monitoring has gained increased attention in psychiatric research as a cost-efficient tool for prospective and ecologically valid assessments based on participants' self-reports. However, a meaningful interpretation of smartphone-based assessments requires knowledge about their psychometric properties, especially their validity. Objective: The goal of this study is to systematically investigate the validity of smartphone-administered assessments of self-reported affective symptoms using the Remote Monitoring Application in Psychiatry (ReMAP). Methods: The ReMAP app was distributed to 173 adult participants of ongoing, longitudinal psychiatric phenotyping studies, including healthy control participants, as well as patients with affective disorders and anxiety disorders; the mean age of the sample was 30.14 years (SD 11.92). The Beck Depression Inventory (BDI) and single-item mood and sleep information were assessed via the ReMAP app and validated with non--smartphone-based BDI scores and clinician-rated depression severity using the Hamilton Depression Rating Scale (HDRS). Results: We found overall high comparability between smartphone-based and non--smartphone-based BDI scores (intraclass correlation coefficient=0.921; P<.001). Smartphone-based BDI scores further correlated with non--smartphone-based HDRS ratings of depression severity in a subsample (r=0.783; P<.001; n=51). Higher agreement between smartphone-based and non--smartphone-based assessments was found among affective disorder patients as compared to healthy controls and anxiety disorder patients. Highly comparable agreement between delivery formats was found across age and gender groups. Similarly, smartphone-based single-item self-ratings of mood correlated with BDI sum scores (r=--0.538; P<.001; n=168), while smartphone-based single-item sleep duration correlated with the sleep item of the BDI (r=--0.310; P<.001; n=166). Conclusions: These findings demonstrate that smartphone-based monitoring of depressive symptoms via the ReMAP app provides valid assessments of depressive symptomatology and, therefore, represents a useful tool for prospective digital phenotyping in affective disorder patients in clinical and research applications. ",
doi="10.2196/24333",
url="https://mental.jmir.org/2021/1/e24333",
url="http://www.ncbi.nlm.nih.gov/pubmed/33433392"
}


@Article{info:doi/10.2196/21563,
author="Iribarren, J. Sarah
and Akande, O. Tokunbo
and Kamp, J. Kendra
and Barry, Dwight
and Kader, G. Yazan
and Suelzer, Elizabeth",
title="Effectiveness of Mobile Apps to Promote Health and Manage Disease: Systematic Review and Meta-analysis of Randomized Controlled Trials",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jan",
day="11",
volume="9",
number="1",
pages="e21563",
keywords="systematic review",
keywords="mobile apps",
keywords="mobile phone",
abstract="Background: Interventions aimed at modifying behavior for promoting health and disease management are traditionally resource intensive and difficult to scale. Mobile health apps are being used for these purposes; however, their effects on health outcomes have been mixed. Objective: This study aims to summarize the evidence of rigorously evaluated health-related apps on health outcomes and explore the effects of features present in studies that reported a statistically significant difference in health outcomes. Methods: A literature search was conducted in 7 databases (MEDLINE, Scopus, PsycINFO, CINAHL, Global Index Medicus, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews). A total of 5 reviewers independently screened and extracted the study characteristics. We used a random-effects model to calculate the pooled effect size estimates for meta-analysis. Sensitivity analysis was conducted based on follow-up time, stand-alone app interventions, level of personalization, and pilot studies. Logistic regression was used to examine the structure of app features. Results: From the database searches, 8230 records were initially identified. Of these, 172 met the inclusion criteria. Studies were predominantly conducted in high-income countries (164/172, 94.3\%). The majority had follow-up periods of 6 months or less (143/172, 83.1\%). Over half of the interventions were delivered by a stand-alone app (106/172, 61.6\%). Static/one-size-fits-all (97/172, 56.4\%) was the most common level of personalization. Intervention frequency was daily or more frequent for the majority of the studies (123/172, 71.5\%). A total of 156 studies involving 21,422 participants reported continuous health outcome data. The use of an app to modify behavior (either as a stand-alone or as part of a larger intervention) confers a slight/weak advantage over standard care in health interventions (standardized mean difference=0.38 [95\% CI 0.31-0.45]; I2=80\%), although heterogeneity was high. Conclusions: The evidence in the literature demonstrates a steady increase in the rigorous evaluation of apps aimed at modifying behavior to promote health and manage disease. Although the literature is growing, the evidence that apps can improve health outcomes is weak. This finding may reflect the need for improved methodological and evaluative approaches to the development and assessment of health care improvement apps. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42018106868; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=106868 ",
doi="10.2196/21563",
url="https://mhealth.jmir.org/2021/1/e21563",
url="http://www.ncbi.nlm.nih.gov/pubmed/33427672"
}


@Article{info:doi/10.2196/20671,
author="Makowsky, J. Mark
and Jones, A. Charlotte
and Davachi, Shahnaz",
title="Prevalence and Predictors of Health-Related Internet and Digital Device Use in a Sample of South Asian Adults in Edmonton, Alberta, Canada: Results From a 2014 Community-Based Survey",
journal="JMIR Public Health Surveill",
year="2021",
month="Jan",
day="8",
volume="7",
number="1",
pages="e20671",
keywords="consumer health information",
keywords="cardiovascular disease",
keywords="type 2 diabetes",
keywords="eHealth",
keywords="mobile phone",
keywords="ethnicity",
keywords="cross-sectional survey",
keywords="Canada",
abstract="Background: South Asian Canadians are at high risk of developing cardiovascular disease and diabetes. Consumer-oriented health information technology may help mitigate lifestyle risk factors and improve chronic disease self-management. Objective: This study aims to explore the prevalence, patterns, and predictors of the use of the internet, digital devices, and apps for health purposes as well as preferences for future use of eHealth support in South Asian Canadians. Methods: We conducted a cross-sectional, mixed-mode survey in a convenience sample of 831 South Asian adults recruited at faith-based gathering places, health care settings, and community events in Edmonton, Alberta, in 2014. The 706 responders (mean age 47.1, SD 17.6 years; n=356, 50.4\% female; n=509, 72.1\% Sikh) who provided complete sociodemographic information were included in the analysis, and the denominators varied based on the completeness of responses to each question. Multivariate logistic regression was used to determine sociodemographic and health status predictors of internet use, being a web-based health information seeker, smartphone or tablet ownership, health app use, and willingness to use various modes of eHealth support. Results: Of all respondents, 74.6\% (527/706) were internet users and 47.8\% (336/703) were web-based health information seekers. In addition, 74.9\% (527/704) of respondents owned a smartphone or tablet and 30.7\% (159/518) of these had a health and fitness app. Most internet users (441/527, 83.7\%) expressed interest in using ?1 mode of eHealth support. Older age, being female, having less than high school education, preferring written health information in languages other than English, and lacking confidence in completing medical forms predicted lack of internet use. Among internet users, factors that predicted web-based health information seeking were being female, use of the internet several times per day, being confident in completing medical forms, and preferring health information in English. Predictors of not owning a smartphone or tablet were being older, preferring health information in languages other than English, having less than high school education, living in Canada for <5 years, having a chronic health condition, and having diabetes. Increasing age was associated with lower odds of having a health app. Preferring health information in languages other than English consistently predicted lower interest in all modes of eHealth support. Conclusions: eHealth-based chronic disease prevention and management interventions are feasible for South Asian adults, but digital divides exist according to language preference, education, age, sex, confidence in completing medical forms, and number of years lived in Canada. Community-based, culturally tailored strategies targeting these factors are required to address existing divides and increase the uptake of credible web-based and app-based resources for health purposes. ",
doi="10.2196/20671",
url="https://publichealth.jmir.org/2021/1/e20671",
url="http://www.ncbi.nlm.nih.gov/pubmed/33416506"
}


@Article{info:doi/10.2196/13770,
author="Chan, C. Eric
and Sun, Yuting
and Aitchison, J. Katherine
and Sivapalan, Sudhakar",
title="Mobile App--Based Self-Report Questionnaires for the Assessment and Monitoring of Bipolar Disorder: Systematic Review",
journal="JMIR Form Res",
year="2021",
month="Jan",
day="8",
volume="5",
number="1",
pages="e13770",
keywords="mobile apps",
keywords="mental health",
keywords="bipolar disorder",
keywords="smartphone",
keywords="cell phone",
abstract="Background: Bipolar disorder is a chronic, progressive illness characterized by recurrent episodes of mania and depression. Self-report scales have historically played a significant role in the monitoring of bipolar symptoms. However, these tools rely on episodic memory, which can be unreliable and do not allow the clinician to monitor brief episodic symptoms or the course of symptoms over shorter periods of time. Mobile app--based questionnaires have been suggested as a tool to improve monitoring of patients with bipolar disorder. Objective: This paper aims to determine the feasibility and validity of mobile app--based self-report questionnaires. Methods: We performed a systematic review of the literature according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, PsycInfo, Web of Science, Ovid MEDLINE, and EMBASE databases were searched for papers published in English that assessed adherence to and the validity of mobile app--based self-report questionnaires. Relevant studies published from database creation to May 22, 2020, were identified, and results examining the validity of and rates of adherence to app-based self-report questionnaires are reported. Results: A total of 13 records were identified for inclusion in this review. Of these studies, 4 assessed the concurrent validity of mobile app--based self-report tools, with the majority of findings indicating significant associations between data collected using these tools and the Young Mania Rating Scale, Hamilton Depression Rating Scale-17, or Montgomery-{\AA}sberg Depression Rating Scale (P<.001 to P=.24). Three studies comparing the variability or range of symptoms between patients with bipolar disorder and healthy controls suggested that these data are capable of differentiating between known groups. Two studies demonstrated statistically significant associations between data collected via mobile app--based self-report tools and instruments assessing other clinically important factors. Adherence rates varied across the studies examined. However, good adherence rates (>70\%) were observed in all but 1 study using a once-daily assessment. There was a wide range of adherence rates observed in studies using twice-daily assessments (42\%-95\%). Conclusions: These findings suggest that mobile app--based self-report tools are valid in the assessment of symptoms of mania and depression in euthymic patients with bipolar disorder. Data collected using these tools appear to differ between patients with bipolar disorder and healthy controls and are significantly associated with other clinically important measures. It is unclear at this time whether these tools can be used to detect acute episodes of mania or depression in patients with bipolar disorder. Adherence data indicate that patients with bipolar disorder show good adherence to self-report assessments administered daily for the duration of the study periods evaluated. ",
doi="10.2196/13770",
url="https://formative.jmir.org/2021/1/e13770",
url="http://www.ncbi.nlm.nih.gov/pubmed/33416510"
}


@Article{info:doi/10.2196/19046,
author="Wang, Yameng
and Ren, Xiaotong
and Liu, Xiaoqian
and Zhu, Tingshao",
title="Examining the Correlation Between Depression and Social Behavior on Smartphones Through Usage Metadata: Empirical Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jan",
day="6",
volume="9",
number="1",
pages="e19046",
keywords="depression",
keywords="digital phenotyping",
keywords="social behavior",
keywords="smartphone usage",
keywords="mobile sensing",
abstract="Background: As smartphone has been widely used, understanding how depression correlates with social behavior on smartphones can be beneficial for early diagnosis of depression. An enormous amount of research relied on self-report questionnaires, which is not objective. Only recently the increased availability of rich data about human behavior in digital space has provided new perspectives for the investigation of individual differences. Objective: The objective of this study was to explore depressed Chinese individuals' social behavior in digital space through metadata collected via smartphones. Methods: A total of 120 participants were recruited to carry a smartphone with a metadata collection app (MobileSens). At the end of metadata collection, they were instructed to complete the Center for Epidemiological Studies-Depression Scale (CES-D). We then separated participants into nondepressed and depressed groups based on their scores on CES-D. From the metadata of smartphone usage, we extracted 44 features, including traditional social behaviors such as making calls and sending SMS text messages, and the usage of social apps (eg, WeChat and Sina Weibo, 2 popular social apps in China). The 2-way ANOVA (nondepressed vs depressed {\texttimes} male vs female) and multiple logistic regression analysis were conducted to investigate differences in social behaviors on smartphones among users. Results: The results found depressed users received less calls from contacts (all day: F1,116=3.995, P=.048, $\eta$2=0.033; afternoon: F1,116=5.278, P=.02, $\eta$2=0.044), and used social apps more frequently (all day: F1,116=6.801, P=.01, $\eta$2=0.055; evening: F1,116=6.902, P=.01, $\eta$2=0.056) than nondepressed ones. In the depressed group, females used Weibo more frequently than males (all day: F1,116=11.744, P=.001, $\eta$2=0.092; morning: F1,116=9.105, P=.003, $\eta$2=0.073; afternoon: F1,116=14.224, P<.001, $\eta$2=0.109; evening: F1,116=9.052, P=.003, $\eta$2=0.072). Moreover, usage of social apps in the evening emerged as a predictor of depressive symptoms for all participants (odds ratio [OR] 1.007, 95\% CI 1.001-1.013; P=.02) and male (OR 1.013, 95\% CI 1.003-1.022; P=.01), and usage of Weibo in the morning emerged as a predictor for female (OR 1.183, 95\% CI 1.015-1.378; P=.03). Conclusions: This paper finds that there exists a certain correlation between depression and social behavior on smartphones. The result may be useful to improve social interaction for depressed individuals in the daily lives and may be insightful for early diagnosis of depression. ",
doi="10.2196/19046",
url="https://mhealth.jmir.org/2021/1/e19046",
url="http://www.ncbi.nlm.nih.gov/pubmed/33404512"
}


@Article{info:doi/10.2196/18496,
author="Cartledge, Susie
and Maddison, Ralph
and Vogrin, Sara
and Falls, Roman
and Tumur, Odgerel
and Hopper, Ingrid
and Neil, Christopher",
title="The Utility of Predicting Hospitalizations Among Patients With Heart Failure Using mHealth: Observational Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Dec",
day="22",
volume="8",
number="12",
pages="e18496",
keywords="cardiac failure",
keywords="heart failure",
keywords="readmission",
keywords="hospitalization",
keywords="risk prediction",
keywords="mHealth",
abstract="Background: Heart failure decompensation is a major driver of hospitalizations and represents a significant burden to the health care system. Identifying those at greatest risk of admission can allow for targeted interventions to reduce this risk. Objective: This paper aims to compare the predictive value of objective and subjective heart failure respiratory symptoms on imminent heart failure decompensation and subsequent hospitalization within a 30-day period. Methods: A prospective observational pilot study was conducted. People living at home with heart failure were recruited from a single-center heart failure outpatient clinic. Objective (blood pressure, heart rate, weight, B-type natriuretic peptide) and subjective (4 heart failure respiratory symptoms scored for severity on a 5-point Likert scale) data were collected twice weekly for a 30-day period. Results: A total of 29 participants (median age 79 years; 18/29, 62\% men) completed the study. During the study period, 10 of the 29 participants (34\%) were hospitalized as a result of heart failure. For objective data, only heart rate exhibited a between-group difference. However, it was nonsignificant for variability (P=.71). Subjective symptom scores provided better prediction. Specifically, the highest precision of heart failure hospitalization was observed when patients with heart failure experienced severe dyspnea, orthopnea, and bendopnea on any given day (area under the curve of 0.77; sensitivity of 83\%; specificity of 73\%). Conclusions: The use of subjective respiratory symptom reporting on a 5-point Likert scale may facilitate a simple and low-cost method of predicting heart failure decompensation and imminent hospitalization. Serial collection of symptom data could be augmented using ecological momentary assessment of self-reported symptoms within a mobile health monitoring strategy for patients at high risk for heart failure decompensation. ",
doi="10.2196/18496",
url="http://mhealth.jmir.org/2020/12/e18496/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33350962"
}


@Article{info:doi/10.2196/19452,
author="Li, Wen-Yi
and Chiu, Fu-Chun
and Zeng, Jyun-Kai
and Li, Yao-Wei
and Huang, Su-Hua
and Yeh, Hui-Chin
and Cheng, Bor-Wen
and Yang, Feng-Jung",
title="Mobile Health App With Social Media to Support Self-Management for Patients With Chronic Kidney Disease: Prospective Randomized Controlled Study",
journal="J Med Internet Res",
year="2020",
month="Dec",
day="15",
volume="22",
number="12",
pages="e19452",
keywords="chronic kidney disease",
keywords="self-management",
keywords="self-efficacy",
keywords="quality of life",
keywords="health management platform",
keywords="wearable device",
abstract="Background: Chronic kidney disease (CKD) is a global health burden. Self-management plays a key role in improving modifiable risk factors. Objective: The aim of this study was to evaluate the effectiveness of wearable devices, a health management platform, and social media at improving the self-management of CKD, with the goal of establishing a new self-management intervention model. Methods: In a 90-day prospective experimental study, a total of 60 people with CKD at stages 1-4 were enrolled in the intervention group (n=30) and control group (n=30). All participants were provided with wearable devices that collected exercise-related data. All participants maintained dietary diaries using a smartphone app. All dietary and exercise information was then uploaded to a health management platform. Suggestions about diet and exercise were provided to the intervention group only, and a social media group was created to inspire the participants in the intervention group. Participants' self-efficacy and self-management questionnaire scores, Kidney Disease Quality of Life scores, body composition, and laboratory examinations before and after the intervention were compared between the intervention and control groups. Results: A total of 49 participants completed the study (25 in the intervention group and 24 in the control group); 74\% of the participants were men and the mean age was 51.22 years. There were no differences in measured baseline characteristics between the groups except for educational background. After the intervention, the intervention group showed significantly higher scores for self-efficacy (mean 171.28, SD 22.92 vs mean 142.21, SD 26.36; P<.001) and self-management (mean 54.16, SD 6.71 vs mean 47.58, SD 6.42; P=.001). Kidney Disease Quality of Life scores were also higher in the intervention group (mean 293.16, SD 34.21 vs mean 276.37, SD 32.21; P=.02). The number of steps per day increased in the intervention group (9768.56 in week 1 and 11,389.12 in week 12). The estimated glomerular filtration rate (eGFR) of the intervention group was higher than that of the control group (mean 72.47, SD 24.28 vs mean 59.69, SD 22.25 mL/min/1.73m2; P=.03) and the decline in eGFR was significantly slower in the intervention group (--0.56 vs --4.58 mL/min/1.73m2). There were no differences in body composition between groups postintervention. Conclusions: The use of wearable devices, a health management platform, and social media support not only strengthened self-efficacy and self-management but also improved quality of life and a slower eGFR decline in people with CKD at stages 1-4. These results outline a new self-management model to promote healthy lifestyle behaviors for patients with CKD. Trial Registration: ClinicalTrials.gov NCT04617431; https://www.clinicaltrials.gov/ct2/show/NCT04617431 ",
doi="10.2196/19452",
url="http://www.jmir.org/2020/12/e19452/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33320101"
}


@Article{info:doi/10.2196/22452,
author="Amann, Julia
and Fiordelli, Maddalena
and Scheel-Sailer, Anke
and Brach, Mirjam
and Rubinelli, Sara",
title="Opportunities and Challenges of a Self-Management App to Support People With Spinal Cord Injury in the Prevention of Pressure Injuries: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Dec",
day="9",
volume="8",
number="12",
pages="e22452",
keywords="mHealth",
keywords="eHealth",
keywords="self-management",
keywords="spinal cord injury",
keywords="pressure injury",
keywords="prevention",
keywords="technology acceptance",
abstract="Background: Mobile health applications can offer tailored self-management support to individuals living with chronic health conditions. However, there are several challenges to the adoption of these technologies in practice. Co-design is a promising approach to overcoming some of these challenges by enabling the development of solutions that meet the actual needs and preferences of the relevant stakeholder groups. Objective: Taking spinal cord injury as a case in point, the overall objectives of this study were to identify the perceived benefits of a co-designed self-management app that could promote its uptake and to explore the factors that may impede adoption. Methods: We adopted a qualitative research approach guided by the Technology Acceptance Model. Data were collected through semistructured interviews with individuals with spinal cord injury (n=15) and two focus groups with health care professionals specialized in spinal cord injury (n=7, n=5). Prior to the interviews and focus groups, study participants were given time to explore the app prototype. All interviews were transcribed verbatim and analyzed using inductive thematic analysis. Results: Findings of our analysis indicate that study participants perceived the app prototype as potentially useful for supporting individuals with spinal cord injury in preventing pressure injuries. In particular, we identified three concrete use cases highlighting the benefits of the app for different audiences: (1) a companion for newly injured individuals, (2) an emergency kit and motivational support, and 3) a guide for informal caregivers and family members. We also uncovered several challenges that might impede the adoption of the self-management app in practice, including (1) challenges in motivating individuals to use the app, (2) concerns about the misuse and abuse of the app, and (3) organizational and maintenance challenges. Conclusions: This study adds to a growing body of research that investigates individuals' adoption and nonadoption behavior regarding mobile health solutions. Building on earlier work, we make recommendations on how to address the barriers to the adoption of mobile health solutions identified by this study. In particular, there is a need to foster trust in mobile health among prospective users, including both patients and health care professionals. Moreover, increasing personal relevance of mobile health solutions through personalization may be a promising approach to promote uptake. Last but not least, organizational support also plays an instrumental role in mobile health adoption. We conclude that even though co-design is promoted as a promising approach to develop self-management tools, co-design does not guarantee adoption. More research is needed to identify the most promising strategies to promote the adoption of evidence-based mobile health solutions in practice. ",
doi="10.2196/22452",
url="http://mhealth.jmir.org/2020/12/e22452/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33295876"
}


@Article{info:doi/10.2196/19593,
author="Buitenweg, David
and van de Mheen, Dike
and Grund, Jean-Paul
and van Oers, Hans
and van Nieuwenhuizen, Chijs",
title="Visual and Personalized Quality of Life Assessment App for People With Severe Mental Health Problems: Qualitative Evaluation",
journal="JMIR Ment Health",
year="2020",
month="Dec",
day="3",
volume="7",
number="12",
pages="e19593",
keywords="quality of life",
keywords="qualitative evaluation",
keywords="visual assessment",
keywords="e-mental health",
keywords="assessment app",
abstract="Background: QoL-ME is a digital visual personalized quality of life assessment app for people with severe mental health problems. Research reveals that e-mental health apps frequently suffer from low engagement and fall short of expectations regarding their impact on patients' daily lives. Studies often indicate that e-mental health apps ought to respect the needs and preferences of end users to achieve optimal user engagement. Objective: The aim of this study was to explore the experiences of users regarding the usability and functionality of QoL-ME and whether the app is actionable and beneficial for patients. Methods: End users (n=8) of QoL-ME contributed to semistructured interviews. An interview guide was used to direct the interviews. All interviews were audiorecorded and transcribed verbatim. Transcriptions were analyzed and coded thematically. Results: Analysis revealed 3 main themes: (1) benefit, (2) actionability, and (3) characteristics of the QoL-ME. The first theme reveals that the QoL-ME app was beneficial for the majority of respondents, primarily by prompting them to reflect on their quality of life. The current version is not yet actionable; the actionability of the QoL-ME app may be improved by enabling users to view their scores over time and by supplying practical advice for quality of life improvements. Overall, participants had positive experiences with the usability, design, and content of the app. Conclusions: The QoL-ME app can be beneficial to users as it provides them with insight into their quality of life and elicits reflection. Incorporating more functionalities that facilitate self-management, such as advice and strategies for improving areas that are lacking, will likely make the app actionable. Patients positively regarded the usability, design, and contents of the QoL-ME app. ",
doi="10.2196/19593",
url="https://mental.jmir.org/2020/12/e19593",
url="http://www.ncbi.nlm.nih.gov/pubmed/33270036"
}


@Article{info:doi/10.2196/20325,
author="Liu, Mandong
and Jiang, Tongge
and Yu, Kexin
and Wu, Shinyi
and Jordan-Marsh, Maryalice
and Chi, Iris",
title="Care Me Too, a Mobile App for Engaging Chinese Immigrant Caregivers in Self-Care: Qualitative Usability Study",
journal="JMIR Form Res",
year="2020",
month="Dec",
day="2",
volume="4",
number="12",
pages="e20325",
keywords="mHealth",
keywords="co-design",
keywords="usability",
keywords="acceptability",
keywords="immigrant",
keywords="caregiver",
keywords="mobile phone",
abstract="Background: Caregiving and self-care are challenging for Chinese immigrants in the United States due to limited accessible support and resources. Few interventions exist to assist Chinese immigrant caregivers in better performing self-care. To address this gap in the literature, our team developed the Care Me Too app to engage Chinese immigrant caregivers in self-care and conducted a user experience test to assess its usability and acceptability. Objective: This paper aims to report the results of the app's usability and acceptability testing with Chinese immigrant caregivers and to solicit participants' feedback of the app design and functions. Methods: A total of 22 Mandarin-speaking Chinese caregivers participated in the study, which consisted of 2 parts: the in-lab testing and the 1-week at-home testing. In-depth face-to-face interviews and follow-up phone interviews were used to assess user experience of the app's usability and acceptability and to solicit feedback for app design and functions. Directed content analysis was used to analyze the qualitative data. Results: Among the 22 participants, the average age was 60.5 (SD 8.1) years, ranging from 46 to 80 years; 17 (77\%) participants were women and 14 (64\%) had an associate degree or higher. Participants reported uniformly positive ratings of the usability and acceptability of the app and provided detailed suggestions for app improvement. We generated guidelines for mobile health (mHealth) app designs targeting immigrant caregivers, including weighing flexibility versus majority preferences, increasing text sizes, using colors effectively, providing engaging and playful visual designs and functions, simplifying navigation, simplifying the log-in process, improving access to and the content on the help document, designing functions to cater to the population's context, and ensuring offline access. Conclusions: The main contribution of this study is the improved understanding of Chinese caregivers' user experiences with a language-appropriate mHealth app for a population that lacks accessible caregiving and self-care resources and support. It is recommended that future researchers and app designers consider the proposed guidelines when developing mHealth apps for their population to enhance user experience and harness mHealth's value. ",
doi="10.2196/20325",
url="https://formative.jmir.org/2020/12/e20325",
url="http://www.ncbi.nlm.nih.gov/pubmed/33263552"
}


@Article{info:doi/10.2196/19150,
author="Signal, Virginia
and McLeod, Melissa
and Stanley, James
and Stairmand, Jeannine
and Sukumaran, Nitin
and Thompson, Donna-Marie
and Henderson, Kelly
and Davies, Cheryl
and Krebs, Jeremy
and Dowell, Anthony
and Grainger, Rebecca
and Sarfati, Diana",
title="A Mobile- and Web-Based Health Intervention Program for Diabetes and Prediabetes Self-Management (BetaMe/Melon): Process Evaluation Following a Randomized Controlled Trial",
journal="J Med Internet Res",
year="2020",
month="Dec",
day="1",
volume="22",
number="12",
pages="e19150",
keywords="diabetes mellitus",
keywords="prediabetes",
keywords="self-management",
keywords="eHealth",
keywords="mobile apps",
keywords="evaluation",
keywords="diabetes",
keywords="digital health",
keywords="app",
keywords="utilization",
keywords="user perception",
keywords="user",
abstract="Background: Technology-assisted self-management programs are increasingly recommended to patients with long-term conditions such as diabetes. However, there are a number of personal and external factors that affect patients' abilities to engage with and effectively utilize such programs. A randomized controlled trial of a multi-modal online program for diabetes self-management (BetaMe/Melon) was conducted in a primary care setting, and a process evaluation was completed at the end of the study period. Objective: This process evaluation aimed to examine the utilization patterns of BetaMe/Melon, identify which components participants found most (and least) useful, and identify areas of future improvement. Methods: Process evaluation data were collected for intervention arm participants from 3 sources: (1) the mobile/web platform (to identify key usage patterns over the 16-week core program), (2) an online questionnaire completed during the final study assessment, and (3) interviews conducted with a subset of participants following the study period. Participants were classified as ``actively engaged'' if any usage data was recorded for the participant (in any week), and patterns were reported by age, gender, ethnicity, and diabetes/prediabetes status. The online questionnaire asked participants about the usefulness of the program and whether they would recommend BetaMe/Melon to others according to a 5-point Likert Scale. Of 23 invited participants, 18 participated in a digitally recorded, semistructured telephone interview. Interview data were thematically analyzed. Results: Out of the 215 participants, 198 (92\%) received an initial health coaching session, and 160 (74\%) were actively engaged with the program at some point during the 16-week core program. Engagement varied by demographic, with women, younger participants, and ethnic majority populations having higher rates of engagement. Usage steadily declined from 50\% at Week 0 to 23\% at Week 15. Participants ranked component usefulness as education resources (63.7\%), health coaches (59.2\%), goal tracking (48.8\%), and online peer support (42.1\%). Although 53\% agreed that the program was easy to use, 64\% would recommend the program to others. Interview participants found BetaMe/Melon useful overall, with most identifying beneficial outcomes such as increased knowledge, behavioral changes, and weight loss. Barriers to engagement were program functionality, internet connectivity, incomplete delivery of all program components, and participant motivation. Participants suggested a range of improvements to the BetaMe/Melon program. Conclusions: The program was generally well received by participants; active engagement was initially high, although it declined steadily. Maintaining participant engagement over time, individualizing programs, and addressing technical barriers are important to maximize potential health benefits from online diabetes self-management programs. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12617000549325; https://tinyurl.com/y622b27q ",
doi="10.2196/19150",
url="https://www.jmir.org/2020/12/e19150",
url="http://www.ncbi.nlm.nih.gov/pubmed/33258776"
}


@Article{info:doi/10.2196/24718,
author="Jaana, Mirou
and Par{\'e}, Guy",
title="Comparison of Mobile Health Technology Use for Self-Tracking Between Older Adults and the General Adult Population in Canada: Cross-Sectional Survey",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Nov",
day="27",
volume="8",
number="11",
pages="e24718",
keywords="mobile health",
keywords="older adults",
keywords="self-tracking",
keywords="wearable technology",
keywords="smart devices",
keywords="mobile apps",
keywords="survey",
keywords="mobile phone",
keywords="seniors",
keywords="elderly",
abstract="Background: The burden of population aging and chronic conditions has been reported worldwide. Older adults, especially those with high needs, experience social isolation and have high rates of emergency visits and limited satisfaction with the care they receive. Mobile health (mHealth) technologies present opportunities to address these challenges. To date, limited information is available on Canadian older adults' attitudes toward and use of mHealth technologies for self-tracking purposes---an area that is increasingly important and relevant during the COVID-19 era. Objective: This study presents contributions to an underresearched area on older adults and mHealth technology use. The aim of this study was to compare older adults' use of mHealth technologies to that of the general adult population in Canada and to investigate the factors that affect their use. Methods: A cross-sectional survey on mHealth and digital self-tracking was conducted. A web-based questionnaire was administered to a national sample of 4109 Canadian residents who spoke either English or French. The survey instrument consisted of 3 sections assessing the following items: (1) demographic characteristics, health status, and comorbidities; (2) familiarity with and use of mHealth technologies (ie, mobile apps, consumer smart devices/wearables such as vital signs monitors, bathroom scales, fitness trackers, intelligent clothing); and (3) factors influencing the continued use of mHealth technologies. Results: Significant differences were observed between the older adults and the general adult population in the use of smart technologies and internet (P<.001). Approximately 47.4\% (323/682) of the older adults in the community reported using smartphones and 49.8\% (340/682) indicated using digital tablets. Only 19.6\% (91/463) of the older adults using smartphones/digital tablets reported downloading mobile apps, and 12.3\% (47/383) of the older adults who heard of smart devices/wearables indicated using them. The majority of the mobile apps downloaded by older adults was health-related; interestingly, their use was sustained over a longer period of time (P=.007) by the older adults compared to that by the general population. Approximately 62.7\% (428/682) of the older adults reported tracking their health measures, but the majority did so manually. Older adults with one or more chronic conditions were mostly nontrackers (odds ratio 0.439 and 0.431 for traditional trackers and digital trackers, respectively). No significant differences were observed between the older adults and the general adult population with regard to satisfaction with mHealth technologies and their intention to continue using them. Conclusions: Leveraging mHealth technologies in partnership with health care providers and sharing of health/well-being data with health care professionals and family members remain very limited. A culture shift in the provision of care to older adults is deemed necessary to keep up with the development of mHealth technologies and the changing demographics and expectations of patients and their caregivers. ",
doi="10.2196/24718",
url="http://mhealth.jmir.org/2020/11/e24718/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33104517"
}


@Article{info:doi/10.2196/21543,
author="Kuosmanen, Elina
and Wolling, Florian
and Vega, Julio
and Kan, Valerii
and Nishiyama, Yuuki
and Harper, Simon
and Van Laerhoven, Kristof
and Hosio, Simo
and Ferreira, Denzil",
title="Smartphone-Based Monitoring of Parkinson Disease: Quasi-Experimental Study to Quantify Hand Tremor Severity and Medication Effectiveness",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Nov",
day="26",
volume="8",
number="11",
pages="e21543",
keywords="Parkinson disease",
keywords="smartphone",
keywords="hand tremor",
keywords="mobile health",
abstract="Background: Hand tremor typically has a negative impact on a person's ability to complete many common daily activities. Previous research has investigated how to quantify hand tremor with smartphones and wearable sensors, mainly under controlled data collection conditions. Solutions for daily real-life settings remain largely underexplored. Objective: Our objective was to monitor and assess hand tremor severity in patients with Parkinson disease (PD), and to better understand the effects of PD medications in a naturalistic environment. Methods: Using the Welch method, we generated periodograms of accelerometer data and computed signal features to compare patients with varying degrees of PD symptoms. Results: We introduced and empirically evaluated the tremor intensity parameter (TIP), an accelerometer-based metric to quantify hand tremor severity in PD using smartphones. There was a statistically significant correlation between the TIP and self-assessed Unified Parkinson Disease Rating Scale (UPDRS) II tremor scores (Kendall rank correlation test: z=30.521, P<.001, $\tau$=0.5367379; n=11). An analysis of the ``before'' and ``after'' medication intake conditions identified a significant difference in accelerometer signal characteristics among participants with different levels of rigidity and bradykinesia (Wilcoxon rank sum test, P<.05). Conclusions: Our work demonstrates the potential use of smartphone inertial sensors as a systematic symptom severity assessment mechanism to monitor PD symptoms and to assess medication effectiveness remotely. Our smartphone-based monitoring app may also be relevant for other conditions where hand tremor is a prevalent symptom. ",
doi="10.2196/21543",
url="http://mhealth.jmir.org/2020/11/e21543/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33242017"
}


@Article{info:doi/10.2196/15978,
author="Deng, Ning
and Chen, Juan
and Liu, Yiyuan
and Wei, Shuoshuo
and Sheng, Leiyi
and Lu, Rong
and Wang, Zheyu
and Zhu, Jiarong
and An, Jiye
and Wang, Bei
and Lin, Hui
and Wang, Xiuyan
and Zhou, Yumin
and Duan, Huilong
and Ran, Pixin",
title="Using Mobile Health Technology to Deliver a Community-Based Closed-Loop Management System for Chronic Obstructive Pulmonary Disease Patients in Remote Areas of China: Development and Prospective Observational Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Nov",
day="25",
volume="8",
number="11",
pages="e15978",
keywords="COPD",
keywords="mobile health technology",
keywords="closed-loop care pathway",
keywords="chronic disease management",
keywords="exacerbations",
abstract="Background: Mobile health (mHealth) technology is an increasingly recognized and effective method for disease management and has the potential to intervene in pulmonary function, exacerbation risk, and psychological status of patients with chronic obstructive pulmonary disease (COPD). Objective: This study aimed to investigate the feasibility of an mHealth-based COPD management system designed for Chinese remote areas with many potential COPD patients but limited medical resources. Methods: The system was implemented based on a tailored closed-loop care pathway that breaks the heavy management tasks into detailed pieces to be quantified and executed by computers. Low-cost COPD evaluation and questionnaire-based psychological intervention are the 2 main characteristics of the pathway. A 6-month prospective observational study at the community level was performed to evaluate the effect of the system. Primary outcomes included changes in peak expiratory flow values, quality of life measured using the COPD assessment test scale, and psychological condition. Acute exacerbations, compliance, and adverse events were also measured during the study. Compliance was defined as the ratio of the actual frequency of self-monitoring records to the prescribed number. Results: A total of 56 patients was enrolled; 39 patients completed the 6-month study. There was no significant difference in the mean peak expiratory flow value before and after the 6-month period (366.1, SD 106.7 versus 313.1, SD 116.6; P=.11). Psychological condition significantly improved after 6 months, especially for depression, as measured using the Patient Health Questionnaire-9 scale (median 6.0, IQR 3.0-9.0 versus median 4.0, IQR 0.0-6.0; P=.001). The COPD assessment test score after 6 months of intervention was also lower than that at the baseline, and the difference was significant (median 4.0, IQR 1.0-6.0 versus median 3.0, IQR 0.0-6.0; P=.003). The median overall compliance was 91.1\% (IQR 67\%-100\%). In terms of acute exacerbation, 110 exacerbations were detected and confirmed by health care providers (per 6 months, median 2.0, IQR 1.0-5.0). Moreover, 72 adverse events occurred during the study, including 1 death, 19 hospitalizations, and 52 clinic visits due to persistent respiratory symptoms. Conclusions: We designed and validated a feasible mHealth-based method to manage COPD in remote Chinese areas with limited medical resources. The proposed closed-loop care pathway was effective at the community level. Proper education and frequent communication with health care providers may encourage patients' acceptance and use of smartphones to support COPD self-management. In addition, WeChat might play an important role in improving patient compliance and psychological distress. Further research might explore the effect of such systems on a larger scale and at a higher evidence level. ",
doi="10.2196/15978",
url="http://mhealth.jmir.org/2020/11/e15978/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33237036"
}


@Article{info:doi/10.2196/19065,
author="Gomis-Pastor, Mar
and Mirabet, Sonia
and Roig, Eulalia
and Lopez, Laura
and Brossa, Vicens
and Galvez-Tugas, Elisabeth
and Rodriguez-Murphy, Esther
and Feliu, Anna
and Ontiveros, Gerardo
and Garcia-Cuy{\`a}s, Francesc
and Salazar, Albert
and Mangues, Antonia M.",
title="Interdisciplinary Mobile Health Model to Improve Clinical Care After Heart Transplantation: Implementation Strategy Study",
journal="JMIR Cardio",
year="2020",
month="Nov",
day="24",
volume="4",
number="1",
pages="e19065",
keywords="cardiology",
keywords="heart transplantation",
keywords="implementation strategy",
keywords="health care model",
keywords="integrated health care systems",
keywords="interdisciplinary health team",
keywords="medication therapy management",
keywords="health care technology",
keywords="mHealth",
keywords="eHealth",
abstract="Background: Solid organ transplantation could be the only life-saving treatment for end-stage heart failure. Nevertheless, multimorbidity and polypharmacy remain major problems after heart transplant. A technology-based behavioral intervention model was established to improve clinical practice in a heart transplant outpatient setting. To support the new strategy, the mHeart app, a mobile health (mHealth) tool, was developed for use by patients and providers. Objective: The primary objective of this study was to describe the implementation of the mHeart model and to outline the main facilitators identified when conceiving an mHealth approach. The secondary objectives were to evaluate the barriers, benefits, and willingness to use mHealth services reported by heart transplant recipients and cardiology providers. Methods: This was an implementation strategy study directed by a multidisciplinary cardiology team conducted in four stages: design of the model and the software, development of the mHeart tool, interoperability among systems, and quality and security requirements. A mixed methods study design was applied combining a literature review, several surveys, interviews, and focus groups. The approach involved merging engineering and behavioral theory science. Participants were chronic-stage heart transplant recipients, patient associations, health providers, stakeholders, and diverse experts from the legal, data protection, and interoperability fields. Results: An interdisciplinary and patient-centered process was applied to obtain a comprehensive care model. The heart transplant recipients (N=135) included in the study confirmed they had access to smartphones (132/135, 97.7\%) and were willing to use the mHeart system (132/135, 97.7\%). Based on stakeholder agreement (>75\%, N=26), the major priorities identified of the mHealth approach were to improve therapy management, patient empowerment, and patient-provider interactions. Stakeholder agreement on the barriers to implementing the system was weak (<75\%). Establishing the new model posed several challenges to the multidisciplinary team in charge. The main factors that needed to be overcome were ensuring data confidentiality, reducing workload, minimizing the digital divide, and increasing interoperability. Experts from various fields, scientific societies, and patient associations were essential to meet the quality requirements and the model scalability. Conclusions: The mHeart model will be applicable in distinct clinical and research contexts, and may inspire other cardiology health providers to create innovative ways to deal with therapeutic complexity and multimorbidity through health care systems. Professionals and patients are willing to use such innovative mHealth programs. The facilitators and key strategies described were needed for success in the implementation of the new holistic theory--based mHealth strategy. ",
doi="10.2196/19065",
url="http://cardio.jmir.org/2020/1/e19065/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33231557"
}


@Article{info:doi/10.2196/19570,
author="Steegers-Theunissen, R{\'e}gine
and Hoek, Annemieke
and Groen, Henk
and Bos, Annelies
and van den Dool, Grada
and Schoonenberg, Marieke
and Smeenk, Jesper
and Creutzberg, Eva
and Vecht, Loes
and Starmans, Luc
and Laven, Joop",
title="Pre-Conception Interventions for Subfertile Couples Undergoing Assisted Reproductive Technology Treatment: Modeling Analysis",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Nov",
day="23",
volume="8",
number="11",
pages="e19570",
keywords="fertility, periconception, pregnancy chance, Smarter Pregnancy, cost-effectiveness, nutrition, obesity, IVF treatment",
keywords="mobile and web-based lifestyle apps",
abstract="Background: Approximately 1 in 7 couples experience subfertility, many of whom have lifestyles that negatively affect fertility, such as poor nutrition, low physical activity, obesity, smoking, or alcohol consumption. Reducing lifestyle risk factors prior to pregnancy or assisted reproductive technology treatment contributes to the improvement of reproductive health, but cost-implications are unknown. Objective: The goal of this study was to evaluate reproductive, maternal pregnancy, and birth outcomes, as well as the costs of pre-conception lifestyle intervention programs in subfertile couples and obese women undergoing assisted reproductive technology. Methods: Using a hypothetical model based on quantitative parameters from published literature and expert opinion, we evaluated the following lifestyle intervention programs: (1) Smarter Pregnancy, an online tool; (2) LIFEstyle, which provides outpatient support for obese women; (3) concurrent use of both Smarter Pregnancy and LIFEstyle for obese women; (4) smoking cessation in men; and (5) a mindfulness mental health support program using group therapy sessions. The model population was based on data from the Netherlands. Results: All model-based analyses of the lifestyle interventions showed a reduction in the number of in vitro fertilization, intracytoplasmic sperm injection, or intrauterine insemination treatments required to achieve pregnancy and successful birth for couples in the Netherlands. Smarter Pregnancy was modeled to have the largest increase in spontaneous pregnancy rate (13.0\%) and the largest absolute reduction in potential assisted reproductive technology treatments. Among obese subfertile women, LIFEstyle was modeled to show a reduction in the occurrence of gestational diabetes, maternal hypertensive pregnancy complications, and preterm births by 4.4\%, 3.8\%, and 3.0\%, respectively, per couple. Modeled cost savings per couple per year were {\texteuro}41 (US \$48.66), {\texteuro}360 (US \$427.23), {\texteuro}513 (US \$608.80), {\texteuro}586 (US \$695.43), and {\texteuro}1163 (US \$1380.18) for smoking cessation, mindfulness, Smarter Pregnancy, combined Smarter Pregnancy AND LIFEstyle, and LIFEstyle interventions, respectively. Conclusions: Although we modeled the potential impact on reproductive outcomes and costs of fertility treatment rather than collecting real-world data, our model suggests that of the lifestyle interventions for encouraging healthier behaviors, all are likely to be cost effective and appear to have positive effects on reproductive, maternal pregnancy, and birth outcomes. Further real-world data are required to determine the cost-effectiveness of pre-conception lifestyle interventions, including mobile apps and web-based tools that help improve lifestyle, and their effects on reproductive health. We believe that further implementation of the lifestyle app Smarter Pregnancy designed for subfertile couples seeking assistance to become pregnant is likely to be cost-effective and would allow reproductive health outcomes to be collected. ",
doi="10.2196/19570",
url="https://mhealth.jmir.org/2020/11/e19570",
url="http://www.ncbi.nlm.nih.gov/pubmed/33226349"
}


@Article{info:doi/10.2196/22136,
author="de Batlle, Jordi
and Massip, Mireia
and Vargiu, Eloisa
and Nadal, Nuria
and Fuentes, Araceli
and Ortega Bravo, Marta
and Colomina, Jordi
and Drudis, Reis
and Torra, Montserrat
and Pallis{\'o}, Francesc
and Miralles, Felip
and Barb{\'e}, Ferran
and Torres, Gerard
and ",
title="Implementing Mobile Health--Enabled Integrated Care for Complex Chronic Patients: Patients and Professionals' Acceptability Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Nov",
day="20",
volume="8",
number="11",
pages="e22136",
keywords="mHealth",
keywords="eHealth",
keywords="patient acceptance of health care",
keywords="patient satisfaction",
keywords="health plan implementation",
keywords="chronic diseases",
abstract="Background: Integrated care (IC) can promote health and social care efficiency through prioritization of preventive patient-centered models and defragmentation of care and collaboration across health tiers, and mobile health (mHealth) can be the cornerstone allowing for the adoption of IC. Objective: This study aims to assess the acceptability, usability, and satisfaction of an mHealth-enabled IC model for complex chronic patients in both patients and health professionals. Methods: As part of the CONNECARE Horizon 2020 project, a prospective, pragmatic, 2-arm, parallel, hybrid effectiveness-implementation trial was conducted from July 2018 to August 2019 in a rural region of Catalonia, Spain. Home-dwelling patients 55 years and older with chronic conditions and a history of hospitalizations for chronic obstructive pulmonary disease or heart failure (use case [UC] 1), or a scheduled major elective hip or knee arthroplasty (UC2) were recruited. During the 3 months, patients experienced an mHealth-enabled IC model, including a self-management app for patients, a set of integrated sensors, and a web-based platform connecting professionals from different settings or usual care. The Person-Centered Coordinated Care Experience Questionnaire (P3CEQ) and the Nijmegen Continuity Questionnaire (NCQ) assessed person-centeredness and continuity of care. Acceptability was assessed for IC arm patients and staff with the Net Promoter Score (NPS) and the System Usability Scale (SUS). Results: The analyses included 77 IC patients, 58 controls who completed the follow-up, and 30 health care professionals. The mean age was 78 (SD 9) years in both study arms. Perception of patient-centeredness was similarly high in both arms (usual care: mean P3CEQ score 16.1, SD 3.3; IC: mean P3CEQ score 16.3, SD 2.4). IC patients reported better continuity of care than controls (usual care: mean NCQ score 3.7, SD 0.9; IC: mean NCQ score 4.0, SD 1; P=.04). The scores for patient acceptability (UC1: NPS +67\%; UC2: NPS +45\%) and usability (UC1: mean SUS score 79, SD 14; UC2: mean SUS score 68, SD 24) were outstanding. Professionals' acceptability was low (UC1: NPS ?25\%; UC2: NPS ?35\%), whereas usability was average (UC1: mean SUS score 63, SD 20; UC2: mean SUS score 62, SD 19). The actual use of technology was high; 77\% (58/75) of patients reported physical activity for at least 60 days, and the ratio of times reported over times prescribed for other sensors ranged from 37\% for oxygen saturation to 67\% for weight. Conclusions: The mHealth-enabled IC model showed outstanding results from the patients' perspective in 2 different UCs but lacked maturity and integration with legacy systems to be fully accepted by professionals. This paper provides useful lessons learned through the development and assessment process and may be of use to organizations willing to develop or implement mHealth-enabled IC for older adults. ",
doi="10.2196/22136",
url="https://mhealth.jmir.org/2020/11/e22136",
url="http://www.ncbi.nlm.nih.gov/pubmed/33216004"
}


@Article{info:doi/10.2196/16158,
author="Edwards, Colin
and Costello, Eamonn
and Cassidy, Nicola
and Vick, Bill
and Russell, Anne-Marie",
title="Use of the patientMpower App With Home-Based Spirometry to Monitor the Symptoms and Impact of Fibrotic Lung Conditions: Longitudinal Observational Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Nov",
day="20",
volume="8",
number="11",
pages="e16158",
keywords="idiopathic pulmonary fibrosis",
keywords="pulmonary fibrosis",
keywords="eHealth",
keywords="mHealth",
keywords="patient-reported outcome measure",
keywords="spirometry",
keywords="home spirometry",
keywords="patient experience",
keywords="digital health",
keywords="patient advocacy",
abstract="Background: Daily home-based spirometry in idiopathic pulmonary fibrosis (IPF) has been shown to be feasible and clinically informative. The patientMpower app facilitates home-based spirometry along with home-based monitoring of IPF-related symptoms. The patientMpower app can be downloaded to the user's mobile phone or tablet device, enabling the recording of objective and subjective data. Objective: The aim of this paper is to report on the 1-year experience of using patientMpower with home-based spirometry by 36 participants with self-reported pulmonary fibrosis (PF) treated with usual care. Methods: Self-selecting participants enrolled in this community-based participatory research program through a patient advocacy group in their country: Irish Lung Fibrosis Association in Ireland and PF Warriors in the United States. Disease severity was comparable with a baseline mean predicted forced vital capacity (FVC) of 64\% and 62\% in the Irish and US participants, respectively. Both groups of participants were allocated to identical, in-country, open-label, single-group observational studies and were provided with a Bluetooth-active Spirobank Smart spirometer integrated directly with patientMpower. Data collected via patientMpower included seated FVC (daily), breathlessness grade (modified Medical Research Council scale score), step count, medication adherence, and symptoms and impact of IPF on daily life, which were measured by a patient-reported outcome measure (PROM) scale that was specifically developed for IPF. Longitudinal patient-reported data on oximetry and oxygen consumption were also collected. Results: A large majority of the 36 participants reported that their experience using patientMpower was positive, and they wanted to continue its use after the initial 6-week observation. Out of 36 participants, 21 (58\%) recorded home-based spirometry without prompting for ?180 days, and 9 (25\%) participants continued with recording home-based spirometry for ?360 days. Conclusions: The patientMpower app with associated Bluetooth-connected devices (eg, spirometer and pulse oximeter) offers an acceptable and accessible approach to collecting patient-reported objective and subjective data in fibrotic lung conditions. ",
doi="10.2196/16158",
url="http://mhealth.jmir.org/2020/11/e16158/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33216007"
}


@Article{info:doi/10.2196/21577,
author="Korpershoek, JG Yvonne
and Holtrop, Tjitske
and Vervoort, CJM Sigrid
and Schoonhoven, Lisette
and Schuurmans, J. Marieke
and Trappenburg, CA Jaap",
title="Early-Stage Feasibility of a Mobile Health Intervention (Copilot) to Enhance Exacerbation-Related Self-Management in Patients With Chronic Obstructive Pulmonary Disease: Multimethods Approach",
journal="JMIR Form Res",
year="2020",
month="Nov",
day="19",
volume="4",
number="11",
pages="e21577",
keywords="mobile health",
keywords="mHealth",
keywords="mobile app",
keywords="COPD",
keywords="exacerbation",
keywords="self-management",
keywords="self-care",
abstract="Background: There is an emergence of mobile health (mHealth) interventions to support self-management in patients with chronic obstructive pulmonary disease (COPD). Recently, an evidence-driven mHealth intervention has been developed to support patients with COPD in exacerbation-related self-management: the Copilot app. Health care providers (HCPs) are important stakeholders as they are the ones who have to provide the app to patients, personalize the app, and review the app. It is, therefore, important to investigate at an early stage whether the app is feasible in the daily practice of the HCPs. Objective: The aim of this study is to evaluate the perceived feasibility of the Copilot app in the daily practice of HCPs. Methods: A multimethods design was used to investigate how HCPs experience working with the app and how they perceive the feasibility of the app in their daily practice. The feasibility areas described by Bowen et al were used for guidance. HCPs were observed while performing tasks in the app and asked to think aloud. The System Usability Scale was used to investigate the usability of the app, and semistructured interviews were conducted to explore the feasibility of the app. The study was conducted in primary, secondary, and tertiary care settings in the Netherlands from February 2019 to September 2019. Results: In total, 14 HCPs participated in this study---8 nurses, 5 physicians, and 1 physician assistant. The HCPs found the app acceptable to use. The expected key benefits of the app were an increased insight into patient symptoms, more structured patient conversations, and more tailored self-management support. The app especially fits within the available time and workflow of nurses. The use of the app will be influenced by the autonomy of the professional, the focus of the organization on eHealth, costs associated with the app, and compatibility with the current systems used. Most HCPs expressed that there are conditions that must be met to be able to use the app. The app can be integrated into the existing care paths of primary, secondary, and tertiary health care settings. Individual organizational factors must be taken into account when integrating the app into daily practice. Conclusions: This early-stage feasibility study shows that the Copilot app is feasible to use in the daily practice of HCPs and can be integrated into primary, secondary, and tertiary health care settings in the Netherlands. The app was considered to best fit the role of the nurses. The app will be less feasible for those organizations in which many conditions need to be met to use the app. This study provides a new approach to evaluate the perceived feasibility of mHealth interventions at an early stage and provides valuable insights for further feasibility testing. ",
doi="10.2196/21577",
url="http://formative.jmir.org/2020/11/e21577/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33211013"
}


@Article{info:doi/10.2196/18982,
author="Biran, Noa
and Anthony Kouyat{\'e}, Robin
and Yucel, Emre
and McGovern, E. Gillian
and Schoenthaler, M. Antoinette
and Durling, G. Olivia
and Unawane, Rashmi
and Schutt, Andrew
and Panjabi, Sumeet",
title="Adaptation and Evaluation of a Symptom-Monitoring Digital Health Intervention for Patients With Relapsed and Refractory Multiple Myeloma: Pilot Mixed-Methods Implementation Study",
journal="JMIR Form Res",
year="2020",
month="Nov",
day="17",
volume="4",
number="11",
pages="e18982",
keywords="mHealth",
keywords="digital health",
keywords="electronic patient-reported outcome",
keywords="ePRO",
keywords="patient-reported outcome",
keywords="PRO",
keywords="mobile",
keywords="app",
keywords="implementation science",
keywords="multiple myeloma",
keywords="relapsed refractory multiple myeloma",
abstract="Background: Relapsed and refractory multiple myeloma (RRMM) is a bone marrow cancer that requires systemic treatment, which often results in severe symptom burden. Recent studies have found that electronic patient-reported outcome (ePRO) interventions implemented in the clinic setting have had positive outcomes for other oncology populations. Evidence of the efficacy of a similar approach is lacking for patients with RRMM. Objective: Recent recommendations for digital health interventions call for the publication of descriptions of iterative development processes in order to improve reproducibility and comparability. This study is an implementation pilot aiming to evaluate the acceptability and appropriateness of an ePRO intervention for patients with RRMM and to explore its impact on clinic workflow. Methods: A total of 11 patients with RRMM were recruited from the John Theurer Cancer Center in Hackensack, New Jersey. Patients used a mobile app to report on 17 symptoms at 4 sessions, each a week apart. Patients could also report symptoms ad hoc. When reports met predefined thresholds, the clinic was alerted and patients received automated guidance. Study end points were assessed using qualitative and quantitative methods. Results: A total of 9 patients (mean age 69.7 years) completed the study. Overall, 83\% (30/36) of weekly sessions were completed. Patients found the frequency and time required to complete reporting acceptable. All patients agreed that the app was easy to use and understand. Providers felt the alerts they received required refinement. Patients and providers agreed it would be beneficial for patients to report for longer than 4 weeks. Patients felt that the training they received was adequate but contained too much information for a single session. All patients found the symptoms tracked to be appropriate; providers suggested shortening the list. All patients understood how to use the app for weekly reporting but had confusion about using it ad hoc. Providers felt the ad hoc feature could be removed. Neither patients nor providers viewed the in-app data reports but agreed on their potential value. Patients reported benefitting from symptom reporting through increased awareness of their symptoms. Clinic staff reported that app alerts were too numerous and redundant. They had difficulty responding to alerts within their existing workflow, partially because the data were not integrated into the electronic medical record system. Conclusions: Overall, the intervention was found to be acceptable and appropriate for patients with RRMM. Points of friction integrating the intervention into the clinic workflow were identified. Clinic staff provided recommendations for addressing these issues. Once such modifications are implemented, ePRO data from patients with RRMM could be used to inform and improve clinical research and care. This study underlines the importance of an iterative approach to implementation that includes all stakeholders in order to ensure successful adoption. ",
doi="10.2196/18982",
url="http://formative.jmir.org/2020/11/e18982/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33200997"
}


@Article{info:doi/10.2196/19180,
author="Maguire, Roma
and Connaghan, John
and Arber, Anne
and Klepacz, Naomi
and Blyth, G. Kevin
and McPhelim, John
and Murray, Paul
and Rupani, Hitasha
and Chauhan, Anoop
and Williams, Peter
and McNaughton, Laura
and Woods, Kirstie
and Moylan, Anne",
title="Advanced Symptom Management System for Patients with Malignant Pleural Mesothelioma (ASyMSmeso): Mixed Methods Study",
journal="J Med Internet Res",
year="2020",
month="Nov",
day="12",
volume="22",
number="11",
pages="e19180",
keywords="malignant pleural mesothelioma",
keywords="patient reported outcome measures",
keywords="cancer",
keywords="mobile health",
keywords="telemedicine, symptom monitoring",
abstract="Background: Patients with malignant pleural mesothelioma (MPM) have a life-limiting illness and short prognosis and experience many debilitating symptoms from early in the illness. Innovations such as remote symptom monitoring are needed to enable patients to maintain wellbeing and manage symptoms in a proactive and timely manner. The Advanced Symptom Management System (ASyMS) has been successfully used to monitor symptoms associated with cancer. Objective: This study aimed to determine the feasibility and acceptability of using an ASyMS adapted for use by patients with MPM, called ASyMSmeso, enabling the remote monitoring of symptoms using a smartphone. Methods: This was a convergent mixed methods study using patient-reported outcome measures (PROMs) at key time points over a period of 2-3 months with 18 patients. The Sheffield Profile for Assessment and Referral for Care (SPARC), Technology Acceptance Model (TAM) measure for eHealth, and Lung Cancer Symptom Scale-Mesothelioma (LCSS-Meso) were the PROMs used in the study. Patients were also asked to complete a daily symptom questionnaire on a smartphone throughout the study. At the end of the study, semistructured interviews with 11 health professionals, 8 patients, and 3 carers were conducted to collect their experience with using ASyMSmeso. Results: Eighteen patients with MPM agreed to participate in the study (33.3\% response rate). The completion rates of study PROMs were high (97.2\%-100\%), and completion rates of the daily symptom questionnaire were also high, at 88.5\%. There were no significant changes in quality of life, as measured by LCSS-Meso. There were statistically significant improvements in the SPARC psychological need domain (P=.049) and in the ``Usefulness'' domain of the TAM (P=.022). End-of-study interviews identified that both patients and clinicians found the system quick and easy to use. For patients, in particular, the system provided reassurance about symptom experience and the feeling of being listened to. The clinicians largely viewed the system as feasible and acceptable, and areas that were mentioned included the early management of symptoms and connectivity between patients and clinicians, leading to enhanced communication. Conclusions: This study demonstrates that remote monitoring and management of symptoms of people with MPM using a mobile phone are feasible and acceptable. The evidence supports future trials using remote symptom monitoring to support patients with MPM at home. ",
doi="10.2196/19180",
url="https://www.jmir.org/2020/11/e19180",
url="http://www.ncbi.nlm.nih.gov/pubmed/33180025"
}


@Article{info:doi/10.2196/15885,
author="Wali, Sahr
and Keshavjee, Karim
and Nguyen, Linda
and Mbuagbaw, Lawrence
and Demers, Catherine",
title="Using an Electronic App to Promote Home-Based Self-Care in Older Patients With Heart Failure: Qualitative Study on Patient and Informal Caregiver Challenges",
journal="JMIR Cardio",
year="2020",
month="Nov",
day="9",
volume="4",
number="1",
pages="e15885",
keywords="mobile health",
keywords="mobile apps",
keywords="heart failure",
keywords="self-care",
keywords="mobile phone",
abstract="Background: Heart failure (HF) affects many older individuals in North America, with recurrent hospitalizations despite postdischarge strategies to prevent readmission. Proper HF self-care can potentially lead to better clinical outcomes, yet many older patients find self-care challenging. Mobile health (mHealth) apps can provide support to patients with respect to HF self-care. However, many mHealth apps are not designed to consider potential patient barriers, such as literacy, numeracy, and cognitive impairment, leading to challenges for older patients. We previously demonstrated that a paper-based standardized diuretic decision support tool (SDDST) with daily weights and adjustment of diuretic dose led to improved self-care. Objective: The aim of this study is to better understand the self-care challenges that older patients with HF and their informal care providers (CPs) face on a daily basis, leading to the conversion of the SDDST into a user-centered mHealth app. Methods: We recruited 14 patients (male: 8/14, 57\%) with a confirmed diagnosis of HF, aged ?60 years, and 7 CPs from the HF clinic and the cardiology ward at the Hamilton General Hospital. Patients were categorized into 3 groups based on the self-care heart failure index: patients with adequate self-care, patients with inadequate self-care without a CP, or patients with inadequate self-care with a CP. We conducted semistructured interviews with patients and their CPs using persona-scenarios. Interviews were transcribed verbatim and analyzed for emerging themes using an inductive approach. Results: Six themes were identified: usability of technology, communication, app customization, complexity of self-care, usefulness of HF-related information, and long-term use and cost. Many of the challenges patients and CPs reported involved their unfamiliarity with technology and the lack of incentive for its use. However, participants were supportive and more likely to actively use the HF app when informed of the intervention's inclusion of volunteer and nurse assistance. Conclusions: Patients with varying self-care adequacy levels were willing to use an mHealth app if it was simple in its functionality and user interface. To promote the adoption and usability of these tools, patients confirmed the need for researchers to engage with end users before developing an app. Findings from this study can be used to help inform the design of an mHealth app to ensure that it is adapted for the needs of older individuals with HF. ",
doi="10.2196/15885",
url="http://cardio.jmir.org/2020/1/e15885/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33164901"
}


@Article{info:doi/10.2196/22212,
author="B{\"o}hm, Anna-Katharina
and Jensen, Lind Morten
and S{\o}rensen, Reinholdt Mads
and Stargardt, Tom",
title="Real-World Evidence of User Engagement With Mobile Health for Diabetes Management: Longitudinal Observational Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Nov",
day="6",
volume="8",
number="11",
pages="e22212",
keywords="user engagement",
keywords="user activity",
keywords="mHealth",
keywords="diabetes mellitus",
keywords="diabetes apps",
abstract="Background: Patient support apps have risen in popularity and provide novel opportunities for self-management of diabetes. Such apps offer patients to play an active role in monitoring their condition, thereby increasing their own treatment responsibility. Although many health apps require active user engagement to be effective, there is little evidence exploring engagement with mobile health (mHealth). Objective: This study aims to analyze the extent to which users engage with mHealth for diabetes and identify patient characteristics that are associated with engagement. Methods: The analysis is based on real-world data obtained by Novo Nordisk's Cornerstones4Care Powered by Glooko diabetes support app. User engagement was assessed as the number of active days and using measures expressing the persistence, longevity, and regularity of interaction within the first 180 days of use. Beta regressions were estimated to assess the associations between user characteristics and engagement outcomes for each module of the app. Results: A total of 9051 individuals initiated use after registration and could be observed for 180 days. Among these, 55.39\% (5013/9051) used the app for one specific purpose. The average user activity ratio varied from 0.05 (medication and food) to 0.55 (continuous glucose monitoring), depending on the module of the app. Average user engagement was lower if modules required manual data entries, although the initial uptake was higher for these modules. Regression analyses further revealed that although more women used the app (2075/3649, 56.86\%), they engaged significantly less with it. Older people and users who were recently diagnosed tended to use the app more actively. Conclusions: Strategies to increase or sustain the use of apps and availability of health data may target the mode of data collection and content design and should take into account privacy concerns of the users at the same time. Users' engagement was determined by various user characteristics, indicating that particular patient groups should be targeted or assisted when integrating apps into the self-management of their disease. ",
doi="10.2196/22212",
url="http://mhealth.jmir.org/2020/11/e22212/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32975198"
}


@Article{info:doi/10.2196/19260,
author="Seppen, F. Bart
and den Boer, Pim
and Wiegel, Jimmy
and ter Wee, M. Marieke
and van der Leeden, Marike
and de Vries, Ralph
and van der Esch, Martin
and Bos, H. Wouter",
title="Asynchronous mHealth Interventions in Rheumatoid Arthritis: Systematic Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Nov",
day="5",
volume="8",
number="11",
pages="e19260",
keywords="mobile health",
keywords="eHealth",
keywords="digital health",
keywords="telehealth",
keywords="telerheumatology",
keywords="mHealth",
keywords="web app",
keywords="smartphone app",
keywords="activity tracker",
keywords="rheumatoid arthritis",
keywords="rheumatology",
keywords="review",
keywords="telemonitoring",
abstract="Background: Mobile devices such as smartphones and tablets have surged in popularity in recent years, generating numerous possibilities for their use in health care as mobile health (mHealth) tools. One advantage of mHealth is that it can be provided asynchronously, signifying that health care providers and patients are not communicating in real time. The integration of asynchronous mHealth into daily clinical practice might therefore help to make health care more efficient for patients with rheumatoid arthritis (RA). The benefits have been reviewed in various medical conditions, such as diabetes and asthma, with promising results. However, to date, it is unclear what evidence exists for the use of asynchronous mHealth in the field of RA. Objective: The objective of this study was to map the different asynchronous mHealth interventions tested in clinical trials in patients with RA and to summarize the effects of the interventions. Methods: A systematic search of Pubmed, Scopus, Cochrane, and PsycINFO was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies were initially screened and later assessed by two independent researchers. Disagreements on inclusion or exclusion of studies were resolved by discussion. Results: The literature search yielded 1752 abstracts. After deduplication and screening, 10 controlled intervention studies were included. All studies were assessed to be at risk for bias in at least one domain of the Cochrane risk-of-bias tool. In the 10 selected studies, 4 different types of mHealth interventions were used: SMS reminders (to increase medication adherence or physical activity; n=3), web apps (for disease monitoring and/or to provide medical information; n=5), smartphone apps (for disease monitoring; n=1), and pedometers (to increase and track steps; n=1). Measured outcomes varied widely between studies; improvements were seen in terms of medication compliance (SMS reminders), reaching rapid remission (web app), various domains of physical activity (pedometer, SMS reminders, and web apps), patient-physician interaction (web apps), and self-efficacy (smartphone app). Conclusions: SMS reminders, web apps, smartphone apps, and pedometers have been evaluated in intervention studies in patients with RA. These interventions have been used to monitor patients or to support them in their health behavior. The use of asynchronous mHealth led to desirable outcomes in nearly all studies. However, since all studies were at risk of bias and methods used were very heterogeneous, high-quality research is warranted to corroborate these promising results. ",
doi="10.2196/19260",
url="http://mhealth.jmir.org/2020/11/e19260/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33151161"
}


@Article{info:doi/10.2196/20322,
author="Gong, Enying
and Baptista, Shaira
and Russell, Anthony
and Scuffham, Paul
and Riddell, Michaela
and Speight, Jane
and Bird, Dominique
and Williams, Emily
and Lotfaliany, Mojtaba
and Oldenburg, Brian",
title="My Diabetes Coach, a Mobile App--Based Interactive Conversational Agent to Support Type 2 Diabetes Self-Management: Randomized Effectiveness-Implementation Trial",
journal="J Med Internet Res",
year="2020",
month="Nov",
day="5",
volume="22",
number="11",
pages="e20322",
keywords="type 2 diabetes mellitus",
keywords="self-management",
keywords="health-related quality of life",
keywords="digital technology",
keywords="coaching",
keywords="mobile phone",
abstract="Background: Delivering self-management support to people with type 2 diabetes mellitus is essential to reduce the health system burden and to empower people with the skills, knowledge, and confidence needed to take an active role in managing their own health. Objective: This study aims to evaluate the adoption, use, and effectiveness of the My Diabetes Coach (MDC) program, an app-based interactive embodied conversational agent, Laura, designed to support diabetes self-management in the home setting over 12 months. Methods: This randomized controlled trial evaluated both the implementation and effectiveness of the MDC program. Adults with type 2 diabetes in Australia were recruited and randomized to the intervention arm (MDC) or the control arm (usual care). Program use was tracked over 12 months. Coprimary outcomes included changes in glycated hemoglobin (HbA1c) and health-related quality of life (HRQoL). Data were assessed at baseline and at 6 and 12 months, and analyzed using linear mixed-effects regression models. Results: A total of 187 adults with type 2 diabetes (mean 57 years, SD 10 years; 41.7\% women) were recruited and randomly allocated to the intervention (n=93) and control (n=94) arms. MDC program users (92/93 participants) completed 1942 chats with Laura, averaging 243 min (SD 212) per person over 12 months. Compared with baseline, the mean estimated HbA1c decreased in both arms at 12 months (intervention: 0.33\% and control: 0.20\%), but the net differences between the two arms in change of HbA1c (?0.04\%, 95\% CI ?0.45 to 0.36; P=.83) was not statistically significant. At 12 months, HRQoL utility scores improved in the intervention arm, compared with the control arm (between-arm difference: 0.04, 95\% CI 0.00 to 0.07; P=.04). Conclusions: The MDC program was successfully adopted and used by individuals with type 2 diabetes and significantly improved the users' HRQoL. These findings suggest the potential for wider implementation of technology-enabled conversation-based programs for supporting diabetes self-management. Future studies should focus on strategies to maintain program usage and HbA1c improvement. Trial Registration: Australia New Zealand Clinical Trials Registry (ACTRN) 12614001229662; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614001229662 ",
doi="10.2196/20322",
url="https://www.jmir.org/2020/11/e20322",
url="http://www.ncbi.nlm.nih.gov/pubmed/33151154"
}


@Article{info:doi/10.2196/19696,
author="Weerts, M. Zsa Zsa R.
and Heinen, E. Koert G.
and Masclee, M. Ad A.
and Quanjel, A. Amber B.
and Winkens, Bjorn
and Vork, Lisa
and Rinkens, M. Paula E. L.
and Jonkers, E. Daisy M. A.
and Keszthelyi, Daniel",
title="Smart Data Collection for the Assessment of Treatment Effects in Irritable Bowel Syndrome: Observational Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Nov",
day="2",
volume="8",
number="11",
pages="e19696",
keywords="irritable bowel syndrome",
keywords="digital diary",
keywords="smartphone application",
keywords="mobile phone application",
keywords="mhealth",
keywords="e-health",
keywords="compliance",
keywords="electronic case report file",
keywords="patient reported outcome measures",
keywords="peppermint oil",
keywords="PERSUADE study.",
abstract="Background: End-of-day symptom diaries are recommended by drug regulatory authorities to assess treatment response in patients with irritable bowel syndrome. We developed a smartphone app to measure treatment response. Objective: Because the employment of an app to measure treatment response in irritable bowel syndrome is relatively new, we aimed to explore patients' adherence to diary use and characteristics associated with adherence. Methods: A smartphone app was developed to serve as a symptom diary. Patients with irritable bowel syndrome (based on Rome IV criteria) were instructed to fill out end-of-day diary questionnaires during an 8-week treatment. Additional online questionnaires assessed demographics, irritable bowel syndrome symptom severity, and psychosocial comorbidities. Adherence rate to the diary was defined as the percentage of days completed out of total days. Adherence to the additional web-based questionnaires was also assessed. Results: Overall, 189 patients were included (age: mean 34.0 years, SD 13.3 years; female: 147/189, 77.8\%; male: 42/189, 22.2\%). The mean adherence rate was 87.9\% (SD 9.4\%). However, adherence to the diary decreased over time (P<.001). No significant association was found between adherence and gender (P=.84), age (P=.22), or education level (lower education level: P=.58, middle education level: P=.46, versus high education level), while higher anxiety scores were associated with lower adherence (P=.03). Adherence to the online questionnaires was also high (>99\%). Missing data due to technical issues were limited. Conclusions: The use of a smartphone app as a symptom diary to assess treatment response resulted in high patient adherence. The data-collection framework described led to standardized data collection with excellent completeness and can be used for future randomized controlled trials. Due to the slight decrease in adherence to diary use throughout the study, this method might be less suitable for longer trials. ",
doi="10.2196/19696",
url="https://mhealth.jmir.org/2020/11/e19696",
url="http://www.ncbi.nlm.nih.gov/pubmed/33030150"
}


@Article{info:doi/10.2196/18922,
author="Ramallo-Fari{\~n}a, Yolanda
and Garc{\'i}a-Bello, Angel Miguel
and Garc{\'i}a-P{\'e}rez, Lidia
and Boronat, Mauro
and W{\"a}gner, M. Ana
and Rodr{\'i}guez-Rodr{\'i}guez, Leticia
and de Pablos-Velasco, Pedro
and Llorente G{\'o}mez de Segura, Ignacio
and Gonz{\'a}lez- Pacheco, Himar
and Carmona Rodr{\'i}guez, Montserrat
and Serrano-Aguilar, Pedro
and ",
title="Effectiveness of Internet-Based Multicomponent Interventions for Patients and Health Care Professionals to Improve Clinical Outcomes in Type 2 Diabetes Evaluated Through the INDICA Study: Multiarm Cluster Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Nov",
day="2",
volume="8",
number="11",
pages="e18922",
keywords="behavior modification",
keywords="primary care",
keywords="type 2 diabetes mellitus",
keywords="patients adherence",
keywords="eHealth",
abstract="Background: Type 2 diabetes mellitus (T2DM) is a chronic disease in which health outcomes are related to decision making by patients and health care professionals. Objective: This study aims to assess the effectiveness of internet-based multicomponent interventions to support decision making of all actors involved in the care of patients with T2DM in primary care. Methods: The INDICA study is an open, community-based, multicenter trial with random allocation to usual care or the intervention for patients, the intervention for health care professionals in primary care, or the combined intervention for both. In the intervention for patients, participants received an educational group program and were monitored and supported by logs, a web-based platform, and automated SMS. Those in the intervention for professionals also received an educational program, a decision support tool embedded in the electronic clinical record, and periodic feedback about patients' results. A total of 2334 people with T2DM, regardless of glycated hemoglobin (HbA1c) levels and without diabetes-related complications, were included. The primary end point was change in HbA1c level. The main analysis was performed using multilevel mixed models. Results: For the overall sample, the intervention for patients attained a significant mean reduction in HbA1c levels of ?0.27 (95\% CI ?0.45 to ?0.10) at month 3 and ?0.26 (95\% CI ?0.44 to ?0.08) at month 6 compared with usual care, which remained marginally significant at month 12. A clinically relevant reduction in HbA1c level was observed in 35.6\% (191/537) of patients in the intervention for patients and 26.0\% (152/586) of those in usual care at month 12 (P=.006). In the combined intervention, HbA1c reduction was significant until month 18 (181/557, 32.6\% vs 140/586, 23.9\%; P=.009). Considering the subgroup of patients uncontrolled at baseline, all interventions produced significant reductions in HbA1c levels across the entire study period: ?0.49 (95\% CI ?0.70 to ?0.27) for the intervention for patients, ?0.35 (95\% CI ?0.59 to ?0.14) for the intervention for professionals, and ?0.35 (95\% CI ?0.57 to ?0.13) for the combined intervention. Differences in HbA1c for the area under the curve considering the entire period were significant for the intervention for patients and the combined intervention compared with usual care (P=.03 for both). Compared with usual care, the intervention for professionals and the combined intervention had significant longer-term reductions in systolic and diastolic blood pressure. Conclusions: In uncontrolled patients, the intervention for patients at baseline provided clinically relevant and significant longer-term reductions of HbA1c levels. The intervention for professionals and combined intervention also improved the cardiovascular risk profile of patients. Trial Registration: ClinicalTrials.gov NCT01657227; https://clinicaltrials.gov/ct2/show/NCT01657227 ",
doi="10.2196/18922",
url="https://mhealth.jmir.org/2020/11/e18922",
url="http://www.ncbi.nlm.nih.gov/pubmed/33136059"
}


@Article{info:doi/10.2196/20747,
author="Davoudi, Mahboube
and Najafi Ghezeljeh, Tahereh
and Vakilian Aghouee, Farveh",
title="Effect of a Smartphone-Based App on the Quality of Life of Patients With Heart Failure: Randomized Controlled Trial",
journal="JMIR Nursing",
year="2020",
month="Nov",
day="2",
volume="3",
number="1",
pages="e20747",
keywords="heart failure",
keywords="mobile app",
keywords="quality of life",
keywords="mobile phone",
abstract="Background: Patients with heart failure have low quality of life because of physical impairments and advanced clinical symptoms. One of the main goals of caring for patients with heart failure is to improve their quality of life. Objective: The aim of this study was to investigate the effect of the use of a smartphone-based app on the quality of life of patients with heart failure. Methods: This randomized controlled clinical trial with a control group was conducted from June to October 2018 in an urban hospital. In this study, 120 patients with heart failure hospitalized in cardiac care units were randomly allocated to control and intervention groups. Besides routine care, patients in the intervention group received a smartphone-based app and used it every day for 3 months. Both the groups completed the Minnesota Living with Heart Failure Questionnaire before entering the study and at 3 months after entering the study. Data were analyzed using the SPSS software V.16. Results: The groups showed statistically significant differences in the mean scores of quality of life and its dimensions after the intervention, thereby indicating a better quality of life in the intervention group (P<.001). The effect size of the intervention on the quality of life was 1.85 (95\% CI 1.41-2.3). Moreover, the groups showed statistically significant differences in the changes in the quality of life scores and its dimensions (P<.001). Conclusions: Use of a smartphone-based app can improve the quality of life in patients with heart failure. The results of our study recommend that digital apps be used for improving the management of patients with heart failure. Trial Registration: Iranian Registry of Clinical Trials IRCT2017061934647N1; https://www.irct.ir/trial/26434 ",
doi="10.2196/20747",
url="https://nursing.jmir.org/2020/1/e20747",
url="http://www.ncbi.nlm.nih.gov/pubmed/34406971"
}


@Article{info:doi/10.2196/16898,
author="Xu, Xiaomeng
and Griva, Konstadina
and Koh, Mark
and Lum, Elaine
and Tan, Shin Woan
and Thng, Steven
and Car, Josip",
title="Creating a Smartphone App for Caregivers of Children With Atopic Dermatitis With Caregivers, Health Care Professionals, and Digital Health Experts: Participatory Co-Design",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Oct",
day="29",
volume="8",
number="10",
pages="e16898",
keywords="atopic dermatitis",
keywords="eczema",
keywords="mobile phone",
keywords="telehealth",
abstract="Background: Smartphone apps could support patients and caregivers in disease self-management. However, as patients' experiences and needs might not always align with clinical judgments, the eliciting and engaging of perspectives of all stakeholders in the smartphone app design process is of paramount importance. Objective: The aims of this study are to better understand the needs of and challenges facing caregivers and health care professionals (HCPs) who care for children with atopic dermatitis (AD) and to explore the desirable features and content of a smartphone app that would support AD self-management. Methods: This study adopted a qualitative participatory co-design methodology involving 3 focus group discussions: workshop one focused on caregivers; workshop two engaged with HCPs; and in the last workshop, caregivers and digital health experts were asked to design the wireframe prototype. The participants completed a sociodemographic questionnaire, a technology acceptance questionnaire, and a workshop evaluation form. Results: Twelve caregivers participated in the first workshop, and 10 HCPs participated in the second workshop. Eight caregivers and 4 digital health experts attended the third workshop. Three superordinate themes that reflected caregivers' and HCPs' challenges and needs were identified: empowerment by education, confusion over treatment, and emotional impact. Workshop participants also raised a series of suggestions on the features and contents of the AD self-management app, which informed the last co-design workshop, and described their needs and challenges. In the last workshop, the participants developed a wireframe prototype of the app following the identified requirements and recommendations. Conclusions: The co-design approach was found to be a successful way of engaging with the participants, as it allowed them to express their creativity and helped us to articulate the root of the clinical problems. The co-design workshop was successful in creating and generating new ideas and solutions for smartphone app development. ",
doi="10.2196/16898",
url="http://mhealth.jmir.org/2020/10/e16898/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33118949"
}


@Article{info:doi/10.2196/15076,
author="Camacho-Rivera, Marlene
and Vo, Huy
and Huang, Xueqi
and Lau, Julia
and Lawal, Adeola
and Kawaguchi, Akira",
title="Evaluating Asthma Mobile Apps to Improve Asthma Self-Management: User Ratings and Sentiment Analysis of Publicly Available Apps",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Oct",
day="29",
volume="8",
number="10",
pages="e15076",
keywords="mHealth",
keywords="asthma apps",
keywords="sentiment analysis",
keywords="user ratings",
keywords="smartphone",
keywords="mobile phone",
abstract="Background: The development and use of mobile health (mHealth) apps for asthma management have risen dramatically over the past two decades. Asthma apps vary widely in their content and features; however, prior research has rarely examined preferences of users of publicly available apps. Objective: The goals of this study were to provide a descriptive overview of asthma mobile apps that are publicly available and to assess the usability of asthma apps currently available on the market to identify content and features of apps associated with positive and negative user ratings. Methods: Reviews were collected on June 23, 2020, and included publicly posted reviews until June 21, 2020. To characterize features associated with high or low app ratings, we first dichotomized the average user rating of the asthma app into 2 categories: a high average rating and a low average rating. Asthma apps with average ratings of 4 and above were categorized as having a high average rating. Asthma apps with average ratings of less than 4 were categorized as having a low average rating. For the sentiment analysis, we modeled both 2-word (bi-gram) and 3-word (tri-gram) phrases which commonly appeared across highly rated and lowly rated apps. Results: Of the 10 apps that met the inclusion criteria, a total of 373 reviews were examined across all apps. Among apps reviewed, 53.4\% (199/373) received high ratings (average ratings of 4 or 5) and 47.2\% (176/373) received low ratings (average ratings of 3 or less). The number of ratings across all apps ranged from 188 (AsthmaMD) to 10 (My Asthma App); 30\% (3/10) of apps were available on both Android and iOS. From the sentiment analysis, key features of asthma management that were common among highly rated apps included the tracking of peak flow readings (n=48), asthma symptom monitoring (n=11), and action plans (n=10). Key features related to functionality that were common among highly rated apps included ease of use (n=5). Users most commonly reported loss of data (n=14) and crashing of app (n=12) as functionality issues among poorly rated asthma apps. Conclusions: Our study results demonstrate that asthma app quality, maintenance, and updates vary widely across apps and platforms. These findings may call into question the long-term engagement with asthma apps, a crucial factor for determining their potential to improve asthma self-management and asthma clinical outcomes. ",
doi="10.2196/15076",
url="http://mhealth.jmir.org/2020/10/e15076/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33118944"
}


@Article{info:doi/10.2196/17453,
author="Melbye, Sigurd
and Kessing, Vedel Lars
and Bardram, Eyvind Jakob
and Faurholt-Jepsen, Maria",
title="Smartphone-Based Self-Monitoring, Treatment, and Automatically Generated Data in Children, Adolescents, and Young Adults With Psychiatric Disorders: Systematic Review",
journal="JMIR Ment Health",
year="2020",
month="Oct",
day="29",
volume="7",
number="10",
pages="e17453",
keywords="mHealth",
keywords="child and adolescent psychiatry",
keywords="eHealth",
keywords="systematic review",
keywords="psychiatry",
keywords="mobile phone",
abstract="Background: Psychiatric disorders often have an onset at an early age, and early identification and intervention help improve prognosis. A fine-grained, unobtrusive, and effective way to monitor symptoms and level of function could help distinguish severe psychiatric health problems from normal behavior and potentially lead to a more efficient use of clinical resources in the current health care system. The use of smartphones to monitor and treat children, adolescents, and young adults with psychiatric disorders has been widely investigated. However, no systematic review concerning smartphone-based monitoring and treatment in this population has been published. Objective: This systematic review aims at describing the following 4 features of the eligible studies: (1) monitoring features such as self-assessment and automatically generated data, (2) treatment delivered by the app, (3) adherence to self-monitoring, and (4) results of the individual studies. Methods: We conducted a systematic literature search of the PubMed, Embase, and PsycInfo databases. We searched for studies that (1) included a smartphone app to collect self-monitoring data, a smartphone app to collect automatically generated smartphone-based data, or a smartphone-based system for treatment; (2) had participants who were diagnosed with psychiatric disorders or received treatment for a psychiatric disorder, which was verified by an external clinician; (3) had participants who were younger than 25 years; and (4) were published in a peer-reviewed journal. This systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The risk of bias in each individual study was systematically assessed. Results: A total of 2546 unique studies were identified through literature search; 15 of these fulfilled the criteria for inclusion. These studies covered 8 different diagnostic groups: psychosis, eating disorders, depression, autism, self-harm, anxiety, substance abuse, and suicidal behavior. Smartphone-based self-monitoring was used in all but 1 study, and 11 of them reported on the participants' adherence to self-monitoring. Most studies were feasibility/pilot studies, and all studies on feasibility reported positive attitudes toward the use of smartphones for self-monitoring. In 2 studies, automatically generated data were collected. Three studies were randomized controlled trials investigating the effectiveness of smartphone-based monitoring and treatment, with 2 of these showing a positive treatment effect. In 2 randomized controlled trials, the researchers were blinded for randomization, but the participants were not blinded in any of the studies. All studies were determined to be at high risk of bias in several areas. Conclusions: Smartphones hold great potential as a modern, widely available technology platform to help diagnose, monitor, and treat psychiatric disorders in children and adolescents. However, a higher level of homogeneity and rigor among studies regarding their methodology and reporting of adherence would facilitate future reviews and meta-analyses. ",
doi="10.2196/17453",
url="http://mental.jmir.org/2020/10/e17453/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33118950"
}


@Article{info:doi/10.2196/20353,
author="Khowaja, Kamran
and Al-Thani, Dena",
title="New Checklist for the Heuristic Evaluation of mHealth Apps (HE4EH): Development and Usability Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Oct",
day="28",
volume="8",
number="10",
pages="e20353",
keywords="mHealth",
keywords="eHealth",
keywords="heuristic evaluation",
keywords="expert evaluation",
keywords="self-monitoring",
keywords="behavior change",
keywords="design guidelines",
keywords="framework",
abstract="Background: Diabetes is one of the leading causes of death in developing countries. Existing mobile health (mHealth) app design guidelines lack a description of the support of continuous self-monitoring of health status, behavior change to improve and adopt a healthy lifestyle, and communication with health educators and health care professionals in case of any need. Objective: This paper presents the development of a specialized set of heuristics called heuristic evaluation for mHealth apps (HE4EH) as an all-in-one tool and its applicability by performing a heuristic evaluation of an mHealth app. Methods: An extensive review of heuristics and checklists was used to develop the HE4EH. The HE4EH was evaluated by domain experts for heuristics, checklist items, severity ratings, and overall satisfaction. The OneTouch app, which helps individuals with diabetes manage their blood glucose levels, was evaluated using HE4EH to identify usability problems that need to be fixed in the app. Results: The expert evaluation of HE4EH revealed that the heuristics were important, relevant, and clear. The checklist items across the heuristics were clear, relevant, and acceptably grouped. In terms of evaluating the OneTouch app using the HE4EH, the most frequently violated heuristics included Content, Visibility, Match, and Self-monitoring. Most of the usability problems found were minor. The system usability scale score indicated that the OneTouch app is marginally acceptable. Conclusions: This heuristic evaluation using the OneTouch app shows that the HE4EH can play a vital role for designers, researchers, and practitioners to use HE4EH heuristics and checklist items as a tool to design a new or evaluate and improve an existing mHealth app. ",
doi="10.2196/20353",
url="http://mhealth.jmir.org/2020/10/e20353/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33112252"
}


@Article{info:doi/10.2196/16774,
author="Tighe, A. Sarah
and Ball, Kylie
and Kensing, Finn
and Kayser, Lars
and Rawstorn, C. Jonathan
and Maddison, Ralph",
title="Toward a Digital Platform for the Self-Management of Noncommunicable Disease: Systematic Review of Platform-Like Interventions",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="28",
volume="22",
number="10",
pages="e16774",
keywords="noncommunicable diseases",
keywords="chronic disease",
keywords="web-based intervention",
keywords="mobile health",
keywords="self-management",
keywords="health behavior",
keywords="mobile phone",
abstract="Background: Digital interventions are effective for health behavior change, as they enable the self-management of chronic, noncommunicable diseases (NCDs). However, they often fail to facilitate the specific or current needs and preferences of the individual. A proposed alternative is a digital platform that hosts a suite of discrete, already existing digital health interventions. A platform architecture would allow users to explore a range of evidence-based solutions over time to optimize their self-management and health behavior change. Objective: This review aims to identify digital platform-like interventions and examine their potential for supporting self-management of NCDs and health behavior change. Methods: A literature search was conducted in January 2020 using EBSCOhost, PubMed, Scopus, and EMBASE. No digital platforms were identified, so criteria were broadened to include digital platform-like interventions. Eligible platform-like interventions offered a suite of discrete, evidence-based health behavior change features to optimize self-management of NCDs in an adult population and provided digitally supported guidance for the user toward the features best suited to their needs and preferences. Data collected on interventions were guided by the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) checklist, including evaluation data on effectiveness and process outcomes. The quality of the included literature was assessed using the Mixed Methods Appraisal Tool. Results: A total of 7 studies were included for review. Targeted NCDs included cardiovascular diseases (CVD; n=3), diabetes (n=3), and chronic obstructive pulmonary disease (n=1). The mean adherence (based on the number of follow-up responders) was 69\% (SD 20\%). Of the 7 studies, 4 with the highest adherence rates (80\%) were also guided by behavior change theories and took an iterative, user-centered approach to development, optimizing intervention relevance. All 7 interventions presented algorithm-supported user guidance tools, including electronic decision support, smart features that interact with patterns of use, and behavior change stage-matching tools. Of the 7 studies, 6 assessed changes in behavior. Significant effects in moderate-to-vigorous physical activity were reported, but for no other specific health behaviors. However, positive behavior change was observed in studies that focused on comprehensive behavior change measures, such as self-care and self-management, each of which addresses several key lifestyle risk factors (eg, medication adherence). No significant difference was found for psychosocial outcomes (eg, quality of life). Significant changes in clinical outcomes were predominately related to disease-specific, multifaceted measures such as clinical disease control and cardiovascular risk score. Conclusions: Iterative, user-centered development of digital platform structures could optimize user engagement with self-management support through existing, evidence-based digital interventions. Offering a palette of interventions with an appropriate degree of guidance has the potential to facilitate disease-specific health behavior change and effective self-management among a myriad of users, conditions, or stages of care. ",
doi="10.2196/16774",
url="http://www.jmir.org/2020/10/e16774/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33112239"
}


@Article{info:doi/10.2196/22074,
author="Alfonsi, E. Jeffrey
and Choi, Y. Elizabeth E.
and Arshad, Taha
and Sammott, S. Stacie-Ann
and Pais, Vanita
and Nguyen, Cynthia
and Maguire, R. Bryan
and Stinson, N. Jennifer
and Palmert, R. Mark",
title="Carbohydrate Counting App Using Image Recognition for Youth With Type 1 Diabetes: Pilot Randomized Control Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Oct",
day="28",
volume="8",
number="10",
pages="e22074",
keywords="carbohydrate counting",
keywords="type 1 diabetes",
keywords="image recognition",
keywords="youth",
keywords="digital health applications (apps)",
keywords="mHealth",
abstract="Background: Carbohydrate counting is an important component of diabetes management, but it is challenging, often performed inaccurately, and can be a barrier to optimal diabetes management. iSpy is a novel mobile app that leverages machine learning to allow food identification through images and that was designed to assist youth with type 1 diabetes in counting carbohydrates. Objective: Our objective was to test the app's usability and potential impact on carbohydrate counting accuracy. Methods: Iterative usability testing (3 cycles) was conducted involving a total of 16 individuals aged 8.5-17.0 years with type 1 diabetes. Participants were provided a mobile device and asked to complete tasks using iSpy app features while thinking aloud. Errors were noted, acceptability was assessed, and refinement and retesting were performed across cycles. Subsequently, iSpy was evaluated in a pilot randomized controlled trial with 22 iSpy users and 22 usual care controls aged 10-17 years. Primary outcome was change in carbohydrate counting ability over 3 months. Secondary outcomes included levels of engagement and acceptability. Change in HbA1c level was also assessed. Results: Use of iSpy was associated with improved carbohydrate counting accuracy (total grams per meal, P=.008), reduced frequency of individual counting errors greater than 10 g (P=.047), and lower HbA1c levels (P=.03). Qualitative interviews and acceptability scale scores were positive. No major technical challenges were identified. Moreover, 43\% (9/21) of iSpy participants were still engaged, with usage at least once every 2 weeks, at the end of the study. Conclusions: Our results provide evidence of efficacy and high acceptability of a novel carbohydrate counting app, supporting the advancement of digital health apps for diabetes care among youth with type 1 diabetes. Further testing is needed, but iSpy may be a useful adjunct to traditional diabetes management. Trial Registration: ClinicalTrials.gov NCT04354142; https://clinicaltrials.gov/ct2/show/NCT04354142 ",
doi="10.2196/22074",
url="http://mhealth.jmir.org/2020/10/e22074/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33112249"
}


@Article{info:doi/10.2196/23893,
author="Bostr{\o}m, Katrine
and B{\o}r{\o}sund, Elin
and Varsi, Cecilie
and Eide, Hilde
and Flakk Nordang, Elise
and Schreurs, MG Karlein
and Waxenberg, B. Lori
and Weiss, E. Karen
and Morrison, J. Eleshia
and Cvancarova Sm{\aa}stuen, Milada
and Stubhaug, Audun
and Solberg Nes, Lise",
title="Digital Self-Management in Support of Patients Living With Chronic Pain: Feasibility Pilot Study",
journal="JMIR Form Res",
year="2020",
month="Oct",
day="23",
volume="4",
number="10",
pages="e23893",
keywords="chronic pain",
keywords="feasibility",
keywords="acceptability",
keywords="self-management",
keywords="eHealth",
keywords="digital",
keywords="cognitive-behavioral pain",
keywords="usability",
keywords="user centered",
abstract="Background: Chronic pain can be complex and taxing to live with, and treatment and support require a multicomponent approach, which may not always be offered or available. Smartphones, tablets, and personal computers are already incorporated into patients' daily lives, and therefore, they can be used to communicate, educate, and support self-management. Although some web-based self-management interventions exist, research examining the evidence and effect of digital solutions supporting self-management for patients living with chronic pain is limited, findings are inconclusive, and new innovative ideas and solutions are needed. Objective: This feasibility pilot study aimed to explore the system use, perceived usefulness, ease of use, and preliminary effects of EPIO, an app-based cognitive-behavioral pain self-management intervention program for patients living with chronic pain. Methods: The EPIO intervention was delivered in a blended-care model containing (1) one face-to-face introduction session, (2) nine cognitive behavior--based pain self-management modules, delivered in an app-based format for smartphones or tablets, and (3) one follow-up phone call at 2 to 3 weeks after the introduction session. Patients living with chronic pain (N=50) completed pre-post outcome measures at baseline and 3 months after the introduction session, with registration of system use (ie, log data) until 6 months. The use, perceived usefulness, and ease of use of the EPIO program were examined through system use data, as well as a study-specific use/usability questionnaire and the System Usability Scale (SUS). Outcome measures to test feasibility of use and estimate preliminary effects included the Brief Pain Inventory, health-related quality of life (HRQoL) scale, Hospital Anxiety and Depression Scale, Self-Regulatory Fatigue scale, Pain Catastrophizing Scale, and Chronic Pain Acceptance Questionnaire. Results: Participants (N=50) had a median age of 52 years (range 29-74 years) at inclusion and were mainly female (40/50, 80\%). Thirty-one participants completed at least six of the nine modules within the 3-month study period (62\% completion rate). Forty-five participants completed outcome measures at 3 months, and the EPIO program was rated as useful (ie, ``totally agree'' or ``agree''; 39/45, 87\%) and easy to use (42/45, 93\%), and as having easily understandable exercises (44/45, 98\%). The average overall system usability (SUS) score was 85.7, indicating grade A and excellent system usability. Preliminary psychosocial outcome measure estimates showed primarily nonsignificant pre-post intervention improvements at 3 months, but with significant positive effects related to some aspects of HRQoL (bodily pain, P=.02 and change, P=.049). Conclusions: ?Digital self-management intervention programs may be of use and support for patients living with chronic pain. In this feasibility study, EPIO showed an acceptable program completion rate and was rated as useful and easy to use, with excellent user satisfaction. Program optimization and efficacy testing in a large-scale randomized controlled trial are warranted and in progress. Trial Registration: ClinicalTrials.gov NCT03705104; https://clinicaltrials.gov/ct2/show/NCT03705104 ",
doi="10.2196/23893",
url="http://formative.jmir.org/2020/10/e23893/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33094734"
}


@Article{info:doi/10.2196/22137,
author="Jiang, Jiang
and Gu, Xiang
and Cheng, Chen-Di
and Li, Hong-Xiao
and Sun, Xiao-Lin
and Duan, Ruo-Yu
and Zhu, Ye
and Sun, Lei
and Chen, Fu-Kun
and Bao, Zheng-Yu
and Zhang, Yi
and Shen, Jian-Hua",
title="The Hospital-Community-Family--Based Telemedicine (HCFT-AF) Program for Integrative Management of Patients With Atrial Fibrillation: Pilot Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Oct",
day="21",
volume="8",
number="10",
pages="e22137",
keywords="atrial fibrillation",
keywords="integrative management",
keywords="telemedicine",
keywords="self-management",
keywords="feasibility study",
abstract="Background: The potential effectiveness of integrated management in further improving the prognosis of patients with atrial fibrillation has been demonstrated; however, the best strategy for implementation remains to be discovered. Objective: The aim of this study was to ascertain the feasibility of implementing integrated atrial fibrillation care via the Hospital-Community-Family--Based Telemedicine (HCFT-AF) program. Methods: In this single-arm, pre-post design pilot study, a multidisciplinary teamwork, supported by efficient infrastructures, provided patients with integrated atrial fibrillation care following the Atrial fibrillation Better Care (ABC) pathway. Eligible patients were continuously recruited and followed up for at least 4 months. The patients' drug adherence, and atrial fibrillation--relevant lifestyles and behaviors were assessed at baseline and at 4 months. The acceptability, feasibility, and usability of the HCFT-AF technology devices and engagement with the HCFT-AF program were assessed at 4 months. Results: A total of 73 patients (mean age, 68.42 years; 52\% male) were enrolled in November 2019 with a median follow up of 132 days (IQR 125--138 days). The patients' drug adherence significantly improved after the 4-month intervention (P<.001). The vast majority (94\%, 64/68) of indicated patients received anticoagulant therapy at 4 months, and none of them received antiplatelet therapy unless there was an additional indication. The atrial fibrillation--relevant lifestyles and behaviors ameliorated to varying degrees at the end of the study. In general, the majority of patients provided good feedback on the HCFT-AF intervention. More than three-quarters (76\%, 54/71) of patients used the software or website more than once a week and accomplished clinic visits as scheduled. Conclusions: The atrial fibrillation--integrated care model described in this study is associated with improved drug adherence, standardized therapy rate, and lifestyles of patients, which highlights the possibility to better deliver integrated atrial fibrillation management. Trial Registration: Clinicaltrials.gov NCT04127799; https://clinicaltrials.gov/ct2/show/NCT04127799 ",
doi="10.2196/22137",
url="http://mhealth.jmir.org/2020/10/e22137/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33084588"
}


@Article{info:doi/10.2196/17986,
author="Czech, Matthew
and Demanuele, Charmaine
and Erb, Kelley Michael
and Ramos, Vesper
and Zhang, Hao
and Ho, Bryan
and Patel, Shyamal",
title="The Impact of Reducing the Number of Wearable Devices on Measuring Gait in Parkinson Disease: Noninterventional Exploratory Study",
journal="JMIR Rehabil Assist Technol",
year="2020",
month="Oct",
day="21",
volume="7",
number="2",
pages="e17986",
keywords="gait",
keywords="Parkinson disease",
keywords="wearable sensors",
keywords="digital medicine",
abstract="Background: Measuring free-living gait using wearable devices may offer higher granularity and temporal resolution than the current clinical assessments for patients with Parkinson disease (PD). However, increasing the number of devices worn on the body adds to the patient burden and impacts the compliance. Objective: This study aimed to investigate the impact of reducing the number of wearable devices on the ability to assess gait impairments in patients with PD. Methods: A total of 35 volunteers with PD and 60 healthy volunteers performed a gait task during 2 clinic visits. Participants with PD were assessed in the On and Off medication state using the Movement Disorder Society version of the Unified Parkinson Disease Rating Scale (MDS-UPDRS). Gait features derived from a single lumbar-mounted accelerometer were compared with those derived using 3 and 6 wearable devices for both participants with PD and healthy participants. Results: A comparable performance was observed for predicting the MDS-UPDRS gait score using longitudinal mixed-effects model fit with gait features derived from a single (root mean square error [RMSE]=0.64; R2=0.53), 3 (RMSE=0.64; R2=0.54), and 6 devices (RMSE=0.54; R2=0.65). In addition, MDS-UPDRS gait scores predicted using all 3 models differed significantly between On and Off motor states (single device, P=.004; 3 devices, P=.004; 6 devices, P=.045). Conclusions: We observed a marginal benefit in using multiple devices for assessing gait impairments in patients with PD when compared with gait features derived using a single lumbar-mounted accelerometer. The wearability burden associated with the use of multiple devices may offset gains in accuracy for monitoring gait under free-living conditions. ",
doi="10.2196/17986",
url="http://rehab.jmir.org/2020/2/e17986/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33084585"
}


@Article{info:doi/10.2196/20480,
author="Collado-Borrell, Roberto
and Escudero-Vilaplana, Vicente
and Ribed, Almudena
and Gonzalez-Anleo, Cristina
and Martin-Conde, Maite
and Romero-Jimenez, Rosa
and Iglesias-Peinado, Irene
and Herranz-Alonso, Ana
and Sanjurjo-Saez, Maria",
title="Effect of a Mobile App for the Pharmacotherapeutic Follow-Up of Patients With Cancer on Their Health Outcomes: Quasi-Experimental Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Oct",
day="16",
volume="8",
number="10",
pages="e20480",
keywords="e-OncoSalud",
keywords="app",
keywords="smartphone",
keywords="oral antineoplastic agent",
keywords="oncology",
abstract="Background: Oral antineoplastic agents (OAAs) have revolutionized cancer management. However, they have been reported with adverse side effects and drug-drug interactions. Moreover, patient adherence to OAA treatment is critical. Mobile apps can enable remote and real-time pharmacotherapeutic monitoring of patients, while also promoting patient autonomy in their health care. Objective: The primary objective was to analyze the effect of using a mobile app for the follow-up of patients with oncohematological malignancies undergoing treatment with OAAs on their health outcomes. The secondary objectives were to analyze the role of the app in communication with health care professionals and patient satisfaction with the app. Methods: We performed a comparative, quasi-experimental study based on a prepost intervention with 101 patients (control group, n=51, traditional pharmacotherapeutic follow-up vs intervention group, n=50, follow-up through e-OncoSalud, a custom-designed app that promotes follow-up at home and the safety of patients receiving OAAs). The effect of this app on drug safety, adherence to treatment, and quality of life was evaluated. Results: With regard to drug safety, 73\% (37/51) of the patients in the control group and 70\% (35/50) of the patients in the intervention group (P=.01) presented with drug-related problems. The probability of detecting an insufficiently treated health problem in the intervention group was significantly higher than that in the control group (P=.04). The proportion of patients who presented with side effects in the intervention group was significantly lower than that in the control group (P>.99). In the control group, 49\% (25/51) of the patients consumed some health resources during the first 6 months of treatment compared with 36\% (18/50) of the patients in the intervention group (P=.76). Adherence to treatment was 97.6\% (SD 7.9) in the intervention group, which was significantly higher than that in the control group (92.9\% [SD 10.0]; P=.02). The EuroQol-5D in the intervention group yielded a mean (SD) index of 0.875 (0.156), which was significantly higher than that in the control group (0.741 [0.177]; P<.001). Approximately 60\% (29/50) of the patients used the messaging module to communicate with pharmacists. The most frequent types of messages were acknowledgments (77/283, 27.2\%), doubts about contraindications and interactions with OAAs (70/283, 24.7\%), and consultations for adverse reactions to treatment (39/283, 13.8\%). The satisfaction with the app survey conducted in the intervention group yielded an overall mean (SD) score of 9.1 (0.4) out of 10. Conclusions: Use of e-OncoSalud for the real-time follow-up of patients receiving OAAs facilitated the optimization of some health outcomes. The intervention group had significantly higher health-related quality of life and adherence to treatment than the control group. Further, the probability of the intervention group presenting with side effects was significantly lower than that of the control group. ",
doi="10.2196/20480",
url="http://mhealth.jmir.org/2020/10/e20480/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33064100"
}


@Article{info:doi/10.2196/18233,
author="Durst, Jennifer
and Roesel, Inka
and Sudeck, Gorden
and Sassenberg, Kai
and Krauss, Inga",
title="Effectiveness of Human Versus Computer-Based Instructions for Exercise on Physical Activity--Related Health Competence in Patients with Hip Osteoarthritis: Randomized Noninferiority Crossover Trial",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="28",
volume="22",
number="9",
pages="e18233",
keywords="digital app",
keywords="exercise",
keywords="movement control",
keywords="self-efficacy",
keywords="control competence",
keywords="mHealth",
keywords="osteoarthritis",
keywords="tablet",
abstract="Background: Hip and knee osteoarthritis is ranked as the 11th highest contributor to global disability. Exercise is a core treatment in osteoarthritis. The model for physical activity--related health competence describes possibilities to empower patients to perform physical exercises in the best possible health-promoting manner while taking into account their own physical condition. Face-to-face supervision is the gold standard for exercise guidance. Objective: The aim of this study was to evaluate whether instruction and guidance via a digital app is not inferior to supervision by a physiotherapist with regard to movement quality, control competence for physical training, and exercise-specific self-efficacy. Methods: Patients with clinically diagnosed hip osteoarthritis were recruited via print advertisements, emails and flyers. The intervention consisted of two identical training sessions with one exercise for mobility, two for strength, and one for balance.  One session was guided by a physiotherapist and the other was guided by a fully automated tablet computer-based app. Both interventions took place at a university hospital. Outcomes were assessor-rated movement quality, and self-reported questionnaires on exercise-specific self-efficacy and control competence for physical training. Participants were randomly assigned to one of two treatment sequences. One sequence started with the app in the first session followed by the physiotherapist in the second session after a minimum washout phase of 27 days (AP group) and the other sequence occurred in the reverse order (PA group). Noninferiority was defined as a between-treatment effect (gIG)<0.2 in favor of the physiotherapist-guided training, including the upper confidence interval. Participants, assessors, and the statistician were neither blinded to the treatment nor to the treatment sequence. Results: A total of 54 participants started the first training session (32 women, 22 men; mean age 62.4, SD 8.2 years). The treatment sequence groups were similar in size (PA: n=26; AP: n=28). Seven subjects did not attend the second training session (PA: n=3; AP: n=4). The app was found to be inferior to the physiotherapist in all outcomes considered, except for movement quality of the mobility exercise (gIG --0.13, 95\% CI --0.41-0.16). In contrast to the two strengthening exercises in different positions (supine gIG 0.76, 95\% CI 0.39-1.13; table gIG 1.19, 95\% CI 0.84-1.55), movement quality of the balance exercise was close to noninferiority (gIG 0.15, 95\% CI --0.17-0.48). Exercise-specific self-efficacy showed a strong effect in favor of the physiotherapist (gIG 0.84, 95\% CI 0.46-1.22). In terms of control competence for physical training, the app was only slightly inferior to the physiotherapist (gIG 0.18, 95\% CI --0.14-0.50). Conclusions: Despite its inferiority in almost all measures of interest, exercise-specific self-efficacy and control competence for physical training did improve in patients who used the digital app. Movement quality was acceptable for exercises that are easy to conduct and instruct. The digital app opens up possibilities as a supplementary tool to support patients in independent home training for less complex exercises; however, it cannot replace a physiotherapist. Trial Registration: German Clinical Trial Register: DRKS00015759; http://www.drks.de/DRKS00015759 ",
doi="10.2196/18233",
url="http://www.jmir.org/2020/9/e18233/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32985991"
}


@Article{info:doi/10.2196/19225,
author="Jones, V. Helen
and Smith, Harry
and Cooksley, Tim
and Jones, Philippa
and Woolley, Toby
and Gwyn Murdoch, Derick
and Thomas, Dafydd
and Foster, Betty
and Wakefield, Valerie
and Innominato, Pasquale
and Mullard, Anna
and Ghosal, Niladri
and Subbe, Christian",
title="Checklists for Complications During Systemic Cancer Treatment Shared by Patients, Friends, and Health Care Professionals: Prospective Interventional Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="25",
volume="8",
number="9",
pages="e19225",
keywords="cancer",
keywords="patient safety",
keywords="checklist",
keywords="quality of life",
keywords="anxiety",
keywords="depression",
keywords="health economics",
keywords="mHealth",
keywords="smartphone",
keywords="redundancy",
abstract="Background: Advances in cancer management have been associated with an increased incidence of emergency presentations with disease- or treatment-related complications. Objective: This study aimed to measure the ability of patients and members of their social network to complete checklists for complications of systemic treatment for cancer and examine the impact on patient-centered and health-economic outcomes. Methods: A prospective interventional cohort study was performed to assess the impact of a smartphone app used by patients undergoing systemic cancer therapy and members of their network to monitor for common complications. The app was used by patients, a nominated ``safety buddy,'' and acute oncology services. The control group was made up of patients from the same institution. Measures were based on process (completion of checklists over 60 days), patient experience outcomes (Hospital Anxiety and Depression Scale and the General version of the Functional Assessment of Cancer Therapy at baseline, 1 month, and 2 months) and health-economic outcomes (usage of appointments in primary care and elective and unscheduled hospital admissions). Results: At the conclusion of the study, 50 patients had completed 2882 checklists, and their 50 ``safety buddies'' had completed 318 checklists. Near daily usage was maintained over the 60-day study period. When compared to a cohort of 50 patients with matching disease profiles from the same institution, patients in the intervention group had comparable changes in Hospital Anxiety and Depression Scale and General version of the Functional Assessment of Cancer Therapy. Patients in the Intervention Group required a third (32 vs 97 nights) of the hospital days with overnight stay compared to patients in the Control Group, though the difference was not significant. The question, ``I feel safer with the checklist,'' received a mean score of 4.27 (SD 0.87) on a Likert scale (1-5) for patients and 4.55 (SD 0.65) for family and friends. Conclusions: Patients undergoing treatment for cancer and their close contacts can complete checklists for common complications of systemic treatments and take an active role in systems supporting their own safety. A larger sample size will be needed to assess the impact on clinical outcomes and health economics. ",
doi="10.2196/19225",
url="http://mhealth.jmir.org/2020/9/e19225/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32975526"
}


@Article{info:doi/10.2196/18660,
author="Kriventsov, Stan
and Lindsey, Alexander
and Hayeri, Amir",
title="The Diabits App for Smartphone-Assisted Predictive Monitoring of Glycemia in Patients With Diabetes: Retrospective Observational Study",
journal="JMIR Diabetes",
year="2020",
month="Sep",
day="22",
volume="5",
number="3",
pages="e18660",
keywords="blood glucose predictions",
keywords="type 1 diabetes",
keywords="artificial intelligence",
keywords="machine learning",
keywords="digital health",
keywords="mobile phone",
abstract="Background: Diabetes mellitus, which causes dysregulation of blood glucose in humans, is a major public health challenge. Patients with diabetes must monitor their glycemic levels to keep them in a healthy range. This task is made easier by using continuous glucose monitoring (CGM) devices and relaying their output to smartphone apps, thus providing users with real-time information on their glycemic fluctuations and possibly predicting future trends. Objective: This study aims to discuss various challenges of predictive monitoring of glycemia and examines the accuracy and blood glucose control effects of Diabits, a smartphone app that helps patients with diabetes monitor and manage their blood glucose levels in real time. Methods: Using data from CGM devices and user input, Diabits applies machine learning techniques to create personalized patient models and predict blood glucose fluctuations up to 60 min in advance. These predictions give patients an opportunity to take pre-emptive action to maintain their blood glucose values within the reference range. In this retrospective observational cohort study, the predictive accuracy of Diabits and the correlation between daily use of the app and blood glucose control metrics were examined based on real app users' data. Moreover, the accuracy of predictions on the 2018 Ohio T1DM (type 1 diabetes mellitus) data set was calculated and compared against other published results. Results: On the basis of more than 6.8 million data points, 30-min Diabits predictions evaluated using Parkes Error Grid were found to be 86.89\% (5,963,930/6,864,130) clinically accurate (zone A) and 99.56\% (6,833,625/6,864,130) clinically acceptable (zones A and B), whereas 60-min predictions were 70.56\% (4,843,605/6,864,130) clinically accurate and 97.49\% (6,692,165/6,864,130) clinically acceptable. By analyzing daily use statistics and CGM data for the 280 most long-standing users of Diabits, it was established that under free-living conditions, many common blood glucose control metrics improved with increased frequency of app use. For instance, the average blood glucose for the days these users did not interact with the app was 154.0 (SD 47.2) mg/dL, with 67.52\% of the time spent in the healthy 70 to 180 mg/dL range. For days with 10 or more Diabits sessions, the average blood glucose decreased to 141.6 (SD 42.0) mg/dL (P<.001), whereas the time in euglycemic range increased to 74.28\% (P<.001). On the Ohio T1DM data set of 6 patients with type 1 diabetes, 30-min predictions of the base Diabits model had an average root mean square error of 18.68 (SD 2.19) mg/dL, which is an improvement over the published state-of-the-art results for this data set. Conclusions: Diabits accurately predicts future glycemic fluctuations, potentially making it easier for patients with diabetes to maintain their blood glucose in the reference range. Furthermore, an improvement in glucose control was observed on days with more frequent Diabits use. ",
doi="10.2196/18660",
url="http://diabetes.jmir.org/2020/3/e18660/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32960180"
}


@Article{info:doi/10.2196/19476,
author="Ryan, Ann Kelly
and Babu, Pallavi
and Easter, Rebecca
and Saunders, Erika
and Lee, Jinseok Andy
and Klasnja, Predrag
and Verchinina, Lilia
and Micol, Valerie
and Doil, Brent
and McInnis, G. Melvin
and Kilbourne, M. Amy",
title="A Smartphone App to Monitor Mood Symptoms in Bipolar Disorder: Development and Usability Study",
journal="JMIR Ment Health",
year="2020",
month="Sep",
day="22",
volume="7",
number="9",
pages="e19476",
keywords="bipolar disorder",
keywords="momentary assessment",
keywords="mood",
keywords="mobile phone",
keywords="mobile app",
abstract="Background: There is considerable scientific interest in finding new and innovative ways to capture rapid fluctuations in functioning within individuals with bipolar disorder (BD), a severe, recurrent mental disorder associated with frequent shifts in symptoms and functioning. The use of smartphones can provide valid and real-world tools for use in measurement-based care and could be used to inform more personalized treatment options for this group, which can improve standard of care. Objective: We examined the feasibility and usability of a smartphone to capture daily fluctuations in mood within BD and to relate daily self-rated mood to smartphone use behaviors indicative of psychomotor activity or symptoms of the illness. Methods: Participants were 26 individuals with BD and 12 healthy control individuals who were recruited from the Prechter Longitudinal Study of BD. All were given a smartphone with a custom-built app and prompted twice a day to complete questions of mood for 28 days. The app automatically and unobtrusively collected phone usage data. A poststudy satisfaction survey was also completed. Results: Our sample showed a very high adherence rate to the daily momentary assessments (91\% of the 58 prompts completed). Multivariate mixed effect models showed that an increase in rapid thoughts over time was associated with a decrease in outgoing text messages ($\beta$=--.02; P=.04), and an increase in impulsivity self-ratings was related to a decrease in total call duration ($\beta$=--.29; P=.02). Participants generally reported positive experiences using the smartphone and completing daily prompts. Conclusions: Use of mobile technology shows promise as a way to collect important clinical information that can be used to inform treatment decision making and monitor outcomes in a manner that is not overly burdensome to the patient or providers, highlighting its potential use in measurement-based care. ",
doi="10.2196/19476",
url="http://mental.jmir.org/2020/9/e19476/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32960185"
}


@Article{info:doi/10.2196/20165,
author="Seppen, F. Bart
and Wiegel, Jimmy
and L'ami, J. Merel
and Duarte dos Santos Rico, Sharon
and Catarinella, S. Fabio
and Turkstra, Franktien
and Boers, Maarten
and Bos, H. Wouter",
title="Feasibility of Self-Monitoring Rheumatoid Arthritis With a Smartphone App: Results of Two Mixed-Methods Pilot Studies",
journal="JMIR Form Res",
year="2020",
month="Sep",
day="21",
volume="4",
number="9",
pages="e20165",
keywords="mHealth",
keywords="eHealth",
keywords="patient-reported outcome, smartphone app",
keywords="rheumatoid arthritis",
keywords="self-monitoring",
keywords="telemonitoring",
keywords="mobile phone",
abstract="Background: Several mobile apps that monitor symptoms of rheumatoid arthritis (RA) exist, but a recent systematic review indicated that high-quality apps are lacking. When patients self-monitor their own disease with patient-reported outcomes (PROs) and self-initiate care at the right moment, it may be possible to reduce the frequency of their clinic visits, which would reduce health care burden and costs. We developed an app, that is, the MijnReuma Reade app, for this purpose and performed 2 pilot tests with weekly self-monitoring. Objective: The primary objective of this study was to design, develop, and evaluate the usability, satisfaction, and usage of the MijnReuma Reade app---an app that allows patients with RA to monitor their own disease. The secondary objective was to review the patients' perspectives on app usage and its intended purpose. Methods: This app was designed in collaboration with patients with RA, rheumatologists, and information technology experts. Two 1-month pilot studies were performed, after which satisfaction (0-10 scale), usability (system usability scale, 0-100), and usage (proportion of completed questionnaires) of this app were assessed. After the second pilot study, semistructured interviews were performed to determine patients' perspectives and the promoters and barriers of app usage. Results: In the first and second pilot study, 42 and 27 patients were included, respectively. Overall, the patients were satisfied (medians, 8 and 7) and found the app usable (mean system usability scores, 76 and 71) in pilot studies 1 and 2, respectively. App usage declined over time in both the pilot studies; 61\% (17/28) and 37\% (10/27) of the patients who disclosed their usage statistics completed the final weekly questionnaire in pilot study 1 and pilot study 2, respectively. Approximately 81\% (25/31) of the patients indicated they would like to skip hospital visits if the self-monitored disease activity is low. In the semistructured interviews, technical problems, internal resistance (respondent fatigue, the app reminded them of their disease), and a lack of symptoms were identified as barriers for usage. Patients reported that ``experiencing more grip on their disease'' and ``improved communication with their physician'' were promoters for usage. Patients reported that pain positively mediated usage, that is, more pain promoted and less pain discouraged app usage. Conclusions: This study illustrates the feasibility of the MijnReuma Reade app that enables self-monitoring of the disease activity in patients with RA with the overarching aim to allocate clinical consultations according to need. Satisfaction with the app and usability of the app were found to be high; however, app usage declined over time. Patients acknowledged the potential of the app to self-monitor their own disease and would like to be able to skip clinic visits if the monitored disease activity is low. To evaluate this strategy, a randomized controlled trial is underway. ",
doi="10.2196/20165",
url="http://formative.jmir.org/2020/9/e20165/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32955447"
}


@Article{info:doi/10.2196/18867,
author="Monteiro-Guerra, Francisco
and Signorelli, Ruiz Gabriel
and Rivera-Romero, Octavio
and Dorronzoro-Zubiete, Enrique
and Caulfield, Brian",
title="Breast Cancer Survivors' Perspectives on Motivational and Personalization Strategies in Mobile App--Based Physical Activity Coaching Interventions: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="21",
volume="8",
number="9",
pages="e18867",
keywords="mHealth",
keywords="mobile app",
keywords="mobile phone",
keywords="coaching",
keywords="physical activity",
keywords="breast cancer",
abstract="Background: Despite growing evidence supporting the vital benefits of physical activity (PA) for breast cancer survivors, the majority do not meet the recommended levels of activity. Mobile app--based PA coaching interventions might be a feasible strategy to facilitate adherence of breast cancer survivors to the PA guidelines. To engage these individuals, PA apps need to be specifically designed based on their needs and preferences and to provide targeted support and motivation. However, more information is needed to understand how these technologies can provide individual and relevant experiences that have the ability to increase PA adherence and retain the individual's interest in the long term. Objective: The aim of this study is to explore insights from breast cancer survivors on motivational and personalization strategies to be used in PA coaching apps and interventions. Methods: A qualitative study was conducted, using individual semistructured interviews, with 14 breast cancer survivors. The moderator asked open-ended questions and made use of a slideshow presentation to elicit the participants' perspectives on potential mobile app--based intervention features. Transcribed interviews were evaluated by 3 reviewers using thematic content analysis. Results: Participants (mean age 53.3, SD 8.7 years) were White women. In total, 57\% (8/14) of the participants did not adhere to the PA guidelines. In general, participants had access to and were interested in using technology. The identified themes included (1) barriers to PA, (2) psychological mediators of PA motivation, (3) needs and suggestions for reinforcing motivation support, (4) personalization aspects of the PA coaching experience, and (5) technology trustworthiness. Motivational determinants included perceived control, confidence and perceived growth, and connectedness. Participants were interested in having a straightforward app for monitoring and goal setting, which would include a prescribed activity program and schedule, and positive communication. Opinions varied in terms of social and game-like system possibilities. In addition, they expressed a desire for a highly personalized coaching experience based on as much information collected from them as possible (eg, disease stage, physical limitations, preferences) to provide individualized progress information, dynamic adjustment of the training plan, and context-aware activity suggestions (eg, based on weather and location). Participants also wanted the app to be validated or backed by professionals and were willing to share their data in exchange for a more personalized experience. Conclusions: This work suggests the need to develop simple, guiding, encouraging, trustworthy, and personalized PA coaching apps. The findings are in line with behavioral and personalization theories and methods that can be used to inform intervention design decisions. This paper opens new possibilities for the design of personalized and motivating PA coaching app experiences for breast cancer survivors, which might ultimately facilitate the sustained adherence of these individuals to the recommended levels of activity. ",
doi="10.2196/18867",
url="https://mhealth.jmir.org/2020/9/e18867",
url="http://www.ncbi.nlm.nih.gov/pubmed/32955446"
}


@Article{info:doi/10.2196/19153,
author="Lee, Young Da
and Yoo, Seung-Hyun
and Min, Pil Kyong
and Park, Cheol-Young",
title="Effect of Voluntary Participation on Mobile Health Care in Diabetes Management: Randomized Controlled Open-Label Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="18",
volume="8",
number="9",
pages="e19153",
keywords="diabetes mellitus",
keywords="health services research",
keywords="mobile applications",
keywords="diabetes",
keywords="mHealth",
keywords="app",
keywords="lifestyle",
keywords="self-management",
keywords="volunteer",
keywords="participation",
abstract="Background: The role of mobile health care (mHealth) in glycemic control has been investigated, but its impact on self-management skills and its psychological aspects have not been studied. Objective: We evaluated the efficacy of mHealth-based diabetes self-management education and the effect of voluntary participation on its effects. Methods: This study was a randomized controlled open-label trial conducted for 6 months at Kangbuk Samsung Hospital. Participants in the control group (n=31) maintained their previous diabetes management strategies. Participants in the intervention group (n=41) additionally received mHealth-based diabetes self-management education through a mobile app and regular individualized feedback from health care professionals. The primary outcome was change in glycated hemoglobin (HbA1c) level over 6 months between the 2 groups (intervention versus control) and within each group (at 6 months versus baseline). The secondary outcomes were changes in body mass index, blood pressure, lipid profile, and questionnaire scores (the Korean version of the Summary of Diabetes Self-Care Activities Questionnaire, an Audit of Diabetes Dependent Quality of Life, the Appraisal of Diabetes Scale, and Problem Areas in Diabetes) over 6 months between groups and within each group. Results: A total of 66 participants completed this study. HbA1c (P=.04), total cholesterol level (P=.04), and Problem Areas in Diabetes scores (P=.02) significantly decreased; total diet (P=.03) and self-monitoring of blood glucose level scores (P=.01), based on the Summary of Diabetes Self-Care Activities Questionnaire, markedly increased within the intervention group. These significant changes were observed in self-motivated participants who were recruited voluntarily via advertisements. Conclusions: mHealth-based diabetes self-management education was effective at improving glycemic control and diabetes self-management skills and lowering diabetes-related distress in voluntary participants. Trial Registration: ClinicalTrials.gov NCT03468283; http://clinicaltrials.gov/ct2/show/NCT03468283 ",
doi="10.2196/19153",
url="http://mhealth.jmir.org/2020/9/e19153/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32945775"
}


@Article{info:doi/10.2196/18663,
author="Yu, Yu
and Li, Yilu
and Li, Tongxin
and Xi, Shijun
and Xiao, Xi
and Xiao, Shuiyuan
and Tebes, Kraemer Jacob",
title="New Path to Recovery and Well-Being: Cross-Sectional Study on WeChat Use and Endorsement of WeChat-Based mHealth Among People Living With Schizophrenia in China",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="18",
volume="22",
number="9",
pages="e18663",
keywords="WeChat",
keywords="mHealth",
keywords="schizophrenia",
keywords="China",
keywords="symptoms",
keywords="functioning",
keywords="recovery",
keywords="quality of life",
keywords="well-being",
abstract="Background: The past few decades have seen an exponential increase in using mobile phones to support medical care (mobile health [mHealth]) among people living with psychosis worldwide, yet little is known about WeChat use and WeChat-based mHealth among people living with schizophrenia (PLS) in China. Objective: This study aims to assess WeChat use, endorsement of WeChat-based mHealth programs, and health related to WeChat use among PLS. Methods: We recruited a random sample of 400 PLS from 12 communities in Changsha City of Hunan Province, China. WeChat use was assessed using the adapted WeChat Use Intensity Questionnaire (WUIQ). We also compared psychiatric symptoms, functioning, disability, recovery, quality of life, and general well-being between WeChat users and nonusers using one-to-one propensity-score matching. Results: The WeChat use rate was 40.8\% in this sample (163/400); 30.7\% (50/163) had more than 50 WeChat friends and nearly half (81/163, 49.7\%) spent more than half an hour on WeChat, a pattern similar to college students and the elderly. PLS also showed higher emotional connectedness to WeChat use than college students. About 80.4\% (131/163) of PLS were willing to participate in a WeChat-based mHealth program, including psychoeducation (91/163, 55.8\%), professional support (82/163, 50.3\%), and peer support (67/163, 41.1\%). Compared with nonusers, WeChat users were younger, better educated, and more likely to be employed. WeChat use was associated with improved health outcomes, including lower psychiatric symptoms, lower depression, higher functioning, better recovery, and higher quality of life. Conclusions: WeChat-based mHealth programs hold promise as an empowering tool to provide cost-effective interventions, to foster global recovery, and to improve both physical and mental well-being among PLS. WeChat and WeChat-based mHealth programs have the potential to offer a new path to recovery and well-being for PLS in China. ",
doi="10.2196/18663",
url="http://www.jmir.org/2020/9/e18663/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32945774"
}


@Article{info:doi/10.2196/18284,
author="Turnbull, Alexandra
and Sculley, Dean
and Escalona-Marfil, Carles
and Riu-Gispert, Llu{\'i}s
and Ruiz-Moreno, Jorge
and Giron{\`e}s, Xavier
and Coda, Andrea",
title="Comparison of a Mobile Health Electronic Visual Analog Scale App With a Traditional Paper Visual Analog Scale for Pain Evaluation: Cross-Sectional Observational Study",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="17",
volume="22",
number="9",
pages="e18284",
keywords="pain",
keywords="mobile app",
keywords="mHealth",
keywords="digital health",
keywords="electronic visual analog scale",
keywords="visual analog scale",
keywords="symptom",
keywords="eHealth",
keywords="reliability",
abstract="Background: Accurate quantification of pain in a clinical setting is vital. The use of an electronic pain scale enables data to be collected, analyzed, and utilized much faster compared with traditional paper-based scales. The advancement of smart technology in pediatric and adult pain evaluation may offer opportunities to introduce easy-to-use and reliable pain assessment methods within different clinical settings. If promptly introduced within different pediatric and adult pain clinic services, validated and easily accessible mobile health pain apps may lead to early pain detection, promoting improvement in patient's quality of life and leading to potentially less time off from school or work. Objective: This cross-sectional observational study aimed to investigate the interchangeability of an electronic visual analog scale (eVAS) app with a traditional paper visual analog scale (pVAS) among Australian children, adolescents, and adults for pain evaluation. Methods: Healthy participants (age range 10-75 years) were recruited from a sporting club and a secondary school in Melbourne (Australia). The data collection process involved application of pressure (8.5 kg/cm2) from a Wagner Force Dial FDK 20 to the midpoint of the thumb. The pressure was applied twice with a 5-minute interval. At each pressure application, participants were asked to randomly record their pain perception using the ``eVAS'' accessible via the ``Interactive Clinics'' app and the traditional pVAS. Statistical analysis was conducted to determine intermethod and intramethod reliabilities. Results: Overall, 109 healthy participants were recruited. Adults (mean age 42.43 years, SD 14.50 years) had excellent reliability, with an intraclass correlation coefficient (ICC) of 0.94 (95\% CI 0.91-0.96). Children and adolescents (mean age 13.91 years, SD 2.89 years) had moderate-to-good intermethod and intramethod reliabilities, with an ICC of 0.80 (95\% CI 0.70-0.87) and average ICC of 0.80 (95\% CI 0.69-0.87), respectively. Conclusions: The eVAS app appears to be interchangeable compared with the traditional pVAS among children, adolescents, and adults. This pain evaluation method may offer new opportunities to introduce user-friendly and validated pain assessment apps for patients, clinicians, and allied health professionals. ",
doi="10.2196/18284",
url="http://www.jmir.org/2020/9/e18284/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32940621"
}


@Article{info:doi/10.2196/16745,
author="Osborn, Y. Chandra
and Hirsch, Ashley
and Sears, E. Lindsay
and Heyman, Mark
and Raymond, Jennifer
and Huddleston, Brian
and Dachis, Jeff",
title="One Drop App With an Activity Tracker for Adults With Type 1 Diabetes: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="17",
volume="8",
number="9",
pages="e16745",
keywords="diabetes",
keywords="type 1 diabetes",
keywords="digital therapy",
keywords="mobile app",
keywords="coaching",
keywords="glucometer",
keywords="activity tracker",
abstract="Background: In 2017, mobile app support for managing diabetes was available to 64\% of the global population of adults with diabetes. One Drop's digital therapeutics solution includes an evidence-based mobile app with global reach, a Bluetooth-connected glucometer, and in-app coaching from Certified Diabetes Educators. Among people with type 1 diabetes and an estimated hemoglobin A1c level?7.5\%, using One Drop for 3 months has been associated with an improved estimated hemoglobin A1c level of 22.2 mg/dL (--0.80\%). However, the added value of integrated activity trackers is unknown. Objective: We conducted a pragmatic, remotely administered randomized controlled trial to evaluate One Drop with a new-to-market activity tracker against One Drop only on the 3-month hemoglobin A1c level of adults with type 1 diabetes. Methods: Social media advertisements and online newsletters were used to recruit adults (?18 years old) diagnosed (?1 year) with T1D, na{\"i}ve to One Drop's full solution and the activity tracker, with a laboratory hemoglobin A1c level?7\%. Participants (N=99) were randomized to receive One Drop and the activity tracker or One Drop only at the start of the study. The One Drop only group received the activity tracker at the end of the study. Multiple imputation, performed separately by group, was used to correct for missing data. Analysis of covariance models, controlling for baseline hemoglobin A1c, were used to evaluate 3-month hemoglobin A1c differences in intent-to-treat (ITT) and per protocol (PP) analyses. Results: The enrolled sample (N=95) had a mean age of 41 (SD 11) years, was 73\% female, 88\% White, diagnosed for a mean of 20 (SD 11) years, and had a mean hemoglobin A1c level of 8.4\% (SD 1.2\%); 11\% of the participants did not complete follow up. Analysis of covariance assumptions were met for the ITT and PP models. In ITT analysis, participants in the One Drop and activity tracker condition had a significantly lower 3-month hemoglobin A1c level (mean 7.9\%, SD 0.60\%, 95\% CI 7.8-8.2) than that of the participants in the One Drop only condition (mean 8.4\%, SD 0.62\%, 95\% CI 8.2-8.5). In PP analysis, participants in the One Drop and activity tracker condition also had a significantly lower 3-month hemoglobin A1c level (mean 7.9\%, SD 0.59\%, 95\% CI 7.7-8.1) than that of participants in the One Drop only condition (mean 8.2\%, SD 0.58\%, 95\% CI 8.0-8.4). Conclusions: Participants exposed to One Drop and the activity tracker for the 3-month study period had a significantly lower 3-month hemoglobin A1c level compared to that of participants exposed to One Drop only during the same timeframe. One Drop and a tracker may work better together than alone in helping people with type 1 diabetes. Trial Registration: ClinicalTrials.gov NCT03459573; https://clinicaltrials.gov/ct2/show/NCT03459573. ",
doi="10.2196/16745",
url="http://mhealth.jmir.org/2020/9/e16745/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32540842"
}


@Article{info:doi/10.2196/16053,
author="Tsuji, Shintaro
and Ishikawa, Tomoki
and Morii, Yasuhiro
and Zhang, Hongjian
and Suzuki, Teppei
and Tanikawa, Takumi
and Nakaya, Jun
and Ogasawara, Katsuhiko",
title="Cost-Effectiveness of a Continuous Glucose Monitoring Mobile App for Patients With Type 2 Diabetes Mellitus: Analysis Simulation",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="17",
volume="22",
number="9",
pages="e16053",
keywords="Markov model",
keywords="telehealth",
keywords="continuous glucose monitoring (CGM)",
keywords="type 2 diabetes mellitus",
keywords="cost-effectiveness",
keywords="incremental cost and effective ratio (ICER)",
abstract="Background: Apps for real-time continuous glucose monitoring (CGM) on smartphones and other devices linked to CGM systems have recently been developed, and such CGM apps are also coming into use in Japan. In comparison with conventional retrospective CGM, the use of CGM apps improves patients' own blood glucose control, which is expected to help slow the progression of type 2 diabetes mellitus (DM) and prevent complications, but the effect of their introduction on medical costs remains unknown. Objective: Our objective in this study was to perform an economic appraisal of CGM apps from the viewpoint of assessing public medical costs associated with type 2 DM, using the probability of developing type 2 DM--associated complications, and data on medical costs and utility value to carry out a medical cost simulation using a Markov model in order to ascertain the cost-effectiveness of the apps. Methods: We developed a Markov model with the transition states of insulin therapy, nephrosis, dialysis, and cardiovascular disease, all of which have a major effect on medical costs, to identify changes in medical costs and utility values resulting from the introduction of a CGM app and calculated the incremental cost-effectiveness ratio (ICER). Results: The ICER for CGM app use was US \$33,039/quality-adjusted life year (QALY). Conclusions: Sensitivity analyses showed that, with the exception of conditions where the transition probability of insulin therapy, utility value, or increased medical costs increases, the ICER for the introduction of CGM apps was below the threshold of US \$43,478/QALY used by the Central Social Insurance Medical Council. Our results provide basic data on the cost-effectiveness of introducing CGM apps, which are currently starting to come into use. ",
doi="10.2196/16053",
url="https://www.jmir.org/2020/9/e16053",
url="http://www.ncbi.nlm.nih.gov/pubmed/32940613"
}


@Article{info:doi/10.2196/18896,
author="Zhu, Haihua
and Chen, Xiuwan
and Yang, Jinqiu
and Wu, Qiaoling
and Zhu, Jiemin
and Chan, Wai-Chi Sally",
title="Mobile Breast Cancer e-Support Program for Chinese Women With Breast Cancer Undergoing Chemotherapy (Part 3): Secondary Data Analysis",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="16",
volume="8",
number="9",
pages="e18896",
keywords="breast cancer",
keywords="chemotherapy",
keywords="mobile app",
keywords="mHealth",
abstract="Background: Many app-based interventions targeting women with breast cancer have been developed and tested for effectiveness. However, information regarding the evaluation of the usage of these interventions is scarce. A better understanding of usage data is important to determine how women use apps and how these interventions affect health outcomes. Objective: This study aimed to examine the usage duration and login frequency of an app-based intervention, the Breast Cancer e-Support (BCS) program, and to investigate the association between usage data and participants' demographic and medical characteristics. Methods: This study is a secondary data analysis of a randomized controlled trial assessing the effectiveness of the BCS program. The BCS program contains four modules: Learning Forum, Discussion Forum, Ask-the-Expert Forum, and Your Story Forum. A total of 57 women in the intervention group accessed the BCS program during their 12-week chemotherapy. The app's background system tracked the usage duration and login frequency for each forum and the entire BCS program. Results: The total usage duration per participant ranged from 0 to 9371 minutes, and the login frequency per participant ranged from 0 to 774 times. The Discussion Forum and the Learning Forum were the most frequently used modules. The general linear model showed that age, education, family monthly income, and employment were associated with BCS usage duration and/or login frequency. Age (F1,45=10.09, P=.003, B=115.34, 95\% CI 42.22-188.47) and education level (F1,45=7.22, P=.01, B=1949.63, 95\% CI 487.76-3411.50) were positively associated with the usage duration of the entire BCS program. Family monthly income was positively associated with the usage duration of the Learning Forum (F1,45=11.85, P=.001, B=1488.55, 95\% CI 617.58-2359.51) and the login frequency of the entire BCS program (F1,45=4.47, P=.04, B=113.68, 95\% CI 5.33-222.03). Employment was negatively associated with the usage duration of the Ask-the-expert Forum (F1,45=4.50, P=.04, B=--971.87, 95\% CI --1894.66 to --49.07) and the Your Story Forum (F1,45=5.36, P=.03, B=--640.71, 95\% CI --1198.30 to --83.11) and positively associated with the login frequency of the entire BCS program (F1,45=10.86, P=.002, B=192.88, 95\% CI 75.01-310.74). No statistical differences were found between BCS usage data and cancer stage, BMI, comorbidity, types of surgery, or cycles of chemotherapy. Conclusions: Overall, this study found considerable variability in the usage of app-based interventions. When health care professionals incorporate app-based interventions into their routine care for women with breast cancer, the learning and discussion functions of apps should be strengthened to promote engagement. Additionally, characteristics of women with breast cancer, such as age, level of education, income, and employment status, should be taken in consideration to develop tailored apps that address their particular needs and therefore improve their engagement with the app. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616000639426; http://www.ANZCTR.org.au/ACTRN12616000639426.aspx ",
doi="10.2196/18896",
url="http://mhealth.jmir.org/2020/9/e18896/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32936087"
}


@Article{info:doi/10.2196/18339,
author="Mandracchia, Floriana
and Llaurad{\'o}, Elisabet
and Tarro, Lucia
and Valls, Maria Rosa
and Sol{\`a}, Rosa",
title="Mobile Phone Apps for Food Allergies or Intolerances in App Stores: Systematic Search and Quality Assessment Using the Mobile App Rating Scale (MARS)",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="16",
volume="8",
number="9",
pages="e18339",
keywords="food allergy",
keywords="food hypersensitivity",
keywords="food intolerance",
keywords="allergens",
keywords="mobile applications",
keywords="mobile health",
keywords="mHealth",
keywords="eHealth.",
abstract="Background: Food allergies and intolerances are increasing worldwide, and mobile phone apps could be a promising tool for self-management of these issues. Objective: This study aimed to systemically search and assess food allergy or intolerance apps in app stores using the multidimensional Mobile App Rating Scale (MARS) to rate the objective and subjective quality and to identify critical points for future improvements. Methods: This systematic search identified apps through the keywords ``food allergy,'' ``food intolerance,'' and ``allergens'' in English, Spanish, and Italian in the Apple App Store (iOS) and Google Play Store (Android). The inclusion criteria were a user star rating of ?3 (of 5 stars) to limit the selection to the most highly rated apps; ?1000 reviews as an indicator of reliability; and the most recent update performed up to 2017. Then, the apps were divided according to their purpose (searching for allergen-free ``food products,'' ``restaurants,'' or recipes in ``meal planners'') and evaluated on a scale of 1 to 5 points using the MARS in terms of (1) app classification category with a descriptive aim; (2) app subjective and objective quality categories comprised of engagement, functionality, esthetics, and information sections (Medline was searched for eligible apps to check whether they had been tested in trials); and (3) an optional app-specific section. Furthermore, the output and input features were evaluated. Differences between MARS sections and between app purposes and correlations among MARS sections, star ratings, and numbers of reviews were evaluated. Results: Of the 1376 apps identified, 14 were included: 12 related to food allergies and intolerances that detect 2-16 food allergens and 2 related only to gluten intolerance. The mean (SD) MARS scores (maximum 5 points) were 3.8 (SD 0.4) for objective quality, highlighting whether any app had been tested in trials; 3.5 (SD 0.6) for subjective quality; and 3.6 (SD 0.7) for the app-specific section. Therefore, a rating ?3 points indicated overall acceptable quality. From the between-section comparison, engagement (mean 3.5, SD 0.6) obtained significantly lower scores than functionality (mean 4.1, SD 0.6), esthetics (mean 4, SD 0.5), and information (mean 3.8, SD 0.4). However, when the apps were compared by purpose, critical points were identified: meal planner apps showed significantly higher engagement (mean 4.1, SD 0.4) than food product (mean 3.0, SD 0.6; P=.05) and restaurant (mean 3.2, SD 0.3; P=.02) apps. Conclusions: In this systematic search of food allergy or intolerance apps, acceptable MARS quality was identified, although the engagement section for food product and restaurant purpose apps should be improved and the included apps should be tested in trials. The critical points identified in this systematic search can help improve the innovativeness and applicability of future food allergy and intolerance apps. ",
doi="10.2196/18339",
url="http://mhealth.jmir.org/2020/9/e18339/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32936078"
}


@Article{info:doi/10.2196/20701,
author="Schachner, Theresa
and Keller, Roman
and v Wangenheim, Florian",
title="Artificial Intelligence-Based Conversational Agents for Chronic Conditions: Systematic Literature Review",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="14",
volume="22",
number="9",
pages="e20701",
keywords="artificial intelligence",
keywords="conversational agents",
keywords="chatbots",
keywords="healthcare",
keywords="chronic diseases",
keywords="systematic literature review",
abstract="Background: A rising number of conversational agents or chatbots are equipped with artificial intelligence (AI) architecture. They are increasingly prevalent in health care applications such as those providing education and support to patients with chronic diseases, one of the leading causes of death in the 21st century. AI-based chatbots enable more effective and frequent interactions with such patients. Objective: The goal of this systematic literature review is to review the characteristics, health care conditions, and AI architectures of AI-based conversational agents designed specifically for chronic diseases. Methods: We conducted a systematic literature review using PubMed MEDLINE, EMBASE, PyscInfo, CINAHL, ACM Digital Library, ScienceDirect, and Web of Science. We applied a predefined search strategy using the terms ``conversational agent,'' ``healthcare,'' ``artificial intelligence,'' and their synonyms. We updated the search results using Google alerts, and screened reference lists for other relevant articles. We included primary research studies that involved the prevention, treatment, or rehabilitation of chronic diseases, involved a conversational agent, and included any kind of AI architecture. Two independent reviewers conducted screening and data extraction, and Cohen kappa was used to measure interrater agreement.A narrative approach was applied for data synthesis. Results: The literature search found 2052 articles, out of which 10 papers met the inclusion criteria. The small number of identified studies together with the prevalence of quasi-experimental studies (n=7) and prevailing prototype nature of the chatbots (n=7) revealed the immaturity of the field. The reported chatbots addressed a broad variety of chronic diseases (n=6), showcasing a tendency to develop specialized conversational agents for individual chronic conditions. However, there lacks comparison of these chatbots within and between chronic diseases. In addition, the reported evaluation measures were not standardized, and the addressed health goals showed a large range. Together, these study characteristics complicated comparability and open room for future research. While natural language processing represented the most used AI technique (n=7) and the majority of conversational agents allowed for multimodal interaction (n=6), the identified studies demonstrated broad heterogeneity, lack of depth of reported AI techniques and systems, and inconsistent usage of taxonomy of the underlying AI software, further aggravating comparability and generalizability of study results. Conclusions: The literature on AI-based conversational agents for chronic conditions is scarce and mostly consists of quasi-experimental studies with chatbots in prototype stage that use natural language processing and allow for multimodal user interaction. Future research could profit from evidence-based evaluation of the AI-based conversational agents and comparison thereof within and between different chronic health conditions. Besides increased comparability, the quality of chatbots developed for specific chronic conditions and their subsequent impact on the target patients could be enhanced by more structured development and standardized evaluation processes. ",
doi="10.2196/20701",
url="http://www.jmir.org/2020/9/e20701/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32924957"
}


@Article{info:doi/10.2196/17083,
author="Alenazi, A. Hanan
and Jamal, Amr
and Batais, A. Mohammed",
title="Identification of Type 2 Diabetes Management Mobile App Features and Engagement Strategies: Modified Delphi Approach",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="11",
volume="8",
number="9",
pages="e17083",
keywords="diabetes",
keywords="mobile features",
keywords="engagement strategies",
keywords="mobile app",
keywords="Delphi consensus",
abstract="Background: Diabetes is a significant public health issue. Saudi Arabia has the highest prevalence of type 2 diabetes mellitus (T2DM) in the Arab world. Currently, it affects 31.6\% of the general population, and the prevalence of T2DM is predicted to rise to 45.36\% by 2030. Mobile health (mHealth) offers improved and cost-effective care to people with T2DM. However, the efficiency of engagement strategies and features of this technology need to be reviewed and standardized according to stakeholder and expert perspectives. Objective: The main objective of this study was to identify the most agreed-upon features for T2DM self-management mobile apps; the secondary objective was to identify the most agreed-upon strategies that prompt users to use these apps. Methods: In this study, a 4-round modified Delphi method was applied by experts in the domain of diabetes care. Results: In total, 11 experts with a mean age of 47.09 years (SD 11.70) consented to participate in the study. Overall, 36 app features were generated. The group of experts displayed weak agreement in their ranking of intervention components (Kendall W=0.275; P<.001). The top 5 features included insulin dose adjustment according to carbohydrate counting and blood glucose readings (5.36), alerting a caregiver of abnormal or critical readings (6.09), nutrition education (12.45), contacts for guidance if required (12.64), and offering patient-specific education tailored to the user's goals, needs, and blood glucose readings (12.90). In total, 21 engagement strategies were generated. Overall, the experts showed a moderate degree of consensus in their strategy rankings (Kendall W=0.454; P<.001). The top 5 engagement strategies included a user-friendly design (educational and age-appropriate design; 2.82), a free app (3.73), allowing the user to communicate or send information/data to a health care provider (HCP; 5.36), HCPs prescribing the mobile app in the clinic and asking about patients' app use compliance during clinical visits (6.91), and flexibility and customization (7.91). Conclusions: This is the first study in the region consisting of a local panel of experts from the diabetes field gathering together. We used an iterative process to combine the experts' opinions into a group consensus. The results of this study could thus be useful for health app developers and HCPs and inform future decision making on the topic. ",
doi="10.2196/17083",
url="http://mhealth.jmir.org/2020/9/e17083/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32678798"
}


@Article{info:doi/10.2196/18729,
author="Nordstoga, Lovise Anne
and Bach, Kerstin
and Sani, Sadiq
and Wiratunga, Nirmalie
and Mork, Jarle Paul
and Villumsen, Morten
and Cooper, Kay",
title="Usability and Acceptability of an App (SELFBACK) to Support Self-Management of Low Back Pain: Mixed Methods Study",
journal="JMIR Rehabil Assist Technol",
year="2020",
month="Sep",
day="9",
volume="7",
number="2",
pages="e18729",
keywords="low back pain",
keywords="self-management",
keywords="physical activity",
keywords="exercise",
keywords="patient education",
keywords="smartphone",
keywords="mHealth",
keywords="eHealth",
keywords="digital health",
keywords="case-based reasoning",
abstract="Background: Self-management is the key recommendation for managing nonspecific low back pain (LBP). However, there are well-documented barriers to self-management; therefore, methods of facilitating adherence are required. Smartphone apps are increasingly being used to support self-management of long-term conditions such as LBP. Objective: The aim of this study was to assess the usability and acceptability of the SELFBACK smartphone app, designed to support and facilitate self-management of non-specific LBP. The app provides weekly self-management plans, comprising physical activity, strength and flexibility exercises, and patient education. The plans are tailored to the patient's characteristics and symptom progress by using case-based reasoning methodology. Methods: The study was carried out in 2 stages using a mixed-methods approach. All participants undertook surveys, and semistructured telephone interviews were conducted with a subgroup of participants. Stage 1 assessed an app version with only the physical activity component and a web questionnaire that collects information necessary for tailoring the self-management plans. The physical activity component included monitoring of steps recorded by a wristband, goal setting, and a scheme for sending personalized, timely, and motivational notifications to the user's smartphone. Findings from Stage 1 were used to refine the app and inform further development. Stage 2 investigated an app version that incorporated 3 self-management components (physical activity, exercises, and education). A total of 16 participants (age range 23-71 years) with ongoing or chronic nonspecific LBP were included in Stage 1, and 11 participants (age range 32-56 years) were included in Stage 2. Results: In Stage 1, 15 of 16 participants reported that the baseline questionnaire was easy to answer, and 84\% (13/16) found the completion time to be acceptable. Overall, participants were positive about the usability of the physical activity component but only 31\% (5/16) found the app functions to be well integrated. Of the participants, 90\% (14/16) were satisfied with the notifications, and they were perceived as being personalized (12/16, 80\%). In Stage 2, all participants reported that the web questionnaire was easy to answer and the completion time acceptable. The physical activity and exercise components were rated useful by 80\% (8/10), while 60\% (6/10) rated the educational component useful. Overall, participants were satisfied with the usability of the app; however, only 50\% (5/10) found the functions to be well integrated, and 20\% (2/10) found them to be inconsistent. Overall, 80\% (8/10) of participants reported it to be useful for self-management. The interviews largely reinforced the survey findings in both stages. Conclusions: This study has demonstrated that participants considered the SELFBACK app to be acceptable and usable and that they thought it would be useful for supporting self-management of LBP. However, we identified some limitations and suggestions useful to guide further development of the SELFBACK app and other mobile health interventions. ",
doi="10.2196/18729",
url="http://rehab.jmir.org/2020/2/e18729/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32902393"
}


@Article{info:doi/10.2196/19962,
author="Adler, A. Daniel
and Ben-Zeev, Dror
and Tseng, W-S Vincent
and Kane, M. John
and Brian, Rachel
and Campbell, T. Andrew
and Hauser, Marta
and Scherer, A. Emily
and Choudhury, Tanzeem",
title="Predicting Early Warning Signs of Psychotic Relapse From Passive Sensing Data: An Approach Using Encoder-Decoder Neural Networks",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Aug",
day="31",
volume="8",
number="8",
pages="e19962",
keywords="psychotic disorders",
keywords="schizophrenia",
keywords="mHealth",
keywords="mental health",
keywords="mobile health",
keywords="smartphone applications",
keywords="machine learning",
keywords="passive sensing",
keywords="digital biomarkers",
keywords="digital phenotyping",
keywords="artificial intelligence",
keywords="deep learning",
keywords="mobile phone",
abstract="Background: Schizophrenia spectrum disorders (SSDs) are chronic conditions, but the severity of symptomatic experiences and functional impairments vacillate over the course of illness. Developing unobtrusive remote monitoring systems to detect early warning signs of impending symptomatic relapses would allow clinicians to intervene before the patient's condition worsens. Objective: In this study, we aim to create the first models, exclusively using passive sensing data from a smartphone, to predict behavioral anomalies that could indicate early warning signs of a psychotic relapse. Methods: Data used to train and test the models were collected during the CrossCheck study. Hourly features derived from smartphone passive sensing data were extracted from 60 patients with SSDs (42 nonrelapse and 18 relapse >1 time throughout the study) and used to train models and test performance. We trained 2 types of encoder-decoder neural network models and a clustering-based local outlier factor model to predict behavioral anomalies that occurred within the 30-day period before a participant's date of relapse (the near relapse period). Models were trained to recreate participant behavior on days of relative health (DRH, outside of the near relapse period), following which a threshold to the recreation error was applied to predict anomalies. The neural network model architecture and the percentage of relapse participant data used to train all models were varied. Results: A total of 20,137 days of collected data were analyzed, with 726 days of data (0.037\%) within any 30-day near relapse period. The best performing model used a fully connected neural network autoencoder architecture and achieved a median sensitivity of 0.25 (IQR 0.15-1.00) and specificity of 0.88 (IQR 0.14-0.96; a median 108\% increase in behavioral anomalies near relapse). We conducted a post hoc analysis using the best performing model to identify behavioral features that had a medium-to-large effect (Cohen d>0.5) in distinguishing anomalies near relapse from DRH among 4 participants who relapsed multiple times throughout the study. Qualitative validation using clinical notes collected during the original CrossCheck study showed that the identified features from our analysis were presented to clinicians during relapse events. Conclusions: Our proposed method predicted a higher rate of anomalies in patients with SSDs within the 30-day near relapse period and can be used to uncover individual-level behaviors that change before relapse. This approach will enable technologists and clinicians to build unobtrusive digital mental health tools that can predict incipient relapse in SSDs. ",
doi="10.2196/19962",
url="https://mhealth.jmir.org/2020/8/e19962",
url="http://www.ncbi.nlm.nih.gov/pubmed/32865506"
}


@Article{info:doi/10.2196/18506,
author="Iio, Misa
and Miyaji, Yumiko
and Yamamoto-Hanada, Kiwako
and Narita, Masami
and Nagata, Mayumi
and Ohya, Yukihiro",
title="Beneficial Features of a mHealth Asthma App for Children and Caregivers: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Aug",
day="24",
volume="8",
number="8",
pages="e18506",
keywords="children",
keywords="caregivers",
keywords="asthma",
keywords="mobile app",
keywords="proposed beneficial features",
abstract="Background: mHealth and uHealth apps are available for children with asthma and their caregivers. However, previous studies on mHealth apps for children older than 7 years old with asthma are limited, and most studies on asthma apps do not consider interactions involving communication between children and caregivers. Therefore, a prototype mHealth child asthma app was developed for children and their caregivers, with features of tailored feedback messages in continuing self-management and interactions between children and caregivers. Objective: The aim of this study was to identify the beneficial features of a prototype mHealth app developed for children with asthma and their caregivers. Methods: Children diagnosed with persistent asthma by allergy specialists at the National Center for Child Health and Development were recruited. The features of a prototype mHealth app for children with asthma and their caregivers were investigated using semistructured interviews after they tried the app. Data were analyzed using thematic analysis. Content-characteristic words were named and grouped together as categories to explore themes. Results: We recruited 27 children with asthma aged 2 to 12 years and 26 their caregivers. Findings on the good aspects of the app for children older than 7 years old and caregivers suggested 4 themes (confirmation of asthma knowledge, child-caregiver interaction, design of the app, and child's interest), and 6 categories were identified. Findings on the good aspects of app for children 7 to 12 years old and caregivers suggested 5 themes (new knowledge, manga as a Japanese-style comic, child's interest, trigger of self-management, and design and operability), and 11 categories were identified. Findings on the beneficial features of app suggested 6 themes (asthma knowledge, elements for continuous, universal design, notification, monitoring, and functions), and 12 categories were identified. Conclusions: Children with asthma and their caregivers perceived that the good aspects of the app were learning asthma knowledge with fun, including manga; interaction between child and caregiver; and easy-to-read design, such as colors. They wanted not only the asthma knowledge but also the universal design and enhanced elements, monitoring, and notification functions of the app. ",
doi="10.2196/18506",
url="http://mhealth.jmir.org/2020/8/e18506/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32831181"
}


@Article{info:doi/10.2196/17015,
author="Wong, SY Zoie
and Siy, Braylien
and Da Silva Lopes, Katharina
and Georgiou, Andrew",
title="Improving Patients' Medication Adherence and Outcomes in Nonhospital Settings Through eHealth: Systematic Review of Randomized Controlled Trials",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="20",
volume="22",
number="8",
pages="e17015",
keywords="eHealth",
keywords="self-administered drug",
keywords="self-management",
keywords="medication adherence",
keywords="nonhospital settings",
keywords="randomized controlled trial",
abstract="Background: Electronic health (eHealth) refers to the use of information and communication technologies for health. It plays an increasingly important role in patients' medication management. Objective: To assess evidence on (1) whether eHealth for patients' medication management can improve drug adherence and health outcomes in nonhospital settings and (2) which eHealth functions are commonly used and are effective in improving drug adherence. Methods: We searched for randomized controlled trials (RCTs) on PubMed, MEDLINE, CINAHL, EMBASE, EmCare, ProQuest, Scopus, Web of Science, ScienceDirect, and IEEE Xplore, in addition to other published sources between 2000 and 2018. We evaluated the studies against the primary outcome measure of medication adherence and multiple secondary health care outcome measures relating to adverse events, quality of life, patient satisfaction, and health expenditure. The quality of the studies included was assessed using the Cochrane Collaboration's Risk of Bias (RoB) tool. Results: Our initial search yielded 9909 records, and 24 studies met the selection criteria. Of these, 13 indicated improvement in medication adherence at the significance level of P<.1 and 2 indicated an improved quality of life at the significance level of P<.01. The top 3 functions that were employed included mechanisms to communicate with caregivers, monitoring health features, and reminders and alerts. eHealth functions of providing information and education, and dispensing treatment and administration support tended to favor improved medication adherence outcomes (Fisher exact test, P=.02). There were differences in the characteristics of the study population, intervention design, functionality provided, reporting adherence, and outcome measures among the included studies. RoB assessment items, including blinding of outcome assessment and method for allocation concealment, were not explicitly reported in a large number of studies. Conclusions: All the studies included were designed for patient home-based care application and provided a mechanism to communicate with caregivers. A targeted study population such as older patients should be considered to maximize the public health impact on the self-management of diseases. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42018096627; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=96627 ",
doi="10.2196/17015",
url="http://www.jmir.org/2020/8/e17015/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32663145"
}


@Article{info:doi/10.2196/20679,
author="Yin, Zenong
and Errisuriz, L. Vanessa
and Evans, Martin
and Inupakutika, Devasena
and Kaghyan, Sahak
and Li, Shiyu
and Esparza, Laura
and Akopian, David
and Parra-Medina, Deborah",
title="A Digital Health Intervention for Weight Management for Latino Families Living in Rural Communities: Perspectives and Lessons Learned During Development",
journal="JMIR Form Res",
year="2020",
month="Aug",
day="20",
volume="4",
number="8",
pages="e20679",
keywords="mhealth",
keywords="digital intervention",
keywords="Latino families",
keywords="rural population",
keywords="weight",
keywords="self-management",
keywords="diet",
keywords="lifestyle",
keywords="chronic disease",
doi="10.2196/20679",
url="http://formative.jmir.org/2020/8/e20679/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32726748"
}


@Article{info:doi/10.2196/18999,
author="Chen, Yi-Wen
and Wei, Jeng
and Chen, Hwei-Ling
and Cheng, Ching-Hui
and Hou, I-Ching",
title="Developing a Heart Transplantation Self-Management Support Mobile Health App in Taiwan: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Aug",
day="19",
volume="8",
number="8",
pages="e18999",
keywords="heart transplantation",
keywords="mobile health app",
keywords="self-management",
abstract="Background: Heart transplantation (HTx) is the most effective treatment for end-stage heart failure patients. After transplantation, patients face physiological, psychological, social, and other health care problems. Mobile health (mHealth) apps can change the delivery of conventional health care to ubiquitous care and improve health care quality. However, a dearth of mHealth apps exists for patients with HTx worldwide, including in Taiwan. Objective: The aim of this study was to investigate the information needed and to develop a preliminary framework for an mHealth app for post-HTx patients. Methods: A qualitative approach with individual in-depth interviews was conducted at a heart center in the regional hospital of northern Taiwan from June to November 2017. Patients that had undergone HTx and their health professionals were recruited for purposeful sampling. A semistructured interview guideline was used for individual interviews and transcribed. Thematic analysis was used for data analysis. Results: A total of 21 subjects, including 17 patients and 4 health professionals, were recruited for the study. The following five major themes were identified: reminding, querying, experience sharing, diet, and expert consulting. Minor themes included a desire to use the app with artificial intelligence and integration with professional management. Conclusions: An intelligent mHealth app that addresses the five main themes and integrates the processes of using a mobile app could facilitate HTx self-management for Taiwanese patients. ",
doi="10.2196/18999",
url="http://mhealth.jmir.org/2020/8/e18999/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32812883"
}


@Article{info:doi/10.2196/21767,
author="Mehdi, Muntazir
and Stach, Michael
and Riha, Constanze
and Neff, Patrick
and Dode, Albi
and Pryss, R{\"u}diger
and Schlee, Winfried
and Reichert, Manfred
and Hauck, J. Franz",
title="Smartphone and Mobile Health Apps for Tinnitus: Systematic Identification, Analysis, and Assessment",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Aug",
day="18",
volume="8",
number="8",
pages="e21767",
keywords="Health care",
keywords="Mobile Health",
keywords="Smartphone Apps",
keywords="Mobile Apps",
keywords="Tinnitus",
keywords="App Quality Assessment and Evaluation",
keywords="MARS",
abstract="Background: Modern smartphones contain sophisticated high-end hardware features, offering high computational capabilities at extremely manageable costs and have undoubtedly become an integral part in users' daily life. Additionally, smartphones offer a well-established ecosystem that is easily discoverable and accessible via the marketplaces of differing mobile platforms, thus encouraging the development of many smartphone apps. Such apps are not exclusively used for entertainment purposes but are also commonplace in health care and medical use. A variety of those health and medical apps exist within the context of tinnitus, a phantom sound perception in the absence of any physical external source. Objective: In this paper, we shed light on existing smartphone apps addressing tinnitus by providing an up-to-date overview. Methods: Based on PRISMA guidelines, we systematically searched and identified existing smartphone apps on the most prominent app markets, namely Google Play Store and Apple App Store. In addition, we applied the Mobile App Rating Scale (MARS) to evaluate and assess the apps in terms of their general quality and in-depth user experience. Results: Our systematic search and screening of smartphone apps yielded a total of 34 apps (34 Android apps, 26 iOS apps). The mean MARS scores (out of 5) ranged between 2.65-4.60. The Tinnitus Peace smartphone app had the lowest score (mean 2.65, SD 0.20), and Sanvello---Stress and Anxiety Help had the highest MARS score (mean 4.60, SD 0.10). The interrater agreement was substantial (Fleiss $\kappa$=0.74), the internal consistency was excellent (Cronbach $\alpha$=.95), and the interrater reliability was found to be both high and excellent---Guttman $\lambda$6=0.94 and intraclass correlation, ICC(2,k) 0.94 (95\% CI 0.91-0.97), respectively. Conclusions: This work demonstrated that there exists a plethora of smartphone apps for tinnitus. All of the apps received MARS scores higher than 2, suggesting that they all have some technical functional value. However, nearly all identified apps were lacking in terms of scientific evidence, suggesting the need for stringent clinical validation of smartphone apps in future. To the best of our knowledge, this work is the first to systematically identify and evaluate smartphone apps within the context of tinnitus. ",
doi="10.2196/21767",
url="http://mhealth.jmir.org/2020/8/e21767/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32808939"
}


@Article{info:doi/10.2196/18818,
author="Darg{\'e}l, A. Aroldo
and Mosconi, Elise
and Masson, Marc
and Plaze, Marion
and Taieb, Fabien
and Von Platen, Cassandra
and Buivan, Phuc Tan
and Pouleriguen, Guillaume
and Sanchez, Marie
and Fournier, St{\'e}phane
and Lledo, Pierre-Marie
and Henry, Chantal",
title="Toi M{\^e}me, a Mobile Health Platform for Measuring Bipolar Illness Activity: Protocol for a Feasibility Study",
journal="JMIR Res Protoc",
year="2020",
month="Aug",
day="18",
volume="9",
number="8",
pages="e18818",
keywords="bipolar disorder",
keywords="digital phenotyping, smartphone app",
keywords="ecological momentary assessment",
keywords="mHealth",
keywords="mood instability",
keywords="cognitive speed",
keywords="affective response",
keywords="big data, machine learning",
abstract="Background: The diagnosis and management of bipolar disorder are limited by the absence of available biomarkers. Patients with bipolar disorder frequently present with mood instability even during remission, which is likely associated with the risk of relapse, impaired functioning, and suicidal behavior, indicating that the illness is active. Objective: This research protocol aimed to investigate the correlations between clinically rated mood symptoms and mood/behavioral data automatically collected using the Toi M{\^e}me app in patients with bipolar disorder presenting with different mood episodes. This study also aimed to assess the feasibility of this app for self-monitoring subjective and objective mood/behavior parameters in those patients. Methods: This open-label, nonrandomized trial will enroll 93 (31 depressive, 31 euthymic, and 31 hypomanic) adults diagnosed with bipolar disorder type I/II (Diagnostic and Statistical Manual of Mental Disorders, 5th edition criteria) and owning an iPhone. Clinical evaluations will be performed by psychiatrists at the baseline and after 2 weeks, 1 month, 2 months, and 3 months during the follow-up. Rather than only accessing the daily mood symptoms, the Toi M{\^e}me app also integrates ecological momentary assessments through 2 gamified tests to assess cognition speed (QUiCKBRAIN) and affective responses (PLAYiMOTIONS) in real-life contexts, continuously measures daily motor activities (eg, number of steps, distance) using the smartphone's motion sensors, and performs a comprehensive weekly assessment. Results: Recruitment began in April 2018 and the completion of the study is estimated to be in December 2021. As of April 2019, 25 participants were enrolled in the study. The first results are expected to be submitted for publication in 2020. This project has been funded by the Perception and Memory Unit of the Pasteur Institute (Paris) and it has received the final ethical/research approvals in April 2018 (ID-RCB: 2017-A02450-53). Conclusions: Our results will add to the evidence of exploring other alternatives toward a more integrated approach in the management of bipolar disorder, including digital phenotyping, to develop an ethical and clinically meaningful framework for investigating, diagnosing, and treating individuals at risk of developing bipolar disorder or currently experiencing bipolar disorder. Further prospective studies on the validity of automatically generated smartphone data are needed for better understanding the longitudinal pattern of mood instability in bipolar disorder as well as to establish the reliability, efficacy, and cost-effectiveness of such an app intervention for patients with bipolar disorder. Trial Registration: ClinicalTrials.gov NCT03508427; https://clinicaltrials.gov/ct2/show/NCT03508427 International Registered Report Identifier (IRRID): DERR1-10.2196/18818 ",
doi="10.2196/18818",
url="http://www.researchprotocols.org/2020/8/e18818/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32638703"
}


@Article{info:doi/10.2196/18632,
author="Elbers, Stefan
and Pool, Jan
and Wittink, Harri{\"e}t
and K{\"o}ke, Alb{\`e}re
and Scheffer, Else
and Smeets, Rob",
title="Mobile Health App (AGRIPPA) to Prevent Relapse After Successful Interdisciplinary Treatment for Patients With Chronic Pain: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2020",
month="Aug",
day="18",
volume="9",
number="8",
pages="e18632",
keywords="telemedicine",
keywords="chronic pain",
keywords="recurrence",
keywords="clinical trial protocol",
keywords="rehabilitation",
keywords="randomized controlled trial",
keywords="cost-benefit analysis",
keywords="treatment adherence and compliance",
keywords="mobile apps",
keywords="patient care team",
abstract="Background: To facilitate adherence to adaptive pain management behaviors after interdisciplinary multimodal pain treatment, we developed a mobile health app (AGRIPPA app) that contains two behavior regulation strategies. Objective: The aims of this project are (1) to test the effectiveness of the AGRIPPA app on pain disability; (2) to determine the cost-effectiveness; and (3) to explore the levels of engagement and usability of app users. Methods: We will perform a multicenter randomized controlled trial with two parallel groups. Within the 12-month inclusion period, we plan to recruit 158 adult patients with chronic pain during the initial stage of their interdisciplinary treatment program in one of the 6 participating centers. Participants will be randomly assigned to the standard treatment condition or to the enhanced treatment condition in which they will receive the AGRIPPA app. Patients will be monitored from the start of the treatment program until 12 months posttreatment. In our primary analysis, we will evaluate the difference over time of pain-related disability between the two conditions. Other outcome measures will include health-related quality of life, illness perceptions, pain self-efficacy, app system usage data, productivity loss, and health care expenses. Results: The study was approved by the local Medical Research Ethics Committee in October 2019. As of March 20, 2020, we have recruited 88 patients. Conclusions: This study will be the first step in systematically evaluating the effectiveness and efficiency of the AGRIPPA app. After 3 years of development and feasibility testing, this formal evaluation will help determine to what extent the app will influence the maintenance of treatment gains over time. The outcomes of this trial will guide future decisions regarding uptake in clinical practice. Trial Registration: Netherlands Trial Register NL8076; https://www.trialregister.nl/trial/8076 International Registered Report Identifier (IRRID): DERR1-10.2196/18632 ",
doi="10.2196/18632",
url="https://www.researchprotocols.org/2020/8/e18632",
url="http://www.ncbi.nlm.nih.gov/pubmed/32808931"
}


@Article{info:doi/10.2196/19006,
author="Harada, Norihiro
and Harada, Sonoko
and Ito, Jun
and Atsuta, Ryo
and Hori, Satoshi
and Takahashi, Kazuhisa",
title="Mobile Health App for Japanese Adult Patients With Asthma: Clinical Observational Study",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="14",
volume="22",
number="8",
pages="e19006",
keywords="asthma",
keywords="cough variant asthma",
keywords="mobile health",
keywords="ResearchKit",
abstract="Background: Inappropriate asthma control reduces quality of life and causes increased exacerbations. Mobile health (mHealth) employs information and communication technology for surveying health-related issues. Objective: This noninterventional, observational study assessed current real-world asthma control levels among Japanese patients with asthma and cough variant asthma (CVA) using the Zensoku-Log app. Methods: We developed the app using the ResearchKit platform and conducted a mobile-based, self-reporting, observational survey among patients with asthma and CVA. The app was downloaded 7855 times between February 2016 and February 2018, and enabled collection of data on symptoms, comorbidities, quality of life, medications, asthma control, and adherence. Results: Of the 1744 eligible participants (median age 33 years; range 20-74 years; male-to-female ratio 38.7:61.3), 50.97\% (889/1744) reported unscheduled visits, 62.84\% (1096/1744) reported regularly scheduled visits, 23.14\% (402/1737) smoked, and 40.75\% (705/1730) had pets. In addition, 91.89\% (1598/1739) of participants had atopic predisposition, including allergic rhinitis and atopic dermatitis. Daily inhaled corticosteroid and oral corticosteroid treatment had been prescribed for 89.45\% (1552/1735) and 22.07\% (383/1735) of participants, respectively. Although an asthma control questionnaire demonstrated poor asthma control in 58.48\% (1010/1727), a leukotriene receptor antagonist, theophylline, and a long-acting muscarinic antagonist had been prescribed for only 30.66\% (532/1735), 15.91\% (276/1735), and 4.38\% (76/1735), respectively. The Adherence Starts with Knowledge 12 total score was 29. In the 421 participants who repeated the questionnaire, asthma control increased significantly between the initial and last rounds (P=.002). Conclusions: Users of this mHealth app in Japan had poorly controlled asthma and may need more treatment for asthma and their comorbidities. Repeated app users demonstrated improved asthma control. Trial Registration: UMIN Clinical Trial Registry UMIN000021043;  https://upload.umin.ac.jp/cgi-open-bin/ctr\_e/ctr\_view.cgi?recptno=R000023913. ",
doi="10.2196/19006",
url="https://www.jmir.org/2020/8/e19006",
url="http://www.ncbi.nlm.nih.gov/pubmed/32795993"
}


@Article{info:doi/10.2196/19861,
author="Eaton, Cyd
and Comer, Margaret
and Pruette, Cozumel
and Psoter, Kevin
and Riekert, Kristin",
title="Text Messaging Adherence Intervention for Adolescents and Young Adults with Chronic Kidney Disease: Pilot Randomized Controlled Trial and Stakeholder Interviews",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="14",
volume="22",
number="8",
pages="e19861",
keywords="medication adherence",
keywords="mobile health",
keywords="pediatrics",
keywords="kidney diseases",
keywords="kidney",
keywords="mHealth",
keywords="adherence",
keywords="adolescent",
keywords="young adult",
keywords="intervention",
abstract="Background: Up to one-third of adolescents and young adults (11-21 years old) with chronic kidney disease exhibit suboptimal rates of adherence to renal-protective antihypertensive medications. Mobile health interventions may promote higher adherence to these medicines in these individuals, but empirical research is needed to inform best practices for applying these modalities. Objective: In this multiphase investigation, we developed and tested a theoretically informed text messaging intervention based on the COM-B model, a well-established health intervention framework stating that capability, opportunity, and motivation interactively modify health behaviors, to improve participants' antihypertensive medication adherence in a pilot randomized controlled trial. Qualitative data on user experiences were obtained. Methods: In phase 1, intervention messages (Reminder+COM-B Message) were developed via stakeholder engagement of participants and pediatric nephrologists. In phase 2, the Reminder+COM-B Message intervention was tested against a Reminder-only Message active control condition in an 8-week pilot randomized controlled trial. The primary outcome was daily electronically monitored antihypertensive medication adherence and secondary outcomes included pre-post participant surveys of adherence self-efficacy, adherence barriers, outcome expectancies for taking medicine, and motivation for and importance of taking medicine. In phase 3, qualitative interviews related to user experiences were conducted with participants in the Reminder+COM-B Message intervention group. Results: Following phase 1, 34 participants (mean age 16.59 years, 41\% female, 38\% African American/Black, 35\% hypertension diagnosis) completed the phase 2 pilot randomized controlled trial (n=18 in the Reminder+COM-B Message intervention group, n=16 in the Reminder-only Message active control group). All participants in the Reminder+COM-B Message intervention group completed a phase 3 qualitative interview. Overall, study procedures were feasible and the Reminder+COM-B Message intervention was acceptable to the participants (eg, 15/18 participants reported reading the majority of messages sent to them, 0/18 reported that the messages reduced their desire to take medicine). Prerandomization, there were no significant group differences in the rate of change in daily adherence over time. However, postrandomization, there was a significant group by time interaction (B=.01, P=.04) in which daily adherence decreased significantly over time in the Reminder-only Message active control group but remained stable in the Reminder+COM-B Message intervention group. There were no significant differences between groups in pre-post changes in survey responses. Qualitative interviews revealed participants' perceptions of how the Reminder+COM-B Message intervention changed adherence behavior and highlighted several areas for improving the intervention (eg, adapt messaging timing, intensity, and content to match daily adherence, send praise when medicine is taken). Conclusions: The Reminder+COM-B Message intervention was feasible and acceptable to adolescents/young adults and demonstrated potential to promote participants' daily medication adherence beyond simple reminders. Further research is needed to determine the Reminder+COM-B Message intervention's mechanisms of adherence behavior change and to incorporate qualitative participant feedback into a modified version of this intervention to enhance its acceptability. Trial Registration: ClinicalTrials.gov NCT03651596; https://clinicaltrials.gov/ct2/show/NCT03651596 ",
doi="10.2196/19861",
url="http://www.jmir.org/2020/8/e19861/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32795983"
}


@Article{info:doi/10.2196/19433,
author="Tobias, Guy
and Spanier, B. Assaf",
title="Developing a Mobile App (iGAM) to Promote Gingival Health by Professional Monitoring of Dental Selfies: User-Centered Design Approach",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Aug",
day="14",
volume="8",
number="8",
pages="e19433",
keywords="mHealth",
keywords="telemedicine",
keywords="public health",
keywords="oral health promotion",
keywords="gum health",
keywords="flow of information",
keywords="COVID-19",
abstract="Background: Dental visits are unpleasant; sometimes, patients only seek treatment when they are in intolerable pain. Recently, the novel coronavirus (COVID-19) pandemic has highlighted the need for remote communication when patients and dentists cannot meet in person. Gingivitis is very common and characterized by red, swollen, bleeding gums. Gingivitis heals within 10 days of professional care and with daily, thorough oral hygiene practices. If left untreated, however, its progress may lead to teeth becoming mobile or lost. Of the many medical apps currently available, none monitor gingivitis. Objective: This study aimed to present a characterization and development model of a mobile health (mHealth) app called iGAM, which focuses on periodontal health and improves the information flow between dentists and patients. Methods: A focus group discussed the potential of an app to monitor gingivitis, and 3 semistructured in-depth interviews were conducted on the use of apps for monitoring gum infections.  We used a qualitative design process based on the Agile approach, which incorporated the following 5 steps: (1) user story, (2) use cases, (3) functional requirements, (4) nonfunctional requirements, and (5) Agile software development cycles. In a pilot study with 18 participants aged 18-45 years and with different levels of health literacy, participants were given a toothbrush, toothpaste, mouthwash, toothpicks, and dental floss. After installing iGAM, they were asked to photograph their gums weekly for 4 weeks. Results: All participants in the focus group believed in the potential of a mobile app to monitor gingivitis and reduce its severity. Concerns about security and privacy issues were discussed. From the interviews, 2 themes were derived: (1) ``what's in it for me?'' and (2) the need for a take-home message.  The 5 cycles of development highlighted the importance of communication between dentists, app developers, and the pilot group. Qualitative analysis of the data from the pilot study showed difficulty with: (1) the camera, which was alleviated with the provision of mouth openers, and (2) the operation of the phone, which was alleviated by changing the app to be fully automated, with a weekly reminder and an instructions document. Final interviews showed satisfaction. Conclusions: iGAM is the first mHealth app for monitoring gingivitis using self-photography.  iGAM facilitates the information flow between dentists and patients between checkups and may be useful when face-to-face consultations are not possible (such as during the COVID-19 pandemic). ",
doi="10.2196/19433",
url="http://mhealth.jmir.org/2020/8/e19433/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32795985"
}


@Article{info:doi/10.2196/18751,
author="Di Matteo, Daniel
and Fotinos, Kathryn
and Lokuge, Sachinthya
and Yu, Julia
and Sternat, Tia
and Katzman, A. Martin
and Rose, Jonathan",
title="The Relationship Between Smartphone-Recorded Environmental Audio and Symptomatology of Anxiety and Depression: Exploratory Study",
journal="JMIR Form Res",
year="2020",
month="Aug",
day="13",
volume="4",
number="8",
pages="e18751",
keywords="depression",
keywords="anxiety",
keywords="mobile phone",
keywords="ecological momentary assessment",
keywords="mobile apps",
keywords="mobile health",
keywords="digital signal processing",
keywords="acoustics",
keywords="speech recognition software",
abstract="Background: Objective and continuous severity measures of anxiety and depression are highly valuable and would have many applications in psychiatry and psychology. A collective source of data for objective measures are the sensors in a person's smartphone, and a particularly rich source is the microphone that can be used to sample the audio environment. This may give broad insight into activity, sleep, and social interaction, which may be associated with quality of life and severity of anxiety and depression. Objective: This study aimed to explore the properties of passively recorded environmental audio from a subject's smartphone to find potential correlates of symptom severity of social anxiety disorder, generalized anxiety disorder, depression, and general impairment. Methods: An Android app was designed, together with a centralized server system, to collect periodic measurements of the volume of sounds in the environment and to detect the presence or absence of English-speaking voices. Subjects were recruited into a 2-week observational study during which the app was run on their personal smartphone to collect audio data. Subjects also completed self-report severity measures of social anxiety disorder, generalized anxiety disorder, depression, and functional impairment. Participants were 112 Canadian adults from a nonclinical population. High-level features were extracted from the environmental audio of 84 participants with sufficient data, and correlations were measured between the 4 audio features and the 4 self-report measures. Results: The regularity in daily patterns of activity and inactivity inferred from the environmental audio volume was correlated with the severity of depression (r=?0.37; P<.001). A measure of sleep disturbance inferred from the environmental audio volume was also correlated with the severity of depression (r=0.23; P=.03). A proxy measure of social interaction based on the detection of speaking voices in the environmental audio was correlated with depression (r=?0.37; P<.001) and functional impairment (r=?0.29; P=.01). None of the 4 environmental audio-based features tested showed significant correlations with the measures of generalized anxiety or social anxiety. Conclusions: In this study group, the environmental audio was shown to contain signals that were associated with the severity of depression and functional impairment. Associations with the severity of social anxiety disorder and generalized anxiety disorder were much weaker in comparison and not statistically significant at the 5\% significance level. This work also confirmed previous work showing that the presence of voices is associated with depression. Furthermore, this study suggests that sparsely sampled audio volume could provide potentially relevant insight into subjects' mental health. ",
doi="10.2196/18751",
url="https://formative.jmir.org/2020/8/e18751",
url="http://www.ncbi.nlm.nih.gov/pubmed/32788153"
}


@Article{info:doi/10.2196/17019,
author="Lewis, Shon
and Ainsworth, John
and Sanders, Caroline
and Stockton-Powdrell, Charlotte
and Machin, Matthew
and Whelan, Pauline
and Hopkins, Richard
and He, Zhimin
and Applegate, Eve
and Drake, Richard
and Bamford, Charlie
and Roberts, Chris
and Wykes, Til",
title="Smartphone-Enhanced Symptom Management In Psychosis: Open, Randomized Controlled Trial",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="13",
volume="22",
number="8",
pages="e17019",
keywords="digital",
keywords="smartphone",
keywords="m-health",
keywords="psychosis",
keywords="mental health",
keywords="self management",
abstract="Background: Improving recovery from acute symptoms and preventing relapse are two significant challenges in severe mental illness. We developed a personalized smartphone-based app to monitor symptoms in real time and validated its acceptance, reliability, and validity. Objective: To assess (i) acceptability of continuous monitoring to SMI patients and health professionals over 3 months; (ii) impact of active self-monitoring on positive psychotic symptoms assessed at 6 and 12 weeks; and (iii) the feasibility of detecting early warning signs of relapse. Methods: The active symptom monitoring smartphone app was built into an end-to-end system in two NHS Trusts to enable real-time symptom self-monitoring and detection by the clinical team of early signs of relapse in people with severe mental illness. We conducted an open randomized controlled trial of active symptom monitoring compared to usual management to assess: (i) acceptability and safety of continuous monitoring over 3 months; (ii) impact of active self-monitoring on positive psychotic symptoms assessed at 6 and 12 weeks; (iii) feasibility of detecting early warning signs of relapse communicated to the healthcare staff via an app streaming data to the electronic health record. Eligible participants with a Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) diagnosis of schizophrenia and related disorders, and a history of relapse within the previous two years were enrolled from an early intervention team and a community mental health team. Results: Of 181 eligible patients, 81 (45\%) consented and were randomized to either active symptom monitoring or management as usual. At 12 weeks, 90\% (33/36) of those in the active monitoring group continued to use the system and exhibited an adherence rate (defined as responding to >33\% of alerts) of 84\% (30/36\}. Active symptom monitoring was associated with no difference on the empowerment scale in comparison to the usual management group at 12 weeks. The pre-planned intent-to-treat analysis of the primary outcome, a positive score on the Positive and Negative Syndrome Scale (PANSS) scale, showed a significant reduction in the active symptom monitoring group over 12 weeks in the early intervention center. Alerts for personalized early warning signs of relapse were built into the workflows of both NHS Trusts, and 100\% of health professional staff used the system in a new digital workflow. Qualitative analyses supported the acceptability of the system to participants and staff. Conclusions: The active smartphone monitoring system is feasible and was accepted by users in a 3-month study of people with severe mental illness, with surprisingly high levels of adherence. App use was associated with psychotic symptom improvement in recent-onset participants, but not those with longstanding illness, supporting the notion of improved self-management. When built into clinical management workflows to enable personalized alerts of symptom deterioration, the app has demonstrated utility in promoting earlier intervention for relapse. Trial Registration: ISRCTN Registry ISRCTN88145142; http://www.isrctn.com/ISRCTN88145142 ",
doi="10.2196/17019",
url="https://www.jmir.org/2020/8/e17019",
url="http://www.ncbi.nlm.nih.gov/pubmed/32788150"
}


@Article{info:doi/10.2196/19661,
author="Knitza, Johannes
and Simon, David
and Lambrecht, Antonia
and Raab, Christina
and Tascilar, Koray
and Hagen, Melanie
and Kleyer, Arnd
and Bayat, Sara
and Derungs, Adrian
and Amft, Oliver
and Schett, Georg
and Hueber, J. Axel",
title="Mobile Health Usage, Preferences, Barriers, and eHealth Literacy in Rheumatology: Patient Survey Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Aug",
day="12",
volume="8",
number="8",
pages="e19661",
keywords="mobile applications",
keywords="eHealth",
keywords="rheumatology",
keywords="mHealth",
keywords="eHEALS",
keywords="telemedicine",
abstract="Background: Mobile health (mHealth) defines the support and practice of health care using mobile devices and promises to improve the current treatment situation of patients with chronic diseases. Little is known about mHealth usage and digital preferences of patients with chronic rheumatic diseases. Objective: The aim of the study was to explore mHealth usage, preferences, barriers, and eHealth literacy reported by German patients with rheumatic diseases. Methods: Between December 2018 and January 2019, patients (recruited consecutively) with rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis were asked to complete a paper-based survey. The survey included questions on sociodemographics, health characteristics, mHealth usage, eHealth literacy using eHealth Literacy Scale (eHEALS), and communication and information preferences. Results: Of the patients (N=193) who completed the survey, 176 patients (91.2\%) regularly used a smartphone, and 89 patients (46.1\%) regularly used social media. Patients (132/193, 68.4\%) believed that using medical apps could be beneficial for their own health. Out of 193 patients, only 8 (4.1\%) were currently using medical apps, and only 22 patients (11.4\%) stated that they knew useful rheumatology websites/mobile apps. Nearly all patients (188/193, 97.4\%) would agree to share their mobile app data for research purposes. Out of 193 patients, 129 (66.8\%) would regularly enter data using an app, and 146 patients (75.6\%) would welcome official mobile app recommendations from the national rheumatology society. The preferred duration for data entry was not more than 15 minutes (110/193, 57.0\%), and the preferred frequency was weekly (59/193, 30.6\%). Medication information was the most desired app feature (150/193, 77.7\%). Internet was the most frequently utilized source of information (144/193, 74.6\%). The mean eHealth literacy was low (26.3/40) and was positively correlated with younger age, app use, belief in benefit of using medical apps, and current internet use to obtain health information. Conclusions: Patients with rheumatic diseases are very eager to use mHealth technologies to better understand their chronic diseases. This open-mindedness is counterbalanced by low mHealth usage and competency. Personalized mHealth solutions and clear implementation recommendations are needed to realize the full potential of mHealth in rheumatology. ",
doi="10.2196/19661",
url="http://mhealth.jmir.org/2020/8/e19661/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32678796"
}


@Article{info:doi/10.2196/17058,
author="Crafoord, Marie-Ther{\'e}se
and Fjell, Maria
and Sundberg, Kay
and Nilsson, Marie
and Langius-Ekl{\"o}f, Ann",
title="Engagement in an Interactive App for Symptom Self-Management during Treatment in Patients With Breast or Prostate Cancer: Mixed Methods Study",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="10",
volume="22",
number="8",
pages="e17058",
keywords="engagement",
keywords="adherence",
keywords="mHealth",
keywords="mobile app",
keywords="cancer supportive care",
keywords="symptom management",
keywords="usage metrics",
keywords="breast cancer",
keywords="prostate cancer",
abstract="Background: Using mobile technology for symptom management and self-care can improve patient-clinician communication and clinical outcomes in patients with cancer. The interactive app Interaktor has been shown to reduce symptom burden during cancer treatment. It includes symptom assessment, an alert system for contact with health care professionals, access to self-care advice, and visualization of symptom history. It is essential to understand how digital interventions operate; one approach is to examine engagement by assessing usage and exploring user experiences. Actual usage in relation to the intended use---adherence---is an essential factor of engagement. Objective: This study aimed to describe engagement with the Interaktor app among patients with breast or prostate cancer during treatment. Methods: Patients from the intervention groups of two separate randomized controlled trials were included: patients with breast cancer receiving neoadjuvant chemotherapy (n=74) and patients with locally advanced prostate cancer receiving treatment with radiotherapy (n=75). The patients reported their symptoms daily. Sociodemographic and clinical data were obtained from baseline questionnaires and medical records. Logged data usage was retrieved from the server and analyzed descriptively and with multiple regression analysis. Telephone interviews were conducted with patients about their perceptions of using the app and analyzed using content analysis. Results: The median adherence percentage to daily symptom reporting was 83\%. Most patients used the self-care advice and free text message component. Among the patients treated for breast cancer, higher age predicted a lower total number of free text messages sent (P=.04). Among the patients treated for prostate cancer, higher age (P=.01) and higher education level (P=.04), predicted an increase in total views on self-care advice, while higher comorbidity (P=.004) predicted a decrease in total views on self-care advice. Being married or living with a partner predicted a higher adherence to daily symptom reporting (P=.02). Daily symptom reporting created feelings of having continuous contact with health care professionals, being acknowledged, and safe. Being contacted by a nurse after a symptom alert was considered convenient and highly valued. Treatment and time-related aspects influenced engagement. Daily symptom reporting was perceived as particularly meaningful at the beginning of treatment. Requests were made for advice on diet and psychological symptoms, as well as for more comprehensive and detailed information as the patient progressed through treatment. Conclusions: Patient engagement in the interactive app Interaktor was high. The app promoted patient participation in their care through continuous and convenient contact with health care professionals. The predictive ability of demographic variables differed between patient groups, but higher age and a higher educational level predicted usage of specific app functions for both patient groups. Patients' experience of relevance and interactivity influenced their engagement positively. ",
doi="10.2196/17058",
url="https://www.jmir.org/2020/8/e17058",
url="http://www.ncbi.nlm.nih.gov/pubmed/32663140"
}


@Article{info:doi/10.2196/17408,
author="Gra{\vs}i{\v c} Kuhar, Cvetka
and Gortnar Cepeda, Tja{\vs}a
and Kova{\v c}, Timotej
and Kukar, Matja?
and Ru?i{\'c} Gorenjec, Nina",
title="Mobile App for Symptom Management and Associated Quality of Life During Systemic Treatment in Early Stage Breast Cancer: Nonrandomized Controlled Prospective Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Aug",
day="4",
volume="8",
number="8",
pages="e17408",
keywords="breast cancer",
keywords="systemic therapy",
keywords="mobile application",
keywords="patient-reported outcome",
keywords="quality of life",
abstract="Background: Providing patients with cancer who are undergoing systemic therapy with useful information about symptom management is essential to prevent unnecessary deterioration of quality of life. Objective: The aim was to evaluate whether use of an app for symptom management was associated with any change in patient quality of life or use of health resources. Methods: Outpatients with early stage breast cancer receiving systemic therapy were recruited at the Institute of Oncology in Ljubljana, Slovenia. Patients who received systemic therapy between December 2017 and March 2018 (control group) and between April 2018 and September 2018 (intervention group) were eligible. All patients received standard care, but only those in the intervention group were asked to use mPRO Mamma, an Android-based smartphone app, in addition. The app supported daily tracking of 50 symptoms, allowed users to grade their symptom severity (as mild, moderate, or severe), and also provided in-depth descriptions and recommendations based on reported symptom level. Patient-reported outcomes in both groups were assessed through the European Organisation for Research and Treatment of Cancer (EORTC) core (C-30) and breast cancer (BR-23) questionnaires, as well as a questionnaire about health resources use. The primary outcomes were the difference in the global quality of life between groups and the difference in summary score of the EORTC C-30 questionnaire between groups after 3 time periods (the first week of treatment, the first treatment cycle, and the entire treatment). The secondary outcome was the use of health resources (doctor visits and hospitalizations) in each time period. Other scales were used for exploratory analysis. Results: The mean difference between the intervention group (n=46) and the control group (n=45) in global quality of life (adjusted for baseline and type of surgery) after the first week was 10.1 (95\% CI 1.8 to 18.5, P=.02). The intervention group summary scores were significantly higher than those of the control group after the first week (adjusted mean difference: 8.9, 95\% CI 3.1 to 14.7, P=.003) and at the end of treatment (adjusted mean difference: 10.6, 95\% CI 3.9 to 17.3, P=.002). Use of health resources was not statistically significant between the groups in either the first week (P=.12) or the first treatment cycle (P=.13). Exploratory analysis findings demonstrated clinically important improvements (indicated by EORTC C-30 or BR-23 scale scores)---social, physical, role, and cognitive function were improved while pain, appetite loss, and systemic therapy side effects were reduced. Conclusions: Use of the app enabled patients undergoing systemic therapy for early stage breast cancer to better cope with symptoms which was demonstrated by a better global quality of life and summary score after the first week and by a better summary score at the end of treatment in the intervention group compared to those of the control group, but no change in the use of health resources was demonstrated. ",
doi="10.2196/17408",
url="https://mhealth.jmir.org/2020/8/e17408",
url="http://www.ncbi.nlm.nih.gov/pubmed/32427567"
}


@Article{info:doi/10.2196/16180,
author="Minen, Tova Mia
and Reichel, Frederica Julia
and Pemmireddy, Pallavi
and Loder, Elizabeth
and Torous, John",
title="Characteristics of Neuropsychiatric Mobile Health Trials: Cross-Sectional Analysis of Studies Registered on ClinicalTrials.gov",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Aug",
day="4",
volume="8",
number="8",
pages="e16180",
keywords="smartphones",
keywords="mobile phones",
keywords="apps",
keywords="mental health",
keywords="regulation",
keywords="stroke",
keywords="migraine",
keywords="major depressive disorder",
keywords="Alzheimer disease",
keywords="anxiety disorders",
keywords="alcohol use disorders",
keywords="opioid use disorders",
keywords="epilepsy",
keywords="schizophrenia",
abstract="Background: The development of mobile health (mHealth) technologies is progressing at a faster pace than that of the science to evaluate their validity and efficacy. Under the International Committee of Journal Medical Editors (ICMJE) guidelines, clinical trials that prospectively assign people to interventions should be registered with a database before the initiation of the study. Objective: The aim of this study was to better understand the smartphone mHealth trials for high-burden neuropsychiatric conditions registered on ClinicalTrials.gov through November 2018, including the number, types, and characteristics of the studies being conducted; the frequency and timing of any outcome changes; and the reporting of results. Methods: We conducted a systematic search of ClinicalTrials.gov for the top 10 most disabling neuropsychiatric conditions and prespecified terms related to mHealth. According to the 2016 World Health Organization Global Burden of Disease Study, the top 10 most disabling neuropsychiatric conditions are (1) stroke, (2) migraine, (3) major depressive disorder, (4) Alzheimer disease and other dementias, (5) anxiety disorders, (6) alcohol use disorders, (7) opioid use disorders, (8) epilepsy, (9) schizophrenia, and (10) other mental and substance use disorders. There were no date, location, or status restrictions. Results: Our search identified 135 studies. A total of 28.9\% (39/135) of studies evaluated interventions for major depressive disorder, 14.1\% (19/135) of studies evaluated interventions for alcohol use disorders, 12.6\% (17/135) of studies evaluated interventions for stroke, 11.1\% (15/135) of studies evaluated interventions for schizophrenia, 8.1\% (11/135) of studies evaluated interventions for anxiety disorders, 8.1\% (11/135) of studies evaluated interventions for other mental and substance use disorders, 7.4\% (10/135) of studies evaluated interventions for opioid use disorders, 3.7\% (5/135) of studies evaluated interventions for Alzheimer disease or other dementias, 3.0\% (4/135) of studies evaluated interventions for epilepsy, and 3.0\% (4/135) of studies evaluated interventions for migraine. The studies were first registered in 2008; more than half of the studies were registered from 2016 to 2018. A total of 18.5\% (25/135) of trials had results reported in some publicly accessible location. Across all the studies, the mean estimated enrollment (reported by the study) was 1078, although the median was only 100. In addition, across all the studies, the actual reported enrollment was lower, with a mean of 249 and a median of 80. Only about a quarter of the studies (35/135, 25.9\%) were funded by the National Institutes of Health. Conclusions: Despite the increasing use of health-based technologies, this analysis of ClinicalTrials.gov suggests that only a few apps for high-burden neuropsychiatric conditions are being clinically evaluated in trials. ",
doi="10.2196/16180",
url="https://mhealth.jmir.org/2020/8/e16180",
url="http://www.ncbi.nlm.nih.gov/pubmed/32749230"
}


@Article{info:doi/10.2196/16924,
author="Brigden, Amberly
and Anderson, Emma
and Linney, Catherine
and Morris, Richard
and Parslow, Roxanne
and Serafimova, Teona
and Smith, Lucie
and Briggs, Emily
and Loades, Maria
and Crawley, Esther",
title="Digital Behavior Change Interventions for Younger Children With Chronic Health Conditions: Systematic Review",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="31",
volume="22",
number="7",
pages="e16924",
keywords="mobile phone",
keywords="mHealth",
keywords="mobile health",
keywords="eHealth",
keywords="electronic health",
keywords="digital health",
keywords="behavior",
keywords="pediatrics",
keywords="chronic illness",
keywords="systematic review",
abstract="Background: The prevalence of chronic health conditions in childhood is increasing, and behavioral interventions can support the management of these conditions. Compared with face-to-face treatment, the use of digital interventions may be more cost-effective, appealing, and accessible, but there has been inadequate attention to their use with younger populations (children aged 5-12 years). Objective: This systematic review aims to (1) identify effective digital interventions, (2) report the characteristics of promising interventions, and (3) describe the user's experience of the digital intervention. Methods: A total of 4 databases were searched (Excerpta Medica Database [EMBASE], PsycINFO, Medical Literature Analysis and Retrieval System Online [MEDLINE], and the Cochrane Library) between January 2014 and January 2019. The inclusion criteria for studies were as follows: (1) children aged between 5 and 12 years, (2) interventions for behavior change, (3) randomized controlled trials, (4) digital interventions, and (5) chronic health conditions. Two researchers independently double reviewed papers to assess eligibility, extract data, and assess quality. Results: Searches run in the databases identified 2643 papers. We identified 17 eligible interventions. The most promising interventions (having a beneficial effect and low risk of bias) were 3 targeting overweight or obesity, using exergaming or social media, and 2 for anxiety, using web-based cognitive behavioral therapy (CBT). Characteristics of promising interventions included gaming features, therapist support, and parental involvement. Most were purely behavioral interventions (rather than CBT or third wave), typically using the behavior change techniques (BCTs) feedback and monitoring, shaping knowledge, repetition and substitution, and reward. Three papers included qualitative data on the user's experience. We developed the following themes: parental involvement, connection with a health professional is important for engagement, technological affordances and barriers, and child-centered design. Conclusions: Of the 17 eligible interventions, digital interventions for anxiety and overweight or obesity had the greatest promise. Using qualitative methods during digital intervention development and evaluation may lead to more meaningful, usable, feasible, and engaging interventions, especially for this underresearched younger population. The following characteristics could be considered when developing digital interventions for younger children: involvement of parents, gaming features, additional therapist support, behavioral (rather than cognitive) approaches, and particular BCTs (feedback and monitoring, shaping knowledge, repetition and substitution, and reward). This review suggests a model for improving the conceptualization and reporting of behavioral interventions involving children and parents. ",
doi="10.2196/16924",
url="http://www.jmir.org/2020/7/e16924/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32735227"
}


@Article{info:doi/10.2196/13686,
author="Fatori, Daniel
and Argeu, Adriana
and Brentani, Helena
and Chiesa, Anna
and Fracolli, Lislaine
and Matijasevich, Alicia
and Miguel, C. Euripedes
and Polanczyk, Guilherme",
title="Maternal Parenting Electronic Diary in the Context of a Home Visit Intervention for Adolescent Mothers in an Urban Deprived Area of S{\~a}o Paulo, Brazil: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="28",
volume="8",
number="7",
pages="e13686",
keywords="mHealth",
keywords="early childhood development",
keywords="maternal care",
keywords="randomized clinical trial",
keywords="daily diary",
keywords="ambulatory assessment",
abstract="Background: Pregnancy during adolescence is prevalent in low- and middle-income countries (LMICs), which is associated with various adverse outcomes that can be prevented with home visiting programs. However, testing these interventions in LMICs can be challenging due to limited resources. The use of electronic data collection via smartphones can be an alternative and ideal low-cost method to measure outcomes in an environment with adverse conditions. Objective: Our study had two objectives: to test the efficacy of a nurse home visiting intervention on maternal parenting and well-being measured by an electronic daily diary (eDiary), and to investigate the compliance rate of the eDiary measurement method. Methods: We conducted a randomized controlled trial to test the efficacy of Primeiros La{\c{c}}os, a nurse home visiting program, for adolescent mothers living in an urban deprived area of S{\~a}o Paulo, Brazil. A total of 169 pregnant adolescents were assessed for eligibility criteria, 80 of whom were included and randomized to the intervention (n=40) and control group (care as usual, n=40). Primeiros La{\c{c}}os is a home visiting intervention delivered by trained nurses tailored to first-time pregnant adolescents and their children, starting during the first 16 weeks of pregnancy until the child reaches 24 months of age. Participants were assessed by blind interviewers at 8-16 weeks of pregnancy (baseline), 30 weeks of pregnancy, and when the child was 3, 6, and 12 months of age. At 18 months, participants were assessed regarding maternal parenting and parental well-being using a 7-consecutive-day eDiary. The smartphone app was programmed to notify participants every day at 9:00 PM over a period of seven days. Results: We were able to contact 57/80 (71\%) participants (29 from the intervention group and 28 from the control group) when the child was 18 months of age. Forty-eight of the 57 participants (84\%) completed at least one day of the eDiary protocol. The daily compliance rate ranged from 49\% to 70\%. Our analyses showed a significant effect of the intervention on parental well-being (B=0.32, 95\% CI [0.06, 0.58], P=.02) and the maternal parenting behavior of the mother telling a story or singing to the child (odds ratio=2.33, 95\% CI [1.20, 4.50], P=.01).Our analyses showed a significant effect of the intervention on parental well-being (B=0.32, P=.02) and the maternal parenting behavior of the mother telling a story or singing to the child (odds ratio=2.33, P=.01). Conclusions: The Primeiros La{\c{c}}os intervention improved maternal parenting and parental well-being, demonstrating its promise for low-income adolescent mothers. The compliance rate of the eDiary assessment showed that it was generally accepted by adolescent mothers with limited resources. Future studies can implement ambulatory assessment in LMICs via smartphones to measure mother and child behaviors. Trial Registration: ClinicalTrials.gov NCT02807818; https://clinicaltrials.gov/ct2/show/NCT02807818 ",
doi="10.2196/13686",
url="https://mhealth.jmir.org/2020/7/e13686",
url="http://www.ncbi.nlm.nih.gov/pubmed/32720906"
}


@Article{info:doi/10.2196/18132,
author="Wang, Tze-Fang
and Huang, Rou-Chen
and Yang, Su-Chen
and Chou, Chyuan
and Chen, Lee-Chen",
title="Evaluating the Effects of a Mobile Health App on Reducing Patient Care Needs and Improving Quality of Life After Oral Cancer Surgery: Quasiexperimental Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="27",
volume="8",
number="7",
pages="e18132",
keywords="care needs",
keywords="health information",
keywords="mobile health app",
keywords="oral cancer",
keywords="technology acceptance",
keywords="quality of life",
abstract="Background: Intervention with a mobile Health (mHealth) app can improve the efficacy of early detection of oral cancer and the outcomes for patients taking oral anticancer medications. The quality of life of oral cancer patients is significantly reduced within three months after surgery; also, their needs for nursing care and health information increase, mainly due to side effects and associated psychological problems. Objective: This study aimed to evaluate changes in the care needs and quality of life of patients with oral cancer after receiving the intervention of a newly developed mHealth app. Methods: After surgery, oral cancer patients were divided into an experimental group (n=50) who received the mHealth app intervention and a control group (n=50) who received routine health care and instruction. After 3 months of intervention, survey questionnaires were used to assess the patients' quality of life, nursing care needs, and acceptance of the mHealth app. Results: The physiological care needs were significantly decreased in the experimental group compared with the control group (P<.05). Although the differences were not statistically significant, the psychological needs, communication needs, and care support needs all improved after the mHealth app intervention. The overall improvement in quality of life was higher in the experimental group than in the control group (--7.24 vs --4.36). In terms of intention to use, perceived usefulness, and perceived ease of use, the acceptability scores of the mHealth app were significantly increased after 3 months of intervention (P<.05). Conclusions: Compared with routine health care and instruction, for patients after surgery, the education/information intervention using the mHealth app significantly reduced their nursing care needs, improved their quality of life, and increased their acceptance of using an mHealth app on a mobile device. These findings can provide a theoretical basis for future health care app design and improvement. This study suggests that an mHealth app should be incorporated into the routine care of oral cancer patients to provide medical information quickly and improve their self-management abilities, thereby reducing the patients' need for physiological care and improving their quality of life. Trial Registration: ClinicalTrials.gov NCT04049968; https://www.clinicaltrials.gov/ct2/show/NCT04049968 ",
doi="10.2196/18132",
url="http://mhealth.jmir.org/2020/7/e18132/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32716303"
}


@Article{info:doi/10.2196/13611,
author="Wang, Max
and Ge, Wenbo
and Apthorp, Deborah
and Suominen, Hanna",
title="Robust Feature Engineering for Parkinson Disease Diagnosis: New Machine Learning Techniques",
journal="JMIR Biomed Eng",
year="2020",
month="Jul",
day="27",
volume="5",
number="1",
pages="e13611",
keywords="machine learning",
keywords="mobile phone",
keywords="nonlinear dynamics",
keywords="Parkinson disease",
keywords="signal processing, computer-assisted",
keywords="speech",
keywords="biomarkers",
abstract="Background: Parkinson disease (PD) is a common neurodegenerative disorder that affects between 7 and 10 million people worldwide. No objective test for PD currently exists, and studies suggest misdiagnosis rates of up to 34\%. Machine learning (ML) presents an opportunity to improve diagnosis; however, the size and nature of data sets make it difficult to generalize the performance of ML models to real-world applications. Objective: This study aims to consolidate prior work and introduce new techniques in feature engineering and ML for diagnosis based on vowel phonation. Additional features and ML techniques were introduced, showing major performance improvements on the large mPower vocal phonation data set. Methods: We used 1600 randomly selected /aa/ phonation samples from the entire data set to derive rules for filtering out faulty samples from the data set. The application of these rules, along with a joint age-gender balancing filter, results in a data set of 511 PD patients and 511 controls. We calculated features on a 1.5-second window of audio, beginning at the 1-second mark, for a support vector machine. This was evaluated with 10-fold cross-validation (CV), with stratification for balancing the number of patients and controls for each CV fold. Results: We showed that the features used in prior literature do not perform well when extrapolated to the much larger mPower data set. Owing to the natural variation in speech, the separation of patients and controls is not as simple as previously believed. We presented significant performance improvements using additional novel features (with 88.6\% certainty, derived from a Bayesian correlated t test) in separating patients and controls, with accuracy exceeding 58\%. Conclusions: The results are promising, showing the potential for ML in detecting symptoms imperceptible to a neurologist. ",
doi="10.2196/13611",
url="https://biomedeng.jmir.org/2020/1/e13611"
}


@Article{info:doi/10.2196/17414,
author="Andrews, A. Jacob
and Craven, P. Michael
and Jamnadas-Khoda, Jennifer
and Lang, R. Alexandra
and Morriss, Richard
and Hollis, Chris
and ",
title="Health Care Professionals' Views on Using Remote Measurement Technology in Managing Central Nervous System Disorders: Qualitative Interview Study",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="24",
volume="22",
number="7",
pages="e17414",
keywords="epilepsy",
keywords="multiple sclerosis",
keywords="depression",
keywords="medical devices",
keywords="barriers",
keywords="health personnel",
keywords="qualitative",
keywords="mobile phones",
keywords="mHealth",
keywords="eHealth",
abstract="Background: Remote measurement technologies (RMT) can be used to collect data on a variety of bio-behavioral variables, which may improve the care of patients with central nervous system disorders. Although various studies have explored their potential, prior work has highlighted a knowledge gap in health care professionals' (HCPs) perceptions of the value of RMT in clinical practice. Objective: This study aims to understand HCPs' perspectives on using RMT in health care practice for the care of patients with depression, epilepsy, or multiple sclerosis (MS). Methods: Semistructured interviews were conducted with 26 multidisciplinary primary and secondary care HCPs who care for patients with epilepsy, depression, or MS. Interviews were transcribed verbatim and analyzed using thematic analysis. Results: A total of 8 main themes emerged from the analysis: (1) potential clinical value of RMT data; (2) when to use RMT in care pathways; (3) roles of health care staff who may use RMT data; (4) presentation and accessibility of data; (5) obstacles to successful use of RMT; (6) limits to the role of RMT; (7) empowering patients; and (8) considerations around alert-based systems. Conclusions: RMT could add value to the system of care for patients with central nervous system disorders by providing clinicians with graphic summaries of data in the patient record. Barriers of both technical and human nature should be considered when using these technologies, as should the limits to the benefits they can offer. ",
doi="10.2196/17414",
url="https://www.jmir.org/2020/7/e17414",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706664"
}


@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/10.2196/13356,
author="O'Connor, Kathleen
and Bagnell, Alexa
and McGrath, Patrick
and Wozney, Lori
and Radomski, Ashley
and Rosychuk, J. Rhonda
and Curtis, Sarah
and Jabbour, Mona
and Fitzpatrick, Eleanor
and Johnson, W. David
and Ohinmaa, Arto
and Joyce, Anthony
and Newton, Amanda",
title="An Internet-Based Cognitive Behavioral Program for Adolescents With Anxiety: Pilot Randomized Controlled Trial",
journal="JMIR Ment Health",
year="2020",
month="Jul",
day="24",
volume="7",
number="7",
pages="e13356",
keywords="internet",
keywords="cognitive behavioral therapy",
keywords="adolescents",
keywords="anxiety",
keywords="randomized controlled trial",
keywords="pilot",
abstract="Background: Internet-based cognitive behavioral therapy (ICBT) is a treatment approach recently developed and studied to provide frontline treatment to adolescents with anxiety disorders. Objective: This study aimed to pilot procedures and obtain data on methodological processes and intervention satisfaction to determine the feasibility of a definitive randomized controlled trial (RCT) to test the effectiveness of a self-managed ICBT program, Breathe (Being Real, Easing Anxiety: Tools Helping Electronically), for adolescents with anxiety concerns. Methods: This study employed a two-arm, multisite, pilot RCT. Adolescents aged 13 to 17 years with a self-identified anxiety concern were recruited online from health care settings and school-based mental health care services across Canada between April 2014 and May 2016. We compared 8 weeks of ICBT with ad hoc telephone and email support (Breathe experimental group) to access to a static webpage listing anxiety resources (control group). The primary outcome was the change in self-reported anxiety from baseline to 8 weeks (posttreatment), which was used to determine the sample size for a definitive RCT. Secondary outcomes were recruitment and retention rates, a minimal clinically important difference (MCID) for the primary outcome, intervention acceptability and satisfaction, use of cointerventions, and health care resource use, including a cost-consequence analysis. Results: Of the 588 adolescents screened, 94 were eligible and enrolled in the study (49 adolescents were allocated to Breathe and 45 were allocated to the control group). Analysis was based on 74\% (70/94) of adolescents who completed baseline measures and progressed through the study. Enrolled adolescents were, on average, 15.3 years old (SD 1.2) and female (63/70, 90\%). Retention rates at 8 weeks were 28\% (13/46; Breathe group) and 58\% (24/43; control group). Overall, 39\% (14/36) of adolescents provided feedback on completion of the Breathe program. Adolescents' scores on a satisfaction survey indicated a moderate level of satisfaction. All but one adolescent indicated that Breathe was easy to use and they understood all the material presented. The most frequent barrier identified for program completion was difficulty in completing exposure activities. The power analysis indicated that 177 adolescents per group would be needed to detect a medium effect size (d=0.3) between groups in a definitive trial. Data for calculating an MCID or conducting a cost-consequence analysis were insufficient due to a low response rate at 8 weeks. Conclusions: Adolescents were moderately satisfied with Breathe. However, program adjustments will be needed to address attrition and reduce perceived barriers to completing key aspects of the program. A definitive RCT to evaluate the effectiveness of the program is feasible if protocol adjustments are made to improve recruitment and retention to ensure timely study completion and increase the completeness of the data at each outcome measurement time point. Trial Registration: ClinicalTrials.gov NCT02059226; http://clinicaltrials.gov/ct2/show/NCT02059226. ",
doi="10.2196/13356",
url="https://mental.jmir.org/2020/7/e13356",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706720"
}


@Article{info:doi/10.2196/17609,
author="Amor-Garc{\'i}a, {\'A}ngel Miguel
and Collado-Borrell, Roberto
and Escudero-Vilaplana, Vicente
and Melgarejo-Ortu{\~n}o, Alejandra
and Herranz-Alonso, Ana
and Arranz Arija, {\'A}ngel Jos{\'e}
and Sanjurjo-S{\'a}ez, Mar{\'i}a",
title="Assessing Apps for Patients with Genitourinary Tumors Using the Mobile Application Rating Scale (MARS): Systematic Search in App Stores and Content Analysis",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="23",
volume="8",
number="7",
pages="e17609",
keywords="genitourinary cancer",
keywords="mobile apps",
keywords="eHealth",
keywords="mHealth",
keywords="rating tool",
abstract="Background: The large number of available cancer apps and their impact on the population necessitates a transparent, objective, and comprehensive evaluation by app experts, health care professionals, and users. To date, there have been no analyses or classifications of apps for patients with genitourinary cancers, which are among the most prevalent types of cancer. Objective: The objective of our study was to analyze the quality of apps for patients diagnosed with genitourinary cancers using the Mobile Application Rating Scale (MARS) and identify high-quality apps. Methods: We performed an observational cross-sectional descriptive study of all smartphone apps for patients diagnosed with genitourinary cancers available on iOS and Android platforms. In July 2019, we searched for all available apps for patients with genitourinary cancers (bladder, prostate, cervical, uterine, endometrial, kidney, testicular, and vulvar) or their caregivers. Apps were downloaded and evaluated, and the general characteristics were entered into a database. The evaluation was performed by 2 independent researchers using the MARS questionnaire, which rates 23 evaluation criteria clustered in 5 domains (Engagement, Functionality, Esthetics, Information, and Subjective Quality) on a scale from 1 to 5. Results: In total, 46 apps were analyzed. Of these, 31 (67\%) were available on Android, 6 (13\%) on iOS, and 9 (20\%) on both platforms. The apps were free in 89\% of cases (41/46), and 61\% (28/46) had been updated in the previous year. The apps were intended for prostate cancer in 30\% of cases (14/46) and cervical cancer in 17\% (8/46). The apps were mainly informative (63\%, 29/46), preventive (24\%, 11/46), and diagnostic (13\%, 6/46). Only 7/46 apps (15\%) were developed by health care organizations. The mean MARS score for the overall quality of the 46 apps was 2.98 (SD 0.77), with a maximum of 4.63 and a minimum of 1.95. Functionality scores were quite similar for most of the apps, with the greatest differences in Engagement and Esthetics, which showed acceptable scores in one-third of the apps. The 5 apps with the highest MARS score were the following: ``Bladder cancer manager,'' ``Kidney cancer manager,'' ``My prostate cancer manager,'' ``Target Ovarian Cancer Symptoms Diary,'' and ``My Cancer Coach.'' We observed statistically significant differences in the MARS score between the operating systems and the developer types (P<.001 and P=.01, respectively), but not for cost (P=.62). Conclusions: MARS is a helpful methodology to decide which apps can be prescribed to patients and to identify which features should be addressed to improve these tools. Most of the apps designed for patients with genitourinary cancers only try to provide data about the disease, without coherent interactivity. The participation of health professionals in the development of these apps is low; nevertheless, we observed that both the participation of health professionals and regular updates were correlated with quality. ",
doi="10.2196/17609",
url="http://mhealth.jmir.org/2020/7/e17609/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706737"
}


@Article{info:doi/10.2196/17409,
author="Alwashmi, F. Meshari
and Fitzpatrick, Beverly
and Farrell, Jamie
and Gamble, John-Michael
and Davis, Erin
and Nguyen, Van Hai
and Farrell, Gerard
and Hawboldt, John",
title="Perceptions of Patients Regarding Mobile Health Interventions for the Management of Chronic Obstructive Pulmonary Disease: Mixed Methods Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="23",
volume="8",
number="7",
pages="e17409",
keywords="mhealth",
keywords="COPD",
keywords="health technology",
keywords="smartphone",
keywords="mobile phone",
abstract="Background: Using a mobile health (mHealth) intervention consisting of a smartphone and compatible medical device has the potential to enhance chronic obstructive pulmonary disease (COPD) treatment outcomes while mitigating health care costs. Objective: This study aims to describe the demographics, use, and access to smartphones of patients with COPD. It also aims to explore and develop an understanding of potential facilitators and barriers that might influence patients using mHealth interventions for COPD management. Methods: This was an explanatory, sequential mixed methods study. Patients who attended respirology clinics completed a questionnaire on technology access and use. We conducted semistructured individual interviews with the patients. Interview topics included the following: demographics, mHealth use, perceptions toward challenges of mHealth adoption, factors facilitating mHealth adoption, and preferences regarding features of mHealth interventions for COPD management. Results: A total of 100 adults completed the survey but 22 participants were excluded because they were not diagnosed with COPD. Of these, 10 patients with COPD participated in the interview. The quantitative component revealed that many patients with COPD owned a mobile phone, but only about one-fourth of the participants (18/77, 23\%) owned a smartphone. The likelihood of owning a smartphone was not associated with age, sex, marital status, or geographical location, but patients with high educational status were more likely to own a smartphone. The qualitative component found that patients with COPD, in general, had a positive attitude toward mHealth adoption for COPD management, but several facilitators and barriers were identified. The main facilitators of mHealth adoption are possible health benefits for patients, ease of use, educating patients, and credibility. Alternatively, the barriers to adoption are technical issues, lack of awareness, potential limited uptake from older adults, privacy and confidentiality issues, finances, and lack of interest in mHealth Conclusions: It is important to understand the perceptions of patients with COPD regarding the adoption of innovative mHealth interventions for COPD management. This study identifies some potential facilitators and barriers that may inform the successful development and implementation of mHealth interventions for COPD management. ",
doi="10.2196/17409",
url="http://mhealth.jmir.org/2020/7/e17409/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706697"
}


@Article{info:doi/10.2196/17038,
author="Baptista, Shaira
and Wadley, Greg
and Bird, Dominique
and Oldenburg, Brian
and Speight, Jane
and ",
title="Acceptability of an Embodied Conversational Agent for Type 2 Diabetes Self-Management Education and Support via a Smartphone App: Mixed Methods Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="22",
volume="8",
number="7",
pages="e17038",
keywords="embodied conversational agent",
keywords="type 2 diabetes",
keywords="mobile apps",
keywords="mHealth",
keywords="smartphone",
keywords="self-management",
keywords="mobile phone",
abstract="Background: Embodied conversational agents (ECAs) are increasingly used in health care apps; however, their acceptability in type 2 diabetes (T2D) self-management apps has not yet been investigated. Objective: This study aimed to evaluate the acceptability of the ECA (Laura) used to deliver diabetes self-management education and support in the My Diabetes Coach (MDC) app. Methods: A sequential mixed methods design was applied. Adults with T2D allocated to the intervention arm of the MDC trial used the MDC app over a period of 12 months. At 6 months, they completed questions assessing their interaction with, and attitudes toward, the ECA. In-depth qualitative interviews were conducted with a subsample of the participants from the intervention arm to explore their experiences of using the ECA. The interview questions included the participants' perceptions of Laura, including their initial impression of her (and how this changed over time), her personality, and human character. The quantitative and qualitative data were interpreted using integrated synthesis. Results: Of the 93 intervention participants, 44 (47\%) were women; the mean (SD) age of the participants was 55 (SD 10) years and the baseline glycated hemoglobin A1c level was 7.3\% (SD 1.5\%). Overall, 66 of the 93 participants (71\%) provided survey responses. Of these, most described Laura as being helpful (57/66, 86\%), friendly (57/66, 86\%), competent (56/66, 85\%), trustworthy (48/66, 73\%), and likable (40/66, 61\%). Some described Laura as not real (18/66, 27\%), boring (26/66, 39\%), and annoying (20/66, 30\%). Participants reported that interacting with Laura made them feel more motivated (29/66, 44\%), comfortable (24/66, 36\%), confident (14/66, 21\%), happy (11/66, 17\%), and hopeful (8/66, 12\%). Furthermore, 20\% (13/66) of the participants were frustrated by their interaction with Laura, and 17\% (11/66) of the participants reported that interacting with Laura made them feel guilty. A total of 4 themes emerged from the qualitative data (N=19): (1) perceived role: a friendly coach rather than a health professional; (2) perceived support: emotional and motivational support; (3) embodiment preference acceptability of a human-like character; and (4) room for improvement: need for greater congruence between Laura's words and actions. Conclusions: These findings suggest that an ECA is an acceptable means to deliver T2D self-management education and support. A human-like character providing ongoing, friendly, nonjudgmental, emotional, and motivational support is well received. Nevertheless, the ECA can be improved by increasing congruence between its verbal and nonverbal communication and accommodating user preferences. Trial Registration: Australian New Zealand Clinical Trials Registry CTRN12614001229662; https://tinyurl.com/yxshn6pd ",
doi="10.2196/17038",
url="https://mhealth.jmir.org/2020/7/e17038",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706734"
}


@Article{info:doi/10.2196/17817,
author="Fakih El Khoury, Cosette
and Crutzen, Rik
and Schols, A. Jos M. G.
and Halfens, G. Ruud J.
and Karavetian, Mirey",
title="A Dietary Mobile App for Patients Undergoing Hemodialysis: Prospective Pilot Study to Improve Dietary Intakes",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="20",
volume="22",
number="7",
pages="e17817",
keywords="mHealth",
keywords="dietary app",
keywords="hemodialysis diet",
abstract="Background: Mobile technology has an impact on the health care sector, also within dietetics. Mobile health (mHealth) apps may be used for dietary assessment and self-monitoring, allowing for real-time reporting of food intakes. Changing eating behaviors is quite challenging, and patients undergoing hemodialysis, particularly, struggle to meet the target intakes set by dietary guidelines. Usage of mobile apps that are developed in a person-centered approach and in line with recommendations may support both patients and health care practitioners. Objective: This study is a pilot that aims at estimating the potential efficacy of a dietary intervention using a theory-based, person-centered smartphone app. Results will be used to improve both the app and a planned large-scale trial intended to assess app efficacy thoroughly. Methods: A prospective pilot study was performed at the hemodialysis unit of Al Qassimi Hospital (The Emirate of Sharjah). All patients that fulfilled the study inclusion criteria were considered eligible to be enrolled in the pilot study. Upon successful installation of the app, users met with a dietitian once a week. Outcomes were measured at baseline (T0) and 2 weeks post app usage (T1). This pilot is reported as per guidelines for nonrandomized pilot and feasibility studies and in line with the CONSORT 2010 checklist for reporting pilot or feasibility trials. Results: A total of 23 patients completed the pilot intervention. Mean energy intakes increased from 24.4 kcal/kg/day (SD 8.0) to 29.1 kcal/kg/day (SD 7.8) with a medium effect size (d=0.6, 95\% CI 0.0-1.2). Mean protein intakes increased from 0.9 g/kg/day (SD 0.3) to 1.3 g/kg/day (SD 0.5) with a large effect size (d=1.0, 95\% CI 0.4-1.6); mean intake of high biological value  (\%HBV) proteins also increased from 58.6\% (SD 10.1) to 70.1\% (SD 10.7) with a large effect size (d=1.1, 95\% CI 0.5-1.7). Dietary intakes of minerals did not change, apart from sodium which decreased from a mean intake of 2218.8 mg/day (SD 631.6) to 1895.3 mg/day (SD 581.0) with a medium effect size (d=0.5, 95\% CI 0.1-1.1). Mean serum phosphorus, potassium, and albumin levels did not change relevantly. Mean serum iron increased from 7.9 mg/dL (SD 2.8) to 11.5 mg/dL (SD 7.9) postintervention with a medium effect size (d=0.6, 95\% CI 0.0-1.2). Conclusions: This pilot study showed that the KELA.AE app has the potential to improve dietary intakes. Processes related to procedure, resources, tools, and app improvement for a future trial were assessed. A more extended intervention using a randomized controlled trial is required to estimate parameters concerning app efficacy accurately. ",
doi="10.2196/17817",
url="http://www.jmir.org/2020/7/e17817/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706698"
}


@Article{info:doi/10.2196/18117,
author="Krusche, Martin
and Klemm, Philipp
and Grahammer, Manuel
and Mucke, Johanna
and Vossen, Diana
and Kleyer, Arnd
and Sewerin, Philipp
and Knitza, Johannes",
title="Acceptance, Usage, and Barriers of Electronic Patient-Reported Outcomes Among German Rheumatologists: Survey Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="20",
volume="8",
number="7",
pages="e18117",
keywords="electronic patient-reported outcome measures",
keywords="eHealth",
keywords="rheumatology",
keywords="rheumatoid arthritis",
keywords="patient perspective",
keywords="mobile phone",
abstract="Background: The use of patient-reported outcomes (PROs) allows for patient-centered, measurable, and transparent care. Electronic PROs (ePROs) have many benefits and hold great potential to improve current usage of PROs, yet limited evidence exists regarding their acceptance, usage, and barriers among rheumatologists. Objective: This study aims to evaluate the current level of acceptance, usage, and barriers among German rheumatologists regarding the use of ePROs. The importance of different ePRO features for rheumatologists was investigated. Additionally, the most frequently used PROs for patients with rheumatoid arthritis (RA) were identified. Methods: Data were collected via an online survey consisting of 18 questions. The survey was completed by members of the Working Group Young Rheumatology of the German Society for Rheumatology (Arbeitsgemeinschaft Junge Rheumatologie der Deutschen Gesellschaft f{\"u}r Rheumatologie [DGRh]) at the 2019 annual DGRh conference. Only members currently working in clinical adult rheumatology were eligible to complete the survey. Results: A total of 119 rheumatologists completed the survey, of which 107 (89.9\%) reported collecting PROs in routine practice and 28 (25.5\%) already used ePROs. Additionally, 44\% (43/97) were planning to switch to ePROs in the near future. The most commonly cited reason for not switching was the unawareness of suitable software solutions. Respondents were asked to rate the features of ePROs on a scale of 0 to 100 (0=unimportant, 100=important). The most important features were automatic score calculation and display (mean 77.50) and simple data transfer to medical reports (mean 76.90). When asked about PROs in RA, the respondents listed pain, morning stiffness, and patient global assessment as the most frequently used PROs. Conclusions: The potential of ePROs is widely seen and there is great interest in them. Despite this, only a minority of physicians use ePROs, and the main reason for not implementing them was cited as the unawareness of suitable software solutions. Developers, patients, and rheumatologists should work closely together to help realize the full potential of ePROs and ensure a seamless integration into clinical practice. ",
doi="10.2196/18117",
url="http://mhealth.jmir.org/2020/7/e18117/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32390592"
}


@Article{info:doi/10.2196/18012,
author="Mena, J. Luis
and F{\'e}lix, G. Vanessa
and Ostos, Rodolfo
and Gonz{\'a}lez, J. Armando
and Mart{\'i}nez-Pel{\'a}ez, Rafael
and Melgarejo, D. Jesus
and Maestre, E. Gladys",
title="Mobile Personal Health Care System for Noninvasive, Pervasive, and Continuous Blood Pressure Monitoring: Development and Usability Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="20",
volume="8",
number="7",
pages="e18012",
keywords="mHealth",
keywords="photoplethysmography",
keywords="blood pressure monitoring",
keywords="hypertension",
abstract="Background: Smartphone-based blood pressure (BP) monitoring using photoplethysmography (PPG) technology has emerged as a promising approach to empower users with self-monitoring for effective diagnosis and control of hypertension. Objective: This study aimed to develop a mobile personal health care system for noninvasive, pervasive, and continuous estimation of BP level and variability, which is user friendly for elderly people. Methods: The proposed approach was integrated by a self-designed cuffless, calibration-free, wireless, and wearable PPG-only sensor and a native purposely designed smartphone app using multilayer perceptron machine learning techniques from raw signals. We performed a development and usability study with three older adults (mean age 61.3 years, SD 1.5 years; 66\% women) to test the usability and accuracy of the smartphone-based BP monitor. Results: The employed artificial neural network model had good average accuracy (>90\%) and very strong correlation (>0.90) (P<.001) for predicting the reference BP values of our validation sample (n=150). Bland-Altman plots showed that most of the errors for BP prediction were less than 10 mmHg. However, according to the Association for the Advancement of Medical Instrumentation and British Hypertension Society standards, only diastolic blood pressure prediction met the clinically accepted accuracy thresholds. Conclusions: With further development and validation, the proposed system could provide a cost-effective strategy to improve the quality and coverage of health care, particularly in rural zones, areas lacking physicians, and areas with solitary elderly populations. ",
doi="10.2196/18012",
url="https://mhealth.jmir.org/2020/7/e18012",
url="http://www.ncbi.nlm.nih.gov/pubmed/32459642"
}


@Article{info:doi/10.2196/18564,
author="Eliasen, Astrid
and Abildtoft, Kramme Mikkel
and Krogh, Steen Niels
and Rechnitzer, Catherine
and Brok, Sune Jesper
and Mathiasen, Ren{\'e}
and Schmiegelow, Kjeld
and Dalhoff, Peder Kim",
title="Smartphone App to Self-Monitor Nausea During Pediatric Chemotherapy Treatment: User-Centered Design Process",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="20",
volume="8",
number="7",
pages="e18564",
keywords="mobile applications",
keywords="patient-reported outcome measures",
keywords="patient compliance",
keywords="neoplasms",
keywords="antiemetics",
keywords="nausea",
keywords="vomiting",
keywords="cancer",
keywords="children",
keywords="app",
abstract="Background: Nausea and vomiting are common and distressing side effects for children receiving chemotherapy. Limited evidence is available to guide antiemetic recommendations; therefore, prospective and reliable evaluation of antiemetic efficacy is needed. Smartphone apps can be used to effortlessly and precisely collect patient-reported outcomes in real time. Objective: Our objective was to develop a smartphone app to monitor nausea and vomiting episodes in pediatric cancer patients aged 0 to 18 years and to test its usability and adherence to its use. Methods: We used a user-centered design process and the evolutionary prototype model to develop and evaluate the app. Multidisciplinary group discussions and several rounds of patient feedback and modification were conducted. We translated the validated Pediatric Nausea Assessment Tool to assess nausea severity in children aged 4 to 18 years. The child's own term for nausea was interactively incorporated in the nausea severity question, with response options expressed as 4 illustrative faces. Parent-reported outcomes were used for children aged 0 to 3 years. Reminders were sent using push notifications in order to ensure high response rates. Children aged 0 to 18 years who were undergoing chemotherapy were recruited from the Department of Pediatric Oncology at Copenhagen University Hospital Rigshospitalet to evaluate the app. Results: The app's most important function was to record nausea severity in children. After assistance from a researcher, children aged 4 to 18 years were able to report their symptoms in the app, and parents were able to report symptoms for their children aged 0 to 3 years. Children (n=20, aged 2.0-17.5 years) and their parents evaluated the app prospectively during a collective total of 60 chemotherapy cycles. They expressed that the app was user-friendly, intuitive, and that the time spent on data entry was fair. The response rates were on average 92\%, 93\%, and 80\% for the day before, the first day of, and the next 3 days after chemotherapy, respectively. Researchers and clinicians were able to obtain an overview of the patient's chemotherapy dates and responses through a secure and encrypted web-based administrative portal. Data could be downloaded for further analysis. Conclusions: The user-friendly app could be used to facilitate future pediatric antiemetic trials and to refine antiemetic treatment during chemotherapy. ",
doi="10.2196/18564",
url="https://mhealth.jmir.org/2020/7/e18564",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706744"
}


@Article{info:doi/10.2196/15365,
author="Safari, Reza
and Jackson, Jessica
and Sheffield, David",
title="Digital Self-Management Interventions for People With Osteoarthritis: Systematic Review With Meta-Analysis",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="20",
volume="22",
number="7",
pages="e15365",
keywords="osteoarthritis",
keywords="self-management",
keywords="internet-based intervention",
keywords="mobile phone",
keywords="eHealth",
keywords="mHealth",
keywords="systematic review",
keywords="meta-analysis",
abstract="Background: Osteoarthritis (OA) is not curable, but the symptoms can be managed through self-management programs (SMPs). Owing to the growing burden of OA on the health system and the need to ensure high-quality integrated services, delivering SMPs through digital technologies could be an economic and effective community-based approach. Objective: This study aims to analyze the effectiveness of digital-based structured SMPs on patient outcomes in people with OA. Methods: A total of 7 web-based and 3 gray literature databases were searched for randomized controlled trials assessing digital-based structured SMPs on self-reported outcomes including pain, physical function, disability, and health-related quality of life (QoL) in people with OA. Two reviewers independently screened the search results and reference lists of the identified papers and related reviews. Data on the intervention components and delivery and behavioral change techniques used were extracted. A meta-analysis, risk of bias sensitivity analysis, and subgroup analysis were performed where appropriate. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used to assess the quality of evidence. Results: A total of 8 studies were included in this review involving 2687 patients with knee (n=2); knee, hip, or both (n=5); and unspecified joint (n=1) OA. SMPs were delivered via telephone plus audio and video, internet, or mobile apps. Studies reported that digital-based structured SMPs compared with the treatment as usual control group (n=7) resulted in a significant, homogeneous, medium reduction in pain and improvement in physical function (standardized mean difference [SMD] --0.28, 95\% CI --0.38 to --0.18 and SMD --0.26, 95\% CI --0.35 to --0.16, respectively) at posttreatment. The digital-based structured SMP effect on pain and function reduced slightly at the 12-month follow-up but remained to be medium and significant. The posttreatment effect of digital-based structured SMPs was small and significant for disability, but nonsignificant for QoL (SMD --0.10, 95\% CI --0.17 to 0.03 and SMD --0.17, 95\% CI --0.47 to 0.14, respectively; each reported in 1 study only). The 12-month follow-up effect of the intervention was very small for disability and QoL. The quality of evidence was rated as moderate for pain and physical function and low and very low for disability and QoL, respectively, using the GRADE approach. Conclusions: Digital-based structured SMPs may result in improvement in pain and physical function that is largely sustained at the 12-month follow-up in people with knee and hip OA. The effects on disability and QoL are smaller and less clear. The quality of evidence is moderate to low, and further research is required to confirm the findings of the review and assess the effects of digital-based structured SMPs on other health-related outcomes. ",
doi="10.2196/15365",
url="http://www.jmir.org/2020/7/e15365/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706657"
}


@Article{info:doi/10.2196/15448,
author="Staite, Emily
and Bayley, Adam
and Al-Ozairi, Ebaa
and Stewart, Kurtis
and Hopkins, David
and Rundle, Jennifer
and Basudev, Neel
and Mohamedali, Zahra
and Ismail, Khalida",
title="A Wearable Technology Delivering a Web-Based Diabetes Prevention Program to People at High Risk of Type 2 Diabetes: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="15",
volume="8",
number="7",
pages="e15448",
keywords="motivational interviewing",
keywords="lifestyle",
keywords="diabetes prevention program",
keywords="theory of planned behavior",
keywords="type 2 diabetes mellitus",
keywords="wearable technology",
keywords="mobile phone",
abstract="Background: Intensive lifestyle interventions are effective in reducing the risk of type 2 diabetes, but the implementation of learnings from landmark studies is expensive and time consuming. The availability of digital lifestyle interventions is increasing, but evidence of their effectiveness is limited. Objective: This randomized controlled trial (RCT) aimed to test the feasibility of a web-based diabetes prevention program (DPP) with step-dependent feedback messages versus a standard web-based DPP in people with prediabetes. Methods: We employed a two-arm, parallel, single-blind RCT for people at high risk of developing diabetes. Patients with a hemoglobin A1c (HbA1c) level of 39-47 mmol/mol were recruited from 21 general practices in London. The intervention integrated a smartphone app delivering a web-based DPP course with SMS texts incorporating motivational interviewing techniques and step-dependent feedback messages delivered via a wearable device over 12 months. The control group received the wearable technology and access to the web-based DDP but not the SMS texts. As this was a feasibility study, the primary aim was to estimate potential sample size at different stages of the study, including the size of the target study population and the proportion of participants who consented, were randomized, and completed follow-up. We also measured the main outcomes for a full-scale RCT, namely, change in weight and physical activity at 6- and 12-month follow-ups, and secondary outcomes, including changes in the HbA1c level, blood pressure, waist circumference, waist-to-hip ratio, and lipid levels. Results: We enrolled 200 participants: 98 were randomized to the intervention and 102 were randomized to the control group. The follow-up rate was higher in the control group (87/102, 85.3\%) than in the intervention group (69/98, 70\%) at 12 months. There was no treatment effect on weight at 6 months (mean difference 0.15; 95\% CI ?0.93 to 1.23) or 12 months (mean difference 0.07 kg; 95\% CI ?1.29 to 1.44) or for physical activity levels at 6 months (mean difference ?382.90 steps; 95\% CI ?860.65 to 94.85) or 12 months (mean difference 92.64 steps; 95\% CI ?380.92 to 566.20). We did not observe a treatment effect on the secondary outcomes measured at the 6-month or 12-month follow-up. For the intervention group, the mean weight was 92.33 (SD 15.67) kg at baseline, 91.34 (SD 16.04) kg at 6 months, and 89.41 (SD 14.93) kg at 12 months. For the control group, the mean weight was 92.59 (SD 17.43) kg at baseline, 91.71 (SD 16.48) kg at 6 months, and 91.10 (SD 15.82) kg at 12 months. In the intervention group, the mean physical activity was 7308.40 (SD 4911.93) steps at baseline, 5008.76 (SD 2733.22) steps at 6 months, and 4814.66 (SD 3419.65) steps at 12 months. In the control group, the mean physical activity was 7599.28 (SD 3881.04) steps at baseline, 6148.83 (SD 3433.77) steps at 6 months, and 5006.30 (SD 3681.1) steps at 12 months. Conclusions: This study demonstrates that it is feasible to successfully recruit and retain patients in an RCT of a web-based DPP. Trial Registration: ClinicalTrials.gov NCT02919397; http://clinicaltrials.gov/ct2/show/NCT02919397 ",
doi="10.2196/15448",
url="https://mhealth.jmir.org/2020/7/e15448",
url="http://www.ncbi.nlm.nih.gov/pubmed/32459651"
}


@Article{info:doi/10.2196/17893,
author="Mrklas, J. Kelly
and Barber, Tanya
and Campbell-Scherer, Denise
and Green, A. Lee
and Li, C. Linda
and Marlett, Nancy
and Miller, Jean
and Shewchuk, Brittany
and Teare, Sylvia
and Wasylak, Tracy
and Marshall, A. Deborah",
title="Co-Design in the Development of a Mobile Health App for the Management of Knee Osteoarthritis by Patients and Physicians: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="10",
volume="8",
number="7",
pages="e17893",
keywords="health services research",
keywords="app",
keywords="knee osteoarthritis",
keywords="community-based participatory research",
abstract="Background: Despite a doubling of osteoarthritis-targeted mobile health (mHealth) apps and high user interest and demand for health apps, their impact on patients, patient outcomes, and providers has not met expectations. Most health and medical apps fail to retain users longer than 90 days, and their potential for facilitating disease management, data sharing, and patient-provider communication is untapped. An important, recurrent criticism of app technology development is low user integration design. User integration ensures user needs, desires, functional requirements, and app aesthetics are responsive and reflect target user preferences. Objective: This study aims to describe the co-design process for developing a knee osteoarthritis minimum viable product (MVP) mHealth app with patients, family physicians, and researchers that facilitates guided, evidence-based self-management and patient-physician communication. Methods: Our qualitative co-design approach involved focus groups, prioritization activities, and a pre-post quality and satisfaction Kano survey. Study participants included family physicians, patient researchers and patients with knee osteoarthritis (including previous participants of related collaborative research), researchers, key stakeholders, and industry partners. The study setting was an academic health center in Southern Alberta. Results: Distinct differences exist between what patients, physicians, and researchers perceive are the most important, convenient, desirable, and actionable app functional requirements. Despite differences, study participants agreed that the MVP should be electronic, should track patient symptoms and activities, and include features customized for patient- and physician-identified factors and international guideline-based self-management strategies. Through the research process, participants negotiated consensus on their respective priority functional requirements. The highest priorities were a visual symptom graph, setting goals, exercise planning and daily tracking, and self-management strategies. The structured co-design with patients, physicians, and researchers established multiple collaborative processes, grounded in shared concepts, language, power, rationale, mutual learning, and respect for diversity and differing opinions. These shared team principles fostered an open and inclusive environment that allowed for effective conceptualization, negotiation, and group reflection, aided by the provision of tangible and ongoing support throughout the research process, which encouraged team members to question conventional thinking. Group-, subgroup-, and individual-level data helped the team reveal how and for whom perspectives about individual functional requirements changed or remained stable over the course of the study. This provided valuable insight into how and why consensus emerged, despite the presence of multiple and differing underlying rationales for functional requirement prioritization. Conclusions: It is feasible to preserve the diversity of perspectives while negotiating a consensus on the core functional requirements of an mHealth prototype app for knee osteoarthritis management. Our study sample was purposely constructed to facilitate high co-design interactivity. This study revealed important differences between the patient, physician, and researcher preferences for functional requirements of an mHealth app that did not preclude the development of consensus. ",
doi="10.2196/17893",
url="http://mhealth.jmir.org/2020/7/e17893/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32673245"
}


@Article{info:doi/10.2196/18018,
author="Amann, Julia
and Fiordelli, Maddalena
and Brach, Mirjam
and Bertschy, Sue
and Scheel-Sailer, Anke
and Rubinelli, Sara",
title="Co-designing a Self-Management App Prototype to Support People With Spinal Cord Injury in the Prevention of Pressure Injuries: Mixed Methods Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="9",
volume="8",
number="7",
pages="e18018",
keywords="co-design",
keywords="mHealth",
keywords="eHealth",
keywords="self-management",
keywords="spinal cord injury",
keywords="pressure injury",
abstract="Background: Spinal cord injury is a complex chronic health condition that requires individuals to actively self-manage. Therefore, an evidence-based, self-management app would be of value to support individuals with spinal cord injury in the prevention of pressure injuries. Objective: The main objectives of this study were to (1) establish a co-design approach for developing a high-fidelity prototype app for the self-management of individuals with spinal cord injury, (2) design the prototype that resulted from this process, and (3) conduct the first usability assessment of the prototype app. Methods: We adopted a co-design approach to develop an evidence-based app prototype. Starting from a preliminary content model (based on clinical guidelines for the prevention of pressure injuries) and three research-based user personas, we conducted an ideation workshop involving individuals with spinal cord injury and health care professionals. The ideation workshop formed the basis for two consecutive design sprints. The result of this co-design phase was an interactive app prototype. The prototype was evaluated in two rounds of usability testing (N=4 and N=15, respectively) using a combination of qualitative and quantitative methods. Results: The co-design process resulted in a high-fidelity prototype with two key components: a self-management component and a communication component. The final prototype included a combination of features to support individuals with spinal cord injury in the prevention of pressure injuries, namely a smart camera, pressure injury diary, expert consultation, reminders, and knowledge repository. Findings of the usability testing showed that most participants navigated the app fluently with little back and forth navigation and were able to successfully complete a set of assigned tasks. These positive results are supported by the average system usability score achieved (78.5/100; range 47.5-95.0) and our qualitative analysis of the semistructured interviews. Despite an overall positive evaluation of the app prototype, we identified areas for improvement (eg, inclusion of a search function). Conclusions: Individuals with spinal cord injury often need to navigate competing interests and priorities, paired with uncertainty about the accuracy and relevance of clinical recommendations. Understanding what matters to individuals with spinal cord injury can help guide the design of behavioral interventions that are useful and acceptable to these individuals in their daily lives. This study shows that involving individuals with spinal cord injury and health care professionals in co-designing a self-management app can foster knowledge cocreation at the intersection of lived experience, medical expertise, and technical solutions. ",
doi="10.2196/18018",
url="https://mhealth.jmir.org/2020/7/e18018",
url="http://www.ncbi.nlm.nih.gov/pubmed/32673241"
}


@Article{info:doi/10.2196/18208,
author="Kelly, Laura
and Jenkinson, Crispin
and Morley, David",
title="Web-Based and mHealth Technologies to Support Self-Management in People Living With Type 2 Diabetes: Validation of the Diabetes Self-Management and Technology Questionnaire (DSMT-Q)",
journal="JMIR Diabetes",
year="2020",
month="Jul",
day="9",
volume="5",
number="3",
pages="e18208",
keywords="mHealth",
keywords="self-care",
keywords="type 2 diabetes",
keywords="self-monitoring",
keywords="questionnaire",
abstract="Background: A growing number of web-based and mobile health (mHealth) technologies have been developed to support type 2 diabetes self-management. Little is known about individuals' experiences with these technologies and how they support self-management. Appropriate tools are needed to understand how web-based and mHealth interventions may impact self-management. Objective: This study aimed to develop an instrument, the Diabetes Self-Management and Technology Questionnaire (DSMT-Q), to assess self-management among people living with type 2 diabetes who use web-based and mHealth technologies. Methods: A total of 36 candidate questionnaire items, drafted previously, were refined using cognitive debriefing interviews (n=8), expert consultation, and public patient involvement feedback. Item reduction steps were performed on survey data (n=250), and tests of validity and reliability were subsequently performed. Results: Following amendments, patients and experts found 21 items relevant and acceptable for inclusion in the instrument. Survey participants included 104 (41.6\%) women and 146 (58.4\%) men. Two subscales with high construct validity, internal consistency, and test-retest reliability were identified: ``Understanding individual health and making informed decisions'' and ``Confidence to reach and sustain goals.'' Conclusions: Analyses confirmed good psychometric properties in the DSMT-Q scales. This tool will facilitate the measurement of self-management in people living with type 2 diabetes who use web-based or mHealth technologies. ",
doi="10.2196/18208",
url="https://diabetes.jmir.org/2020/3/e18208",
url="http://www.ncbi.nlm.nih.gov/pubmed/32673214"
}


@Article{info:doi/10.2196/15896,
author="Floch, Jacqueline
and Vilarinho, Thomas
and Zettl, Annabel
and Ibanez-Sanchez, Gema
and Calvo-Lerma, Joaquim
and Stav, Erlend
and Haro, Halland Peter
and Aalberg, Lein Asbj{\o}rn
and Fides-Valero, Alvaro
and Bayo Mont{\'o}n, Luis Jos{\'e}",
title="Users' Experiences of a Mobile Health Self-Management Approach for the Treatment of Cystic Fibrosis: Mixed Methods Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jul",
day="8",
volume="8",
number="7",
pages="e15896",
keywords="mobile health",
keywords="mHealth",
keywords="self-management",
keywords="user experience",
keywords="user acceptance",
keywords="mixed methods study",
keywords="cystic fibrosis",
keywords="pediatrics",
abstract="Background: Despite a large number of clinical trials aiming at evaluating the digital self-management of chronic diseases, there is little discussion about users' experiences with digital approaches. However, a good user experience is a critical factor for technology adoption. Understanding users' experiences can inform the design of approaches toward increased motivation for digital self-management. Objective: This study aimed to evaluate the self-management of cystic fibrosis (CF) with a focus on gastrointestinal concerns and the care of young patients. Following a user-centered design approach, we developed a self-management app for patients and parents and a web tool for health care professionals (HCPs). To evaluate the proposed solutions, a 6-month clinical trial was conducted in 6 European CF competence centers. This paper analyzes the user acceptance of the technology and the benefits and disadvantages perceived by the trial participants. Methods: A mixed methods approach was applied. Data were collected through 41 semistructured qualitative interviews of patients, parents, and HCPs involved in the clinical trial. In addition, data were collected through questionnaires embedded in the self-management app. Results: Support for enzyme dose calculation and nutrition management was found to be particularly useful. Patients and parents rapidly strengthened their knowledge about the treatment and increased their self-efficacy. Reported benefits include reduced occurrence of symptoms and enhanced quality of life. Patients and parents had different skills, requiring follow-up by HCPs in an introductory phase. HCPs valued obtaining precise information about the patients, allowing for more personalized advice. However, the tight follow-up of several patients led to an increased workload. Over time, as patient self-efficacy increased, patient motivation for using the app decreased and the quality of the reported data was reduced. Conclusions: Self-management enfolds a collaboration between patients and HCPs. To be successful, a self-management approach should be accepted by both parties. Through understanding behaviors and experiences, this study defines recommendations for a complex case---the demanding treatment of CF. We identify target patient groups and situations for which the app is most beneficial and suggest focusing on these rather than motivating for regular app usage over a long time. We also advise the personalized supervision of patients during the introduction of the approach. Finally, we propose to develop guidance for HCPs to facilitate changes in practice. As personalization and technology literacy are factors found to influence the acceptance of digital self-management of other chronic diseases, it is relevant to consider the proposed recommendations beyond the case of CF. ",
doi="10.2196/15896",
url="https://mhealth.jmir.org/2020/7/e15896",
url="http://www.ncbi.nlm.nih.gov/pubmed/32673237"
}


@Article{info:doi/10.2196/18480,
author="Larbi, Dillys
and Randine, Pietro
and {\AA}rsand, Eirik
and Antypas, Konstantinos
and Bradway, Meghan
and Gabarron, Elia",
title="Methods and Evaluation Criteria for Apps and Digital Interventions for Diabetes Self-Management: Systematic Review",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="6",
volume="22",
number="7",
pages="e18480",
keywords="self-management",
keywords="diabetes mellitus",
keywords="mobile applications",
keywords="computer communication networks",
keywords="mHealth",
keywords="eHealth",
keywords="health care evaluation mechanisms",
abstract="Background: There is growing evidence that apps and digital interventions have a positive impact on diabetes self-management. Standard self-management for patients with diabetes could therefore be supplemented by apps and digital interventions to increase patients' skills. Several initiatives, models, and frameworks suggest how health apps and digital interventions could be evaluated, but there are few standards for this. And although there are many methods for evaluating apps and digital interventions, a more specific approach might be needed for assessing digital diabetes self-management interventions. Objective: This review aims to identify which methods and criteria are used to evaluate apps and digital interventions for diabetes self-management, and to describe how patients were involved in these evaluations. Methods: We searched CINAHL, EMBASE, MEDLINE, and Web of Science for articles published from 2015 that referred to the evaluation of apps and digital interventions for diabetes self-management and involved patients in the evaluation. We then conducted a narrative qualitative synthesis of the findings, structured around the included studies' quality, methods of evaluation, and evaluation criteria. Results: Of 1681 articles identified, 31 fulfilled the inclusion criteria. A total of 7 articles were considered of high confidence in the evidence. Apps were the most commonly used platform for diabetes self-management (18/31, 58\%), and type 2 diabetes (T2D) was the targeted health condition most studies focused on (12/31, 38\%). Questionnaires, interviews, and user-group meetings were the most common methods of evaluation. Furthermore, the most evaluated criteria for apps and digital diabetes self-management interventions were cognitive impact, clinical impact, and usability. Feasibility and security and privacy were not evaluated by studies considered of high confidence in the evidence. Conclusions: There were few studies with high confidence in the evidence that involved patients in the evaluation of apps and digital interventions for diabetes self-management. Additional evaluation criteria, such as sustainability and interoperability, should be focused on more in future studies to provide a better understanding of the effects and potential of apps and digital interventions for diabetes self-management. ",
doi="10.2196/18480",
url="https://www.jmir.org/2020/7/e18480",
url="http://www.ncbi.nlm.nih.gov/pubmed/32628125"
}


@Article{info:doi/10.2196/15605,
author="Schleimer, Erica
and Pearce, Jennifer
and Barnecut, Andrew
and Rowles, William
and Lizee, Antoine
and Klein, Arno
and Block, J. Valerie
and Santaniello, Adam
and Renschen, Adam
and Gomez, Refujia
and Keshavan, Anisha
and Gelfand, M. Jeffrey
and Henry, G. Roland
and Hauser, L. Stephen
and Bove, Riley",
title="A Precision Medicine Tool for Patients With Multiple Sclerosis (the Open MS BioScreen): Human-Centered Design and Development",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="6",
volume="22",
number="7",
pages="e15605",
keywords="human-centered design",
keywords="mobile phone",
keywords="personal health record",
keywords="participatory medicine",
keywords="visualization in eHealth",
keywords="human factors",
abstract="Background: Patients with multiple sclerosis (MS) face several challenges in accessing clinical tools to help them monitor, understand, and make meaningful decisions about their disease course. The University of California San Francisco MS BioScreen is a web-based precision medicine tool initially designed to be clinician facing. We aimed to design a second, openly available tool, Open MS BioScreen, that would be accessible, understandable, and actionable by people with MS. Objective: This study aimed to describe the human-centered design and development approach (inspiration, ideation, and implementation) for creating the Open MS BioScreen platform. Methods: We planned an iterative and cyclical development process that included stakeholder engagement and iterative feedback from users. Stakeholders included patients with MS along with their caregivers and family members, MS experts, generalist clinicians, industry representatives, and advocacy experts. Users consisted of anyone who wants to track MS measurements over time and access openly available tools for people with MS. Phase I (inspiration) consisted of empathizing with users and defining the problem. We sought to understand the main challenges faced by patients and clinicians and what they would want to see in a web-based app. In phase II (ideation), our multidisciplinary team discussed approaches to capture, display, and make sense of user data. Then, we prototyped a series of mock-ups to solicit feedback from clinicians and people with MS. In phase III (implementation), we incorporated all concepts to test and iterate a minimally viable product. We then gathered feedback through an agile development process. The design and development were cyclical---many times throughout the process, we went back to the drawing board. Results: This human-centered approach generated an openly available, web-based app through which patients with MS, their clinicians, and their caregivers can access the site and create an account. Users can enter information about their MS (basic level as well as more advanced concepts), visualize their data longitudinally, access a series of algorithms designed to empower them to make decisions about their treatments, and enter data from wearable devices to encourage realistic goal setting about their ambulatory activity. Agile development will allow us to continue to incorporate precision medicine tools, as these are validated in the clinical research arena. Conclusions: After engaging intended users into the iterative human-centered design of the Open MS BioScreen, we will now monitor the adaptation and dissemination of the tool as we expand its functionality and reach. The insights generated from this approach can be applied to the development of a number of self-tracking, self-management, and user engagement tools for patients with chronic conditions. ",
doi="10.2196/15605",
url="https://www.jmir.org/2020/7/e15605",
url="http://www.ncbi.nlm.nih.gov/pubmed/32628124"
}


@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/10.2196/15295,
author="Nichols, Michelle
and Miller, Sarah
and Treiber, Frank
and Ruggiero, Kenneth
and Dawley, Erin
and Teufel II, Ronald",
title="Patient and Parent Perspectives on Improving Pediatric Asthma Self-Management Through a Mobile Health Intervention: Pilot Study",
journal="JMIR Form Res",
year="2020",
month="Jul",
day="3",
volume="4",
number="7",
pages="e15295",
keywords="asthma",
keywords="mobile health",
keywords="ecological momentary assessment",
keywords="adolescents",
keywords="medication adherence",
keywords="self-management",
keywords="mobile phone",
abstract="Background: Asthma is a common chronic pediatric disease that can negatively impact children and families. Self-management strategies are challenging to adopt but critical for achieving positive outcomes. Mobile health technology may facilitate self-management of pediatric asthma, especially as adolescents mature and assume responsibility for their disease. Objective: This study aimed to explore the perceptions of youths with high-risk asthma and their caregivers on the use of a smartphone app, Smartphone Asthma Management System, in the prevention and treatment of asthma symptoms, possible use of the app to improve self-management of asthma outside traditional clinical settings, and the impact of asthma on everyday life to identify potential needs for future intervention development. Methods: Key informant interviews were completed with parent-child dyads post participation in an asthma management feasibility intervention study to explore the perceptions of users on a smartphone app designed to monitor symptoms and medication use and offer synchronous and asynchronous provider encounters. A thematic qualitative analysis was conducted inductively through emergent findings and deductively based on the self-determination theory (SDT), identifying 4 major themes. Results: A total of 19 parent-child dyads completed the postintervention interviews. The major themes identified included autonomy, competence, relatedness, and the impact of asthma on life. The participants also shared their perceptions of the benefits and challenges associated with using the app and in the self-management of asthma. Both children and parents conveyed a preference for using technology to facilitate medication and disease management, and children demonstrated a strong willingness and ability to actively engage in their care. Conclusions: Our study included support for the app and demonstrated the feasibility of enhancing the self-management of asthma by youth in the community. Participant feedback led to intervention refinement and app improvements, and the use of the SDT allowed insight into motivational drivers of behavioral change. The use of mobile apps among high-risk children with asthma and their parents shows promise in improving self-management, medication adherence, and disease awareness and in reducing overall disease morbidity. ",
doi="10.2196/15295",
url="https://formative.jmir.org/2020/7/e15295",
url="http://www.ncbi.nlm.nih.gov/pubmed/32442127"
}


@Article{info:doi/10.2196/18781,
author="Lawitschka, Anita
and Buehrer, Stephanie
and Bauer, Dorothea
and Peters, Konrad
and Silbernagl, Marisa
and Zubarovskaya, Natalia
and Brunmair, Barbara
and Kayali, Fares
and Hlavacs, Helmut
and Mateus-Berr, Ruth
and Riedl, David
and Rumpold, Gerhard
and Peters, Christina",
title="A Web-Based Mobile App (INTERACCT App) for Adolescents Undergoing Cancer and Hematopoietic Stem Cell Transplantation Aftercare to Improve the Quality of Medical Information for Clinicians: Observational Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jun",
day="30",
volume="8",
number="6",
pages="e18781",
keywords="mobile app",
keywords="adolescents",
keywords="cancer",
keywords="stem cell transplant",
keywords="self-reported heath status",
keywords="medical information exchange",
keywords="mobile phone",
abstract="Background: A growing number of cancer and hematopoietic stem cell transplant (HSCT) survivors require long-term follow-up with optimal communication schemes, and patients' compliance is crucial. Adolescents have various unmet needs. Regarding self-report of symptoms and health status, users of mobile apps showed enhanced compliance. Currently, HSCT aftercare at the HSCT outpatient clinic of the St. Anna Children's Hospital in Vienna, Austria, is based on handwritten diaries, carrying various disadvantages. Recently, we developed the prototype of a web-based, self-monitoring gamified mobile app tailored for adolescents: the INTERACCT (Integrating Entertainment and Reaction Assessment into Child Cancer Therapy) app. Objective: This observational, prospective study evaluated the usability of the INTERACCT app for tracking real-time self-reported symptoms and health status data in adolescent HSCT patients and a healthy matched control group. The primary outcome of the study was the quality of the self-reported medical information. We hypothesized that the mobile app would provide superior medical information for the clinicians than would the handwritten diaries. Methods: Health data were reported via paper diary and mobile app for 5 consecutive days each. The quality of medical information was rated on a 5-point scale independently and blinded by two HSCT clinicians, and the duration of use was evaluated. A total of 52 participant questionnaires were assessed for gaming patterns and device preferences, self-efficacy, users' satisfaction, acceptability, and suggestions for improvement of the mobile app. Interrater reliability was calculated with the intraclass correlation coefficient, based on a two-way mixed model; one-way repeated-measures analysis of variance and t tests were conducted post hoc. Descriptive methods were used for correlation with participants' demographics. For users' satisfaction and acceptability of the mobile app, the median and the IQR were calculated. Results: Data from 42 participants---15 patients and 27 healthy students---with comparable demographics were evaluated. The results of our study indicated a superiority of the quality of self-reported medical data in the INTERACCT app over traditional paper-and-pencil assessment (mobile app: 4.14 points, vs paper-based diary: 3.77 points, P=.02). The mobile app outperformed paper-and-pencil assessments mainly among the patients, in particular among patients with treatment-associated complications (mobile app: 4.43 points, vs paper-based diary: 3.73 points, P=.01). The mobile app was used significantly longer by adolescents (?14 years: 4.57 days, vs ?13 years: 3.14 days, P=.03) and females (4.76 days for females vs 2.95 days for males, P=.004). This corresponds with a longer duration of use among impaired patients with comorbidities. User satisfaction and acceptability ratings for the mobile app were high across all groups, but adherence to entering a large amount of data decreased over time. Based on our results, we developed a case vignette of the target group. Conclusions: Our study was the first to show that the quality of patient-reported medical information submitted via the INTERACCT app embedded in a serious game is superior to that submitted via a handwritten diary. In light of these results, a refinement of the mobile app supported by a machine learning approach is planned within an international research project. ",
doi="10.2196/18781",
url="http://mhealth.jmir.org/2020/6/e18781/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32602847"
}


@Article{info:doi/10.2196/15547,
author="Pryss, R{\"u}diger
and Schlee, Winfried
and Hoppenstedt, Burkhard
and Reichert, Manfred
and Spiliopoulou, Myra
and Langguth, Berthold
and Breitmayer, Marius
and Probst, Thomas",
title="Applying Machine Learning to Daily-Life Data From the TrackYourTinnitus Mobile Health Crowdsensing Platform to Predict the Mobile Operating System Used With High Accuracy: Longitudinal Observational Study",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="30",
volume="22",
number="6",
pages="e15547",
keywords="mHealth",
keywords="crowdsensing",
keywords="tinnitus",
keywords="machine learning",
keywords="mobile operating system differences",
keywords="ecological momentary assessment",
keywords="mobile phone",
abstract="Background: Tinnitus is often described as the phantom perception of a sound and is experienced by 5.1\% to 42.7\% of the population worldwide, at least once during their lifetime. The symptoms often reduce the patient's quality of life. The TrackYourTinnitus (TYT) mobile health (mHealth) crowdsensing platform was developed for two operating systems (OS)---Android and iOS---to help patients demystify the daily moment-to-moment variations of their tinnitus symptoms. In all platforms developed for more than one OS, it is important to investigate whether the crowdsensed data predicts the OS that was used in order to understand the degree to which the OS is a confounder that is necessary to consider. Objective: In this study, we explored whether the mobile OS---Android and iOS---used during user assessments can be predicted by the dynamic daily-life TYT data. Methods: TYT mainly applies the paradigms ecological momentary assessment (EMA) and mobile crowdsensing to collect dynamic EMA (EMA-D) daily-life data. The dynamic daily-life TYT data that were analyzed included eight questions as part of the EMA-D questionnaire. In this study, 518 TYT users were analyzed, who each completed at least 11 EMA-D questionnaires. Out of these, 221 were iOS users and 297 were Android users. The iOS users completed, in total, 14,708 EMA-D questionnaires; the number of EMA-D questionnaires completed by the Android users was randomly reduced to the same number to properly address the research question of the study. Machine learning methods---a feedforward neural network, a decision tree, a random forest classifier, and a support vector machine---were applied to address the research question. Results: Machine learning was able to predict the mobile OS used with an accuracy up to 78.94\% based on the provided EMA-D questionnaires on the assessment level. In this context, the daily measurements regarding how users concentrate on the actual activity were particularly suitable for the prediction of the mobile OS used. Conclusions: In the work at hand, two particular aspects have been revealed. First, machine learning can contribute to EMA-D data in the medical context. Second, based on the EMA-D data of TYT, we found that the accuracy in predicting the mobile OS used has several implications. Particularly, in clinical studies using mobile devices, the OS should be assessed as a covariate, as it might be a confounder. ",
doi="10.2196/15547",
url="http://www.jmir.org/2020/6/e15547/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32602842"
}


@Article{info:doi/10.2196/16414,
author="Gatsios, Dimitris
and Antonini, Angelo
and Gentile, Giovanni
and Marcante, Andrea
and Pellicano, Clelia
and Macchiusi, Lucia
and Assogna, Francesca
and Spalletta, Gianfranco
and Gage, Heather
and Touray, Morro
and Timotijevic, Lada
and Hodgkins, Charo
and Chondrogiorgi, Maria
and Rigas, George
and Fotiadis, I. Dimitrios
and Konitsiotis, Spyridon",
title="Feasibility and Utility of mHealth for the Remote Monitoring of Parkinson Disease: Ancillary Study of the PD\_manager Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jun",
day="29",
volume="8",
number="6",
pages="e16414",
keywords="Parkinson's disease",
keywords="determinants of compliance",
keywords="clinically meaningful data",
keywords="ecological validity",
abstract="Background: Mobile health, predominantly wearable technology and mobile apps, have been considered in Parkinson disease to provide valuable ecological data between face-to-face visits and improve monitoring of motor symptoms remotely. Objective: We explored the feasibility of using a technology-based mHealth platform comprising a smartphone in combination with a smartwatch and a pair of smart insoles, described in this study as the PD\_manager system, to collect clinically meaningful data. We also explored outcomes and disease-related factors that are important determinants to establish feasibility. Finally, we further validated a tremor evaluation method with data collected while patients performed their daily activities. Methods: PD\_manager trial was an open-label parallel group randomized study.The mHealth platform consists of a wristband, a pair of sensor insoles, a smartphone (with dedicated mobile Android apps) and a knowledge platform serving as the cloud backend. Compliance was assessed with statistical analysis and the factors affecting it using appropriate regression analysis. The correlation of the scores of our previous algorithm for tremor evaluation and the respective Unified Parkinson's Disease Rating Scale estimations by clinicians were explored. Results: Of the 75 study participants, 65 (87\%) completed the protocol. They used the PD\_manager system for a median 11.57 (SD 3.15) days. Regression analysis suggests that the main factor associated with high use was caregivers' burden. Motor Aspects of Experiences of Daily Living and patients' self-rated health status also influence the system's use. Our algorithm provided clinically meaningful data for the detection and evaluation of tremor. Conclusions: We found that PD patients, regardless of their demographics and disease characteristics, used the system for 11 to 14 days. The study further supports that mHealth can be an effective tool for the ecologically valid, passive, unobtrusive monitoring and evaluation of symptoms. Future studies will be required to demonstrate that an mHealth platform can improve disease management and care. Trial Registration: ISRCTN Registry ISRCTN17396879; http://www.isrctn.com/ISRCTN17396879 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-2767-4 ",
doi="10.2196/16414",
url="https://mhealth.jmir.org/2020/6/e16414",
url="http://www.ncbi.nlm.nih.gov/pubmed/32442154"
}


@Article{info:doi/10.2196/15517,
author="Templeton, Michael John
and Poellabauer, Christian
and Schneider, Sandra",
title="Enhancement of Neurocognitive Assessments Using Smartphone Capabilities: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jun",
day="24",
volume="8",
number="6",
pages="e15517",
keywords="mobile phone",
keywords="mobile health",
keywords="neurocognitive tests",
keywords="neurodegenerative disease",
keywords="neurocognitive disorders",
abstract="Background: Comprehensive exams such as the Dean-Woodcock Neuropsychological Assessment System, the Global Deterioration Scale, and the Boston Diagnostic Aphasia Examination are the gold standard for doctors and clinicians in the preliminary assessment and monitoring of neurocognitive function in conditions such as neurodegenerative diseases and acquired brain injuries (ABIs). In recent years, there has been an increased focus on implementing these exams on mobile devices to benefit from their configurable built-in sensors, in addition to scoring, interpretation, and storage capabilities. As smartphones become more accepted in health care among both users and clinicians, the ability to use device information (eg, device position, screen interactions, and app usage) for subject monitoring also increases. Sensor-based assessments (eg, functional gait using a mobile device's accelerometer and/or gyroscope or collection of speech samples using recordings from the device's microphone) include the potential for enhanced information for diagnoses of neurological conditions; mapping the development of these conditions over time; and monitoring efficient, evidence-based rehabilitation programs. Objective: This paper provides an overview of neurocognitive conditions and relevant functions of interest, analysis of recent results using smartphone and/or tablet built-in sensor information for the assessment of these different neurocognitive conditions, and how human-device interactions and the assessment and monitoring of these neurocognitive functions can be enhanced for both the patient and health care provider. Methods: This survey presents a review of current mobile technological capabilities to enhance the assessment of various neurocognitive conditions, including both neurodegenerative diseases and ABIs. It explores how device features can be configured for assessments as well as the enhanced capability and data monitoring that will arise due to the addition of these features. It also recognizes the challenges that will be apparent with the transfer of these current assessments to mobile devices. Results: Built-in sensor information on mobile devices is found to provide information that can enhance neurocognitive assessment and monitoring across all functional categories. Configurations of positional sensors (eg, accelerometer, gyroscope, and GPS), media sensors (eg, microphone and camera), inherent sensors (eg, device timer), and participatory user-device interactions (eg, screen interactions, metadata input, app usage, and device lock and unlock) are all helpful for assessing these functions for the purposes of training, monitoring, diagnosis, or rehabilitation. Conclusions: This survey discusses some of the many opportunities and challenges of implementing configured built-in sensors on mobile devices to enhance assessments and monitoring of neurocognitive functions as well as disease progression across neurodegenerative and acquired neurological conditions. ",
doi="10.2196/15517",
url="http://mhealth.jmir.org/2020/6/e15517/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32442150"
}


@Article{info:doi/10.2196/17855,
author="Gustavell, Tina
and Sundberg, Kay
and Langius-Ekl{\"o}f, Ann",
title="Using an Interactive App for Symptom Reporting and Management Following Pancreatic Cancer Surgery to Facilitate Person-Centered Care: Descriptive Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jun",
day="17",
volume="8",
number="6",
pages="e17855",
keywords="pancreatic neoplasms",
keywords="mHealth",
keywords="interactive",
keywords="symptoms",
keywords="self-care",
keywords="support",
keywords="patient-reported outcomes, person-centered care",
abstract="Background: Pancreatic and periampullary cancers are rare but have high mortality rates. The only hope for cure is surgical removal of the tumor. Following pancreatic surgery, the patients have a great deal of responsibility for managing their symptoms. Patients report a lack of sufficient knowledge of self-care and unmet supportive care needs. This necessitates a health care system responsive to these needs and health care professionals who pay close attention to symptoms. Person-centered care is widely encouraged and means a shift from a model in which the patient is the passive object of care to a model involving the patient as an active participant in their own care. To address the challenges in care following pancreatic cancer surgery, an interactive app (Interaktor) was developed in which patients regularly report symptoms and receive support for self-care. The app has been shown to reduce patients' symptom burden and to increase their self-care activity levels following pancreaticoduodenectomy due to cancer. Objective: The aim of the study was to describe how patients used the Interaktor app following pancreaticoduodenectomy due to cancer and their experience with doing so. Methods: A total of 115 patients were invited to use Interaktor for 6 months following pancreaticoduodenectomy. Of those, 35 declined, 8 dropped out, and 46 did not meet the inclusion criteria after surgery, leaving 26 patients for inclusion in the analysis. The patients were instructed to report symptoms daily through the app for up to 6 months following surgery. In case of alerting symptoms, they were contacted by their nurse. Data on reported symptoms, alerts, and viewed self-care advice were logged and analyzed with descriptive statistics. Also, the patients were interviewed about their experiences, and the data were analyzed using thematic analysis. Results: The patients' median adherence to symptom reporting was 82\%. Fatigue and pain were the most reported symptoms. Alerting symptoms were reported by 24 patients, and the most common alert was fever. There were variations in how many times the patients viewed the self-care advice (range 3-181 times). The most commonly viewed advice concerned pancreatic enzyme supplements. Through the interviews, the overarching theme was ``Being seen as a person,'' with the following 3 sub-themes: ``Getting your voice heard,'' ``Having access to an extended arm of health care,'' and ``Learning about own health.'' Conclusions: Interaktor proved to be well accepted. It made patients feel reassured at home and offered support for self-care. The app facilitated person-centered care by its multiple features targeting individual supportive care needs and enabled participation in their own care. This supports our recent studies showing that patients using the app had less symptom burden and higher self-care activity levels than patients receiving only standard care. ",
doi="10.2196/17855",
url="http://mhealth.jmir.org/2020/6/e17855/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32554375"
}


@Article{info:doi/10.2196/17890,
author="Zahed, Karim
and Sasangohar, Farzan
and Mehta, Ranjana
and Erraguntla, Madhav
and Qaraqe, Khalid",
title="Diabetes Management Experience and the State of Hypoglycemia: National Online Survey Study",
journal="JMIR Diabetes",
year="2020",
month="Jun",
day="17",
volume="5",
number="2",
pages="e17890",
keywords="tremor",
keywords="hypoglycemia",
keywords="diabetes mellitus",
keywords="remote sensing technology",
keywords="survey methods",
keywords="mobile phone",
abstract="Background: Hypoglycemia, or low blood sugar levels, in people with diabetes can be a serious life-threatening condition, and serious outcomes can be avoided if low levels of blood sugar are proactively detected. Although technologies exist to detect the onset of hypoglycemia, they are invasive or costly or exhibit a high incidence of false alarms. Tremors are commonly reported symptoms of hypoglycemia and may be used to detect hypoglycemic events, yet their onset is not well researched or understood. Objective: This study aimed to understand diabetic patients' perceptions of hypoglycemic tremors, as well as their user experiences with technology to manage diabetes, and expectations from a self-management tool to ultimately inform the design of a noninvasive and cost-effective technology that detects tremors associated with hypoglycemia. Methods: A cross-sectional internet panel survey was administered to adult patients with type 1 diabetes using the Qualtrics platform in May 2019. The questions focused on 3 main constructs: (1) perceived experiences of hypoglycemia, (2) experiences and expectations about a diabetes management device and mobile app, and (3) beliefs and attitudes regarding intention to use a diabetes management device. The analysis in this paper focuses on the first two constructs. Nonparametric tests were used to analyze the Likert scale data, with a Mann-Whitney U test, Kruskal-Wallis test, and Games-Howell post hoc test as applicable, for subgroup comparisons to highlight differences in perceived frequency, severity, and noticeability of hypoglycemic tremors across age, gender, years living with diabetes, and physical activity. Results: Data from 212 respondents (129 [60.8\%] females) revealed statistically significant differences in perceived noticeability of tremors by gender, whereby males noticed their tremors more (P<.001), and age, with the older population reporting lower noticeability than the young and middle age groups (P<.001). Individuals living longer with diabetes noticed their tremors significantly less than those with diabetes for ?1 year but not in terms of frequency or severity. Additionally, the majority of our participants (150/212, 70.7\%) reported experience with diabetes-monitoring devices. Conclusions: Our findings support the need for cost-efficient and noninvasive continuous monitoring technologies. Although hypoglycemic tremors were perceived to occur frequently, such tremors were not found to be severe compared with other symptoms such as sweating, which was the highest rated symptom in our study. Using a combination of tremor and galvanic skin response sensors may show promise in detecting the onset of hypoglycemic events. ",
doi="10.2196/17890",
url="http://diabetes.jmir.org/2020/2/e17890/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32442145"
}


@Article{info:doi/10.2196/19200,
author="Lowres, Nicole
and Duckworth, Andrew
and Redfern, Julie
and Thiagalingam, Aravinda
and Chow, K. Clara",
title="Use of a Machine Learning Program to Correctly Triage Incoming Text Messaging Replies From a Cardiovascular Text--Based Secondary Prevention Program: Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jun",
day="16",
volume="8",
number="6",
pages="e19200",
keywords="eHealth",
keywords="machine learning, secondary prevention, SMS text messaging, cardiovascular, mHealth, digital health, mobile phone",
abstract="Background: SMS text messaging programs are increasingly being used for secondary prevention, and have been shown to be effective in a number of health conditions including cardiovascular disease. SMS text messaging programs have the potential to increase the reach of an intervention, at a reduced cost, to larger numbers of people who may not access traditional programs. However, patients regularly reply to the SMS text messages, leading to additional staffing requirements to monitor and moderate the patients' SMS text messaging replies. This additional staff requirement directly impacts the cost-effectiveness and scalability of SMS text messaging interventions. Objective: This study aimed to test the feasibility and accuracy of developing a machine learning (ML) program to triage SMS text messaging replies (ie, identify which SMS text messaging replies require a health professional review). Methods: SMS text messaging replies received from 2 clinical trials were manually coded (1) into ``Is staff review required?'' (binary response of yes/no); and then (2) into 12 general categories. Five ML models (Na{\"i}ve Bayes, OneVsRest, Random Forest Decision Trees, Gradient Boosted Trees, and Multilayer Perceptron) and an ensemble model were tested. For each model run, data were randomly allocated into training set (2183/3118, 70.01\%) and test set (935/3118, 29.98\%). Accuracy for the yes/no classification was calculated using area under the receiver operating characteristics curve (AUC), false positives, and false negatives. Accuracy for classification into 12 categories was compared using multiclass classification evaluators. Results: A manual review of 3118 SMS text messaging replies showed that 22.00\% (686/3118) required staff review. For determining need for staff review, the Multilayer Perceptron model had highest accuracy (AUC 0.86; 4.85\% false negatives; and 4.63\% false positives); with addition of heuristics (specified keywords) fewer false negatives were identified (3.19\%), with small increase in false positives (7.66\%) and AUC 0.79. Application of this model would result in 26.7\% of SMS text messaging replies requiring review (true + false positives). The ensemble model produced the lowest false negatives (1.43\%) at the expense of higher false positives (16.19\%). OneVsRest was the most accurate (72.3\%) for the 12-category classification. Conclusions: The ML program has high sensitivity for identifying the SMS text messaging replies requiring staff input; however, future research is required to validate the models against larger data sets. Incorporation of an ML program to review SMS text messaging replies could significantly reduce staff workload, as staff would not have to review all incoming SMS text messages. This could lead to substantial improvements in cost-effectiveness, scalability, and capacity of SMS text messaging--based interventions. ",
doi="10.2196/19200",
url="http://mhealth.jmir.org/2020/6/e19200/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32543439"
}


@Article{info:doi/10.2196/17708,
author="Cho, Hwayoung
and Porras, Tiffany
and Flynn, Gabriella
and Schnall, Rebecca",
title="Usability of a Consumer Health Informatics Tool Following Completion of a Clinical Trial: Focus Group Study",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="15",
volume="22",
number="6",
pages="e17708",
keywords="consumer health informatics tool",
keywords="mobile Health",
keywords="mobile apps",
keywords="clinical trial",
keywords="symptom care",
keywords="self-management",
keywords="HIV-associated nonAIDS (HANA)",
keywords="HANA conditions",
keywords="HIV/AIDS",
abstract="Background: Mobile health (mHealth) apps have the potential to be effective tools for encouraging patients with chronic diseases to self-manage their health. The success of mHealth apps is related to technology acceptance and its subsequent use by intended consumers. Therefore, it is essential to gain insights from consumers' perspectives about their use of mHealth apps in daily life. Objective: The purpose of this work was to understand consumers' perspectives on use of a self-management app following completion of a clinical trial that tested the efficacy of the app for improving health outcomes. Methods: We conducted five focus groups with paricipants of a clinical trial (NCT03182738) who were randomized to use the video information provider (VIP) for HIV-associated nonAIDS (HANA) conditions app (VIP-HANA) or an attention control app. Thematic analysis was conducted, and the themes were organized according to the two key constructs of the technology acceptance model framework: perceived usefulness and perceived ease of use. Results: Thirty-nine people living with HIV (20 from the intervention group and 19 from the control group) participated in the focus group sessions. Of the eight themes identified from focus group data, the five themes related to perceived usefulness were: (1) self-monitoring HIV-related symptoms of HANA conditions, (2) enhanced relationship with clinical providers, (3) improvement in physical and emotional health, (4) long-term impact of self-care strategies on improvement in symptoms of HANA conditions, and (5) inspired lifestyle changes to manage symptoms. The three themes related to perceived ease of use were: (1) easy to navigate, (2) avatar personalization, and (3) privacy/confidentiality maintained even when changing the location of app use. Conclusions: Perceived ease of use was similar in both study groups but perceived usefulness differed between study groups. Participants in both study groups found the VIP-HANA app to be useful in monitoring their symptoms and enhancing communication with their clinical care providers. However, only intervention group participants perceived the app to be useful in improving overall health and long-term symptom management. Findings from this study highlight factors that are essential to ensure the usefulness of self-management apps and facilitate sustained use of mHealth apps for people living with chronic illnesses. ",
doi="10.2196/17708",
url="http://www.jmir.org/2020/6/e17708/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32538796"
}


@Article{info:doi/10.2196/15449,
author="Korpershoek, G. Yvonne J.
and Hermsen, Sander
and Schoonhoven, Lisette
and Schuurmans, J. Marieke
and Trappenburg, A. Jaap C.",
title="User-Centered Design of a Mobile Health Intervention to Enhance Exacerbation-Related Self-Management in Patients With Chronic Obstructive Pulmonary Disease (Copilot): Mixed Methods Study",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="15",
volume="22",
number="6",
pages="e15449",
keywords="mobile health",
keywords="mHealth",
keywords="user-centered design",
keywords="behavior change",
keywords="COPD",
keywords="exacerbation",
keywords="self-management",
keywords="self-care",
keywords="mobile phone",
abstract="Background: Adequate self-management skills are of great importance for patients with chronic obstructive pulmonary disease (COPD) to reduce the impact of COPD exacerbations. Using mobile health (mHealth) to support exacerbation-related self-management could be promising in engaging patients in their own health and changing health behaviors. However, there is limited knowledge on how to design mHealth interventions that are effective, meet the needs of end users, and are perceived as useful. By following an iterative user-centered design (UCD) process, an evidence-driven and usable mHealth intervention was developed to enhance exacerbation-related self-management in patients with COPD. Objective: This study aimed to describe in detail the full UCD and development process of an evidence-driven and usable mHealth intervention to enhance exacerbation-related self-management in patients with COPD. Methods: The UCD process consisted of four iterative phases: (1) background analysis and design conceptualization, (2) alpha usability testing, (3) iterative software development, and (4) field usability testing. Patients with COPD, health care providers, COPD experts, designers, software developers, and a behavioral scientist were involved throughout the design and development process. The intervention was developed using the behavior change wheel (BCW), a theoretically based approach for designing behavior change interventions, and logic modeling was used to map out the potential working mechanism of the intervention. Furthermore, the principles of design thinking were used for the creative design of the intervention. Qualitative and quantitative research methods were used throughout the design and development process. Results: The background analysis and design conceptualization phase resulted in final guiding principles for the intervention, a logic model to underpin the working mechanism of the intervention, and design requirements. Usability requirements were obtained from the usability testing phases. The iterative software development resulted in an evidence-driven and usable mHealth intervention---Copilot, a mobile app consisting of a symptom-monitoring module, and a personalized COPD action plan. Conclusions: By following a UCD process, an mHealth intervention was developed that meets the needs and preferences of patients with COPD, is likely to be used by patients with COPD, and has a high potential to be effective in reducing exacerbation impact. This extensive report of the intervention development process contributes to more transparency in the development of complex interventions in health care and can be used by researchers and designers as guidance for the development of future mHealth interventions. ",
doi="10.2196/15449",
url="https://www.jmir.org/2020/6/e15449",
url="http://www.ncbi.nlm.nih.gov/pubmed/32538793"
}


@Article{info:doi/10.2196/17121,
author="Bonnech{\`e}re, Bruno
and Bier, Jean-Christophe
and Van Hove, Olivier
and Sheldon, Sally
and Samadoulougou, S{\'e}kou
and Kirakoya-Samadoulougou, Fati
and Klass, Malgorzata",
title="Age-Associated Capacity to Progress When Playing Cognitive Mobile Games: Ecological Retrospective Observational Study",
journal="JMIR Serious Games",
year="2020",
month="Jun",
day="12",
volume="8",
number="2",
pages="e17121",
keywords="cognitive performance",
keywords="brain training",
keywords="cognitive monitoring",
keywords="mobile games",
keywords="aging",
keywords="serious games",
abstract="Background: The decline of cognitive function is an important issue related to aging. Over the last few years, numerous mobile apps have been developed to challenge the brain with cognitive exercises; however, little is currently known about how age influences capacity for performance improvement when playing cognitive mobile games. Objective: The objective of this study was to analyze the score data of cognitive mobile games over a period of 100 gaming sessions to determine age-related learning ability for new cognitive tasks by measuring the level of score improvement achieved by participants of different ages. Methods: Scores from 9000 individuals of different ages for 7 cognitive mobile games over 100 gaming sessions were analyzed. Scores from the first session were compared between age groups using one-way analysis of variance. Mixed models were subsequently used to investigate the progression of scores over 100 sessions. Results: Statistically significant differences were found between age groups for the initial scores of 6 of the 7 games (linear trend, P<.001). Cognitive mobile game scores increased for all participants (P<.001) suggesting that all participants were able to improve their performance. The rate of improvement was, however, strongly influenced by the age of the participant with slower progression for older participants (P<.001). Conclusions: This study provides evidence to support two interesting insights---cognitive mobile game scores appear to be sensitive to the changes in cognitive ability that occur with advancing age; therefore, these games could be a convenient way to monitor cognitive function over long-term follow-up, and users who train with the cognitive mobile games improve regardless of age. ",
doi="10.2196/17121",
url="http://games.jmir.org/2020/2/e17121/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32530432"
}


@Article{info:doi/10.2196/17114,
author="Wessels, J. Nienke
and Hulshof, Lisa
and Loohuis, M. Anne M.
and van Gemert-Pijnen, Lisette
and Jellema, Petra
and van der Worp, Henk
and Blanker, H. Marco",
title="User Experiences and Preferences Regarding an App for the Treatment of Urinary Incontinence in Adult Women: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jun",
day="12",
volume="8",
number="6",
pages="e17114",
keywords="ehealth",
keywords="mobile applications",
keywords="self-management",
keywords="qualitative research",
abstract="Background: Although several apps are available to support the treatment of urinary incontinence (UI), little has been reported about the experiences and preferences of their users. Objective: The objective of this study was to explore the experiences and preferences of women using a mobile app for the treatment of UI and to identify potential improvements to the app. We developed this app for three types of UI: stress UI, urgency UI, and mixed UI. Methods: The participants in this qualitative study were women with self-reported stress UI, urgency UI, or mixed UI who used an app-based treatment to manage their condition for at least six weeks. Following the intervention, semistructured interviews were conducted to explore the participants' experiences and preferences regarding the app. All interviews were audio-recorded, transcribed verbatim, and analyzed separately by two researchers. Results: Data saturation was reached after interviewing 9 women (aged 32-68 years) with stress UI (n=1, 11\%), urgency UI (n=3, 33\%), or mixed UI (n=5, 56\%). Accessibility, awareness, usability, and adherence emerged as the main themes. On the one hand, participants appreciated that the app increased their accessibility to care, preserved their privacy, increased their awareness of therapeutic options, was easy to use and useful, and supported treatment adherence. On the other hand, some participants reported that they wanted more contact with a care provider, and others reported that using the app increased their awareness of symptoms. Conclusions: This qualitative study indicates that women appreciate app-based treatment for UI because it can lower barriers to treatment and increase both awareness and adherence to treatment. However, the app does not offer the ability of face-to-face contact and can lead to a greater focus on symptoms. ",
doi="10.2196/17114",
url="http://mhealth.jmir.org/2020/6/e17114/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32530431"
}


@Article{info:doi/10.2196/17802,
author="Adu, D. Mary
and Malabu, H. Usman
and Malau-Aduli, EO Aduli
and Drovandi, Aaron
and Malau-Aduli, S. Bunmi",
title="User Retention and Engagement With a Mobile App Intervention to Support Self-Management in Australians With Type 1 or Type 2 Diabetes (My Care Hub): Mixed Methods Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jun",
day="11",
volume="8",
number="6",
pages="e17802",
keywords="mobile apps",
keywords="engagement",
keywords="retention",
keywords="diabetes mellitus, self-management",
keywords="behavioral intervention technology",
abstract="Background: Mobile health apps are commonly used to support diabetes self-management (DSM). However, there is limited research assessing whether such apps are able to meet the basic requirements of retaining and engaging users. Objective: This study aimed to evaluate participants' retention and engagement with My Care Hub, a mobile app for DSM. Methods: The study employed an explanatory mixed methods design. Participants were people with type 1 or type 2 diabetes who used the health app intervention for 3 weeks. Retention was measured by completion of the postintervention survey. Engagement was measured using system log indices and interviews. Retention and system log indices were presented using descriptive statistics. Transcripts were analyzed using content analysis to develop themes interpreted according to the behavioral intervention technology theory. Results: Of the 50 individuals enrolled, 42 (84\%) adhered to the study protocol. System usage data showed multiple and frequent interactions with the app by most of the enrolled participants (42/50, 84\%). Two-thirds of participants who inputted data during the first week returned to use the app after week 1 (36/42, 85\%) and week 2 (30/42, 71\%) of installation. Most daily used features were tracking of blood glucose (BG; 28/42, 68\%) and accessing educational information (6/42, 13\%). The interview results revealed the app's potential as a behavior change intervention tool, particularly because it eased participants' self-care efforts and improved their engagement with DSM activities such as BG monitoring, physical exercise, and healthy eating. Participants suggested additional functionalities such as extended access to historical analytic data, automated data transmission from the BG meter, and periodic update of meals and corresponding nutrients to further enhance engagement with the app. Conclusions: The findings of this short-term intervention study suggested acceptable levels of participant retention and engagement with My Care Hub, indicating that it may be a promising tool for extending DSM support and education beyond the confines of a physical clinic. ",
doi="10.2196/17802",
url="https://mhealth.jmir.org/2020/6/e17802",
url="http://www.ncbi.nlm.nih.gov/pubmed/32525491"
}


@Article{info:doi/10.2196/17730,
author="Yang, Qing
and Hatch, Daniel
and Crowley, J. Matthew
and Lewinski, A. Allison
and Vaughn, Jacqueline
and Steinberg, Dori
and Vorderstrasse, Allison
and Jiang, Meilin
and Shaw, J. Ryan",
title="Digital Phenotyping Self-Monitoring Behaviors for Individuals With Type 2 Diabetes Mellitus: Observational Study Using Latent Class Growth Analysis",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jun",
day="11",
volume="8",
number="6",
pages="e17730",
keywords="digital phenotype",
keywords="latent class growth analysis",
keywords="type 2 diabetes",
keywords="self-management",
keywords="self-monitoring",
keywords="Mobile Health",
abstract="Background: Sustained self-monitoring and self-management behaviors are crucial to maintain optimal health for individuals with type 2 diabetes mellitus (T2DM). As smartphones and mobile health (mHealth) devices become widely available, self-monitoring using mHealth devices is an appealing strategy in support of successful self-management of T2DM. However, research indicates that engagement with mHealth devices decreases over time. Thus, it is important to understand engagement trajectories to provide varying levels of support that can improve self-monitoring and self-management behaviors. Objective: The aims of this study were to develop (1) digital phenotypes of the self-monitoring behaviors of patients with T2DM based on their engagement trajectory of using multiple mHealth devices, and (2) assess the association of individual digital phenotypes of self-monitoring behaviors with baseline demographic and clinical characteristics. Methods: This longitudinal observational feasibility study included 60 participants with T2DM who were instructed to monitor their weight, blood glucose, and physical activity using a wireless weight scale, phone-tethered glucometer, and accelerometer, respectively, over 6 months. We used  latent class growth analysis (LCGA) with multitrajectory modeling to associate the digital phenotypes of participants' self-monitoring behaviors based on their engagement trajectories with multiple mHealth devices. Associations between individual characteristics and digital phenotypes on participants' self-monitoring behavior were assessed by analysis of variance or the Chi square test. Results: The engagement with accelerometers to monitor daily physical activities was consistently high for all participants over time. Three distinct digital phenotypes were identified based on participants' engagement with the wireless weight scale and glucometer: (1) low and waning engagement group (24/60, 40\%), (2) medium engagement group (20/60, 33\%), and (3) consistently high engagement group (16/60, 27\%). Participants that were younger, female, nonwhite, had a low income, and with a higher baseline hemoglobin A1c level were more likely to be in the low and waning engagement group. Conclusions: We demonstrated how to digitally phenotype individuals' self-monitoring behavior based on their engagement trajectory with multiple mHealth devices. Distinct self-monitoring behavior groups were identified. Individual demographic and clinical characteristics were associated with different self-monitoring behavior groups. Future research should identify methods to provide tailored support for people with T2DM to help them better monitor and manage their condition. International Registered Report Identifier (IRRID): RR2-10.2196/13517 ",
doi="10.2196/17730",
url="https://mhealth.jmir.org/2020/6/e17730",
url="http://www.ncbi.nlm.nih.gov/pubmed/32525492"
}


@Article{info:doi/10.2196/15086,
author="Simblett, Sara
and Matcham, Faith
and Curtis, Hannah
and Greer, Ben
and Polhemus, Ashley
and Nov{\'a}k, Jan
and Ferrao, Jose
and Gamble, Peter
and Hotopf, Matthew
and Narayan, Vaibhav
and Wykes, Til
and ",
title="Patients' Measurement Priorities for Remote Measurement Technologies to Aid Chronic Health Conditions: Qualitative Analysis",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jun",
day="10",
volume="8",
number="6",
pages="e15086",
keywords="qualitative analysis",
keywords="patient involvement",
keywords="remote measurement technology",
keywords="mHealth",
abstract="Background: Remote measurement technology (RMT), including the use of mobile phone apps and wearable devices, may provide the opportunity for real-world assessment and intervention that will streamline clinical input for years to come. In order to establish the benefits of this approach, we need to operationalize what is expected in terms of a successful measurement. We focused on three clinical long-term conditions where a novel case has been made for the benefits of RMT: major depressive disorder (MDD), multiple sclerosis (MS), and epilepsy. Objective: The aim of this study was to conduct a consultation exercise on the clinical end point or outcome measurement priorities for RMT studies, drawing on the experiences of people with chronic health conditions. Methods: A total of 24 participants (16/24 women, 67\%), ranging from 28 to 65 years of age, with a diagnosis of one of three chronic health conditions?MDD, MS, or epilepsy?took part in six focus groups. A systematic thematic analysis was used to extract themes and subthemes of clinical end point or measurement priorities. Results: The views of people with MDD, epilepsy, and MS differed. Each group highlighted unique measurements of importance, relevant to their specific needs. Although there was agreement that remote measurement could be useful for tracking symptoms of illness, some symptoms were specific to the individual groups. Measuring signs of wellness was discussed more by people with MDD than by people with MS and epilepsy. However, overlap did emerge when considering contextual factors, such as life events and availability of support (MDD and epilepsy) as well as ways of coping (epilepsy and MS). Conclusions: This is a unique study that puts patients' views at the forefront of the design of a clinical study employing novel digital resources. In all cases, measuring symptom severity is key; people want to know when their health is getting worse. Second, symptom severity needs to be placed into context. A holistic approach that, in some cases, considers signs of wellness as well as illness, should be the aim of studies employing RMT to understand the health of people with chronic conditions. ",
doi="10.2196/15086",
url="https://mhealth.jmir.org/2020/6/e15086",
url="http://www.ncbi.nlm.nih.gov/pubmed/32519975"
}


@Article{info:doi/10.2196/18315,
author="Slater, Helen
and Stinson, N. Jennifer
and Jordan, E. Joanne
and Chua, Jason
and Low, Ben
and Lalloo, Chitra
and Pham, Quynh
and Cafazzo, A. Joseph
and Briggs, M. Andrew",
title="Evaluation of Digital Technologies Tailored to Support Young People's Self-Management of Musculoskeletal Pain: Mixed Methods Study",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="5",
volume="22",
number="6",
pages="e18315",
keywords="musculoskeletal pain",
keywords="mHealth",
keywords="eHealth",
keywords="self-management",
keywords="adolescent",
keywords="mobile phone",
keywords="smartphone",
abstract="Background: Digital technologies connect young people with health services and resources that support their self-care. The lack of accessible, reliable digital resources tailored to young people with persistent musculoskeletal pain is a significant gap in the health services in Australia. Recognizing the intense resourcing required to develop and implement effective electronic health (eHealth) interventions, the adaptation of extant, proven digital technologies may improve access to pain care with cost and time efficiencies. Objective: This study aimed to test the acceptability and need for adaptation of extant digital technologies, the painHEALTH website and the iCanCope with Pain app, for use by young Australians with musculoskeletal pain. Methods: A 3-phased, mixed methods evaluation was undertaken from May 2019 to August 2019 in Australia. Young people aged 15 to 25 years with musculoskeletal pain for >3 months were recruited. Phases were sequential: (1) phase 1, participant testing (3 groups, each of n=5) of co-designed website prototypes compared with a control website (painHEALTH), with user tasks mapped to eHealth quality and engagement criteria; (2) phase 2, participants' week-long use of the iCanCope with Pain app with engagement data captured using a real-time analytic platform (daily check-ins for pain, interference, sleep, mood, physical activity, and energy levels; goal setting; and accessing resources); and (3) phase 3, semistructured interviews were conducted to gain insights into participants' experiences of using these digital technologies. Results: Fifteen young people (12/15, 80\% female; mean age 20.5 [SD 3.3] years; range 15-25 years) participated in all 3 phases. The phase 1 aggregated group data informed the recommendations used to guide 3 rapid cycles of prototype iteration. Adaptations included optimizing navigation, improving usability (functionality), and enhancing content to promote user engagement and acceptability. In phase 2, all participants checked in, with the highest frequency of full check-ins attributed to pain intensity (183/183, 100.0\%), pain interference (175/183, 95.6\%), and mood (152/183, 83.1\%), respectively. Individual variability was evident for monitoring progress with the highest frequency of history views for pain intensity (51/183, 32.3\%), followed by pain interference (24/183, 15.2\%). For the goals set feature, 87\% (13/15) of participants set a total of 42 goals covering 5 areas, most frequently for activity (35/42, 83\%). For phase 3, metasynthesis of qualitative data highlighted that these digital tools were perceived as youth-focused and acceptable. A total of 4 metathemes emerged: (1) importance of user-centered design to leverage user engagement; (2) website design (features) promoting user acceptability and engagement; (3) app functionality supporting self-management; and (4) the role of wider promotion, health professional digital prescriptions, and strategies to ensure longer-term engagement. Conclusions: Leveraging extant digital tools, with appropriate user-informed adaptations, can help to build capacity tailored to support young people's self-management of musculoskeletal pain. ",
doi="10.2196/18315",
url="https://www.jmir.org/2020/6/e18315",
url="http://www.ncbi.nlm.nih.gov/pubmed/32442143"
}


@Article{info:doi/10.2196/16420,
author="Sengupta, Avijit
and Beckie, Theresa
and Dutta, Kaushik
and Dey, Arup
and Chellappan, Sriram",
title="A Mobile Health Intervention System for Women With Coronary Heart Disease: Usability Study",
journal="JMIR Form Res",
year="2020",
month="Jun",
day="3",
volume="4",
number="6",
pages="e16420",
keywords="coronary heart disease",
keywords="mobile health technology",
keywords="behavior change interventions",
keywords="women",
keywords="mobile phone",
abstract="Background: Coronary heart disease (CHD) is the leading cause of death and disability among American women. The prevalence of CHD is expected to increase by more than 40\% by 2035. In 2015, the estimated cost of caring for patients with CHD was US \$182 billion in the United States; hospitalizations accounted for more than half of the costs. Compared with men, women with CHD or those who have undergone coronary revascularization have up to 30\% more rehospitalizations within 30 days and up to 1 year. Center-based cardiac rehabilitation is the gold standard of care after an acute coronary event, but few women attend these valuable programs. Effective home-based interventions for improving cardiovascular health among women with CHD are vital for addressing this gap in care. Objective: The ubiquity of mobile phones has made mobile health (mHealth) behavioral interventions a viable option to improve healthy behaviors of both women and men with CHD. First, this study aimed to examine the usability of a prototypic mHealth intervention designed specifically for women with CHD (herein referred to as HerBeat). Second, we examined the influence of HerBeat on selected health behaviors (self-efficacy for diet, exercise, and managing chronic illness) and psychological (perceived stress and depressive symptoms) characteristics of the participants. Methods: Using a single-group, pretest, posttest design, 10 women participated in the 12-week usability study. Participants were provided a smartphone and a smartwatch on which the HerBeat app was installed. Using a web portal dashboard, a health coach monitored participants' ecological momentary assessment data, their behavioral data, and their heart rate and step count. Participants then completed a 12-week follow-up assessment. Results: All 10 women (age: mean 64.4 years, SD 6.3 years) completed the study. The usability and acceptability of HerBeat were good, with a mean system usability score of 83.60 (SD 16.3). The participants demonstrated statistically significant improvements in waist circumference (P=.048), weight (P=.02), and BMI (P=.01). Furthermore, depressive symptoms, measured with the Patient Health Questionnaire-9, significantly improved from baseline (P=.04). Conclusions: The mHealth prototype was feasible and usable for women with CHD. Participants provided data that were useful for further development of HerBeat. The mHealth intervention is expected to help women with CHD self-manage their health behaviors. A randomized controlled trial is needed to further verify the findings. ",
doi="10.2196/16420",
url="https://formative.jmir.org/2020/6/e16420",
url="http://www.ncbi.nlm.nih.gov/pubmed/32348270"
}


@Article{info:doi/10.2196/14024,
author="Chiu, Ching-Ju
and Yu, Yung-Chen
and Du, Ye-Fong
and Yang, Yi-Ching
and Chen, Jou-Yin
and Wong, Li-Ping
and Tanasugarn, Chanuantong",
title="Comparing a Social and Communication App, Telephone Intervention, and Usual Care for Diabetes Self-Management: 3-Arm Quasiexperimental Evaluation Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jun",
day="2",
volume="8",
number="6",
pages="e14024",
keywords="diabetes",
keywords="self-management",
keywords="depression symptoms",
keywords="distress",
keywords="middle-aged and older adults",
abstract="Background: Many technology-assisted innovations have been used to manage disease. However, most of these innovations are not broadly used by older adults due to their cost. Additionally, disease management through technology-assisted innovations has not been compared with other interventions. Objective: In this study, we tested the employment of a free and widely used social and communication app to help older adults with diabetes manage their distress and glycemic control. We also compared the effectiveness of the app with 2 other methods, namely telephone and conventional health education, and determined which subgroup experiences the most effects within each intervention. Methods: Adults aged ?50 years with type 2 diabetes were recruited from Southern Taiwan (N=231) and were allocated to different 3-month interventions. Informed consent was obtained at the Ministry of Science and Technology and approved by the National Cheng Kung University Hospital Institutional Review Board (No. A-ER-102-425). Results: Participants in the mobile-based group had significant reductions in hemoglobin A1c compared with the telephone-based and usual care groups (mean changes of --0.4\%, 0.1\%, and 0.03\%, respectively; P=.02). Diabetes-specific distress decreased to a greater extent in the mobile-based group compared to the other 2 groups (mean changes of --5.16, --3.49, and --2.44, respectively, P=.02). Subgroup analyses further revealed that the effects on reducing blood glucose levels in the social and communication app groups were especially evident in patients with lower distress scores, and diabetes-related distress was especially evident in participants who were younger than 60 years or had higher educational levels. Conclusions: The findings of this study inform more flexible use of social and communication apps with in-person diabetes education and counselling. ",
doi="10.2196/14024",
url="https://mhealth.jmir.org/2020/6/e14024",
url="http://www.ncbi.nlm.nih.gov/pubmed/32484448"
}


@Article{info:doi/10.2196/13247,
author="Kim, Heejung
and Kim, Sunah
and Kong, Sook Seong
and Jeong, Yi-Rang
and Kim, Hyein
and Kim, Namhee",
title="Possible Application of Ecological Momentary Assessment to Older Adults' Daily Depressive Mood: Integrative Literature Review",
journal="JMIR Ment Health",
year="2020",
month="Jun",
day="2",
volume="7",
number="6",
pages="e13247",
keywords="ecological momentary assessment",
keywords="depression",
keywords="aged",
keywords="review",
abstract="Background: Ecological momentary assessment is a method of investigating individuals' real-time experiences, behaviors, and moods in their natural environment over time. Despite its general usability and clinical value for evaluating daily depressive mood, there are several methodological challenges when applying ecological momentary assessment to older adults. Objective: The aims of this integrative literature review were to examine possible uses of the ecological momentary assessment methodology with older adults and to suggest strategies to increase the feasibility of its application in geriatric depression research and practice. Methods: We searched 4 electronic databases (MEDLINE, CINAHL, PsycINFO, and EMBASE) and gray literature; we also hand searched the retrieved articles' references. We limited all database searches to articles published in peer-reviewed journals from 2009 to 2019. Search terms were ``ecological momentary assessment,'' ``smartphone assessment,'' ``real time assessment,'' ``electronic daily diary,'' ``mHealth momentary assessment,'' ``mobile-based app,'' and ``experience sampling method,'' combined with the relevant terms of depression. We included any studies that enrolled older adults even as a subgroup and that reported depressive mood at least once a day for more than 2 days. Results: Of the 38 studies that met the inclusion criteria, only 1 study enrolled adults aged 65 years or older as the entire sample; the remainder of the reviewed studies used mixed samples of both younger and older adults. Most of the analyzed studies (18/38, 47\%) were quantitative, exploratory (descriptive, correlational, and predictive), and cohort in design. Ecological momentary assessment was used to describe the fluctuating pattern of participants' depressive moods primarily and to examine the correlation between mood patterns and other health outcomes as a concurrent symptom. We found 3 key methodological issues: (1) heterogeneity in study design and protocol, (2) issues with definitions of dropout and adherence, and (3) variation in how depressive symptoms were measured with ecological momentary assessment. Some studies (8/38, 21\%) examined the age difference of participants with respect to dropout or poor compliance rate. Detailed participant burden was reported, such as technical problems, aging-related health problems, or discomfort while using the device. Conclusions: Ecological momentary assessment has been used for comprehensive assessment of multiple mental health indicators in relation to depressive mood. Our findings provide methodological considerations for further studies that may be implemented using ecological momentary assessment to assess daily depressive mood in older adults. Conducting more feasibility studies focusing on older adults with standardized data collection protocols and mixed-methods research is required to reflect users' experiences. Further telepsychiatric evaluation and diagnosis based on ecological momentary assessment data should involve standardized and sophisticated strategies to maximize the potential of ecological momentary assessment for older adults with depression in the community setting. ",
doi="10.2196/13247",
url="https://mental.jmir.org/2020/6/e13247",
url="http://www.ncbi.nlm.nih.gov/pubmed/32484442"
}


@Article{info:doi/10.2196/15372,
author="Seo, Dongjin
and Park, Rang Yu
and Lee, Yura
and Kim, Young Ji
and Park, Joong-Yeol
and Lee, Jae-Ho",
title="The Use of Mobile Personal Health Records for Hemoglobin A1c Regulation in Patients With Diabetes: Retrospective Observational Study",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="2",
volume="22",
number="6",
pages="e15372",
keywords="personal health record",
keywords="mobile health",
keywords="electronic medical record",
keywords="diabetes mellitus",
keywords="glycated hemoglobin A",
abstract="Background: The effectiveness of personal health records (PHRs) in diabetes management has already been verified in several clinical trials; however, evidence of their effectiveness in real-world scenarios is also necessary. To provide solid real-world evidence, an analysis that is more accurate than the analyses solely based on patient-generated health data should be conducted. Objective: This study aimed to conduct a more accurate analysis of the effectiveness of using PHRs within electronic medical records (EMRs). The results of this study will provide precise real-world evidence of PHRs as a feasible diabetes management tool. Methods: We collected log data of the sugar function in the My Chart in My Hand version 2.0 (MCMH 2.0) app from Asan Medical Center (AMC), Seoul, Republic of Korea, between December 2015 and April 2018. The EMR data of MCMH 2.0 users from AMC were collected and integrated with the PHR data. We classified users according to whether they were continuous app users. We analyzed and compared their characteristics, patterns of hemoglobin A1c (HbA1c) levels, and the proportion of successful HbA1c control. The following confounders were adjusted for HbA1c pattern analysis and HbA1c regulation proportion comparison: age, sex, first HbA1c measurement, diabetes complications severity index score, sugar function data generation weeks, HbA1c measurement weeks before MCMH 2.0 start, and generated sugar function data count. Results: The total number of MCMH 2.0 users was 64,932, with 7453 users having appropriate PHRs and diabetes criteria. The number of continuous and noncontinuous users was 133 and 7320, respectively. Compared with noncontinuous users, continuous users were younger (P<.001) and had a higher male proportion (P<.001). Furthermore, continuous users had more frequent HbA1c measurements (P=.007), shorter HbA1c measurement days (P=.04), and a shorter period between the first HbA1c measurement and MCMH 2.0 start (P<.001). Diabetes severity--related factors were not statistically significantly different between the two groups. Continuous users had a higher decrease in HbA1c (P=.02) and a higher proportion of regulation of HbA1c levels to the target level (P=.01). After adjusting the confounders, continuous users had more decline in HbA1c levels than noncontinuous users (P=.047). Of the users who had a first HbA1c measurement higher than 6.5\% (111 continuous users and 5716 noncontinuous users), continuous users had better regulation of HbA1c levels with regard to the target level, 6.5\%, which was statistically significant (P=.04). Conclusions: By integrating and analyzing patient- and clinically generated data, we demonstrated that the continuous use of PHRs improved diabetes management outcomes. In addition, the HbA1c reduction pattern was prominent in the PHR continuous user group. Although the continued use of PHRs has proven to be effective in managing diabetes, further evaluation of its effectiveness for various diseases and a study on PHR adherence are also required. ",
doi="10.2196/15372",
url="https://www.jmir.org/2020/6/e15372",
url="http://www.ncbi.nlm.nih.gov/pubmed/32484447"
}


@Article{info:doi/10.2196/16497,
author="Byambasuren, Oyungerel
and Beller, Elaine
and Hoffmann, Tammy
and Glasziou, Paul",
title="mHealth App Prescription in Australian General Practice: Pre-Post Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jun",
day="1",
volume="8",
number="6",
pages="e16497",
keywords="mHealth apps",
keywords="app prescription",
keywords="general practice",
abstract="Background: Evidence of effectiveness of mobile health (mHealth) apps as well as their usability as non-drug interventions in primary care are emerging around the globe. Objective: This study aimed to explore the feasibility of mHealth app prescription by general practitioners (GPs) and to evaluate the effectiveness of an implementation intervention to increase app prescription. Methods: A single-group, before-and-after study was conducted in Australian general practice. GPs were given prescription pads for 6 mHealth apps and reported the number of prescriptions dispensed for 4 months. After the reporting of month 2, a 2-minute video of one of the apps was randomly selected and sent to each GP. Data were collected through a prestudy questionnaire, monthly electronic reporting, and end-of-study interviews. The primary outcome was the number of app prescriptions (total, monthly, per GP, and per GP per fortnight). Secondary outcomes included confidence in prescribing apps (0-5 scale), the impact of the intervention video on subsequent prescription numbers, and acceptability of the interventions. Results: Of 40 GPs recruited, 39 commenced, and 36 completed the study. In total, 1324 app prescriptions were dispensed over 4 months. The median number of apps prescribed per GP was 30 (range 6-111 apps). The median number of apps prescribed per GP per fortnight increased from the pre-study level of 1.7 to 4.1. Confidence about prescribing apps doubled from a mean of 2 (not so confident) to 4 (very confident). App videos did not affect subsequent prescription rates substantially. Post-study interviews revealed that the intervention was highly acceptable. Conclusions: mHealth app prescription in general practice is feasible, and our implementation intervention was effective in increasing app prescription. GPs need more tailored education and training on the value of mHealth apps and knowledge of prescribable apps to be able to successfully change their prescribing habits to include apps. The future of sustainable and scalable app prescription requires a trustworthy electronic app repository of prescribable mHealth apps for GPs. ",
doi="10.2196/16497",
url="https://mhealth.jmir.org/2020/6/e16497",
url="http://www.ncbi.nlm.nih.gov/pubmed/32478660"
}


@Article{info:doi/10.2196/13808,
author="Lim, Jun-Hao
and Lim, Cordelia-Kheng-May
and Ibrahim, Imliya
and Syahrul, Jazlina
and Mohamed Zabil, Hazli Mohd
and Zakaria, Fadhlina Nor
and Daud, Mat Zulfitri Azuan",
title="Limitations of Existing Dialysis Diet Apps in Promoting User Engagement and Patient Self-Management: Quantitative Content Analysis Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jun",
day="1",
volume="8",
number="6",
pages="e13808",
keywords="renal apps",
keywords="nutrition",
keywords="dialysis",
keywords="self-management",
keywords="mHealth",
abstract="Background: With the unprecedented growth of mobile technology, a plethora of dialysis diet apps have been developed to promote patient dietary self-management. Nevertheless, the utility of such apps remains questionable. Objective: This study aimed to evaluate the content, features, and quality of commercial dialysis diet apps for adult dialysis patients. Methods: This study consisted of a quantitative content analysis of commercial dialysis diet apps downloaded from Google Play and the Apple App Store available in the Asian marketplace, searched for using the following keywords in English: dialysis diet and diet for kidney disease. Free and paid apps available in English that provide nutrition information for adult dialysis patients were included. Apps that were not relevant to the dialysis diet, not meant for patient self-management, or redundant were excluded. Apps were evaluated for language medium (subscore=1), credibility (subscore=1), food database (subscore=1), valuable features (subscore=12), health-behavior theory constructs (subscore=60), and technical quality (subscore=25). The relationships among the variables of interest were determined by Pearson correlation. Stepwise multiple linear regression analysis was performed to identify the features that contribute to greater technical quality of dialysis diet apps. Statistical significance was defined as P<.05. Results: A total of 22 out of 253 apps (8.7\%) were eligible for evaluation. Based on a 100-point scale, the mean overall score of the apps was 31.30 (SD 14.28). Only 5\% (1/22) of the apps offered relevant language options, and 46\% (10/22) contained food databases. In addition, 54\% (12/22) of the apps were not credible. The mean score for valuable features was 3.45 (SD 1.63) out of 12, in which general education (16/22, 73\%), free download (15/22, 68\%), and usability (13/22, 59\%) were the three most popular features. However, the apps scored a mean of 13.41 (SD 11.56) out of 60 for health-behavior theory constructs. The overall app technical quality was considered poor, with a mean score of 2.70 (SD 0.41) out of 5. The scores of valuable features (r=.65, P=.001) and health-behavior theory constructs (r=.55, P=.009) were positively correlated with the overall technical quality of the commercial dialysis diet apps. Features such as free download ($\beta$=.43, P=.03) and usability ($\beta$=.41, P=.03) could significantly determine the functional quality of the apps. Health-behavior theory constructs such as self-monitoring could significantly predict both the subjective quality ($\beta$=.55, P=.008) and the engagement quality ($\beta$=.66, P=.001) of the apps, whereas the information quality domain could be determined by plan or orders ($\beta$=.48, P=.007) and knowledge ($\beta$=.45, P=.01). Conclusions: Although most of the available commercial dialysis diet apps are free and easy to use, they are subject to theory deficiency, limited language options, and a lack of food databases, credibility, tailored education, and overall technical quality. ",
doi="10.2196/13808",
url="https://mhealth.jmir.org/2020/6/e13808",
url="http://www.ncbi.nlm.nih.gov/pubmed/32478665"
}


@Article{info:doi/10.2196/17458,
author="Lecomte, Tania
and Potvin, St{\'e}phane
and Corbi{\`e}re, Marc
and Guay, St{\'e}phane
and Samson, Crystal
and Cloutier, Briana
and Francoeur, Audrey
and Pennou, Antoine
and Khazaal, Yasser",
title="Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses",
journal="JMIR Mhealth Uhealth",
year="2020",
month="May",
day="29",
volume="8",
number="5",
pages="e17458",
keywords="apps",
keywords="mental health",
keywords="depression",
keywords="anxiety",
keywords="review",
keywords="meta",
abstract="Background: Mental health apps have great potential to help people needing support to cope with distress or specific symptoms. In fact, there is an exponential increase in the number of mental health apps available on the internet, with less than 5\% being actually studied. Objective: This study aimed to assess the quality of the available evidence regarding the use of mental health apps and to summarize the results obtained so far. Methods: Systematic reviews and meta-analyses were searched, specifically for mobile apps on mental health issues or symptoms, and rated using the Grading of Recommendations Assessment, Development and Evaluation system. Results: A total of 7 meta-analyses were carefully reviewed and rated. Although some meta-analyses looked at any mental health issue and analyzed the data together, these studies were of poorer quality and did not offer strong empirical support for the apps. Studies focusing specifically on anxiety symptoms or depressive symptoms were of moderate to high quality and generally had small to medium effect sizes. Similarly, the effects of apps on stress and quality of life tended to offer small to medium effects and were of moderate to high quality. Studies looking at stand-alone apps had smaller effect sizes but better empirical quality than studies looking at apps with guidance. The studies that included follow-ups mostly found a sustained impact of the app at an 11-week follow-up. Conclusions: This meta-review revealed that apps for anxiety and depression hold great promise with clear clinical advantages, either as stand-alone self-management or as adjunctive treatments. More meta-analyses and more quality studies are needed to recommend apps for other mental health issues or for specific populations. ",
doi="10.2196/17458",
url="https://mhealth.jmir.org/2020/5/e17458",
url="http://www.ncbi.nlm.nih.gov/pubmed/32348289"
}


@Article{info:doi/10.2196/17968,
author="Gimbel, W. Ronald
and Rennert, M. Lior
and Crawford, Paul
and Little, R. Jeanette
and Truong, Khoa
and Williams, E. Joel
and Griffin, F. Sarah
and Shi, Lu
and Chen, Liwei
and Zhang, LingLing
and Moss, B. Jennie
and Marshall, C. Robert
and Edwards, W. Karen
and Crawford, J. Kristy
and Hing, Marie
and Schmeltz, Amanda
and Lumsden, Brandon
and Ashby, Morgan
and Haas, Elizabeth
and Palazzo, Kelly",
title="Enhancing Patient Activation and Self-Management Activities in Patients With Type 2 Diabetes Using the US Department of Defense Mobile Health Care Environment: Feasibility Study",
journal="J Med Internet Res",
year="2020",
month="May",
day="26",
volume="22",
number="5",
pages="e17968",
keywords="mHealth",
keywords="diabetes mellitus",
keywords="patient activation",
keywords="patient-centered care",
keywords="eHealth",
abstract="Background: Past mobile health (mHealth) efforts to empower type 2 diabetes (T2D) self-management include portals, text messaging, collection of biometric data, electronic coaching, email, and collection of lifestyle information. Objective: The primary objective was to enhance patient activation and self-management of T2D using the US Department of Defense's Mobile Health Care Environment (MHCE) in a patient-centered medical home setting. Methods: A multisite study, including a user-centered design and a controlled trial, was conducted within the US Military Health System. Phase I assessed preferences regarding the enhancement of the enabling technology. Phase II was a single-blinded 12-month feasibility study that randomly assigned 240 patients to either the intervention (n=123, received mHealth technology and behavioral messages tailored to Patient Activation Measure [PAM] level at baseline) or the control group (n=117, received equipment but not messaging. The primary outcome measure was PAM scores. Secondary outcome measures included Summary of Diabetes Self-Care Activities (SDSCA) scores and cardiometabolic outcomes. We used generalized estimating equations to estimate changes in outcomes. Results: The final sample consisted of 229 patients. Participants were 61.6\% (141/229) male, had a mean age of 62.9 years, mean glycated hemoglobin (HbA1c) of 7.5\%, mean BMI of 32.7, and a mean duration of T2D diagnosis of 9.8 years. At month 12, the control group showed significantly greater improvements compared with the intervention group in PAM scores (control mean 7.49, intervention mean 1.77; P=.007), HbA1c (control mean ?0.53, intervention mean ?0.11; P=.006), and low-density lipoprotein cholesterol (control mean ?7.14, intervention mean 4.38; P=.01). Both groups showed significant improvement in SDSCA, BMI, waist size, and diastolic blood pressure; between-group differences were not statistically significant. Except for patients with the highest level of activation (PAM level 4), intervention group patients exhibited significant improvements in PAM scores. For patients with the lowest level of activation (PAM level 1), the intervention group showed significantly greater improvement compared with the control group in HbA1c (control mean ?0.09, intervention mean ?0.52; P=.04), BMI (control mean 0.58, intervention mean ?1.22; P=.01), and high-density lipoprotein cholesterol levels (control mean ?4.86, intervention mean 3.56; P<.001). Significant improvements were seen in AM scores, SDSCA, and waist size for both groups and in diastolic and systolic blood pressure for the control group; the between-group differences were not statistically significant. The percentage of participants who were engaged with MHCE for ?50\% of days period was 60.7\% (68/112; months 0-3), 57.4\% (62/108; months 3-6), 49.5\% (51/103; months 6-9), and 43\% (42/98; months 9-12). Conclusions: Our study produced mixed results with improvement in PAM scores and outcomes in both the intervention and control groups. Structural design issues may have hampered the influence of tailored behavioral messaging within the intervention group. Trial Registration: ClinicalTrials.gov NCT02949037; https://clinicaltrials.gov/ct2/show/NCT02949037 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.6993 ",
doi="10.2196/17968",
url="http://www.jmir.org/2020/5/e17968/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32329438"
}


@Article{info:doi/10.2196/17034,
author="Yang, Sook Yong
and Ryu, Wook Gi
and Park, Gi Chang
and Yeom, Insun
and Shim, Won Kyu
and Choi, Mona",
title="Mood and Stress Evaluation of Adult Patients With Moyamoya Disease in Korea: Ecological Momentary Assessment Method Using a Mobile Phone App",
journal="JMIR Mhealth Uhealth",
year="2020",
month="May",
day="25",
volume="8",
number="5",
pages="e17034",
keywords="affect",
keywords="ecological momentary assessment",
keywords="mood",
keywords="Moyamoya disease",
keywords="psychological stress",
abstract="Background: Moyamoya disease (MMD) is a known progressive obstructive cerebrovascular disorder. Monitoring and managing mood and stress are critical for patients with MMD, as they affect clinical outcomes. The ecological momentary assessment (EMA) method is a longitudinal study design by which multiple variable assessments can be performed over time to detect momentary fluctuations and changes in psychological dimensions such as mood and stress over time. Objective: This study aimed to identify predicting factors associated with momentary mood and stress at both the within-person and between-person levels and to examine individual fluctuation of mood over time in the short term using an EMA method combined with a mobile phone app. Methods: Participants aged older than 18 years were recruited from a tertiary hospital in Seoul, Korea, between July 2018 and January 2019. The PsyMate scale for negative affect (NA) and positive affect (PA) and the Trier Inventory for Chronic Stress Scale were uploaded on patient mobile phones. Using a mobile app, data were collected four times a day for 7 days. Pearson correlations and mixed modeling were used to predict relationships between repeatedly measured variables at both the between-person and within-person levels. Results: The mean age of the 93 participants was 40.59 (SD 10.06) years, 66 (71\%) were female, and 71 (76\%) were married. Participants provided 1929 responses out of a possible 2604 responses (1929/2604, 74.08\%). The mean momentary NA and PA values were 2.15 (SD 1.12) and 4.70 (SD 1.31) out of 7, respectively. The momentary stress value was 2.03 (SD 0.98) out of 5. Momentary NA, PA, and stress were correlated (P<.001) and varied over time in relation to momentary variables. Common momentary variables associated with momentary mood and stress at both the within-person (level 1) and between-person (level 2) levels were identified. Momentary NA increased when being alone and being at the hospital at both levels, whereas momentary PA increased when eating or drinking, resting, being at a caf{\'e}, restaurant or a public place but decreased when being alone at both levels. Momentary stress increased when being at the office, at a public place, or as the time of the day went by but decreased when resting or during the weekend. Different factors affecting mood and stress at different levels were identified. Fluctuations in individual momentary mood over time at the within-person level were captured. Conclusions: The EMA method using a mobile phone app demonstrated its ability to capture changes in mood and stress in various environmental contexts in patients with MMD. The results could provide baseline information for developing interventions to manage negative mood and stress of patients with MMD based on the identified predictors affecting mood and stress at two different levels. ",
doi="10.2196/17034",
url="http://mhealth.jmir.org/2020/5/e17034/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32449687"
}


@Article{info:doi/10.2196/17737,
author="Helweg-J{\o}rgensen, Stig
and Beck Lichtenstein, Mia
and Fruzzetti, E. Alan
and M{\o}ller Dahl, Christian
and Pedersen, S. Susanne",
title="Daily Self-Monitoring of Symptoms and Skills Learning in Patients With Borderline Personality Disorder Through a Mobile Phone App: Protocol for a Pragmatic Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2020",
month="May",
day="25",
volume="9",
number="5",
pages="e17737",
keywords="borderline personality disorder",
keywords="dialectical behavior therapy",
keywords="mobile app",
keywords="psychotherapy",
keywords="patient-reported outcome measures",
keywords="mhealth",
abstract="Background: Patient self-monitoring via mobile phones during psychotherapy can enhance and provide an overview of psychotherapeutic progress by graphically displaying current and previous symptom scores, providing feedback to the patient, delivering psychoeducative material, and providing timely data to the therapist or treatment team. Objective: This study will aim to assess the effects of using a mobile phone to self-monitor symptoms and acquire coping skills instead of using pen and paper during psychotherapy in patients with borderline personality disorder (BPD). Dialectical behavior therapy will be performed to treat BPD. The primary outcome is the mean time needed to learn coping skills directed at emotion regulation; the secondary outcome is changes in the BPD symptom score as measured by the Zanarini Rating Scale for Borderline Personality Disorder. Methods: This study is a pragmatic, multicenter randomized controlled trial. Participants were recruited through five public general psychiatric outpatient treatment facilities in Denmark. Patients are randomly assigned, on a 1:1 basis, to either the mobile phone condition (using the Monsenso mDiary mobile app) or pen-and-paper condition. Patients will complete several self-report questionnaires on symptom severity; assessments by trained raters on BPD severity will be performed as well. Survival analysis with a shared frailty model will be used to assess the primary outcome. Results: Recruitment began in June 2017 and was completed in February 2019 after 80 participants were recruited. The study ended in February 2020. It is expected that the benefits of mobile phone--based self-report compared to the pen-and-paper method will be demonstrated for skill learning speed and registration compliance. To our knowledge, this is the first trial exploring the impact of cloud-based mobile registration in BPD treatment. Conclusions: This trial will report on the effectiveness of mobile phone--based self-monitoring during psychiatric treatment. It has the potential to contribute to evidence-based clinical practice since apps are already in use clinically. Trial Registration: ClinicalTrials.gov NCT03191565; https://clinicaltrials.gov/ct2/show/NCT03191565 International Registered Report Identifier (IRRID): DERR1-10.2196/17737 ",
doi="10.2196/17737",
url="http://www.researchprotocols.org/2020/5/e17737/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32449690"
}


@Article{info:doi/10.2196/16147,
author="Fan, G. Kathleen
and Mandel, Jess
and Agnihotri, Parag
and Tai-Seale, Ming",
title="Remote Patient Monitoring Technologies for Predicting Chronic Obstructive Pulmonary Disease Exacerbations: Review and Comparison",
journal="JMIR Mhealth Uhealth",
year="2020",
month="May",
day="21",
volume="8",
number="5",
pages="e16147",
keywords="COPD",
keywords="disease exacerbation",
keywords="remote patient monitoring",
keywords="mobile health",
keywords="telehealth",
keywords="at-home monitoring",
keywords="remote monitoring system",
keywords="wearable",
abstract="Background: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death by disease worldwide and has a 30-day readmission rate of 22.6\%. In 2015, COPD was added to the Medicare Hospital Readmission Reductions Program. Objective: The objective of this paper was to survey the current medical technologies for remote patient monitoring (RPM) tools that forecast COPD exacerbations in order to reduce COPD readmissions. Methods: We searched literature and digital health news to find commercially available RPM devices focused on predicting COPD exacerbations. These technologies were reviewed and compared according to four criteria: forecasting ability, cost, ease of use, and appearance. A rating system was developed to facilitate the evaluation process. Results: As of June 2019, a list of handheld and hands-free devices was compiled. We compared features and found substantial variations. Devices that ranked higher on all criteria tended to have a high or unlisted price. Commonly mass-marketed devices like the pulse oximeter and spirometer surprisingly fulfilled the least criteria. Conclusions: The COPD RPM technologies with most technological promise and compatibility with daily living appear to have high or unlisted prices. Consumers and providers need better access to product information to make informed decisions. ",
doi="10.2196/16147",
url="http://mhealth.jmir.org/2020/5/e16147/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32348262"
}


@Article{info:doi/10.2196/15818,
author="Fiordelli, Maddalena
and Zanini, Claudia
and Amann, Julia
and Scheel-Sailer, Anke
and Brach, Mirjam
and Stucki, Gerold
and Rubinelli, Sara",
title="Selecting Evidence-Based Content for Inclusion in Self-Management Apps for Pressure Injuries in Individuals With Spinal Cord Injury: Participatory Design Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="May",
day="20",
volume="8",
number="5",
pages="e15818",
keywords="mHealth",
keywords="paraplegia",
keywords="tetraplegia",
keywords="pressure ulcers",
keywords="consensus meeting",
keywords="community engagement",
keywords="recommendations",
abstract="Background: Technological solutions, particularly mobile health (mHealth), have been shown to be potentially viable approaches for sustaining individuals' self-management of chronic health conditions. Theory-based interventions are more successful, as evidence-based information is an essential prerequisite for appropriate self-management. However, several reviews have shown that many existing mobile apps fail to be either theoretically grounded or based on evidence. Although some authors have attempted to address these two issues by focusing on the design and development processes of apps, concrete efforts to systematically select evidence-based content are scant. Objective: The objective of this study was to present a procedure for the participatory identification of evidence-based content to ground the development of a self-management app. Methods: To illustrate the procedure, we focused on the prevention and management of pressure injuries (PIs) in individuals with spinal cord injury (SCI). The procedure involves the following three steps: (1) identification of existing evidence through review and synthesis of existing recommendations on the prevention and self-management of PIs in SCI; (2) a consensus meeting with experts from the field of SCI and individuals with SCI to select the recommendations that are relevant and applicable to community-dwelling individuals in their daily lives; and (3) consolidation of the results of the study. Results: In this case study, at the end of the three-step procedure, the content for an mHealth intervention was selected in the form of 98 recommendations. Conclusions: This study describes a procedure for the participatory identification and selection of disease-specific evidence and professional best practices to inform self-management interventions. This procedure might be especially useful in cases of complex chronic health conditions, as every recommendation in these cases needs to be evaluated and considered in light of all other self-management requirements. Hence, the agreement of experts and affected individuals is essential to ensure the selection of evidence-based content that is considered to be relevant and applicable. ",
doi="10.2196/15818",
url="http://mhealth.jmir.org/2020/5/e15818/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32432559"
}


@Article{info:doi/10.2196/14396,
author="St{\"u}hmann, M. Lena
and Paprott, Rebecca
and Heidemann, Christin
and Baumert, Jens
and Hansen, Sylvia
and Zahn, Daniela
and Scheidt-Nave, Christa
and Gellert, Paul",
title="Health App Use and Its Correlates Among Individuals With and Without Type 2 Diabetes: Nationwide Population-Based Survey",
journal="JMIR Diabetes",
year="2020",
month="May",
day="20",
volume="5",
number="2",
pages="e14396",
keywords="mobile app",
keywords="smartphone",
keywords="diabetes mellitus",
keywords="type 2 diabetes",
keywords="risk factors",
keywords="health-related behavior",
keywords="health promotion",
abstract="Background: Evidence suggests that mobile health app use is beneficial for the prevention and management of type 2 diabetes (T2D) and its associated complications; however, population-based research on specific determinants of health app use in people with and without T2D is scarce. Objective: This cross-sectional study aimed to provide population-based evidence on rates and determinants of health app use among adults with and without T2D, thereby covering a prevention perspective and a diabetes management perspective, respectively. Methods: The study population included 2327 adults without a known diabetes diagnosis and 1149 adults with known T2D from a nationwide telephone survey in Germany conducted in 2017. Rates of smartphone ownership and health app use were estimated based on weighted sample proportions. Among smartphone owners, determinants of health app use were identified for both groups separately in multivariable logistic regression models. Sociodemographic factors, diabetes-related factors or indicators, psychological and health-related factors, and physician-provided information were selected as potential determinants. Results: Among participants without known diabetes, 74.72\% (1690/2327) were smartphone owners. Of those, 49.27\% (717/1690) used health apps, most often to improve regular physical activity. Among participants with T2D, 42.26\% (481/1149) were smartphone owners. Of those, 41.1\% (171/481) used health apps, most commonly to target a healthy diet. Among people without known diabetes, determinants significantly (all P values <.05) associated with an increased likelihood of health app use compared with their reference group were as follows: younger and middle age of 18 to 44 or 45 to 64 years (odds ratios [ORs] 3.89; P<.001 and 1.76; P=.004, respectively), overweight or obesity (ORs 1.58; P<.001 and 2.07; P<.001, respectively), hypertension diagnosis (OR 1.31; P=.045), former or current smoking (ORs 1.51; P=.002 and 1.58; P<.001, respectively), perceiving health as very good (OR 2.21; P<.001), other chronic diseases (OR 1.48; P=.002), and having received health advice from a physician (OR 1.48; P<.001). A slight or high perceived diabetes risk (ORs 0.78; P=.04 and 0.23; P<.001, respectively) was significantly associated with a decreased likelihood of health app use. Among people with T2D, younger and middle age (18-64 years; OR 1.84; P=.007), female gender (OR 1.61; P=.02), and using a glucose sensor in addition or instead of a glucose meter (OR 2.74; P=.04) were significantly positively associated with health app use. Conclusions: In terms of T2D prevention, age, diabetes-related risk factors, psychological and health-related factors, and medical health advice may inform app development for specific target groups. In addition, health professionals may encourage health app use when giving advice on health behaviors. Concerning T2D management, only a few determinants seem relevant for explaining health app use among people with T2D, indicating a need for more future research on which people with T2D use health apps and why. ",
doi="10.2196/14396",
url="http://diabetes.jmir.org/2020/2/e14396/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32432555"
}


@Article{info:doi/10.2196/15895,
author="Ector, ICG Genevi{\`e}ve
and Westerweel, E. Peter
and Hermens, PMG Rosella
and Braspenning, AE Karin
and Heeren, CM Barend
and Vinck, MF Oscar
and de Jong, JM Jan
and Janssen, JWM Jeroen
and Blijlevens, MA Nicole",
title="The Development of a Web-Based, Patient-Centered Intervention for Patients With Chronic Myeloid Leukemia (CMyLife): Design Thinking Development Approach",
journal="J Med Internet Res",
year="2020",
month="May",
day="15",
volume="22",
number="5",
pages="e15895",
keywords="eHealth",
keywords="chronic myeloid leukemia",
keywords="patient participation",
keywords="mobile apps",
abstract="Background: With the global rise in chronic health conditions, health care is transforming, and patient empowerment is being emphasized to improve treatment outcomes and reduce health care costs. Patient-centered innovations are needed. We focused on patients with chronic myeloid leukemia (CML), a chronic disease with a generally good long-term prognosis because of the advent of tyrosine kinase inhibitors. However, both medication adherence by patients and guideline adherence by physicians are suboptimal, unnecessarily jeopardizing treatment outcomes. Objective: The aim of this study was to develop a patient-centered innovation for patients with CML using a design thinking methodology. Methods: The 5 phases of design thinking (ie, empathize, define, ideate, prototype, and test) were completed, and each phase started with the patient. Stakeholders and end users were identified and interviewed, and observations in the care system were made. Using tools in human-centered design, problems were defined and various prototypes of solutions were generated. These were evaluated by patients and stakeholders and then further refined. Results: The patients desired (1) insights into their own disease; (2) insights into the symptoms experienced, both in terms of knowledge and comprehension; and (3) improvements in the organization of care delivery. A web-based platform, CMyLife, was developed and pilot-tested. It has multiple features, all targeting parts of the bigger solution, including a website with reliable information and a forum, a guideline app, personal medical records with logs of symptoms and laboratory results (including a molecular marker and linked to the guideline app), tailored feedback based on the patients' symptoms and/or results, screen-to-screen consulting, delivery of medication, and the collection of blood samples at home. Conclusions: The multifeatured innovation, CMyLife, was developed in a multidisciplinary way and with active patient participation. The aim of developing CMyLife was to give patients the tools to monitor their results, interpret these results, and act on them. With this tool, they are provided with the know-how to consider their results in relation to their personal care process. Whether CMyLife achieves its goal and the evaluation of the added value will be the focus of future studies. CML could become the first malignancy for which patients are able to monitor and manage their disease by themselves. ",
doi="10.2196/15895",
url="https://www.jmir.org/2020/5/e15895",
url="http://www.ncbi.nlm.nih.gov/pubmed/32412424"
}


@Article{info:doi/10.2196/16289,
author="Davies, Alan
and Mueller, Julia
and Hennings, Jean
and Caress, Ann-Louise
and Jay, Caroline",
title="Recommendations for Developing Support Tools With People Suffering From Chronic Obstructive Pulmonary Disease: Co-Design and Pilot Testing of a Mobile Health Prototype",
journal="JMIR Hum Factors",
year="2020",
month="May",
day="15",
volume="7",
number="2",
pages="e16289",
keywords="chronic obstructive pulmonary disease",
keywords="app design",
keywords="mHealth",
keywords="ecological momentary assessment",
keywords="mobile phone",
abstract="Background: Gaps exist between developers, commissioners, and end users in terms of the perceived desirability of different features and functionalities of mobile apps. Objective: The objective of this study was to co-design a prototype mobile app for people with chronic obstructive pulmonary disease (COPD). We present lessons learned and recommendations from working on a large project with various stakeholders to develop a mobile app for patients with COPD. Methods: We adopted a user-centered, participatory approach to app development. Following a series of focus groups and interviews to capture requirements, we developed a prototype app designed to enable daily symptom recording (experience sampling). The prototype was tested in a usability study applying the think aloud protocol with people with COPD. It was then released via the Android app store, and experience sampling data and event data were captured to gather further usability data. Results: A total of 5 people with COPD participated in the pilot study. Identified themes include familiarity with technology, appropriate levels for feeding back information, and usability issues such as manual dexterity. Moreover, 37 participants used the app over a 4-month period (median age 47 years). The symptoms most correlated to perceived well-being were tiredness (r=0.61; P<.001) and breathlessness (r=0.59; P<.001). Conclusions: Design implications for COPD apps include the need for clearly labeled features (rather than relying on colors or symbols that require experience using smartphones), providing weather information, and using the same terminology as health care professionals (rather than simply lay terms). Target users, researchers, and developers should be involved at every stage of app development, using an iterative approach to build a prototype app, which should then be tested in controlled settings as well as in the wild (ie, when deployed and used in real-world settings) over longer periods. ",
doi="10.2196/16289",
url="http://humanfactors.jmir.org/2020/2/e16289/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32410730"
}


@Article{info:doi/10.2196/15989,
author="Bartlett, Kiera Yvonne
and Farmer, Andrew
and Rea, Rustam
and French, P. David",
title="Use of Brief Messages Based on Behavior Change Techniques to Encourage Medication Adherence in People With Type 2 Diabetes: Developmental Studies",
journal="J Med Internet Res",
year="2020",
month="May",
day="13",
volume="22",
number="5",
pages="e15989",
keywords="behavior change",
keywords="behavior change techniques",
keywords="type 2 diabetes, brief messages",
keywords="mHealth",
keywords="medication adherence",
abstract="Background: Brief messages are a promising way to improve adherence to medication for people with type 2 diabetes. However, it is often unclear how messages have been developed and their precise content, making it difficult to ascertain why certain messages are successful and some are not. Objective: The goal of the research was to develop messages that have proven fidelity to specified evidence-derived behavior change techniques (BCTs) and are acceptable to people with type 2 diabetes. Methods: Four studies were conducted: (1) a workshop (n=21) where behavioral change researchers and health care professionals developed messages based on specific BCTs or beliefs or concerns related to taking medication, (2) a focus group study with people with type 2 diabetes (n=23) to assess acceptability of the approach, (3) a survey to ascertain the acceptability of a subset of messages to people with type 2 diabetes (n=61) and, (4) a survey with behavior change researchers to assess the fidelity of a subset of messages to their intended BCT (n=18). Results: In study 1, 371 messages based on 38 BCTs and beliefs/concerns were developed. Workshop participants rated BCTs to be relevant to medication adherence (mean 7.12/10 [SD 1.55]) and messages to have good fidelity (mean 7.42/10 [SD 1.19]). In study 2, the approach of providing medication adherence support through text messages was found to be acceptable. In study 3, mean acceptability of all BCTs was found to be above the midpoint (mean 3.49/5 [SD 0.26]). In study 4, mean fidelity for all BCTs was found to be above the midpoint (mean 7.61/10 [SD 1.38]). Conclusions: A library of brief messages acceptable to people with type 2 diabetes and representative of specific evidence-derived BCTs was developed. This approach allowed brief messages to be developed with known content that can be used to test theory. ",
doi="10.2196/15989",
url="https://www.jmir.org/2020/5/e15989",
url="http://www.ncbi.nlm.nih.gov/pubmed/32401214"
}


@Article{info:doi/10.2196/17219,
author="Li, Li
and Huang, Jia
and Wu, Jingsong
and Jiang, Cai
and Chen, Shanjia
and Xie, Guanli
and Ren, Jinxin
and Tao, Jing
and Chan, H. Chetwyn C.
and Chen, Lidian
and Wong, K. Alex W.",
title="A Mobile Health App for the Collection of Functional Outcomes After Inpatient Stroke Rehabilitation: Pilot Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="May",
day="13",
volume="8",
number="5",
pages="e17219",
keywords="telemedicine",
keywords="cell phone",
keywords="stroke",
keywords="rehabilitation",
keywords="activities of daily living",
keywords="outcome and process assessment",
keywords="health care",
abstract="Background: Monitoring the functional status of poststroke patients after they transition home is significant for rehabilitation. Mobile health (mHealth) technologies may provide an opportunity to reach and follow patients post discharge. However, the feasibility and validity of functional assessments administered by mHealth technologies are unknown. Objective: This study aimed to evaluate the feasibility, validity, and reliability of functional assessments administered through the videoconference function of a mobile phone--based app compared with administration through the telephone function in poststroke patients after rehabilitation hospitalization. Methods: A randomized controlled trial was conducted in a rehabilitation hospital in Southeast China. Participants were randomly assigned to either a videoconference follow-up (n=60) or a telephone follow-up (n=60) group. We measured the functional status of participants in each group at 2-week and 3-month follow-up periods. Half the participants in each group were followed by face-to-face home visit assessments as the gold standard. Validity was assessed by comparing any score differences between videoconference follow-up and home visit assessments, as well as telephone follow-up and home visit assessments. Reliability was assessed by computing agreements between videoconference follow-up and home visit assessments, as well as telephone follow-up and home visit assessments. Feasibility was evaluated by the levels of completion, satisfaction, comfort, and confidence in the 2 groups. Results: Scores obtained from the videoconference follow-up were similar to those of the home visit assessment. However, most scores collected from telephone administration were higher than those of the home visit assessment. The agreement between videoconference follow-up and home visit assessments was higher than that between telephone follow-up and home visit assessments at all follow-up periods. In the telephone follow-up group, completion rates were 95\% and 82\% at 2-week and 3-month follow-up points, respectively. In the videoconference follow-up group, completion rates were 95\% and 80\% at 2-week and 3-month follow-up points, respectively. There were no differences in the completion rates between the 2 groups at all follow-up periods (X21=1.6, P=.21 for 2-week follow-up; X21=1.9, P=.17 for 3-month follow-up). Patients in the videoconference follow-up group perceived higher confidence than those in the telephone follow-up group at both 2-week and 3-month follow-up periods (X23=6.7, P=.04 for 2-week follow-up; X23=8.0, P=.04 for 3-month follow-up). The videoconference follow-up group demonstrated higher satisfaction than the telephone follow-up group at 3-month follow-up (X23=13.9; P=.03). Conclusions: The videoconference follow-up assessment of functional status demonstrates higher validity and reliability, as well as higher confidence and satisfaction perceived by patients, than the telephone assessment. The videoconference assessment provides an efficient means of assessing functional outcomes of patients after hospital discharge. This method provides a novel solution for clinical trials requiring longitudinal assessments. Trial Registration: chictr.org.cn: ChiCTR1900027626; http://www.chictr.org.cn/edit.aspx?pid=44831\&htm=4. ",
doi="10.2196/17219",
url="https://mhealth.jmir.org/2020/5/e17219",
url="http://www.ncbi.nlm.nih.gov/pubmed/32401221"
}


@Article{info:doi/10.2196/15628,
author="Habets, Jeroen
and Heijmans, Margot
and Herff, Christian
and Simons, Claudia
and Leentjens, FG Albert
and Temel, Yasin
and Kuijf, Mark
and Kubben, Pieter",
title="Mobile Health Daily Life Monitoring for Parkinson Disease: Development and Validation of Ecological Momentary Assessments",
journal="JMIR Mhealth Uhealth",
year="2020",
month="May",
day="11",
volume="8",
number="5",
pages="e15628",
keywords="ecological momentary assessment",
keywords="experience sampling method",
keywords="electronic diary",
keywords="Parkinson's disease monitoring",
abstract="Background: Parkinson disease monitoring is currently transitioning from periodic clinical assessments to continuous daily life monitoring in free-living conditions. Traditional Parkinson disease monitoring methods lack intraday fluctuation detection. Electronic diaries (eDiaries) hold the potential to collect subjective experiences on the severity and burden of motor and nonmotor symptoms in free-living conditions. Objective: This study aimed to develop a Parkinson disease--specific eDiary based on ecological momentary assessments (EMAs) and to explore its validation. Methods: An observational cohort of 20 patients with Parkinson disease used the smartphone-based EMA eDiary for 14 consecutive days without adjusting free-living routines. The eDiary app presented an identical questionnaire consisting of questions regarding affect, context, motor and nonmotor symptoms, and motor performance 7 times daily at semirandomized moments. In addition, patients were asked to complete a morning and an evening questionnaire. Results: Mean affect correlated moderate-to-strong and moderate with motor performance (R=0.38 to 0.75; P<.001) and motor symptom (R=0.34 to 0.50; P<.001) items, respectively. The motor performance showed a weak-to-moderate negative correlation with motor symptoms (R=?0.31 to ?0.48; P<.001). Mean group answers given for on-medication conditions vs wearing-off-medication conditions differed significantly (P<.05); however, not enough questionnaires were completed for the wearing-off-medication condition to reproduce these findings on individual levels. Conclusions: We presented a Parkinson disease--specific EMA eDiary. Correlations between given answers support the internal validity of the eDiary and underline EMA's potential in free-living Parkinson disease monitoring. Careful patient selection and EMA design adjustment to this targeted population and their fluctuations are necessary to generate robust proof of EMA validation in future work. Combining clinical Parkinson disease knowledge with practical EMA experience is inevitable to design and perform studies, which will lead to the successful integration of eDiaries in free-living Parkinson disease monitoring. ",
doi="10.2196/15628",
url="https://mhealth.jmir.org/2020/5/e15628",
url="http://www.ncbi.nlm.nih.gov/pubmed/32339999"
}


@Article{info:doi/10.2196/15178,
author="Subnis, B. Utkarsh
and Farb, AS Norman
and Piedalue, Laura Katherine-Ann
and Speca, Michael
and Lupichuk, Sasha
and Tang, A. Patricia
and Faris, Peter
and Thoburn, Mark
and Saab, J. Bechara
and Carlson, E. Linda",
title="A Smartphone App--Based Mindfulness Intervention for Cancer Survivors: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2020",
month="May",
day="11",
volume="9",
number="5",
pages="e15178",
keywords="mobile health",
keywords="psycho-oncology",
keywords="mindfulness",
keywords="mind-body therapies",
abstract="Background: Cancer patients transitioning to survivorship after completing cancer treatments need psychosocial interventions to manage stressors such as anxiety, depression, and fear of cancer recurrence. Mindfulness-based interventions (MBIs) are effective for treating these symptoms; however, cancer survivors are often unable to participate in face-to-face interventions because of difficulties such as work and family commitments, treatment-related side-effects, scheduling conflicts, and geography. Smartphone app--based MBIs are an innovative way to deliver psychosocial cancer care and can overcome several such difficulties, since patients can participate at their own convenience. Objective: The SEAMLESS (Smartphone App--Based Mindfulness Intervention for Cancer Survivors) study aims to evaluate the efficacy of a tailored app-based mindfulness intervention for cancer survivors (the Am Mindfulness-Based Cancer Survivorship---MBCS---Journey) for treating (1) symptoms of stress (primary outcome), as well as (2) fear of cancer recurrence, anxiety, depression, fatigue, and overall physical functioning (secondary outcomes). This is the first Canadian efficacy trial of a tailored mindfulness app intervention in cancer survivors. Methods: This is a randomized waitlist-controlled trial, which will evaluate the effectiveness of Am MBCS for impacting the primary and secondary outcomes in cancer survivors who have completed all their cancer treatments. Outcomes will be assessed using web-based surveys with validated psychometric instruments at (1) baseline, (2) mid-intervention (2 weeks later), (3) immediately postintervention (4 weeks), (4) 3 months postbaseline, (5) 6 months postbaseline, and (6) 12 months postbaseline. The waitlist group will complete all assessments and will cross over to the intervention condition after the 3-month assessment. In addition, data will be obtained by the smartphone app itself, which includes users' engagement with the app-based intervention, their emotional state (eg, angry and elated) from a user-inputted digital emotion-mapping board, and psychobiometric data using photoplethysmography technology. Results: The study received ethics approval in September 2018 and recruitment commenced in January 2019. Participants are being recruited through a provincial cancer registry, and the majority of participants currently enrolled are breast (44/83, 53\%) or colorectal (17/83, 20\%) cancer survivors, although some survivors of other cancer are also present. Data collection for analysis of the primary outcome time-point will be complete by September 2019, and the follow-up data will be collected and analyzed by September 2020. Data will be analyzed to determine group differences using linear mixed modelling statistical techniques. Conclusions: Cancer care providers are uncertain about the efficacy of app-based mindfulness interventions for patients, which are available in great supply in today's digital world. This study will provide rigorously evaluated efficacy data for an app-based mindfulness intervention for cancer survivors, which if helpful, could be made available for psychosocial care at cancer centers worldwide. Trial Registration: ClinicalTrials.gov NCT03484000; https://clinicaltrials.gov/ct2/show/NCT03484000 International Registered Report Identifier (IRRID): DERR1-10.2196/15178 ",
doi="10.2196/15178",
url="https://www.researchprotocols.org/2020/5/e15178",
url="http://www.ncbi.nlm.nih.gov/pubmed/32390591"
}


@Article{info:doi/10.2196/17085,
author="Dittrich, Florian
and Beck, Sascha
and Harren, Katharina Anna
and Reinecke, Felix
and Serong, Sebastian
and Jung, Jochen
and Back, Alexander David
and Wolf, Milan
and Landgraeber, Stefan",
title="Analysis of Secure Apps for Daily Clinical Use by German Orthopedic Surgeons: Searching for the ``Needle in a Haystack''",
journal="JMIR Mhealth Uhealth",
year="2020",
month="May",
day="7",
volume="8",
number="5",
pages="e17085",
keywords="smartphone",
keywords="mHealth",
keywords="app",
keywords="orthopedics",
keywords="app store",
keywords="screening",
abstract="Background: It is undeniable that appropriate smartphone apps offer enormous opportunities for dealing with future challenges in orthopedic surgery and public health, in general. However, it is still unclear how the apps currently available in the two major app stores can be used in daily clinical routine by German orthopedic surgeons. Objective: This study aimed to gain evidence regarding the quantity and quality of apps available in the two major app stores and their suitability for use by orthopedic surgeons in Germany. Methods: We conducted a systematic, keyword-based app store screening to obtain evidence concerning the quantity and quality of commercially available apps. Apps that met the inclusion criteria were evaluated using the app synopsis--checklist for users and the German Mobile App Rating Scale for secure use, trustworthiness, and quality. Results: The investigation revealed serious shortcomings regarding legal and medical aspects. Furthermore, most apps turned out to be useless and unsuitable for the clinical field of application (4242/4249, 99.84\%). Finally, 7 trustworthy and high-quality apps (7/4249, 0.16\%) offering secure usage in the daily clinical routine of orthopedists were identified. These apps mainly focused on education (5/7). None of them were CE (Conformit{\'e} Europ{\'e}enne) certified. Moreover, there are no studies providing evidence that these apps have any positive use whatsoever. Conclusions: The data obtained in our study suggest that the number of trustworthy and high-quality apps on offer is extremely low. Nowadays, finding appropriate apps in the fast-moving, complex, dynamic, and rudimentarily controlled app stores is most challenging. Promising approaches, for example, systematic app store screenings, app-rating developments, reviews or app libraries, and the creation of consistent standards have been established. However, further efforts are necessary to ensure that these innovative mobile health apps not only provide the correct information but are also safe to use in daily clinical practice. ",
doi="10.2196/17085",
url="https://mhealth.jmir.org/2020/5/e17085",
url="http://www.ncbi.nlm.nih.gov/pubmed/32379054"
}


@Article{info:doi/10.2196/13989,
author="Weerahandi, Himali
and Paul, Soaptarshi
and Quintiliani, M. Lisa
and Chokshi, Sara
and Mann, M. Devin",
title="A Mobile Health Coaching Intervention for Controlling Hypertension: Single-Arm Pilot Pre-Post Study",
journal="JMIR Form Res",
year="2020",
month="May",
day="7",
volume="4",
number="5",
pages="e13989",
keywords="eHealth",
keywords="mobile",
keywords="telemedicine",
abstract="Background: The seminal Dietary Approaches to Stopping Hypertension (DASH) study demonstrated the effectiveness of diet to control hypertension; however, the effective implementation and dissemination of its principles have been limited. Objective: This study aimed to determine the feasibility and effectiveness of a DASH mobile health intervention. We hypothesized that combining Bluetooth-enabled data collection, social networks, and a human coach with a smartphone DASH app (DASH Mobile) would be an effective medium for the delivery of the DASH program. Methods: We conducted a single-arm pilot study from August 2015 through August 2016, using a pre-post evaluation design to evaluate the feasibility and preliminary effectiveness of a smartphone version of DASH that incorporated a human health coach. Participants were recruited both online and offline. Results: A total of 17 patients participated in this study; they had a mean age of 59 years (SD 6) and 10 (60\%) were women. Participants were engaged with the app; in the 120 days of the study, the mean number of logged blood pressure measurements was 63 (SD 46), the mean number of recorded weight measurements was 52 (SD 45), and participants recorded a mean of 55 step counts (SD 36). Coaching phone calls had a high completion rate (74/102, 73\%). The mean number of servings documented per patient for the dietary assessment was 709 (SD 541), and patients set a mean number of 5 (SD 2) goals. Mean systolic and diastolic blood pressure, heart rate, weight, body mass index, and step count did not significantly change over time (P>.10 for all parameters). Conclusions: In this pilot study, we found that participants were engaged with an interactive mobile app that promoted healthy behaviors to treat hypertension. We did not find a difference in the physiological outcomes, but were underpowered to identify such changes. ",
doi="10.2196/13989",
url="http://formative.jmir.org/2020/5/e13989/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32379049"
}


@Article{info:doi/10.2196/18400,
author="Fedele, A. David
and Cushing, C. Christopher
and Koskela-Staples, Natalie
and Patton, R. Susana
and McQuaid, L. Elizabeth
and Smyth, M. Joshua
and Prabhakaran, Sreekala
and Gierer, Selina
and Nezu, M. Arthur",
title="Adaptive Mobile Health Intervention for Adolescents with Asthma: Iterative User-Centered Development",
journal="JMIR Mhealth Uhealth",
year="2020",
month="May",
day="6",
volume="8",
number="5",
pages="e18400",
keywords="asthma",
keywords="mobile health",
keywords="adherence",
keywords="adolescence",
keywords="self-regulation",
keywords="problem-solving",
keywords="adolescent",
keywords="youth",
abstract="Background: Adolescents diagnosed with persistent asthma commonly take less than 50\% of their prescribed inhaled corticosteroids (ICS), placing them at risk for asthma-related morbidity. Adolescents' difficulties with adherence occur in the context of normative developmental changes (eg, increased responsibility for disease management) and rely upon still developing self-regulation and problem-solving skills that are integral for asthma self-management. We developed an adaptive mobile health system, Responsive Asthma Care for Teens (ReACT), that facilitates self-regulation and problem-solving skills during times when adolescents' objectively measured ICS adherence data indicate suboptimal rates of medication use. Objective: The current paper describes our user-centered and evidence-based design process in developing ReACT. We explain how we leveraged a combination of individual interviews, national crowdsourced feedback, and an advisory board comprised of target users to develop the intervention content. Methods: We developed ReACT over a 15-month period using one-on-one interviews with target ReACT users (n=20), national crowdsourcing (n=257), and an advisory board (n=4) to refine content. Participants included 13-17--year-olds with asthma and their caregivers. A total of 280 adolescents and their caregivers participated in at least one stage of ReACT development. Results: Consistent with self-regulation theory, adolescents identified a variety of salient intrapersonal (eg, forgetfulness, mood) and external (eg, changes in routine) barriers to ICS use during individual interviews. Adolescents viewed the majority of ReACT intervention content (514/555 messages, 93\%) favorably during the crowdsourcing phase, and the advisory board helped to refine the content that did not receive favorable feedback during crowdsourcing. Additionally, the advisory board provided suggestions for improving additional components of ReACT (eg, videos, message flow). Conclusions: ReACT involved stakeholders via qualitative approaches and crowdsourcing throughout the creation and refinement of intervention content. The feedback we received from participants largely supported ReACT's emphasis on providing adaptive and personalized intervention content to facilitate self-regulation and problem-solving skills, and the research team successfully completed the recommended refinements to the intervention content during the iterative development process. ",
doi="10.2196/18400",
url="https://mhealth.jmir.org/2020/5/e18400",
url="http://www.ncbi.nlm.nih.gov/pubmed/32374273"
}


@Article{info:doi/10.2196/16262,
author="Otis, Marisa
and Zhu, Jack
and Mustafa-Kutana, N. Suleiman
and Bernier, V. Angelina
and Ma Shum, Julio
and Soros Dupre, A. Arlette
and Wang, L. Monica",
title="Testing Usability and Feasibility of a Mobile Educator Tool for Pediatric Diabetes Self-Management: Mixed Methods Pilot Study",
journal="JMIR Form Res",
year="2020",
month="May",
day="1",
volume="4",
number="5",
pages="e16262",
keywords="diabetes mellitus",
keywords="self-management",
keywords="health education",
keywords="mHealth",
keywords="mobile health",
keywords="child health",
abstract="Background: Mobile interventions hold promise as an intervention modality to engage children in improving diabetes self-management education, attitudes, and behaviors. Objective: This pilot study aimed to explore the usability, acceptability, and feasibility of delivering a mobile diabetes educational tool to parent-child pairs in a clinical setting. Methods: This mixed methods pilot study comprised two concurrent phases with differing study participants. Phase 1 used user testing interviews to collect qualitative data on the usability and acceptability of the tool. Phase 2 used a single-arm pre- and poststudy design to quantitatively evaluate the feasibility and preliminary efficacy of the intervention. Study participants (English-speaking families with youth aged 5-14 years with insulin-dependent diabetes) were recruited from an urban hospital in Massachusetts, United States. In phase 1, parent-child pairs were invited to complete the intervention together and participate in 90-min user testing interviews assessing the tool's usability and acceptability. Interview transcripts were analyzed using a directed content analysis approach. In phase 2, parent-child pairs were invited to complete the intervention together in the clinical setting. Measures included parental and child knowledge, attitudes, and behaviors related to diabetes management (self-report surveys) and child hemoglobin A1c levels (medical record extractions); data were collected at baseline and 1-month follow-up. Pre- and postoutcomes were compared using paired t tests and the Fisher exact test. Results: A total of 11 parent-child pairs (N=22) participated in phase 1 of the study, and 10 parent-child pairs (N=20) participated in phase 2 of the study. Participants viewed the mobile educational tool as acceptable (high engagement and satisfaction with the layout, activities, and videos) and identified the areas of improvement for tool usability (duration, directions, and animation). Conclusions: The findings from this pilot study suggest that the mobile educational tool is an informative, engaging, and feasible way to deliver diabetes self-management education to parents and children in an urban hospital setting. Data will inform future iterations of this mobile diabetes educational intervention to improve usability and test intervention efficacy. ",
doi="10.2196/16262",
url="https://formative.jmir.org/2020/5/e16262",
url="http://www.ncbi.nlm.nih.gov/pubmed/32356773"
}


@Article{info:doi/10.2196/16814,
author="Bradway, Meghan
and Gabarron, Elia
and Johansen, Monika
and Zanaboni, Paolo
and Jardim, Patricia
and Joakimsen, Ragnar
and Pape-Haugaard, Louise
and {\AA}rsand, Eirik",
title="Methods and Measures Used to Evaluate Patient-Operated Mobile Health Interventions: Scoping Literature Review",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="30",
volume="8",
number="4",
pages="e16814",
keywords="mobile health",
keywords="apps",
keywords="self-management",
keywords="chronic disease",
keywords="noncommunicable diseases",
keywords="interventions",
keywords="patient-centered approach",
keywords="patient-operated intervention",
abstract="Background: Despite the prevalence of mobile health (mHealth) technologies and observations of their impacts on patients' health, there is still no consensus on how best to evaluate these tools for patient self-management of chronic conditions. Researchers currently do not have guidelines on which qualitative or quantitative factors to measure or how to gather these reliable data. Objective: This study aimed to document the methods and both qualitative and quantitative measures used to assess mHealth apps and systems intended for use by patients for the self-management of chronic noncommunicable diseases. Methods: A scoping review was performed, and PubMed, MEDLINE, Google Scholar, and ProQuest Research Library were searched for literature published in English between January 1, 2015, and January 18, 2019. Search terms included combinations of the description of the intention of the intervention (eg, self-efficacy and self-management) and description of the intervention platform (eg, mobile app and sensor). Article selection was based on whether the intervention described a patient with a chronic noncommunicable disease as the primary user of a tool or system that would always be available for self-management. The extracted data included study design, health conditions, participants, intervention type (app or system), methods used, and measured qualitative and quantitative data. Results: A total of 31 studies met the eligibility criteria. Studies were classified as either those that evaluated mHealth apps (ie, single devices; n=15) or mHealth systems (ie, more than one tool; n=17), and one study evaluated both apps and systems. App interventions mainly targeted mental health conditions (including Post-Traumatic Stress Disorder), followed by diabetes and cardiovascular and heart diseases; among the 17 studies that described mHealth systems, most involved patients diagnosed with cardiovascular and heart disease, followed by diabetes, respiratory disease, mental health conditions, cancer, and multiple illnesses. The most common evaluation method was collection of usage logs (n=21), followed by standardized questionnaires (n=18) and ad-hoc questionnaires (n=13). The most common measure was app interaction (n=19), followed by usability/feasibility (n=17) and patient-reported health data via the app (n=15). Conclusions: This review demonstrates that health intervention studies are taking advantage of the additional resources that mHealth technologies provide. As mHealth technologies become more prevalent, the call for evidence includes the impacts on patients' self-efficacy and engagement, in addition to traditional measures. However, considering the unstructured data forms, diverse use, and various platforms of mHealth, it can be challenging to select the right methods and measures to evaluate mHealth technologies. The inclusion of app usage logs, patient-involved methods, and other approaches to determine the impact of mHealth is an important step forward in health intervention research. We hope that this overview will become a catalogue of the possible ways in which mHealth has been and can be integrated into research practice. ",
doi="10.2196/16814",
url="https://mhealth.jmir.org/2020/4/e16814",
url="http://www.ncbi.nlm.nih.gov/pubmed/32352394"
}


@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/10.2196/17883,
author="Badawy, M. Sherif
and Shah, Richa
and Beg, Usman
and Heneghan, B. Mallorie",
title="Habit Strength, Medication Adherence, and Habit-Based Mobile Health Interventions Across Chronic Medical Conditions: Systematic Review",
journal="J Med Internet Res",
year="2020",
month="Apr",
day="28",
volume="22",
number="4",
pages="e17883",
keywords="habit strength",
keywords="medication adherence",
keywords="habit index",
keywords="medication compliance",
keywords="mobile health",
keywords="health",
keywords="digital health",
keywords="interventions",
keywords="mobile phone",
abstract="Background: Unintentional medication nonadherence is common and has been associated with poor health outcomes and increased health care costs. Earlier research demonstrated a relationship between habit strength and medication adherence. Previous research also examined a habit's direct effect on adherence and how habit interacts with more conscious factors to influence or overrule them. However, the relationship between habit and adherence and the role of habit-based mobile health (mHealth) interventions remain unclear. Objective: This review aimed to systematically evaluate the most recent evidence for habit strength, medication adherence, and habit-based mHealth interventions across chronic medical conditions. Methods: A keyword search with combinations of the terms habit, habit strength, habit index, medication adherence, and medication compliance was conducted on the PubMed database. After duplicates were removed, two authors conducted independent abstract and full-text screening. The guidelines for the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed when reporting evidence across the included and reviewed studies. Results: Of the 687 records examined, 11 met the predefined inclusion criteria and were finalized for data extraction, grading, and synthesis. Most included studies (6/11, 55\%) were cross-sectional and used a theoretical model (8/11, 73\%). The majority of studies measured habit strength using the self-report habit index and self-report behavioral automaticity index (9/11, 82\%). Habit strength was positively correlated with medication adherence in most studies (10/11, 91\%). Habit mediated the effects of self-efficacy on medication adherence (1/11, 9\%), and social norms moderated the effects of habit strength on medication adherence (1/11, 9\%). Habit strength also moderated the effects of poor mental health symptoms and medication adherence (1/11, 9\%). None of the included studies reported on using or proposing a habit-based mHealth behavioral intervention to promote medication adherence. Conclusions: Habit strength was strongly correlated with medication adherence, and stronger habit was associated with higher medication adherence rates, regardless of the theoretical model and/or guiding framework. Habit-based interventions should be used to increase medication adherence, and these interventions could leverage widely available mobile technology tools such as mobile apps or text messaging, and existing routines. ",
doi="10.2196/17883",
url="http://www.jmir.org/2020/4/e17883/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32343250"
}


@Article{info:doi/10.2196/13536,
author="Steinman, Lesley
and Heang, Hen
and van Pelt, Maurits
and Ide, Nicole
and Cui, Haixia
and Rao, Mayuree
and LoGerfo, James
and Fitzpatrick, Annette",
title="Facilitators and Barriers to Chronic Disease Self-Management and Mobile Health Interventions for People Living With Diabetes and Hypertension in Cambodia: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="24",
volume="8",
number="4",
pages="e13536",
keywords="diabetes mellitus",
keywords="hypertension",
keywords="chronic disease",
keywords="noncommunicable diseases",
keywords="health educators",
keywords="mHealth",
keywords="qualitative",
keywords="disease management",
keywords="developing countries",
abstract="Background: In many low- and middle-income countries (LMICs), heart disease and stroke are the leading causes of death as cardiovascular risk factors such as diabetes and hypertension rapidly increase. The Cambodian nongovernmental organization, MoPoTsyo, trains local residents with diabetes to be peer educators (PEs) to deliver chronic disease self-management training and medications to 14,000 people with hypertension and/or diabetes in Cambodia. We collaborated with MoPoTsyo to develop a mobile-based messaging intervention (mobile health; mHealth) to link MoPoTsyo's database, PEs, pharmacies, clinics, and people living with diabetes and/or hypertension to improve adherence to evidence-based treatment guidelines. Objective: This study aimed to understand the facilitators and barriers to chronic disease management and the acceptability, appropriateness, and feasibility of mHealth to support chronic disease management and strengthen community-clinical linkages to existing services. Methods: We conducted an exploratory qualitative study using semistructured interviews and focus groups with PEs and people living with diabetes and/or hypertension. Interviews were recorded and conducted in Khmer script, transcribed and translated into the English language, and uploaded into Atlas.ti for analysis. We used a thematic analysis to identify key facilitators and barriers to disease management and opportunities for mHealth content and format. The information-motivation-behavioral model was used to guide data collection, analysis, and message development. Results: We conducted six focus groups (N=59) and 11 interviews in one urban municipality and five rural operating districts from three provinces in October 2016. PE network participants desired mHealth to address barriers to chronic disease management through reminders about medications, laboratory tests and doctor's consultations, education on how to incorporate self-management into their daily lives, and support for obstacles to disease management. Participants preferred mobile-based voice messages to arrive at dinnertime for improved phone access and family support. They desired voice messages over texts to communicate trust and increase accessibility for persons with limited literacy, vision, and smartphone access. PEs shared similar views and perceived mHealth as acceptable and feasible for supporting their work. We developed 34 educational, supportive, and reminder mHealth messages based on these findings. Conclusions: These mHealth messages are currently being tested in a cluster randomized controlled trial (\#1R21TW010160) to improve diabetes and hypertension control in Cambodia. This study has implications for practice and policies in Cambodia and other LMICs and low-resource US settings that are working to engage PEs and build community-clinical linkages to facilitate chronic disease management. ",
doi="10.2196/13536",
url="http://mhealth.jmir.org/2020/4/e13536/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32329737"
}


@Article{info:doi/10.2196/17108,
author="Zahid, Mahnoor
and Gallant, L. Natasha
and Hadjistavropoulos, Thomas
and Stroulia, Eleni",
title="Behavioral Pain Assessment Implementation in Long-Term Care Using a Tablet App: Case Series and Quasi-Experimental Design",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="22",
volume="8",
number="4",
pages="e17108",
keywords="pain measurement",
keywords="long-term care",
keywords="nursing",
keywords="technology Alzheimer disease",
keywords="mHealth",
abstract="Background: Pain is often underassessed and undertreated among long-term care (LTC) residents living with dementia. When used regularly, the Pain Assessment Checklist for Seniors With Limited Ability to Communicate (PACSLAC) scales have been shown to have beneficial effects on pain assessment and management practices and stress and burnout levels in frontline staff in LTC facilities. Such scales, however, are not utilized as often as recommended, which is likely to be related to additional record-keeping and tracking over time involved with their paper-and-pencil administration. Objective: Using implementation science principles, we assessed the introduction of the PACSLAC-II scale by comparing two methods of administration---a newly developed tablet app version and the original paper-and-pencil version---with respect to the frequency of pain assessment and facility staff feedback. Methods: Using a case series approach, we tracked pain-related quality indicators at baseline, implementation, and follow-up periods. A quasi-experimental design was used to evaluate the effect of the method of administration (ie, paper-and-pencil only [n=18], tablet only [n=12], paper-and-pencil followed by tablet app [n=31], and tablet app followed by paper-and-pencil [n=31]) on pain assessment frequency and frontline staff stress and burnout levels. Finally, semistructured interviews were conducted with frontline staff to obtain perspectives on each method of administration. Results: The implementation effort resulted in a great increase in pain assessment frequency across 7 independent LTC units, although these increases were not maintained during the follow-up period. Frontline staff reported lower levels of workload in the paper-and-pencil followed by tablet app condition than those in the paper-and-pencil only (P<.001) and tablet app followed by paper-and-pencil (P<.001) conditions. Frontline staff also reported lower levels of workload in the tablet-only condition than those in the paper-and-pencil only condition (P=.05). Similarly, lower levels of emotional exhaustion were reported by frontline staff in the paper-and-pencil followed by tablet app condition than those in the paper-and-pencil only (P=.002) and tablet app followed by paper-and-pencil (P=.002) conditions. Finally, frontline staff reported higher levels of depersonalization in the paper-and-pencil only condition than those in the tablet app only (P=.008), paper-and-pencil followed by tablet app (P<.001), and tablet app followed by paper-and-pencil (P<.001) conditions. Furthermore, narrative data from individual interviews with frontline staff revealed a preference for the tablet app over the paper-and-pencil method of administration. Conclusions: This study provides support for the use of either the tablet app or the paper-and-pencil version of the PACSLAC-II to improve pain-related quality indicators, but a reported preference for and lower levels of stress and burnout with the use of the tablet app method of administration suggests that the use of the tablet app may have more advantages compared with the paper-and-pencil method of administration. ",
doi="10.2196/17108",
url="http://mhealth.jmir.org/2020/4/e17108/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32319955"
}


@Article{info:doi/10.2196/14351,
author="Najm, Aurelie
and Lempp, Heidi
and Gossec, Laure
and Berenbaum, Francis
and Nikiphorou, Elena",
title="Needs, Experiences, and Views of People With Rheumatic and Musculoskeletal Diseases on Self-Management Mobile Health Apps: Mixed Methods Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="20",
volume="8",
number="4",
pages="e14351",
keywords="mHealth",
keywords="mixed methods",
keywords="mobile health apps",
keywords="rheumatic and musculoskeletal disease",
keywords="smartphone",
keywords="apps",
keywords="rheumatoid arthritis, digital health, mobile health",
abstract="Background: Despite the growing interest and exponential popularity of mobile health (mHealth) apps for long-term conditions such as rheumatic and musculoskeletal diseases (RMDs) and their self-management, patients are rarely directly consulted and involved in the app development process. Objective: This study aims to explore the needs, experiences, and views of people diagnosed with RMDs on mHealth apps. Methods: The study used a mixed methods approach: (1) an initial qualitative phase via a patient focus group in the UK and (2) a survey disseminated through national organizations for patients with RMDs across European countries, the United States, Canada, and Australia. Results: The focus group included six patients with life-long musculoskeletal conditions. Half had used a self-management app at least once. The use of existing apps was reported as time-consuming due to a lack of functionality. The need for bespoke apps was voiced by all participants. Among 424 patients across European countries, the United States, Canada, and Australia, the main age group was 45 to 54 years (122/424, 28.7\%), and 86.8\% (368/424) were women. Half of the respondents were aware of the existence of apps to support self-management of their RMDs (188/355, 53\%), with 42\% (79/188) of them currently using such devices. Patients were mostly interested in an app to self-monitor their health parameters (259/346, 74.9\%) and disease activity (221/346, 63.9\%) or communicate directly with their health care provider (200/346, 57.8\%). Conclusions: Patients considered that using an app could help them to self-manage their RMD condition if it was tailored to their needs and co-developed with health professionals. The development of such apps will require standardization and regular quality control. ",
doi="10.2196/14351",
url="https://mhealth.jmir.org/2020/4/e14351",
url="http://www.ncbi.nlm.nih.gov/pubmed/32310151"
}


@Article{info:doi/10.2196/15514,
author="Glattacker, Manuela
and Boeker, Martin
and Anger, Robin
and Reichenbach, Frank
and Tassoni, Adrian
and Bredenkamp, Rainer
and Giesler, M. Juergen",
title="Evaluation of a Mobile Phone App for Patients With Pollen-Related Allergic Rhinitis: Prospective Longitudinal Field Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="17",
volume="8",
number="4",
pages="e15514",
keywords="mobile applications",
keywords="rhinitis, allergic, seasonal",
keywords="patient reported outcome measures",
keywords="prospective studies",
keywords="longitudinal studies",
keywords="usability",
keywords="effectiveness",
abstract="Background: Mobile health apps have great potential to support the self-management of chronic conditions such as allergic diseases, which constitute significant challenges in health care. However, the health app market is confusing for users, as it is vast, dynamic, and lacks scientific evidence regarding the effectiveness of the apps on offer. To our knowledge, no health app for pollen-related allergic rhinitis has been evaluated. Objective: The aim of our study was to evaluate the Husteblume mobile phone health app, developed in Germany to facilitate the self-management of pollen-related allergic rhinitis. Methods: We evaluated usability and changes in quality of life, health literacy, and self-efficacy for managing one's chronic disease. We conducted 2 online surveys of registered users of the app, 1 before and 1 after the 2017 pollen season, allowing for the analysis of both cross-sectional and longitudinal data in a field setting. Results: The sample comprised 661 app users at the first measurement point and 143 users at follow-up. The subgroup of study participants at follow-up rated the usability of the app as good or very good. There were no significant changes in patient-reported outcomes such as quality of life, health literacy, and self-efficacy between the 2 measurement points (P>.05). However, those reached at follow-up perceived subjective improvements due to the app: 55.9\% (80/143) reported being subjectively better informed about their allergy, 27.3\% (39/143) noted improved quality of life, 33.6\% (48/143) reported subjectively better coping with their allergy, and 28.0\% (40/143) felt better prepared for the consultation with their physician. Finally, 90.9\% (130/143) users did not identify any adverse effects of the app. Conclusions: Despite some methodological caveats, the results of the evaluation of the Husteblume app are encouraging for the subgroup using the app in the long term. However, further studies evaluating the effectiveness of the app are needed. Trial Registration: German Clinical Trials Register DRKS00011897; https://tinyurl.com/yxxrg9av ",
doi="10.2196/15514",
url="http://mhealth.jmir.org/2020/4/e15514/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32301735"
}


@Article{info:doi/10.2196/16939,
author="Ross, L. Edgar
and Jamison, N. Robert
and Nicholls, Lance
and Perry, M. Barbara
and Nolen, D. Kim",
title="Clinical Integration of a Smartphone App for Patients With Chronic Pain: Retrospective Analysis of Predictors of Benefits and Patient Engagement Between Clinic Visits",
journal="J Med Internet Res",
year="2020",
month="Apr",
day="16",
volume="22",
number="4",
pages="e16939",
keywords="chronic pain",
keywords="patient engagement",
keywords="telemedicine",
keywords="mHealth",
keywords="pain measurement",
abstract="Background: Although many pain-related smartphone apps exist, little attention has been given to understanding how these apps are used over time and what factors contribute to greater compliance and patient engagement. Objective: This retrospective analysis was designed to help identify factors that predicted the benefits and future use of a smartphone pain app among patients with chronic pain. Methods: An app designed for both Android and iOS devices was developed by Brigham and Women's Hospital Pain Management Center (BWH-PMC) for users with chronic pain to assess and monitor pain and communicate with their providers. The pain app offered chronic pain assessment, push notification reminders and communication, personalized goal setting, relaxation sound files, topics of interest with psychological and medical pain management strategies, and line graphs from daily assessments. BWH-PMC recruited 253 patients with chronic pain over time to use the pain app. All subjects completed baseline measures and were asked to record their progress every day using push notification daily assessments. After 3 months, participants completed follow-up questionnaires and answered satisfaction questions. We defined the number of completed daily assessments as a measure of patient engagement with the pain app. Results: The average age of participants was 51.5 years (SD 13.7, range 18-92), 72.8\% (182/253) were female, and 36.8\% (78/212) reported the low back as their primary pain site. The number of daily assessments ranged from 1 to 426 (average 62.0, SD 49.9). The app was easy to introduce among patients, and it was well accepted. Those who completed more daily assessments (greater patient engagement) throughout the study were more likely to report higher pain intensity, more activity interference, and greater disability and were generally overweight compared with others. Patients with higher engagement with the app rated the app as offering greater benefit in coping with their pain and expressed more willingness to use the app in the future (P<.05) compared with patients showing lower engagement. Patients completing a small number of daily assessments reported less pain intensity, less daily activity interference, and less pain-related disability on average and were less likely to use the two-way messaging than those who were more engaged with the pain app (P<.05). Conclusions: Patients with chronic pain who appeared to manage their pain better were less likely to report benefits of a smartphone pain app designed for chronic pain management. They demonstrated lower patient engagement in reporting their daily progress, in part, owing to the perceived burden of regularly using an app without a perceived benefit. An intrinsically different pain app designed and targeted for individuals based on early identification of user characteristics and adapted for each individual would likely improve compliance and app-related patient engagement. ",
doi="10.2196/16939",
url="http://www.jmir.org/2020/4/e16939/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32297871"
}


@Article{info:doi/10.2196/16395,
author="Baltaxe, Erik
and Embid, Cristina
and Aumatell, Eva
and Mart{\'i}nez, Mar{\'i}a
and Barberan-Garcia, Anael
and Kelly, John
and Eaglesham, John
and Herranz, Carmen
and Vargiu, Eloisa
and Montserrat, Maria Josep
and Roca, Josep
and Cano, Isaac",
title="Integrated Care Intervention Supported by a Mobile Health Tool for Patients Using Noninvasive Ventilation at Home: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="13",
volume="8",
number="4",
pages="e16395",
keywords="behavioral change",
keywords="eHealth",
keywords="noninvasive ventilation",
keywords="mobile health",
keywords="chronic diseases",
abstract="Background: Home-based noninvasive ventilation has proven cost-effective. But, adherence to therapy still constitutes a common clinical problem. We hypothesized that a behavioral intervention supported by a mobile health (mHealth) app could enhance patient self-efficacy. It is widely accepted that mHealth-supported services can enhance productive interactions among the stakeholders involved in home-based respiratory therapies. Objective: This study aimed to measure changes in self-efficacy in patients with chronic respiratory failure due to diverse etiologies during a 3-month follow-up period after the intervention. Ancillary objectives were assessment of usability and acceptability of the mobile app as well as its potential contribution to collaborative work among stakeholders. Methods: A single-blind, single-center, randomized controlled trial was conducted between February 2019 and June 2019 with 67 adult patients with chronic respiratory failure undergoing home-based noninvasive ventilation. In the intervention group, a psychologist delivered a face-to-face motivational intervention. Follow-up was supported by a mobile app that allowed patients to report the number of hours of daily noninvasive ventilation use and problems with the therapy. Advice was automatically delivered by the mobile app in case of a reported problem. The control group received usual care. The primary outcome was the change in the Self Efficacy in Sleep Apnea questionnaire score. Secondary outcomes included app usability, app acceptability, continuity of care, person-centered care, and ventilatory parameters. Results: Self-efficacy was not significantly different in the intervention group after the intervention (before: mean 3.4, SD 0.6; after: mean 3.4, SD 0.5, P=.51). No changes were observed in adherence to therapy nor quality of life. Overall, the mHealth tool had a good usability score (mean 78 points) and high acceptance rate (mean score of 7.5/10 on a Likert scale). It was considered user-friendly (mean score of 8.2/10 on a Likert scale) and easy to use without assistance (mean score of 8.5/10 on a Likert scale). Patients also scored the perception of continuity of care and person-centered care as high. Conclusions: The integrated care intervention supported by the mobile app did not improve patient self-management.  However, the high acceptance of the mobile app might indicate potential for enhanced communication among stakeholders. The study identified key elements required for mHealth tools to provide effective support to collaborative work and personalized care. Trial Registration: ClinicalTrials.gov NCT03932175; https://clinicaltrials.gov/ct2/show/NCT03932175 ",
doi="10.2196/16395",
url="http://mhealth.jmir.org/2020/4/e16395/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32281941"
}


@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/10.2196/15806,
author="Hauser-Ulrich, Sandra
and K{\"u}nzli, Hansj{\"o}rg
and Meier-Peterhans, Danielle
and Kowatsch, Tobias",
title="A Smartphone-Based Health Care Chatbot to Promote Self-Management of Chronic Pain (SELMA): Pilot Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="3",
volume="8",
number="4",
pages="e15806",
keywords="conversational agent",
keywords="chatbot",
keywords="digital health",
keywords="pain self-management",
keywords="cognitive behavior therapy",
keywords="smartphone",
keywords="psychoeducation",
keywords="text-based",
keywords="health care",
keywords="chronic pain",
abstract="Background: Ongoing pain is one of the most common diseases and has major physical, psychological, social, and economic impacts. A mobile health intervention utilizing a fully automated text-based health care chatbot (TBHC) may offer an innovative way not only to deliver coping strategies and psychoeducation for pain management but also to build a working alliance between a participant and the TBHC. Objective: The objectives of this study are twofold: (1) to describe the design and implementation to promote the chatbot painSELfMAnagement (SELMA), a 2-month smartphone-based cognitive behavior therapy (CBT) TBHC intervention for pain self-management in patients with ongoing or cyclic pain, and (2) to present findings from a pilot randomized controlled trial, in which effectiveness, influence of intention to change behavior, pain duration, working alliance, acceptance, and adherence were evaluated. Methods: Participants were recruited online and in collaboration with pain experts, and were randomized to interact with SELMA for 8 weeks either every day or every other day concerning CBT-based pain management (n=59), or weekly concerning content not related to pain management (n=43). Pain-related impairment (primary outcome), general well-being, pain intensity, and the bond scale of working alliance were measured at baseline and postintervention. Intention to change behavior and pain duration were measured at baseline only, and acceptance postintervention was assessed via self-reporting instruments. Adherence was assessed via usage data. Results: From May 2018 to August 2018, 311 adults downloaded the SELMA app, 102 of whom consented to participate and met the inclusion criteria. The average age of the women (88/102, 86.4\%) and  men (14/102, 13.6\%) participating was 43.7 (SD 12.7) years. Baseline group comparison did not differ with respect to any demographic or clinical variable. The intervention group reported no significant change in pain-related impairment (P=.68) compared to the control group postintervention. The intention to change behavior was positively related to pain-related impairment (P=.01) and pain intensity (P=.01). Working alliance with the TBHC SELMA was comparable to that obtained in guided internet therapies with human coaches. Participants enjoyed using the app, perceiving it as useful and easy to use. Participants of the intervention group replied with an average answer ratio of 0.71 (SD 0.20) to 200 (SD 58.45) conversations initiated by SELMA. Participants' comments revealed an appreciation of the empathic and responsible interaction with the TBHC SELMA. A main criticism was that there was no option to enter free text for the patients' own comments. Conclusions: SELMA is feasible, as revealed mainly by positive feedback and valuable suggestions for future revisions. For example, the participants' intention to change behavior or a more homogenous sample (eg, with a specific type of chronic pain) should be considered in further tailoring of SELMA. Trial Registration: German Clinical Trials Register DRKS00017147; https://tinyurl.com/vx6n6sx,  Swiss National Clinical Trial Portal: SNCTP000002712; https://www.kofam.ch/de/studienportal/suche/70582/studie/46326. ",
doi="10.2196/15806",
url="http://mhealth.jmir.org/2020/4/e15806/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32242820"
}


@Article{info:doi/10.2196/17142,
author="Heiney, P. Sue
and Donevant, B. Sara
and Arp Adams, Swann
and Parker, D. Pearman
and Chen, Hongtu
and Levkoff, Sue",
title="A Smartphone App for Self-Management of Heart Failure in Older African Americans:  Feasibility and Usability Study",
journal="JMIR Aging",
year="2020",
month="Apr",
day="3",
volume="3",
number="1",
pages="e17142",
keywords="heart failure",
keywords="mobile health app",
keywords="self-management",
abstract="Background: Mobile health (mHealth) apps are dramatically changing how patients and providers manage and monitor chronic health conditions, especially in the area of self-monitoring.  African Americans have higher mortality rates from heart failure than other racial groups in the United States. Therefore, self-management of heart failure may improve health outcomes for African American patients. Objective: The aim of the present study was to determine the feasibility of using an mHealth app, and explore the outcomes of quality of life, including self-care maintenance, management, and confidence, among African American patients managing their condition after discharge with a diagnosis of heart failure. Methods: Prior to development of the app, we conducted qualitative interviews with 7 African American patients diagnosed with heart failure, 3 African American patients diagnosed with cardiovascular disease, and 6 health care providers (cardiologists, nurse practitioners, and a geriatrician) who worked with heart failure patients.  In addition, we asked 6 hospital chaplains to provide positive spiritual messages for the patients, since spirituality is an important coping method for many African Americans.  These formative data were then used for creating a prototype of the app, named Healthy Heart.  Specifically, the Healthy Heart app incorporated the following evidence-based features to promote self-management: one-way messages, journaling (ie, weight and symptoms), graphical display of data, and customized feedback (ie, clinical decision support) based on daily or weekly weight.  The educational messages about heart failure self-management were derived from the teaching materials provided to the patients diagnosed with heart failure, and included information on diet, sleep, stress, and medication adherence. The information was condensed and simplified to be appropriate for text messages and to meet health literacy standards.  Other messages were derived from interviews conducted during the formative stage of app development, including interviews with African American chaplains. Usability testing was conducted over a series of meetings between nurses, social workers, and computer engineers. A pilot one-group pretest-posttest design was employed with participants using the mHealth app for 4 weeks. Descriptive statistics were computed for each of the demographic variables, overall and subscales for Health Related Quality of Life Scale 14 (HQOL14) and subscales for the Self-Care of Heart Failure Index (SCHFI) Version 6 using frequencies for categorical measures and means with standard deviations for continuous measures.  Baseline and postintervention comparisons were computed using the Fisher exact test for overall health and paired t tests for HQOL14 and SCHFI questionnaire subscales. Results: A total of 12 African American participants (7 men, 5 women; aged 51-69 years) diagnosed with heart failure were recruited for the study. There was no significant increase in quality of life (P=.15), but clinically relevant changes in self-care maintenance, management, and confidence were observed. Conclusions: An mHealth app to assist with the self-management of heart failure is feasible in patients with low literacy, low health literacy, and limited smartphone experience. Based on the clinically relevant changes observed in this feasibility study of the Healthy Heart app, further research should explore effectiveness in this vulnerable population. ",
doi="10.2196/17142",
url="http://aging.jmir.org/2020/1/e17142/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32242822"
}


@Article{info:doi/10.2196/16142,
author="Lancaster, Claire
and Koychev, Ivan
and Blane, Jasmine
and Chinner, Amy
and Wolters, Leona
and Hinds, Chris",
title="Evaluating the Feasibility of Frequent Cognitive Assessment Using the Mezurio Smartphone App: Observational and Interview Study in Adults With Elevated Dementia Risk",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="2",
volume="8",
number="4",
pages="e16142",
keywords="technology assessment",
keywords="cognition",
keywords="smartphone",
keywords="mhealth",
keywords="mobile phone",
keywords="Alzheimer disease",
keywords="early diagnosis",
keywords="feasibility study",
keywords="ecological momentary assessment",
abstract="Background: By enabling frequent, sensitive, and economic remote assessment, smartphones will facilitate the detection of early cognitive decline at scale. Previous studies have sustained participant engagement with remote cognitive assessment over a week; extending this to a period of 1 month clearly provides a greater opportunity for measurement. However, as study durations are increased, the need to understand how participant burden and scientific value might be optimally balanced also increases. Objective: This study explored the little but often approach to assessment employed by the Mezurio app when prompting participants to interact every day for over a month. Specifically, this study aimed to understand whether this extended duration of remote study is feasible, and which factors promote sustained participant engagement over such periods. Methods: A total of 35 adults (aged 40-59 years) with no diagnosis of cognitive impairment were prompted to interact with the Mezurio smartphone app platform for up to 36 days, completing short, daily episodic memory tasks in addition to optional executive function and language tests. A subset (n=20) of participants completed semistructured interviews focused on their experience of using the app. Results: Participants complied with 80\% of the daily learning tasks scheduled for subsequent tests of episodic memory, with 88\% of participants still actively engaged by the final task. A thematic analysis of the participants' experiences highlighted schedule flexibility, a clear user interface, and performance feedback as important considerations for engagement with remote digital assessment. Conclusions: Despite the extended study duration, participants demonstrated high compliance with the schedule of daily learning tasks and were extremely positive about their experiences. Long durations of remote digital interaction are therefore definitely feasible but only when careful attention is paid to the design of the users' experience. ",
doi="10.2196/16142",
url="https://mhealth.jmir.org/2020/4/e16142",
url="http://www.ncbi.nlm.nih.gov/pubmed/32238339"
}


@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/10.2196/14702,
author="Mazoteras-Pardo, Victoria
and Becerro-De-Bengoa-Vallejo, Ricardo
and Losa-Iglesias, Elena Marta
and L{\'o}pez-L{\'o}pez, Daniel
and Calvo-Lobo, C{\'e}sar
and Rodr{\'i}guez-Sanz, David
and Mart{\'i}nez-Jim{\'e}nez, Mar{\'i}a Eva
and Palomo-L{\'o}pez, Patricia",
title="An Automated Blood Pressure Display for Self-Measurement in Patients With Chronic Kidney Disease (iHealth Track): Device Validation Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="2",
volume="8",
number="4",
pages="e14702",
keywords="iHealth Track",
keywords="validation",
keywords="blood pressure",
keywords="heart rate",
keywords="International Protocol",
abstract="Background: Hypertension is a global public health issue and is closely related to chronic kidney disorder (CKD). In people with CKD, strict monitoring of blood pressure is an important part of therapy. Objective: The aim of this research was to validate the iHealth Track blood pressure monitoring device for patients with CKD according to the European Society of Hypertension International Protocol 2010 (ESH-IP2). Methods: In total, 33 patients who received hemodialysis in Plasencia participated in the study. There were 9 successive measurements made, which conformed to the ESH-IP2. We calculated the differences between the standard reference device (Omron M3 Intellisense) and the test device (iHealth Track) for blood pressure and heart rate values. For 99 total comparisons of paired measurements, we classified differences into various categories (?5 mmHg, ?10 mmHg, and ?15 mmHg for blood pressure; ?3, ?5, and ?8 beats per minute for heart rate). Results: In 90 of 99 systolic blood pressure and 89 of 99 diastolic blood pressure comparisons between the devices, measurement differences were within 5 mmHg. In 81 of 99 heart rate comparisons between the devices, measurement differences were within 3 beats per minute. The mean differences between the test and reference standard measurements were 3.27 (SD 2.99) mmHg for systolic blood pressure, 3.59 (SD 4.55) mmHg for diastolic blood pressure, and 2.18 (SD 2.75) beats per minute for heart rate.We also observed that for both systolic and diastolic blood pressure, 31 of 33 participants had at least two of three comparisons between the devices with measurement differences less than 5 mmHg. For heart rate, 28 of 33 patients had at least two of three comparisons between the devices with measurement differences less than 3 beats per minute. Conclusions: To our knowledge, this is the first study to show that iHealth Track meets the requirements of the ESH-IP2 in patients with CKD. Therefore, the iHealth Track is suitable for use in renal patients. ",
doi="10.2196/14702",
url="https://mhealth.jmir.org/2020/4/e14702",
url="http://www.ncbi.nlm.nih.gov/pubmed/32238337"
}


@Article{info:doi/10.2196/15098,
author="Hyun, Chul
and McMenamin, Joseph
and Ko, Okhyun
and Kim, Soonsik",
title="Efficacy of a Mobile Texting App (HepTalk) in Encouraging Patient Participation in Viral Hepatitis B Care: Development and Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="1",
volume="8",
number="4",
pages="e15098",
keywords="chronic hepatitis B",
keywords="hepatitis B virus infection",
keywords="linkage to care",
keywords="mobile texting app",
keywords="remote consultation",
abstract="Background: Chronic hepatitis B virus (HBV) infection is a major cause of liver-related morbidity and mortality among Asian Americans in the United States. Despite the available resources, a majority of HBV-infected individuals are not able to access adequate health care owing to numerous barriers. Objective: This study aimed to assess the efficacy of a newly developed mobile texting app (HepTalk) in overcoming these barriers and improving patient engagement and health care access among HBV-infected and nonimmune individuals. Methods: HepTalk was employed for two-way communication between participants and patient navigators. A total of 82 Korean American participants who were either HBV infected or nonimmune to HBV, identified from a community hepatitis B campaign in New York, were enrolled in the study. After informed consent was obtained, both the frequency and themes of the text messages were evaluated. The effects of this communication on linkage to care at the end of the 6-month intervention period were analyzed and discussed. Results: On average, patient navigators sent and received 14 and 8 messages per participant, respectively, during the 6-month period. The themes of the messages were similar to the following 4 categories: finding providers, scheduling appointments with providers, health education, and financial issues. Of the 82 participants, 78 were linked to care within 6 months (a 95\% linkage rate). Conclusions: HepTalk may be employed as an effective and strategic tool to facilitate communicative interaction between patients and patient navigators or health care providers, thereby improving patient engagement and health care access. ",
doi="10.2196/15098",
url="https://mhealth.jmir.org/2020/4/e15098",
url="http://www.ncbi.nlm.nih.gov/pubmed/32234704"
}


@Article{info:doi/10.2196/15028,
author="Busk, Jonas
and Faurholt-Jepsen, Maria
and Frost, Mads
and Bardram, E. Jakob
and Vedel Kessing, Lars
and Winther, Ole",
title="Forecasting Mood in Bipolar Disorder From Smartphone Self-assessments: Hierarchical Bayesian Approach",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="1",
volume="8",
number="4",
pages="e15028",
keywords="bipolar disorder",
keywords="mood",
keywords="early medical intervention",
keywords="digital phenotyping",
keywords="machine learning",
keywords="forecasting",
keywords="Bayesian analysis",
abstract="Background: Bipolar disorder is a prevalent mental health condition that is imposing significant burden on society. Accurate forecasting of symptom scores can be used to improve disease monitoring, enable early intervention, and eventually help prevent costly hospitalizations. Although several studies have examined the use of smartphone data to detect mood, only few studies deal with forecasting mood for one or more days. Objective: This study aimed to examine the feasibility of forecasting daily subjective mood scores based on daily self-assessments collected from patients with bipolar disorder via a smartphone-based system in a randomized clinical trial. Methods: We applied hierarchical Bayesian regression models, a multi-task learning method, to account for individual differences and forecast mood for up to seven days based on 15,975 smartphone self-assessments from 84 patients with bipolar disorder participating in a randomized clinical trial. We reported the results of two time-series cross-validation 1-day forecast experiments corresponding to two different real-world scenarios and compared the outcomes with commonly used baseline methods. We then applied the best model to evaluate a 7-day forecast. Results: The best performing model used a history of 4 days of self-assessment to predict future mood scores with historical mood being the most important predictor variable. The proposed hierarchical Bayesian regression model outperformed pooled and separate models in a 1-day forecast time-series cross-validation experiment and achieved the predicted metrics, R2=0.51 and root mean squared error of 0.32, for mood scores on a scale of ?3 to 3. When increasing the forecast horizon, forecast errors also increased and the forecast regressed toward the mean of data distribution. Conclusions: Our proposed method can forecast mood for several days with low error compared with common baseline methods. The applicability of a mood forecast in the clinical treatment of bipolar disorder has also been discussed. ",
doi="10.2196/15028",
url="https://mhealth.jmir.org/2020/4/e15028",
url="http://www.ncbi.nlm.nih.gov/pubmed/32234702"
}


@Article{info:doi/10.2196/14768,
author="Gardiner, Paula
and D'Amico, Salvatore
and Luo, Man
and Haas, Niina",
title="An Innovative Electronic Health Toolkit (Our Whole Lives for Chronic Pain) to Reduce Chronic Pain in Patients With Health Disparities: Open Clinical Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Mar",
day="30",
volume="8",
number="3",
pages="e14768",
keywords="minority health",
keywords="internet",
keywords="Web-based",
keywords="complementary therapies",
keywords="mindfulness-based stress reduction",
abstract="Background: Chronic pain affects millions of Americans. Our Whole Lives, an electronic health (eHealth) toolkit for Chronic Pain (Our Whole Lives for Chronic Pain [OWLCP]), is a mind-body chronic pain management platform that teaches self-management strategies to reduce pain impact and pain medication use. Objective: The primary goal of this study was to evaluate the feasibility of OWLCP in reducing pain impact and pain-related outcomes. Methods: We conducted a pre-post clinical study (2 cohorts) to assess the feasibility of OWLCP usage among low-income patients with chronic pain. Outcome data, collected at baseline and 9 weeks, included Patient-Reported Outcomes Measurement Information System (PROMIS-29), pain self-efficacy, and pain medication use. In the statistical analysis, we used descriptive statistics, logistic regression, linear regression, and qualitative methods. Results: Among the enrolled 43 participants, the average age was 50 years, (39/43) 91\% were female, (16/43) 37\% were black, and (7/43) 16\% were Hispanic. From baseline to follow-up, the PROMIS measures showed a reduction in depression (P=.02), pain interference (P=.003), and average pain impact score (P=.007). Pain self-efficacy increased ((P<.001), whereas opioid use had a 13\% reduction (P=.03). Conclusions: The eHealth chronic pain management platform, OWLCP, is a potential tool to reduce the impact of chronic pain for low-income racially diverse populations. ",
doi="10.2196/14768",
url="https://mhealth.jmir.org/2020/3/e14768",
url="http://www.ncbi.nlm.nih.gov/pubmed/32224487"
}


@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/10.2196/14599,
author="Issom, David-Zacharie
and Henriksen, Andr{\'e}
and Woldaregay, Zebene Ashenafi
and Rochat, Jessica
and Lovis, Christian
and Hartvigsen, Gunnar",
title="Factors Influencing Motivation and Engagement in Mobile Health Among Patients With Sickle Cell Disease in Low-Prevalence, High-Income Countries: Qualitative Exploration of Patient Requirements",
journal="JMIR Hum Factors",
year="2020",
month="Mar",
day="24",
volume="7",
number="1",
pages="e14599",
keywords="mHealth",
keywords="wearable devices",
keywords="self-management",
keywords="sickle cell disease",
keywords="patient engagement",
keywords="adoption",
keywords="motivation",
keywords="user computer interfaces",
keywords="health behavior",
keywords="persuasion",
abstract="Background: Sickle cell disease (SCD) is a hematological genetic disease affecting over 25 million people worldwide. The main clinical manifestations of SCD, hemolytic anemia and vaso-occlusion, lead to chronic pain and organ damages. With recent advances in childhood care, high-income countries have seen SCD drift from a disease of early childhood mortality to a neglected chronic disease of adulthood. In particular, coordinated, preventive, and comprehensive care for adults with SCD is largely underresourced. Consequently, patients are left to self-manage. Mobile health (mHealth) apps for chronic disease self-management are now flooding app stores. However, evidence remains unclear about their effectiveness, and the literature indicates low user engagement and poor adoption rates. Finally, few apps have been developed for people with SCD and none encompasses their numerous and complex self-care management needs. Objective: This study aimed to identify factors that may influence the long-term engagement and user adoption of mHealth among the particularly isolated community of adult patients with SCD living in low-prevalence, high-income countries. Methods: Semistructured interviews were conducted. Interviews were audiotaped, transcribed verbatim, and analyzed using thematic analysis. Analysis was informed by the Braun and Clarke framework and mapped to the COM-B model (capability, opportunity, motivation, and behavior). Results were classified into high-level functional requirements (FRs) and nonfunctional requirements (NFRs) to guide the development of future mHealth interventions. Results: Overall, 6 males and 4 females were interviewed (aged between 21 and 55 years). Thirty FRs and 31 NFRs were extracted from the analysis. Most participants (8/10) were concerned about increasing their physical capabilities being able to stop pain symptoms quickly. Regarding the psychological capability aspects, all interviewees desired to receive trustworthy feedback on their self-care management practices. About their physical opportunities, most (7/10) expressed a strong desire to receive alerts when they would reach their own physiological limitations (ie, during physical activity). Concerning social opportunity, most (9/10) reported wanting to learn about the self-care practices of other patients. Relating to motivational aspects, many interviewees (6/10) stressed their need to learn how to avoid the symptoms and live as normal a life as possible. Finally, NFRs included inconspicuousness and customizability of user experience, automatic data collection, data shareability, and data privacy. Conclusions: Our findings suggest that motivation and engagement with mHealth technologies among the studied population could be increased by providing features that clearly benefit them. Self-management support and self-care decision aid are patients' major demands. As the complexity of SCD self-management requires a high cognitive load, pervasive health technologies such as wearable sensors, implantable devices, or inconspicuous conversational user interfaces should be explored to ease it. Some of the required technologies already exist but must be integrated, bundled, adapted, or improved to meet the specific needs of people with SCD. ",
doi="10.2196/14599",
url="http://humanfactors.jmir.org/2020/1/e14599/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32207692"
}


@Article{info:doi/10.2196/15699,
author="Rodriguez  Hermosa, Luis Juan
and Fuster Gomila, Antonia
and Puente Maestu, Luis
and Amado Diago, Antonio Carlos
and Callejas Gonz{\'a}lez, Javier Francisco
and Malo De Molina Ruiz, Rosa
and Fuentes Ferrer, E. Manuel
and {\'A}lvarez Sala-Walther, Luis Jose
and Calle Rubio, Myriam",
title="Compliance and Utility of a Smartphone App for the Detection of Exacerbations in Patients With Chronic Obstructive Pulmonary Disease: Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Mar",
day="19",
volume="8",
number="3",
pages="e15699",
keywords="chronic obstructive pulmonary disease",
keywords="mHealth",
keywords="compliance",
keywords="mobile phone",
abstract="Background: In recent years, mobile health (mHealth)--related apps have been developed to help manage chronic diseases. Apps may allow patients with a chronic disease characterized by exacerbations, such as chronic obstructive pulmonary disease (COPD), to track and even suspect disease exacerbations, thereby facilitating self-management and prompt intervention. Nevertheless, there is insufficient evidence regarding patient compliance in the daily use of mHealth apps for chronic disease monitoring. Objective: This study aimed to provide further evidence in support of prospectively recording daily symptoms as a useful strategy to detect COPD exacerbations through the smartphone app, Prevexair. It also aimed to analyze daily compliance and the frequency and characteristics of acute exacerbations of COPD recorded using Prevexair. Methods: This is a multicenter cohort study with prospective case recruitment including 116 patients with COPD who had a documented history of frequent exacerbations and were monitored over the course of 6 months. At recruitment, the Prevexair app was installed on their smartphones, and patients were instructed on how to use the app. The information recorded in the app included symptom changes, use of medication, and use of health care resources. The patients received messages on healthy lifestyle behaviors and a record of their cumulative symptoms in the app. There was no regular contact with the research team and no mentoring process. An exacerbation was considered reported if medical attention was sought and considered unreported if it was not reported to a health care professional. Results: Overall, compliance with daily records in the app was 66.6\% (120/180), with a duration compliance of 78.8\%, which was similar across disease severity, age, and comorbidity variables. However, patients who were active smokers, with greater dyspnea and a diagnosis of depression and obesity had lower compliance (P<.05). During the study, the patients experienced a total of 262 exacerbations according to daily records in the app, 99 (37.8\%) of which were reported exacerbations and 163 (62.2\%) were unreported exacerbations. None of the subject-related variables were found to be significantly associated with reporting. The duration of the event and number of symptoms present during the first day were strongly associated with reporting. Despite substantial variations in the COPD Assessment Test (CAT), there was improvement only among patients with no exacerbation and those with reported exacerbations. Nevertheless, CAT scores deteriorated among patients with unreported exacerbations. Conclusions: The daily use of the Prevexair app is feasible and acceptable for patients with COPD who are motivated in their self-care because of frequent exacerbations of their disease. Monitoring through the Prevexair app showed great potential for the implementation of self-care plans and offered a better diagnosis of their chronic condition. ",
doi="10.2196/15699",
url="http://mhealth.jmir.org/2020/3/e15699/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32191213"
}


@Article{info:doi/10.2196/14538,
author="Gavil{\'a}n-Carrera, Blanca
and Segura-Jim{\'e}nez, V{\'i}ctor
and Acosta-Manzano, Pedro
and Borges-Cosic, Milkana
and {\'A}lvarez-Gallardo, C. Inmaculada
and Delgado-Fern{\'a}ndez, Manuel",
title="Patterns of Sedentary Time and Quality of Life in Women With Fibromyalgia: Cross-Sectional Study From the al-{\'A}ndalus Project",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Mar",
day="19",
volume="8",
number="3",
pages="e14538",
keywords="GT3X+",
keywords="accelerometry",
keywords="sedentary behavior",
keywords="symptomatology",
abstract="Background: Sedentary time (ST) has been associated with detrimental health outcomes in fibromyalgia. Previous evidence in the general population has shown that not only is the total amount of ST harmful but the pattern of accumulation of sedentary behaviors is also relevant to health, with prolonged unbroken periods (ie, bouts) being particularly harmful. Objective: To examine the association of the patterns of ST with health-related quality of life (HRQoL) in women with fibromyalgia and to test whether these associations are independent of moderate-to-vigorous physical activity (MVPA). Methods: A total of 407 women (mean 51.4 years of age [SD 7.6]) with fibromyalgia participated. ST and MVPA were measured with triaxial accelerometry. The percentage of ST accumulated in bouts and the frequency of sedentary bouts of different lengths (?10 min, ?20 min, ?30 min, and ?60 min) were obtained. Four groups combining total ST and sedentary bout duration (?30 min) were created. We assessed HRQoL using the 36-item Short-Form Health Survey (SF-36). Results: A greater percentage of ST spent in all bout lengths was associated with worsened physical function, bodily pain, vitality, social function, and physical component summary (PCS) (all P<.05). In addition, a higher percentage of ST in bouts of 60 minutes or more was related to worsened physical role (P=.04). A higher frequency of bouts was negatively associated with physical function, social function, the PCS (?30 min and ?60 min), physical role (?60 min), bodily pain (?60 min), and vitality (?20 min, ?30 min, and ?60 min) (all P<.05). Overall, for different domains of HRQoL, these associations were independent of MVPA for higher bout lengths. Patients with high total ST and high sedentary bout duration had significantly worsened physical function (mean difference 8.73 units, 95\% CI 2.31-15.15; independent of MVPA), social function (mean difference 10.51 units, 95\% CI 2.59-18.44; not independent of MVPA), and PCS (mean difference 2.71 units, 95\% CI 0.36-5.06; not independent of MVPA) than those with low ST and low sedentary bout duration. Conclusions: Greater ST in prolonged periods of any length and a higher frequency of ST bouts, especially in longer bout durations, are associated with worsened HRQoL in women with fibromyalgia. These associations were generally independent of MVPA. ",
doi="10.2196/14538",
url="http://mhealth.jmir.org/2020/3/e14538/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32191211"
}


@Article{info:doi/10.2196/15390,
author="Li, Jing
and Sun, Li
and Wang, Yaogang
and Guo, Lichuan
and Li, Daiqing
and Liu, Chang
and Sun, Ning
and Xu, Zheng
and Li, Shu
and Jiang, Yunwen
and Wang, Yuan
and Zhang, Shunming
and Chen, Liming",
title="A Mobile-Based Intervention for Glycemic Control in Patients With Type 2 Diabetes: Retrospective, Propensity Score-Matched Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Mar",
day="11",
volume="8",
number="3",
pages="e15390",
keywords="mobile health",
keywords="glycemic control",
keywords="type 2 diabetes",
keywords="propensity score matching",
abstract="Background: Mobile-based interventions appear to be promising in ameliorating huge burdens experienced by patients with type 2 diabetes. However, it is unclear how effective mobile-based interventions are in glycemic management of patients with type 2 diabetes based on real-world evidence. Objective: This study aimed to evaluate the effectiveness of a mobile-based intervention on glycemic control in patients with type 2 diabetes based on real-world population data. Methods: This retrospective, propensity score-matched cohort study analyzed longitudinal data from a clinical electronic health database. The study population included 37,913 patients with type 2 diabetes at cohort entry between October 1, 2016, and July 31, 2018. A total of 2400 patients were matched 1:1, using  propensity score matching, into the usual care and mobile health (mHealth) groups. The primary outcomes of glycemic control included control rates of glycated hemoglobin (HbA1c), fasting blood glucose (FBG), and postprandial 2-hour blood glucose (P2BG). Mean values and variation trends of difference with 95\% CI were the secondary outcomes. The general linear model was used to calculate repeated-measures analyses of variance to examine the differences between the two groups. Subgroup and sensitivity analyses were performed. Results: Of the 2400 patients included in the analysis, 1440 (60.00\%) were male and the mean age was 52.24 years (SD 11.56). At baseline, the control rates of HbA1c, FBG, and P2BG in the mHealth and usual care groups were 45.75\% versus 47.00\% (P=.57), 38.03\% versus 32.76\% (P=.07), and 47.32\% versus 47.89\% (P=.83), respectively. At the 3-, 6-, 9-, and 12-month follow-ups, the mHealth group reported higher control rates of HbA1c than did the usual care group: 69.97\% versus 46.06\% (P<.001), 71.89\% versus 61.24\% (P=.004), 75.38\% versus 53.44\% (P<.001), and 72.31\% versus 46.70\% (P<.001), respectively. At the four follow-up sessions, the control rates of FBG in the mHealth and usual care groups were statistically different: 59.24\% versus 34.21\% (P<.001), 56.61\% versus 35.14\% (P<.001), 59.54\% versus 34.99\% (P<.001), and 59.77\% versus 32.83\% (P<.001), respectively. At the four follow-up sessions, the control rates of P2BG in the mHealth group were statistically higher than in the usual care group: 79.72\% versus 48.75\% (P<.001), 80.20\% versus 57.45\% (P<.001), 81.97\% versus 54.07\% (P<.001), and 76.19\% versus 54.21\% (P=.001), respectively. At the four follow-up sessions, the percentages of HbA1c reduction in the mHealth group were 8.66\% (95\% CI 6.69-10.63), 10.60\% (95\% CI 8.66-12.54), 10.64\% (95\% CI 8.70-12.58), and 8.11\% (95\% CI 6.08-10.14), respectively. At the four follow-up sessions, the percentages of P2BG reduction in the mHealth group were 8.44\% (95\% CI 7.41-10.73), 17.77\% (95\% CI 14.98-20.23), 16.23\% (95\% CI 13.05-19.35), and 16.91\% (95\% CI 13.17-19.84), respectively. Starting from the sixth month, the mean HbA1c and P2BG values in the two groups increased slightly. Conclusions: This mobile-based intervention delivered by a multidisciplinary team can better improve glycemic control rates of patients with type 2 diabetes than usual care. These effects were best sustained within the first 6 months. Starting from the sixth month, intensive management needs to be conducted to maintain long-term effectiveness of the mobile-based intervention. ",
doi="10.2196/15390",
url="http://mhealth.jmir.org/2020/3/e15390/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32159518"
}


@Article{info:doi/10.2196/17455,
author="Zhang, Yiyu
and Liu, Chaoyuan
and Luo, Shuoming
and Huang, Jin
and Li, Xia
and Zhou, Zhiguang",
title="Effectiveness of Lilly Connected Care Program (LCCP) App-Based Diabetes Education for Patients With Type 2 Diabetes Treated With Insulin: Retrospective Real-World Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Mar",
day="6",
volume="8",
number="3",
pages="e17455",
keywords="diabetes mellitus",
keywords="mobile app",
keywords="diabetes self-management education",
keywords="glycemic control",
abstract="Background: Diabetes poses heavy economic and social burdens worldwide. Mobile apps show great potential for diabetes self-management education. However, there is limited evidence for the effectiveness of providing general diabetes education through mobile apps. Objective: The aim of this study was to clarify the effectiveness of Lilly Connected Care Program (LCCP) app-based diabetes education for glycemic control. Methods: This retrospective cohort study included patients with diabetes recruited to the LCCP platform from September 1, 2018, to May 31, 2019. Each patient was followed for 12 weeks. According to the number of diabetes education courses they had completed, the patients were divided into the following three groups: group A (0-4 courses), group B (5-29 courses), and group C (?30 courses). The main outcomes were the change in blood glucose at the 12th week compared with baseline and the differences in blood glucose at the 12th week among the three groups. The associations of the number of diabetes education courses completed with the average blood glucose and frequency of self-monitoring of blood glucose (SMBG) at the 12th week were assessed by multivariate linear regression analyses controlling for other confounding covariates. Univariate and multivariate linear regression analyses were used to assess factors influencing patients' engagement in the diabetes education courses. Results: A total of 5011 participants were enrolled. Their mean fasting blood glucose (FBG) and postprandial blood glucose (PBG) were significantly lower at the 12th week than at baseline (FBG, 7.46 [standard deviation (SD) 1.95] vs 7.79 [SD 2.18] mmol/L, P<.001; PBG, 8.94 [SD 2.74] vs 9.53 [SD 2.81] mmol/L, P<.001). The groups that completed more diabetes education courses had lower FBG (group B, $\beta$=?0.14, 95\% CI ?0.26 to ?0.03; group C, $\beta$=?0.29, 95\% CI ?0.41 to ?0.16; P for trend <.001) and PBG (group B, $\beta$=?0.29, 95\% CI ?0.46 to ?0.11; group C, $\beta$=?0.47, 95\% CI ?0.66 to ?0.28; P for trend <.001) and a higher frequency of SMBG at the 12th week (group B, $\beta$=1.17, 95\% CI 0.81-1.53; group C, $\beta$=4.21, 95\% CI 3.81-4.62; P for trend <.001) when compared with the findings in group A. Age and education were related to patients' engagement in the diabetes education courses. Middle-aged patients (35-59 years old) and elderly patients (?60 years old) completed more diabetes education courses (middle-aged group, $\beta$=2.22, P=.01; elderly group, $\beta$=2.42, P=.02) than young patients (18-34 years old). Conclusions: LCCP app-based diabetes education is effective for glycemic control and SMBG behavior improvement in patients with type 2 diabetes receiving insulin therapy. Young patients' engagement in the education courses was relatively low. We need to conduct in-depth interviews with users to further improve the curriculum. ",
doi="10.2196/17455",
url="https://mhealth.jmir.org/2020/3/e17455",
url="http://www.ncbi.nlm.nih.gov/pubmed/32141838"
}


@Article{info:doi/10.2196/17084,
author="Hou, I-Ching
and Lin, Hsin-Yi
and Shen, Shan-Hsiang
and Chang, King-Jen
and Tai, Hao-Chih
and Tsai, Ay-Jen
and Dykes, C. Patricia",
title="Quality of Life of Women After a First Diagnosis of Breast Cancer Using a Self-Management Support mHealth App in Taiwan: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Mar",
day="4",
volume="8",
number="3",
pages="e17084",
keywords="breast cancer",
keywords="mHealth app",
keywords="self-management",
keywords="quality of life",
abstract="Background: There are over 2 million newly diagnosed patients with breast cancer worldwide with more than 10,000 cases in Taiwan each year. During 2017-2018, the National Yang-Ming University, the Taiwan University of Science and Technology, and the Taiwan Breast Cancer Prevention Foundation collaborated to develop a breast cancer self-management support (BCSMS) mHealth app for Taiwanese women with breast cancer. Objective: The aim of this study was to investigate the quality of life (QoL) of women with breast cancer in Taiwan after using the BCSMS app. Methods: After receiving a first diagnosis of breast cancer, women with stage 0 to III breast cancer, who were recruited from social networking sites or referred by their oncologists or oncology case managers, were randomized 1:1 into intervention and control groups. Intervention group subjects used the BCSMS app and the control group subjects received usual care. Two questionnaires---the European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire Core 30 (QLQ-C30) and the EORTC Breast Cancer-Specific Quality-of-Life Questionnaire (QLQ-BR23)---were distributed to subjects in both arms. Paper-based questionnaires were used at baseline; paper-based or Web-based questionnaires were used at 1.5-month and 3-month follow-up evaluations. All evaluations were self-assessed and anonymous, and participants were blinded to their allocation groups. Descriptive analysis, the Pearson chi-square test, analysis of variance, and the generalized estimating equation were used to analyze the data. Missing values, with and without multi-imputation techniques, were used for sensitivity analysis. Results: A total of 112 women were enrolled and randomly allocated to either the experimental group (n=53) or control group (n=59). The follow-up completion rate was 89.3\% (100/112). The demographic data showed homogeneity between the two groups in age (range 50-64 years), breast cancer stage (stage II), marital status (married), working status (employed), and treatment status (receiving treatments). The mean total QoL summary scores from the QLQ-C30 (83.45 vs 82.23, P=.03) and the QLQ-BR23 (65.53 vs 63.13, P=.04) were significantly higher among the experimental group versus the control group, respectively, at 3 months. Conclusions: This research provides support for using a mobile health care app to promote the QoL among women in Taiwan after a first diagnosis of breast cancer. The BCSMS app could be used to support disease self-management, and further evaluation of whether QoL is sustained is warranted. Trial Registration: ClinicalTrials.gov NCT004174248; https://clinicaltrials.gov/ct2/show/NCT04174248 ",
doi="10.2196/17084",
url="http://mhealth.jmir.org/2020/3/e17084/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130181"
}


@Article{info:doi/10.2196/16831,
author="Kristjansdottir, Birna Ol{\"o}f
and B{\o}r{\o}sund, Elin
and Westeng, Marianne
and Ruland, Cornelia
and Stenberg, Una
and Zangi, A. Heidi
and Stange, Kurt
and Mirkovic, Jelena",
title="Mobile App to Help People With Chronic Illness Reflect on Their Strengths: Formative Evaluation and Usability Testing",
journal="JMIR Form Res",
year="2020",
month="Mar",
day="4",
volume="4",
number="3",
pages="e16831",
keywords="mobile app",
keywords="self-management",
keywords="strengths",
keywords="chronic illness",
keywords="rheumatology",
keywords="usability",
keywords="formative evaluation",
abstract="Background: Supporting patient engagement and empowerment is increasingly seen as essential in providing person-centered health care to people with chronic illness. Mobile apps helping patients reflect on their concerns as preparation for consultations with their health care providers can have beneficial effects on the consultation quality. However, apps focusing on empowerment and personal strengths are still scarce. Objective: This study aimed to (1) develop a mobile app to support patients with rheumatic diseases in reflecting on their strengths in preparation for consultations with health care providers and (2) explore patients' perceived usability of the app in a nonclinical test setting. Methods: A prototype app was developed based on input from patients and health care providers, as reported in previous studies. The app was designed for use in self-management support settings aiming to promote awareness of strengths and to focus attention on strengths in the patient-health care provider dialogue. The features included in the prototype were as follows: (1) introduction to the topic of strengths, (2) list of examples of strengths to promote reflection and registration of own strengths, (3) summary of registered strengths, (4) value-based goal setting, (5) linking of strengths to goals, (6) summary of all registrations, and (7) options to share summary digitally or as a print version. In this study, the app was refined through a formative evaluation with patients and health care providers recruited from a specialized rheumatology hospital unit. Patients' perceptions of the app's usability were explored in a test setting with self-report measurements and semistructured interviews. The interviews were audiotaped, transcribed, and analyzed with directed content analysis. Data from questionnaires were analyzed with descriptive statistics. Results: Developmental and formative evaluation included 18 patients and 7 health care providers. The evaluation resulted in minor adjustments to the prototype but no major changes in features. The usability testing included 12 patients. All participants found the usability acceptable; the median score on the System Usability Scale was 86.3 (range 70-100). All reported that it was meaningful and relevant to use the app. Out of 12 participants, 9 (75\%) reported becoming more aware of their own strengths by using the app; 1 (8\%) disagreed and 2 (17\%) provided a neutral response. The results on the goal-related feature were mixed, with half of the patients finding it useful to link strengths to concrete goals. A statistically significant positive change from pre- to postintervention was identified on measures of self-efficacy and negative emotions. Conclusions: In this formative evaluation of a mobile app to promote patients' reflections on their strengths, patients perceived the app as meaningful and supporting awareness. The results suggest the usefulness of building in functionality to support use of strengths and goal attainment. Further studies on efficacy and usability in a clinical setting, including health care providers, are needed. ",
doi="10.2196/16831",
url="https://formative.jmir.org/2020/3/e16831",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130126"
}


@Article{info:doi/10.2196/16665,
author="Young, M. Heather
and Miyamoto, Sheridan
and Dharmar, Madan
and Tang-Feldman, Yajarayma",
title="Nurse Coaching and Mobile Health Compared With Usual Care to Improve Diabetes Self-Efficacy for Persons With Type 2 Diabetes: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Mar",
day="2",
volume="8",
number="3",
pages="e16665",
keywords="mHealth",
keywords="electronic health record",
keywords="type 2 diabetes",
keywords="motivational interviewing",
abstract="Background: Type 2 diabetes is a growing public health problem amenable to prevention and health promotion. As healthy behaviors have an impact on disease outcomes, approaches to support and sustain diabetes self-management are vital. Objective: This study aimed to evaluate the effectiveness of a nurse coaching program using motivational interviewing paired with mobile health (mHealth) technology on diabetes self-efficacy and self-management for persons with type 2 diabetes. Methods: This randomized controlled trial compared usual care with an intervention that entailed nurse health coaching and mHealth technology to track patient-generated health data and integrate these data into an electronic health record. The inclusion criteria were as follows: (1) enrolled at 1 of 3 primary care clinics, (2) aged 18 years or above, (3) living with type 2 diabetes, and (4) English-speaking. We collected outcome measures at baseline, 3 months, and 9 months. The primary outcome was diabetes self-efficacy; secondary outcomes were depressive symptoms, perceived stress, physical functioning, and emotional distress and anxiety. Linear regression mixed modeling estimated the population trends and individual differences in change. Results: We enrolled 319 participants; 287 participants completed the study (155 control and 132 intervention). The participants in the intervention group had significant improvements in diabetes self-efficacy (Diabetes Empowerment Scale, 0.34; 95\% CI --0.15,0.53; P<.01) and a decrease in depressive symptoms compared with usual care at 3 months (Patient Health Questionnaire-9; 0.89; 95\% CI 0.01-1.77; P=.05), with no differences in the other outcomes. The differences in self-efficacy and depression scores between the 2 arms at 9 months were not sustained. The participants in the intervention group demonstrated a significant increase in physical activity (from 23,770 steps per week to 39,167 steps per week at 3 months and 32,601 per week at 9 months). Conclusions: We demonstrated the short-term effectiveness of this intervention; however, by 9 months, although physical activity remained above the baseline, the improvements in self-efficacy were not sustained. Further research should evaluate the minimum dose of coaching required to continue progress after active intervention and the potential of technology to provide effective ongoing automated reinforcement for behavior change. Trial Registration: ClinicalTrials.gov NCT02672176; https://clinicaltrials.gov/ct2/show/NCT02672176 ",
doi="10.2196/16665",
url="https://mhealth.jmir.org/2020/3/e16665",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130184"
}


@Article{info:doi/10.2196/16266,
author="Yang, Yeoree
and Lee, Young Eun
and Kim, Hun-Sung
and Lee, Seung-Hwan
and Yoon, Kun-Ho
and Cho, Jae-Hyoung",
title="Effect of a Mobile Phone--Based Glucose-Monitoring and Feedback System for Type 2 Diabetes Management in Multiple Primary Care Clinic Settings: Cluster Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Feb",
day="26",
volume="8",
number="2",
pages="e16266",
keywords="diabetes mellitus, type 2",
keywords="primary care",
keywords="mHealth",
keywords="telehealth",
abstract="Background: Recent evidence of the effectiveness of mobile phone--based diabetes management systems is generally based on studies conducted in tertiary hospitals or professional diabetes clinics. Objective: This study aimed to evaluate the clinical efficacy and applicability of a mobile phone--based glucose-monitoring and feedback system for the management of type 2 diabetes mellitus (T2DM) in multiple primary care clinic settings. Methods: In this multicenter, cluster-randomized controlled, open trial, 13 primary care clinics in Seoul and other large cities in South Korea were voluntarily recruited. Overall, 150 (9 clinics) and 97 (4 clinics) participants with T2DM were assigned to the intervention and control groups, respectively (2:1 allocation). Every month, participants in both groups attended face-to-face physicians' consultation for the management of diabetes in the clinic. For the intervention group, participants were required to upload their daily self-monitoring of blood glucose (SMBG) results using the mobile phone app in addition to outpatient care for 3 months. The results were automatically transmitted to the main server. Physicians had to check their patients' SMBG results through an administrator's website and send a short feedback message at least once a week. At baseline and 3 months, both groups had anthropometry and blood tests, including hemoglobin A1c (HbA1c), and responded to questionnaires about treatment satisfaction and compliance. Results: At 3 months, participants in the intervention group showed significantly more improvement in HbA1c (adjusted mean difference to control ?0.30\%, 95\% CI ?0.50 to ?0.11; P=.003) and fasting plasma glucose (?17.29 mg/dL, 95\% CI ?29.33 to ?5.26; P=.005) than those in the control group. In addition, there was significantly more reduction in blood pressure, and the score regarding treatment satisfaction and motivation for medication adherence increased more in the intervention group than in the control group. In the subgroup analyses, the effect on glycemic control was more significant among younger patients and higher baseline HbA1c levels. Conclusions: The mobile phone--based glucose-monitoring and feedback system was effective in glycemic control when applied in primary care clinic settings. This system could be utilized effectively with diverse institutions and patients. Trial Registration: Clinical Research Information Service (CRIS) https://tinyurl.com/tgqawbz ",
doi="10.2196/16266",
url="http://mhealth.jmir.org/2020/2/e16266/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130172"
}


@Article{info:doi/10.2196/14466,
author="Duan, Huilong
and Wang, Zheyu
and Ji, Yumeng
and Ma, Li
and Liu, Fang
and Chi, Mingwei
and Deng, Ning
and An, Jiye",
title="Using Goal-Directed Design to Create a Mobile Health App to Improve Patient Compliance With Hypertension Self-Management: Development and Deployment",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Feb",
day="25",
volume="8",
number="2",
pages="e14466",
keywords="goal-directed design",
keywords="smartphone",
keywords="mobile health",
keywords="patients",
keywords="hypertension self-management",
keywords="mobile phone",
abstract="Background: Hypertension is a lifestyle-induced chronic disease that threatens the lives of patients. Control of hypertension requires patients to follow self-management regimes; unfortunately, however, patient compliance with hypertension self-management is low, especially in developing countries. Improvement of patient compliance is premised on meeting patient needs. Mobile health apps are becoming increasingly popular for self-management of chronic diseases. However, few mobile apps have been designed to meet patient needs for hypertension self-management. Objective: The goal of this study was to develop a mobile health app to improve patient compliance with hypertension self-management and evaluate the effectiveness of the app in terms of patient compliance. Methods: The goal-directed design method was applied to guide study design. We divided the study into 4 stages. Stages 1 to 3 comprised the development process. To improve the applicability of the goal-directed design method to chronic disease management, we extracted elements of user models concerned with patient compliance and defined a concrete process for user modeling. In stage 1, personas of hypertensive patients were built using qualitative and quantitative methods. Clustering methods based on questionnaire responses were used to group patients. Qualitative interviews were conducted to identify the needs of different groups. In stage 2, several functional modules were designed to meet the needs of different groups based on the results from stage 1. In stage 3, prototypes of functional modules were designed and implemented as a real app. Stage 4 was the deployment process, in which we conducted a pilot study to investigate patient compliance after using the app. Patient compliance was calculated through the frequency with which they took blood pressure measurements. In addition, qualitative interviews were conducted to learn the underlying reasons for the compliance results. Results: In stage 1, patients were divided into 3 groups based on 82 valid questionnaire responses. Eighteen patients from the different groups (7, 5, and 6 patients) were interviewed, and the needs of the groups were summarized as follows: improve self-management ability, enhance self-management motivation, and receive self-management support. In stages 2 and 3, 6 functional modules were designed and implemented based on specified needs, and the usability of the app was improved through usability tests. In stage 4, 143 patients were recruited to use different versions of the app for 2 months. Results show that patient compliance improved as functional modules were added (P<.001) and was maintained at a high level (rate of 0.73). Interview results from 32 patients show that the design of the app met different needs; thus, patients were more compliant with it. Conclusions: This study developed a mobile health app for hypertension self-management using the goal-directed design method. The app proved to be effective for improving patient compliance with hypertension self-management. ",
doi="10.2196/14466",
url="http://mhealth.jmir.org/2020/2/e14466/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130161"
}


@Article{info:doi/10.2196/16767,
author="Bastl, Katharina
and Bastl, Maximilian
and Bergmann, Karl-Christian
and Berger, Markus
and Berger, Uwe",
title="Translating the Burden of Pollen Allergy Into Numbers Using Electronically Generated Symptom Data From the Patient's Hayfever Diary in Austria and Germany: 10-Year Observational Study",
journal="J Med Internet Res",
year="2020",
month="Feb",
day="21",
volume="22",
number="2",
pages="e16767",
keywords="symptom data",
keywords="Patient's Hayfever Diary",
keywords="pollen allergy",
keywords="symptom score calculation",
abstract="Background: Pollen allergies affect a significant proportion of the population globally. At present, Web-based tools such as pollen diaries and mobile apps allow for easy and fast documentation of allergic symptoms via the internet. Objective: This study aimed to characterize the users of the Patient's Hayfever Diary (PHD), a Web-based platform and mobile app, to apply different symptom score calculations for comparison, and to evaluate the contribution of organs and medications to the total score for the first time. Methods: The PHD users were filtered with regard to their location in Austria and Germany, significant positive correlation to the respective pollen type (birch/grass), and at least 15 entries in the respective season. Furthermore, 4 different symptom score calculation methods were applied to the datasets from 2009 until 2018, of which 2 were raw symptom scores and 2 were symptom load index (normalized) calculations. Pearson correlation coefficients were calculated pairwise for these 4 symptom score calculations. Results: Users were mostly male and belonged to the age groups of 21 to 40 years or >40 years. User numbers have increased in the last 5 years, especially when mobile apps were made available. The Pearson correlation coefficients showed a significant linear relationship above 0.9 among the 4 symptom score datasets and thus indicated no significant difference between the different methods of symptom score calculation. The nose contributed the most to the symptom score and determined about 40\% of the score. Conclusions: The exact method of calculation of the symptom score is not critical. All computation methods show the same behavior (increase/decrease during the season). Therefore, the symptom load index is a useful computation method in all fields exploring pollen allergy, and Web-based diaries are a globally applicable tool to monitor the effect of pollen on human health via electronically generated symptom data. ",
doi="10.2196/16767",
url="http://www.jmir.org/2020/2/e16767/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130130"
}


@Article{info:doi/10.2196/16105,
author="Stone, A. Arthur
and Wen, Fred Cheng K.
and Schneider, Stefan
and Junghaenel, U. Doerte",
title="Evaluating the Effect of Daily Diary Instructional Phrases on Respondents' Recall Time Frames: Survey Experiment",
journal="J Med Internet Res",
year="2020",
month="Feb",
day="21",
volume="22",
number="2",
pages="e16105",
keywords="end-of-day dairy",
keywords="daily diary study",
keywords="recall time frame",
abstract="Background: Daily diaries are extensively used for examining participants' daily experience in behavioral and medical science. However, little attention is paid to whether participants recall their experiences within the time frames prescribed by the task. Objective: This study aimed to describe survey respondents' self-reported recall time frames and to evaluate the impact of different daily diary items on respondents' reported affective states. Methods: In this study, 577 participants completed a mood survey with one of the following 4 time frame instructions: (1) today, (2) since waking up today, (3) during the last 24 hours, or (4) in the last day. They were also asked to indicate the periods they considered when answering these items and to recall the instructional phrases associated with the items. Results: Almost all participants in the today (141/146, 96.6\%) and since waking up today (136/145, 93.8\%) conditions reported using periods consistent with our expectations, whereas a lower proportion was observed in the during the last 24 hours (100/145, 69.0\%) condition. A diverse range of responses was observed in the in the last day condition. Furthermore, the instructions influenced the levels of some self-reported affects, although exploratory analyses were not able to identify the mechanism underlying this finding. Conclusions: Overall, these results indicate that today and since waking up today are the most effective instructional phrases for inquiring about daily experience and that investigators should use caution when using the other 2 instructional phrases. ",
doi="10.2196/16105",
url="http://www.jmir.org/2020/2/e16105/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130129"
}


@Article{info:doi/10.2196/15364,
author="Huang, Zhilian
and Lum, Elaine
and Car, Josip",
title="Medication Management Apps for Diabetes: Systematic Assessment of the Transparency and Reliability of Health Information Dissemination",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Feb",
day="19",
volume="8",
number="2",
pages="e15364",
keywords="health apps",
keywords="digital health",
keywords="diabetes",
keywords="privacy",
keywords="evidence-based guidance",
abstract="Background: Smartphone apps are increasingly used for diabetes self-management because of their ubiquity and ability to help users to personalize health care management. The number of diabetes apps has proliferated in recent years, but only a small subset of apps that pose a higher risk are regulated by governmental agencies. The transparency and reliability of information sources are unclear for apps that provide health care advice and are not regulated by governmental agencies. Objective: This study aimed to assess the transparency and reliability of information disseminated via diabetes apps against 8 criteria adapted from the Health On the Net code of conduct (HONcode) principles. Methods: English-language diabetes-related terms were searched on a market explorer (42matters) on June 12, 2018. Apps with medication and blood glucose management features were downloaded and evaluated against the App-HONcode criteria adapted from the 8 HONcode principles: authoritative, complementarity, privacy, attribution, justifiability, transparency, financial disclosure, and advertising policy. Apps were profiled by operating platforms (ie, Android and iOS) and the number of downloads (ie, Android only: ?100,000 downloads and <100,000 downloads). Results: A total of 143 apps (81 Android and 62 iOS) were downloaded and assessed against the adapted App-HONcode criteria. Most of the apps on the Android and iOS platforms fulfilled between 2 and 6 criteria, but few (20/143, 14.0\%) apps mentioned the qualifications of individuals who contributed to app development. Less than half (59/143, 39.2\%) of the apps disclaimed that the information provided or app functions do not replace the advice of the health care provider. A higher proportion of iOS apps fulfilled 5 or more App-HONcode criteria compared with Android apps. However, Android apps were more likely to have the developer's email listed on the app store (Android: 75/81, 98\%; and iOS: 52/62, 84\%; P=.005) compared with iOS apps. Of the Android apps assessed, a significantly higher proportion of highly downloaded apps had a privacy and confidentiality clause (high downloads: 15/17, 88\%; and low downloads: 33/64, 52\%; P=.006) and were more likely to discuss their financial sources (high downloads: 14/17, 82\%; and low downloads: 32/64, 50\%; P=.03) compared with apps with a low number of downloads. Conclusions: Gaps in the disclosure of the developer's qualification, funding source, and the complementary role of the app in disease management were identified. App stores, developers, and medical providers should collaborate to close these gaps and provide more transparency and reliability to app users. Future work can further examine the consent-seeking process for data collection, data management policies, the appropriateness of advertising content, and clarity of privacy clause of these apps. ",
doi="10.2196/15364",
url="http://mhealth.jmir.org/2020/2/e15364/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130163"
}


@Article{info:doi/10.2196/15105,
author="Seppen, F. Bart
and L'ami, J. Merel
and Duarte dos Santos Rico, Sharon
and ter Wee, M. Marieke
and Turkstra, Franktien
and Roorda, D. Leo
and Catarinella, S. Fabio
and van Schaardenburg, Dirkjan
and Nurmohamed, T. Michael
and Boers, Maarten
and Bos, H. Wouter",
title="A Smartphone App for Self-Monitoring of Rheumatoid Arthritis Disease Activity to Assist Patient-Initiated Care: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2020",
month="Feb",
day="19",
volume="9",
number="2",
pages="e15105",
keywords="smartphone app",
keywords="telemonitoring",
keywords="rheumatoid arthritis",
abstract="Background: Telemedicine based on self-measurement of disease activity could be one of the key components to create the health care system of the future. Previous publications in various medical fields have shown that it is possible to safely telemonitor patients while reducing the number of outpatient clinic visits. For this purpose, we developed a mobile phone app for patients with rheumatoid arthritis (RA), which allows them to self-monitor their disease. Objective: The objective of this study is to assess the safety and efficacy of self-initiated care assisted by a smartphone app in patients with RA. Methods: This is a randomized controlled trial that will be performed for 1 year. A total of 176 patients with RA will be randomized to either self-initiated care with only one scheduled follow-up consultation assisted by our app or usual care. The coprimary outcome measures are the number of outpatient clinic consultations with a rheumatologist taking place during the trial period and the mean disease activity score as measured by the disease activity score 28 (DAS28) at 12 months. The secondary outcomes are patient satisfaction, adherence, patient empowerment, and cost evaluation of health care assisted by the app. Results: Recruitment started in May 2019, and up to 18 months will be required for completion of recruitment. Thus far, 78 patients have been randomized, and thus far, experiences with the app have been positive. The study results are expected to be published by the end of 2021. Conclusions: The completion of this study will provide important data regarding the following: (1) safety of self-initiated care supported by a smartphone app in terms of DAS28 and (2) efficacy of lowering health care usage with this new strategy of providing health care. Trial Registration: Netherlands Trial Register NL7715; https://www.trialregister.nl/trial/7715 International Registered Report Identifier (IRRID): DERR1-10.2196/15105 ",
doi="10.2196/15105",
url="http://www.researchprotocols.org/2020/2/e15105/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130182"
}


@Article{info:doi/10.2196/14694,
author="{\O}ksnebjerg, Laila
and Woods, Bob
and Ruth, Kathrine
and Lauridsen, Annette
and Kristiansen, Susanne
and Holst, Dalsgaard Helle
and Waldemar, Gunhild",
title="A Tablet App Supporting Self-Management for People With Dementia: Explorative Study of Adoption and Use Patterns",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jan",
day="17",
volume="8",
number="1",
pages="e14694",
keywords="dementia",
keywords="technology",
keywords="information technology",
keywords="self-help devices",
keywords="app",
keywords="self-management",
keywords="rehabilitation",
keywords="memory",
keywords="caregivers",
abstract="Background: Assistive technology (AT) is rapidly emerging within dementia care and support. One area of AT application is support of people with dementia in compensating for cognitive symptoms and thereby promoting their self-management. There is, however, little evidence for the applicability, usability, and effectiveness of AT for people with dementia, and there is a need to identify factors that can promote adoption. Objective: This study aimed to (1) evaluate the applicability and usability of an app, tailor-made for people with dementia; (2) explore factors affecting adoption; (3) explore the possible influence of caregiver involvement; and (4) contribute to process evaluation of the intervention. Methods: The ReACT (Rehabilitation in Alzheimer's disease using Cognitive support Technology) app was designed as a holistic solution to support memory and structure in daily living. Persons with dementia had access to a personal user account, and family caregivers were given a parallel login. Written and Web-based materials were provided to support self-applied implementation. A mixed methods design was applied to explore adoption and use patterns, including background and disease-related data, qualitative data from a survey, and log data. Adoption was defined as the use of the app over a period of ?90 days. Results: Data from 112 participants and 98 caregivers were included. Shorter time from diagnosis (U=595; P=.046; r=0.19) and caregiver activating the app (P=.02) had a significant impact on the participant adoption status. Logistic regression analysis showed that if caregivers had activated the app, the participant was five times more likely to become an adopter (odds ratio 5.1, 95\% CI 1.29-19.99; P=.02). However, the overall predictive power was low, and there was a wide variation in background and disease-related characteristics among adopters. The level of experience and skills in tablet use were not significantly different between adopters and nonadopters. Adopters generally rated the app high on usefulness, satisfaction, and ease of use (rated on the USEdem questionnaire). Their scores were significantly higher compared with nonadopters (U=5.5; P=.02; r=0.64). Analysis of use patterns showed that all functionalities of the app were used among adopters. Conclusions: For participants who became adopters, the ReACT app and the methods for self-applied implementation were applicable. However, the results were also in accordance with the well-known challenges of nonadoption and nonadherence to digital health interventions. The study provided insight into the importance of timely introduction and caregiver support for adoption of AT among people with dementia. It also underlined the high complexity of personal and contextual factors that influence adoption. These complex factors need to be considered when designing and implementing AT for people with dementia. ",
doi="10.2196/14694",
url="https://mhealth.jmir.org/2020/1/e14694",
url="http://www.ncbi.nlm.nih.gov/pubmed/31951217"
}


@Article{info:doi/10.2196/15188,
author="Goodday, M. Sarah
and Atkinson, Lauren
and Goodwin, Guy
and Saunders, Kate
and South, Matthew
and Mackay, Clare
and Denis, Mike
and Hinds, Chris
and Attenburrow, Mary-Jane
and Davies, Jim
and Welch, James
and Stevens, William
and Mansfield, Karen
and Suvilehto, Juulia
and Geddes, John",
title="The True Colours Remote Symptom Monitoring System: A Decade of Evolution",
journal="J Med Internet Res",
year="2020",
month="Jan",
day="15",
volume="22",
number="1",
pages="e15188",
keywords="symptom assessment",
keywords="signs and symptoms",
keywords="digital health",
keywords="ecological momentary assessment",
keywords="mood disorders",
doi="10.2196/15188",
url="https://www.jmir.org/2020/1/e15188",
url="http://www.ncbi.nlm.nih.gov/pubmed/31939746"
}


@Article{info:doi/10.2196/16211,
author="Parks, C. Acacia
and Williams, L. Allison
and Kackloudis, M. Gina
and Stafford, L. Julia
and Boucher, M. Eliane
and Honomichl, D. Ryan",
title="The Effects of a Digital Well-Being Intervention on Patients With Chronic Conditions: Observational Study",
journal="J Med Internet Res",
year="2020",
month="Jan",
day="10",
volume="22",
number="1",
pages="e16211",
keywords="chronic illness",
keywords="happiness",
keywords="subjective well-being",
keywords="psychology, positive",
keywords="internet-based intervention",
keywords="mobile apps",
abstract="Background: Chronic conditions account for 75\% of health care costs, and the impact of chronic illness is expected to grow over time. Although subjective well-being predicts better health outcomes, people with chronic conditions tend to report lower well-being. Improving well-being might mitigate costs associated with chronic illness; however, existing interventions can be difficult to access and draw from a single theoretical approach. Happify, a digital well-being intervention program drawing from multiple theoretical traditions to target well-being, has already been established as an efficacious means of improving well-being in both distressed and nondistressed users. Objective: This study aimed to compare change in well-being over time after using Happify for users with and without a chronic condition. Methods: Data were obtained from Happify users, a publicly available digital well-being program accessible via website or mobile phone app. Users work on tracks addressing a specific issue (eg, conquering negative thoughts) composed of games and activities based on positive psychology, cognitive behavioral therapy, and mindfulness principles. The sample included 821 users receiving at least 6 weeks' exposure to Happify (ranging from 42 to 179 days) who met other inclusion criteria. As part of a baseline questionnaire, respondents reported demographic information (age and gender) and whether they had any of the prespecified chronic conditions: arthritis, diabetes, insomnia, multiple sclerosis, chronic pain, psoriasis, eczema, or some other condition (450 reported a chronic condition, whereas 371 did not). Subjective well-being was assessed with the Happify Scale, a 9-item measure of positive emotionality and life satisfaction. To evaluate changes in well-being over time, a mixed effects linear regression model was fit for subjective well-being, controlling for demographics and platform usage. Results: At baseline, users with a chronic condition had significantly lower subjective well-being (mean 38.34, SD 17.40) than users without a chronic condition (mean 43.65, SD 19.13). However, change trajectories for users with or without a chronic condition were not significantly different; both groups experienced equivalent improvements in well-being. We also found an effect for time from baseline (b=0.071; SE=0.010; P<.01) and number of activities completed (b=0.03; SE=0.009; P<.01), and a 2-way interaction between number of activities completed and time from baseline (b=0.0002; SE=0.00006; P<.01), such that completing more activities and doing so over increasingly longer periods produced improved well-being scores. Conclusions: Data from this study support the conclusion that users with a chronic condition experienced significant improvement over time. Despite reporting lower subjective well-being on the whole, their change trajectory while using Happify was equivalent to those without a chronic condition. Consistent with past research, users who completed more activities over a longer period showed the most improvement. In short, the presence of a chronic condition did not prevent users from showing improved well-being when using Happify. ",
doi="10.2196/16211",
url="https://www.jmir.org/2020/1/e16211",
url="http://www.ncbi.nlm.nih.gov/pubmed/31922491"
}


@Article{info:doi/10.2196/15058,
author="Gumley, Andrew
and Bradstreet, Simon
and Ainsworth, John
and Allan, Stephanie
and Alvarez-Jimenez, Mario
and Beattie, Louise
and Bell, Imogen
and Birchwood, Max
and Briggs, Andrew
and Bucci, Sandra
and Castagnini, Emily
and Clark, Andrea
and Cotton, M. Sue
and Engel, Lidia
and French, Paul
and Lederman, Reeva
and Lewis, Shon
and Machin, Matthew
and MacLennan, Graeme
and Matrunola, Claire
and McLeod, Hamish
and McMeekin, Nicola
and Mihalopoulos, Cathrine
and Morton, Emma
and Norrie, John
and Reilly, Frank
and Schwannauer, Matthias
and Singh, P. Swaran
and Smith, Lesley
and Sundram, Suresh
and Thomson, David
and Thompson, Andrew
and Whitehill, Helen
and Wilson-Kay, Alison
and Williams, Christopher
and Yung, Alison
and Farhall, John
and Gleeson, John",
title="Early Signs Monitoring to Prevent Relapse in Psychosis and Promote Well-Being, Engagement, and Recovery: Protocol for a Feasibility Cluster Randomized Controlled Trial Harnessing Mobile Phone Technology Blended With Peer Support",
journal="JMIR Res Protoc",
year="2020",
month="Jan",
day="9",
volume="9",
number="1",
pages="e15058",
keywords="schizophrenia",
keywords="psychosis",
keywords="relapse",
keywords="mHealth",
keywords="randomized controlled trial",
abstract="Background: Relapse in schizophrenia is a major cause of distress and disability and is predicted by changes in symptoms such as anxiety, depression, and suspiciousness (early warning signs [EWSs]). These can be used as the basis for timely interventions to prevent relapse. However, there is considerable uncertainty regarding the implementation of EWS interventions. Objective: This study was designed to establish the feasibility of conducting a definitive cluster randomized controlled trial comparing Early signs Monitoring to Prevent relapse in psychosis and prOmote Well-being, Engagement, and Recovery (EMPOWER) against treatment as usual (TAU). Our primary outcomes are establishing parameters of feasibility, acceptability, usability, safety, and outcome signals of a digital health intervention as an adjunct to usual care that is deliverable in the UK National Health Service and Australian community mental health service (CMHS) settings. We will assess the feasibility of candidate primary outcomes, candidate secondary outcomes, and candidate mechanisms for a definitive trial. Methods: We will randomize CMHSs to EMPOWER or TAU. We aim to recruit up to 120 service user participants from 8 CMHSs and follow them for 12 months. Eligible service users will (1) be aged 16 years and above, (2) be in contact with local CMHSs, (3) have either been admitted to a psychiatric inpatient service or received crisis intervention at least once in the previous 2 years for a relapse, and (4) have an International Classification of Diseases-10 diagnosis of a schizophrenia-related disorder. Service users will also be invited to nominate a carer to participate. We will identify the feasibility of the main trial in terms of recruitment and retention to the study and the acceptability, usability, safety, and outcome signals of the EMPOWER intervention. EMPOWER is a mobile phone app that enables the monitoring of well-being and possible EWSs of relapse on a daily basis. An algorithm calculates changes in well-being based on participants' own baseline to enable tailoring of well-being messaging and clinical triage of possible EWSs. Use of the app is blended with ongoing peer support. Results: Recruitment to the trial began September 2018, and follow-up of participants was completed in July 2019. Data collection is continuing. The database was locked in July 2019, followed by analysis and disclosing of group allocation. Conclusions: The knowledge gained from the study will inform the design of a definitive trial including finalizing the delivery of our digital health intervention, sample size estimation, methods to ensure successful identification, consent, randomization, and follow-up of participants, and the primary and secondary outcomes. The trial will also inform the final health economic model to be applied in the main trial. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 99559262; http://isrctn.com/ISRCTN99559262 International Registered Report Identifier (IRRID): DERR1-10.2196/15058 ",
doi="10.2196/15058",
url="https://www.researchprotocols.org/2020/1/e15058",
url="http://www.ncbi.nlm.nih.gov/pubmed/31917372"
}


@Article{info:doi/10.2196/14939,
author="Quaedackers, Laury
and De Wit, Jan
and Pillen, Sigrid
and Van Gilst, Merel
and Batalas, Nikolaos
and Lammers, Jan Gert
and Markopoulos, Panos
and Overeem, Sebastiaan",
title="A Mobile App for Longterm Monitoring of Narcolepsy Symptoms: Design, Development, and Evaluation",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jan",
day="7",
volume="8",
number="1",
pages="e14939",
keywords="outcome measure",
keywords="hypersomnia",
keywords="patient-related outcome measure",
keywords="PROM",
keywords="mHealth",
keywords="symptom monitoring",
abstract="Background: Narcolepsy is a chronic sleep disorder with a broad variety of symptoms. Although narcolepsy is primarily characterized by excessive daytime sleepiness and cataplexy (loss of muscle control triggered by emotions), patients may suffer from hypnagogic hallucinations, sleep paralysis, and fragmented night sleep. However, the spectrum of narcolepsy also includes symptoms not related to sleep, such as cognitive or psychiatric problems. Symptoms vary greatly among patients and day-to-day variance can be considerable. Available narcolepsy questionnaires do not cover the whole symptom spectrum and may not capture symptom variability. Therefore, there is a clinical need for tools to monitor narcolepsy symptoms over time to evaluate their burden and the effect of treatment. Objective: This study aimed to describe the design, development, implementation, and evaluation of the Narcolepsy Monitor, a companion app for long-term symptom monitoring in narcolepsy patients. Methods: After several iterations during which content, interaction design, data management, and security were critically evaluated, a complete version of the app was built. The Narcolepsy Monitor allows patients to report a broad spectrum of experienced symptoms and rate their severity based on the level of burden that each symptom imposes. The app emphasizes the reporting of changes in relative severity of the symptoms. A total of 7 patients with narcolepsy were recruited and asked to use the app for 30 days. Evaluation was done by using in-depth interviews and user experience questionnaire. Results: We designed and developed a final version of the Narcolepsy Monitor after which user evaluation took place. Patients used the app on an average of 45.3 (SD 19.2) days. The app was opened on 35\% of those days. Daytime sleepiness was the most dynamic symptom, with a mean number of changes of 5.5 (SD 3.7) per month, in contrast to feelings of anxiety or panic, which was only moved 0.3 (SD 0.7) times per month. Mean symptom scores were highest for daytime sleepiness (1.8 [SD 1.0]), followed by lack of energy (1.6 [SD 1.4]) and often awake at night (1.5 [SD 1.0]). The personal in-depth interviews revealed 3 major themes: (1) reasons to use, (2) usability, and (3) features. Overall, patients appreciated the concept of ranking symptoms on subjective burden and found the app easy to use. Conclusions: The Narcolepsy Monitor appears to be a helpful tool to gain more insight into the individual burden of narcolepsy symptoms over time and may serve as a patient-reported outcome measure for this debilitating disorder. ",
doi="10.2196/14939",
url="https://mhealth.jmir.org/2020/1/e14939",
url="http://www.ncbi.nlm.nih.gov/pubmed/31909723"
}


@Article{info:doi/10.2196/13433,
author="Garcia-Gancedo, Luis
and Kelly, L. Madeline
and Lavrov, Arseniy
and Parr, Jim
and Hart, Rob
and Marsden, Rachael
and Turner, R. Martin
and Talbot, Kevin
and Chiwera, Theresa
and Shaw, E. Christopher
and Al-Chalabi, Ammar",
title="Objectively Monitoring Amyotrophic Lateral Sclerosis Patient Symptoms During Clinical Trials With Sensors: Observational Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Dec",
day="20",
volume="7",
number="12",
pages="e13433",
keywords="amyotrophic lateral sclerosis",
keywords="objective symptom monitoring",
keywords="clinical trial",
keywords="physical activity",
keywords="digital phenotyping",
keywords="digital biomarker",
keywords="heart rate",
keywords="speech",
keywords="accelerometer",
keywords="wearable",
abstract="Background: Objective symptom monitoring of patients with Amyotrophic Lateral Sclerosis (ALS) has the potential to provide an important source of information to evaluate the impact of the disease on aspects of real-world functional capacity and activities of daily living in the home setting, providing useful objective outcome measures for clinical trials. Objective: This study aimed to investigate the feasibility of a novel digital platform for remote data collection of multiple symptoms---physical activity, heart rate variability (HRV), and digital speech characteristics---in 25 patients with ALS in an observational clinical trial setting to explore the impact of the devices on patients' everyday life and to record tolerability related to the devices and study procedures over 48 weeks. Methods: In this exploratory, noncontrolled, nondrug study, patients attended a clinical site visit every 3 months to perform activity reference tasks while wearing a sensor, to conduct digital speech tests and for conventional ALS monitoring. In addition, patients wore the sensor in their daily life for approximately 3 days every month for the duration of the study. Results: The amount and quality of digital speech data captured at the clinical sites were as intended, and there were no significant issues. All the home monitoring sensor data available were propagated through the system and were received as expected. However, the amount and quality of physical activity home monitoring data were lower than anticipated. A total of 3 or more days (or partial days) of data were recorded for 65\% of protocol time points, with no data collected for 24\% of time points. At baseline, 24 of 25 patients provided data, reduced to 13 of 18 patients at Week 48. Lower-than-expected quality HRV data were obtained, likely because of poor contact between the sensor and the skin. In total, 6 of 25 patients had mild or moderate adverse events (AEs) in the skin and subcutaneous tissue disorders category because of skin irritation caused by the electrode patch. There were no reports of serious AEs or deaths. Most patients found the sensor comfortable, with no or minimal impact on daily activities. Conclusions: The platform can measure physical activity in patients with ALS in their home environment; patients used the equipment successfully, and it was generally well tolerated. The quantity of home monitoring physical activity data was lower than expected, although it was sufficient to allow investigation of novel physical activity end points. Good-quality in-clinic speech data were successfully captured for analysis. Future studies using objective patient monitoring approaches, combined with the most current technological advances, may be useful to elucidate novel digital biomarkers of disease progression. ",
doi="10.2196/13433",
url="https://mhealth.jmir.org/2019/12/e13433",
url="http://www.ncbi.nlm.nih.gov/pubmed/31859676"
}


@Article{info:doi/10.2196/15045,
author="Herkert, Cyrille
and Kraal, Johannes Jos
and van Loon, Agnes Eline Maria
and van Hooff, Martijn
and Kemps, Clemens Hareld Marijn",
title="Usefulness of Modern Activity Trackers for Monitoring Exercise Behavior in Chronic Cardiac Patients: Validation Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Dec",
day="19",
volume="7",
number="12",
pages="e15045",
keywords="cardiac diseases",
keywords="activity trackers",
keywords="energy metabolism",
keywords="physical activity",
keywords="validation studies",
abstract="Background: Improving physical activity (PA) is a core component of secondary prevention and cardiac (tele)rehabilitation. Commercially available activity trackers are frequently used to monitor and promote PA in cardiac patients. However, studies on the validity of these devices in cardiac patients are scarce. As cardiac patients are being advised and treated based on PA parameters measured by these devices, it is highly important to evaluate the accuracy of these parameters in this specific population. Objective: The aim of this study was to determine the accuracy and responsiveness of 2 wrist-worn activity trackers, Fitbit Charge 2 (FC2) and Mio Slice (MS), for the assessment of energy expenditure (EE) in cardiac patients. Methods: EE assessed by the activity trackers was compared with indirect calorimetry (Oxycon Mobile [OM]) during a laboratory activity protocol. Two groups were assessed: patients with stable coronary artery disease (CAD) with preserved left ventricular ejection fraction (LVEF) and patients with heart failure with reduced ejection fraction (HFrEF). Results: A total of 38 patients were included: 19 with CAD and 19 with HFrEF (LVEF 31.8\%, SD 7.6\%). The CAD group showed no significant difference in total EE between FC2 and OM (47.5 kcal, SD 112 kcal; P=.09), in contrast to a significant difference between MS and OM (88 kcal, SD 108 kcal; P=.003). The HFrEF group showed significant differences in EE between FC2 and OM (38 kcal, SD 57 kcal; P=.01), as well as between MS and OM (106 kcal, SD 167 kcal; P=.02). Agreement of the activity trackers was low in both groups (CAD: intraclass correlation coefficient [ICC] FC2=0.10, ICC MS=0.12; HFrEF: ICC FC2=0.42, ICC MS=0.11). The responsiveness of FC2 was poor, whereas MS was able to detect changes in cycling loads only. Conclusions: Both activity trackers demonstrated low accuracy in estimating EE in cardiac patients and poor performance to detect within-patient changes in the low-to-moderate exercise intensity domain. Although the use of activity trackers in cardiac patients is promising and could enhance daily exercise behavior, these findings highlight the need for population-specific devices and algorithms. ",
doi="10.2196/15045",
url="http://mhealth.jmir.org/2019/12/e15045/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31855191"
}


@Article{info:doi/10.2196/15758,
author="Gong, Enying
and Gu, Wanbing
and Luo, Erdan
and Tan, Liwei
and Donovan, Julian
and Sun, Cheng
and Yang, Ying
and Zang, Longkai
and Bao, Peng
and Yan, L. Lijing",
title="Development and Local Contextualization of Mobile Health Messages for Enhancing Disease Management Among Community-Dwelling Stroke Patients in Rural China: Multimethod Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Dec",
day="17",
volume="7",
number="12",
pages="e15758",
keywords="phone messages",
keywords="stroke",
keywords="secondary prevention",
keywords="rural population",
keywords="China",
abstract="Background: Rural China has experienced an increasing health burden because of stroke. Stroke patients in rural communities have relatively poor awareness of and adherence to evidence-based secondary prevention and self-management of stroke. Mobile technology represents an innovative way to influence patient behaviors and improve their self-management. Objective: This study is part of the System-Integrated Technology-Enabled Model of Care (the SINEMA trial) to improve the health of stroke patients in resource-poor settings in China. This study aimed to develop and pilot-test a mobile phone message--based package, as a component of the SINEMA intervention. Methods: The SINEMA trial was conducted in Nanhe County, Hebei Province, China. A total of 4 villages were selected for pretrial contextual research and pilot study. The 5 stages for developing the mobile phone messages were as follows: (1) conducting literature review on existing message banks and analyzing the characteristics of these banks; (2) interviewing stroke patients and caregivers to identify their needs; (3) drafting message contents and designing dispatching algorithms for a 3-month pilot testing; (4) collecting feedback from pilot participants through questionnaire survey and in-depth interviews on facilitators and barriers related to their acceptance and understanding of messages; and (5) finalizing the message-based intervention based on participants' feedback for the SINEMA trial. Results: On the basis of 5 existing message banks screened out of 120 papers and patients' needs identified from 32 in-depth interviews among stroke patients and caregivers, we developed a message bank containing 224 messages for a pilot study among 54 community-dwelling stroke patients from 4 villages. Of 54 participants, 51 (response rate: 94.4\%) completed the feedback survey after receiving daily messages for 3 months. Participants' mean age was 68 years (SD 9.2), and about half had never been to school. We observed a higher proportion of participants who were in favor of voice messages (23/42, 54\%) than text messages (14/40, 35\%). Among participants who received voice messages (n=43) and text messages (n=40), 41 and 30, respectively, self-reported a full or partial understanding of the contents, and 39 (39/43, 91\%) and 32 (32/40, 80\%), respectively, rated the messages as helpful. Analyses of the 32 interviews further revealed that voice messages containing simple and single-theme content, in plain language, with a repeated structure, a slow playback speed, and recorded in local dialect, were preferred by rural stroke patients. In addition, the dispatching algorithm and tools may also influence the acceptance of message-based interventions. Conclusions: By applying multiple methodologies and conducting a pilot study, we designed and fine-tuned a voice message--based intervention package for promoting secondary prevention among community-dwelling stroke patients in rural China. Design of the content and dispatching algorithm should engage both experts and end users and adequately consider the needs and preferences of recipients. ",
doi="10.2196/15758",
url="https://mhealth.jmir.org/2019/12/e15758",
url="http://www.ncbi.nlm.nih.gov/pubmed/31845901"
}


@Article{info:doi/10.2196/13229,
author="Guo, Xiaorong
and Gu, Xiang
and Jiang, Jiang
and Li, Hongxiao
and Duan, Ruoyu
and Zhang, Yi
and Sun, Lei
and Bao, Zhengyu
and Shen, Jianhua
and Chen, Fukun",
title="A Hospital-Community-Family--Based Telehealth Program for Patients With Chronic Heart Failure: Single-Arm, Prospective Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Dec",
day="13",
volume="7",
number="12",
pages="e13229",
keywords="telehealth",
keywords="chronic heart failure",
keywords="feasibility studies",
keywords="precise follow-up",
keywords="self-management",
abstract="Background: An increasing number of patients with chronic heart failure (CHF) are demanding more convenient and efficient modern health care systems, especially in remote areas away from central cities. Telehealth is receiving increasing attention, which may be useful to patients with CHF. Objective: This study aimed to evaluate the feasibility of a hospital-community-family (HCF)--based telehealth program, which was designed to implement remote hierarchical management in patients with CHF. Methods: This was a single-arm prospective study in which 70 patients with CHF participated in the HCF-based telehealth program for remote intervention for at least 4 months. The participants were recruited from the clinic and educated on the use of smart health tracking devices and mobile apps to collect and manually upload comprehensive data elements related to the risk of CHF self-care management. They were also instructed on how to use the remote platform and mobile app to send text messages, check notifications, and open video channels. The general practitioners viewed the index of each participant on the mobile app and provided primary care periodically, and cardiologists in the regional central hospital offered remote guidance, if necessary. The assessed outcomes included accomplishments of the program, usability and satisfaction, engagement with the intervention, and changes of heart failure--related health behaviors. Results: As of February 2018, a total of 66 individuals, aged 40-79 years, completed the 4-month study. Throughout the study period, 294 electronic medical records were formed on the remote monitoring service platform. In addition, a total of 89 remote consultations and 196 remote ward rounds were conducted. Participants indicated that they were generally satisfied with the intervention for its ease of use and usefulness. More than 91\% (21/23) of physicians believed the program was effective, and 87\% (20/23) of physicians stated that their professional knowledge could always be refreshed and enhanced through a library hosted on the platform and remote consultation. More than 60\% (40/66) of participants showed good adherence to the care plan in the study period, and 79\% (52/66) of patients maintained a consistent pattern of reporting and viewing their data over the course of the 4-month follow-up period. The program showed a positive effect on self-management for patients (healthy diet: P=.046, more fruit and vegetable intake: P=.02, weight monitoring: P=.002, blood pressure: P<.001, correct time: P=.049, and daily dosages of medicine taken: P=.006). Conclusions: The HCF-based telehealth program is feasible and provided researchers with evidence of remote hierarchical management for patients with CHF, which can enhance participants' and their families' access and motivation to engage in self-management. Further prospective studies with a larger sample size are necessary to confirm the program's effectiveness. ",
doi="10.2196/13229",
url="https://mhealth.jmir.org/2019/12/e13229",
url="http://www.ncbi.nlm.nih.gov/pubmed/31833835"
}


@Article{info:doi/10.2196/15401,
author="Zhang, Lei
and He, Xingxing
and Shen, Yun
and Yu, Haoyong
and Pan, Jiemin
and Zhu, Wei
and Zhou, Jian
and Bao, Yuqian",
title="Effectiveness of Smartphone App--Based Interactive Management on Glycemic Control in Chinese Patients With Poorly Controlled Diabetes: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2019",
month="Dec",
day="9",
volume="21",
number="12",
pages="e15401",
keywords="app",
keywords="self-management",
keywords="interactive management",
keywords="guidance",
keywords="glycated hemoglobin A1c",
keywords="diabetes",
abstract="Background: In recent years, the rapid development of mobile medical technology has provided multiple ways for the long-term management of chronic diseases, especially diabetes. As a new type of management model, smartphone apps are global, convenient, cheap, and interactive. Although apps were proved to be more effective at glycemic control, compared with traditional computer- and Web-based telemedicine technologies, how to gain a further and sustained improvement is still being explored. Objective: The objective of this study was to investigate the effectiveness of an app-based interactive management model by a professional health care team on glycemic control in Chinese patients with poorly controlled diabetes. Methods: This study was a 6-month long, single-center, prospective randomized controlled trial. A total of 276 type 1 or type 2 diabetes patients were enrolled and randomized to the control group (group A), app self-management group (group B), and app interactive management group (group C) in a 1:1:1 ratio. The primary outcome was the change in glycated hemoglobin (HbA1c) level. Missing data were handled by multiple imputation. Results: At months 3 and 6, all 3 groups showed significant decreases in HbA1c levels (all P<.05). Patients in the app interactive management group had a significantly lower HbA1clevel than those in the app self-management group at 6 months (P=.04). The average HbA1c reduction in the app interactive management group was larger than that in the app self-management and control groups at both months 3 and 6 (all P<.05). However, no differences in HbA1c reduction were observed between the app self-management and control groups at both months 3 and 6 (both P>.05). Multivariate line regression analyses also showed that the app interactive management group was associated with the larger reduction of HbA1c compared with groups A and B at both months 3 and 6 (all P>.05). In addition, the app interactive management group had better control of triglyceride and high-density lipoprotein cholesterol levels at both months 3 and 6 compared with baseline (both P<.05). Conclusions: In Chinese patients with poorly controlled diabetes, it was difficult to achieve long-term effective glucose improvement by using app self-management alone, but combining it with interactive management can help achieve rapid and sustained glycemic control. Trial Registration: ClinicalTrials.gov NCT02589730; https://clinicaltrials.gov/ct2/show/NCT02589730. ",
doi="10.2196/15401",
url="https://www.jmir.org/2019/12/e15401",
url="http://www.ncbi.nlm.nih.gov/pubmed/31815677"
}


@Article{info:doi/10.2196/12639,
author="Barsky, Jordan
and Hunter, Rebekah
and McAllister, Colin
and Yeates, Karen
and Campbell, Norm
and Liu, Peter
and Perkins, Nancy
and Hua-Stewart, Diane
and Maar, A. Marion
and Tobe, W. Sheldon",
title="Analysis of the Implementation, User Perspectives, and Feedback From a Mobile Health Intervention for Individuals Living With Hypertension (DREAM-GLOBAL): Mixed Methods Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Dec",
day="9",
volume="7",
number="12",
pages="e12639",
keywords="blood pressure",
keywords="hypertension",
keywords="mHealth",
keywords="population groups",
keywords="short message service",
abstract="Background: DREAM-GLOBAL (Diagnosing hypertension---Engaging Action and Management in Getting Lower Blood Pressure in Indigenous and low- and middle-income countries) studied a SMS text messaging--based system for blood pressure measurement and hypertension management in Canadian Aboriginal and Tanzanian communities. The use of SMS text messages is an emerging point of interest in global health care initiatives because of their scalability, customizability, transferability, and cost-effectiveness. Objective: The study aim was to assess the effect on the difference in blood pressure reduction of active hypertension management messages or passive health behavior messages. The system was designed to be implemented in remote areas with wireless availability. This study described the implementation and evaluation of technical components, including quantitative data from the transmission of blood pressure measurements and qualitative data collected on the operational aspects of the system from participants, health care providers, and community leadership. Methods: The study was implemented in six remote Indigenous Canadian and two rural Tanzanian communities. Blood pressure readings were taken by a community health worker and transmitted to a mobile phone via Bluetooth, then by wireless to a programmed central server. From the server, the readings were sent to the participant's own phone as well. Participants also received biweekly tailored SMS text messages on their phones. Quantitative data on blood pressure reading transmissions were collected from the study central server. Qualitative data were collected by surveys, focus groups, and key informant interviews of participants, health care providers, and health leadership. Results: In Canada, between February 2014 and February 2017, 2818 blood pressure readings from 243 patients were transmitted to the central server. In Tanzania, between October 2014 and August 2015, 1165 readings from 130 patients were transmitted to the central server. The use of Bluetooth technology enabled the secure, reliable transmission of information from participants to their health care provider. The timing and frequency were satisfactory to 137 of 187 (73.2\%) of participants, supporting the process of sending weekly messages twice on Mondays and Thursdays at 11 am. A total of 97.0\% (164/169) of the participants surveyed said they would recommend participation in the DREAM-GLOBAL program to a friend or relative with hypertension. Conclusions: In remote communities, the DREAM-GLOBAL study helped local health care providers deliver a blood pressure management program that enabled patients and community workers to feel connected. The technical components of the study were implemented as planned, and patients felt supported in their management through the SMS text messaging and mobile health program. Technological issues were solved with troubleshooting. Overall, the technical aspects of this research program enhanced clinical care and study evaluation and were well received by participants, health care workers, and community leadership. Trial Registration: Clinicaltrials.gov NCT02111226; https://clinicaltrials.gov/ct2/show/NCT02111226. ",
doi="10.2196/12639",
url="https://mhealth.jmir.org/2019/12/e12639",
url="http://www.ncbi.nlm.nih.gov/pubmed/31815678"
}


@Article{info:doi/10.2196/14720,
author="Sandal, Fleng Louise
and Stochkendahl, Jensen Mette
and Svendsen, Jagd Malene
and Wood, Karen
and {\O}ver{\aa}s, K. Cecilie
and Nordstoga, Lovise Anne
and Villumsen, Morten
and Rasmussen, N{\o}rregaard Charlotte Diana
and Nicholl, Barbara
and Cooper, Kay
and Kjaer, Per
and Mair, S. Frances
and Sj{\o}gaard, Gisela
and Nilsen, Lund Tom Ivar
and Hartvigsen, Jan
and Bach, Kerstin
and Mork, Jarle Paul
and S{\o}gaard, Karen",
title="An App-Delivered Self-Management Program for People With Low Back Pain: Protocol for the selfBACK Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2019",
month="Dec",
day="3",
volume="8",
number="12",
pages="e14720",
keywords="low back pain",
keywords="self-management",
keywords="case-based reasoning",
keywords="eHealth",
keywords="mHealth",
keywords="app",
keywords="decision support system",
abstract="Background: Low back pain (LBP) is prevalent across all social classes, in all age groups, and across industrialized and developing countries. From a global perspective, LBP is considered the leading cause of disability and negatively impacts everyday life and well-being. Self-management is a recommended first-line treatment, and mobile apps are a promising platform to support self-management of conditions like LBP. In the selfBACK project, we have developed a digital decision support system made available for the user via an app intended to support tailored self-management of nonspecific LBP. Objective: The trial aims to evaluate the effectiveness of using the selfBACK app to support self-management in addition to usual care (intervention group) versus usual care only (control group) in people with nonspecific LBP. Methods: This is a single-blinded, randomized controlled trial (RCT) with two parallel arms. The selfBACK app provides tailored self-management plans consisting of advice on physical activity, physical exercises, and educational content. Tailoring of plans is achieved by using case-based reasoning (CBR) methodology, which is a branch of artificial intelligence. The core of the CBR methodology is to use data about the current case (participant) along with knowledge about previous and similar cases to tailor the self-management plan to the current case. This enables a person-centered intervention based on what has and has not been successful in previous cases. Participants in the RCT are people with LBP who consulted a health care professional in primary care within the preceding 8 weeks. Participants are randomized to using the selfBACK app in addition to usual care versus usual care only. We aim to include a total of 350 participants (175 participants in each arm). Outcomes are collected at baseline, 6 weeks, and 3, 6, and 9 months. The primary end point is difference in pain-related disability between the intervention group and the control group assessed by the Roland-Morris Disability Questionnaire at 3 months. Results: The trial opened for recruitment in February 2019. Data collection is expected to be complete by fall 2020, and the results for the primary outcome are expected to be published in fall 2020. Conclusions: This RCT will provide insights regarding the benefits of supporting tailored self-management of LBP through an app available at times convenient for the user. If successful, the intervention has the potential to become a model for the provision of tailored self-management support to people with nonspecific LBP and inform future interventions for other painful musculoskeletal conditions. Trial Registration: ClinicalTrial.gov NCT03798288; https://clinicaltrials.gov/ct2/show/NCT03798288 International Registered Report Identifier (IRRID): DERR1-10.2196/14720 ",
doi="10.2196/14720",
url="https://www.researchprotocols.org/2019/12/e14720",
url="http://www.ncbi.nlm.nih.gov/pubmed/31793897"
}


@Article{info:doi/10.2196/13671,
author="Johnson, Amanda
and Yang, Fan
and Gollarahalli, Siddharth
and Banerjee, Tanvi
and Abrams, Daniel
and Jonassaint, Jude
and Jonassaint, Charles
and Shah, Nirmish",
title="Use of Mobile Health Apps and Wearable Technology to Assess Changes and Predict Pain During Treatment of Acute Pain in Sickle Cell Disease: Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Dec",
day="2",
volume="7",
number="12",
pages="e13671",
keywords="pain",
keywords="sickle cell disease",
keywords="SCD",
keywords="machine learning",
abstract="Background: Sickle cell disease (SCD) is an inherited red blood cell disorder affecting millions worldwide, and it results in many potential medical complications throughout the life course. The hallmark of SCD is pain. Many patients experience daily chronic pain as well as intermittent, unpredictable acute vaso-occlusive painful episodes called pain crises. These pain crises often require acute medical care through the day hospital or emergency department. Following presentation, a number of these patients are subsequently admitted with continued efforts of treatment focused on palliative pain control and hydration for management. Mitigating pain crises is challenging for both the patients and their providers, given the perceived unpredictability and subjective nature of pain. Objective: The objective of this study was to show the feasibility of using objective, physiologic measurements obtained from a wearable device during an acute pain crisis to predict patient-reported pain scores (in an app and to nursing staff) using machine learning techniques. Methods: For this feasibility study, we enrolled 27 adult patients presenting to the day hospital with acute pain. At the beginning of pain treatment, each participant was given a wearable device (Microsoft Band 2) that collected physiologic measurements. Pain scores from our mobile app, Technology Resources to Understand Pain Assessment in Patients with Pain, and those obtained by nursing staff were both used with wearable signals to complete time stamp matching and feature extraction and selection. Following this, we constructed regression and classification machine learning algorithms to build between-subject pain prediction models. Results: Patients were monitored for an average of 3.79 (SD 2.23) hours, with an average of 5826 (SD 2667) objective data values per patient. As expected, we found that pain scores and heart rate decreased for most patients during the course of their stay. Using the wearable sensor data and pain scores, we were able to create a regression model to predict subjective pain scores with a root mean square error of 1.430 and correlation between observations and predictions of 0.706. Furthermore, we verified the hypothesis that the regression model outperformed the classification model by comparing the performances of the support vector machines (SVM) and the SVM for regression. Conclusions: The Microsoft Band 2 allowed easy collection of objective, physiologic markers during an acute pain crisis in adults with SCD. Features can be extracted from these data signals and matched with pain scores. Machine learning models can then use these features to feasibly predict patient pain scores. ",
doi="10.2196/13671",
url="https://mhealth.jmir.org/2019/12/e13671",
url="http://www.ncbi.nlm.nih.gov/pubmed/31789599"
}


@Article{info:doi/10.2196/14730,
author="Najm, Aur{\'e}lie
and Gossec, Laure
and Weill, Catherine
and Benoist, David
and Berenbaum, Francis
and Nikiphorou, Elena",
title="Mobile Health Apps for Self-Management of Rheumatic and Musculoskeletal Diseases: Systematic Literature Review",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Nov",
day="26",
volume="7",
number="11",
pages="e14730",
keywords="mobile health",
keywords="self-management",
keywords="arthritis",
keywords="telemedicine",
keywords="musculoskeletal diseases",
abstract="Background: Although the increasing availability of mobile health (mHealth) apps may enable people with rheumatic and musculoskeletal diseases (RMDs) to better self-manage their health, there is a general lack of evidence on ways to ensure appropriate development and evaluation of apps. Objective: This study aimed to obtain an overview on existing mHealth apps for self-management in patients with RMDs, focusing on content and development methods. Methods: A search was performed up to December 2017 across 5 databases. For each publication relevant to an app for RMDs, information on the disease, purpose, content, and development strategies was extracted and qualitatively assessed. Results: Of 562 abstracts, 32 were included in the analysis. Of these 32 abstracts, 11 (34\%) referred to an app linked to a connected device. Most of the apps targeted rheumatoid arthritis (11/32, 34\%). The top three aspects addressed by the apps were pain (23/32, 71\%), fatigue (15/32, 47\%), and physical activity (15/32, 47\%). The development process of the apps was described in 84\% (27/32) of the articles and was of low to moderate quality in most of the cases. Despite most of the articles having been published within the past two years, only 5 apps were still commercially available at the time of our search. Moreover, only very few studies showed improvement of RMD outcome measures. Conclusions: The development process of most apps was of low or moderate quality in many studies. Owing to the increasing RMD patients' willingness to use mHealth apps for self-management, optimal standards and quality assurance of new apps are mandatory. ",
doi="10.2196/14730",
url="https://mhealth.jmir.org/2019/11/e14730",
url="http://www.ncbi.nlm.nih.gov/pubmed/31769758"
}


@Article{info:doi/10.2196/14946,
author="Whelan, E. Maxine
and Velardo, Carmelo
and Rutter, Heather
and Tarassenko, Lionel
and Farmer, J. Andrew",
title="Mood Monitoring Over One Year for People With Chronic Obstructive Pulmonary Disease Using a Mobile Health System: Retrospective Analysis of a Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Nov",
day="22",
volume="7",
number="11",
pages="e14946",
keywords="pulmonary disease, chronic obstructive",
keywords="self-management",
keywords="telemedicine",
keywords="computers",
keywords="handheld",
keywords="anxiety",
keywords="depression",
abstract="Background: Comorbid anxiety and depression can add to the complexity of managing treatment for people living with chronic obstructive pulmonary disease (COPD). Monitoring mood has the potential to identify individuals who might benefit from additional support and treatment. Objective: We used data from the sElf-management anD support proGrammE (EDGE) trial to examine: (1) the extent to which the mood-monitoring components of a mobile health system for patients with COPD were used by participants; (2) the levels of anxiety and depression symptoms among study participants; (3) the extent to which videos providing advice about coping with low mood were viewed; and (4) the characteristics of participants with differing levels of mood and utilization of mood monitoring. Methods: A total of 107 men and women with a clinical diagnosis of COPD, aged ?40 years old, were recruited to the intervention arm of the EDGE trial. Participants were invited to complete the Patient Health Questionnaire-8 and the Generalized Anxiety Disorder-7 test every four weeks using a tablet computer. Mood disturbance based on these measures was defined as a score ?5 on either scale. Participants reporting a mood disturbance were automatically directed (signposted) to a stress or mood management video. Study outcomes included measures of health status, respiratory quality of life, and symptoms of anxiety and depression. Results: Overall, 94 (87.9\%) participants completed the 12-month study. A total of 80 participants entered at least one response each month for at least ten months. On average, 16 participants (range 8-38 participants) entered ?2 responses each month. Of all the participants, 47 (50\%) gave responses indicating a mood disturbance. Participants with a mood disturbance score for both scales (n=47) compared with those without (n=20) had lower health status (P=.008), lower quality of life (P=.009), and greater anxiety (P<.001) and increased depression symptoms (P<.001). Videos were viewed by 64 (68\%) people over 12 months. Of the 220 viewing visualizations, 70 (34.7\%) began after being signposted. Participants signposted to the stress management video (100\%; IQR 23.3-100\%) watched a greater proportion of it compared to those not signposted (38.4\%; IQR 16.0-68.1\%; P=.03), whereas duration of viewing was not significantly different for the mood management video. Conclusions: Monitoring of anxiety and depression symptoms for people with COPD is feasible. More than half of trial participants reported scores indicating a mood disturbance during the study. Signposting participants to an advisory video when reporting increased symptoms of a mood disturbance resulted in a longer view-time for the stress management video. The opportunity to elicit measures of mood regularly as part of a health monitoring system could contribute to better care for people with COPD. ",
doi="10.2196/14946",
url="http://mhealth.jmir.org/2019/11/e14946/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31755872"
}


@Article{info:doi/10.2196/12442,
author="Rudolf, Isa
and Pieper, Katharina
and Nolte, Helga
and Junge, Sibylle
and Dopfer, Christian
and Sauer-Heilborn, Annette
and Ringshausen, C. Felix
and T{\"u}mmler, Burkhard
and von Jan, Ute
and Albrecht, Urs-Vito
and Fuge, Jan
and Hansen, Gesine
and Dittrich, Anna-Maria",
title="Assessment of a Mobile App by Adolescents and Young Adults With Cystic Fibrosis: Pilot Evaluation",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Nov",
day="21",
volume="7",
number="11",
pages="e12442",
keywords="mobile phone",
keywords="mobile phone app",
keywords="mHealth",
keywords="self-management",
keywords="adolescence",
keywords="cystic fibrosis",
abstract="Background: Cystic fibrosis (CF) continues to be the most common life-limiting chronic pulmonary disease in adolescents and young adults. Treatment of CF demands a high treatment time investment to slow the progression of lung function decline, the most important contributor to morbidity and mortality. Adherence is challenging in CF due to the high treatment burden and the lack of immediate health consequences in case of nonadherence. Lung function decline is particularly pronounced in the transition phase between 12 and 24 years of age. The improvement of self-management and self-responsibility and independence from parents and desire for normalcy are conflicting aspects for many adolescents with CF, which influence adherence to the time-consuming pulmonary therapy. Mobile health (mHealth) care apps could help to support self-management and independence and thereby reconcile seemingly conflicting goals to improve adherence, quality of life, and ultimately CF life expectancy. Objective: This study aimed to (1) assess user behavior and satisfaction among adolescents and young adults with CF over an observation period of three months using an mHealth app; (2) identify areas of improvement for this mHealth app; and (3) compare overall and disease-specific satisfaction, lung function, and anthropometry before and after using the mHealth app. Methods: A total of 27 adolescents and young adults with CF (age range 12-24 years, mean age 16 years, SD 3 years; 14 females, 11 males) used a free mHealth app for three months of whom 25 provided questionnaire data for analysis at the end of the study. Data collection was carried out using questionnaires on usage characteristics and life satisfaction, and standardized assessment of lung function and anthropometry. Results: The use of the reminder function for medication declined from 70\% (15/21) of the participants at week 4 to 65\% (13/20) at week 8 of the observation period. At the end of the study, only 17\% (4/23) of the participants wanted to continue using the app. Nevertheless, 56\% (14/25) of participants saw the mobile app as a support for everyday life. Potential improvements targeting hedonistic qualities were identified to improve mHealth app adherence. Comparisons of satisfaction with different life aspects hinted at improvements or stabilization for the subitem respiration and the subitem lack of handicap by CF, suggesting that app use might stabilize certain CF-specific aspects of the weighted satisfaction with life. Lung function and anthropometry were not affected consistently. Conclusions: Most of the patients did not want to continue using the app after the study period. Only a few CF-specific aspects of weighted life satisfaction were possibly stabilized by the mHealth app; clinical parameters were not affected. Adaptation of the functions to adolescent-specific needs could improve the long-term use and thus positively affect the disease course. ",
doi="10.2196/12442",
url="https://mhealth.jmir.org/2019/11/e12442",
url="http://www.ncbi.nlm.nih.gov/pubmed/31750841"
}


@Article{info:doi/10.2196/13579,
author="Virella P{\'e}rez, Ilene Yisselle
and Medlow, Sharon
and Ho, Jane
and Steinbeck, Katharine",
title="Mobile and Web-Based Apps That Support Self-Management and Transition in Young People With Chronic Illness: Systematic Review",
journal="J Med Internet Res",
year="2019",
month="Nov",
day="20",
volume="21",
number="11",
pages="e13579",
keywords="adolescent",
keywords="mobile app",
keywords="Web-based app",
keywords="chronic illness",
keywords="self-management",
keywords="transition to adult care",
abstract="Background: More adolescents with chronic physical illness are living into adulthood, and they require the development of proficient self-management skills to maintain optimal physical health as they transition into adult care services. It is often during this vulnerable transition period that deterioration in illness control is seen as a result of inadequate self-management skills and understanding of their chronic illness. Mobile technology has been proposed as an innovative opportunity to assist in improving the management of chronic conditions as young people transition to adult care services. Over the past 5 years, there has been a significant increase in research into the use of health-related apps. Objective: This study aimed to evaluate the utility and effectiveness of mobile and Web-based health apps that support self-management and transition in young people with chronic physical health illnesses. Methods: We conducted a comprehensive review of the literature in 5 bibliographic databases, using key search terms, considering only articles published from 2013, as we were extending the data from 2 previous systematic reviews. Abstracts were screened for possible inclusion by 2 reviewers. Data extraction and quality assessment tools were used for the evaluation of included studies. Results: A total of 1737 records were identified from the combined electronic searches, and 854 records were removed as duplicates. A total of 68 full articles were further assessed for eligibility, and 6 articles met our review criteria: 3 pilot studies, 2 randomized controlled trials, and 1 prospective cohort study. Publication years ranged from 2015 to 2018. The apps reported were targeted at type 1 diabetes mellitus, epilepsy, asthma, beta thalassemia major, and sickle cell disease, with a combined sample size of 336. A total of 4 studies included in this review reported being effective in increasing knowledge of the targeted condition and increasing therapy adherence, including increased medication adherence. A total of 2 manuscripts only mentioned the word transition. Participant's satisfaction was reported for all studies. Heterogeneity of the studies prevented meta-analysis. Conclusions: There remain limited data on the effectiveness and use of mobile and Web-based apps, which might facilitate the transition of adolescents with chronic illnesses from pediatric to adult health care services. This systematic review provides an updated overview of available apps for adolescents with chronic illnesses. This systematic review has been unable to provide evidence for effectiveness of this approach, but it does provide insights into future study design, with reference to the development, evaluation, and efficacy of apps tailored for adolescents with chronic illnesses, including the involvement of adolescents in such designs. Trial Registration: PROSPERO CRD42018104611; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=104611 ",
doi="10.2196/13579",
url="http://www.jmir.org/2019/11/e13579/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31746773"
}


@Article{info:doi/10.2196/15601,
author="Rahman, Abidur Quazi
and Janmohamed, Tahir
and Clarke, Hance
and Ritvo, Paul
and Heffernan, Jane
and Katz, Joel",
title="Interpretability and Class Imbalance in Prediction Models for Pain Volatility in Manage My Pain App Users: Analysis Using Feature Selection and Majority Voting Methods",
journal="JMIR Med Inform",
year="2019",
month="Nov",
day="20",
volume="7",
number="4",
pages="e15601",
keywords="chronic pain",
keywords="pain volatility",
keywords="data mining",
keywords="cluster analysis",
keywords="machine learning",
keywords="prediction model",
keywords="Manage My Pain",
keywords="pain app",
abstract="Background: Pain volatility is an important factor in chronic pain experience and adaptation. Previously, we employed machine-learning methods to define and predict pain volatility levels from users of the Manage My Pain app. Reducing the number of features is important to help increase interpretability of such prediction models. Prediction results also need to be consolidated from multiple random subsamples to address the class imbalance issue. Objective: This study aimed to: (1) increase the interpretability of previously developed pain volatility models by identifying the most important features that distinguish high from low volatility users; and (2) consolidate prediction results from models derived from multiple random subsamples while addressing the class imbalance issue. Methods: A total of 132 features were extracted from the first month of app use to develop machine learning--based models for predicting pain volatility at the sixth month of app use. Three feature selection methods were applied to identify features that were significantly better predictors than other members of the large features set used for developing the prediction models: (1) Gini impurity criterion; (2) information gain criterion; and (3) Boruta. We then combined the three groups of important features determined by these algorithms to produce the final list of important features. Three machine learning methods were then employed to conduct prediction experiments using the selected important features: (1) logistic regression with ridge estimators; (2) logistic regression with least absolute shrinkage and selection operator; and (3) random forests. Multiple random under-sampling of the majority class was conducted to address class imbalance in the dataset. Subsequently, a majority voting approach was employed to consolidate prediction results from these multiple subsamples. The total number of users included in this study was 879, with a total number of 391,255 pain records. Results: A threshold of 1.6 was established using clustering methods to differentiate between 2 classes: low volatility (n=694) and high volatility (n=185). The overall prediction accuracy is approximately 70\% for both random forests and logistic regression models when using 132 features. Overall, 9 important features were identified using 3 feature selection methods. Of these 9 features, 2 are from the app use category and the other 7 are related to pain statistics. After consolidating models that were developed using random subsamples by majority voting, logistic regression models performed equally well using 132 or 9 features. Random forests performed better than logistic regression methods in predicting the high volatility class. The consolidated accuracy of random forests does not drop significantly (601/879; 68.4\% vs 618/879; 70.3\%) when only 9 important features are included in the prediction model. Conclusions: We employed feature selection methods to identify important features in predicting future pain volatility. To address class imbalance, we consolidated models that were developed using multiple random subsamples by majority voting. Reducing the number of features did not result in a significant decrease in the consolidated prediction accuracy. ",
doi="10.2196/15601",
url="http://medinform.jmir.org/2019/4/e15601/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31746764"
}


@Article{info:doi/10.2196/12814,
author="Cormack, Francesca
and McCue, Maggie
and Taptiklis, Nick
and Skirrow, Caroline
and Glazer, Emilie
and Panagopoulos, Elli
and van Schaik, A. Tempest
and Fehnert, Ben
and King, James
and Barnett, H. Jennifer",
title="Wearable Technology for High-Frequency Cognitive and Mood Assessment in Major Depressive Disorder: Longitudinal Observational Study",
journal="JMIR Ment Health",
year="2019",
month="Nov",
day="18",
volume="6",
number="11",
pages="e12814",
keywords="depression",
keywords="cognition",
keywords="mood",
keywords="mobile health",
keywords="mHealth",
keywords="mobile apps",
keywords="ecological momentary assessment",
keywords="digital phenotyping",
keywords="digital biomarkers",
abstract="Background: Cognitive symptoms are common in major depressive disorder and may help to identify patients who need treatment or who are not experiencing adequate treatment response. Digital tools providing real-time data assessing cognitive function could help support patient treatment and remediation of cognitive and mood symptoms. Objective: The aim of this study was to examine feasibility and validity of a wearable high-frequency cognitive and mood assessment app over 6 weeks, corresponding to when antidepressant pharmacotherapy begins to show efficacy. Methods: A total of 30 patients (aged 19-63 years; 19 women) with mild-to-moderate depression participated in the study. The new Cognition Kit app was delivered via the Apple Watch, providing a high-resolution touch screen display for task presentation and logging responses. Cognition was assessed by the n-back task up to 3 times daily and depressed mood by 3 short questions once daily. Adherence was defined as participants completing at least 1 assessment daily. Selected tests sensitive to depression from the Cambridge Neuropsychological Test Automated Battery and validated questionnaires of depression symptom severity were administered on 3 occasions (weeks 1, 3, and 6). Exploratory analyses examined the relationship between mood and cognitive measures acquired in low- and high-frequency assessment. Results: Adherence was excellent for mood and cognitive assessments (95\% and 96\%, respectively), did not deteriorate over time, and was not influenced by depression symptom severity or cognitive function at study onset. Analyses examining the relationship between high-frequency cognitive and mood assessment and validated measures showed good correspondence. Daily mood assessments correlated moderately with validated depression questionnaires (r=0.45-0.69 for total daily mood score), and daily cognitive assessments correlated moderately with validated cognitive tests sensitive to depression (r=0.37-0.50 for mean n-back). Conclusions: This study supports the feasibility and validity of high-frequency assessment of cognition and mood using wearable devices over an extended period in patients with major depressive disorder. ",
doi="10.2196/12814",
url="https://mental.jmir.org/2019/11/e12814",
url="http://www.ncbi.nlm.nih.gov/pubmed/31738172"
}


@Article{info:doi/10.2196/15489,
author="Zhu, Mengting
and Cai, Weiping
and Li, Linghua
and Guo, Yan
and Monroe-Wise, Aliza
and Li, Yiran
and Zeng, Chengbo
and Qiao, Jiaying
and Xu, Zhimeng
and Zhang, Hanxi
and Zeng, Yu
and Liu, Cong",
title="Mediators of Intervention Effects on Depressive Symptoms Among People Living With HIV: Secondary Analysis of a Mobile Health Randomized Controlled Trial Using Latent Growth Curve Modeling",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Nov",
day="15",
volume="7",
number="11",
pages="e15489",
keywords="mobile health",
keywords="depression",
keywords="HIV",
keywords="randomized controlled trial",
keywords="longitudinal studies",
abstract="Background: Although several studies have investigated the effects of mobile health (mHealth) interventions on depression among people living with HIV, few studies have explored mediators of mHealth-based interventions to improve mental health in people living with HIV. Identifying influential mediators may enhance and refine effective components of mHealth interventions to improve mental health of people living with HIV. Objective: This study aimed to examine mediating factors of the effects of a mHealth intervention, Run4Love, designed to reduce depression among people living with HIV using 4 time-point measurement data. Methods: This study used data from a randomized controlled trial of a mHealth intervention among people living with HIV with elevated depressive symptoms in Guangzhou, China. A total of 300 patients were assigned to receive either the mHealth intervention (n=150) or a waitlist control group (n=150) through computer-generated block randomization. Depressive symptoms, coping, and HIV-related stigma were measured at baseline, 3-, 6-, and 9-month follow-ups. The latent growth curve model was used to examine the effects of the intervention on depressive symptoms via potential mediators. Mediating effects were estimated using bias-corrected 95\% bootstrapped CIs (BCIs) with resampling of 5000. Results: Enhanced positive coping and reduced HIV-related stigma served as effective treatment mediators in the mHealth intervention. Specially, there was a significant indirect effect of the mHealth intervention on the slope of depressive symptoms via the slope of positive coping (beta=--2.86; 95\% BCI --4.78 to --0.94). The indirect effect of the mHealth intervention on the slope of depressive symptoms via the slope of HIV-related stigma was also statistically significant (beta=--1.71; 95\% BCI --3.03 to --0.40). These findings indicated that enhancement of positive coping and reduction of HIV-related stigma were important mediating factors of the mHealth intervention in reducing depression among people living with HIV. Conclusions: This study revealed the underlying mediators of a mHealth intervention to reduce depression among people living with HIV using latent growth curve model and 4 time-point longitudinal measurement data. The study results underscored the importance of improving positive coping skills and mitigating HIV-related stigma in mHealth interventions to reduce depression among people living with HIV. ",
doi="10.2196/15489",
url="http://mhealth.jmir.org/2019/11/e15489/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31730042"
}


@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/10.2196/13236,
author="Shang, Jie
and Wei, Shaoming
and Jin, Jianbo
and Zhang, Puhong",
title="Mental Health Apps in China: Analysis and Quality Assessment",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Nov",
day="7",
volume="7",
number="11",
pages="e13236",
keywords="mental health",
keywords="mental disorder",
keywords="quality assessment",
keywords="mobile health",
keywords="digital health",
keywords="innovative health",
keywords="smartphone application",
abstract="Background: Mental disorders have been a great burden on health care systems, affecting the quality of life of millions of people worldwide. Developing countries, including China, suffer from the double burden of both the increasing mental health issues in population and the deficiency in mental health care resources. The use of mobile health technologies, especially for mobile phone apps, can be a possible solution. Objective: This review aimed to describe the features and assess the quality of mental health apps in major mobile phone app markets in China and further discuss the priorities for mental health app development. Methods: Keywords including psychology, psychological health, psychological hygiene, psychological health service(s), mental, mental health, mental hygiene, mental health service(s), depression, and anxiety were searched in Chinese in 3 Android app markets (Baidu Mobile Assistant, Tencent MyApp, and 360 Mobile Assistant) and iOS App Store independently. Mental health apps were then selected according to established criteria for in-depth analysis and quality assessment by the Mobile App Rating Scale. Results: In total, 63 of 997 mental health apps were analyzed in depth, of which 78\% (49/63) were developed by commercial entities for general population, 17\% (11/63) were for patients or clients of specialized psychiatric hospitals or counseling agencies, 3\% (2/63) were by government or local Centers for Disease Control and Prevention for general information, and 2\% (1/63) for students of a university. Major built-in features of the apps included counseling services, mental health education, and self-assessment of mental health status by validated self-rating scales. The overall quality score of the MH apps was acceptable. Conclusions: Mental health apps are emerging in the area of mobile health in China. Popular mental health apps usually provide a synthetic platform organizing resources of information, knowledge, counseling services, self-tests, and management for the general population with mental health-related inquiries. The quality of the apps was rated as acceptable on average, suggesting some space for improvement. Official guidelines and regulations are urgently required for the field in the future. ",
doi="10.2196/13236",
url="https://mhealth.jmir.org/2019/11/e13236",
url="http://www.ncbi.nlm.nih.gov/pubmed/31697245"
}


@Article{info:doi/10.2196/14452,
author="Faruqui, Akhter Syed Hasib
and Du, Yan
and Meka, Rajitha
and Alaeddini, Adel
and Li, Chengdong
and Shirinkam, Sara
and Wang, Jing",
title="Development of a Deep Learning Model for Dynamic Forecasting of Blood Glucose Level for Type 2 Diabetes Mellitus: Secondary Analysis of a Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Nov",
day="1",
volume="7",
number="11",
pages="e14452",
keywords="type 2 diabetes",
keywords="long short-term memory (LSTM)-based recurrent neural networks (RNNs)",
keywords="glucose level prediction",
keywords="mobile health lifestyle data",
abstract="Background: Type 2 diabetes mellitus (T2DM) is a major public health burden. Self-management of diabetes including maintaining a healthy lifestyle is essential for glycemic control and to prevent diabetes complications. Mobile-based health data can play an important role in the forecasting of blood glucose levels for lifestyle management and control of T2DM. Objective: The objective of this work was to dynamically forecast daily glucose levels in patients with T2DM based on their daily mobile health lifestyle data including diet, physical activity, weight, and glucose level from the day before. Methods: We used data from 10 T2DM patients who were overweight or obese in a behavioral lifestyle intervention using mobile tools for daily monitoring of diet, physical activity, weight, and blood glucose over 6 months. We developed a deep learning model based on long short-term memory--based recurrent neural networks to forecast the next-day glucose levels in individual patients. The neural network used several layers of computational nodes to model how mobile health data (food intake including consumed calories, fat, and carbohydrates; exercise; and weight) were progressing from one day to another from noisy data. Results: The model was validated based on a data set of 10 patients who had been monitored daily for over 6 months. The proposed deep learning model demonstrated considerable accuracy in predicting the next day glucose level based on Clark Error Grid and {\textpm}10\% range of the actual values. Conclusions: Using machine learning methodologies may leverage mobile health lifestyle data to develop effective individualized prediction plans for T2DM management. However, predicting future glucose levels is challenging as glucose level is determined by multiple factors. Future study with more rigorous study design is warranted to better predict future glucose levels for T2DM management. ",
doi="10.2196/14452",
url="https://mhealth.jmir.org/2019/11/e14452",
url="http://www.ncbi.nlm.nih.gov/pubmed/31682586"
}


@Article{info:doi/10.2196/14926,
author="Wang, Guangyu
and Zhou, Silu
and Rezaei, Shahbaz
and Liu, Xin
and Huang, Anpeng",
title="An Ambulatory Blood Pressure Monitor Mobile Health System for Early Warning for Stroke Risk: Longitudinal Observational Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Oct",
day="30",
volume="7",
number="10",
pages="e14926",
keywords="ambulatory blood pressure monitor",
keywords="mHealth",
keywords="stroke-risk early warning",
keywords="abnormal blood pressure data analyzing",
keywords="longitudinal observational study",
abstract="Background: Stroke, as a leading cause of death around the globe, has become a heavy burden on our society. Studies show that stroke can be predicted and prevented if a person's blood pressure (BP) status is appropriately monitored via an ambulatory blood pressure monitor (ABPM) system. However, currently there exists no efficient and user-friendly ABPM system to provide early warning for stroke risk in real-time. Moreover, most existing ABPM devices measure BP during the deflation of the cuff, which fails to reflect blood pressure accurately. Objective: In this study, we sought to develop a new ABPM mobile health (mHealth) system that was capable of monitoring blood pressure during inflation and could detect early stroke-risk signals in real-time. Methods: We designed an ABPM mHealth system that is based on mobile network infrastructure and mobile apps. The proposed system contains two major parts: a new ABPM device in which an inflation-type BP measurement algorithm is embedded, and an abnormal blood pressure data analysis algorithm for stroke-risk prediction services at our health data service center. For evaluation, the ABPM device was first tested using simulated signals and compared with the gold standard of a mercury sphygmomanometer. Then, the performance of our proposed mHealth system was evaluated in an observational study. Results: The results are presented in two main parts: the device test and the longitudinal observational studies of the presented system. The average measurement error of the new ABPM device with the inflation-type algorithm was less than 0.55 mmHg compared to a reference device using simulated signals. Moreover, the results of correlation coefficients and agreement analyses show that there is a strong linear correlation between our device and the standard mercury sphygmomanometer. In the case of the system observational study, we collected a data set with 88 features, including real-time data, user information, and user records. Our abnormal blood pressure data analysis algorithm achieved the best performance, with an area under the curve of 0.904 for the low risk level, 0.756 for the caution risk level, and 0.912 for the high-risk level. Our system enables a patient to be aware of their risk in real-time, which improves medication adherence with risk self-management. Conclusions: To our knowledge, this device is the first ABPM device that measures blood pressure during the inflation process and has obtained a government medical license. Device tests and longitudinal observational studies were conducted in Peking University hospitals, and they showed the device's high accuracy for BP measurements, its efficiency in detecting early signs of stroke, and its efficiency at providing an early warning for stroke risk. ",
doi="10.2196/14926",
url="http://mhealth.jmir.org/2019/10/e14926/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31670694"
}


@Article{info:doi/10.2196/12586,
author="Vandenberk, Thijs
and Storms, Valerie
and Lanssens, Dorien
and De Canni{\`e}re, H{\'e}l{\`e}ne
and Smeets, JP Christophe
and Thijs, M. Inge
and Batool, Tooba
and Vanrompay, Yves
and Vandervoort, M. Pieter
and Grieten, Lars",
title="A Vendor-Independent Mobile Health Monitoring Platform for Digital Health Studies: Development and Usability Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Oct",
day="29",
volume="7",
number="10",
pages="e12586",
keywords="information science",
keywords="patient care management",
keywords="mobile health",
keywords="telemonitoring",
keywords="monitoring, ambulatory",
abstract="Background: Medical smartphone apps and mobile health devices are rapidly entering mainstream use because of the rising number of smartphone users. Consequently, a large amount of consumer-generated data is being collected. Technological advances in innovative sensory systems have enabled data connectivity and aggregation to become cornerstones in developing workable solutions for remote monitoring systems in clinical practice. However, few systems are currently available to handle such data, especially for clinical use. Objective: The aim of this study was to develop and implement the digital health research platform for mobile health (DHARMA) that combines data saved in different formats from a variety of sources into a single integrated digital platform suitable for mobile remote monitoring studies. Methods: DHARMA comprises a smartphone app, a Web-based platform, and custom middleware and has been developed to collect, store, process, and visualize data from different vendor-specific sensors. The middleware is a component-based system with independent building blocks for user authentication, study and patient administration, data handling, questionnaire management, patient files, and reporting. Results: A prototype version of the research platform has been tested and deployed in multiple clinical studies. In this study, we used the platform for the follow-up of pregnant women at risk of developing pre-eclampsia. The patients' blood pressure, weight, and activity were semi-automatically captured at home using different devices. DHARMA automatically collected and stored data from each source and enabled data processing for the end users in terms of study-specific parameters, thresholds, and visualization. Conclusions: The increasing use of mobile health apps and connected medical devices is leading to a large amount of data for collection. There has been limited investment in handling and aggregating data from different sources for use in academic and clinical research focusing on remote monitoring studies. In this study, we created a modular mobile health research platform to collect and integrate data from a variety of third-party devices in several patient populations. The functionality of the platform was demonstrated in a real-life setting among women with high-risk pregnancies. ",
doi="10.2196/12586",
url="https://mhealth.jmir.org/2019/10/e12586",
url="http://www.ncbi.nlm.nih.gov/pubmed/31663862"
}


@Article{info:doi/10.2196/14753,
author="Kwan, Heng Yu
and Ong, Jie Wei
and Xiong, Mengfei
and Leung, Ying Ying
and Phang, Kie Jie
and Wang, May Charmaine Tze
and Fong, Warren",
title="Evaluation of Mobile Apps Targeted at Patients With Spondyloarthritis for Disease Monitoring: Systematic App Search",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Oct",
day="28",
volume="7",
number="10",
pages="e14753",
keywords="spondylarthropathies",
keywords="mobile apps",
keywords="ankylosing spondylitis",
keywords="psoriatic arthritis",
abstract="Background: There are many apps developed for patients with spondyloarthritis in the market, but their purpose and quality are not objectively evaluated. Objective: The objective of this study was to identify and evaluate existing publicly available, high-quality apps that use validated measurement instruments for monitoring spondyloarthritis disease activity. Methods: We conducted a review of apps available on the Apple App Store and the Google Play Store based on a combination of keywords and inclusion and exclusion criteria. Validated disease activity measurement instruments were identified. Data regarding app characteristics, including the presence of validated disease activity measurement, were extracted. The Mobile App Rating Scale (MARS) was used to review the apps for user experience. Results: A total of 1253 apps were identified in the app stores, and 5 apps met the criteria and were further analyzed. Moreover, 2 apps (MySpA and Group for Research and Assessment of Psoriasis and Psoriatic Arthritis App) contained some of the validated disease activity monitoring instruments for specific spondyloarthritis subtypes. These 2 apps were also rated good on the MARS (with total mean scores ?4 out of 5), whereas the other apps scored poorly in comparison. Conclusions: There are 2 high-quality spondyloarthritis disease activity monitoring apps publicly available, but they only target 2 spondyloarthritis subtypes---ankylosing spondylitis and psoriatic arthritis. There is a lack of high-quality apps that can measure disease activity for other spondyloarthritis subtypes, and no app that consolidates all validated disease activity instruments across subtypes was available. ",
doi="10.2196/14753",
url="http://mhealth.jmir.org/2019/10/e14753/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31661080"
}


@Article{info:doi/10.2196/14195,
author="Whelan, E. Maxine
and Orme, W. Mark
and Kingsnorth, P. Andrew
and Sherar, B. Lauren
and Denton, L. Francesca
and Esliger, W. Dale",
title="Examining the Use of Glucose and Physical Activity Self-Monitoring Technologies in Individuals at Moderate to High Risk of Developing Type 2 Diabetes: Randomized Trial",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Oct",
day="28",
volume="7",
number="10",
pages="e14195",
keywords="usage",
keywords="self-monitoring",
keywords="feedback",
keywords="behavior",
keywords="physiology, wearable electronic devices",
keywords="biobehavioral sciences",
abstract="Background: Self-monitoring of behavior (namely, diet and physical activity) and physiology (namely, glucose) has been shown to be effective in type 2 diabetes (T2D) and prediabetes prevention. By combining self-monitoring technologies, the acute physiological consequences of behaviors could be shown, prompting greater consideration to physical activity levels today, which impact the risk of developing diabetes years or decades later. However, until recently, commercially available technologies have not been able to show individuals the health benefits of being physically active. Objective: The objective of this study was to examine the usage, feasibility, and acceptability of behavioral and physiological self-monitoring technologies in individuals at risk of developing T2D. Methods: A total of 45 adults aged ?40 years and at moderate to high risk of T2D were recruited to take part in a 3-arm feasibility trial. Each participant was provided with a behavioral (Fitbit Charge 2) and physiological (FreeStyle Libre flash glucose monitor) monitor for 6 weeks, masked according to group allocation. Participants were allocated to glucose feedback (4 weeks) followed by glucose and physical activity (biobehavioral) feedback (2 weeks; group 1), physical activity feedback (4 weeks) followed by biobehavioral feedback (2 weeks; group 2), or biobehavioral feedback (6 weeks; group 3). Participant usage (including time spent on the apps and number of glucose scans) was the primary outcome. Secondary outcomes were the feasibility (including recruitment and number of sensor displacements) and acceptability (including monitor wear time) of the intervention. Semistructured qualitative interviews were conducted at the 6-week follow-up appointment. Results: For usage, time spent on the Fitbit and FreeStyle Libre apps declined over the 6 weeks for all groups. Of the FreeStyle Libre sensor scans conducted by participants, 17\% (1798/10,582) recorded rising or falling trends in glucose, and 24\% (13/45) of participants changed ?1 of the physical activity goals. For feasibility, 49\% (22/45) of participants completed the study using the minimum number of FreeStyle Libre sensors, and a total of 41 sensors were declared faulty or displaced. For acceptability, participants wore the Fitbit for 40.1 (SD 3.2) days, and 20\% (9/45) of participants and 53\% (24/45) of participants were prompted by email to charge or sync the Fitbit, respectively. Interviews unearthed participant perceptions on the study design by suggesting refinements to the eligibility criteria and highlighting important issues about the usability, wearability, and features of the technologies. Conclusions: Individuals at risk of developing T2D engaged with wearable digital health technologies providing behavioral and physiological feedback. Modifications are required to both the study and to commercially available technologies to maximize the chances of sustained usage and behavior change. The study and intervention were feasible to conduct and acceptable to most participants. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 17545949; isrctn.com/ISRCTN17545949 ",
doi="10.2196/14195",
url="http://mhealth.jmir.org/2019/10/e14195/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31661077"
}


@Article{info:doi/10.2196/14366,
author="Allan, Stephanie
and Bradstreet, Simon
and Mcleod, Hamish
and Farhall, John
and Lambrou, Maria
and Gleeson, John
and Clark, Andrea
and 
and Gumley, Andrew",
title="Developing a Hypothetical Implementation Framework of Expectations for Monitoring Early Signs of Psychosis Relapse Using a Mobile App: Qualitative Study",
journal="J Med Internet Res",
year="2019",
month="Oct",
day="24",
volume="21",
number="10",
pages="e14366",
keywords="psychosis",
keywords="self-management",
keywords="implementation science",
abstract="Background: Relapse is a common experience for people diagnosed with psychosis, which is associated with increased service costs and profound personal and familial distress. EMPOWER (Early signs Monitoring to Prevent relapse in psychosis and prOmote Well-being, Engagement, and Recovery) is a peer worker--supported digital intervention that aims to enable service users to self-monitor their mental health with the aim of encouraging self-management and the shared use of personal data to promote relapse prevention. Digital interventions have not been widely used in relapse prevention and, therefore, little is currently known about their likely implementation---both within trials and beyond. Objective: Seeking the perspectives of all relevant stakeholder groups is recommended in developing theories about implementation because this can reveal important group differences in understandings and assumptions about whether and for whom the intervention is expected to work. However, the majority of intervention implementation research has been retrospective. This study aimed to discover and theoretically frame implementation expectations in advance of testing and synthesize these data into a framework. Methods: To develop a hypothetical implementation framework, 149 mental health professionals, carers, and people diagnosed with psychosis participated in 25 focus groups in both Australia and the United Kingdom. An interview schedule informed by the normalization process theory was used to explore stakeholders' expectations about the implementation of the EMPOWER intervention. Data were analyzed using thematic analysis and then theoretically framed using the Medical Research Council guidelines for understanding the implementation of complex interventions. Results: All groups expected that EMPOWER could be successfully implemented if the intervention generated data that were meaningful to mental health staff, carers, and service users within their unique roles. However, there were key differences between staff, carers, and service users about what facilitators and barriers that stakeholders believe exist for intervention implementation in both the cluster randomized controlled trial stage and beyond. For example, service user expectations mostly clustered around subjective user experiences, whereas staff and carers spoke more about the impact upon staff interactions with service users. Conclusions: A hypothetical implementation framework synthesized from stakeholder implementation expectations provides an opportunity to compare actual implementation data gathered during an ongoing clinical trial, giving valuable insights into the accuracy of these stakeholders' previous expectations. This is among the first studies to assess and record implementation expectations for a newly developed digital intervention for psychosis in advance of testing in a clinical trial. Trial Registration: ISRCTN Registry ISRCTN99559262; http://www.isrctn.com/ISRCTN99559262 ",
doi="10.2196/14366",
url="https://www.jmir.org/2019/10/e14366",
url="http://www.ncbi.nlm.nih.gov/pubmed/31651400"
}


@Article{info:doi/10.2196/13286,
author="Chen, Jessica
and Kaye, Leanne
and Tuffli, Michael
and Barrett, A. Meredith
and Jones-Ford, Shelanda
and Shenouda, Tina
and Gondalia, Rahul
and Henderson, Kelly
and Combs, Veronica
and Van Sickle, David
and Stempel, A. David",
title="Passive Monitoring of Short-Acting Beta-Agonist Use via Digital Platform in Patients With Chronic Obstructive Pulmonary Disease: Quality Improvement Retrospective Analysis",
journal="JMIR Form Res",
year="2019",
month="Oct",
day="23",
volume="3",
number="4",
pages="e13286",
keywords="chronic obstructive pulmonary disease",
keywords="telemedicine",
keywords="quality improvement, feasibility",
keywords="nebulizers and vaporizers",
keywords="health services",
abstract="Background: Digital health programs assist patients with chronic obstructive pulmonary disease (COPD) to better manage their disease. Technological and adoption barriers have been perceived as a limitation. Objective: The aim of the research was to evaluate a digital quality improvement pilot in Medicare-eligible patients with COPD. Methods: COPD patients were enrolled in a digital platform to help manage their medications and symptoms as part of their routine clinical care. Patients were provided with electronic medication monitors (EMMs) to monitor short-acting beta-agonist (SABA) use passively and a smartphone app to track use trends and receive feedback. Providers also had access to data collected via a secure website and were sent email notifications if a patient had a significant change in their prescribed inhaler use. Providers then determined if follow-up was needed. Change in SABA use and feasibility outcomes were evaluated at 3, 6, and 12 months. Results: A total of 190 patients enrolled in the pilot. At 3, 6, and 12 months, patients recorded significant reductions in daily and nighttime SABA use and increases in SABA-free days (all P<.001). Patient engagement, as measured by the ratio of daily active use to monthly active use, was >90\% at both 6 and 12 months. Retention at 6 months was 81\% (154/190). Providers were sent on average two email notifications per patient during the 12-month program. Conclusions: A digital health program integrated as part of standard clinical practice was feasible and had low provider burden. The pilot demonstrated significant reduction in SABA use and increased SABA-free days among Medicare-eligible COPD patients. Further, patients readily adopted the digital platform and demonstrated strong engagement and retention rates at 6 and 12 months. ",
doi="10.2196/13286",
url="http://formative.jmir.org/2019/4/e13286/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31647471"
}


@Article{info:doi/10.2196/14259,
author="Peiris, David
and Wright, Lachlan
and News, Madeline
and Corcoran, Katherine",
title="Community-Based Chronic Disease Prevention and Management for Aboriginal People in New South Wales, Australia: Mixed Methods Evaluation of the 1 Deadly Step Program ",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Oct",
day="21",
volume="7",
number="10",
pages="e14259",
keywords="chronic disease",
keywords="screening",
keywords="indigenous health",
keywords="prevention",
keywords="primary health care",
abstract="Background: Chronic diseases account for over 70\% of health gaps between Aboriginal people and the rest of the Australian population. The 1 Deadly Step program involves community-based events that use a sporting platform and cultural ambassadors to improve chronic disease prevention and management in New South Wales (NSW). Objective: This study aimed to evaluate the feasibility and acceptability of a community-based chronic disease screening program for Aboriginal people. Methods: In 2015, the program was enhanced to include an iPad app for screening assessments, a results portal for nominated care providers, and a reporting portal for program administrators and implemented in 9 NSW community events. A mixed methods evaluation comprising survey data, analytics obtained from iPad and Web portal usage, and key informant interviews was conducted. Results: Overall, 1046 people were screened between April 2015 and April 2016 (mean age 40.3 years, 640 (61.19\%) female, 957 (91.49\%) Aboriginal or Torres Strait Islander). High chronic disease rates were observed (231 [22.08\%] participants at high cardiovascular disease (CVD) risk, 173 [16.54\%] with diabetes, and 181 [17.30\%] with albuminuria). A minority at high risk of CVD (99/231 [42.9\%]) and with diabetes (73/173 [42.2\%]) were meeting guideline-recommended management goals. Overall, 297 participants completed surveys (response rate 37.4\%) with 85.1\% reporting satisfaction with event organization and information gained and 6.1\% experiencing problems with certain screening activities. Furthermore, 21 interviews were conducted. A strong local working group and processes that harnessed community social networks were key to implementation success. Although software enhancements facilitated screening and data management, some technical difficulties (eg, time delays in processing blood test results) impeded smooth processing of information. Only 51.43\% of participants had a medical review recorded postevent with wide intersite variability (10.5\%-85.6\%). Factors associated with successful follow-up included clinic managers with overall program responsibility and availability of medical staff for immediate discussion of results on event day. The program was considered highly resource intensive to implement and support from a central coordinating body and integration with existing operational processes was essential. Conclusions: 1 Deadly Step offers an effective and acceptable strategy to engage Aboriginal communities in chronic disease screening. High rates of risk factors and management gaps were encountered, including people with no previous knowledge of these issues. Strategies to improve linkage to primary care could enhance the program's impact on reducing chronic disease burden. ",
doi="10.2196/14259",
url="http://mhealth.jmir.org/2019/10/e14259/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31638591"
}


@Article{info:doi/10.2196/14408,
author="Boer, Lonneke
and Bischoff, Erik
and van der Heijden, Maarten
and Lucas, Peter
and Akkermans, Reinier
and Vercoulen, Jan
and Heijdra, Yvonne
and Assendelft, Willem
and Schermer, Tjard",
title="A Smart Mobile Health Tool Versus a Paper Action Plan to Support Self-Management of Chronic Obstructive Pulmonary Disease Exacerbations: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Oct",
day="9",
volume="7",
number="10",
pages="e14408",
keywords="COPD",
keywords="symptom flare up",
keywords="mHealth",
keywords="self-management",
abstract="Background: Many patients with chronic obstructive pulmonary disease (COPD) suffer from exacerbations, a worsening of their respiratory symptoms that warrants medical treatment. Exacerbations are often poorly recognized or managed by patients, leading to increased disease burden and health care costs. Objective: This study aimed to examine the effects of a smart mobile health (mHealth) tool that supports COPD patients in the self-management of exacerbations by providing predictions of early exacerbation onset and timely treatment advice without the interference of health care professionals. Methods: In a multicenter, 2-arm randomized controlled trial with 12-months follow-up, patients with COPD used the smart mHealth tool (intervention group) or a paper action plan (control group) when they experienced worsening of respiratory symptoms. For our primary outcome exacerbation-free time, expressed as weeks without exacerbation, we used an automated telephone questionnaire system to measure weekly respiratory symptoms and treatment actions. Secondary outcomes were health status, self-efficacy, self-management behavior, health care utilization, and usability. For our analyses, we used negative binomial regression, multilevel logistic regression, and generalized estimating equation regression models. Results: Of the 87 patients with COPD recruited from primary and secondary care centers, 43 were randomized to the intervention group. We found no statistically significant differences between the intervention group and the control group in exacerbation-free weeks (mean 30.6, SD 13.3 vs mean 28.0, SD 14.8 weeks, respectively; rate ratio 1.21; 95\% CI 0.77-1.91) or in health status, self-efficacy, self-management behavior, and health care utilization. Patients using the mHealth tool valued it as a more supportive tool than patients using the paper action plan. Patients considered the usability of the mHealth tool as good. Conclusions: This study did not show beneficial effects of a smart mHealth tool on exacerbation-free time, health status, self-efficacy, self-management behavior, and health care utilization in patients with COPD compared with the use of a paper action plan. Participants were positive about the supportive function and the usability of the mHealth tool. mHealth may be a valuable alternative for COPD patients who prefer a digital tool instead of a paper action plan. Trial Registration: ClinicalTrials.gov NCT02553096; https://clinicaltrials.gov/ct2/show/NCT02553096. ",
doi="10.2196/14408",
url="https://mhealth.jmir.org/2019/10/e14408",
url="http://www.ncbi.nlm.nih.gov/pubmed/31599729"
}


@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/10.2196/14633,
author="Woods, Leanna
and Duff, Jed
and Roehrer, Erin
and Walker, Kim
and Cummings, Elizabeth",
title="Design of a Consumer Mobile Health App for Heart Failure: Findings From the Nurse-Led Co-Design of Care4myHeart",
journal="JMIR Nursing",
year="2019",
month="Sep",
day="23",
volume="2",
number="1",
pages="e14633",
keywords="heart failure",
keywords="mobile health (mHealth)",
keywords="mobile apps",
keywords="self-management",
keywords="mobile phone",
keywords="patient involvement",
abstract="Background: Consumer health care technology shows potential to improve outcomes for community-dwelling persons with chronic conditions, yet health app quality varies considerably. In partnership with patients and family caregivers, hospital clinicians developed Care4myHeart, a mobile health (mHealth) app for heart failure (HF) self-management. Objective: The aim of this paper was to report the outcomes of the nurse-led design process in the form of the features and functions of the developed app, Care4myHeart. Methods: Seven patients, four family caregivers, and seven multidisciplinary hospital clinicians collaborated in a design thinking process of innovation. The co-design process, involving interviews, design workshops, and prototype feedback sessions, incorporated the lived experience of stakeholders and evidence-based literature in a design that would be relevant and developed with rigor. Results: The home screen displays the priority HF self-management components with a reminder summary, general information on the condition, and a settings tab. The health management section allows patients to list health care team member's contact details, schedule medical appointments, and store documents. The My Plan section contains nine important self-management components with a combination of information and advice pages, graphical representation of patient data, feedback, and more. The greatest strength of the co-design process to achieve the design outcomes was the involvement of local patients, family caregivers, and clinicians. Moreover, incorporating the literature, guidelines, and current practices into the design strengthened the relevance of the app to the health care context. However, the strength of context specificity is also a limitation to portability, and the final design is limited to the stakeholders involved in its development. Conclusions: We recommend health app development teams strategically incorporate relevant stakeholders and literature to design mHealth solutions that are rigorously designed from a solid evidence base and are relevant to those who will use or recommend their use. ",
doi="10.2196/14633",
url="https://nursing.jmir.org/2019/1/e14633",
url="http://www.ncbi.nlm.nih.gov/pubmed/34345774"
}


@Article{info:doi/10.2196/14657,
author="Chung, Kyungmi
and Park, Young Jin
and Joung, DaYoung
and Jhung, Kyungun",
title="Response Time as an Implicit Self-Schema Indicator for Depression Among Undergraduate Students: Preliminary Findings From a Mobile App--Based Depression Assessment",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Sep",
day="13",
volume="7",
number="9",
pages="e14657",
keywords="depressive symptoms",
keywords="response time",
keywords="self-concept",
keywords="mobile phone",
keywords="mobile apps",
keywords="diagnostic screening programs",
keywords="self-assessment",
keywords="treatment adherence",
keywords="compliance",
abstract="Background: Response times to depressive symptom items in a mobile-based depression screening instrument has potential as an implicit self-schema indicator for depression but has yet to be determined; the instrument was designed to readily record depressive symptoms experienced on a daily basis. In this study, the well-validated Korean version of the Center for Epidemiologic Studies Depression Scale-Revised (K-CESD-R) was adopted. Objective: The purpose of this study was to investigate the relationship between depression severity (ie, explicit measure: total K-CESD-R Mobile scores) and the latent trait of interest in schematic self-referent processing of depressive symptom items (ie, implicit measure: response times to items in the K-CESD-R Mobile scale). The purpose was to investigate this relationship among undergraduate students who had never been diagnosed with, but were at risk for, major depressive disorder (MDD) or comorbid MDD with other neurological or psychiatric disorders. Methods: A total of 70 participants---36 males (51\%) and 34 females (49\%)---aged 19-29 years (mean 22.66, SD 2.11), were asked to complete both mobile and standard K-CESD-R assessments via their own mobile phones. The mobile K-CESD-R sessions (binary scale: yes or no) were administered on a daily basis for 2 weeks. The standard K-CESD-R assessment (5-point scale) was administered on the final day of the 2-week study period; the assessment was delivered via text message, including a link to the survey, directly to participants' mobile phones. Results: A total of 5 participants were excluded from data analysis. The result of polynomial regression analysis showed that the relationship between total K-CESD-R Mobile scores and the reaction times to the depressive symptom items was better explained by a quadratic trend---F (2, 62)=21.16, P<.001, R2=.41---than by a linear trend---F (1, 63)=25.43, P<.001, R2=.29. It was further revealed that the K-CESD-R Mobile app had excellent internal consistency (Cronbach alpha=.94); at least moderate concurrent validity with other depression scales, such as the Korean version of the Quick Inventory for Depressive Symptomatology-Self Report ($\rho$=.38, P=.002) and the Patient Health Questionnaire-9 ($\rho$=.48, P<.001); a high adherence rate for all participants (65/70, 93\%); and a high follow-up rate for 10 participants whose mobile or standard K-CESD-R score was 13 or greater (8/10, 80\%). Conclusions: As hypothesized, based on a self-schema model for depression that represented both item and person characteristics, the inverted U-shaped relationship between the explicit and implicit self-schema measures for depression showed the potential of an organizational breakdown; this also showed the potential for a subsequent return to efficient processing of schema-consistent information along a continuum, ranging from nondepression through mild depression to severe depression. Further, it is expected that the updated K-CESD-R Mobile app can play an important role in encouraging people at risk for depression to seek professional follow-up for mental health care. ",
doi="10.2196/14657",
url="https://mhealth.jmir.org/2019/9/e14657/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31586362"
}


@Article{info:doi/10.2196/12604,
author="Siddique, Bakkar Abu
and Krebs, Mary
and Alvarez, Sarai
and Greenspan, Iris
and Patel, Amit
and Kinsolving, Julianna
and Koizumi, Naoru",
title="Mobile Apps for the Care Management of Chronic Kidney and End-Stage Renal Diseases: Systematic Search in App Stores and Evaluation",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Sep",
day="04",
volume="7",
number="9",
pages="e12604",
keywords="mobile apps",
keywords="mhealth",
keywords="digital health",
keywords="kidney patient",
keywords="nutrition tracking",
keywords="systematic assessment",
keywords="Mobile App Rating Scale",
abstract="Background: Numerous free and low-cost mobile apps for the care management of kidney disease have become available in recent years. Although these appear to be promising tools, they have not been evaluated comparatively based on standard mobile app metrics, and thus, limited evidence is available regarding their efficacy. This study systematically cataloged and assessed mobile apps designed to assist medication compliance and nutrition tracking that are useful to the chronic kidney disease (CKD) and the end-stage renal disease (ESRD) patients who are on dialysis. Objective: The objective of this study was to comprehensively evaluate mobile apps used for medication compliance and nutrition tracking for possible use by CKD and ESRD patients. Methods: A systematic review framework was applied to the search, screening, and assessment of apps identified and downloaded from the iOS and Android app stores. We selected apps using 13 relevant search terms, narrowed down based on a set of inclusion and exclusion criteria, and then used the Mobile App Rating Scale (MARS), a widely adopted app evaluation tool to assess the effectiveness of apps. The internal consistency and interrater reliability were tested using Cronbach alpha and interclass correlation coefficients (ICCs), respectively. Results: The MARS total score had excellent internal consistency (Cronbach alpha=.90) and a moderate level of interrater reliability (2-way mixed ICC 0.65). Overall, 11 out of the 12 reviewed apps met the minimum acceptable score of 3.0 in MARS rating. The 3 apps with the highest combined scores were My Kidneys, My Health Handbook (MARS=4.68); My Food Coach (MARS=4.48); and National Kidney Foundation Malaysia (MARS=4.20). The study identified 2 general weaknesses in the existing apps: the apps fell short of accommodating advanced interactive features such as providing motivational feedback and promoting family member and caregiver participations in the app utilization. Conclusions: The MARS rating system performed well in the app evaluation. The 3 highest ranked apps scored consistently high across the 5 dimensions specified in MARS. These apps were developed in collaboration with reputable organizations and field experts, demonstrating the importance of expert guidance in developing medical apps. ",
doi="10.2196/12604",
url="https://mhealth.jmir.org/2019/9/e12604/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31486408"
}


@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/10.2196/15023,
author="Zhang, Yiyu
and Liu, Chaoyuan
and Luo, Shuoming
and Xie, Yuting
and Liu, Fang
and Li, Xia
and Zhou, Zhiguang",
title="Factors Influencing Patients' Intentions to Use Diabetes Management Apps Based on an Extended Unified Theory of Acceptance and Use of Technology Model: Web-Based Survey",
journal="J Med Internet Res",
year="2019",
month="Aug",
day="13",
volume="21",
number="8",
pages="e15023",
keywords="diabetes mellitus",
keywords="mobile applications",
keywords="survey",
keywords="structural equation modeling",
keywords="China",
abstract="Background: Diabetes poses heavy social and economic burdens worldwide. Diabetes management apps show great potential for diabetes self-management. However, the adoption of diabetes management apps by diabetes patients is poor. The factors influencing patients' intention to use these apps are unclear. Understanding the patients' behavioral intention is necessary to support the development and promotion of diabetes app use. Objective: This study aimed to identify the determinants of patients' intention to use diabetes management apps based on an integrated theoretical model. Methods: The hypotheses of our research model were developed based on an extended Unified Theory of Acceptance and Use of Technology (UTAUT). From April 20 to May 20, 2019, adult patients with diabetes across China, who were familiar with diabetes management apps, were surveyed using the Web-based survey tool Sojump. Structural equation modeling was used to analyze the data. Results: A total of 746 participants who met the inclusion criteria completed the survey. The fitness indices suggested that the collected data fit well with the research model. The model explained 62.6\% of the variance in performance expectancy and 57.1\% of the variance in behavioral intention. Performance expectancy and social influence had the strongest total effects on behavioral intention ($\beta$=0.482; P=.001). Performance expectancy ($\beta$=0.482; P=.001), social influence ($\beta$=0.223; P=.003), facilitating conditions ($\beta$=0.17; P=.006), perceived disease threat ($\beta$=0.073; P=.005), and perceived privacy risk ($\beta$=--0.073; P=.012) had direct effects on behavioral intention. Additionally, social influence, effort expectancy, and facilitating conditions had indirect effects on behavioral intention that were mediated by performance expectancy. Social influence had the highest indirect effects among the three constructs ($\beta$=0.259; P=.001). Conclusions: Performance expectancy and social influence are the most important determinants of the intention to use diabetes management apps. Health care technology companies should improve the usefulness of apps and carry out research to provide clinical evidence for the apps' effectiveness, which will benefit the promotion of these apps. Facilitating conditions and perceived privacy risk also have an impact on behavioral intention. Therefore, it is necessary to improve facilitating conditions and provide solid privacy protection. Our study supports the use of UTAUT in explaining patients' intention to use diabetes management apps. Context-related determinants should also be taken into consideration. ",
doi="10.2196/15023",
url="http://www.jmir.org/2019/8/e15023/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31411146"
}


@Article{info:doi/10.2196/15021,
author="Serlachius, Anna
and Schache, Kiralee
and Kieser, Anel
and Arroll, Bruce
and Petrie, Keith
and Dalbeth, Nicola",
title="Association Between User Engagement of a Mobile Health App for Gout and Improvements in Self-Care Behaviors: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Aug",
day="13",
volume="7",
number="8",
pages="e15021",
keywords="mobile apps",
keywords="mHealth",
keywords="gout",
keywords="chronic disease",
keywords="user engagement",
keywords="illness perceptions",
abstract="Background: Mobile health (mHealth) apps represent a promising approach for improving health outcomes in patients with chronic illness, but surprisingly few mHealth interventions have investigated the association between user engagement and health outcomes. We aimed to examine the efficacy of a recommended, commercially available gout self-management app for improving self-care behaviors and to assess self-reported user engagement of the app in a sample of adults with gout. Objective: Our objective was to examine differences in self-reported user engagement between a recommended gout app (treatment group) and a dietary app (active control group) over 2 weeks as well as to examine any differences in self-care behaviors and illness perceptions. Methods: Seventy-two adults with gout were recruited from the community and three primary and secondary clinics. Participants were randomized to use either Gout Central (n=36), a self-management app, or the Dietary Approaches to Stop Hypertension Diet Plan (n=36), an app based on a diet developed for hypertension, for 2 weeks. The user version of the Mobile Application Rating Scale (uMARS, scale: 1 to 5) was used after the 2 weeks to assess self-reported user engagement, which included an open-ended question. Participants also completed a self-report questionnaire on self-care behaviors (scale: 1-5 for medication adherence and diet and 0-7 for exercise) and illness perceptions (scale: 0-10) at baseline and after the 2-week trial. Independent samples t tests and analysis of covariance were used to examine differences between groups at baseline and postintervention. Results: Participants rated the gout app as more engaging (mean difference --0.58, 95\% CI --0.96 to --0.21) and more informative (mean difference --0.34, 95\% CI --0.67 to --0.01) than the dietary app at the 2-week follow-up. The gout app group also reported a higher awareness of the importance of gout (mean difference --0.64, 95\% CI --1.27 to --0.003) and higher knowledge/understanding of gout (mean difference --0.70, 95\% CI --1.30 to --0.09) than the diet app group at follow-up. There were no significant differences in self-care behaviors between the two groups postintervention. The gout app group also demonstrated stronger negative beliefs regarding the impact of gout (mean difference --2.43, 95\% CI --3.68 to --1.18), stronger beliefs regarding the severity of symptoms (mean difference --1.97, 95\% CI --3.12 to --0.82), and a stronger emotional response to gout (mean difference --2.38, 95\% CI --3.85 to --0.90) at follow-up. Participant feedback highlighted the importance of tracking health-related information, customizing to the target group/individual, providing more interactive features, and simplifying information. Conclusions: Participants found the commercially available gout app more engaging. However, these findings did not translate into differences in self-care behaviors. The gout app group also demonstrated stronger negative illness perceptions at the follow-up. Overall, these findings suggest that the development of gout apps would benefit from a user-centered approach with a focus on daily, long-term self-care behaviors as well as modifying illness beliefs. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12617001052325; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373217. ",
doi="10.2196/15021",
url="http://mhealth.jmir.org/2019/8/e15021/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31411147"
}


@Article{info:doi/10.2196/14991,
author="Knitza, Johannes
and Tascilar, Koray
and Messner, Eva-Maria
and Meyer, Marco
and Vossen, Diana
and Pulla, Almut
and Bosch, Philipp
and Kittler, Julia
and Kleyer, Arnd
and Sewerin, Philipp
and Mucke, Johanna
and Haase, Isabell
and Simon, David
and Krusche, Martin",
title="German Mobile Apps in Rheumatology: Review and Analysis Using the Mobile Application Rating Scale (MARS)",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Aug",
day="05",
volume="7",
number="8",
pages="e14991",
keywords="mobile apps",
keywords="eHealth",
keywords="rheumatology",
keywords="mHealth",
keywords="Mobile Application Rating Scale",
abstract="Background: Chronic rheumatic diseases need long-term treatment and professional supervision. Mobile apps promise to improve the lives of patients and physicians. In routine practice, however, rheumatology apps are largely unknown and little is known about their quality and safety. Objective: The aim of this study was to provide an overview of mobile rheumatology apps currently available in German app stores, evaluate app quality using the Mobile Application Rating Scale (MARS), and compile brief, ready-to-use descriptions for patients and rheumatologists. Methods: The German App Store and Google Play store were systematically searched to identify German rheumatology mobile apps for patient and physician use. MARS was used to independently assess app quality by 8 physicians, 4 using Android and 4 using iOS smartphones. Apps were randomly assigned so that 4 apps were rated by all raters and the remaining apps were rated by two Android and two iOS users. Furthermore, brief app descriptions including app developers, app categories, and features were compiled to inform potential users and developers. Results: In total, 128 and 63 apps were identified in the German Google Play and App Store, respectively. After removing duplicates and only including apps that were available in both stores, 28 apps remained. Sixteen apps met the inclusion criteria, which were (1) German language, (2) availability in both app stores, (3) targeting patients or physicians as users, and (4) clearly including rheumatology or rheumatic diseases as subject matter. Exclusion criteria were (1) congress apps and (2) company apps with advertisements. Nine apps addressed patients and 7 apps addressed physicians. No clinical studies to support the effectiveness and safety of apps could be found. Pharmaceutical companies were the main developers of two apps. Rheuma Auszeit was the only app mainly developed by a patient organization. This app had the highest overall MARS score (4.19/5). Three out of 9 patient apps featured validated questionnaires. The median overall MARS score was 3.85/5, ranging from 2.81/5 to 4.19/5. One patient-targeted and one physician-targeted app had MARS scores >4/5. No significant rater gender or platform (iOS/Android) differences could be observed. The overall correlation between app store ratings and MARS scores was low and inconsistent between platforms. Conclusions: To our knowledge, this is the first study that systematically identified and evaluated mobile apps in rheumatology for patients and physicians available in German app stores. We found a lack of supporting clinical studies, use of validated questionnaires, and involvement of academic developers. Overall app quality was heterogeneous. To create high-quality apps, closer cooperation led by patients and physicians is vital. ",
doi="10.2196/14991",
url="https://mhealth.jmir.org/2019/8/e14991/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31381501"
}


@Article{info:doi/10.2196/13906,
author="Rogers, Erin
and Aidasani, R. Sneha
and Friedes, Rebecca
and Hu, Lu
and Langford, T. Aisha
and Moloney, N. Dana
and Orzeck-Byrnes, Natasha
and Sevick, Ann Mary
and Levy, Natalie",
title="Barriers and Facilitators to the Implementation of a Mobile Insulin Titration Intervention for Patients With Uncontrolled Diabetes: A Qualitative Analysis",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jul",
day="31",
volume="7",
number="7",
pages="e13906",
keywords="type 2 diabetes",
keywords="telemedicine",
keywords="implementation science",
abstract="Background: In 2016, a short message service text messaging intervention to titrate insulin in patients with uncontrolled type 2 diabetes was implemented at two health care facilities in New York City. Objective: This study aimed to conduct a qualitative evaluation assessing barriers to and the facilitators of the implementation of the Mobile Insulin Titration Intervention (MITI) program into usual care. Methods: We conducted in-depth interviews with 36 patients enrolled in the MITI program and the staff involved in MITI (n=19) in the two health care systems. Interviews were transcribed and iteratively coded by two study investigators, both inductively and deductively using a codebook guided by the Consolidated Framework for Implementation Research. Results: Multiple facilitator themes emerged: (1) MITI had strong relative advantages to in-person titration, including its convenience and time-saving design, (2) the free cost of MITI was important to the patients, (3) MITI was easy to use and the patients were confident in their ability to use it, (4) MITI was compatible with the patients' home routines and clinic workflow, (5) the patients and staff perceived MITI to have value beyond insulin titration by reminding and motivating the patients to engage in healthy behaviors and providing a source of patient support, and (6) implementation in clinics was made easy by having a strong implementation climate, communication networks to spread information about MITI, and a strong program champion. The barriers identified included the following: (1) language limitations, (2) initial nurse concerns about the scope of practice changes required to deliver MITI, (3) initial provider knowledge gaps about the program, and (4) provider perceptions that MITI might not be appropriate for some patients (eg, older or not tech-savvy). There was also a theme that emerged during the patient and staff interviews of an unmet need for long-term additional diabetes management support among this population, specifically diet, nutrition, and exercise support. Conclusions: The patients and staff were overwhelmingly supportive of MITI and believed that it had many benefits and that it was compatible with the clinic workflow and patients' lives. Initial implementation efforts should address staff training and nurse concerns. Future research should explore options for integrating additional diabetes support for patients. ",
doi="10.2196/13906",
url="http://mhealth.jmir.org/2019/7/e13906/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31368439"
}


@Article{info:doi/10.2196/12071,
author="McCann, Lisa
and McMillan, Anne Kathryn
and Pugh, Gemma",
title="Digital Interventions to Support Adolescents and Young Adults With Cancer: Systematic Review",
journal="JMIR Cancer",
year="2019",
month="Jul",
day="31",
volume="5",
number="2",
pages="e12071",
keywords="adolescent",
keywords="neoplasms",
keywords="telemedicine",
keywords="systematic review",
keywords="eHealth",
abstract="Background: The last decade has seen an increase in the number of digital health interventions designed to support adolescents and young adults (AYAs) with cancer. Objective: The objective of this review was to identify, characterize, and fully assess the quality, feasibility, and efficacy of existing digital health interventions developed specifically for AYAs, aged between 13 and 39 years, living with or beyond a cancer diagnosis. Methods: Searches were performed in PubMed, EMBASE, and Web of Science to identify digital health interventions designed specifically for AYA living with or beyond a cancer diagnosis. Data on the characteristics and outcomes of each intervention were synthesized. Results: A total of 4731 intervention studies were identified through the searches; 38 interventions (43 research papers) met the inclusion criteria. Most (20/38, 53\%) were website-based interventions. Most studies focused on symptom management and medication adherence (15, 39\%), behavior change (15, 39\%), self-care (8, 21\%), and emotional health (7, 18\%). Most digital health interventions included multiple automated and communicative functions such as enriched information environments, automated follow-up messages, and access to peer support. Where reported (20, 53\% of studies), AYAs' subjective experience of using the digital platform was typically positive. The overall quality of the studies was found to be good (mean Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields scores >68\%). Some studies reported feasibility outcomes (uptake, acceptability, and attrition) but were not sufficiently powered to comment on intervention effects. Conclusions: Numerous digital interventions have been developed and designed to support young people living with and beyond a diagnosis of cancer. However, many of these interventions have yet to be deployed, implemented, and evaluated at scale. ",
doi="10.2196/12071",
url="http://cancer.jmir.org/2019/2/e12071/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31368438"
}


@Article{info:doi/10.2196/14087,
author="Braune, Katarina
and O'Donnell, Shane
and Cleal, Bryan
and Lewis, Dana
and Tappe, Adrian
and Willaing, Ingrid
and Hauck, Bastian
and Raile, Klemens",
title="Real-World Use of Do-It-Yourself Artificial Pancreas Systems in Children and Adolescents With Type 1 Diabetes: Online Survey and Analysis of Self-Reported Clinical Outcomes",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jul",
day="30",
volume="7",
number="7",
pages="e14087",
keywords="artificial pancreas",
keywords="do it yourself",
keywords="open source",
keywords="mobile health",
keywords="diabetes",
keywords="type 1 diabetes",
keywords="pediatric diabetes",
keywords="closed loop",
keywords="automated insulin delivery",
abstract="Background: Patient-driven initiatives have made uptake of Do-it-Yourself Artificial Pancreas Systems (DIYAPS) increasingly popular among people with diabetes of all ages. Observational studies have shown improvements in glycemic control and quality of life among adults with diabetes. However, there is a lack of research examining outcomes of children and adolescents with DIYAPS in everyday life and their social context. Objective: This survey assesses the self-reported clinical outcomes of a pediatric population using DIYAPS in the real world. Methods: An online survey was distributed to caregivers to assess the hemoglobin A1c levels and time in range (TIR) before and after DIYAPS initiation and problems during DIYAPS use. Results: A total of 209 caregivers of children from 21 countries responded to the survey. Of the children, 47.4\% were female, with a median age of 10 years, and 99.4\% had type 1 diabetes, with a median duration of 4.3 years (SD 3.9). The median duration of DIYAPS use was 7.5 (SD 10.0) months. Clinical outcomes improved significantly, including the hemoglobin A1c levels (from 6.91\% [SD 0.88\%] to 6.27\% [SD 0.67]; P<.001) and TIR (from 64.2\% [SD 15.94] to 80.68\% [SD 9.26]; P<.001). Conclusions: Improved glycemic outcomes were found across all pediatric age groups, including adolescents and very young children. These findings are in line with clinical trial results from commercially developed closed-loop systems. ",
doi="10.2196/14087",
url="http://mhealth.jmir.org/2019/7/e14087/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31364599"
}


@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/10.2196/11086,
author="Slattery, W. Brian
and Haugh, Stephanie
and O'Connor, Laura
and Francis, Kady
and Dwyer, P. Christopher
and O'Higgins, Siobh{\'a}n
and Egan, Jonathan
and McGuire, E. Brian",
title="An Evaluation of the Effectiveness of the Modalities Used to Deliver Electronic Health Interventions for Chronic Pain: Systematic Review With Network Meta-Analysis",
journal="J Med Internet Res",
year="2019",
month="Jul",
day="17",
volume="21",
number="7",
pages="e11086",
keywords="eHealth",
keywords="mHealth",
keywords="digital health",
keywords="Virtual Reality",
keywords="chronic pain",
keywords="systematic review",
keywords="network meta-analysis",
abstract="Background: Electronic health (eHealth) is the use of information and communication technology in the context of health care and health research. Recently, there has been a rise in the number of eHealth modalities and the frequency with which they are used to deliver technology-assisted self-management interventions for people living with chronic pain. However, there has been little or no research directly comparing these eHealth modalities. Objective: The aim of this systematic review with a network meta-analysis (NMA) is to compare the effectiveness of eHealth modalities in the context of chronic pain. Methods: Randomized controlled trials (N>20 per arm) that investigated interventions for adults with chronic pain, delivered via an eHealth modality, were included. Included studies were categorized into their primary node of delivery. Data were extracted on the primary outcome, pain interference, and secondary outcomes, pain severity, psychological distress, and health-related quality of life. Pairwise meta-analyses were undertaken where possible, and an NMA was conducted to generate indirect comparisons and rankings of modalities for reducing pain interference. Results: The search returned 18,470 studies with 18,349 being excluded (duplicates=2310; title and abstract=16,039). Of the remaining papers, 30 studies with 5394 randomized participants were included in the review. Rankings tentatively indicated that modern eHealth modalities are the most effective, with a 43\% chance that mobile apps delivered the most effective interventions, followed by a 34\% chance that interventions delivered via virtual reality were the most effective. Conclusions: This systematic review with an NMA generated comparisons between eHealth modalities previously not compared to determine which delivered the most effective interventions for the reduction of pain interference in chronic pain patients. There are limitations with this review, in particular, the underrepresented nature of some eHealth modalities included in the analysis. However, in the event that the review is regularly updated, a clear ranking of eHealth modalities for the reduction of pain interference will emerge. ",
doi="10.2196/11086",
url="https://www.jmir.org/2019/7/e11086/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31317869"
}


@Article{info:doi/10.2196/11527,
author="Holubov{\'a}, Anna
and Vlas{\'a}kov{\'a}, Martina
and Mu?{\'i}k, Jan
and Bro?, Jan",
title="Customizing the Types of Technologies Used by Patients With Type 1 Diabetes Mellitus for Diabetes Treatment: Case Series on Patient Experience",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jul",
day="09",
volume="7",
number="7",
pages="e11527",
keywords="type 1 diabetes mellitus",
keywords="technology",
keywords="self-management",
keywords="wearable electronic devices",
keywords="education",
keywords="telemedicine",
abstract="Background: Despite the fact there are many wearable and mobile medical devices that enable patients to better self-manage their diabetes, not many patients are aware of all the options they have. In addition, there are those who are not fully satisfied with the devices they use, and those who often do not use them effectively. Objective: The study aimed to propose possible changes to the combination of devices used by 6 specific patients for diabetes self-management. We assessed the suitability of selected technical devices for diabetes control. Methods: Data of 6 patients (3 men and 3 women) with type 1 diabetes mellitus, who had been using the Diani telemedicine system for at least 3 months, were analyzed. The suitability of selected technical devices for diabetes control was ascertained using the data obtained via the Diani telemedicine system, as well as the patients' subjective feelings and statements, their everyday life habits, and self-management of diabetes. Informed consent was signed and obtained from each of the patients included. Results: Each of the presented case studies describes how a given patient handled the system and its specific components based on his or her lifestyle, level of education, habits related to diabetes management, personality type, and other factors. At the conclusion of each case study, the best composition of devices for patients with similar personal descriptions was suggested. Conclusions: We believe this study can provide relevant guidance on how to help particular patients choose the technology that is best suited for their needs, based on the specific patient information we are able to obtain from them. Furthermore, clinicians or educators should be aware of available technologies a given patient can choose from. In addition, there is a substantial need for proper patient education in order for them to effectively use devices for diabetes self-management. ",
doi="10.2196/11527",
url="https://mhealth.jmir.org/2019/7/e11527/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31290400"
}


@Article{info:doi/10.2196/13543,
author="N{\'a}poles, Mar{\'i}a Anna
and Santoyo-Olsson, Jasmine
and Chac{\'o}n, Liliana
and Stewart, L. Anita
and Dixit, Niharika
and Ortiz, Carmen",
title="Feasibility of a Mobile Phone App and Telephone Coaching Survivorship Care Planning Program Among Spanish-Speaking Breast Cancer Survivors",
journal="JMIR Cancer",
year="2019",
month="Jul",
day="09",
volume="5",
number="2",
pages="e13543",
keywords="Hispanic Americans",
keywords="cancer survivors",
keywords="mobile apps",
keywords="feasibility studies",
abstract="Background: Spanish-speaking Latina breast cancer survivors experience disparities in knowledge of breast cancer survivorship care, psychosocial health, lifestyle risk factors, and symptoms compared with their white counterparts. Survivorship care planning programs (SCPPs) could help these women receive optimal follow-up care and manage their condition. Objective: This study aimed to evaluate the feasibility, acceptability, and preliminary efficacy of a culturally and linguistically suitable SCPP called the Nuevo Amanecer (New Dawn) Survivorship Care Planning Program for Spanish-speaking breast cancer patients in public hospital settings, approaching the end of active treatment. Methods: The 2-month intervention was delivered via a written bilingual survivorship care plan and booklet, Spanish-language mobile phone app with integrated activity tracker, and telephone coaching. This single-arm feasibility study used mixed methods to evaluate the intervention. Acceptability and feasibility were examined via tracking of implementation processes, debriefing interviews, and postintervention satisfaction surveys. Preliminary efficacy was assessed via baseline and 2-month interviews using structured surveys and pre- and postintervention average daily steps count based on activity tracker data. Primary outcomes were self-reported fatigue, health distress, knowledge of cancer survivorship care, and self-efficacy for managing cancer follow-up health care and self-care. Secondary outcomes were emotional well-being, depressive and somatic symptoms, and average daily steps. Results: All women (n=23) were foreign-born with limited English proficiency; 13 (57\%) had an elementary school education or less, 16 (70\%) were of Mexican origin, and all had public health insurance. Coaching calls lasted on average 15 min each (SD 3.4). A total of 19 of 23 participants (83\%) completed all 5 coaching calls. The majority (n=17; 81\%) rated the overall quality of the app as ``very good'' or ``excellent'' (all rated it as at least ``good''). Women checked their daily steps graph on the app between 4.2 to 5.9 times per week. Compared with baseline, postintervention fatigue (B=--.26; P=.02; Cohen d=0.4) and health distress levels (B=--.36; P=.01; Cohen d=0.3) were significantly lower and knowledge of recommended follow-up care and resources (B=.41; P=.03; Cohen d=0.5) and emotional well-being improved significantly (B=1.42; P=.02; Cohen d=0.3); self-efficacy for managing cancer follow-up care did not change. Average daily steps increased significantly from 6157 to 7469 (B=1311.8; P=.02; Cohen d=0.5). Conclusions: We found preliminary evidence of program feasibility, acceptability, and efficacy, with significant 2-month improvements in fatigue, health distress, and emotional well-being and increased knowledge of recommended follow-up care and average daily steps. Tailored mobile phone and health coaching SCPPs could help to ensure equitable access to these services and improve symptoms and physical activity levels among Spanish-speaking Latina breast cancer survivors. ",
doi="10.2196/13543",
url="http://cancer.jmir.org/2019/2/e13543/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31290395"
}


@Article{info:doi/10.2196/14032,
author="Ritholz, D. Marilyn
and Henn, Owen
and Atakov Castillo, Astrid
and Wolpert, Howard
and Edwards, Stephanie
and Fisher, Lawrence
and Toschi, Elena",
title="Experiences of Adults With Type 1 Diabetes Using Glucose Sensor--Based Mobile Technology for Glycemic Variability: Qualitative Study",
journal="JMIR Diabetes",
year="2019",
month="Jul",
day="08",
volume="4",
number="3",
pages="e14032",
keywords="diabetes mellitus, type 1",
keywords="educational technology",
keywords="blood glucose self-monitoring",
keywords="qualitative research",
abstract="Background: Adults with type 1 diabetes (PWDs) face challenging self-management regimens including monitoring their glucose values multiple times a day to assist with achieving glycemic targets and reduce the risk of long-term diabetes complications. Recent advances in diabetes technology have reportedly improved glycemia, but little is known about how PWDs utilize mobile technology to make positive changes in their diabetes self-management. Objective: The aim of this qualitative study was to explore PWDs' experiences using Sugar Sleuth, a glucose sensor--based mobile app and Web-based reporting system, integrated with the FreeStyle Libre glucose monitor that provides feedback about glycemic variability. Methods: We used a qualitative descriptive research design and conducted semistructured interviews with 10 PWDs (baseline mean glycated hemoglobin, HbA1c) 8.0\%, (SD 0.45); 6 males and 4 females, aged 52 years (SD 15), type 1 diabetes (T1D) duration 31 years (SD 13), 40\% (4/10, insulin pump) following a 14-week intervention during which they received clinical support and used Sugar Sleuth to evaluate and understand their glucose data. Audio-recorded interviews were transcribed, coded, and analyzed using thematic analysis and NVivo 11 (QSR International Pty Ltd). Results: A total of 4 main themes emerged from the data. Participants perceived Sugar Sleuth as an Empowering Tool that served to inform lifestyle choices and diabetes self-management tasks, promoted preemptive self-care actions, and improved discussions with clinicians. They also described Sugar Sleuth as providing a Source of Psychosocial Support and offering relief from worry, reducing glycemic uncertainty, and supporting positive feelings about everyday life with diabetes. Participants varied in their Approaches to Glycemic Data: 40\% (4/10) described using Sugar Sleuth to review data, understand glycemic cause and effect, and plan for future self-care. On the contrary, 60\% (6/10) were reluctant to review past data; they described receiving benefits from the immediate numbers and trend arrows, but the app still prompted them to enter in the suspected causes of glucose excursions within hours of their occurrence. Finally, only 2 participants voiced Concerns About Use of Sugar Sleuth; they perceived the app as sometimes too demanding of information or as not attuned to the socioeconomic backgrounds of PWDs from diverse populations. Conclusions: Results suggest that Sugar Sleuth can be an effective educational tool to enhance both patient-clinician collaboration and diabetes self-management. Findings also highlight the importance of exploring psychosocial and socioeconomic factors that may advance the understanding of PWDs' individual differences when using glycemic technology and may promote the development of customized mobile tools to improve diabetes self-management. ",
doi="10.2196/14032",
url="http://diabetes.jmir.org/2019/3/e14032/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31287065"
}


@Article{info:doi/10.2196/12305,
author="Dunsmuir, Dustin
and Wu, Helen
and Sun, Terri
and West, C. Nicholas
and Lauder, R. Gillian
and G{\"o}rges, Matthias
and Ansermino, Mark J.",
title="A Postoperative Pain Management Mobile App (Panda) for Children at Home After Discharge: Usability and Feasibility",
journal="JMIR Perioper Med",
year="2019",
month="Jul",
day="04",
volume="2",
number="2",
pages="e12305",
keywords="pain management",
keywords="pain, postoperative period",
keywords="outpatients",
keywords="mobile apps",
keywords="child",
keywords="parents",
abstract="Background: Emphasis on outpatient pediatric surgical procedures places the burden of responsibility for postoperative pain management on parents or guardians. Panda is a mobile phone app that provides scheduled medication alerts and allows parents to track their child's pain and medication administration. We have previously tested and optimized the usability and feasibility of Panda within the hospital setting. Objective: The purpose of this study was to evaluate and optimize the usability and feasibility of Panda for use at home based on alert response adherence (response to any medication notification within 1 hour) and parents' satisfaction. Methods: Parents or guardians of children aged 3 to 18 years undergoing day surgery were recruited to use Panda at home for 1 to 7 days to manage their scheduled medications and to assess their child's pain. After the surgical procedure, a research assistant guided parents through app setup before independent use at home. We aimed to recruit 10 child-caregiver pairs in each of three rounds of evaluation. Each user's adherence with the recommended medication alerts was analyzed through audit-trail data generated during the use of the app. We used the Computer System Usability Questionnaire and a poststudy phone interview to evaluate the app's ease of use and identify major barriers to adoption. Suggestions provided during the interviews were used to improve the app between each round. Results: Twenty-nine child-caregiver pairs participated in three rounds, using the app for 1 to 5 days. Alert response adherence (response to any medication notification within 1 hour) improved as the study progressed: participants responded to a median 30\% (interquartile range [IQR] 22\%-33\%) of alerts within 1 hour in round 1, and subsequently to median 60\% (IQR 44\%-64\%) in round 2 and median 64\% (IQR 56\%-72\%) in round 3 (P=.005). Similarly, response times decreased from median 131 (IQR 77-158) minutes in round 1 to median 31 (IQR 18-61) minutes in round 2 and median 10 (IQR 2-14) minutes in round 3 (P=.002). Analysis of interview feedback from the first two rounds revealed usability issues, such as complaints of too many pages and trouble hearing app alerts, which were addressed to streamline app function, as well as improve visual appearance and audible alerts. Conclusions: It is feasible for parents or guardians to use Panda at home to manage their child's medication schedule and track their pain. Simple modifications to the app's alert sounds and user interface improved response times. ",
doi="10.2196/12305",
url="https://periop.jmir.org/2019/2/e12305/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33393928"
}


@Article{info:doi/10.2196/13847,
author="Grady, Mike
and Venugopal, Usha
and Robert, Katia
and Hurrell, Graham
and Schnell, Oliver",
title="Health Care Professionals' Clinical Perspectives and Acceptance of a Blood Glucose Meter and Mobile App Featuring a Dynamic Color Range Indicator and Blood Sugar Mentor: Online Evaluation in Seven Countries",
journal="JMIR Hum Factors",
year="2019",
month="Jul",
day="03",
volume="6",
number="3",
pages="e13847",
keywords="ColorSure Dynamic Range Indicator",
keywords="Blood Sugar Mentor",
keywords="mobile app",
keywords="blood glucose meter",
keywords="self-monitoring of blood glucose",
keywords="health care professionals",
abstract="Background: Despite many new therapies and technologies becoming available in the last decade, people with diabetes continue to struggle to achieve good glycemic control. Innovative and affordable solutions are needed to support health care professionals (HCPs) to improve patient outcomes. Objective: To gather current self-management perceptions of HCPs in seven countries and investigate HCP satisfaction with a new glucose meter and mobile app featuring a dynamic color range indicator and a blood sugar mentor. Methods: A total of 355 HCPs, including 142 endocrinologists (40.0\%), 108 primary care physicians (30.4\%), and 105 diabetes nurses (29.6\%), were recruited from the United Kingdom (n=50), France (n=50), Germany (n=50), India (n=54), Algeria (50), Canada (n=51), and the United States (n=50). HCPs experienced the OneTouch Verio Reflect glucose meter and the OneTouch Reveal mobile app online from their own office computers using interactive demonstrations via webpages and multiple animations. After providing demographic and clinical practice insights, HCPs responded to statements about the utility of the system. Results: Concerning current practice, 83.1\% (295/355) of HCPs agreed that poor numeracy or health literacy was a barrier for their patients. A total of 85.9\% (305/355) and 92.1\% (327/355) of HCPs responded that type 2 diabetes (T2D) and type 1 diabetes (T1D) patients were aware of what represented a low, in-range, or high blood glucose result. Only 62.0\% (220/355) felt current glucose meters made it easy for patients to understand if results were in range. A total of 50.1\% (178/355) and 78.0\% (277/355) of HCPs were confident that T1D and T2D patients took action for low or high results. A total of 87.0\% (309/355) agreed that the ColorSure Dynamic Range Indicator could help them teach patients how to interpret results and 88.7\% (315/355) agreed it made them more aware of hyper- and hypoglycemic results so they could take action. A total of 83.7\% (297/355) of HCPs agreed that the Blood Sugar Mentor feature gave personalized guidance, insight, and encouragement so patients could take action. A total of 82.8\% (294/355) of HCPs also agreed that the Blood Sugar Mentor provided real-time guidance to reinforce the goals HCPs had set so patients could take steps to manage their diabetes between office visits. After experiencing the full system, 85.9\% (305/355) of HCPs agreed it was beneficial for patients with lower numeracy or health literacy; 96.1\% (341/355) agreed that it helped patients understand when results were low, in range, or high; and 91.0\% (323/355) agreed that the way it displayed diabetes information would make patients more inclined to act upon results. A total of 89.0\% (316/355) of HCPs agreed that it would be helpful for agreeing upon appropriate in-range goals for their patients for their next clinic visit. Conclusions: This multi-country online study provides evidence that HCPs were highly satisfied with the OneTouch Verio Reflect meter and the OneTouch Reveal mobile app. Each of these use color-coded information and the Blood Sugar Mentor feature to assist patients with interpreting, analyzing, and acting upon their blood glucose results, which is particularly beneficial to keep patients on track between scheduled office visits. ",
doi="10.2196/13847",
url="https://humanfactors.jmir.org/2019/3/e13847/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31271146"
}


@Article{info:doi/10.2196/14300,
author="Venkataramanan, Revathy
and Thirunarayan, Krishnaprasad
and Jaimini, Utkarshani
and Kadariya, Dipesh
and Yip, Yung Hong
and Kalra, Maninder
and Sheth, Amit",
title="Determination of Personalized Asthma Triggers From Multimodal Sensing and a Mobile App: Observational Study",
journal="JMIR Pediatr Parent",
year="2019",
month="Jun",
day="27",
volume="2",
number="1",
pages="e14300",
keywords="personalized digital health",
keywords="medical internet of things",
keywords="asthma management",
keywords="patient-generated health data",
keywords="pediatric asthma",
keywords="asthma control",
keywords="medication adherence",
keywords="childhood asthma",
keywords="understanding and treatment of asthma",
abstract="Background: Asthma is a chronic pulmonary disease with multiple triggers. It can be managed by strict adherence to an asthma care plan and by avoiding these triggers. Clinicians cannot continuously monitor their patients' environment and their adherence to an asthma care plan, which poses a significant challenge for asthma management. Objective: In this study, pediatric patients were continuously monitored using low-cost sensors to collect asthma-relevant information. The objective of this study was to assess whether kHealth kit, which contains low-cost sensors, can identify personalized triggers and provide actionable insights to clinicians for the development of a tailored asthma care plan. Methods: The kHealth asthma kit was developed to continuously track the symptoms of asthma in pediatric patients and monitor the patients' environment and adherence to their care plan for either 1 or 3 months. The kit consists of an Android app--based questionnaire to collect information on asthma symptoms and medication intake, Fitbit to track sleep and activity, the Peak Flow meter to monitor lung functions, and Foobot to monitor indoor air quality. The data on the patient's outdoor environment were collected using third-party Web services based on the patient's zip code. To date, 107 patients consented to participate in the study and were recruited from the Dayton Children's Hospital, of which 83 patients completed the study as instructed. Results: Patient-generated health data from the 83 patients who completed the study were included in the cohort-level analysis. Of the 19\% (16/83) of patients deployed in spring, the symptoms of 63\% (10/16) and 19\% (3/16) of patients suggested pollen and particulate matter (PM2.5), respectively, to be their major asthma triggers. Of the 17\% (14/83) of patients deployed in fall, symptoms of 29\% (4/17) and 21\% (3/17) of patients suggested pollen and PM2.5, respectively, to be their major triggers. Among the 28\% (23/83) of patients deployed in winter, PM2.5 was identified as the major trigger for 83\% (19/23) of patients. Similar correlations were not observed between asthma symptoms and factors such as ozone level, temperature, and humidity. Furthermore, 1 patient from each season was chosen to explain, in detail, his or her personalized triggers by observing temporal associations between triggers and asthma symptoms gathered using the kHealth asthma kit. Conclusions: The continuous monitoring of pediatric asthma patients using the kHealth asthma kit generates insights on the relationship between their asthma symptoms and triggers across different seasons. This can ultimately inform personalized asthma management and intervention plans. ",
doi="10.2196/14300",
url="http://pediatrics.jmir.org/2019/1/e14300/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518318"
}


@Article{info:doi/10.2196/10896,
author="Yin, Kathleen
and Laranjo, Liliana
and Tong, Ly Huong
and Lau, YS Annie
and Kocaballi, Baki A.
and Martin, Paige
and Vagholkar, Sanjyot
and Coiera, Enrico",
title="Context-Aware Systems for Chronic Disease Patients: Scoping Review",
journal="J Med Internet Res",
year="2019",
month="Jun",
day="17",
volume="21",
number="6",
pages="e10896",
keywords="self-care",
keywords="medical informatics",
keywords="mobile applications",
keywords="chronic disease",
keywords="self-management",
abstract="Background: Context-aware systems, also known as context-sensitive systems, are computing applications designed to capture, interpret, and use contextual information and provide adaptive services according to the current context of use. Context-aware systems have the potential to support patients with chronic conditions; however, little is known about how such systems have been utilized to facilitate patient work. Objective: This study aimed to characterize the different tasks and contexts in which context-aware systems for patient work were used as well as to assess any existing evidence about the impact of such systems on health-related process or outcome measures. Methods: A total of 6 databases (MEDLINE, EMBASE, CINAHL, ACM Digital, Web of Science, and Scopus) were scanned using a predefined search strategy. Studies were included in the review if they focused on patients with chronic conditions, involved the use of a context-aware system to support patients' health-related activities, and reported the evaluation of the systems by the users. Studies were screened by independent reviewers, and a narrative synthesis of included studies was conducted. Results: The database search retrieved 1478 citations; 6 papers were included, all published from 2009 onwards. The majority of the papers were quasi-experimental and involved pilot and usability testing with a small number of users; there were no randomized controlled trials (RCTs) to evaluate the efficacy of a context-aware system. In the included studies, context was captured using sensors or self-reports, sometimes involving both. Most studies used a combination of sensor technology and mobile apps to deliver personalized feedback. A total of 3 studies examined the impact of interventions on health-related measures, showing positive results. Conclusions: The use of context-aware systems to support patient work is an emerging area of research. RCTs are needed to evaluate the effectiveness of context-aware systems in improving patient work, self-management practices, and health outcomes in chronic disease patients. ",
doi="10.2196/10896",
url="http://www.jmir.org/2019/6/e10896/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31210138"
}


@Article{info:doi/10.2196/12377,
author="Farmer, Andrew
and Bobrow, Kirsty
and Leon, Natalie
and Williams, Nicola
and Phiri, Enita
and Namadingo, Hazel
and Cooper, Sara
and Prince, John
and Crampin, Amelia
and Besada, Donela
and Daviaud, Emmanuelle
and Yu, Ly-Mee
and Ngoma, Jonathan
and Springer, David
and Pauly, Bruno
and Norris, Shane
and Tarassenko, Lionel
and Nyirenda, Moffat
and Levitt, Naomi",
title="Mobile Messaging Support Versus Usual Care for People With Type 2 Diabetes on Glycemic Control: Protocol for a Multicenter Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2019",
month="May",
day="30",
volume="8",
number="6",
pages="e12377",
keywords="randomized controlled trial",
keywords="diabetes mellitus",
keywords="type 2 diabetes",
keywords="mobile health",
keywords="treatment adherence",
abstract="Background: Health outcomes for people treated for type 2 diabetes could be substantially improved in sub-Saharan Africa. Failure to take medicine regularly to treat diabetes has been identified as a major problem. Resources to identify and support patients who are not making the best use of medicine in low- and middle-income settings are scarce. Mobile phones are widely available in these settings, including among people with diabetes; linked technologies, such as short message service (SMS) text messaging, have shown promise in delivering low-cost interventions efficiently. However, evidence showing that these interventions will work when carried out at a larger scale and measuring the extent to which they will improve health outcomes when added to usual care is limited. Objective: The objective of this trial is to test the effectiveness of sending brief, automated SMS text messages for improving health outcomes and medication adherence in patients with type 2 diabetes compared to an active control. Methods: We will carry out a randomized trial recruiting from clinics in two contrasting settings in sub-Saharan Africa: Cape Town, South Africa, and Lilongwe, Malawi. Intervention messages will advise people about the benefits of their diabetes treatment and offer motivation and encouragement around lifestyle and use of medication. We allocated patients, using randomization with a minimization algorithm, to receive either three to four intervention messages per week or non-health-related messages every 6 weeks. We will follow up with participants for 12 months, measuring important risk factors for poor health outcomes and complications in diabetes. This will enable us to estimate potential health benefits, including the primary outcome of hemoglobin A1c (HbA1c) levels as a marker for long-term blood glucose control and a secondary outcome of blood pressure control. We will record the costs of performing these activities and estimate cost-effectiveness. We will also use process evaluation to capture the collection of medication and assess the reception of the intervention by participants and health care workers. Results: Recruitment to the trial began in September 2016 and follow-up of participants was completed in October 2018. Data collection from electronic health records and other routinely collected sources is continuing. The database lock is anticipated in June 2019, followed by analysis and disclosing of group allocation. Conclusions: The knowledge gained from this study will have wide applications and advance the evidence base for effectiveness of mobile phone-based, brief text messaging on clinical outcomes and in large-scale, operational settings. It will provide evidence for cost-effectiveness and acceptability that will further inform policy development and decision making. We will work with a wide network that includes patients, clinicians, academics, industry, and policy makers to help us identify opportunities for informing people about the work and raise awareness of what is being developed and studied. Trial Registration: ISRCTN Registry ISRCTN70768808; http://www.isrctn.com/ISRCTN70768808 (Archived by WebCite at http://www.webcitation.org/786316Zqk) International Registered Report Identifier (IRRID): DERR1-10.2196/12377 ",
doi="10.2196/12377",
url="https://www.researchprotocols.org/2019/6/e12377/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31199346"
}


@Article{info:doi/10.2196/13257,
author="Hui, Yan Chi
and Creamer, Emily
and Pinnock, Hilary
and McKinstry, Brian",
title="Apps to Support Self-Management for People With Hypertension: Content Analysis",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jun",
day="03",
volume="7",
number="6",
pages="e13257",
keywords="hypertension",
keywords="self-management",
keywords="telehealth",
keywords="telemedicine",
keywords="mobile app",
abstract="Background: Home blood pressure monitoring (HBPM) is one component of effective supported self-management, which may potentially be mediated by mobile apps. Objective: The aim of this study was to identify the self-management features (HBPM and broader support strategies) offered by currently available apps and to determine the features associated with download frequency and user ratings. Methods: We searched Google Play store, Apple App store, National Health Services Apps Library and myhealthapps.net (first search on February 1, 2018; updated August 18, 2018). We included high blood pressure apps available in the United Kingdom and extracted their features, number of downloads, and the average users' rating from the app stores. We mapped the features to the holistic Practical Reviews In Self-Management Support (PRISMS) taxonomy of self-management support. We employed a regression analysis to determine if any features were associated with download frequency or user rating. Results: We included 151 apps. The 3 most common features were as follows: monitoring blood pressure (BP) and charting logs; lifestyle (exercise or dietary) advice; and providing information about hypertension. The other 11 components of the PRISMS taxonomy were rarely featured. There was little evidence to support associations between specific features and the download statistics and rating scores, with only 2 uncommon features achieving borderline significant associations. The presence of social support features, such as a forum, was weakly but significantly (R2=.04, P=.02) correlated with the number of downloads. Apps designed specifically for particular BP monitors/smart watches were weakly associated with a higher rating score (R2=.05, P<.001). Apps with more ratings were associated with more downloads (R2=.91, P<.001). Conclusions: The functionality of currently available apps is limited to logging BP, offering lifestyle advice, and providing information about hypertension. Future app development should consider broadening the remit to produce a system that can respond flexibly to the diversity of support that enables people to self-manage their hypertension. ",
doi="10.2196/13257",
url="https://mhealth.jmir.org/2019/6/e13257/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31162124"
}


@Article{info:doi/10.2196/10299,
author="Lv, Qing
and Jiang, Yutong
and Qi, Jun
and Zhang, Yanli
and Zhang, Xi
and Fang, Linkai
and Tu, Liudan
and Yang, Mingcan
and Liao, Zetao
and Zhao, Minjing
and Guo, Xinghua
and Qiu, Minli
and Gu, Jieruo
and Lin, Zhiming",
title="Using Mobile Apps for Health Management: A New Health Care Mode in China",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jun",
day="03",
volume="7",
number="6",
pages="e10299",
keywords="mHealth",
keywords="internet",
keywords="health care",
keywords="medical informatics",
abstract="Background: China has a large population; however, medical resources are unevenly distributed and extremely limited, and more medical services are needed. With the development and ever-increasing popularity of mobile internet communication, China has created a mode of mobile health (mHealth) care to resolve this problem. Objective: The aim of this study was (1) to describe the problems associated with China's medical care practice, (2) explore the need for and the feasibility of internet-based medical care in China, and (3) analyze the functionality of and services offered by internet-based health care platforms for the management of chronic diseases. Methods: Data search was performed by searching national websites, the popular search engine Baidu, the App Store, and websites of internet medical care institutions, using search terms like ``mobile health,'' ``Internet health,'' ``mobile medical,'' ``Internet medical,'' ``digital medical,'' ``digital health,'' and ``online doctor.'' A total of 6 mobile apps and websites with the biggest enrollment targeting doctors and end users with chronic diseases in China were selected. Results: We recognized the limitations of medical and health care providers and unequal distribution of medical resources in China. An mHealth care platform is a novel and efficient way for doctors and patients to follow up and manage chronic diseases. Services offered by these platforms include reservation and payment, medical consultation, medical education assessment, pharmaceutical and medical instruments sales, electronic medical records, and chronic disease management. China's health policies are now strongly promoting the implementation of mHealth solutions, particularly in response to the increasing burden of chronic diseases and aging in the population. Conclusions: China's internet-based medical and health care mode can benefit the populace by providing people with high-quality medical resources. This can help other countries and regions with high population density and unevenly distributed medical resources manage their health care concerns. ",
doi="10.2196/10299",
url="https://mhealth.jmir.org/2019/6/e10299/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31162131"
}


@Article{info:doi/10.2196/13517,
author="Shaw, J. Ryan
and Barnes, Angel
and Steinberg, Dori
and Vaughn, Jacqueline
and Diane, Anna
and Levine, Erica
and Vorderstrasse, Allison
and Crowley, J. Matthew
and Wood, Eleanor
and Hatch, Daniel
and Lewinski, Allison
and Jiang, Meilin
and Stevenson, Janee
and Yang, Qing",
title="Enhancing Diabetes Self-Management Through Collection and Visualization of Data From Multiple Mobile Health Technologies: Protocol for a Development and Feasibility Trial",
journal="JMIR Res Protoc",
year="2019",
month="Jun",
day="03",
volume="8",
number="6",
pages="e13517",
keywords="self-management",
keywords="technology",
keywords="type 2 diabetes",
abstract="Background: Self-management is integral for control of type 2 diabetes mellitus (T2DM). Patient self-management is improved when they receive real-time information on their health status and behaviors and ongoing facilitation from health professionals. However, timely information for these behaviors is notably absent in the health care system. Providing real-time data could help improve patient understanding of the dynamics of their illness and assist clinicians in developing targeted approaches to improve health outcomes and in delivering personalized care when and where it is most needed. Mobile technologies (eg, wearables, apps, and connected scales) have the potential to make these patient-provider interactions a reality. What strategies might best help patients overcome self-management challenges using self-generated diabetes-related data? How might clinicians effectively guide patient self-management with the advantage of real-time data? Objective: This study aims to describe the protocol for an ongoing study (June 2016-May 2019) that examines trajectories of symptoms, health behaviors, and associated challenges among individuals with T2DM utilizing multiple mobile technologies, including a wireless body scale, wireless glucometer, and a wrist-worn accelerometer over a 6-month period. Methods: We are conducting an explanatory sequential mixed methods study of 60 patients with T2DM recruited from a primary care clinic. Patients were asked to track relevant clinical data for 6 months using a wireless body scale, wireless glucometer, a wrist-worn accelerometer, and a medication adherence text message (short message service, SMS) survey. Data generated from the devices were then analyzed and visualized. A subset of patients is currently being interviewed to discuss their challenges and successes in diabetes self-management, and they are being shown visualizations of their own data. Following the data collection period, we will conduct interviews with study clinicians to explore ways in which they might collaborate with patients. Results: This study has received regulatory approval. Patient enrollment ongoing with a sample size of 60 patients is complete, and up to 20 clinicians will be enrolled. At the patient level, data collection is complete, but data analysis is pending. At the clinician level, data collection is currently ongoing. Conclusions: This study seeks to expand the use of mobile technologies to generate real-time data to enhance self-management strategies. It also seeks to obtain both patient and provider perspectives on using real-time data to develop algorithms for software that will facilitate real-time self-management strategies. We expect that the findings of this study will offer important insight into how to support patients and providers using real-time data to manage a complex chronic illness. International Registered Report Identifier (IRRID): DERR1-10.2196/13517 ",
doi="10.2196/13517",
url="https://www.researchprotocols.org/2019/6/e13517/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31162127"
}


@Article{info:doi/10.2196/12940,
author="Grasaas, Erik
and Fegran, Liv
and Helseth, S{\o}lvi
and Stinson, Jennifer
and Martinez, Santiago
and Lalloo, Chitra
and Haraldstad, Kristin",
title="iCanCope With Pain: Cultural Adaptation and Usability Testing of a Self-Management App for Adolescents With Persistent Pain in Norway",
journal="JMIR Res Protoc",
year="2019",
month="Jun",
day="03",
volume="8",
number="6",
pages="e12940",
keywords="health",
keywords="self-management",
keywords="adolescent",
keywords="chronic pain",
keywords="translating",
keywords="mobile app",
abstract="Background: Persistent or chronic pain is a common health problem among adolescents. Thus, it is important that they receive evidence-based strategies for symptom management. iCanCope with Pain is a mobile phone app designed to help adolescents cope with chronic pain. The app comprises 5 evidence- and theory-based features: (I) symptom trackers for pain, sleep, mood, physical function, and energy; (II) goal setting to improve pain and function; (III) a coping toolbox of pain self-management strategies; (IV) social support; and (V) age-appropriate pain education. The iCanCope with Pain app is based on theory, identified health care needs, and current best practices for pain self-management. Objective: The objectives of this study were to describe the translation and cultural adaptation of the app into the Norwegian context and evaluate the app's usability using a phased approach. Methods: Phase 1 included translation and cultural adaptation of the app into the Norwegian context. This process used an expert panel of researchers and target group representatives who were responsible for the linguistic quality assurance and assessment. In phases 2 and 3 the app's usability was tested. For phase 2, the assessments of usability and user experiences included observation, the think aloud method, audiovisual recordings, questionnaires, and individual interviews in a laboratory setting. For phase 3, the assessment of usability and user experience over a 2-week home-based test included questionnaires and individual end-user interviews. Overall, app usability was determined based on ease of use, efficiency, and user satisfaction. Qualitative data were analyzed using deductive content analysis. Descriptive statistics were calculated for quantitative data. Results: End users did not report any misunderstandings or discrepancies with the words or phrasing of the translated and culturally adapted app. Participants in both the laboratory- and home-based usability tests found the app self-explanatory and reported that all 5 of its features were easy to use. All tasks were completed within the allocated time frame (ie, efficiency), with few errors. Overall System Usability Scale scores were high, with average scores of 82 and 89 out of 100 from laboratory- and field-based tests, respectively. Participants liked the idea of a social support function (feature IV), although qualitative and internet server data revealed that this feature was rarely used. Conclusions: This study described the cultural and linguistic adaptation and usability testing of the Norwegian version of the iCanCope with Pain app. High user satisfaction, ease of use, efficiency, and only minor errors cumulatively indicated that no changes to the app were needed, with the exception of facilitating user interaction within the social support feature. The app will be used in an upcoming randomized controlled trial with a larger sample. ",
doi="10.2196/12940",
url="https://www.researchprotocols.org/2019/6/e12940/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31162132"
}


@Article{info:doi/10.2196/11461,
author="Chien, Tsair-Wei
and Chow, Chi Julie
and Chou, Willy",
title="An App Detecting Dengue Fever in Children: Using Sequencing Symptom Patterns for a Web-Based Assessment",
journal="JMIR Mhealth Uhealth",
year="2019",
month="May",
day="31",
volume="7",
number="5",
pages="e11461",
keywords="dengue fever",
keywords="HT person mapping statistic",
keywords="logistic regression",
keywords="score summation",
keywords="receiver operating characteristic curve",
abstract="Background: Dengue fever (DF) is one of the most common arthropod-borne viral diseases worldwide, particularly in South East Asia, Africa, the Western Pacific, and the Americas. However, DF symptoms are usually assessed using a dichotomous (ie, absent vs present) evaluation. There has been no published study that has reported using the specific sequence of symptoms to detect DF. An app is required to help patients or their family members or clinicians to identify DF at an earlier stage. Objective: The aim of this study was to develop an app examining symptoms to effectively predict DF. Methods: We extracted statistically significant features from 17 DF-related clinical symptoms in 177 pediatric patients (69 diagnosed with DF) using (1) the unweighted summation score and (2) the nonparametric HT person fit statistic, which can jointly combine (3) the weighted score (yielded by logistic regression) to predict DF risk. Results: A total of 6 symptoms (family history, fever ?39{\textdegree}C, skin rash, petechiae, abdominal pain, and weakness) significantly predicted DF. When a cutoff point of >--0.68 (P=.34) suggested combining the weighted score and the HT coefficient, the sensitivity was 0.87, and the specificity was 0.84. The area under the receiver operating characteristic curve was 0.91, which was a better predictor: specificity was 10.2\% higher than it was for the traditional logistic regression. Conclusions: A total of 6 simple symptoms analyzed using logistic regression were useful and valid for early detection of DF risk in children. A better predictive specificity increased after combining the nonparametric HT coefficient with the weighted regression score. A self-assessment using patient mobile phones is available to discriminate DF, and it may eliminate the need for a costly and time-consuming dengue laboratory test. ",
doi="10.2196/11461",
url="https://mhealth.jmir.org/2019/5/e11461",
url="http://www.ncbi.nlm.nih.gov/pubmed/31152525"
}


@Article{info:doi/10.2196/12542,
author="Yang, Jing
and Weng, Lizhu
and Chen, Zhikui
and Cai, Hongfu
and Lin, Xiaoyan
and Hu, Zhijian
and Li, Na
and Lin, Bijuan
and Zheng, Bin
and Zhuang, Qian
and Du, Bin
and Zheng, Zhiyuan
and Liu, Maobai",
title="Development and Testing of a Mobile App for Pain Management Among  Cancer Patients Discharged From Hospital Treatment: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2019",
month="May",
day="29",
volume="7",
number="5",
pages="e12542",
keywords="cancer",
keywords="pain management",
keywords="quality of life",
keywords="adherence",
abstract="Background: The incidence of cancer pain increases in discharged patients because of discontinued standard treatments and reductions in medication adherence. Motivated by the need for better pain management in discharged patients, we developed a mobile phone app (Pain Guard) to provide continuous treatment information and feedback to discharged cancer patients suffering from pain. Objective: The aim was to design, construct, and test the Pain Guard app in patients managing cancer pain, evaluate the total remission rate of pain and the improvement in quality of life (QoL) to improve pain management for cancer pain patients, and assess patient acceptance of the app. Methods: This randomized controlled double-arm study involved 58 patients with cancer pain symptoms. Participants were randomly assigned to a group receiving care through the Pain Guard app (n=31) or to a control group (n=27) who received only traditional pharmaceutical care. In a pretest, participants were rated using a baseline cancer pain assessment and QoL evaluation. During treatment, the consumption levels of analgesic drugs were recorded every week. After a 4-week study period, another round of cancer pain assessment and QoL evaluation was conducted. The system's usability, feasibility, app compliance, and satisfaction were also assessed. Our primary outcome was remission rate of pain, and secondary outcomes were medication adherence, improvements in QoL, frequency of breakthrough cancer pain (BTcP), incidence of adverse reactions, and satisfaction of patients. Results: All participants (N=58) successfully completed the study. There were no significant differences in baseline pain scores or baseline QoL scores between groups. At the end of the study, the rate of pain remission in the trial group was significantly higher than that in the control group (P<.001). The frequency of BTcP in the app group was considerably lower than that in the control group (P<.001). The rate of medication adherence in the trial group was considerably higher than that in the control group (P<.001). Improvements in global QoL scores in the trial group were also significantly higher than those in the control group (P<.001). The incidence of adverse reactions in the trial group (7/31) was lower than that in the control group (12/27), especially constipation, with significant differences (P=.01). The 31 participants in the trial group completed a satisfaction survey regarding Pain Guard: 23 (74\%) indicated that they were satisfied with receiving pharmaceutical care by Pain Guard, 5 (16\%) indicated that they were somewhat satisfied, 2 (6\%) indicated neutral feelings, and 1 (3\%) indicated that they were somewhat dissatisfied; no participants indicated that they were very dissatisfied. Conclusions: Pain Guard was effective for the management of pain in discharged patients with cancer pain, and its operability was effective and easily accepted by patients. Trial Registration: Chinese Clinical Trials Registry ChiCTR1800016066; http://www.chictr.org.cn/showproj.aspx?proj=27153 ",
doi="10.2196/12542",
url="http://mhealth.jmir.org/2019/5/e12542/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31144672"
}


@Article{info:doi/10.2196/12965,
author="Koot, David
and Goh, Chye Paul Soo
and Lim, May Robyn Su
and Tian, Yubing
and Yau, Yan Teng
and Tan, Chuan Ngiap
and Finkelstein, Andrew Eric",
title="A Mobile Lifestyle Management Program (GlycoLeap) for People With Type 2 Diabetes: Single-Arm Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="May",
day="24",
volume="7",
number="5",
pages="e12965",
keywords="type 2 diabetes mellitus",
keywords="self-management",
keywords="mobile health",
keywords="mHealth",
keywords="mobile phone app",
keywords="mobile apps",
keywords="health coaching",
keywords="blood glucose",
keywords="single-arm feasibility study",
keywords="RE-AIM",
abstract="Background: Singapore's current prevalence of diabetes exceeds 13.6\%. Although lifestyle modification can be effective for reducing the risks for complications of type 2 diabetes mellitus (T2DM), traditional lifestyle interventions are often difficult to administer in the primary care setting due to limited resources. Mobile health apps can address these limitations by offering low-cost, adaptable, and accessible platforms for disseminating lifestyle management interventions. Objective: Using the RE-AIM evaluation framework, this study assessed the potential effectiveness and feasibility of GlycoLeap, a mobile lifestyle management program for people with T2DM, as an add-on to standard care. Methods: This single-arm feasibility study recruited 100 patients with T2DM and glycated hemoglobin (HbA1c) levels of ?7.5\% from a single community health care facility in Singapore. All participants were given access to a 6-month mobile lifestyle management program, GlycoLeap, comprising online lessons and the Glyco mobile phone app with a health coaching feature. The GlycoLeap program was evaluated using 4 relevant dimensions of the RE-AIM framework: (1) reach (percentage who consented to participate out of all patients approached), (2) effectiveness (percentage point change in HbA1c [primary outcome] and weight loss [secondary outcome]), (3) implementation (program engagement as assessed by various participatory metrics), and (4) maintenance (postintervention user satisfaction surveys to predict the sustainability of GlycoLeap). Participants were assessed at baseline and at follow-up (?12 weeks after starting the intervention). Results: A total of 785 patients were approached of whom 104 consented to participate, placing the reach at 13.2\%. Four were excluded after eligibility screening, and 100 patients were recruited. Program engagement (implementation) started out high but decreased with time for all evaluated components. Self-reported survey data suggest that participants monitored their blood glucose on more days in the past week at follow-up compared to baseline (P<.001) and reported positive changes to their diet due to app engagement (P<.001) (implementation). Primary outcome data were available for 83 participants. Statistically significant improvements were observed for HbA1c (--1.3 percentage points, P<.001) with greater improvements for those who logged their weight more often (P=.007) (effectiveness). Participants also had a 2.3\% reduction in baseline weight (P<.001) (effectiveness). User satisfaction was high with 74\% (59/80) and 79\% (63/80) of participants rating the app good or very good and claiming that they would probably or definitely recommend the app to others, respectively (maintenance). Conclusions: Although measures of program engagement decreased with time, clinically significant improvements in HbA1c were achieved with the potential for broader implementation. However, we cannot rule out that these improvements were due to factors unrelated to GlycoLeap. Therefore, we would recommend evaluating the effectiveness and cost effectiveness of GlycoLeap using a randomized controlled trial of at least 12 months. Trial Registration: ClinicalTrials.gov NCT03091517; https://clinicaltrials.gov/ct2/show/NCT03091517 (Archived by WebCite at http://www.webcitation.org/77rNqhwRn) ",
doi="10.2196/12965",
url="http://mhealth.jmir.org/2019/5/e12965/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31127720"
}


@Article{info:doi/10.2196/10388,
author="Rodriguez, Sarah
and Hwang, Kevin
and Wang, Jing",
title="Connecting Home-Based Self-Monitoring of Blood Pressure Data Into Electronic Health Records for Hypertension Care: A Qualitative Inquiry With Primary Care Providers",
journal="JMIR Form Res",
year="2019",
month="May",
day="23",
volume="3",
number="2",
pages="e10388",
keywords="patient-generated health data",
keywords="connected health",
keywords="remote monitoring",
keywords="electronic health record",
keywords="hypertension",
keywords="patient reported outcome",
keywords="self-measured blood pressure",
keywords="self-monitoring of blood pressure",
abstract="Background: There is a lack of research on how to best incorporate home-based self-measured blood pressure (SMBP) measurements, combined with other patient-generated health data (PGHD), into electronic health record (EHR) systems in a way that promotes primary care workflow without burdening the primary care team with irrelevant or superfluous data. Objective: The purpose of this study was to explore the perspectives of primary care providers in utilizing SMBP measurements and integrating SMBP data into the clinical workflow for the management of hypertension in the primary care setting. Methods: A total of 13 primary care physicians were interviewed in total; 5 in individual interviews and 8 in a focus group. The interview questions were centered on (1) the value of SMBP in hypertension care, (2) needs of viewing SMBP and desired visual display, (3) desired alert algorithm and critical values, (4) needs for other PGHD, and (5) workflow of primary care team in utilizing SMBP. The interviews were audiotaped and transcribed verbatim, and a thematic analysis was performed to extract overarching themes. Results: The primary care experience of the 13 providers ranged from 5 to 35 years. The following themes emerged from the individual and focus group interviews: (1) ways to utilize SMBP measurements in primary care, (2) preferred visual display of SMBP, (3) patient condition determines preferred scheduling of patient SMBP measurements and provider's preferred frequency of viewing SMBP data, (4) effect of patient condition on alert parameters, (5) location to receive critical value alerts, (6) primary recipient of critical value alerts, and (7) the need of additional PGHD (eg, emotional stressors, food diary, and medication adherence) to provide context of SMBP values. Conclusions: The perspectives of primary care providers need to be incorporated into the design of a built-in interface in the EHR to incorporate SMBP and other PGHD. Future usability evaluation should be conducted with mock-up interfaces to solicit opinions on the optimal alert frequency and mechanism to best fit the workflow in the primary care setting. Future studies should examine how the utilization of a built-in interface that fully integrates SMBP measurements and PGHD into EHR systems can support patient self-management and thus, improve patient outcomes. ",
doi="10.2196/10388",
url="http://formative.jmir.org/2019/2/e10388/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31124468"
}


@Article{info:doi/10.2196/13502,
author="Zhang, Lingling
and Babu, V. Sabarish
and Jindal, Meenu
and Williams, E. Joel
and Gimbel, W. Ronald",
title="A Patient-Centered Mobile Phone App (iHeartU) With a Virtual Human Assistant for Self-Management of Heart Failure: Protocol for a Usability Assessment Study",
journal="JMIR Res Protoc",
year="2019",
month="May",
day="23",
volume="8",
number="5",
pages="e13502",
keywords="heart failure",
keywords="mobile health",
keywords="self-management",
keywords="patient engagement",
keywords="virtual human",
abstract="Background: Heart failure (HF) causes significant economic and humanistic burden for patients and their families, especially those with a low income, partly due to high hospital readmission rates. Optimal self-care is considered an important nonpharmacological aspect of HF management that can improve health outcomes. Emerging evidence suggests that self-management assisted by smartphone apps may reduce rehospitalization rates and improve the quality of life of patients. We developed a virtual human--assisted, patient-centered mobile health app (iHeartU) for patients with HF to enhance their engagement in self-management and improve their communication with health care providers and family caregivers. iHeartU may help patients with HF in self-management to reduce the technical knowledge and usability barrier while maintaining a low cost and natural, effective social interaction with the user. Objective: With a standardized systematic usability assessment, this study had two objectives: (1) to determine the obstacles to effective and efficient use of iHeartU in patients with HF and (2) to evaluate of HF patients' adoption, satisfaction, and engagement with regard to the of iHeartU app. Methods: The basic methodology to develop iHeartU systems consists of a user-centric design, development, and mixed methods formative evaluation. The iterative design and evaluation are based on the guidelines of the American College of Cardiology Foundation and American Heart Association for the management of heart failure and the validated ``Information, Motivation, and Behavioral skills'' behavior change model. Our hypothesis is that this method of a user-centric design will generate a more usable, useful, and easy-to-use mobile health system for patients, caregivers, and practitioners. Results: The prototype of iHeartU has been developed. It is currently undergoing usability testing. As of September 2018, the first round of usability testing data have been collected. The final data collection and analysis are expected to be completed by the end of 2019. Conclusions: The main contribution of this project is the development of a patient-centered self-management system, which may support HF patients' self-care at home and aid in the communication between patients and their health care providers in a more effective and efficient way. Widely available mobile phones serve as care coordination and ``no-cost'' continuum of care. For low-income patients with HF, a mobile self-management tool will expand their accessibility to care and reduce the cost incurred due to emergency visits or readmissions. The user-centered design will improve the level of engagement of patients and ultimately lead to better health outcomes. Developing and testing a novel mobile system for patients with HF that incorporates chronic disease management is critical for advancing research and clinical practice of care for them. This research fills in the gap in user-centric design and lays the groundwork for a large-scale population study in the next phase. International Registered Report Identifier (IRRID): DERR1-10.2196/13502 ",
doi="10.2196/13502",
url="http://www.researchprotocols.org/2019/5/e13502/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31124472"
}


@Article{info:doi/10.2196/11497,
author="Opoku, Daniel
and Busse, Reinhard
and Quentin, Wilm",
title="Achieving Sustainability and Scale-Up of Mobile Health Noncommunicable Disease Interventions in Sub-Saharan Africa: Views of Policy Makers in Ghana",
journal="JMIR Mhealth Uhealth",
year="2019",
month="May",
day="03",
volume="7",
number="5",
pages="e11497",
keywords="implementation science",
keywords="mHealth",
keywords="eHealth",
keywords="noncommunicable diseases",
keywords="disease management",
keywords="sub-Saharan Africa",
keywords="qualitative research",
keywords="health policy",
abstract="Background: A growing body of evidence shows that mobile health (mHealth) interventions may improve treatment and care for the rapidly rising number of patients with noncommunicable diseases (NCDs) in sub-Saharan Africa (SSA). A recent realist review developed a framework highlighting the influence of context factors, including predisposing characteristics, needs, and enabling resources (PNE), for the long-term success of mHealth interventions. The views of policy makers will ultimately determine implementation and scale-up of mHealth interventions in SSA. However, their views about necessary conditions for sustainability and scale-up remain unexplored. Objective: This study aimed to understand the views of policy makers in Ghana with regard to the most important factors for successful implementation, sustainability, and scale-up of mHealth NCD interventions. Methods: Members of the technical working group responsible for Ghana's national NCD policy were interviewed about their knowledge of and attitude toward mHealth and about the most important factors contributing to long-term intervention success. Using qualitative methods and applying a qualitative content analysis approach, answers were categorized according to the PNE framework. Results: A total of 19 policy makers were contacted and 13 were interviewed. Interviewees had long-standing work experience of an average of 26 years and were actively involved in health policy making in Ghana. They were well-informed about the potential of mHealth, and they strongly supported mHealth expansion in the country. Guided by the PNE framework's categories, the policy makers ascertained which critical factors would support the successful implementation of mHealth interventions in Ghana. The policy makers mentioned many factors described in the literature as important for mHealth implementation, sustainability, and scale-up, but they focused more on enabling resources than on predisposing characteristics and need. Furthermore, they mentioned several factors that have been rather unexplored in the literature. Conclusions: The study shows that the PNE framework is useful to guide policy makers toward a more systematic assessment of context factors that support intervention implementation, sustainability, and scale-up. Furthermore, the framework was refined by adding additional factors. Policy makers may benefit from using the PNE framework at the various stages of mHealth implementation. Researchers may (and should) use the framework when investigating reasons for success (or failure) of interventions. ",
doi="10.2196/11497",
url="https://mhealth.jmir.org/2019/5/e11497/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31066706"
}


@Article{info:doi/10.2196/10368,
author="Wickramasinghe, Nilmini
and John, Blooma
and George, Joey
and Vogel, Doug",
title="Achieving Value-Based Care in Chronic Disease Management: Intervention Study",
journal="JMIR Diabetes",
year="2019",
month="May",
day="03",
volume="4",
number="2",
pages="e10368",
keywords="diabetes",
keywords="gestational diabetes",
keywords="chronic disease management",
keywords="value-based care",
keywords="mobile health",
keywords="power knowledge",
keywords="Australian health care system",
keywords="2-period 2-arm crossover",
keywords="clinical trial",
abstract="Background: The World Health Organization notes that diabetes, a chronic disease, is a silent epidemic, and by 2020 there will be a 54\% rise in the total number of individuals diagnosed with this disease. These are alarming figures that have significant repercussions for the quality of life of individuals and their families as well as for the financial stress of health care systems globally. Early detection and proactive management of diabetes is essential. The Diamond solution provides diabetes self-management by enabling patients to send details about their blood sugar readings at specific times to their nominated care coordinator to receive recommendations for diet and exercise and insulin titration. Objective: The aim of the study was to assess the usability, acceptability, and fidelity of the Diamond diabetes monitoring device for patients with gestational diabetes mellitus (GDM). Specifically assessed were (1) patient compliance, (2) patient satisfaction, (3) level of glycemic control achieved, and (4) health professional satisfaction. Methods: Using a design science research perspective, the Diamond diabetes monitoring device solution was adapted to the Australian health care environment. Once the solution was deemed fit for purpose by the director of the OB/GYN clinical institute and on securing all relevant ethics approvals, a 2-period 2-arm nonblinded crossover clinical trial was conducted for 8 weeks total time with crossover at 4 weeks to establish proof of concept, usability, and fidelity. The patient perspective was assessed by using structured questionnaires at 4 specific stages of the project, while the clinician perspective was captured via semistructured interviews and unstructured questionnaires. Results: The 10 patients studied reported preferring standard care with the technology solution to standard care alone. Further, all clinicians involved concurred that the technology solution greatly assisted their ability to provide higher value patient-centered care. They also noted that it was extremely helpful for assisting in systematically monitoring glucose levels and any/all changes and trends. Conclusions: Based on these initial findings, we offer a holistic pervasive approach to enable the achievement of value-based, patient-centered care in chronic disease management. Key lessons include the importance when designing such solutions to focus on the two primary user groups (patients and clinicians). ",
doi="10.2196/10368",
url="http://diabetes.jmir.org/2019/2/e10368/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31066699"
}


@Article{info:doi/10.2196/13009,
author="Woods, Sarah Leanna
and Duff, Jed
and Roehrer, Erin
and Walker, Kim
and Cummings, Elizabeth",
title="Patients' Experiences of Using a Consumer mHealth App for Self-Management of Heart Failure: Mixed-Methods Study",
journal="JMIR Hum Factors",
year="2019",
month="May",
day="02",
volume="6",
number="2",
pages="e13009",
keywords="heart failure",
keywords="mobile health (mHealth)",
keywords="mobile apps",
keywords="usability study",
keywords="Mobile Application Rating Scale",
keywords="patient experience",
keywords="self-management",
keywords="mobile phone",
abstract="Background: To support the self-management of heart failure, a team of hospital clinicians, patients, and family caregivers have co-designed the consumer mobile health app, Care4myHeart. Objective: This research aimed to determine patient experiences of using the app to self-manage heart failure. Methods: Patients with heart failure used the app for 14 days on their own smart device in a home setting, following which a mixed-methods evaluation was performed. Eight patients were recruited, of whom six completed the Mobile Application Rating Scale and attended an interview. Results: The overall app quality score was ``acceptable'' with 3.53 of 5 points, with the aesthetics (3.83/5) and information (3.78/5) subscales scoring the highest. The lowest mean score was in the app-specific subscale representing the perceived impact on health behavior change (2.53/5). Frequently used features were weight and fluid restriction tracking, with graphical representation of data particularly beneficial for improved self-awareness and ongoing learning. The use of technology for self-management will fundamentally differ from current practices and require a change in daily routines. However, app use was correlated with potential utility for daily management of illness with benefits of accurate recording and review of personal health data and as a communication tool for doctors to assist with care planning, as all medical information is available in one place. Technical considerations included participants' attitudes toward technology, functionality and data entry issues, and relatively minor suggested changes. Conclusions: The findings from this usability study suggest that a significant barrier to adoption is the lack of integration of technology into everyday life in the context of already established disease self-management routines. Future studies should explore the barriers to adoption and sustainability of consumer mobile health interventions for chronic conditions, particularly whether introducing such apps is more beneficial at the commencement of a self-management regimen. ",
doi="10.2196/13009",
url="http://humanfactors.jmir.org/2019/2/e13009/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31045504"
}


@Article{info:doi/10.2196/10830,
author="Vizer, M. Lisa
and Eschler, Jordan
and Koo, Mi Bon
and Ralston, James
and Pratt, Wanda
and Munson, Sean",
title="``It's Not Just Technology, It's People'': Constructing a Conceptual Model of Shared Health Informatics for Tracking in Chronic Illness Management",
journal="J Med Internet Res",
year="2019",
month="Apr",
day="29",
volume="21",
number="4",
pages="e10830",
keywords="consumer health informatics",
keywords="chronic illness",
keywords="patient generated health data",
keywords="patient reported outcomes",
keywords="workflow",
keywords="information seeking behavior",
keywords="shared decision making",
abstract="Background: For many people, tracking health indicators is central to managing a chronic illness. However, previous informatics research has largely viewed tracking as a solitary process that lacks the characteristics essential to tracking in support of chronic illness management. Objective: To inform development of effective technologies that aid tracking of health indicators to support chronic illness management, this study aimed to construct a health informatics model that accurately describes the work and social context of that tracking work. Methods: As part of a larger project, we conducted semistructured interviews with 40 adults concerning their chronic illness management practices, including tracking and communication. We also assembled transcripts of 30 publicly available videos of 24 adults discussing tracking processes for managing their own chronic illness. We used qualitative methods to analyze interviews and video transcripts through the lens of ongoing personal and health informatics research. Results: We have described the people and work involved in tracking in support of chronic illness management and contributed a Conceptual Model of Shared Health Informatics (CoMSHI). Specifically, we identified the need for a health informatics model that (1) incorporates the ongoing nature of tracking work and (2) represents the social dimension of tracking for illness management. Our model depicts communication, information, collection, integration, reflection, and action work in the social context of the person with chronic illness, informal carers, health care providers, and community members. Conclusions: The resulting CoMSHI yields a more detailed and nuanced viewpoint of tracking in support of chronic illness management and can inform technology design to improve tracking tools to support people in more confident and capable chronic illness management. ",
doi="10.2196/10830",
url="http://www.jmir.org/2019/4/e10830/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31033452"
}


@Article{info:doi/10.2196/12134,
author="Athilingam, Ponrathi
and Jenkins, Bradlee
and Redding, A. Barbara",
title="Reading Level and Suitability of Congestive Heart Failure (CHF) Education in a Mobile App (CHF Info App): Descriptive Design Study",
journal="JMIR Aging",
year="2019",
month="Apr",
day="25",
volume="2",
number="1",
pages="e12134",
keywords="health literacy",
keywords="reading level",
keywords="patient education",
keywords="heart failure",
keywords="mobile app",
abstract="Background: Education at the time of diagnosis or at discharge after an index illness is a vital component of improving outcomes in congestive heart failure (CHF). About 90 million Americans have limited health literacy and have a readability level at or below a 5th-grade level, which could affect their understanding of education provided at the time of diagnosis or discharge from hospital. Objective: The aim of this paper was to assess the suitability and readability level of a mobile phone app, the CHF Info App. Methods: A descriptive design was used to assess the reading level and suitability of patient educational materials included in the CHF Info App. The suitability assessment of patient educational materials included in the CHF Info App was independently assessed by two of the authors using the 26-item Suitability Assessment of Materials (SAM) tool. The reading grade level for each of the 10 CHF educational modules included in the CHF Info App was assessed using the comprehensive online Text Readability Consensus Calculator based on the seven most-common readability formulas: the Flesch Reading Ease Formula, the Gunning Fog Index, the Flesch-Kincaid Grade Level Formula, the Coleman-Liau Index, the Simplified Measure of Gobbledygook Index, the Automated Readability Index, and the Linsear Write Formula. The reading level included the text-scale score, the ease-of-reading score, and the corresponding grade level. Results: The educational materials included in the CHF Info App ranged from a 5th-grade to an 8th-grade reading level, with a mean of a 6th-grade level, which is recommended by the American Medical Association. The SAM tool result demonstrated adequate-to-superior levels in all four components assessed, including content, appearance, visuals, and layout and design, with a total score of 77\%, indicating superior suitability. Conclusions: The authors conclude that the CHF Info App will be suitable and meet the recommended health literacy level for American adult learners. Further testing of the CHF Info App in a longitudinal study is warranted to determine improvement in CHF knowledge. ",
doi="10.2196/12134",
url="http://aging.jmir.org/2019/1/e12134/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518265"
}


@Article{info:doi/10.2196/12982,
author="Setiawan, Agus I. Made
and Zhou, Leming
and Alfikri, Zakiy
and Saptono, Andi
and Fairman, D. Andrea
and Dicianno, Edward Brad
and Parmanto, Bambang",
title="An Adaptive Mobile Health System to Support Self-Management for Persons With Chronic Conditions and Disabilities: Usability and Feasibility Studies",
journal="JMIR Form Res",
year="2019",
month="Apr",
day="25",
volume="3",
number="2",
pages="e12982",
keywords="mHealth",
keywords="adaptive mHealth",
keywords="mobile apps",
keywords="telemedicine",
keywords="personalized medicine",
keywords="self-management",
keywords="self-care",
keywords="caregivers",
keywords="chronic disease",
keywords="persons with disabilities",
abstract="Background: Persons with chronic conditions and disabilities (PwCCDs) are vulnerable to secondary complications. Many of these secondary complications are preventable with proactive self-management and proper support. To enhance PwCCDs' self-management skills and conveniently receive desired support, we have developed a mobile health (mHealth) system called iMHere. In 2 previous clinical trials, iMHere was successfully used to improve health outcomes of adult participants with spina bifida and spinal cord injury. To further expand use of iMHere among people with various types of disabilities and chronic diseases, the system needs to be more adaptive to address 3 unique challenges: 1) PwCCDs have very diverse needs with regards to self-management support, 2) PwCCDs' self-management needs may change over time, and 3) it is a challenge to keep PwCCDs engaged and interested in long-term self-management. Objective: The aim of this study was to develop an adaptive mHealth system capable of supporting long-term self-management and adapting to the various needs and conditions of PwCCDs. Methods: A scalable and adaptive architecture was designed and implemented for the new version, iMHere 2.0. In this scalable architecture, a set of mobile app modules was created to provide various types of self-management support to PwCCDs with the ability to add more as needed. The adaptive architecture empowers PwCCDs with personally relevant app modules and allows clinicians to adapt these modules in response to PwCCDs' evolving needs and conditions over time. Persuasive technologies, social support, and personalization features were integrated into iMHere 2.0 to engage and motivate PwCCDs and support long-term usage. Two initial studies were performed to evaluate the usability and feasibility of the iMHere 2.0 system. Results: The iMHere 2.0 system consists of cross-platform client and caregiver apps, a Web-based clinician portal, and a secure 2-way communication protocol for providing interactions among these 3 front-end components, all supported by a back-end server. The client and caregiver apps have 12 adaptive app modules to support various types of self-management tasks. The adaptive architecture makes it possible for PwCCDs to receive personalized app modules relevant to their conditions with or without support from various types of caregivers. The personalization and persuasive technologies in the architecture can be used to engage PwCCDs for long-term usage of the iMHere 2.0 system. Participants of the usability study were satisfied with the iMHere 2.0 client app. The feasibility evaluation revealed several practical issues to consider when implementing the system on a large scale. Conclusions: We developed an adaptive mHealth system as a novel method to support diverse needs in self-management for PwCCDs that can dynamically change over time. The usability of the client app is high, and it was feasible for PwCCDs to use in supporting personalized and evolving self-care needs. ",
doi="10.2196/12982",
url="http://formative.jmir.org/2019/2/e12982/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31021324"
}


@Article{info:doi/10.2196/13204,
author="Yamaguchi, Satoko
and Waki, Kayo
and Nannya, Yasuhito
and Nangaku, Masaomi
and Kadowaki, Takashi
and Ohe, Kazuhiko",
title="Usage Patterns of GlucoNote, a Self-Management Smartphone App, Based on ResearchKit for Patients With Type 2 Diabetes and Prediabetes",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Apr",
day="24",
volume="7",
number="4",
pages="e13204",
keywords="telemedicine",
keywords="mHealth",
keywords="self-management",
keywords="diabetes mellitus",
abstract="Background: Preventing?progression from prediabetes to diabetes---or slowing?the?progression of diabetes---is an urgent task worldwide.?Previous studies have shown that mobile health (mHealth)?may?powerfully?support self-management for?patients with type 2 diabetes.?Certainly,?mHealth improves health care efficiency and gives patients convenient access to self-management of their own health. Many health care apps are available?right now, and?their use in?clinical studies with large-scale real-life data is expected.?However, the usage patterns of those apps---especially in the absence of intervention by medical professionals---remain unknown. Objective: We developed GlucoNote, an app?that?uses?Apple's ResearchKit to support self-management?for?patients with type 2 diabetes and prediabetes; the app does not require prescription or intervention by medical professionals.?We?evaluated its usage patterns via a remotely conducted study. Methods: iPhone users across Japan?who have?type 2 diabetes or prediabetes were free to download GlucoNote and?to?participate in the study after?they?provided consent?electronically?on the app.?The?522 users who enrolled in the study within 1 year of?its?release were analyzed.?We analyzed the retention rates of 357 participants who recorded at least 1 of 4 items---body weight, blood sugar, blood pressure, or dietary information.?Characteristics?of?participants who used GlucoNote longer than 4 weeks (robust users)?were compared with?those?of participants?who did not (nonrobust users).?The changes among robust users?were evaluated. Results: The?median observation and retention durations were 382?days?(interquartile range [IQR] 275-423) and 8?days?(IQR 1-63), respectively. The retention rates for 2 days?and for?4, 8, and 12 weeks were 0.627 (95\% CI 0.575-0.675), 0.353 (0.304-0.403), 0.272 (0.227-0.319), and 0.220 (0.179-0.265), respectively.?Men were more likely to be robust users than women?(P=.02).?At week 0, robust users were more likely?than nonrobust users to?have a?higher daily energy intake (median 1595 [IQR 1198-1788] kcal vs 1451 [IQR 769-1657] kcal; P=.04) and?have?higher daily step counts (median 6108 [IQR 3797-9227] vs 5171 [IQR 2885-7258]; P=.001).?Among?robust users, body weight decreased from weeks?0 to 4 (mean 71.3 [SD 14.1] kg to 70.8 [SD 13.9] kg; P=.002) by mean 0.6\% (SD 1.6). Conclusions: GlucoNote offered a valuable opportunity to evaluate usage patterns of apps.?Future challenges include improving low retention rates and evaluating?their?effects. ",
doi="10.2196/13204",
url="http://mhealth.jmir.org/2019/4/e13204/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31017586"
}


@Article{info:doi/10.2196/12223,
author="Ahn, Hyun Sang
and Zhiang, Jooho
and Kim, Hyery
and Chang, Seyun
and Shin, Jaewon
and Kim, Myeongchan
and Lee, Yura
and Lee, Jae-Ho
and Park, Rang Yu",
title="Postvaccination Fever Response Rates in Children Derived Using the Fever Coach Mobile App: A Retrospective Observational Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Apr",
day="22",
volume="7",
number="4",
pages="e12223",
keywords="patient-generated health data",
keywords="vaccination",
keywords="postvaccination fever",
keywords="digital health care",
keywords="mobile app",
abstract="Background: Postvaccination fever is a mild adverse event that naturally improves without complications, but is highly prevalent and can be accompanied by febrile convulsions in some cases. These adverse effects may cause parents to delay or avoid vaccinating their children. Objective: This study aimed to identify postvaccination fever patterns and the ability of antipyretics to affect changes in these patterns from data collected from a mobile app named Fever Coach. Methods: Data provided by parents of feverish children derived from a mobile app, Fever Coach, were used to identify postvaccination fever patterns according to vaccinations and the use of antipyretic drugs. We selected single vaccination records that contained five or more body temperature readings performed within 48 hours of vaccination, and we analyzed postvaccination fever onset, offset, duration, and maximum body temperature. Through observing the postvaccination fever response to vaccination, we identified the effects of antipyretic drugs on postvaccination fever onset, offset, and duration times; the extent of fever; and the rate of decline. We also performed logistic regression analysis to determine demographic variables (age, weight, and sex) involved in relatively high fevers (body temperature ?39{\textdegree}C). Results: The total number of Fever Coach users was 25,037, with 3834 users having entered single vaccination records, including 4448 vaccinations and 55,783 body temperature records. Most records were obtained from children receiving the following vaccinations: pneumococcus (n=2069); Japanese encephalitis (n=911); influenza (n=669); diphtheria, tetanus, and pertussis (n=403); and hepatitis A (n=252). According to the 4448 vaccination records, 3427 (77.05\%) children had taken antipyretic drugs, and 3238 (89.15\%) children took antibiotics at body temperatures above 38{\textdegree}C. The number of children taking antipyretics at a body temperature of 38{\textdegree}C was more than four times that of those taking antipyretics at 37.9{\textdegree}C (307 vs 67 cases). The number of instances in which this temperature threshold was reached was more than four times greater than the number when the temperature was 37.9{\textdegree}C. A comparative analysis of antipyretic and nonantipyretic cases showed there was no difference in onset time; however, offset and duration times were significantly shorter in nonantipyretic cases than in antipyretic cases (P<.001). In nonantipyretic cases, offset times and duration times were 9.9 and 10.1 hours shorter, respectively, than in antipyretic cases. Body temperatures also decreased faster in nonantipyretic cases. Influenza vaccine-associated fevers lasted relatively longer, whereas pneumococcus vaccine-associated fevers were relatively short-lived. Conclusions: These findings suggest that postvaccination fever has its own fever pattern, which is dependent on vaccine type and the presence of antipyretic drugs, and that postvaccination temperature monitoring may ease fever phobia and reduce the unnecessary use of antipyretics in medical care. ",
doi="10.2196/12223",
url="http://mhealth.jmir.org/2019/4/e12223/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31008712"
}


@Article{info:doi/10.2196/12028,
author="Birnie, A. Kathryn
and Campbell, Fiona
and Nguyen, Cynthia
and Lalloo, Chitra
and Tsimicalis, Argerie
and Matava, Clyde
and Cafazzo, Joseph
and Stinson, Jennifer",
title="iCanCope PostOp: User-Centered Design of a Smartphone-Based App for Self-Management of Postoperative Pain in Children and Adolescents",
journal="JMIR Form Res",
year="2019",
month="Apr",
day="22",
volume="3",
number="2",
pages="e12028",
keywords="postoperative pain",
keywords="smartphone",
keywords="mobile applications",
keywords="mHealth",
keywords="pain management",
keywords="self-management",
keywords="adolescent",
abstract="Background: Moderate to severe postoperative pain in children is common. Increased pediatric day surgeries have shifted postoperative pain management predominantly to the home setting. Mobile health technology has the potential to overcome barriers to pain care by improving access to self-management resources. However, pain apps generally lack scientific evidence and are highly underutilized due to lack of involvement of end users in their development. Thus, an evidence-based pain self-management smartphone app that incorporates the needs and perspective of children and adolescents (end users) has potential to improve postoperative pain management. Objective: This paper aimed to describe how the principles of user-centered design were applied to the development of iCanCope PostOp, a smartphone-based pain self-management app for children and adolescents after surgery. Specifically, it presents 2 completed phases of the user-centered design process (concept generation and ideation) for the iCanCope PostOp app. Methods: Phase 1 was a multisite needs assessment from the perspective of 19 children and adolescents who had undergone various day surgeries, 19 parents, and 32 multidisciplinary health care providers. Children, adolescents, and parents completed individual semistructured interviews, and health care providers participated in focus groups. Data were summarized using qualitative content analysis. Phase 2 developed a pain care algorithm for the app using Delphi surveys and a 2-day in-person design workshop with 11 multidisciplinary pediatric postoperative pain experts and 2 people with lived experience with postoperative pain. Results: Phase 1 identified self-management challenges to postoperative pain management and recovery; limited available resources and reliance on medications as a predominant postoperative pain management strategy; and shared responsibility of postoperative pain care by children and adolescents, parents, and health care providers. Key app functions of tracking pain, pain self-management strategies, and goal setting were identified as priorities. Phase 2 led to the successful and efficient generation of a complete preliminary pain care algorithm for the iCanCope PostOp app, including clinically relevant inputs for feasible assessment and reassessment of pain and function (rest or sleep, movement or play, and mood or worry), as well as a catalog of pain management advice to be pushed to end users (psychological, physical, pharmacological, and education). Conclusions: The concept ideation and generation phases of the user-centered design approach were successfully completed for the iCanCope PostOp app. Next steps will include design finalization, app development (iOS or Android), evaluation through a randomized controlled trial, and subsequent implementation of the iCanCope PostOp app in clinical care. ",
doi="10.2196/12028",
url="http://formative.jmir.org/2019/2/e12028/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31008704"
}


@Article{info:doi/10.2196/13362,
author="Martinez-Millana, Antonio
and Zettl, Annabel
and Floch, Jacqueline
and Calvo-Lerma, Joaquim
and Sevillano, Luis Jose
and Ribes-Koninckx, Carmen
and Traver, Vicente",
title="The Potential of Self-Management mHealth for Pediatric Cystic Fibrosis: Mixed-Methods Study for Health Care and App Assessment",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Apr",
day="18",
volume="7",
number="4",
pages="e13362",
keywords="mHealth",
keywords="cystic fibrosis",
keywords="health care systems",
keywords="user requirements",
keywords="apps",
keywords="market analysis",
abstract="Background: Remote care services and patient empowerment have boosted mobile health (mHealth). A study of user needs related to mHealth for pediatric cystic fibrosis (PCF) identified the set of preferred features mobile apps should support; however, the potential use of PCF apps and their suitability to fit into PCF clinical management remains unexplored. Objective: We examine whether PCF holds potential for the implementation of mHealth care. Methods: The study is based on a literature review and qualitative analysis of content and was conducted in two parts: (1) we reviewed scientific and gray literature to explore how European countries manage PCF and conducted a qualitative study of 6 PCF units and (2) we performed a systematic review of apps available in the myhealthapps.net repository searching for cystic fibrosis (CF) management and nutrition apps, which we analyzed for characteristics, business models, number of downloads, and usability. Results: European CF routine care guidelines are acknowledged in most European countries, and treatments are fully covered in almost all countries. The majority of teams in CF units are interdisciplinary. With respect to the systematic review of apps, we reviewed 12 apps for CF management and 9 for general nutrition management in the myhealthapps.net directory. All analyzed apps provided functionalities for recording aspects related to the disease and nutrition such as medication, meals, measurements, reminders, and educational material. None of the apps reviewed in this study supported pancreatic enzyme replacement therapy. CF apps proved to be less appealing and usable than nutrition apps (2.66 [SD 1.15] vs 4.01 [SD 0.90]; P<.001, z-value: --2.6). User needs detected in previous research are partially matched by current apps for CF management. Conclusions: The health care context for PCF is a unique opportunity for the adoption of mHealth. Well-established clinical guidelines, heterogeneous clinical teams, and coverage by national health care systems provide a suitable scenario for the use of mHealth solutions. However, available apps for CF self-management do not cover essential aspects such as nutrition and education. To increase the adoption of mHealth for CF self-management, new apps should include these features. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2016-014931 ",
doi="10.2196/13362",
url="http://mhealth.jmir.org/2019/4/e13362/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30998222"
}


@Article{info:doi/10.2196/11590,
author="Jeon, Eunjoo
and Park, Hyeoun-Ae",
title="Experiences of Patients With a Diabetes Self-Care App Developed Based on the Information-Motivation-Behavioral Skills Model: Before-and-After Study",
journal="JMIR Diabetes",
year="2019",
month="Apr",
day="18",
volume="4",
number="2",
pages="e11590",
keywords="diabetes mellitus",
keywords="self-management",
keywords="blood glucose self-monitoring",
keywords="mobile applications",
abstract="Background: Mobile phones have been actively used in various ways for diabetes self-care. Mobile phone apps can manage lifestyle factors such as diet, exercise, and medication without time or place restrictions. A systematic review has found these apps to be effective in reducing blood glucose. However, the existing apps were developed and evaluated without a theoretical framework to explain the process of changes in diabetes self-care behaviors. Objective: This study aimed to evaluate the diabetes self-care app that we developed by measuring differences in diabetes self-care factors between before and after using the app with the Information-Motivation-Behavioral skills model of Diabetes Self-Care (IMB-DSC). Methods: We conducted a single-group pre- and postintervention study with a convenience sample of diabetes patients. A total of 38 adult patients with diabetes who had an Android smartphone were recruited. After conducting a preliminary survey of those who agreed to participate in the study, we provided them with a manual and a tutorial video about the diabetes self-care app. The app has functions for education, recommendations, writing a diary, recording, goal setting, sharing, communication, feedback, and interfacing with a glucometer, and it was applied for 4?weeks. We measured the general characteristics of participants, their history of diabetes self-care app usage, IMB-DSC factors, and blood glucose levels. The IMB-DSC factors of information, personal motivation, social motivation, behavioral skills, and behaviors were measured using an assessment tool consisting of 87 items extracted from the Diabetes Knowledge Test, third version of the Diabetes Attitude Scale, Diabetes Family Behavior Checklist, and Diabetes Self-Management Assessment Report Tool. Results: The mean age of the participants was 43.87 years. A total 30 participants out of 38 (79\%) had type 2 diabetes and 8 participants (21\%) had type 1 diabetes. The most frequently used app function was recording, which was used by 34 participants out of 38 (89\%). Diabetes self-care behaviors (P=.02) and diabetes self-care social motivation (P=.05) differed significantly between pre- and postintervention, but there was no significant difference in diabetes self-care information (P=.85), diabetes self-care personal motivation (P=.57), or diabetes self-care behavioral skills (P=.89) between before and after using the diabetes self-care app. Conclusions: Diabetes self-care social motivation was significantly improved with our diabetes self-care app by sharing experiences and sympathizing with other diabetes patients. Diabetes self-care behavior was also significantly improved with the diabetes self-care app by providing an interface with a glucometer that removes the effort of manual input. Diabetes self-care information, diabetes self-care personal motivation, and diabetes self-care behavioral skills were not significantly improved. However, they will be improved with additional offline interventions such as reflective listening and simulation. ",
doi="10.2196/11590",
url="http://diabetes.jmir.org/2019/2/e11590/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30998218"
}


@Article{info:doi/10.2196/12772,
author="Wetterholm, Madeleine
and Bonn, Erika Stephanie
and Alexandrou, Christina
and L{\"o}f, Marie
and Trolle Lagerros, Ylva",
title="Validation of Two Automatic Blood Pressure Monitors With the Ability to Transfer Data via Bluetooth",
journal="J Med Internet Res",
year="2019",
month="Apr",
day="17",
volume="21",
number="4",
pages="e12772",
keywords="blood pressure monitors",
keywords="diabetes mellitus, type 2",
keywords="hypertension",
keywords="methods",
keywords="mHealth",
keywords="self-care",
keywords="self-management",
abstract="Background: Patients with chronic diseases are in need of regular health controls. Diabetes mellitus type 2 is currently the most prevalent chronic metabolic disease. A majority of diabetic patients have at least one comorbid chronic disease, where hypertension is the most common. The standard for blood pressure (BP) measurement is manual BP monitoring at health care clinics. Nevertheless, several advantages of self-measured BP have been documented. With BP data transfer from an automatic BP monitor via Bluetooth to software, for example, a smartphone app, home measurement could effectively be integrated into regular care. Objective: The aim of this study was to validate two commercially available automatic BP monitors with the ability to transfer BP data via Bluetooth (Beurer BM 85 and Andersson Lifesense BDR 2.0), against manual BP monitoring in patients with type 2 diabetes. Methods: A total of 181 participants with type 2 diabetes were recruited from 6 primary care centers in Stockholm, Sweden. BP was first measured using a manual BP monitor and then measured using the two automatic BP monitors. The mean differences between the automatic and manual measurements were calculated by subtracting the manual BP monitor measurement from the automatic monitor measurement. Validity of the two automatic BP monitors was further assessed using Spearman rank correlation coefficients and the Bland-Altman method. Results: In total, 180 participants, 119 men and 61 women, were included. The mean age was 60.1 (SD 11.4) years and the mean body mass index was 30.4 (SD 5.4) kg/m2. The mean difference between the Beurer BM 85 and the manual BP monitor was 11.1 (SD 11.2) mmHg for systolic blood pressure (SBP) and 8.0 (SD 8.1) mmHg for diastolic blood pressure (DBP). The mean difference between the Andersson Lifesense BDR 2.0 and the manual BP monitor was 3.2 (SD 10.8) mmHg for SBP and 4.2 (SD 7.2) mmHg for DBP. The automatic BP measurements were significantly correlated (P<.001) with the manual BP measurement values (Andersson Lifesense BDR 2.0: r=0.78 for SBP and r=0.71 for DBP; Beurer BM 85: r=0.78 for SBP and r=0.69 for DBP). Conclusions: The two automatic BP monitors validated measure sufficiently accurate on a group level, with the Andersson Lifesense BDR 2.0 more often falling within the ranges for what is acceptable in clinical practice compared with the Beurer BM 85. ",
doi="10.2196/12772",
url="https://www.jmir.org/2019/4/e12772/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30994459"
}


@Article{info:doi/10.2196/11879,
author="Wallace, David
and Perry, Julie
and Yu, Janelle
and Mehta, Joshua
and Hunter, Paul
and Cross, Michelle Karen",
title="Assessing the Need for Mobile Health (mHealth) in Monitoring the Diabetic Lower Extremity",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Apr",
day="16",
volume="7",
number="4",
pages="e11879",
keywords="mHealth",
keywords="diabetes",
keywords="diabetic foot ulcers",
abstract="Background: Complications of the diabetic lower extremity (such as diabetic foot ulcers, DFUs) occur when monitoring is infrequent, and often result in serious sequelae like amputation or even death. Objective: To evaluate the potential application of mobile health (mHealth) to diabetic foot monitoring. We surveyed the self-management routines of a group of diabetic patients, as well as patient and clinician opinions on the use of mHealth in this context. Methods: Patients with DFUs in Toronto, Ontario, Canada completed a 25-item questionnaire addressing their foot care practices, mobile phone use, and views on mHealth. Wound care clinicians across Canada were also surveyed using a 9-item questionnaire. Results: Of the patients surveyed, 59/115 (51.3\%) spend less than a minute checking their feet, and 17/115 (15\%) of patients find it difficult to see their doctor or get to the hospital regularly. Mobile phone use was widespread in our patient cohort (93/115, 80.9\%). Of mobile phone users, 68/93 (73.1\%) would use a device on their mobile phone to help them check their feet. Of the clinicians who completed the questionnaire, only 7/202 (3.5\%) were familiar with mHealth; however, 181/202 (92\%) of clinicians expressed interest in using mHealth to monitor their patients between visits. Conclusions: Patient education or motivation and clinician training were identified as the major barriers to mHealth use in the diabetic lower extremity, which may be a viable mechanism to improve DFU monitoring practices. ",
doi="10.2196/11879",
url="https://mhealth.jmir.org/2019/4/e11879/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30990455"
}


@Article{info:doi/10.2196/10809,
author="Leong, Y. Amanda
and Makowsky, J. Mark",
title="Quality of Blood Pressure Tracking Apps for the iPhone: Content Analysis and Evaluation of Adherence With Home Blood Pressure Measurement Best Practices",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Apr",
day="12",
volume="7",
number="4",
pages="e10809",
keywords="hypertension",
keywords="mobile apps",
keywords="self-management",
keywords="blood pressure monitoring, ambulatory",
keywords="cross-sectional studies",
abstract="Background: Blood pressure (BP) tracking apps may aid in hypertension (HTN) self-management, but app quality may be problematic. Objective: This study aimed to develop a content-dependent rating system for BP tracking apps and systematically evaluate BP tracking features, content-independent quality, functional characteristics, and educational comprehensiveness of English language iPhone apps developed with the primary purpose of tracking a consumer's BP measurements. Methods: We created a 28-item checklist reflecting overall app quality and a simplified 2-item checklist to assess adherence with home BP monitoring best practices. Apps with educational information were evaluated for comprehensiveness on a 7-point scale and for consistency with evidence-based guidelines. Higher scores represent better quality and comprehensiveness. We searched the Canadian App Store on June 28, 2016, using the keywords hypertension and blood pressure. A total of 2 reviewers independently assessed apps according to the standardized template. We determined if paid apps, educational apps, or those rated ?4 stars were of higher quality. Results: Of the 948 apps screened, 62 met the inclusion criteria. The mean overall quality score was 12.2 (SD 4.6, out of 28) and 6 apps (10\%, 6/62) met the home BP monitoring best practice criteria. In all, 12 apps contained educational content (mean comprehensiveness 2.4, SD 1.6 out of 14), most commonly, background information on HTN. Apps with educational content (mean 15.1, SD 3.8 vs 11.8, SD 4.8; P=.03) or a ?4 star rating (median 19, interquartile range [IQR] 15-20, vs 12, IQR 9-15; P=.02) had higher overall quality. Conclusions: The BP tracking apps reviewed had variable quality and few met the home BP monitoring best practice criteria. When deciding to recommend a specific BP tracking app, we suggest clinicians should evaluate whether the app allows input of duplicate BP readings in the morning and evening for at least seven days and presents the mean BP value for user-specified dates. Greater attention to home BP measurement best practices is required during app development. ",
doi="10.2196/10809",
url="https://mhealth.jmir.org/2019/4/e10809/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30977739"
}


@Article{info:doi/10.2196/12541,
author="Lewinski, A. Allison
and Patel, D. Uptal
and Diamantidis, J. Clarissa
and Oakes, Megan
and Baloch, Khaula
and Crowley, J. Matthew
and Wilson, Jonathan
and Pendergast, Jane
and Biola, Holly
and Boulware, Ebony L.
and Bosworth, B. Hayden",
title="Addressing Diabetes and Poorly Controlled Hypertension: Pragmatic mHealth Self-Management Intervention",
journal="J Med Internet Res",
year="2019",
month="Apr",
day="09",
volume="21",
number="4",
pages="e12541",
keywords="telemedicine",
keywords="cardiovascular diseases",
keywords="diabetes mellitus type 2",
keywords="vulnerable populations",
keywords="renal insufficiency",
keywords="professional-patient relations",
keywords="hypertension",
abstract="Background: Patients with diabetes and poorly controlled hypertension are at increased risk for adverse renal and cardiovascular outcomes. Identifying these patients early and addressing modifiable risk factors is central to delaying renal complications such as diabetic kidney disease. Mobile health (mHealth), a relatively inexpensive and easily scalable technology, can facilitate patient-centered care and promote engagement in self-management, particularly for patients of lower socioeconomic status. Thus, mHealth may be a cost-effective way to deliver self-management education and support. Objective: This feasibility study aimed to build a population management program by identifying patients with diabetes and poorly controlled hypertension who were at risk for adverse renal outcomes and evaluate a multifactorial intervention to address medication self-management. We recruited patients from a federally qualified health center (FQHC) in an underserved, diverse county in the southeastern United States. Methods: Patients were identified via electronic health record. Inclusion criteria were age between 18 and 75 years, diagnosis of type 2 diabetes, poorly controlled hypertension over the last 12 months (mean clinic systolic blood pressure [SBP] ?140 mm Hg and/or diastolic blood pressure [DBP] ?90 mm Hg), access to a mobile phone, and ability to receive text messages and emails. The intervention consisted of monthly telephone calls for 6 months by a case manager and weekly, one-way informational text messages. Engagement was defined as the number of phone calls completed during the intervention; individuals who completed 4 or more calls were considered engaged. The primary outcome was change in SBP at the conclusion of the intervention. Results: Of the 141 patients enrolled, 84.0\% (118/141) of patients completed 1 or more phone calls and had follow-up SBP measurements for analysis. These patients were on average 56.9 years of age, predominately female (73/118, 61.9\%), and nonwhite by self-report (103/118, 87.3\%). The proportion of participants with poor baseline SBP control (50/118, 42.4\%) did not change significantly at study completion (53/118, 44.9\%) (P=.64). Participants who completed 4 or more phone calls (98/118, 83.1\%) did not experience a statistically significant decrease in SBP when compared to those who completed fewer calls. Conclusion: We did not reduce uncontrolled hypertension even among the more highly engaged. However, 83\% of a predominately minority and low-income population completed at least 67\% of the multimodal mHealth intervention. Findings suggest that combining an automated electronic health record system to identify at-risk patients with a tailored mHealth protocol can provide education to this population. While this intervention was insufficient to effect behavioral change resulting in better hypertension control, it does suggest that this FQHC population will engage in low-cost population health applications with a potentially promising impact. Trial Registration: ClinicalTrials.gov NCT02418091; https://clinicaltrials.gov/ct2/show/NCT02418091 (Archived by WebCite at http://www.webcitation.org/76RBvacVU) ",
doi="10.2196/12541",
url="https://www.jmir.org/2019/4/e12541/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30964439"
}


@Article{info:doi/10.2196/11671,
author="Hartmann, Ralf
and Sander, Christian
and Lorenz, Noah
and B{\"o}ttger, Daniel
and Hegerl, Ulrich",
title="Utilization of Patient-Generated Data Collected Through Mobile Devices: Insights From a Survey on Attitudes Toward Mobile Self-Monitoring and Self-Management Apps for Depression",
journal="JMIR Ment Health",
year="2019",
month="Apr",
day="03",
volume="6",
number="4",
pages="e11671",
keywords="mHealth",
keywords="depression",
keywords="adherence",
keywords="mobile applications, self-management",
abstract="Background: Depression is a severe psychiatric disease with high prevalence and an elevated risk for recurrence and chronicity. A substantial proportion of individuals with a diagnosis of unipolar depressive disorder do not receive treatment as advised by national guidelines. Consequently, self-monitoring and self-management become increasingly important. New mobile technologies create unique opportunities to obtain and utilize patient-generated data. As common adherence rates to mobile technologies are scarce, a profound knowledge of user behavior and attitudes and preferences is important throughout any developmental process of mobile technologies and apps. Objective: The aim of this survey was to provide descriptive data upon usage and anticipated usage of self-monitoring and self-management of depression and preferences of potential users in terms of documented parameters and data-sharing options. Methods: A Web-based survey comprising 55 questions was conducted to obtain data on the usage of mobile devices, app usage, and participant's attitudes and preferences toward mobile health apps for the self-monitoring and self-management of depression. Results: A total of 825 participants provided information. Moreover, two-thirds of the sample self-reported to be affected by depressive symptoms, but only 12.1\% (81/668) of those affected by depression have ever used any mobile self-monitoring or self-management app. Analysis showed that people want personally relevant information and feedback but also focus on handling sensitive data. Conclusions: New mobile technologies and smartphone apps, especially in combination with mobile sensor systems, offer unique opportunities to overcome challenges in the treatment of depression by utilizing the potential of patient-generated data. Focus on patient-relevant information, security and safe handling of sensitive personal data, as well as options to share data with self-selected third parties should be considered mandatory throughout any development process. ",
doi="10.2196/11671",
url="https://mental.jmir.org/2019/4/e11671/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30942693"
}


@Article{info:doi/10.2196/10187,
author="Boceta, Jaime
and Samper, Daniel
and de la Torre, Alejandro
and S{\'a}nchez-de la Rosa, Rainel
and Gonz{\'a}lez, Gloria",
title="Usability, Acceptability, and Usefulness of an mHealth App for Diagnosing and Monitoring Patients With Breakthrough Cancer Pain",
journal="JMIR Cancer",
year="2019",
month="Apr",
day="01",
volume="5",
number="1",
pages="e10187",
keywords="breakthrough cancer pain",
keywords="mHealth",
keywords="mobile app",
keywords="App INES{\textperiodcentered}DIO",
abstract="Background: Breakthrough pain is a major problem and a source of distress in patients with cancer. We hypothesized that health care professionals may benefit from a real-time mobile app to assist in the diagnosis and monitoring of breakthrough cancer pain (BTcP). Objective: This study aimed to test the usability, acceptability, and usefulness in real-world practice of the mobile App INES{\textperiodcentered}DIO developed for the management of patients with BTcP. Methods: This study consisted of a survey of a multidisciplinary sample of 175 physicians who evaluated the mobile app after testing it with 4 patients with BTcP each (for a total of 700 patients). The digital profile of the physicians, use of the different resources contained in the app, usefulness of the resources, acceptability, usability, potential improvements, intention to use, and additional resources to add were recorded. Results: Of the 175 physicians, 96\% (168/175) were working in public hospitals. They had an average of 12 (SD 7) years of experience in BTcP and almost all (174/175, 99.43\%) had an active digital profile. The Eastern Cooperative Oncology Group and Karnofsky performance scales, the Visual Analogue Scale, and the Davies algorithm to diagnose BTcP were the most frequently used tools with patients and were assessed as very useful by more than 80\% (140/175) of physicians. The majority (157/175, 90\%) answered that App INES{\textperiodcentered}DIO was well designed and 94\% (165/175) would probably or very probably recommend it to other colleagues. More than two-thirds indicated that the report provided by the app was worth being included in patients' clinical records. The most valued resource in the app was the recording of the number, duration, and intensity of pain flares each day and baseline pain control to enhance diagnosis of BTcP. Additional patient-oriented cancer pain educational content was suggested for inclusion in future versions of App INES{\textperiodcentered}DIO. Conclusions: Our study showed that App INES{\textperiodcentered}DIO is easy to use and useful for physicians to help diagnose and monitor breakthrough pain in patients with cancer. Participants suggested the implementation of additional educational content about breakthrough pain. They agreed on the importance of adding new clinical guidelines/protocols for the management of BTcP, improving their communication skills with patients, and introducing an evidence-based video platform that gathers new educational material on BTcP. ",
doi="10.2196/10187",
url="https://cancer.jmir.org/2019/1/e10187/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30932862"
}


@Article{info:doi/10.2196/11568,
author="Eisner, Emily
and Drake, James Richard
and Berry, Natalie
and Barrowclough, Christine
and Emsley, Richard
and Machin, Matthew
and Bucci, Sandra",
title="Development and Long-Term Acceptability of ExPRESS, a Mobile Phone App to Monitor Basic Symptoms and Early Signs of Psychosis Relapse",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Mar",
day="29",
volume="7",
number="3",
pages="e11568",
keywords="schizophrenia",
keywords="psychotic disorders",
keywords="recurrence",
keywords="telemedicine",
keywords="mobile health",
keywords="mHealth",
keywords="eHealth",
keywords="mental health",
abstract="Background: Schizophrenia relapses are common, have profound, adverse consequences for patients and are costly to health services. Early signs interventions aim to use warning signs of deterioration to prevent full relapse. Such interventions show promise but could be further developed. This study addresses 2 developments: adding basic symptoms to checklists of conventional early signs and using a mobile phone app ExPRESS to aid early signs monitoring. Objective: This study aimed to (1) design a pool of self-report items assessing basic symptoms (Basic Symptoms Checklist, BSC); (2) develop and beta test a mobile phone app (ExPRESS) for monitoring early signs, basic symptoms, and psychotic symptoms; and (3) evaluate the long-term acceptability of ExPRESS via qualitative feedback from participants in a 6-month feasibility study. Methods: The BSC items and ExPRESS were developed and then adjusted following feedback from beta testers (n=5) with a schizophrenia diagnosis. Individuals (n=18) experiencing a relapse of schizophrenia within the past year were asked to use ExPRESS for 6 months to answer weekly questions about experiences of early signs, basic symptoms, and psychotic symptoms. At the end of follow-up, face-to-face qualitative interviews (n=16; 2 were uncontactable) explored experiences of using ExPRESS. The topic guide sought participants' views on the following a priori themes regarding app acceptability: item content, layout, and wording; app appearance; length and frequency of assessments; worries about app use; how app use fitted with participants' routines; and the app's extra features. Interview transcripts were analyzed using the framework method, which allows examination of both a priori and a posteriori themes, enabling unanticipated aspects of app use experiences to be explored. Results: Participants' mean age was 38 years (range 22-57 years). Responses to a priori topics indicated that long-term use of ExPRESS was acceptable; small changes for future versions of ExPRESS were suggested. A posteriori themes gave further insight into individuals' experiences of using ExPRESS. Some reported finding it more accessible than visits from a clinician, as assessments were more frequent, more anonymous, and did not require the individual to explain their feelings in their own words. Nevertheless, barriers to app use (eg, unfamiliarity with smartphones) were also reported. Despite ExPRESS containing no overtly therapeutic components, some participants found that answering the weekly questions prompted self-reflection, which had therapeutic value for them. Conclusions: This study suggests that apps are acceptable for long-term symptom monitoring by individuals with a schizophrenia diagnosis across a wide age range. If the potential benefits are understood, patients are generally willing and motivated to use a weekly symptom-monitoring app; most participants in this study were prepared to do so for more than 6 months. Trial Registration: ClinicalTrials.gov NCT03558529; https://clinicaltrials.gov/ct2/show/NCT03558529 (Archived by WebCite at http://www.webcitation.org/70qvtRmZY). ",
doi="10.2196/11568",
url="http://mhealth.jmir.org/2019/3/e11568/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30924789"
}


@Article{info:doi/10.2196/10271,
author="Rossmann, Constanze
and Riesmeyer, Claudia
and Brew-Sam, Nicola
and Karnowski, Veronika
and Joeckel, Sven
and Chib, Arul
and Ling, Rich",
title="Appropriation of Mobile Health for Diabetes Self-Management: Lessons From Two Qualitative Studies",
journal="JMIR Diabetes",
year="2019",
month="Mar",
day="29",
volume="4",
number="1",
pages="e10271",
keywords="diabetes",
keywords="Germany",
keywords="mHealth",
keywords="mobile phone",
keywords="self-management",
keywords="Singapore",
abstract="Background: To achieve clarity on mobile health's (mHealth's) potential in the diabetes context, it is necessary to understand potential users' needs and expectations, as well as the factors determining their mHealth use. Recently, a few studies have examined the user perspective in the mHealth context, but their explanatory value is constrained because of their limitation to adoption factors. Objective: This paper uses the mobile phone appropriation model to examine how individuals with type 1 or type 2 diabetes integrate mobile technology into their everyday self-management. The study advances the field beyond mere usage metrics or the simple dichotomy of adoption versus rejection. Methods: Data were gathered in 2 qualitative studies in Singapore and Germany, with 21 and 16 respondents, respectively. Conducting semistructured interviews, we asked respondents about their explicit use of diabetes-related apps, their general use of varied mobile technologies to manage their disease, and their daily practices of self-management. Results: The analysis revealed that although some individuals with diabetes used dedicated diabetes apps, most used tools across the entire mobile-media spectrum, including lifestyle and messaging apps, traditional health information websites and forums. The material indicated general barriers to usage, including financial, technical, and temporal restrictions. Conclusions: In sum, we find that use patterns differ regarding users' evaluations, expectancies, and appropriation styles, which might explain the inconclusive picture of effects studies in the diabetes mHealth context. ",
doi="10.2196/10271",
url="http://diabetes.jmir.org/2019/1/e10271/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30924786"
}


@Article{info:doi/10.2196/12179,
author="Ernsting, Clemens
and St{\"u}hmann, Mareike Lena
and Dombrowski, U. Stephan
and Voigt-Antons, Jan-Niklas
and Kuhlmey, Adelheid
and Gellert, Paul",
title="Associations of Health App Use and Perceived Effectiveness in People With Cardiovascular Diseases and Diabetes: Population-Based Survey",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Mar",
day="28",
volume="7",
number="3",
pages="e12179",
keywords="mHealth",
keywords="eHealth",
keywords="smartphone",
keywords="telemedicine",
keywords="health literacy",
keywords="chronic disease",
keywords="comorbidity",
keywords="multimorbidity",
abstract="Background: Mobile health apps can help to change health-related behaviors and manage chronic conditions in patients with cardiovascular diseases (CVDs) and diabetes mellitus, but a certain level of health literacy and electronic health (eHealth) literacy may be needed. Objective: The aim of this study was to identify factors associated with mobile health app use in individuals with CVD or diabetes and detect relations with the perceived effectiveness of health apps among app users. Methods: The study used population-based Web-based survey (N=1500) among Germans, aged 35 years and older, with CVD, diabetes, or both. A total of 3 subgroups were examined: (1) Individuals with CVD (n=1325), (2) Individuals with diabetes (n=681), and (3) Individuals with CVD and diabetes (n=524). Sociodemographics, health behaviors, CVD, diabetes, health and eHealth literacy, characteristics of health app use, and characteristics of apps themselves were assessed by questionnaires. Linear and logistic regression models were applied. Results: Overall, patterns of factors associated with health app use were comparable in individuals with CVD or diabetes or both. Across subgroups, about every fourth patient reported using apps for health-related purposes, with physical activity and weight loss being the most prominent target behaviors. Health app users were younger, more likely to be female (except in those with CVD and diabetes combined), better educated, and reported more physical activity. App users had higher eHealth literacy than nonusers. Those users who perceived the app to have a greater effectiveness on their health behaviors tended to be more health and eHealth literate and rated the app to use more behavior change techniques (BCTs). Conclusions: There are health- and literacy-related disparities in the access to health app use among patients with CVD, diabetes, or both, which are relevant to specific health care professionals such as endocrinologists, dieticians, cardiologists, or general practitioners. Apps containing more BCTs had a higher perceived effect on people's health, and app developers should take the complexity of needs into account. Furthermore, eHealth literacy appears to be a requirement to use health apps successfully, which should be considered in health education strategies to improve health in patients with CVD and diabetes. ",
doi="10.2196/12179",
url="http://mhealth.jmir.org/2019/3/e12179/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30920383"
}


@Article{info:doi/10.2196/12378,
author="Buitenweg, C. David
and Bongers, L. Ilja
and van de Mheen, Dike
and van Oers, AM Hans
and van Nieuwenhuizen, Chijs",
title="Cocreative Development of the QoL-ME: A Visual and Personalized Quality of Life Assessment App for People With Severe Mental Health Problems",
journal="JMIR Ment Health",
year="2019",
month="Mar",
day="28",
volume="6",
number="3",
pages="e12378",
keywords="mobile app",
keywords="quality of life",
keywords="mental health",
keywords="homeless persons",
keywords="medical informatics",
abstract="Background: Quality of life (QoL) is a prominent outcome measure in mental health. However, conventional methods for QoL assessment rely heavily on language?based communication and therefore may not be optimal for all individuals with severe mental health problems. In addition, QoL assessment is usually based on a fixed number of life domains. This approach conflicts with the notion that QoL is influenced by individual values and preferences. A digital assessment app facilitates both the accessibility and personalization of QoL assessment and may, therefore, help to further advance QoL assessment among individuals with severe mental health problems. Objective: This study focused on the development of an innovative, visual, and personalized QoL assessment app for people with severe mental health problems: the QoL-ME. Methods: This study targeted 3 groups of individuals with severe mental health problems: (1) people with psychiatric problems, (2) people treated in forensic psychiatry, and (3) people who are homeless. A group of 59 participants contributed to the 6 iterations of the cocreative development of the QoL-ME. In the brainstorming stage, consisting of the first iteration, participants' previous experiences with questionnaires and mobile apps were explored. Participants gave their feedback on initial designs and wireframes in the second to fourth iterations that made up the design stage. In the usability stage that comprised the final 2 iterations, the usability of the QoL-ME was evaluated. Results: In the brainstorming stage, participants stressed the importance of privacy and data security and of receiving feedback when answering questionnaires. Participants in the design stage indicated a preference for paging over scrolling, linear navigation, a clean and minimalist layout, the use of touchscreen functionality in various modes of interaction, and the use of visual analog scales. The usability evaluation in the usability stage revealed good to excellent usability. Conclusions: The cocreative development of the QoL-ME resulted in an app that corresponds to the preferences of participants and has strong usability. Further research is needed to evaluate the psychometric quality of the QoL-ME and to investigate its usefulness in practice. ",
doi="10.2196/12378",
url="http://mental.jmir.org/2019/3/e12378/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30920381"
}


@Article{info:doi/10.2196/12411,
author="Kosse, C. Richelle
and Bouvy, L. Marcel
and Belitser, V. Svetlana
and de Vries, W. Tjalling
and van der Wal, S. Piet
and Koster, S. Ellen",
title="Effective Engagement of Adolescent Asthma Patients With Mobile Health--Supporting Medication Adherence",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Mar",
day="27",
volume="7",
number="3",
pages="e12411",
keywords="adolescent",
keywords="asthma",
keywords="medication adherence",
keywords="pharmacists",
keywords="telemedicine",
abstract="Background: Mobile health (mHealth) apps have the potential to support patients' medication use and are therefore increasingly used. Apps with broad functionality are suggested to be more effective; however, not much is known about the actual use of different functionalities and the effective engagement. Objective: The aim of this study was to explore the use and the effective engagement of adolescents (aged 12 to 18 years) with the Adolescent Adherence Patient Tool (ADAPT). Methods: The ADAPT intervention consisted of an app for patients, which was connected to a management system for their pharmacist. The aim of the ADAPT intervention was to improve medication adherence and, therefore, the app contained multiple functionalities: questionnaires to monitor symptoms and adherence, medication reminders, short movies, pharmacist chat, and peer chat. For this study, data of the ADAPT study and a cluster randomized controlled trial were used. Adolescents with asthma had 6 months' access to the ADAPT intervention, and all app usage was securely registered in a log file. Results: In total, 86 adolescents (mean age 15.0, SD 2.0 years) used the ADAPT app 17 times (range 1-113) per person. Females used the app more often than males (P=.01) and for a longer period of time (P=.03). On average, 3 different functionalities were used, and 13\% of the adolescents used all functionalities of the app. The questionnaires to monitor symptoms and adherence were used by most adolescents. The total app use did not affect adherence; however, activity in the pharmacist chat positively affected medication adherence (P=.03), in particular, if patients sent messages to their pharmacist (P=.01). Conclusions: mHealth apps for adolescents with asthma should contain different functionalities to serve the diverging needs and preferences of individual patients. Suggested key functionalities to promote use and effectiveness in adolescents with asthma are questionnaires to monitor symptoms and a health care provider chat. ",
doi="10.2196/12411",
url="http://mhealth.jmir.org/2019/3/e12411/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30916664"
}


@Article{info:doi/10.2196/11365,
author="Bangerter, Abigail
and Manyakov, V. Nikolay
and Lewin, David
and Boice, Matthew
and Skalkin, Andrew
and Jagannatha, Shyla
and Chatterjee, Meenakshi
and Dawson, Geraldine
and Goodwin, S. Matthew
and Hendren, Robert
and Leventhal, Bennett
and Shic, Frederick
and Ness, Seth
and Pandina, Gahan",
title="Caregiver Daily Reporting of Symptoms in Autism Spectrum Disorder: Observational Study Using Web and Mobile Apps",
journal="JMIR Ment Health",
year="2019",
month="Mar",
day="26",
volume="6",
number="3",
pages="e11365",
keywords="autism spectrum disorder",
keywords="ecological momentary assessment",
keywords="symptom assessment",
keywords="mobile app",
keywords="mHealth",
keywords="affect",
keywords="patient reported outcome measures",
abstract="Background: Currently, no medications are approved to treat core symptoms of autism spectrum disorder (ASD). One barrier to ASD medication development is the lack of validated outcome measures able to detect symptom change. Current ASD interventions are often evaluated using retrospective caregiver reports that describe general clinical presentation but often require recall of specific behaviors weeks after they occur, potentially reducing accuracy of the ratings. My JAKE, a mobile and Web-based mobile health (mHealth) app that is part of the Janssen Autism Knowledge Engine---a dynamically updated clinical research system---was designed to help caregivers of individuals with ASD to continuously log symptoms, record treatments, and track progress, to mitigate difficulties associated with retrospective reporting. Objective: My JAKE was deployed in an exploratory, noninterventional clinical trial to evaluate its utility and acceptability to monitor clinical outcomes in ASD. Hypotheses regarding relationships among daily tracking of symptoms, behavior, and retrospective caregiver reports were tested. Methods: Caregivers of individuals with ASD aged 6 years to adults (N=144) used the My JAKE app to make daily reports on their child's sleep quality, affect, and other self-selected specific behaviors across the 8- to 10-week observational study. The results were compared with commonly used paper-and-pencil scales acquired over a concurrent period at regular 4-week intervals. Results: Caregiver reporting of behaviors in real time was successfully captured by My JAKE. On average, caregivers made reports 2-3 days per week across the study period. Caregivers were positive about their use of the system, with over 50\% indicating that they would like to use My JAKE to track behavior outside of a clinical trial. More positive average daily reporting of overall type of day was correlated with 4 weekly reports of lower caregiver burden made at 4-week intervals (r=--0.27, P=.006, n=88) and with ASD symptoms (r=--0.42, P<.001, n=112). Conclusions: My JAKE reporting aligned with retrospective Web-based or paper-and-pencil scales. Use of mHealth apps, such as My JAKE, has the potential to increase the validity and accuracy of caregiver-reported outcomes and could be a useful way of identifying early changes in response to intervention. Such systems may also assist caregivers in tracking symptoms and behavior outside of a clinical trial, help with personalized goal setting, and monitoring of progress, which could collectively improve understanding of and quality of life for individuals with ASD and their families. Trial Registration: ClinicalTrials.gov NCT02668991;?https://clinicaltrials.gov/ct2/show/NCT02668991? ",
doi="10.2196/11365",
url="http://mental.jmir.org/2019/3/e11365/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30912762"
}


@Article{info:doi/10.2196/10044,
author="Manini, Matthew Todd
and Mendoza, Tonatiuh
and Battula, Manoj
and Davoudi, Anis
and Kheirkhahan, Matin
and Young, Ellen Mary
and Weber, Eric
and Fillingim, Benton Roger
and Rashidi, Parisa",
title="Perception of Older Adults Toward Smartwatch Technology for Assessing Pain and Related Patient-Reported Outcomes: Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Mar",
day="26",
volume="7",
number="3",
pages="e10044",
keywords="smartwatch",
keywords="focus group",
keywords="ecological momentary assessment (EMA)",
keywords="patient-reported outcomes (PRO)",
abstract="Background: Chronic pain, including arthritis, affects about 100 million adults in the United States. Complexity and diversity of the pain experience across time and people and its fluctuations across and within days show the need for valid pain reports that do not rely on patient's long-term recall capability. Smartwatches can be used as digital ecological momentary assessment (EMA) tools for real-time collection of pain scores. Smartwatches are generally less expensive than smartphones, are highly portable, and have a simpler user interface, providing an excellent medium for continuous data collection and enabling a higher compliance rate. Objective: The aim of this study was to explore the attitudes and perceptions of older adults towards design and technological aspects of a smartwatch framework for measuring patient report outcomes (PRO) as an EMA tool. Methods: A focus group session was conducted to explore the perception of participants towards smartwatch technology and its utility for PRO assessment. Participants included older adults (age 65+), with unilateral or bilateral symptomatic knee osteoarthritis. A preliminary user interface with server communication capability was developed and deployed on 10 Samsung Gear S3 smartwatches and provided to the users during the focus group. Pain was designated as the main PRO, while fatigue, mood, and sleep quality were included as auxiliary PROs. Pre-planned topics included participants' attitude towards the smartwatch technology, usability of the custom-designed app interface, and suitability of the smartwatch technology for PRO assessment. Discussions were transcribed, and content analysis with theme characterization was performed to identify and code the major themes. Results: We recruited 19 participants (age 65+) who consented to take part in the focus group study. The overall attitude of the participants toward the smartwatch technology was positive. They showed interest in the direct phone-call capability, availability of extra apps such as the weather apps and sensors for tracking health and wellness such as accelerometer and heart rate sensor. Nearly three-quarters of participants showed willingness to participate in a one-year study to wear the watch daily. Concerns were raised regarding usability, including accessibility (larger icons), notification customization, and intuitive interface design (unambiguous icons and assessment scales). Participants expressed interest in using smartwatch technology for PRO assessment and the availability of methods for sharing data with health care providers. Conclusions: All participants had overall positive views of the smartwatch technology for measuring PROs to facilitate patient-provider communications and to provide more targeted treatments and interventions in the future. Usability concerns were the major issues that will require special consideration in future smartwatch PRO user interface designs, especially accessibility issues, notification design, and use of intuitive assessment scales. ",
doi="10.2196/10044",
url="http://mhealth.jmir.org/2019/3/e10044/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30912756"
}


@Article{info:doi/10.2196/12535,
author="Geuens, Jonas
and Geurts, Luc
and Swinnen, W. Thijs
and Westhovens, Rene
and Vanden Abeele, Vero",
title="Mobile Health Features Supporting Self-Management Behavior in Patients With Chronic Arthritis: Mixed-Methods Approach on Patient Preferences",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Mar",
day="25",
volume="7",
number="3",
pages="e12535",
keywords="mobile applications",
keywords="arthritis",
keywords="self-management",
abstract="Background: Patients with chronic arthritis (CA) ideally apply self-management behaviors between consultations. This enduring, tedious task of keeping track of disease-related parameters, adhering to medication schemes, and engaging in physical therapy may be supported by using a mobile health (mHealth) app. However, further research is needed to determine which self-management features are valued most by adult patients with CA patients. Objective: The aim of this study was to determine the preference of features for an mHealth app to support self-management behavior in patients with CA. In addition, we aimed to explore the motives behind these ratings. Methods: A mixed-methods approach was used to gather information from 31 adult patients (14 females), aged 23 to 71 years (mean 51 [SD 12.16]), with CA. Structured interviews were conducted to gather data pertaining to preferences of app features. Interviews were analyzed qualitatively, whereas ratings for each of the 28 features studied were analyzed quantitatively. Results: In general, patients with CA favored the use of features pertaining to supporting active and direct disease management, (eg, medication intake and detecting and alarming of bad posture), helping them to keep a close watch on their disease status and inform their health care professional (eg, providing a means to log and report disease-related data) and receiving personalized information (eg, offering tailored information based on the patient's health data). Patients strongly disliked features that provide a means of social interaction or provide incentivization for disease-related actions (eg, being able to compare yourself with other patients, cooperating toward a common goal, and receiving encouragement from friends and/or family). Driving these evaluations is the finding that every patient with CA hurts in his/her own way, the way the disease unfolds over time and manifests itself in the patient and social environment is different for every patient, and patients with CA are well aware of this. Conclusions: We have offered an insight into how patients with CA favor mHealth features for self-management apps. The results of this research can inform the design and development of prospective self-management apps for patients with CA. ",
doi="10.2196/12535",
url="http://mhealth.jmir.org/2019/3/e12535/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30907737"
}


@Article{info:doi/10.2196/11082,
author="Petersen, L. Curtis
and Weeks, B. William
and Norin, Olof
and Weinstein, N. James",
title="Development and Implementation of a Person-Centered, Technology-Enhanced Care Model For Managing Chronic Conditions: Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Mar",
day="20",
volume="7",
number="3",
pages="e11082",
keywords="mHealth",
keywords="mobile health",
keywords="telemedicine",
keywords="digital biomarker",
keywords="person-centered care",
keywords="chronic condition",
keywords="chronic disease",
abstract="Background: Caring for individuals with chronic conditions is labor intensive, requiring ongoing appointments, treatments, and support. The growing number of individuals with chronic conditions makes this support model unsustainably burdensome on health care systems globally. Mobile health technologies are increasingly being used throughout health care to facilitate communication, track disease, and provide educational support to patients. Such technologies show promise, yet they are not being used to their full extent within US health care systems. Objective: The purpose of this study was to examine the use of staff and costs of a remote monitoring care model in persons with and without a chronic condition. Methods: At Dartmouth-Hitchcock Health, 2894 employees volunteered to monitor their health, transmit data for analysis, and communicate digitally with a care team. Volunteers received Bluetooth-connected consumer-grade devices that were paired to a mobile phone app that facilitated digital communication with nursing and health behavior change staff. Health data were collected and automatically analyzed, and behavioral support communications were generated based on those analyses. Care support staff were automatically alerted according to purpose-developed algorithms. In a subgroup of participants and matched controls, we used difference-in-difference techniques to examine changes in per capita expenditures. Results: Participants averaged 41 years of age; 72.70\% (2104/2894) were female and 12.99\% (376/2894) had at least one chronic condition. On average each month, participants submitted 23 vital sign measurements, engaged in 1.96 conversations, and received 0.25 automated messages. Persons with chronic conditions accounted for 39.74\% (8587/21,607) of all staff conversations, with higher per capita conversation rates for all shifts compared to those without chronic conditions (P<.001). Additionally, persons with chronic conditions engaged nursing staff more than those without chronic conditions (1.40 and 0.19 per capita conversations, respectively, P<.001). When compared to the same period in the prior year, per capita health care expenditures for persons with chronic conditions dropped by 15\% (P=.06) more than did those for matched controls. Conclusions: The technology-based chronic condition management care model was frequently used and demonstrated potential for cost savings among participants with chronic conditions. While further studies are necessary, this model appears to be a promising solution to efficiently provide patients with personalized care, when and where they need it. ",
doi="10.2196/11082",
url="http://mhealth.jmir.org/2019/3/e11082/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30892274"
}


@Article{info:doi/10.2196/13137,
author="Mazoteras-Pardo, Victoria
and Becerro-De-Bengoa-Vallejo, Ricardo
and Losa-Iglesias, Elena Marta
and L{\'o}pez-L{\'o}pez, Daniel
and Palomo-L{\'o}pez, Patricia
and Rodr{\'i}guez-Sanz, David
and Calvo-Lobo, C{\'e}sar",
title="Validation in the General Population of the iHealth Track Blood Pressure Monitor for Self-Measurement According to the European Society of Hypertension International Protocol Revision 2010: Descriptive Investigation",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Mar",
day="19",
volume="7",
number="3",
pages="e13137",
keywords="blood pressure determination",
keywords="heart rate determination",
keywords="validation studies",
keywords="telemedicine",
abstract="Background: High blood pressure is one of the most common reasons why patients seek assistance in daily clinical practice. Screening for hypertension is fundamental and, because hypertension is identified only when blood pressure is measured, accurate measurements are key to the diagnosis and management of this disease. The European Society of Hypertension International Protocol revision 2010 (ESH-IP2) was developed to assess the validity of automatic blood pressure measuring devices that are increasingly being used to replace mercury sphygmomanometers. Objective: We sought to determine whether the iHealth Track blood pressure monitor meets ESH-IP2 requirements for self-measurement of blood pressure and heart rate at the brachial level and is appropriate for use in the general population. Methods: This study was a descriptive investigation. ESH-IP2 requires a total number of 33 participants. For each measure, the difference between observer and device blood pressure and heart rate values is calculated. In all, 99 pairs of blood pressure differences are classified into 3 categories (?5, ?10, and ?15 mm Hg), and 99 pairs of heart rate differences are classified into 3 categories (?3, ?5, and ?8 beats/min). We followed these protocol procedures in a convenience sample of 33 participants. Results: iHealth Track fulfilled ESH-IP2 requirements and passed the validation process successfully. We observed an absolute difference within 5 mm Hg in 75 of 99 comparisons for systolic blood pressure, 78 of 99 comparisons for diastolic blood pressure, and 89 of 99 comparisons for heart rate. The mean differences between the test and standard readings were 4.19 (SD 4.48) mm Hg for systolic blood pressure, 3.74 (SD 4.55) mm Hg for diastolic blood pressure, and 1.95 (SD 3.27) beats/min for heart rate. With regard to part 2 of ESH-IP2, we observed a minimum of 2 of 3 measurements within a 5-mm Hg difference in 29 of 33 participants for systolic blood pressure and 26 of 33 for diastolic blood pressure, and a minimum of 2 of 3 measurements within a 3-beat/min difference in 30 of 33 participants for heart rate. Conclusions: iHealth Track readings differed from the standard by less than 5, 10, and 15 mm Hg, fulfilling ESH-IP2 requirements. Consequently, this device is suitable for use in the general population. ",
doi="10.2196/13137",
url="http://mhealth.jmir.org/2019/3/e13137/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30888331"
}


@Article{info:doi/10.2196/11614,
author="Fitzpatrick, L. Annette
and van Pelt, Maurits
and Heang, Hen
and Steinman, Lesley
and Ide, Nicole
and Chhea, Chhorvann
and LoGerfo, P. James",
title="Using Targeted mHealth Messages to Address Hypertension and Diabetes Self-Management in Cambodia: Protocol for a Clustered Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2019",
month="Mar",
day="19",
volume="8",
number="3",
pages="e11614",
keywords="Cambodia",
keywords="diabetes",
keywords="hypertension",
keywords="mHealth",
keywords="mobile phone",
abstract="Background: Hypertension and diabetes represent the first and third highest contributors to global disability. While mobile health (mHealth) messaging programs have rapidly increased in low- and middle-income countries (LMIC), adaptations for specific patient health needs is a new approach to manage chronic conditions. Objective: The primary aim of this study is to develop and test an mHealth communication intervention using electronic data capture (by tablet) and voice messaging to improve hypertension and diabetes self-management in Cambodia. The secondary aim is to share results with the Cambodian Ministry of Health and development partners to inform health policy and develop strategies for hypertension and diabetes control. Methods: The study design is a cluster randomized controlled clinical trial randomizing each of 75 Community peer educators (PEs), trained and coordinated by MoPoTsyo Patient Information Center in Phnom Penh, into one of 3 groups of 25 (approximately 60 patients each) to receive either tablet+messages, tablet only, or no intervention (control). The total sample within each group includes 25 clusters and approximately 1500 patients located in 7 Operational Districts in rural regions or urban slums in Cambodia. The interventions (groups 1 and 2) were compared with usual PE monitoring without the tablet or mHealth messaging interventions. Focus groups and informant interviews were conducted to develop messages according to specific themes---medications adherence, laboratory testing, physician visits, obesity, smoking, and general lifestyle issues. Using the data received at monthly PE monitoring meetings, patients will receive specific messages based on their individual health challenges. Following the intervention completion, clinical and process outcomes will be compared with baseline metrics between groups. Results: PEs were randomized in July 2017, and the intervention was implemented in September 2017 through June 2018. Analyses are underway. Conclusions: This project is unique in its combination of electronic data transfer, which can be accessed immediately, with voice messages most relevant to individual patients' needs. Positive results will indicate the value of using targeted messaging in patient-specific, self-management issues to improve hypertension and diabetes control. International Registered Report Identifier (IRRID): DERR1-10.2196/11614 ",
doi="10.2196/11614",
url="http://www.researchprotocols.org/2019/3/e11614/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30888330"
}


@Article{info:doi/10.2196/10813,
author="Furlong, Eileen
and Darley, Andrew
and Fox, Patricia
and Buick, Alison
and Kotronoulas, Grigorios
and Miller, Morven
and Flowerday, Adrian
and Miaskowski, Christine
and Patiraki, Elisabeth
and Katsaragakis, Stylianos
and Ream, Emma
and Armes, Jo
and Gaiger, Alexander
and Berg, Geir
and McCrone, Paul
and Donnan, Peter
and McCann, Lisa
and Maguire, Roma",
title="Adaptation and Implementation of a Mobile Phone--Based Remote Symptom Monitoring System for People With Cancer in Europe",
journal="JMIR Cancer",
year="2019",
month="Mar",
day="14",
volume="5",
number="1",
pages="e10813",
keywords="telemedicine",
keywords="methods",
keywords="patient care",
keywords="cancer",
keywords="symptom management",
abstract="Background: There has been an international shift in health care, which has seen an increasing focus and development of technological and personalized at-home interventions that aim to improve health outcomes and patient-clinician communication. However, there is a notable lack of empirical evidence describing the preparatory steps of adapting and implementing technology of this kind across multiple countries and clinical settings. Objective: This study aimed to describe the steps undertaken in the preparation of a multinational, multicenter randomized controlled trial (RCT) to test a mobile phone--based remote symptom monitoring system, that is, Advanced Symptom Management System (ASyMS), designed to enhance management of chemotherapy toxicities among people with cancer receiving adjuvant chemotherapy versus standard cancer center care. Methods: There were 13 cancer centers across 5 European countries (Austria, Greece, Ireland, Norway, and the United Kingdom). Multiple steps were undertaken, including a scoping review of empirical literature and clinical guidelines, translation and linguistic validation of study materials, development of standardized international care procedures, and the integration and evaluation of the technology within each cancer center. Results: The ASyMS was successfully implemented and deployed in clinical practices across 5 European countries. The rigorous and simultaneous steps undertaken by the research team highlighted the strengths of the system in clinical practice, as well as the clinical and technical changes required to meet the diverse needs of its intended users within each country, before the commencement of the RCT. Conclusions: Adapting and implementing this multinational, multicenter system required close attention to diverse considerations and unique challenges primarily related to communication and clinical and technical issues. Success was dependent on collaborative and transparent communication among academics, the technology industry, translation partners, patients, and clinicians as well as a simultaneous and rigorous methodological approach within the 5 relevant countries. ",
doi="10.2196/10813",
url="http://cancer.jmir.org/2019/1/e10813/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30869641"
}


@Article{info:doi/10.2196/11933,
author="Vehi, Josep
and Reginc{\'o}s Isern, Jordi
and Parcerisas, Adri{\`a}
and Calm, Remei
and Contreras, Ivan",
title="Impact of Use Frequency of a Mobile Diabetes Management App on Blood Glucose Control: Evaluation Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Mar",
day="07",
volume="7",
number="3",
pages="e11933",
keywords="diabetes mellitus",
keywords="mHealth",
keywords="self-management",
keywords="blood glucose self-monitoring",
keywords="evaluation studies",
abstract="Background: Technology has long been used to carry out self-management as well as to improve adherence to treatment in people with diabetes. However, most technology-based apps do not meet the basic requirements for engaging patients. Objective: This study aimed to evaluate the effect of use frequency of a diabetes management app on glycemic control. Methods: Overall, 2 analyses were performed. The first consisted of an examination of the reduction of blood glucose (BG) mean, using a randomly selected group of 211 users of the SocialDiabetes app (SDA). BG levels at baseline, month 3, and month 6 were calculated using the intercept of a regression model based on data from months 1, 4, and 7, respectively. In the second analysis, the impact of low and high BG risk was examined. A total of 2692 users logging SDA ?5 days/month for ?6 months were analyzed. The highest quartile regarding low blood glucose index (LBGI) and high blood glucose index (HBGI) at baseline (t1) was selected (n=74 for group A; n=440 for group B). Changes in HBGI and LBGI at month 6 (t2) were analyzed. Results: For analysis 1, baseline BG results for type 1 diabetes mellitus (T1DM) groups A and B were 213.61 (SD 31.57) mg/dL and 206.43 (SD 18.65) mg/dL, respectively, which decreased at month 6 to 175.15 (SD 37.88) mg/dL and 180.6 (SD 40.47) mg/dL, respectively. For type 2 diabetes mellitus (T2DM), baseline BG was 218.77 (SD 40.18) mg/dL and 232.55 (SD 46.78) mg/dL, respectively, which decreased at month 6 to 160.51 (SD 39.32) mg/dL and 173.14 (SD 52.81) mg/dL for groups A and B, respectively. This represents a reduction of estimated A1c (eA1c) of approximately 1.3\% (P<.001) and 0.9\% (P=.001) for T1DM groups A and B, respectively, and 2\% (P<.001) for both A and B T2DM groups, respectively. For analysis 2, T1DM baseline LBGI values for groups A and B were 5.2 (SD 3.9) and 4.4 (SD 2.3), respectively, which decreased at t2 to 3.4 (SD 3.3) and 3.4 (SD 1.9), respectively; this was a reduction of 34.6\% (P=.005) and 22.7\% (P=.02), respectively. Baseline HBGI values for groups A and B were 12.6 (SD 4.3) and 10.6 (SD 4.03), respectively, which decreased at t2 to 9.0 (SD 6.5) and 8.6 (SD 4.7), respectively; this was a reduction of 30\% (P=.001) and 22\% (P=.003), respectively. Conclusions: A significant reduction in BG was found in all groups, independent of the use frequency of the app. Better outcomes were found for T2DM patients. A significant reduction in LBGI and HBGI was found in all groups, regardless of the use frequency of the app. LBGI and HBGI indices of both groups tend to have similar values after 6 months of app use. ",
doi="10.2196/11933",
url="http://mhealth.jmir.org/2019/3/e11933/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30843865"
}


@Article{info:doi/10.2196/13259,
author="Ware, Patrick
and Dorai, Mala
and Ross, J. Heather
and Cafazzo, A. Joseph
and Laporte, Audrey
and Boodoo, Chris
and Seto, Emily",
title="Patient Adherence to a Mobile Phone--Based Heart Failure Telemonitoring Program: A Longitudinal Mixed-Methods Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Feb",
day="26",
volume="7",
number="2",
pages="e13259",
keywords="telemonitoring",
keywords="mHealth",
keywords="adherence",
keywords="heart failure",
abstract="Background: Telemonitoring (TM) can improve heart failure (HF) outcomes by facilitating patient self-care and clinical decision support. However, these outcomes are only possible if patients consistently adhere to taking prescribed home readings. Objective: The objectives of this study were to (1) quantify the degree to which patients adhered to taking prescribed home readings in the context of a mobile phone--based TM program and (2) explain longitudinal adherence rates based on the duration of program enrollment, patient characteristics, and patient perceptions of the TM program. Methods: A mixed-methods explanatory sequential design was used to meet the 2 research objectives, and all explanatory methods were guided by the unified theory of acceptance and use of technology 2 (UTAUT2). Overall adherence rates were calculated as the proportion of days patients took weight, blood pressure, heart rate, and symptom readings over the total number of days they were enrolled in the program up to 1 year. Monthly adherence rates were also calculated as the proportion of days patients took the same 4 readings over each 30-day period following program enrollment. Next, simple and multivariate regressions were performed to determine the influence of time, age, sex, and disease severity on adherence rates. Additional explanatory methods included questionnaires at 6 and 12 months probing patients on the perceived benefits and ease of use of the TM program, an analysis of reasons for patients leaving the program, and semistructured interviews conducted with a purposeful sampling of patients (n=24) with a range of adherence rates and demographics. Results: Overall average adherence was 73.6\% (SD 25.0) with average adherence rates declining over time at a rate of 1.4\% per month (P<.001). The multivariate regressions found no significant effect of sex and disease severity on adherence rates. When grouping patients' ages by decade, age was a significant predictor (P=.04) whereby older patients had higher adherence rates over time. Adherence rates were further explained by patients' perceptions with regard to the themes of (1) performance expectancy (improvements in HF management and peace of mind), (2) effort expectancy (ease of use and technical issues), (3) facilitating conditions (availability of technical support and automated adherence calls), (4) social influence (support from family, friends, and trusted clinicians), and (5) habit (degree to which taking readings became automatic). Conclusions: The decline in adherence rates over time is consistent with findings from other studies. However, this study also found adherence to be the highest and most consistent over time in older age groups and progressively lower over time for younger age groups. These findings can inform the design and implementation of TM interventions that maximize patient adherence, which will enable a more accurate evaluation of impact and optimization of resources. International Registered Report Identifier (IRRID): RR2-10.2196/resprot.9911 ",
doi="10.2196/13259",
url="http://mhealth.jmir.org/2019/2/e13259/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30806625"
}


@Article{info:doi/10.2196/12204,
author="Soh, Yeong Ji
and Lee, Uk Se
and Lee, Inpyo
and Yoon, Sang Ki
and Song, Changho
and Kim, Hun Nam
and Sohn, Sung Tae
and Bae, Moon Jae
and Chang, Kyung Dong
and Cha, Chul Won",
title="A Mobile Phone--Based Self-Monitoring Tool for Perioperative Gastric Cancer Patients With Incentive Spirometer: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Feb",
day="19",
volume="7",
number="2",
pages="e12204",
keywords="incentive spirometer",
keywords="mobile health",
keywords="postoperative care",
keywords="gastric cancer",
keywords="motivation",
abstract="Background: An incentive spirometer (IS) is a medical device used to help patients improve the functioning of their lungs. It is provided to patients who have had any surgery that might jeopardize respiratory function. An incentive spirometer plays a key role in the prevention of postoperative complications, and the appropriate use of an IS is especially well known for the prevention of respiratory complications. However, IS utilization depends on the patient's engagement, and information and communication technology (ICT) can help in this area. Objective: This study aimed to determine the effect of mobile ICT on the usage of an IS (Go-breath) app by postoperative patients after general anesthesia. Methods: For this study, we recruited patients from April to May 2018, who used the Go-breath app at a single tertiary hospital in South Korea. The patients were randomly classified into either a test or control group. The main function of the Go-breath app was to allow for self-reporting and frequency monitoring of IS use, deep breathing, and active coughing in real time. The Go-breath app was identical for both the test and control groups, except for the presence of the alarm function. The test group heard an alarm every 60 min from 9 am to 9 pm for 2 days. For the test group alone, a dashboard was established in the nurse's station through which a nurse could rapidly assess the performance of multiple patients. To evaluate the number of performances per group, we constructed an incentive spirometer index (ISI). Results: A total of 44 patients were recruited, and 42 of them completed the study protocol. ISI in the test group was 20.2 points higher than that in the control group (113.5 points in the test group and 93.2 points in the control group, P=.22). The system usability scale generally showed almost the same score in the 2 groups (79.3 points in the test group and 79.4 points in the control group, P=.94). We observed that the performance rates of IS count, active coughing, and deep breathing were also higher in the test group but with no statistically significant difference between the groups. For the usefulness ``yes or no'' question, over 90\% (38/42) of patients answered ``yes'' and wanted more functional options and information. Conclusions: The use of the Go-breath app resulted in considerable differences between the test group and control group but with no statistically significant differences. Trial Registration: ClinicalTrials.gov NCT03569332; https://clinicaltrials.gov/ct2/show/NCT03569332 (Archived by WebCite at http://www.webcitation.org/74ihKmQIX). ",
doi="10.2196/12204",
url="http://mhealth.jmir.org/2019/2/e12204/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30777844"
}


@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/10.2196/12658,
author="Zhang, Yiyu
and Li, Xia
and Luo, Shuoming
and Liu, Chaoyuan
and Xie, Yuting
and Guo, Jia
and Liu, Fang
and Zhou, Zhiguang",
title="Use, Perspectives, and Attitudes Regarding Diabetes Management Mobile Apps Among Diabetes Patients and Diabetologists in China: National Web-Based Survey",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Feb",
day="08",
volume="7",
number="2",
pages="e12658",
keywords="diabetes mellitus",
keywords="mobile applications",
keywords="surveys and questionnaires",
abstract="Background: The diabetes disease burden in China is heavy, and mobile apps have a great potential for diabetes management. However, there is a lack of investigation of diabetes app use among Chinese diabetes patients and diabetologists. The perspectives and attitudes of diabetes patients and diabetologists regarding diabetes apps are also unclear. Objective: Our objectives were to investigate diabetes patients' and diabetologists' use, attitudes, and perspectives, as well as patients' needs, with respect to diabetes apps to provide information regarding the optimal design of diabetes apps and the best strategies to promote their use. Methods: Diabetes patients and diabetologists across China were surveyed on the WeChat (Tencent Corp) network using Sojump (Changsha ran Xing InfoTech Ltd) from January 23, 2018, to July 30, 2018. In total, 2 survey links were initially sent to doctors from 46 Latent Autoimmune Diabetes of Adults Study collaborative hospitals in China in 25 major cities and were spread on their WeChat contacts network. We also published the patient survey link on 3 WeChat public accounts and requested diabetes patients to fill out questionnaires. A multivariate regression analysis was used to identify associations of demographic and basic disease information with app usage among adult patients. Results: Overall, 1276 individuals from 30 provincial regions responded to the patient survey; among them, the overall app awareness rate was 29.94\% (382/1276) and usage was 15.44\% (197/1276). The usage was higher among patients with type 1 diabetes (T1DM) than among patients with type 2 diabetes (T2DM; 108/473, 22.8\% vs 79/733, 10.8\%; P<.001). The multivariate regression analysis showed that diabetes type, age, education, family income, and location were associated with app use in adult patients (P<.05). The need for and selection of diabetes apps differed slightly between patients with T1DM and patients with T2DM. The reasons why patients discontinued the use of an app included limited time (59/197, 29.9\%), complicated operations (50/197, 25.4\%), ineffectiveness for glycemic control (48/197, 24.4\%), and cost (38/197, 19.3\%). Of the 608 responders to the diabetologist survey, 40.5\% (246/608) recommended diabetes apps to patients and 25.2\% (153/608) used diabetes apps to manage patients. The greatest obstacles to the diabetologists' use of apps to manage diabetes patients include limited time (280/608, 46.1\%), legal issues (129/608, 21.2\%), patients' distrust (108/608, 17.8\%), and billing issues (66/608, 10.9\%). Conclusions: The awareness and use of diabetes apps in Chinese people with diabetes and the proportion of diabetologists using diabetes apps to manage patients are low. Designing apps targeting different patient needs and conducting high-quality randomized controlled trials will improve the effectiveness of the apps, provide evidence for patients to choose suitable apps, and be conducive to the promotion of app use. ",
doi="10.2196/12658",
url="http://mhealth.jmir.org/2019/2/e12658/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30735147"
}


@Article{info:doi/10.2196/10956,
author="Morita, Pelegrini Plinio
and Yeung, S. Melanie
and Ferrone, Madonna
and Taite, K. Ann
and Madeley, Carole
and Stevens Lavigne, Andrea
and To, Teresa
and Lougheed, Diane M.
and Gupta, Samir
and Day, G. Andrew
and Cafazzo, A. Joseph
and Licskai, Christopher",
title="A Patient-Centered Mobile Health System That Supports Asthma Self-Management (breathe): Design, Development, and Utilization",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jan",
day="28",
volume="7",
number="1",
pages="e10956",
keywords="smartphone",
keywords="asthma",
keywords="self report",
keywords="self-management",
keywords="patient compliance",
keywords="telemedicine",
keywords="risk reduction behavior",
keywords="internet",
keywords="monitoring, physiologic",
keywords="mobile applications",
abstract="Background: Uncontrolled asthma poses substantial negative personal and health system impacts. Web-based technologies, including smartphones, are novel means to enable evidence-based care and improve patient outcomes. Objective: The aim of this study was to design, develop, and assess the utilization of an asthma collaborative self-management (CSM) platform (breathe) using content based on international evidence-based clinical guidelines. Methods: We designed and developed breathe as a Web-based mobile health (mHealth) platform accessible on smartphones, tablets, or desktop with user-centered design methods and International Organization for Standardization--certified quality development processes. Moreover, breathe was envisioned as a multifunctional, CSM mHealth platform, with content based on international clinical practice guidelines and compliant with national privacy and security specifications. The system enabled CSM (patient, provider, and breathe) and self-monitoring of asthma patients through (1) assessment of asthma control, (2) real-time access to a dynamic asthma action plan, (3) access to real-time environmental conditions, and (4) risk-reduction messaging. The data collection protocol collected user data for 12 months, with clinic visits at baseline and 6 and 12 months. Utilization outcomes included user interactions with the platform, user impressions, self-reported medication use, asthma symptom profile, reported peak flow measurement, and the delivery and impact of email reminders. Results: We enrolled 138 patients with a mean age of 45.3 years to receive the breathe intervention. Majority were female (100/138, 72.5\%), had a smartphone (92/138, 66.7\%), and had a mean Asthma Control Test score of 18.3 (SD 4.9). A majority reported that breathe helped in the management of their asthma. Moreover, breathe scored 71.1 (SD 18.9) on the System Usability Scale. Overall, 123 patients had complete usage analytics datasets. The platform sent 7.96 reminder emails per patient per week (pppw), patients accessed breathe 3.08 times, journaled symptoms 2.56 times, reported medication usage 0.30 times, and reported peak flow measurements 0.92 times pppw. Furthermore, breathe calculated patients' action plan zone of control 2.72 times pppw, with patients being in the green (well-controlled) zone in 47.71\% (8300/17,396) of the total calculations. Usage analysis showed that 67.5\% (83/123) of the participants used the app at week 4 and only 57.7\% (71/123) by week 45. Physician visits, email reminders, and aged 50 years and above were associated with higher utilization. Conclusions: Individuals with asthma reported good usability and high satisfaction levels, reacted to breathe notifications, and had confidence in the platform's assessment of asthma control. Strong utilization was seen at the intervention's initiation, followed by a rapid reduction in use. Patient reminders, physician visits, and being aged 50 years and above were associated with higher utilization. Trial Registration: ClinicalTrials.gov NCT01964469;?https://clinicaltrials.gov/ct2/show/NCT01964469 ",
doi="10.2196/10956",
url="http://mhealth.jmir.org/2019/1/e10956/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30688654"
}


@Article{info:doi/10.2196/11838,
author="Lalloo, Chitra
and Hundert, Amos
and Harris, Lauren
and Pham, Quynh
and Campbell, Fiona
and Chorney, Jill
and Dick, Bruce
and Simmonds, Mark
and Cafazzo, Joseph
and Stinson, Jennifer",
title="Capturing Daily Disease Experiences of Adolescents With Chronic Pain: mHealth-Mediated Symptom Tracking",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jan",
day="17",
volume="7",
number="1",
pages="e11838",
keywords="adherence",
keywords="adolescents",
keywords="chronic pain",
keywords="disease experience",
keywords="feasibility",
keywords="mHealth",
keywords="self-report",
keywords="smartphones",
keywords="symptom monitoring",
keywords="mobile phone",
abstract="Background: Chronic pain is a common problem in adolescents that can negatively impact all aspects of their health-related quality of life. The developmental period of adolescence represents a critical window of opportunity to optimize and solidify positive health behaviors and minimize future pain-related disability and impaired work productivity. This research focuses on the development and evaluation of a smartphone-based pain self-management app for adolescents with chronic pain. Objective: The objectives of this study were to characterize (1) the feasibility of deploying a mobile health (mHealth) app (iCanCope) to the personal smartphones of adolescent research participants; (2) adherence to daily symptom tracking over 55 consecutive days; (3) participant interaction with their symptom history; and (4) daily pain-related experiences of adolescents with chronic pain. Methods: We recruited adolescents aged 15-18 years from 3 Canadian pediatric tertiary care chronic pain clinics. Participants received standardized instructions to download the iCanCope app and use it once a day for 55 days. Detailed app analytics were captured at the user level. Adherence was operationally defined as per the relative proportion of completed symptom reports. Linear mixed models were used to examine the trajectories of daily symptom reporting. Results: We recruited 60 participants between March 2017 and April 2018. The mean age of the participants was 16.4 (SD 0.9) years, and 88\% (53/60) of them were female. The app was deployed to 98\% (59/60) devices. Among the 59 participants, adherence was as follows: low (4, 7\%), low-moderate (14, 24\%), high-moderate (16, 27\%), and high (25, 42\%). Most (49/59, 83\%) participants chose to view their historical symptom trends. Participants reported pain intensity and pain-related symptoms of moderate severity, and these ratings tended to be stable over time. Conclusions: This study indicates that (1) the iCanCope app can be deployed to adolescents' personal smartphones with high feasibility; (2) adolescents demonstrated moderate-to-high adherence over 55 days; (3) most participants chose to view their symptom history; and (4) adolescents with chronic pain experience stable symptomology of moderate severity. Trial Registration: ClinicalTrials.gov NCT02601755; https://clinicaltrials.gov/ct2/show/NCT02601755 (Archived by WebCite at http://www.webcitation.org/74F4SLnmc) ",
doi="10.2196/11838",
url="http://mhealth.jmir.org/2019/1/e11838/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30664472"
}


@Article{info:doi/10.2196/11885,
author="Ayre, Julie
and Bonner, Carissa
and Bramwell, Sian
and McClelland, Sharon
and Jayaballa, Rajini
and Maberly, Glen
and McCaffery, Kirsten",
title="Factors for Supporting Primary Care Physician Engagement With Patient Apps for Type 2 Diabetes Self-Management That Link to Primary Care: Interview Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jan",
day="16",
volume="7",
number="1",
pages="e11885",
keywords="diabetes mellitus, type 2",
keywords="electronic health records",
keywords="telemedicine",
keywords="mobile apps",
keywords="general practitioners",
keywords="physicians, primary care",
keywords="self-management",
keywords="qualitative research",
keywords="translational medical research",
abstract="Background: The health burden of type 2 diabetes can be mitigated by engaging patients in two key aspects of diabetes care: self-management and regular contact with health professionals. There is a clear benefit to integrating these aspects of care into a single clinical tool, and as mobile phone ownership increases, apps become a more feasible platform. However, the effectiveness of online health interventions is contingent on uptake by health care providers, which is typically low. There has been little research that focuses specifically on barriers and facilitators to health care provider uptake for interventions that link self-management apps to the user's primary care physician (PCP). Objective: This study aimed to explore PCP perspectives on proposed features for a self-management app for patients with diabetes that would link to primary care services. Methods: Researchers conducted 25 semistructured interviews. The interviewer discussed potential features that would link in with the patient's primary care services. Interviews were audio-recorded, transcribed, and coded. Framework analysis and the Consolidated Criteria for Reporting Qualitative Research checklist were employed to ensure rigor. Results: Our analysis indicated that PCP attitudes toward proposed features for an app were underpinned by perceived roles of (1) diabetes self-management, (2) face-to-face care, and (3) the anticipated burden of new technologies on their practice. Theme 1 explored PCP perceptions about how an app could foster patient independence for self-management behaviors but could also increase responsibility and liability for the PCP. Theme 2 identified beliefs underpinning a commonly expressed preference for face-to-face care. PCPs perceived information was more motivating, better understood, and presented with greater empathy when delivered face to face rather than online. Theme 3 described how most PCPs anticipated an initial increase in workload while they learned to use a new clinical tool. Some PCPs accepted this burden on the basis that the change was inevitable as health care became more integrated. Others reported potential benefits were outweighed by effort to implement an app. This study also identified how app features can be positively framed, highlighting potential benefits for PCPs to maximize PCP engagement, buy-in, and uptake. For example, PCPs were more positive when they perceived that an app could facilitate communication and motivation between consultations, focus on building capacity for patient independence, and reinforce rather than replace in-person care. They were also more positive about app features that were automated, integrated with existing software, flexible for different patients, and included secondary benefits such as improved documentation. Conclusions: This study provided insight into PCP perspectives on a diabetes app integrated with primary care services. This was observed as more than a technological change; PCPs were concerned about changes in workload, their role in self-management, and the nature of consultations. Our research highlighted potential facilitators and barriers to engaging PCPs in the implementation process. ",
doi="10.2196/11885",
url="http://mhealth.jmir.org/2019/1/e11885/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30664468"
}


@Article{info:doi/10.2196/11848,
author="Jimenez, Geronimo
and Lum, Elaine
and Car, Josip",
title="Examining Diabetes Management Apps Recommended From a Google Search: Content Analysis",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jan",
day="16",
volume="7",
number="1",
pages="e11848",
keywords="chronic diseases",
keywords="diabetes",
keywords="Google",
keywords="health apps",
keywords="mobile phone",
abstract="Background: The availability of smartphone health apps empowers people to manage their own health. Currently, there are over 300,000 health apps available in the market targeting a variety of user needs from weight loss to management of chronic conditions, with diabetes being the most commonly targeted condition. To date, health apps largely fall outside government regulation, and there are no official guidelines to help clinicians and patients in app selection. Patients commonly resort to the internet for suggestions on which diabetes app to use. Objective: The objective of this study was to investigate apps identified through a Google search and characterize these apps in terms of features that support diabetes management. Methods: We performed a Google search for the ``best diabetes apps 2017'' and explored the first 4 search results. We identified and compiled a list of the apps recommended in the returned search results, which were Web articles. Information about each app was extracted from the papers and corresponding app store descriptions. We examined the apps for the following diabetes management features: medication management, blood glucose self-management, physical activity, diet and nutrition, and weight management. Results: Overall, 26 apps were recommended in 4 papers. One app was listed in all 4 papers, and 3 apps appeared on 3 of the 4 lists. Apart from one paper, there were no explicit criteria to justify or explain the selection of apps. We found a wide variation in the type and the number of diabetes management features in the recommended apps. Five apps required payment to be used. Two-thirds of the apps had blood glucose management features, and less than half had medication management features. The most prevalent app features were nutrition or diet-related (19/24, 79\%) and physical activity tracking (14/24, 58\%). Conclusions: The ambiguity of app selection and the wide variability in key features of the apps recommended for diabetes management may pose difficulties for patients when selecting the most appropriate app. It is critical to involve patients, clinicians, relevant professional bodies, and policy makers to define the key features an app should have for it to be classified as a ``diabetes management'' app. The lessons learned here may be extrapolated for the development and recommendation of apps for the management of other chronic conditions. ",
doi="10.2196/11848",
url="http://mhealth.jmir.org/2019/1/e11848/"
}


@Article{info:doi/10.2196/12228,
author="Langford, T. Aisha
and Solid, A. Craig
and Scott, Ebony
and Lad, Meeki
and Maayan, Eli
and Williams, K. Stephen
and Seixas, A. Azizi",
title="Mobile Phone Ownership, Health Apps, and Tablet Use in US Adults With a Self-Reported History of Hypertension: Cross-Sectional Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jan",
day="14",
volume="7",
number="1",
pages="e12228",
keywords="smartphone",
keywords="text messaging",
keywords="health communication",
keywords="ownership",
keywords="goals",
keywords="cell phone",
keywords="telemedicine",
keywords="hypertension",
keywords="tablets",
keywords="chronic disease",
abstract="Background: Mobile phone and tablet ownership have increased in the United States over the last decade, contributing to the growing use of mobile health (mHealth) interventions to help patients manage chronic health conditions like diabetes. However, few studies have characterized mobile device ownership and the presence of health-related apps on mobile devices in people with a self-reported history of hypertension. Objective: This study aimed to describe the prevalence of smartphone, tablet, and basic mobile phone ownership and the presence of health apps by sociodemographic factors and self-reported hypertension status (ie, history) in a nationally representative sample of US adults, and to describe whether mobile devices are associated with health goal achievement, medical decision making, and patient-provider communication. Methods: Data from 3285 respondents from the 2017 Health Information National Trends Survey were analyzed. Participants were asked if they owned a smartphone, tablet, or basic mobile phone and if they had health apps on a smartphone or tablet. Participants were also asked if their smartphones or tablets helped them achieve a health-related goal like losing weight, make a decision about how to treat an illness, or talk with their health care providers. Chi-square analyses were conducted to test for differences in mobile device ownership, health app presence, and app helpfulness by patient characteristics. Results: Approximately 1460 (37.6\% weighted prevalence) participants reported a history of hypertension. Tablet and smartphone ownership were lower in participants with a history of hypertension than in those without a history of hypertension (55\% vs 66\%, P=.001, and 86\% vs 68\%, P<.001, respectively). Participants with a history of hypertension were more likely to own a basic mobile phone only as compared to those without a history of hypertension (16\% vs 9\%, P<.001). Among those with a history of hypertension exclusively, basic mobile phone, smartphone, and tablet ownership were associated with age and education, but not race or sex. Older adults were more likely to report having a basic mobile phone only, whereas those with higher education were more likely to report owning a tablet or smartphone. Compared to those without a history of hypertension, participants with a history of hypertension were less likely to have health-related apps on their smartphones or tablets (45\% vs 30\%, P<.001) and report that mobile devices helped them achieve a health-related goal (72\% vs 63\%, P=.01). Conclusions: Despite the increasing use of smartphones, tablets, and health-related apps, these tools are used less among people with a self-reported history of hypertension. To reach the widest cross-section of patients, a mix of novel mHealth interventions and traditional health communication strategies (eg, print, web based, and in person) are needed to support the diverse needs of people with a history of hypertension. ",
doi="10.2196/12228",
url="http://mhealth.jmir.org/2019/1/e12228/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31344667"
}


@Article{info:doi/10.2196/10321,
author="Agarwal, Payal
and Mukerji, Geetha
and Desveaux, Laura
and Ivers, M. Noah
and Bhattacharyya, Onil
and Hensel, M. Jennifer
and Shaw, James
and Bouck, Zachary
and Jamieson, Trevor
and Onabajo, Nike
and Cooper, Madeline
and Marani, Husayn
and Jeffs, Lianne
and Bhatia, Sacha R.",
title="Mobile App for Improved Self-Management of Type 2 Diabetes: Multicenter Pragmatic Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jan",
day="10",
volume="7",
number="1",
pages="e10321",
keywords="mobile apps",
keywords="diabetes mellitus, type 2",
keywords="self-management",
keywords="blood glucose self-monitoring",
keywords="randomized controlled trial",
keywords="pragmatic clinical trial",
abstract="Background: As the increasing prevalence of type 2 diabetes mellitus has put pressure on health systems to appropriately manage these patients, there have been a growing number of mobile apps designed to improve the self-management of diabetes. One such app, BlueStar, has been shown to significantly reduce hemoglobin A1c (HbA1c) levels in small studies and is the first app in the United States to receive Food and Drug Administration approval as a mobile prescription therapy. However, the impact of the app across real-world population among different clinical sites and health systems remains unclear. Objective: The primary objective of this study was to conduct a pragmatic randomized controlled trial of the BlueStar mobile app to determine if app usage leads to improved HbA1c levels among diverse participants in real-life clinical contexts. We hypothesized that this mobile app would improve self-management and HbA1c levels compared with controls. Methods: The study consisted of a multicenter pragmatic randomized controlled trial. Overall, 110 participants randomized to the immediate treatment group (ITG) received the intervention for 6 months, and 113 participants randomized to the wait-list control (WLC) group received usual care for the first 3 months and then received the intervention for 3 months. The primary outcome was glucose control measured by HbA1c levels at 3 months. Secondary outcomes assessed intervention impact on patient self-management, experience of care, and self-reported health utilization using validated scales, including the Problem Areas in Diabetes, the Summary of Diabetes Self-Care Activities, and the EuroQol-5D. Intervention usage data were collected directly from the app. Results: The results of an analysis of covariance controlling for baseline HbA1c levels did not show evidence of intervention impact on HbA1c levels at 3 months (mean difference [ITG?WLC] ?0.42, 95\% CI ?1.05 to 0.21; P=.19). Similarly, there was no intervention effect on secondary outcomes measuring diabetes self-efficacy, quality of life, and health care utilization behaviors. An exploratory analysis of 57 ITG participants investigating the impact of app usage on HbA1c levels showed that each additional day of app use corresponded with a 0.016-point decrease in participants' 3-month HbA1c levels (95\% CI ?0.03 to ?0.003). App usage varied significantly by site, as participants from 1 site logged in to the app a median of 36 days over 14 weeks (interquartile range [IQR] 10.5-124); those at another site used the app significantly less (median 9; IQR 6-51). Conclusions: The results showed no difference between intervention and control arms for the primary clinical outcome of glycemic control measured by HbA1c levels. Although there was low usage of the app among participants, results indicate contextual factors, particularly site, had a significant impact on overall usage. Future research into the patient and site-specific factors that increase app utilization are needed. Trial Registration: Clinicaltrials.gov NCT02813343; https://clinicaltrials.gov/ct2/show/NCT02813343 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT02813343) ",
doi="10.2196/10321",
url="https://mhealth.jmir.org/2019/1/e10321/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30632972"
}


@Article{info:doi/10.2196/10371,
author="Maddison, Ralph
and Cartledge, Susie
and Rogerson, Michelle
and Goedhart, Sylvia Nicole
and Ragbir Singh, Tarveen
and Neil, Christopher
and Phung, Dinh
and Ball, Kylie",
title="Usefulness of Wearable Cameras as a Tool to Enhance Chronic Disease Self-Management: Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jan",
day="03",
volume="7",
number="1",
pages="e10371",
keywords="eHealth",
keywords="review",
keywords="cameras",
keywords="life-logging",
keywords="lifestyle behavior",
keywords="chronic disease",
abstract="Background: Self-management is a critical component of chronic disease management and can include a host of activities, such as adhering to prescribed medications, undertaking daily care activities, managing dietary intake and body weight, and proactively contacting medical practitioners. The rise of technologies (mobile phones, wearable cameras) for health care use offers potential support for people to better manage their disease in collaboration with their treating health professionals. Wearable cameras can be used to provide rich contextual data and insight into everyday activities and aid in recall. This information can then be used to prompt memory recall or guide the development of interventions to support self-management. Application of wearable cameras to better understand and augment self-management by people with chronic disease has yet to be investigated. Objective: The objective of our review was to ascertain the scope of the literature on the use of wearable cameras for self-management by people with chronic disease and to determine the potential of wearable cameras to assist people to better manage their disease. Methods: We conducted a scoping review, which involved a comprehensive electronic literature search of 9 databases in July 2017. The search strategy focused on studies that used wearable cameras to capture one or more modifiable lifestyle risk factors associated with chronic disease or to capture typical self-management behaviors, or studies that involved a chronic disease population. We then categorized and described included studies according to their characteristics (eg, behaviors measured, study design or type, characteristics of the sample). Results: We identified 31 studies: 25 studies involved primary or secondary data analysis, and 6 were review, discussion, or descriptive articles. Wearable cameras were predominantly used to capture dietary intake, physical activity, activities of daily living, and sedentary behavior. Populations studied were predominantly healthy volunteers, school students, and sports people, with only 1 study examining an intervention using wearable cameras for people with an acquired brain injury. Most studies highlighted technical or ethical issues associated with using wearable cameras, many of which were overcome. Conclusions: This scoping review highlighted the potential of wearable cameras to capture health-related behaviors and risk factors of chronic disease, such as diet, exercise, and sedentary behaviors. Data collected from wearable cameras can be used as an adjunct to traditional data collection methods such as self-reported diaries in addition to providing valuable contextual information. While most studies to date have focused on healthy populations, wearable cameras offer promise to better understand self-management of chronic disease and its context. ",
doi="10.2196/10371",
url="https://mhealth.jmir.org/2019/1/e10371/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30609985"
}


@Article{info:doi/10.2196/10336,
author="Vo, Vinh Jonathan Duc
and Gorbach, M. Alexander",
title="A Platform to Record Patient Events During Physiological Monitoring With Wearable Sensors: Proof-of-Concept Study",
journal="Interact J Med Res",
year="2019",
month="Jan",
day="03",
volume="8",
number="1",
pages="e10336",
keywords="data collection",
keywords="mobile phone",
keywords="mobile-based platform",
keywords="patient journal",
keywords="sensors",
abstract="Background: Patient journals have been used as valuable resources in clinical studies. However, the full potential value of such journals can be undermined by inefficiencies and ambiguities associated with handwritten patient reports. The increasing number of mobile phones and mobile-based health care approaches presents an opportunity to improve communications from patients to clinicians and clinical researchers through the use of digital patient journals. Objective: The objective of this project was to develop a smartphone-based platform that would enable patients to record events and symptoms on the same timeline as clinical data collected by wearable sensors. Methods: This platform consists of two major components: a smartphone for patients to record their journals and wireless sensors for clinical data collection. The clinical data and patient records are then exported to a clinical researcher interface, and the data and journal are processed and combined into a single time-series graph for analysis. This paper gives a block diagram of the platform's principal components and compares its features to those of other methods but does not explicitly discuss the process of design or development of the system. Results: As a proof of concept, body temperature data were obtained in a 4-hour span from a 22-year-old male, during which the subject simultaneously recorded relevant activities and events using the iPhone platform. After export to a clinical researcher's desktop, the digital records and temperature data were processed and fused into a single time-series graph. The events were filtered based on specific keywords to facilitate data analysis. Conclusions: We have developed a user-friendly patient journal platform, based on widely available smartphone technology, that gives clinicians and researchers a simple method to track and analyze patient activities and record the activities on a shared timeline with clinical data from wearable devices. ",
doi="10.2196/10336",
url="https://www.i-jmr.org/2019/1/e10336/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30609977"
}


@Article{info:doi/10.2196/10280,
author="Tutelman, R. Perri
and Chambers, T. Christine
and Stinson, N. Jennifer
and Parker, A. Jennifer
and Barwick, Melanie
and Witteman, O. Holly
and Jibb, Lindsay
and Stinson, C. Hayley
and Fernandez, V. Conrad
and Nathan, C. Paul
and Campbell, Fiona
and Irwin, Karen",
title="The Implementation Effectiveness of a Freely Available Pediatric Cancer Pain Assessment App: A Pilot Implementation Study",
journal="JMIR Cancer",
year="2018",
month="Dec",
day="21",
volume="4",
number="2",
pages="e10280",
keywords="cancer pain",
keywords="pain assessment",
keywords="pediatric cancer",
keywords="mHealth",
keywords="eHealth",
keywords="implementation",
abstract="Background: Pain Squad is an evidence-based, freely available iOS app designed to assess pain in children with cancer. Once research-based technologies such as Pain Squad are validated, it is important to evaluate their performance in natural settings to optimize their real-world clinical use. Objective: The objective of this study was to evaluate the implementation effectiveness of Pain Squad in a natural setting. Methods: Parents of 149 children with cancer (aged 8-18 years) were contacted to invite their child to participate. Participating children downloaded Pain Squad on their own iOS devices from the Apple App Store and reported their pain using the app twice daily for 1 week. Participants then emailed their pain reports from the app to the research team and completed an online survey on their experiences. Key implementation outcomes included acceptability, appropriateness, cost, feasibility, fidelity, penetration, and sustainability. Results: Of the 149 parents contacted, 16 of their children agreed to participate. More than a third (6/16, 37.5\%) of participating children returned their pain reports to the research team. Adherence to the pain assessments was 62.1\% (mean 8.7/14 assessments). The 6 children who returned reports rated the app as highly feasible to download and use and rated their overall experience as acceptable. They also reported that they would be willing to sustain their Pain Squad use over several weeks and that they would recommend it to other children with cancer, which suggests that it may have potential for penetration. Conclusions: While Pain Squad was well received by the small number of children who completed the study, user uptake, engagement, and adherence were significant barriers to the implementation of Pain Squad in a natural setting. Implementation studies such as this highlight important challenges and opportunities for promoting the use and uptake of evidence-based technologies by the intended end-users. ",
doi="10.2196/10280",
url="http://cancer.jmir.org/2018/2/e10280/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30578200"
}


@Article{info:doi/10.2196/11315,
author="Agarwal, Vibhu
and Smuck, Matthew
and Tomkins-Lane, Christy
and Shah, H. Nigam",
title="Inferring Physical Function From Wearable Activity Monitors: Analysis of Free-Living Activity Data From Patients With Knee Osteoarthritis",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Dec",
day="18",
volume="6",
number="12",
pages="e11315",
keywords="physical function",
keywords="passive monitoring",
keywords="physical function profile",
keywords="wearable activity data",
keywords="statistical learning",
abstract="Background: Clinical assessments for physical function do not objectively quantify routine daily activities. Wearable activity monitors (WAMs) enable objective measurement of daily activities, but it remains unclear how these map to clinically measured physical function measures. Objective: This study aims to derive a representation of physical function from daily measurements of free-living activity obtained through a WAM. In addition, we evaluate our derived measure against objectively measured function using an ordinal classification setup. Methods: We defined function profiles representing average time spent in a set of pattern classes over consecutive days. We constructed a function profile using minute-level activity data from a WAM available from the Osteoarthritis Initiative. Using the function profile as input, we trained statistical models that classified subjects into quartiles of objective measurements of physical function as measured through the 400-m walk test, 20-m walk test, and 5 times sit-stand test. Furthermore, we evaluated model performance on held-out data. Results: The function profile derived from minute-level activity data can accurately predict physical performance as measured through clinical assessments. Using held-out data, the Goodman-Kruskal Gamma statistic obtained in classifying performance values in the first quartile, interquartile range, and the fourth quartile was 0.62, 0.53, and 0.51 for the 400-m walk, 20-m walk, and 5 times sit-stand tests, respectively. Conclusions: Function profiles accurately represent physical function, as demonstrated by the relationship between the profiles and clinically measured physical performance. The estimation of physical performance through function profiles derived from free-living activity data may enable remote functional monitoring of patients. ",
doi="10.2196/11315",
url="http://mhealth.jmir.org/2018/12/e11315/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30394876"
}


@Article{info:doi/10.2196/jmir.9284,
author="Lancaster, Karla
and Abuzour, Aseel
and Khaira, Manmeet
and Mathers, Annalise
and Chan, April
and Bui, Vivian
and Lok, Annie
and Thabane, Lehana
and Dolovich, Lisa",
title="The Use and Effects of Electronic Health Tools for Patient Self-Monitoring and Reporting of Outcomes Following Medication Use: Systematic Review",
journal="J Med Internet Res",
year="2018",
month="Dec",
day="18",
volume="20",
number="12",
pages="e294",
keywords="eHealth",
keywords="mHealth",
keywords="electronic health record",
keywords="telemedicine",
keywords="self-report",
keywords="patient portals",
keywords="patient-centered care",
keywords="drug monitoring",
keywords="adverse effects",
abstract="Background: Electronic health (eHealth) tools are becoming increasingly popular for helping patients' self-manage chronic conditions. Little research, however, has examined the effect of patients using eHealth tools to self-report their medication management and use. Similarly, there is little evidence showing how eHealth tools might prompt patients and health care providers to make appropriate changes to medication use. Objective: The objective of this systematic review was to determine the impact of patients' use of eHealth tools on self-reporting adverse effects and symptoms that promote changes to medication use. Related secondary outcomes were also evaluated. Methods: MEDLINE, EMBASE, and CINAHL were searched from January 1, 2000, to April 25, 2018. Reference lists of relevant systematic reviews and included articles from the literature search were also screened to identify relevant studies. Title, abstract, and full-text review as well as data extraction and risk of bias assessment were performed independently by 2 reviewers. Due to high heterogeneity, results were not meta-analyzed and instead presented as a narrative synthesis. Results: A total of 14 studies, including 13 randomized controlled trials (RCTs) and 1 open-label intervention, were included, from which 11 unique eHealth tools were identified. In addition, 14 RCTs found statistically significant increases in positive medication changes as a result of using eHealth tools, as did the single open-label study. Moreover, 8 RCTs found improvement in patient symptoms following eHealth tool use, especially in adolescent asthma patients. Furthermore, 3 RCTs showed that eHealth tools might improve patient self-efficacy and self-management of chronic disease. Little or no evidence was found to support the effectiveness of eHealth tools at improving medication recommendations and reconciliation by clinicians, medication-use behavior, health service utilization, adverse effects, quality of life, or patient satisfaction. eHealth tools with multifaceted functionalities and those allowing direct patient-provider communication may be more effective at improving patient self-management and self-efficacy. Conclusions: Evidence suggests that the use of eHealth tools may improve patient symptoms and lead to medication changes. Patients generally found eHealth tools useful in improving communication with health care providers. Moreover, health-related outcomes among frequent eHealth tool users improved in comparison with individuals who did not use eHealth tools frequently. Implementation issues such as poor patient engagement and poor clinician workflow integration were identified. More high-quality research is needed to explore how eHealth tools can be used to effectively manage use of medications to improve medication management and patient outcomes. ",
doi="10.2196/jmir.9284",
url="https://www.jmir.org/2018/12/e294/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30563822"
}


@Article{info:doi/10.2196/11988,
author="Jaimini, Utkarshani
and Thirunarayan, Krishnaprasad
and Kalra, Maninder
and Venkataraman, Revathy
and Kadariya, Dipesh
and Sheth, Amit",
title="``How Is My Child's Asthma?'' Digital Phenotype and Actionable Insights for Pediatric Asthma",
journal="JMIR Pediatr Parent",
year="2018",
month="Nov",
day="30",
volume="1",
number="2",
pages="e11988",
keywords="digital phenotype",
keywords="actionable insights",
keywords="asthma control level",
keywords="asthma control test",
keywords="digital phenotype score",
keywords="controller compliance score",
keywords="mobile health",
abstract="Background: In the traditional asthma management protocol, a child meets with a clinician infrequently, once in 3 to 6 months, and is assessed using the Asthma Control Test questionnaire. This information is inadequate for timely determination of asthma control, compliance, precise diagnosis of the cause, and assessing the effectiveness of the treatment plan. The continuous monitoring and improved tracking of the child's symptoms, activities, sleep, and treatment adherence can allow precise determination of asthma triggers and a reliable assessment of medication compliance and effectiveness. Digital phenotyping refers to moment-by-moment quantification of the individual-level human phenotype in situ using data from personal digital devices, in particular, mobile phones. The kHealth kit consists of a mobile app, provided on an Android tablet, that asks timely and contextually relevant questions related to asthma symptoms, medication intake, reduced activity because of symptoms, and nighttime awakenings; a Fitbit to monitor activity and sleep; a Microlife Peak Flow Meter to monitor the peak expiratory flow and forced exhaled volume in 1 second; and a Foobot to monitor indoor air quality. The kHealth cloud stores personal health data and environmental data collected using Web services. The kHealth Dashboard interactively visualizes the collected data.   Objective: The objective of this study was to discuss the usability and feasibility of collecting clinically relevant data to help clinicians diagnose or intervene in a child's care plan by using the kHealth system for continuous and comprehensive monitoring of child's symptoms, activity, sleep pattern, environmental triggers, and compliance. The kHealth system helps in deriving actionable insights to help manage asthma at both the personal and cohort levels. The Digital Phenotype Score and Controller Compliance Score introduced in the study are the basis of ongoing work on addressing personalized asthma care and answer questions such as, ``How can I help my child better adhere to care instructions and reduce future exacerbation?'' Methods: The Digital Phenotype Score and Controller Compliance Score summarize the child's condition from the data collected using the kHealth kit to provide actionable insights. The Digital Phenotype Score formalizes the asthma control level using data about symptoms, rescue medication usage, activity level, and sleep pattern. The Compliance Score captures how well the child is complying with the treatment protocol. We monitored and analyzed data for 95 children, each recruited for a 1- or 3-month-long study. The Asthma Control Test scores obtained from the medical records of 57 children were used to validate the asthma control levels calculated using the Digital Phenotype Scores. Results: At the cohort level, we found asthma was very poorly controlled in 37\% (30/82) of the children, not well controlled in 26\% (21/82), and well controlled in 38\% (31/82). Among the very poorly controlled children (n=30), we found 30\% (9/30) were highly compliant toward their controller medication intake---suggesting a re-evaluation for change in medication or dosage---whereas 50\% (15/30) were poorly compliant and candidates for a more timely intervention to improve compliance to mitigate their situation. We observed a negative Kendall Tau correlation between Asthma Control Test scores and Digital Phenotype Score as ?0.509 (P<.01). Conclusions: kHealth kit is suitable for the collection of clinically relevant information from pediatric patients. Furthermore, Digital Phenotype Score and Controller Compliance Score, computed based on the continuous digital monitoring, provide the clinician with timely and detailed evidence of a child's asthma-related condition when compared with the Asthma Control Test scores taken infrequently during clinic visits. ",
doi="10.2196/11988",
url="http://pediatrics.jmir.org/2018/2/e11988/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31008446"
}


@Article{info:doi/10.2196/12178,
author="Lefler, L. Leanne
and Rhoads, J. Sarah
and Harris, Melodee
and Funderburg, E. Ashley
and Lubin, A. Sandra
and Martel, D. Isis
and Faulkner, L. Jennifer
and Rooker, L. Janet
and Bell, K. Deborah
and Marshall, Heather
and Beverly, J. Claudia",
title="Evaluating the Use of Mobile Health Technology in Older Adults With Heart Failure: Mixed-Methods Study",
journal="JMIR Aging",
year="2018",
month="Dec",
day="04",
volume="1",
number="2",
pages="e12178",
keywords="heart failure",
keywords="remote monitoring",
keywords="mHealth",
keywords="older adults",
keywords="feasibility",
keywords="self-management",
abstract="Background: Heart failure (HF) is associated with high rates of hospitalizations, morbidity, mortality, and costs. Remote patient monitoring (mobile health, mHealth) shows promise in improving self-care and HF management, thus increasing quality of care while reducing hospitalizations and costs; however, limited information exists regarding perceptions of older adults with HF about mHealth use. Objective: This study aimed to compare perspectives of older adults with HF who were randomized to either (1) mHealth equipment connected to a 24-hour call center, (2) digital home equipment, or (3) standard care, with regard to ease and satisfaction with equipment, provider communication and engagement, and ability to self-monitor and manage their disease. Methods: We performed a pilot study using a mixed-methods descriptive design with pre- and postsurveys, following participants for 12 weeks. We augmented these data with semistructured qualitative interviews to learn more about feasibility, satisfaction, communication, and self-management. Results: We enrolled 28 patients with HF aged 55 years and above, with 57\% (16/28) male, 79\% (22/28) non-Hispanic white, and with multiple comorbid conditions. At baseline, 50\% (14/28) rated their health fair or poor and 36\% (10/28) and 25\% (7/28) were very often/always frustrated and discouraged by their health. At baseline, 46\% (13/28) did not monitor their weight, 29\% (8/28) did not monitor their blood pressure, and 68\% (19/28) did not monitor for symptoms. Post intervention, 100\% of the equipment groups home monitored daily. For technology anxiety, 36\% (10/28) indicated technology made them nervous, and 32\% (9/28) reported fear of technology, without significant changes post intervention. Technology usability post intervention scored high (91/100), reflecting ease of use. A majority indicated that a health care provider should be managing their health, and 71\% reported that one should trust and not question the provider. Moreover, 57\% (16/28) believed it was better to seek professional help than caring for oneself. Post intervention, mHealth users relied more on themselves, which was not mirrored in the home equipment or standard care groups. Participants were satisfied with communication and engagement with providers, yet many described access problems. Distressing symptoms were unpredictable and prevailed over the 12 weeks with 79 provider visits and 7 visits to emergency departments. The nurse call center received 872 readings, and we completed 289 telephone calls with participants. Narrative data revealed the following main themes: (1) traditional communication and engagement with providers prevailed, delaying access to care; (2) home monitoring with technology was described as useful, and mHealth users felt secure knowing that someone was observing them; (3) equipment groups felt more confident in self-monitoring and managing; and finally, (4) uncertainty and frustration with persistent health problems. Conclusions: mHealth equipment is feasible with potential to improve patient-centered outcomes and increase self-management in older adults with HF. ",
doi="10.2196/12178",
url="http://aging.jmir.org/2018/2/e12178/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518257"
}


@Article{info:doi/10.2196/diabetes.9531,
author="Tack, J. Cornelis
and Lancee, J. Gerardus
and Heeren, Barend
and Engelen, JLPG Lucien
and Hendriks, Sandra
and Zimmerman, Lisa
and De Massari, Daniele
and van Gelder, MHJ Marleen
and van de Belt, H. Tom",
title="Glucose Control, Disease Burden, and Educational Gaps in People With Type 1 Diabetes: Exploratory Study of an Integrated Mobile Diabetes App",
journal="JMIR Diabetes",
year="2018",
month="Nov",
day="23",
volume="3",
number="4",
pages="e17",
keywords="diabetes",
keywords="app",
keywords="self-care",
keywords="medication suggestion",
keywords="disease management",
keywords="diabetes mellitus, type 1",
keywords="mobile applications",
abstract="Background: Self-monitoring and self-management, crucial for optimal glucose control in type 1 diabetes, requires many disease-related decisions per day and imposes a substantial disease burden on people with diabetes. Innovative technologies that integrate relevant measurements may offer solutions that support self-management, decrease disease burden, and benefit diabetes control. Objective: The objective of our study was to evaluate a prototype integrated mobile phone diabetes app in people with type 1 diabetes. Methods: In this exploratory study, we developed an app that contained cloud-stored log functions for glucose, carbohydrates (including a library), insulin, planned exercise, and mood, combined with a bolus calculator and communication functions. Adults with diabetes tested the app for 6 weeks. We assessed the feasibility of app use, user experiences, perceived disease burden (through questionnaires), insulin dose and basal to bolus ratio, mean glucose level, hemoglobin A1c, and number of hypoglycemic events. Results: A total of 19 participants completed the study, resulting in 5782 data entries. The most frequently used feature was logging blood glucose, insulin, and carbohydrates. Mean diabetes-related emotional problems (measured with the Problem Areas in Diabetes scale) scores decreased from 14.4 (SD 10.0) to 12.2 (SD 10.3; P=.04), and glucose control improved, with hemoglobin A1c decreasing from 7.9\% (mean 62.3, SD 8 mmol/mol) to 7.6\% (mean 59.8, SD 7 mmol/mol; P=.047). The incidence of hypoglycemic events did not change. Participants were generally positive about the app, rating it as ``refreshing,'' and as providing structure by reinforcing insulin-dosing principles. The app revealed substantial knowledge gaps. Logged data enabled additional detailed analyses. Conclusions: An integrated mobile diabetes app has the potential to improve diabetes self-management and provide tailored educational support, which may decrease disease burden and benefit diabetes control. ",
doi="10.2196/diabetes.9531",
url="http://diabetes.jmir.org/2018/4/e17/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30470680"
}


@Article{info:doi/10.2196/12237,
author="Martinez-Millana, Antonio
and Jarones, Elena
and Fernandez-Llatas, Carlos
and Hartvigsen, Gunnar
and Traver, Vicente",
title="App Features for Type 1 Diabetes Support and Patient Empowerment: Systematic Literature Review and Benchmark Comparison",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Nov",
day="21",
volume="6",
number="11",
pages="e12237",
keywords="mHealth",
keywords="type 1 diabetes mellitus",
keywords="patient empowerment",
keywords="apps",
keywords="diabetes self-management",
abstract="Background: Research in type 1 diabetes management has increased exponentially since the irruption of mobile health apps for its remote and self-management. Despite this fact, the features affect in the disease management and patient empowerment are adopted by app makers and provided to the general population remain unexplored. Objective: To study the gap between literature and available apps for type 1 diabetes self-management and patient empowerment and to discover the features that an ideal app should provide to people with diabetes. Methods: The methodology comprises systematic reviews in the scientific literature and app marketplaces. We included articles describing interventions that demonstrated an effect on diabetes management with particular clinical endpoints through the use of mobile technologies. The features of these apps were gathered in a taxonomy of what an ideal app should look like to then assess which of these features are available in the market. Results: The literature search resulted in 231 matches. Of these, 55 met the inclusion criteria. A taxonomy featuring 3 levels of characteristics was designed based on 5 papers which were selected for the synthesis. Level 1 includes 10 general features (Personalization, Family support, Agenda, Data record, Insulin bolus calculator, Data management, Interaction, Tips and support, Reminders, and Rewards) Level 2 and Level 3 included features providing a descriptive detail of Level 1 features. Eighty apps matching the inclusion criteria were analyzed. None of the assessed apps fulfilled the features of the taxonomy of an ideal app. Personalization (70/80, 87.5\%) and Data record (64/80, 80.0\%) were the 2 top prevalent features, whereas Agenda (5/80, 6.3\%) and Rewards (3/80, 3.8\%) where the less predominant. The operating system was not associated with the number of features (P=.42, F=.81) nor the type of feature (P=.20, $\chi$2=11.7). Apps were classified according to the number of level 1 features and sorted into quartiles. First quartile apps had a regular distribution of the ten features in the taxonomy whereas the other 3 quartiles had an irregular distribution. Conclusions: There are significant gaps between research and the market in mobile health for type 1 diabetes management. While the literature focuses on aspects related to gamification, rewarding, and social communities, the available apps are focused on disease management aspects such as data record and appointments. Personalized and tailored empowerment features should be included in commercial apps for large-scale assessment of potential in the self-management of the disease. ",
doi="10.2196/12237",
url="http://mhealth.jmir.org/2018/11/e12237/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30463839"
}


@Article{info:doi/10.2196/12001,
author="Rahman, Abidur Quazi
and Janmohamed, Tahir
and Pirbaglou, Meysam
and Clarke, Hance
and Ritvo, Paul
and Heffernan, M. Jane
and Katz, Joel",
title="Defining and Predicting Pain Volatility in Users of the Manage My Pain App: Analysis Using Data Mining and Machine Learning Methods",
journal="J Med Internet Res",
year="2018",
month="Nov",
day="15",
volume="20",
number="11",
pages="e12001",
keywords="chronic pain",
keywords="pain volatility",
keywords="data mining",
keywords="cluster analysis",
keywords="machine learning",
keywords="prediction model",
keywords="Manage My Pain",
keywords="pain app",
abstract="Background: Measuring and predicting pain volatility (fluctuation or variability in pain scores over time) can help improve pain management. Perceptions of pain and its consequent disabling effects are often heightened under the conditions of greater uncertainty and unpredictability associated with pain volatility. Objective: This study aimed to use data mining and machine learning methods to (1) define a new measure of pain volatility and (2) predict future pain volatility levels from users of the pain management app, Manage My Pain, based on demographic, clinical, and app use features. Methods: Pain volatility was defined as the mean of absolute changes between 2 consecutive self-reported pain severity scores within the observation periods. The k-means clustering algorithm was applied to users' pain volatility scores at the first and sixth month of app use to establish a threshold discriminating low from high volatility classes. Subsequently, we extracted 130 demographic, clinical, and app usage features from the first month of app use to predict these 2 volatility classes at the sixth month of app use. Prediction models were developed using 4 methods: (1) logistic regression with ridge estimators; (2) logistic regression with Least Absolute Shrinkage and Selection Operator; (3) Random Forests; and (4) Support Vector Machines. Overall prediction accuracy and accuracy for both classes were calculated to compare the performance of the prediction models. Training and testing were conducted using 5-fold cross validation. A class imbalance issue was addressed using a random subsampling of the training dataset. Users with at least five pain records in both the predictor and outcome periods (N=782 users) are included in the analysis. Results: k-means clustering algorithm was applied to pain volatility scores to establish a threshold of 1.6 to differentiate between low and high volatility classes. After validating the threshold using random subsamples, 2 classes were created: low volatility (n=611) and high volatility (n=171). In this class-imbalanced dataset, all 4 prediction models achieved 78.1\% (611/782) to 79.0\% (618/782) in overall accuracy. However, all models have a prediction accuracy of less than 18.7\% (32/171) for the high volatility class. After addressing the class imbalance issue using random subsampling, results improved across all models for the high volatility class to greater than 59.6\% (102/171). The prediction model based on Random Forests performs the best as it consistently achieves approximately 70\% accuracy for both classes across 3 random subsamples. Conclusions: We propose a novel method for measuring pain volatility. Cluster analysis was applied to divide users into subsets of low and high volatility classes. These classes were then predicted at the sixth month of app use with an acceptable degree of accuracy using machine learning methods based on the features extracted from demographic, clinical, and app use information from the first month. ",
doi="10.2196/12001",
url="http://www.jmir.org/2018/11/e12001/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30442636"
}


@Article{info:doi/10.2196/11062,
author="Comulada, Scott W.
and Swendeman, Dallas
and Rezai, Roxana
and Ramanathan, Nithya",
title="Time Series Visualizations of Mobile Phone-Based Daily Diary Reports of Stress, Physical Activity, and Diet Quality in Mostly Ethnic Minority Mothers: Feasibility Study",
journal="JMIR Formativ Res",
year="2018",
month="Nov",
day="05",
volume="2",
number="2",
pages="e11062",
keywords="changepoint",
keywords="diet quality",
keywords="mobile phone",
keywords="moving average",
keywords="physical activity",
keywords="stress",
keywords="time series",
abstract="Background: Health behavior patterns reported through daily diary data are important to understand and intervene upon at the individual level in N-of-1 trials and related study designs. There is often interest in relationships between multiple outcomes, such as stress and health behavior. However, analyses often utilize regressions that evaluate aggregate effects across individuals, and standard analyses target single outcomes. Objective: This paper aims to illustrate how individuals' daily reports of stress and health behavior (time series) can be explored using visualization tools. Methods: Secondary analysis was conducted on 6 months of daily diary reports of stress and health behavior (physical activity and diet quality) from mostly ethnic minority mothers who pilot-tested a self-monitoring mobile health app. Time series with minimal missing data from 14 of the 44 mothers were analyzed. Correlations between stress and health behavior within each time series were reported as a preliminary step. Stress and health behavior time series patterns were visualized by plotting moving averages and time points where mean shifts in the data occurred (changepoints). Results: Median correlation was small and negative for associations of stress with physical activity (r=?.14) and diet quality (r=?.08). Moving averages and changepoints for stress and health behavior were aligned for some participants but not for others. A third subset of participants exhibited little variation in stress and health behavior reports. Conclusions: Median correlations in this study corroborate prior findings. In addition, time series visualizations highlighted variations in stress and health behavior across individuals and time points, which are difficult to capture through correlations and regression-based summary measures. ",
doi="10.2196/11062",
url="https://formative.jmir.org/2018/2/e11062/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30684407"
}


@Article{info:doi/10.2196/10183,
author="Bashi, Nazli
and Hassanzadeh, Hamed
and Varnfield, Marlien
and Wee, Yong
and Walters, Darren
and Karunanithi, Mohanraj",
title="Multidisciplinary Smartphone-Based Interventions to Empower Patients With Acute Coronary Syndromes: Qualitative Study on Health Care Providers' Perspectives",
journal="JMIR Cardio",
year="2018",
month="Oct",
day="31",
volume="2",
number="2",
pages="e10183",
keywords="acute coronary syndrome",
keywords="focus group",
keywords="health care professionals",
keywords="mobile phone",
keywords="multidisciplinary",
keywords="thematic analysis",
abstract="Background: Postdischarge interventions are limited in patients with acute coronary syndrome (ACS) due to few scheduled visits to outpatient clinics and travel from remote areas. Smartphones have become a viable lifestyle technology to deliver educational and health interventions following discharge from hospital. Objective: The purpose of this study was to identify the requirements for the delivery of a mobile health intervention for the postdischarge management of patients with ACS via a multidisciplinary focus group. Methods: We conducted a focus group among health care professionals (n=10) from a large metropolitan hospital in May 2017. These participants from a multidisciplinary team contributed to a 1-hour discussion by responding to 8 questions relating to the applicability of smartphone-based educational and health interventions. Descriptive statistics of the focus group data were analyzed using SPSS. The qualitative data were analyzed according to relevant themes extracted from the focus group transcription, using a qualitative description software program (NVivo 11) and an ontology-based concept mapping approach. Results: The mean age of the participants was 47 (SD 8) years: 3 cardiologists; 2 nurse practitioners; 2 clinical nurses; 2 research scientists; and 1 physiotherapist. Of these participants, 70\% (7/10) had experience using electronic health intervention during their professional practice. A total of 7 major themes and their subthemes emerged from the qualitative analysis. Health care providers indicated that comprehensive education on diet, particularly providing daily meal plans, is critical for patients with ACS. In terms of ACS symptoms, a strong recommendation was to focus on educating patients instead of daily monitoring of chest pain and shortness of breathing due to subjectivity and insufficient information for clinicians. Participants pointed that monitoring health measures such as blood pressure and body weight may result in increased awareness of patient physical health, yet may not be sufficient to support patients with ACS via the smartphone-based intervention. Therefore, monitoring pain and emotional status along with other health measures was recommended. Real-time support via FaceTime or video conferencing was indicated as motivational and supportive for patient engagement and self-monitoring. The general demographics of patients with ACS being older, having a low educational level, and a lack of computer skills were identified as potential barriers for engagement with the smartphone-based intervention. Conclusions: A smartphone-based program that incorporates the identified educational materials and health interventions would motivate patients with ACS to engage in the multidisciplinary intervention and improve their health outcomes following discharge from hospital. ",
doi="10.2196/10183",
url="http://cardio.jmir.org/2018/2/e10183/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31758781"
}


@Article{info:doi/10.2196/mhealth.8292,
author="Meyer, Nicholas
and Kerz, Maximilian
and Folarin, Amos
and Joyce, W. Dan
and Jackson, Richard
and Karr, Chris
and Dobson, Richard
and MacCabe, James",
title="Capturing Rest-Activity Profiles in Schizophrenia Using Wearable and Mobile Technologies: Development, Implementation, Feasibility, and Acceptability of a Remote Monitoring Platform",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Oct",
day="30",
volume="6",
number="10",
pages="e188",
keywords="sleep",
keywords="circadian rhythm",
keywords="mHealth",
keywords="smartphone",
keywords="relapse",
keywords="psychosis",
abstract="Background: There is growing interest in the potential for wearable and mobile devices to deliver clinically relevant information in real-world contexts. However, there is limited information on their acceptability and barriers to long-term use in people living with psychosis. Objective: This study aimed to describe the development, implementation, feasibility, acceptability, and user experiences of the Sleepsight platform, which harnesses consumer wearable devices and smartphones for the passive and unobtrusive capture of sleep and rest-activity profiles in people with schizophrenia living in their homes. Methods: A total of 15 outpatients with a diagnosis of schizophrenia used a consumer wrist-worn device and smartphone to continuously and remotely gather rest-activity profiles over 2 months. Once-daily sleep and self-rated symptom diaries were also collected via a smartphone app. Adherence with the devices and smartphone app, end-of-study user experiences, and agreement between subjective and objective sleep measures were analyzed. Thresholds for acceptability were set at a wear time or diary response rate of 70\% or greater. Results: Overall, 14 out of 15 participants completed the study. In individuals with a mild to moderate symptom severity at baseline (mean total Positive and Negative Syndrome Scale score 58.4 [SD 14.4]), we demonstrated high rates of engagement with the wearable device (all participants meeting acceptability criteria), sleep diary, and symptom diary (93\% and 86\% meeting criteria, respectively), with negative symptoms being associated with lower diary completion rate. The end-of-study usability and acceptability questionnaire and qualitative analysis identified facilitators and barriers to long-term use, and paranoia with study devices was not a significant barrier to engagement. Comparison between sleep diary and wearable estimated sleep times showed good correspondence ($\rho$=0.50, P<.001). Conclusions: Extended use of wearable and mobile technologies are acceptable to people with schizophrenia living in a community setting. In the future, these technologies may allow predictive, objective markers of clinical status, including early markers of impending relapse. ",
doi="10.2196/mhealth.8292",
url="http://mhealth.jmir.org/2018/10/e188/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30377146"
}


@Article{info:doi/10.2196/12221,
author="Mollard, Elizabeth
and Michaud, Kaleb",
title="A Mobile App With Optical Imaging for the Self-Management of Hand Rheumatoid Arthritis: Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Oct",
day="29",
volume="6",
number="10",
pages="e12221",
keywords="optical imaging",
keywords="mobile applications",
keywords="self-management",
keywords="rheumatoid arthritis",
keywords="self efficacy",
keywords="patient activation",
keywords="pilot study",
abstract="Background: Patient outcomes are improved and the burden to the health care system is reduced when individuals are active self-managers of their own health. There is a need for technology that facilitates self-management of rheumatoid arthritis (RA) and can reduce the number of patient visits, promptly identify treatment needs, and reduce the costs associated with poor RA management. A mobile app named LiveWith Arthritis (eTreatMD, Vancouver, BC) has been developed that allows patients with RA to use their mobile device to regularly collect self-management data and to take objective measurements of the impact of RA on their finger joints using optical imaging technology. Objective: The objectives of this pilot study were to (1) gather preliminary data as to whether a mobile app with hand optical imaging capabilities improves self-management behaviors (self-efficacy in managing symptoms and patient activation), (2) determine if app use shows promise in improving health outcomes (Pain, Health Assessment Questionnaire-II [HAQ-II]), and (3) determine barriers to using the mobile app in adults with RA. Methods: This pilot study used a mixed-methods design. The quantitative portion was a traditional 2-group experimental design, and the qualitative portion was a follow-up telephone interview for intervention participants who did not complete the study. Measures of self-management included the Patient-Reported Outcomes Measurement Information System (PROMIS) self-efficacy in managing symptoms (P-SEMS) and Patient Activation Measure (PAM). Health outcomes included pain by Visual Analog Scale and disability by HAQ-II. Results: The final sample consisted of 21 intervention participants and 15 controls. There was a statistically significant improvement in P-SEMS and promising trends for improvement in PAM, HAQ-II, and pain scores for participants who used the app. Of the intervention participants who did not complete the study, 12 completed the qualitative interview on barriers to use. Qualitative content analysis revealed 3 themes for barriers to using the app, including (1) frustration with technology, (2) RA made the app difficult to use, and (3) satisfaction with current self-management system. Conclusions: The LiveWith Arthritis app shows promise for improving self-management behaviors and health outcomes in adults with RA. Future study with a larger sample size is required to confirm findings. Initial app experience is important for adoption and continual use of the app. Individuals with significant disability to the hand would benefit from voice-activated app features. Participants who already have a system of managing their RA may not feel compelled to switch methods, even when a novel optical imaging feature is available. ",
doi="10.2196/12221",
url="http://mhealth.jmir.org/2018/10/e12221/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30373732"
}


@Article{info:doi/10.2196/10147,
author="Rabbi, Mashfiqui
and Aung, SH Min
and Gay, Geri
and Reid, Cary M.
and Choudhury, Tanzeem",
title="Feasibility and Acceptability of Mobile Phone--Based Auto-Personalized Physical Activity Recommendations for Chronic Pain Self-Management: Pilot Study on Adults",
journal="J Med Internet Res",
year="2018",
month="Oct",
day="26",
volume="20",
number="10",
pages="e10147",
keywords="chronic pain",
keywords="machine learning",
keywords="personalization",
keywords="chronic back pain",
keywords="reinforcement learning",
abstract="Background: Chronic pain is a globally prevalent condition. It is closely linked with psychological well-being, and it is often concomitant with anxiety, negative affect, and in some cases even depressive disorders. In the case of musculoskeletal chronic pain, frequent physical activity is beneficial. However, reluctance to engage in physical activity is common due to negative psychological associations (eg, fear) between movement and pain. It is known that encouragement, self-efficacy, and positive beliefs are effective to bolster physical activity. However, given that the majority of time is spent away from personnel who can give such encouragement, there is a great need for an automated ubiquitous solution. Objective: MyBehaviorCBP is a mobile phone app that uses machine learning on sensor-based and self-reported physical activity data to find routine behaviors and automatically generate physical activity recommendations that are similar to existing behaviors. Since the recommendations are based on routine behavior, they are likely to be perceived as familiar and therefore likely to be actualized even in the presence of negative beliefs. In this paper, we report the preliminary efficacy of MyBehaviorCBP based on a pilot trial on individuals with chronic back pain. Methods: A 5-week pilot study was conducted on people with chronic back pain (N=10). After a week long baseline period with no recommendations, participants received generic recommendations from an expert for 2 weeks, which served as the control condition. Then, in the next 2 weeks, MyBehaviorCBP recommendations were issued. An exit survey was conducted to compare acceptance toward the different forms of recommendations and map out future improvement opportunities. Results: In all, 90\% (9/10) of participants felt positive about trying the MyBehaviorCBP recommendations, and no participant found the recommendations unhelpful. Several significant differences were observed in other outcome measures. Participants found MyBehaviorCBP recommendations easier to adopt compared to the control ($\beta$int=0.42, P<.001) on a 5-point Likert scale. The MyBehaviorCBP recommendations were actualized more ($\beta$int=0.46, P<.001) with an increase in approximately 5 minutes of further walking per day ($\beta$int=4.9 minutes, P=.02) compared to the control. For future improvement opportunities, participants wanted push notifications and adaptation for weather, pain level, or weekend/weekday. Conclusions: In the pilot study, MyBehaviorCBP's automated approach was found to have positive effects. Specifically, the recommendations were actualized more, and perceived to be easier to follow. To the best of our knowledge, this is the first time an automated approach has achieved preliminary success to promote physical activity in a chronic pain context. Further studies are needed to examine MyBehaviorCBP's efficacy on a larger cohort and over a longer period of time. ",
doi="10.2196/10147",
url="http://www.jmir.org/2018/10/e10147/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30368433"
}


@Article{info:doi/10.2196/11632,
author="Mazoteras-Pardo, Victoria
and Becerro-De-Bengoa-Vallejo, Ricardo
and Losa-Iglesias, Elena Marta
and L{\'o}pez-L{\'o}pez, Daniel
and Palomo-L{\'o}pez, Patricia
and Rodr{\'i}guez-Sanz, David
and Calvo-Lobo, C{\'e}sar",
title="The QardioArm Blood Pressure App for Self-Measurement in an Obese Population: Validation Study Using the European Society of Hypertension International Protocol Revision 2010",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Oct",
day="25",
volume="6",
number="10",
pages="e11632",
keywords="obesity",
keywords="blood pressure determination",
abstract="Background: Obesity and high blood pressure (HBP) pose high cardiovascular risks, and they are frequent causes of cardiovascular disease. Objective: The aim of this study was to validate the mobile app QardioArm for high blood pressure monitoring in obese subjects (body mass index ?30 kg/m2) according to guidelines in the European Society of Hypertension-International Protocol 2 (ESH-IP2). Methods: We recruited 33 obese subjects and measured their blood pressure using QardioArm (test device) and Omron M3 Intellisense (Omron Healthcare, Kyoto, Japan; standard device). We compared systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) according to the ESH-IP2. Results: A total of 95 of 99 differences for SBP and 91 of 99 for DBP displayed absolute differences within 10 mm Hg. A total of 98 of 99 differences for SBP and 98 of 99 for DBP exhibited absolute differences within 15 mm Hg. This result satisfied requirements for part 1 of the ESH-IP2. A total of 27 out of 33 individuals for SBP and 30 out of 33 individuals for DBP had a minimum of 2 of 3 comparisons within 5 mm Hg difference. None of the subjects had 3 differences outside 5 mm Hg for SBP and DBP, satisfying part 2 of the ESH-IP2. For HR measurements, a total of 90 of 99 differences had absolute differences within 3 beats per minute (bpm), and a total of 94 or 99 differences had absolute differences within 5 bpm. A total of 98 of 99 differences had absolute differences within 8 bpm. Therefore, the test device satisfied part 1 of ESH-IP2 criteria for HR. For part 2 of ESH-IP2, 31 of 33 individuals had a minimum of 2 of 3 comparisons within 3 bpm difference for HR. Only 1 of 33 subjects had 3 differences outside 3 bpm. Conclusions: To the best of our knowledge, this was the first study to show that an app that measures blood pressure and HR meets the requirements of the ESH-IP2 in an obese population. We believe the ESH-IP2 should publish explicit criteria for validation of blood pressure devices in specific populations. ",
doi="10.2196/11632",
url="http://mhealth.jmir.org/2018/10/e11632/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30361193"
}


@Article{info:doi/10.2196/10718,
author="Salazar, Alejandro
and de Sola, Helena
and Failde, Inmaculada
and Moral-Munoz, Antonio Jose",
title="Measuring the Quality of Mobile Apps for the Management of Pain: Systematic Search and Evaluation Using the Mobile App Rating Scale",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Oct",
day="25",
volume="6",
number="10",
pages="e10718",
keywords="mobile app",
keywords="chronic pain",
keywords="Mobile App Rating Scale",
keywords="mHealth",
keywords="mobile phones",
abstract="Background: Chronic pain is a major health issue requiring an approach that not only considers medication, but also many other factors included in the biopsychosocial model of pain. New technologies, such as mobile apps, are tools to address these factors, although in many cases they lack proven quality or are not based on scientific evidence, so it is necessary to review and measure their quality. Objective: The aim is to evaluate and measure the quality of mobile apps for the management of pain using the Mobile App Rating Scale (MARS). Methods: This study included 18 pain-related mobile apps from the App Store and Play Store. The MARS was administered to measure their quality. We list the scores (of each section and the final score) of every app and we report the mean score (and standard deviation) for an overall vision of the quality of the pain-related apps. We compare the section scores between the groups defined according to the tertiles via analysis of variance (ANOVA) or Kruskal-Wallis test, depending on the normality of the distribution (Shapiro-Wilk test). Results: The global quality ranged from 1.74 (worst app) to 4.35 (best app). Overall, the 18 apps obtained a mean score of 3.17 (SD 0.75). The best-rated sections were functionality (mean 3.92, SD 0.72), esthetics (mean 3.29, SD 1.05), and engagement (mean 2.87, SD 1.14), whereas the worst rated were app specific (mean 2.48, SD 1.00), information (mean 2.52, SD 0.82), and app subjective quality (mean 2.68, SD 1.22). The main differences between tertiles were found on app subjective quality, engagement, esthetics, and app specific. Conclusions: Current pain-related apps are of a certain quality mainly regarding their technical aspects, although they fail to offer information and have an impact on the user. Most apps are not based on scientific evidence, have not been rigorously tested, and the confidentiality of the information collected is not guaranteed. Future apps would need to improve these aspects and exploit the capabilities of current devices. ",
doi="10.2196/10718",
url="http://mhealth.jmir.org/2018/10/e10718/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30361196"
}


@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/10.2196/10776,
author="Quinn, C. Charlene
and Swasey, K. Krystal
and Torain, M. Jamila
and Shardell, D. Michelle
and Terrin, L. Michael
and Barr, A. Erik
and Gruber-Baldini, L. Ann",
title="An mHealth Diabetes Intervention for Glucose Control: Health Care Utilization Analysis",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Oct",
day="15",
volume="6",
number="10",
pages="e10776",
keywords="cluster randomized clinical trial",
keywords="health care",
keywords="health service utilization",
keywords="mHealth",
keywords="type 2 diabetes",
abstract="Background: Type 2 diabetes (T2D) is a major chronic condition requiring management through lifestyle changes and recommended health service visits. Mobile health (mHealth) is a promising tool to encourage self-management, but few studies have investigated the impact of mHealth on health care utilization. Objective: The objective of this analysis was to determine the change in 2-year health service utilization and whether utilization explained a 1.9\% absolute decrease in glycated hemoglobin (HbA1c) over 1-year in the Mobile Diabetes Intervention Study (MDIS). Methods: We used commercial claims data from 2006 to 2010 linked to enrolled patients' medical chart data in 26 primary care practices in Maryland, USA. Secondary claims data analyses were available for 56\% (92/163) of participants. In the primary MDIS study, physician practices were recruited and randomized to usual care and 1 of 3 increasingly complex interventions. Patients followed physician randomization assignment. The main variables in the analysis included health service utilization by type of service and change in HbA1c. The claims data was aggregated into 12 categories of utilization to assess change in 2-year health service usage, comparing rates of usage pre- and posttrial. We also examined whether utilization explained the 1.9\% decrease in HbA1c over 1 year in the MDIS cluster randomized clinical trial. Results: A significant group by time effect was observed in physician office visits, general practitioner visits, other outpatient services, prescription medications, and podiatrist visits. Physician office visits (P=.01) and general practitioner visits (P=.02) both decreased for all intervention groups during the study period, whereas prescription claims (P<.001) increased. The frequency of other outpatient services (P=.001) and podiatrist visits (P=.04) decreased for the control group and least complex intervention group but increased for the 2 most complex intervention groups. No significant effects of utilization were observed to explain the clinically significant change in HbA1c. Conclusions: Claims data analyses identified patterns of utilization relevant to mHealth interventions. Findings may encourage patients and health providers to discuss the utilization of treatment-recommended services, lab tests, and prescribed medications. Trial Registration: ClinicalTrials.gov NCT01107015; https://clinicaltrials.gov/ct2/show/NCT01107015 (Archived by Webcite at http://www.webcitation.org/72XgTaxIj) ",
doi="10.2196/10776",
url="http://mhealth.jmir.org/2018/10/e10776/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30322839"
}


@Article{info:doi/10.2196/mhealth.9811,
author="Nguyen, D. Amy
and Frensham, J. Lauren
and Wong, XC Michael
and Meslin, MM Sylvain
and Martin, Paige
and Lau, YS Annie
and Baysari, T. Melissa
and Day, O. Richard",
title="mHealth App Patient Testing and Review of Educational Materials Designed for Self-Management of Gout Patients: Descriptive Qualitative Studies",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Oct",
day="15",
volume="6",
number="10",
pages="e182",
keywords="mobile apps",
keywords="gout",
keywords="self-management",
keywords="chronic disease",
keywords="uric acid",
abstract="Background: Gout is a form of chronic arthritis caused by elevated serum uric acid (SUA) and culminates in painful gout attacks. Although effective uric acid-lowering therapies exist, adherence is low. This is partly due to the lack of support for patients to self-manage their disease. Mobile health apps have been used in the self-management of chronic conditions. However, not all are developed with patients, limiting their effectiveness. Objective: The objective of our study was to collect feedback from gout patients to design an effective gout self-management app. Methods: Two descriptive qualitative studies were conducted. In Study 1, researchers developed a short educational video and written materials about gout management, designed to be embedded into an app; 6 interviews and 1 focus group were held with gout patients to gather feedback on these materials. Usability testing in Study 2 involved additional gout patients using a pilot version of Healthy.me Gout, a gout self-management app, for 2 weeks. Following the trial, patients participated in an interview about their experiences using the app. Results: Patients viewed the gout educational material positively, appreciating the combined use of video, text, and images. Patients were receptive to using a mobile app to self-manage their gout. Feedback about Healthy.me Gout was generally positive with patients reporting that the tracking and diary features were most useful. Patients also provided suggestions for improving the app and educational materials. Conclusions: These studies involved patients in the development of a gout self-management app. Patients provided insight to improve the app's presentation and usability and general lessons on useful features for chronic disease apps. Gout patients enjoyed tracking their SUA concentrations and gout attack triggers. These capabilities can be translated into self-management apps for chronic diseases that require monitoring of pathological values, medication adherence, or symptoms. Future health app design should integrate patient input and be developed iteratively to address concerns identified by patients. ",
doi="10.2196/mhealth.9811",
url="http://mhealth.jmir.org/2018/10/e182/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30322835"
}


@Article{info:doi/10.2196/10291,
author="Whitney, L. Robin
and Ward, H. Deborah
and Marois, T. Maria
and Schmid, H. Christopher
and Sim, Ida
and Kravitz, L. Richard",
title="Patient Perceptions of Their Own Data in mHealth Technology--Enabled N-of-1 Trials for Chronic Pain: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Oct",
day="11",
volume="6",
number="10",
pages="e10291",
keywords="mHealth",
keywords="patient-generated health data",
keywords="self-management",
keywords="chronic pain",
keywords="qualitative research",
keywords="N-of-1 trials",
keywords="mobile phones",
abstract="Background: N-of-1 (individual comparison) trials are a promising approach for comparing the effectiveness of 2 or more treatments for individual patients; yet, few studies have qualitatively examined how patients use and make sense of their own patient-generated health data (PGHD) in the context of N-of-1 trials. Objective: The objective of our study was to explore chronic pain patients' perceptions about the PGHD they compiled while comparing 2 chronic pain treatments and tracking their symptoms using a smartphone N-of-1 app in collaboration with their clinicians. Methods: Semistructured interviews were recorded with 33 patients, a consecutive subset of the intervention group in a primary study testing the feasibility and effectiveness of the Trialist N-of-1 app. Interviews were transcribed verbatim, and a descriptive thematic analysis was completed. Results: Patients were enthusiastic about recording and accessing their own data. They valued sharing data with clinicians but also used their data independently. Conclusions: N-of-1 trials remain a promising approach to evidence-based decision making. Patients appear to value their roles as trial participants but place as much or more importance on the independent use of trial data as on comparative effectiveness results. Future efforts to design patient-centered N-of-1 trials might consider adaptable designs that maximize patient flexibility and autonomy while preserving a collaborative role with clinicians and researchers. ",
doi="10.2196/10291",
url="http://mhealth.jmir.org/2018/10/e10291/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30309834"
}


@Article{info:doi/10.2196/pediatrics.9796,
author="Teufel II, John Ronald
and Patel, K. Sachin
and Shuler, B. Anita
and Andrews, L. Anne
and Nichols, Michelle
and Ebeling, D. Myla
and Dawley, Erin
and Mueller, Martina
and Ruggiero, J. Kenneth
and Treiber, A. Frank",
title="Smartphones for Real-time Assessment of Adherence Behavior and Symptom Exacerbation for High-Risk Youth with Asthma: Pilot Study",
journal="JMIR Pediatr Parent",
year="2018",
month="Oct",
day="5",
volume="1",
number="2",
pages="e8",
keywords="children",
keywords="ecological momentary assessment",
keywords="medication adherence",
keywords="medication monitoring device",
keywords="mHealth",
keywords="mobile phone",
keywords="symptoms",
keywords="youth",
abstract="Background: Youth with asthma who have poor medication adherence, have limited access to care, and are frequently seen in the acute care setting are often termed ``high risk.'' Objective: This study aimed to design and test the feasibility of using smartphone technology to assess contextual factors that may impact changes in daily medication adherence and to identify new symptom episodes among high-risk youth with asthma in their home environment. Methods: Youth aged 8-17 years with high-risk asthma from 2 children's hospitals were eligible for the 2-month study. An app was downloaded on participants' phones at enrollment. Daily text message (short message service) reminders were sent to complete ecological momentary assessment of asthma symptoms and other contextual factors such as emotional state using the app. Bluetooth inhaler devices were used to record timestamps of inhaler use with the ability to review and manually enter data. The acceptability was assessed with surveys, key informant interviews (KII), and frequency of days with asthma data. KII data were used in an iterative design approach to identify challenges, strengths, and suggestions for maximizing use. Generalized linear mixed modeling was used to preliminarily explore contextual factors associated with changes in daily adherence. Results: We enrolled 14 children aged 8-16 years (13/14, 93\% were African Americans). Over the 2-month study period, participants reported coughing (42/110, 38\%), wheezing (8/111, 7\%), chest tightness (9/109, 8\%), boredom (57/109, 52\%), and 10 new asthma symptom episodes. The controller medication adherence was 30\%, which increased significantly on days with asthma symptoms or boredom. Data were received on 89\% (606/681) of study days. Surveys and KIIs suggest acceptability among youth and their caregivers. Challenges reported during the study included lost or damaged phones and available memory. Conclusions: Youth and their caregivers reported the acceptability of using smartphones for real-time asthma monitoring. Overall, the controller medication adherence was low but increased significantly on days with reported asthma symptoms or boredom, suggesting that daily contextual factors may be associated with a change in the adherence behavior. ",
doi="10.2196/pediatrics.9796",
url="http://pediatrics.jmir.org/2018/2/e8/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518299"
}


@Article{info:doi/10.2196/10157,
author="Terp, Malene
and J{\o}rgensen, Rikke
and Laursen, Schantz Birgitte
and Mainz, Jan
and Bj{\o}rnes, D. Charlotte",
title="A Smartphone App to Foster Power in the Everyday Management of Living With Schizophrenia: Qualitative Analysis of Young Adults' Perspectives",
journal="JMIR Ment Health",
year="2018",
month="Oct",
day="01",
volume="5",
number="4",
pages="e10157",
keywords="mental health",
keywords="mHealth",
keywords="mobile app",
keywords="participatory design",
keywords="patient empowerment",
keywords="patient involvement",
keywords="patient participation",
keywords="schizophrenia",
keywords="smartphone",
keywords="young adults",
abstract="Background: Literature indicates that using smartphone technology is a feasible way of empowering young adults recently diagnosed with schizophrenia to manage everyday living with their illness. The perspective of young adults on this matter, however, is unexplored. Objective: This study aimed at exploring how young adults recently diagnosed with schizophrenia used and perceived a smartphone app (MindFrame) as a tool to foster power in the everyday management of living with their illness. Methods: Using participatory design thinking and methods, MindFrame was iteratively developed. MindFrame consists of a smartphone app that allows young adults to access resources to aid their self-management. The app is affiliated with a website to support collaboration with their health care providers (HCPs). From January to December 2016, community-dwelling young adults with a recent diagnosis of schizophrenia were invited to use MindFrame as part of their care. They customized the resources while assessing their health on a daily basis. Then, they were invited to evaluate the use and provide their perspective on the app. The evaluation was qualitative, and data were generated from in-depth interviews. Data were analyzed using a hermeneutical approach. Results: A total of 98 individuals were eligible for the study (mean age 24.8, range 18-36). Of these, 27 used MindFrame and 13 participated in the evaluation. The analysis showed that to the young adults, MindFrame served to foster power in their everyday management of living with schizophrenia. When MindFrame was used with the HCPs consistently for more than a month, it could provide them with the power to keep up their medication, to keep a step ahead of their illness, and to get appropriate help based on their needs. This empowered them to stay on track with their illness, thus in control of it. It was also reported that MindFrame could fuel the fear of restraint and illness exacerbation, thereby disempowering some from feeling certain and secure. Conclusions: The findings demonstrate that young adults diagnosed with schizophrenia are amenable to use a smartphone app to monitor their health, manage their medication, and stay alert of the early signs of illness exacerbation. This may empower them to stay on track with their illness, thus in control of it. This indicates the potential of smartphone-based care being capable of aiding this specific population to more confidently manage their new life situation. The potentially disempowering aspect of MindFrame accentuates a need for further research to understand the best uptake and the limitations of smartphone-based schizophrenia care of young adults. ",
doi="10.2196/10157",
url="https://mental.jmir.org/2018/4/e10157/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30274966"
}


@Article{info:doi/10.2196/10035,
author="Pung, Alison
and Fletcher, Louise Susan
and Gunn, Maree Jane",
title="Mobile App Use by Primary Care Patients to Manage Their Depressive Symptoms: Qualitative Study",
journal="J Med Internet Res",
year="2018",
month="Sep",
day="27",
volume="20",
number="9",
pages="e10035",
keywords="mobile apps",
keywords="depression",
keywords="health care",
keywords="general practice",
abstract="Background: Mobile apps are emerging as tools with the potential to revolutionize the treatment of mental health conditions such as depression. At the forefront of the community health sector, general practitioners are in a unique position to guide the integration of technology and depression management; however, little is currently known about how primary care patients with depressive symptoms are currently using apps. Objective: The objective of our study was to explore the natural patterns of mobile app use among patients with depressive symptoms to facilitate the understanding of the potential role for mobile apps in managing depressive symptoms in the community. Methods: Semistructured phone interviews were conducted with primary care patients in Victoria, Australia, who reported symptoms of depression and were enrolled in a larger randomized controlled trial of depression care. Interviews explored current depression management strategies and the use of mobile apps (if any). Interviews were audio-recorded and transcribed verbatim. Inductive thematic analysis was iteratively conducted using QSR NVivo 11 Pro to identify emergent themes. Results: A total of 16 participants, aged between 20 to 58 years, took part in the interviews with 11 reporting the use of at least one mobile app to manage depressive symptoms and 5 reporting no app use. A variety of apps were described including relaxation, mindfulness, cognitive, exercise, gaming, social media, and well-being apps to aid with depressive symptoms. Among users, there were the following 4 main patterns of app use: skill acquisition, social connectedness, inquisitive trial, and safety netting. Factors that influenced app use included accessibility, perceptions of technology, and personal compatibility. Health care providers also had a role in initiating app use. Conclusions: Mobile apps are being utilized for self-management of depressive symptoms by primary care patients. This study provided insight into the natural patterns and perspectives of app use, which enhanced the understanding of how this technology may be integrated into the toolbox for the management of depression. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616000537459; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367152 (Archived at WebCite at http://www.webcitation.org/71Vf06X2T) ",
doi="10.2196/10035",
url="http://www.jmir.org/2018/9/e10035/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30262449"
}


@Article{info:doi/10.2196/11400,
author="Zhang, Yiyu
and Li, Xia
and Luo, Shuoming
and Liu, Chaoyuan
and Liu, Fang
and Zhou, Zhiguang",
title="Exploration of Users' Perspectives and Needs and Design of a Type 1 Diabetes Management Mobile App: Mixed-Methods Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Sep",
day="21",
volume="6",
number="9",
pages="e11400",
keywords="diabetes mellitus, type 1",
keywords="mobile applications",
keywords="qualitative research",
keywords="surveys and questionnaires",
abstract="Background: With the popularity of mobile phones, mobile apps have great potential for the management of diabetes, but the effectiveness of current diabetes apps for type 1 diabetes mellitus (T1DM) is poor. No study has explored the reasons for this deficiency from the users' perspective. Objective: The aims of this study were to explore the perspectives and needs of T1DM patients and diabetes experts concerning a diabetes app and to design a new T1DM management mobile app. Methods: A mixed-methods design combining quantitative surveys and qualitative interviews was used to explore users' needs and perspectives. Experts were surveyed at 2 diabetes conferences using paper questionnaires. T1DM patients were surveyed using Sojump (Changsha ran Xing InfoTech Ltd) on a network. We conducted semistructured, in-depth interviews with adult T1DM patients or parents of child patients who had ever used diabetes apps. The interviews were audio-recorded, transcribed, and coded for theme identification. Results: The expert response rate was 63.5\% (127/200). The respondents thought that the reasons for app invalidity were that patients did not continue using the app (76.4\%, 97/127), little guidance was received from health care professionals (HCPs; 73.2\%, 93/127), diabetes education knowledge was unsystematic (52.8\%, 67/127), and the app functions were incomplete (44.1\%, 56/127). A total of 245 T1DM patient questionnaires were collected, of which 21.2\% (52/245) of the respondents had used diabetes apps. The reasons for their reluctance to use an app were limited time (39\%, 20/52), complicated operations (25\%, 13/52), uselessness (25\%, 13/52), and cost (25\%, 13/52). Both the experts and patients thought that the most important functions of the app were patient-doctor communication and the availability of a diabetes diary. Two themes that were useful for app design were identified from the interviews: (1) problems with patients' diabetes self-management and (2) problems with current apps. In addition, needs and suggestions for a diabetes app were obtained. Patient-doctor communication, diabetes diary, diabetes education, and peer support were all considered important by the patients, which informed the development of a prototype multifunctional app. Conclusions: Patient-doctor communication is the most important function of a diabetes app. Apps should be integrated with HCPs rather than stand-alone. We advocate that doctors follow up with their patients using a diabetes app. Our user-centered method explored comprehensively and deeply why the effectiveness of current diabetes apps for T1DM was poor and what T1DM patients needed for a diabetes app and provided meaningful guidance for app design. ",
doi="10.2196/11400",
url="http://mhealth.jmir.org/2018/9/e11400/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30249580"
}


@Article{info:doi/10.2196/mhealth.8256,
author="Selter, Aliza
and Tsangouri, Christina
and Ali, B. Sana
and Freed, Diana
and Vatchinsky, Adrian
and Kizer, James
and Sahuguet, Arnaud
and Vojta, Deneen
and Vad, Vijay
and Pollak, JP
and Estrin, Deborah",
title="An mHealth App for Self-Management of Chronic Lower Back Pain (Limbr): Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Sep",
day="17",
volume="6",
number="9",
pages="e179",
keywords="low back pain",
keywords="chronic disease",
keywords="self-assessment",
keywords="telemedicine",
keywords="self-management",
keywords="activities of daily living",
keywords="pain",
keywords="rehabilitation",
abstract="Background: Although mobile health (mHealth) interventions can help improve outcomes among patients with chronic lower back pain (CLBP), many available mHealth apps offer content that is not evidence based. Limbr was designed to enhance self-management of CLBP by packaging self-directed rehabilitation tutorial videos, visual self-report tools, remote health coach support, and activity tracking into a suite of mobile phone apps, including Your Activities of Daily Living, an image-based tool for quantifying pain-related disability. Objective: The aim is to (1) describe patient engagement with the Limbr program, (2) describe patient-perceived utility of the Limbr program, and (3) assess the validity of the Your Activities of Daily Living module for quantifying functional status among patients with CLBP. Methods: This was a single-arm trial utilizing a convenience sample of 93 adult patients with discogenic back pain who visited a single physiatrist from January 2016 to February 2017. Eligible patients were enrolled in 3-month physical therapy program and received the Limbr mobile phone app suite for iOS or Android. The program included three daily visual self-reports to assess pain, activity level, and medication/coping mechanisms; rehabilitation video tutorials; passive activity-level measurement; and chat-based health coaching. Patient characteristics, patient engagement, and perceived utility were analyzed descriptively. Associations between participant characteristics and program interaction were analyzed using multiple linear regression. Associations between Your Activities of Daily Living and Oswestry Disability Index (ODI) assessments were examined using Pearson correlation and hierarchical linear modeling. Results: A total of 93 participants were enrolled; of these, 35 (38\%) completed the program (age: mean 46, SD 16 years; female: 22/35, 63\%). More than half of completers finished assessments at least every 3 days and 70\% (19/27) used the rehabilitation component at least once a week. Among respondents to a Web-based feedback survey, 76\% (16/21) found the daily notifications helped them remember to complete their exercises, 81\% (17/21) found the system easy to use, and 62\% (13/21) rated their overall experience good or excellent. Baseline Your Activities of Daily Living score was a significant predictor of baseline ODI score, with ODI increasing by 0.30 units for every 1-unit increase in Your Activities of Daily Living (P<.001). Similarly, hierarchical linear modeling analysis indicated that Your Activities of Daily Living daily assessment scores were significant predictors of ODI scores over the course of the study (P=.01). Conclusions: Engagement among participants who completed the Limbr program was high, and program utility was rated positively by most respondents. Your Activities of Daily Living was significantly associated with ODI scores, supporting the validity of this novel tool. Future studies should assess the effect of Limbr on clinical outcomes, evaluate its use among a wider patient sample, and explore strategies for reducing attrition. Trial Registration: ClinicalTrials.gov NCT03040310; https://clinicaltrials.gov/ct2/show/NCT03040310 (Archived by WebCite at http://www.webcitation.org/722mEvAiv) ",
doi="10.2196/mhealth.8256",
url="http://mhealth.jmir.org/2018/9/e179/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30224333"
}


@Article{info:doi/10.2196/mhealth.9656,
author="Crouthamel, Michelle
and Quattrocchi, Emilia
and Watts, Sarah
and Wang, Sherry
and Berry, Pamela
and Garcia-Gancedo, Luis
and Hamy, Valentin
and Williams, E. Rachel",
title="Using a ResearchKit Smartphone App to Collect Rheumatoid Arthritis Symptoms From Real-World Participants: Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Sep",
day="13",
volume="6",
number="9",
pages="e177",
keywords="rheumatoid arthritis",
keywords="smartphone",
keywords="mobile phone",
keywords="patient-reported outcome measures",
keywords="mobile applications",
abstract="Background: Using smartphones to enroll, obtain consent, and gather self-reported data from patients has the potential to enhance our understanding of disease burden and quantify physiological impact in the real world. It may also be possible to harness integral smartphone sensors to facilitate remote collection of clinically relevant data. Objective: We conducted the Patient Rheumatoid Arthritis Data From the Real World (PARADE) observational study using a customized ResearchKit app with a bring-your-own-device approach. Our objective was to assess the feasibility of using an entirely digital approach (social media and smartphone app) to conduct a real-world observational study of patients with rheumatoid arthritis. Methods: We conducted this observational study using a customized ResearchKit app with a bring-your-own-device approach. To recruit patients, the PARADE app, designed to guide patients through a series of tasks, was publicized via social media platforms and made available for patients in the United States to download from the Apple App Store. We collected patient-reported data, such as medical history, rheumatoid arthritis-related medications (past and present), and a range of patient-reported outcome measures. We included in the assessment a joint-pain map and a novel objective assessment of wrist range of movement, measured by the smartphone-embedded gyroscope and accelerometer. Results: Within 1 month of recruitment via social media campaigns, 399 participants self-enrolled, self-consented, and provided complete demographic data. Joint pain was the most frequently reported rheumatoid arthritis symptom to bother study participants (344/393, 87.5\%). Severe patient-reported wrist pain appeared to be inversely linked with the range of wrist movement measured objectively by the app. At study entry, 292 of 399 participants (73.2\%) indicated a preference for participating in a mobile app--based study. The number of participants in the study declined to 45 of 399 (11.3\%) at week 12. Conclusions: Despite the declining number of participants over time, the combination of social media and smartphone app with sensor integration was a feasible and cost-effective approach for the collection of patient-reported data in rheumatoid arthritis. Integral sensors within smartphones can be harnessed to provide novel end points, and the novel wrist range of movement test warrants further clinical validation. ",
doi="10.2196/mhealth.9656",
url="http://mhealth.jmir.org/2018/9/e177/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30213779"
}


@Article{info:doi/10.2196/formative.9963,
author="Lopez, N. Keila
and O'Connor, Michael
and King, Jason
and Alexander, James
and Challman, Melissa
and Lovick, K. Donna
and Goodly, Nicole
and Smith, Amelia
and Fawcett, Elliott
and Mulligan, Courtney
and Thompson, Debbe
and Fordis, Michael",
title="Improving Transitions of Care for Young Adults With Congenital Heart Disease: Mobile App Development Using Formative Research",
journal="JMIR Formativ Res",
year="2018",
month="Sep",
day="11",
volume="2",
number="2",
pages="e16",
keywords="adolescent health",
keywords="chronic disease",
keywords="transitions of care",
keywords="health disparities",
keywords="mobile health",
keywords="mHealth",
keywords="patient empowerment",
keywords="patient involvement",
keywords="self-efficacy",
keywords="user-centered design",
abstract="Background: Congenital heart diseases (CHDs) are the most common type of birth defects. Improvements in CHD care have led to approximately 1.4 million survivors reaching adulthood. Successful transition and transfer from pediatric to adult care is crucial. Unfortunately, less than 30\% of adolescents with CHD successfully transition to adult care; this number is lower for minority and lower socioeconomic status populations. Few CHD programs exist to facilitate successful transition. Objective: The goal of our study was to describe the formative research used to develop a prototype mobile app to facilitate transition to adult care for adolescents with CHD. Methods: A literature search about best practices in transition medicine for CHD was conducted to inform app development. Formative research with a diverse group of CHD adolescents and their parents was conducted to determine gaps and needs for CHD transition to adult care. As part of the interview, surveys assessing transition readiness and CHD knowledge were completed. Two adolescent CHD expert panels were convened to inform educational content and app design. Results: The literature review revealed 113 articles, of which 38 were studies on transition programs and attitudes and 3 identified best practices in transition specific to CHD. A total of 402 adolescents aged 15 to 22 years (median 16 years) participated in semistructured interviews. The group was racially and ethnically diverse (12.6\% [51/402] African American and 37.8\% [152/402] Latino) and 42.0\% (169/402) female; 36.3\% (146/402) received public insurance. Most adolescents (313/402, 76.7\%) had moderate or severe CHD complexity and reported minimal CHD understanding (79.0\% [275/348] of those aged 15 to 17 years and 61.1\% [33/54] of those aged 18 to 22 years). Average initial transition readiness score was 50.9/100, meaning that transition readiness training was recommended. When participants with moderate to severe CHD (313/402, 77.9\%) were asked about technology use, 94.2\% (295/313) reported having access to a mobile phone. Interviews with parents revealed limited interactions with the pediatric cardiologist about transition-related topics: 79.4\% (331/417) reported no discussions regarding future family planning, and 55.2\% (230/417) reported the adolescent had not been screened for mental health concerns (depression, anxiety). Further, 66.4\% (277/417) reported not understanding how health care changes as adolescents become adults. Adolescents in the expert panels (2 groups of 3 adolescents each) expressed interest in a CHD-specific tailored app consisting of quick access to specific educational questions (eg, ``Can I exercise?''), a CHD story-blog forum, a mentorship platform, a question and answer space, and a checklist to facilitate transition. They expressed interest in using the app to schedule CHD clinic appointments and receive medication reminders. Based on this data, a prototype mobile app was created to assist in adolescent CHD transition. Conclusions: Formative research revealed that most adolescents with CHD had access to mobile phones, were not prepared for transition to adult care, and were interested in an app to facilitate transition to adult CHD care. Understanding adolescent and parent needs, interests, and concerns helped in the development of a mobile app with a broader, tailored approach for adolescents with CHD. ",
doi="10.2196/formative.9963",
url="http://formative.jmir.org/2018/2/e16/"
}


@Article{info:doi/10.2196/10502,
author="Kwon, Hee
and Lee, Sungin
and Jung, Ji Eun
and Kim, SangHee
and Lee, Jung-Kyu
and Kim, Kyeom Deog
and Kim, Tae-Hyung
and Lee, Hyeun Seung
and Lee, Kyu Myoung
and Song, Seungjae
and Shin, Kichul",
title="An mHealth Management Platform for Patients with Chronic Obstructive Pulmonary Disease (efil breath): Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Aug",
day="24",
volume="6",
number="8",
pages="e10502",
keywords="chronic obstructive pulmonary disease",
keywords="mHealth",
keywords="mobile phone",
keywords="physical activity",
keywords="rehabilitation",
keywords="quality of life",
abstract="Background: Chronic obstructive pulmonary disease (COPD) is one of the major morbidities in public health, and the use of mHealth technology for rehabilitation of patients with COPD can help increase physical activity and ameliorate respiratory symptoms. Objective: This study aimed to develop a comprehensive rehabilitation management platform to improve physical activity and quality of life in patients with COPD. Methods: The study comprised the following 2 stages: (1) a pilot stage in which a prototype app was developed; and (2) a fully-fledged platform development stage in which 2 apps and 1 COPD patient monitoring website were developed. We conducted a randomized clinical trial to investigate the efficacy of the apps developed in the second stage of the study. In addition, two 12-week exercise regimens (fixed and fixed-interactive) were tested for the trial. The clinical parameters of the respiratory function and patient global assessment (PGA) of the app were obtained and analyzed. Notably, Android was the chosen operating system for apps. Results: We developed 2 COPD rehabilitation apps and 1 patient monitoring website. For the clinical trial, 85 patients were randomized into the following 3 groups: 57 were allocated to the 2 intervention groups and 28 to the control group. After 6 weeks, the COPD assessment test scores were significantly reduced in the fixed group (P=.01), and signs of improvement were witnessed in the fixed-interactive group. In addition, the PGA score was moderate or high in all aspects of the user experience of the apps in both intervention groups. Conclusions: A well-designed mobile rehabilitation app for monitoring and managing patients with COPD can supplement or replace traditional center-based rehabilitation programs and achieve improved patient health outcomes. Trial Registration: ClinicalTrials.gov NCT03432117; https://clinicaltrials.gov/ct2/show/NCT03432117 (Archived by WebCite at http://www.webcitation.org/71Yp0P64a) ",
doi="10.2196/10502",
url="http://mhealth.jmir.org/2018/8/e10502/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30143475"
}


@Article{info:doi/10.2196/10130,
author="Pratap, Abhishek
and Renn, N. Brenna
and Volponi, Joshua
and Mooney, D. Sean
and Gazzaley, Adam
and Arean, A. Patricia
and Anguera, A. Joaquin",
title="Using Mobile Apps to Assess and Treat Depression in Hispanic and Latino Populations: Fully Remote Randomized Clinical Trial",
journal="J Med Internet Res",
year="2018",
month="Aug",
day="09",
volume="20",
number="8",
pages="e10130",
keywords="mobile apps",
keywords="smartphone",
keywords="depression",
keywords="Hispanics",
keywords="Latinos",
keywords="clinical trial",
keywords="cognition",
keywords="problem solving",
keywords="mHealth",
keywords="minority groups",
abstract="Background: Most people with mental health disorders fail to receive timely access to adequate care. US Hispanic/Latino individuals are particularly underrepresented in mental health care and are historically a very difficult population to recruit into clinical trials; however, they have increasing access to mobile technology, with over 75\% owning a smartphone. This technology has the potential to overcome known barriers to accessing and utilizing traditional assessment and treatment approaches. Objective: This study aimed to compare recruitment and engagement in a fully remote trial of individuals with depression who either self-identify as Hispanic/Latino or not. A secondary aim was to assess treatment outcomes in these individuals using three different self-guided mobile apps: iPST (based on evidence-based therapeutic principles from problem-solving therapy, PST), Project Evolution (EVO; a cognitive training app based on cognitive neuroscience principles), and health tips (a health information app that served as an information control). Methods: We recruited Spanish and English speaking participants through social media platforms, internet-based advertisements, and traditional fliers in select locations in each state across the United States. Assessment and self-guided treatment was conducted on each participant's smartphone or tablet. We enrolled 389 Hispanic/Latino and 637 non-Hispanic/Latino adults with mild to moderate depression as determined by Patient Health Questionnaire-9 (PHQ-9) score?5 or related functional impairment. Participants were first asked about their preferences among the three apps and then randomized to their top two choices. Outcomes were depressive symptom severity (measured using PHQ-9) and functional impairment (assessed with Sheehan Disability Scale), collected over 3 months. Engagement in the study was assessed based on the number of times participants completed active surveys. Results: We screened 4502 participants and enrolled 1040 participants from throughout the United States over 6 months, yielding a sample of 348 active users. Long-term engagement surfaced as a key issue among Hispanic/Latino participants, who dropped from the study 2 weeks earlier than their non-Hispanic/Latino counterparts (P<.02). No significant differences were observed for treatment outcomes between those identifying as Hispanic/Latino or not. Although depressive symptoms improved (beta=--2.66, P=.006) over the treatment course, outcomes did not vary by treatment app. Conclusions: Fully remote mobile-based studies can attract a diverse participant pool including people from traditionally underserved communities in mental health care and research (here, Hispanic/Latino individuals). However, keeping participants engaged in this type of ``low-touch'' research study remains challenging. Hispanic/Latino populations may be less willing to use mobile apps for assessing and managing depression. Future research endeavors should use a user-centered design to determine the role of mobile apps in the assessment and treatment of depression for this population, app features they would be interested in using, and strategies for long-term engagement. Trial Registration: Clinicaltrials.gov NCT01808976; https://clinicaltrials.gov/ct2/show/NCT01808976 (Archived by WebCite at http://www.webcitation.org/70xI3ILkz) ",
doi="10.2196/10130",
url="http://www.jmir.org/2018/8/e10130/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30093372"
}


@Article{info:doi/10.2196/10063,
author="Grassl, Niklas
and Nees, Juliane
and Schramm, Katharina
and Spratte, Julia
and Sohn, Christof
and Schott, C. Timm
and Schott, Sarah",
title="A Web-Based Survey Assessing the Attitudes of Health Care Professionals in Germany Toward the Use of Telemedicine in Pregnancy Monitoring: Cross-Sectional Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Aug",
day="08",
volume="6",
number="8",
pages="e10063",
keywords="telemedicine",
keywords="obstetrics",
keywords="eHealth",
keywords="pregnancy monitoring",
keywords="job satisfaction",
keywords="sleeping problems",
keywords="night shift",
keywords="emergency consultation",
abstract="Background: The demand for fetal monitoring and constant reassurance is high in pregnant women. Consequently, pregnant women use various health apps and are more likely to visit emergency departments due to subjective but nonurgent complaints. However, electronic health (eHealth) and mobile health (mHealth) solutions are rarely used to prevent nonurgent emergency consultations. To implement modern care solutions, a better understanding of the attitudes, fears, and hopes of health care professionals toward eHealth and mHealth is needed. Objective: The aim of this study was to investigate the attitudes of health care professionals in obstetrics toward telemedicine. Methods: A quantitative Web-based survey on health care professionals in obstetrics in Germany was conducted. The participants included nurses, midwives, and physicians of all age groups and job positions working in hospitals that provide various levels of health care. The questionnaire comprised 24 questions about the characteristics of the study population, views about emergency consultations in obstetrics, attitude toward telemedicine, job satisfaction, and sleeping behavior. Results: In total, 244 health care professionals participated in the Web-based survey. In general, health care professionals were skeptical (170/233, 72.9\%) about the use of telemedicine in obstetrics; however, 55.8\% (130/233) recognized its potential. Moreover, 72\% (62/86) of physicians were optimistic in using apps for pregnancy monitoring, whereas 36.1\% (47/130) of nonphysicians (P<.001) were not. Significantly, more nonphysicians rejected such developments (75/130, 57.7\% rejected) compared with physicians (24/86, 28\%; P<.001). We also found that obstetricians with more than 10 years of work-experience are more skeptical; however, approximately 49\% (18/37) of them believed that telemedicine could reduce nonurgent emergency consultations, whereas 73.2\% (106/145) of obstetricians with less than 5 years of experience (P=.01) thought otherwise. Our survey revealed a high job satisfaction and a prevalence of regular sleeping problems of 45.9\% (91/198) among health care professionals in obstetrics. Surprisingly, both job satisfaction and sleeping problems were independent from the number of night shifts per month (P=.77 and P=.99, respectively). Yet, 56.6\% (112/198) of the survey participants thought they would be happier with their job if they had to work fewer night shifts per month. Conclusions: Our study reveals an ambivalent attitude toward the use of telemedicine among health care professionals in obstetrics in Germany at the moment. Efforts to promote the use of telemedicine should focus on nurses and midwives because these groups are the most skeptical. By contrast, particularly young physicians recognize the potential of apps in patient care and would like to use such technology in pregnancy monitoring. ",
doi="10.2196/10063",
url="http://mhealth.jmir.org/2018/8/e10063/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30089606"
}


@Article{info:doi/10.2196/resprot.9619,
author="Fuchs, C. Sandra
and Harzheim, Erno
and Iochpe, Cirano
and David, de Caroline N.
and Gon{\c{c}}alves, R. Marcelo
and Sesin, P. Guilhermo
and Costa, M. Cassio
and Moreira, B. Leila
and Fuchs, D. Flavio",
title="Technologies for Innovative Monitoring to Reduce Blood Pressure and Change Lifestyle Using Mobile Phones in Adult and Elderly Populations (TIM Study): Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2018",
month="Aug",
day="07",
volume="7",
number="8",
pages="e169",
keywords="blood pressure",
keywords="blood pressure monitoring",
keywords="hypertension",
keywords="weight",
keywords="diet",
keywords="sodium",
keywords="physical activity",
keywords="randomized controlled trial",
keywords="text messages",
abstract="Background: Hypertension is a growing problem worldwide, markedly in low- and middle-income countries, where the rate of control slightly decreased. The overall prevalence of hypertension in Brazil is 28.7\% among adult individuals and 68.9\% in the population aged 60 years and older, and less than a third of patients have controlled blood pressure (BP). The use of technologies---mobile phones and the internet---to implement interventions to reduce blood pressure can minimize costs and diminish cardiovascular risk. Interventions through text messaging and electronic BP monitoring present divergent results. Objective: This trial evaluates the effectiveness of interventions---personalized messages and telemonitoring of BP---to reduce systolic BP and improve lifestyle compared to the usual care of patients with hypertension (control group). Methods: This factorial randomized controlled trial enrolls individuals aged 30 to 75 years who have a mobile phone and internet access with the diagnosis of hypertension under drug treatment with up to 2 medications and uncontrolled BP. Eligible participants should have both increased office BP and 24-hour BP with ambulatory BP monitoring. Participants with severe hypertension (systolic BP ?180 or diastolic BP ?110 mm Hg), life threatening conditions, low life expectancy, recent major cardiovascular event (last 6 months), other indications for the use of antihypertensive medication, diagnosis of secondary hypertension, pregnant or lactating women, or those unable to understand the interventions are excluded. Participants are randomly allocate to 1 of 4 experimental arms: (1) Telemonitoring of blood pressure (TELEM) group: receives an automatic oscillometric device to measure BP, (2) telemonitoring by text message (TELEMEV) group: receives personalized, standardized text messages to stimulate lifestyle changes and adhere with BP-lowering medication, (3) TELEM-TELEMEV group: receives both interventions, and (4) control group: receives usual clinical treatment (UCT). Data collection is performed in a clinical research center located in a referent hospital. The primary outcomes are reduction of systolic BP assessed by 24-hour ambulatory BP monitoring (primary outcome) and change of lifestyle (based on dietary approaches to stop hypertension (DASH)-type diet, sodium restriction, weight loss or control, increase of physical activity). Results: This study was funded by two Brazilian agencies: the National Council for Scientific and Technological Development and Funda{\c{c}}{\~a}o de Amparo {\`a} Pesquisa do Estado do Rio Grande do Sul. Enrollment was completed at the end of 2017 (N=231), the follow-up is ongoing, and data analysis is expected to begin in early 2019. A reduction of 24-hour systolic BP of approximately 8.8 [SD 13.1] mm Hg for participants in the BP monitoring group versus 3.4 [SD 11.6] mm Hg in the UCT group is expected. A similar reduction in the text messaging group is expected. Conclusions: The use of mobile technologies connected to the internet through mobile phones promotes time optimization, cost reduction, and better use of public health resources. However, it has not been established whether simple interventions such as text messaging are superior to electronic BP monitoring and whether both outperform conventional counseling. Trial Registration: ClinicalTrials.gov NCT03005470; https://clinicaltrials.gov/ct2/show/NCT03005470 (Archived by WebCite at http://www.webcitation.org/70AoANESu). Plataforma Brasil CAAE 31423214.0.0000.5327. Registered Report Identifier: RR1-10.2196/9619 ",
doi="10.2196/resprot.9619",
url="http://www.researchprotocols.org/2018/8/e169/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30087093"
}


@Article{info:doi/10.2196/10723,
author="Alessa, Tourkiah
and Abdi, Sarah
and Hawley, S. Mark
and de Witte, Luc",
title="Mobile Apps to Support the Self-Management of Hypertension: Systematic Review of Effectiveness, Usability, and User Satisfaction",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Jul",
day="23",
volume="6",
number="7",
pages="e10723",
keywords="mobile phone",
keywords="mobile application",
keywords="mobile app",
keywords="self-management",
keywords="hypertension",
keywords="blood pressure",
abstract="Background: Hypertension is a chronic disease that is considered to be a public health problem and requires efforts by patients to manage themselves. The global growth in the use of mobile phones and tablets has been accompanied by the increased use of health apps. Many of these apps support the self-management of hypertension and, therefore, they have the potential benefits of lowering blood pressure. Despite this, there is currently a lack of evidence for their effectiveness, usability, and patient satisfaction with their use. Objective: A systematic review was conducted to assess the effectiveness of apps in lowering blood pressure, as well as their usability and patients' satisfaction with their use. Methods: We conducted searches in the following databases: MEDLINE (OVID), EMBASE (OVID), PsycINFO (OVID), CINAHL, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), IEEE Xplore ASSIAN, Google Scholar and the main Arabic databases Al Manhal, AskZad, and Mandumah. We looked for studies that used apps in the self-management of hypertension from 2008-2016. We also checked the reference lists of the review papers and all the primary studies for additional references. Results: A total of 21 studies with a total of 3112 participants were included in the review. Of the 14 studies that assessed the effectiveness of the apps in lowering blood pressure, 10 (71.4\%) studies (6 RCTs and 4 nonrandomized studies) reported that using the apps led to significant decreases in blood pressure and seemed to be effective in the self-management of hypertension. Of these 10, only 2 (20\%) RCTs and 3 (30\%) nonrandomized studies had a low--moderate risk of bias. The results of this review are inconclusive regarding which combinations of functionalities would be most effective in lowering blood pressure because of variation in the studies' quality, but the data suggest that apps incorporating more comprehensive functionalities are likely to be more effective. In all the studies that assessed the usability of the apps and users' acceptance of them, all the apps seemed to be accepted and easy to use. Conclusions: Most of the studies reported that apps might be effective in lowering blood pressure and are accepted by users. However, these findings should be interpreted with caution, as most of the studies had a high risk of bias. More well-designed, large-scale studies are required to evaluate the real effect of using apps in lowering blood pressure and to identify the most effective functionality combinations for lowering blood pressure. ",
doi="10.2196/10723",
url="http://mhealth.jmir.org/2018/7/e10723/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30037787"
}


@Article{info:doi/10.2196/mhealth.9884,
author="Lee, Jie-Eun
and Lee, Hwa Dong
and Oh, Jung Tae
and Kim, Min Kyoung
and Choi, Hee Sung
and Lim, Soo
and Park, Joo Young
and Park, Joon Do
and Jang, Chul Hak
and Moon, Hoon Jae",
title="Clinical Feasibility of Monitoring Resting Heart Rate Using a Wearable Activity Tracker in Patients With Thyrotoxicosis: Prospective Longitudinal Observational Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Jul",
day="13",
volume="6",
number="7",
pages="e159",
keywords="activity tracker",
keywords="wearable device",
keywords="heart rate",
keywords="thyrotoxicosis",
keywords="hyperthyroidism",
keywords="Graves' disease",
abstract="Background: Symptoms and signs of thyrotoxicosis are nonspecific and assessing its clinical status is difficult with conventional physical examinations and history taking. Increased heart rate (HR) is one of the easiest signs to quantify this, and current wearable devices can monitor HR. Objective: We assessed the association between thyroid function and resting HR measured by a wearable activity tracker (WD-rHR) and evaluated the clinical feasibility of using this method in patients with thyrotoxicosis. Methods: Thirty patients with thyrotoxicosis and 10 controls were included in the study. Participants were instructed to use the wearable activity tracker during the study period so that activity and HR data could be collected. The primary study outcomes were verification of changes in WD-rHR during thyrotoxicosis treatment and associations between WD-rHR and thyroid function. Linear and logistic model generalized estimating equation analyses were performed and the results were compared to conventionally obtained resting HR during clinic visits (on-site resting HR) and the Hyperthyroidism Symptom Scale. Results: WD-rHR was higher in thyrotoxic patients than in the control groups and decreased in association with improvement of thyrotoxicosis. A one standard deviation--increase of WD-rHR of about 11 beats per minute (bpm) was associated with the increase of serum free T4 levels (beta=.492, 95\% CI 0.367-0.616, P<.001) and thyrotoxicosis risk (odds ratio [OR] 3.840, 95\% CI 2.113-6.978, P<.001). Although the Hyperthyroidism Symptom Scale showed similar results with WD-rHR, a 1 SD-increase of on-site rHR (about 16 beats per minute) showed a relatively lower beta and OR (beta=.396, 95\% CI 0.204-0.588, P<.001; OR 2.114, 95\% CI 1.365-3.273, P<.001) compared with WD-rHR. Conclusions: Heart rate data measured by a wearable device showed reasonable predictability of thyroid function. This simple, easy-to-measure parameter is clinically feasible and has the potential to manage thyroid dysfunction. Trial Registration: ClinicalTrials.gov NCT03009357; https://clinicaltrials.gov/ct2/show/NCT03009357 (Archived by WebCite at http://www.webcitation.org/70h55Llyg) ",
doi="10.2196/mhealth.9884",
url="http://mhealth.jmir.org/2018/7/e159/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30006328"
}


@Article{info:doi/10.2196/10480,
author="Simblett, Sara
and Greer, Ben
and Matcham, Faith
and Curtis, Hannah
and Polhemus, Ashley
and Ferr{\~a}o, Jos{\'e}
and Gamble, Peter
and Wykes, Til",
title="Barriers to and Facilitators of Engagement With Remote Measurement Technology for Managing Health: Systematic Review and Content Analysis of Findings",
journal="J Med Internet Res",
year="2018",
month="Jul",
day="12",
volume="20",
number="7",
pages="e10480",
keywords="mHealth",
keywords="technology",
keywords="engagement",
keywords="systematic review",
keywords="telemedicine",
keywords="remote sensing technology",
keywords="patient participation",
keywords="review",
abstract="Background: Remote measurement technology refers to the use of mobile health technology to track and measure change in health status in real time as part of a person's everyday life. With accurate measurement, remote measurement technology offers the opportunity to augment health care by providing personalized, precise, and preemptive interventions that support insight into patterns of health-related behavior and self-management. However, for successful implementation, users need to be engaged in its use. Objective: Our objective was to systematically review the literature to update and extend the understanding of the key barriers to and facilitators of engagement with and use of remote measurement technology, to guide the development of future remote measurement technology resources. Methods: We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines involving original studies dating back to the last systematic review published in 2014. We included studies if they met the following entry criteria: population (people using remote measurement technology approaches to aid management of health), intervention (remote measurement technology system), comparison group (no comparison group specified), outcomes (qualitative or quantitative evaluation of the barriers to and facilitators of engagement with this system), and study design (randomized controlled trials, feasibility studies, and observational studies). We searched 5 databases (MEDLINE, IEEE Xplore, EMBASE, Web of Science, and the Cochrane Library) for articles published from January 2014 to May 2017. Articles were independently screened by 2 researchers. We extracted study characteristics and conducted a content analysis to define emerging themes to synthesize findings. Formal quality assessments were performed to address risk of bias. Results: A total of 33 studies met inclusion criteria, employing quantitative, qualitative, or mixed-methods designs. Studies were conducted in 10 countries, included male and female participants, with ages ranging from 8 to 95 years, and included both active and passive remote monitoring systems for a diverse range of physical and mental health conditions. However, they were relatively short and had small sample sizes, and reporting of usage statistics was inconsistent. Acceptability of remote measurement technology according to the average percentage of time used (64\%-86.5\%) and dropout rates (0\%-44\%) was variable. The barriers and facilitators from the content analysis related to health status, perceived utility and value, motivation, convenience and accessibility, and usability. Conclusions: The results of this review highlight gaps in the design of studies trialing remote measurement technology, including the use of quantitative assessment of usage and acceptability. Several processes that could facilitate engagement with this technology have been identified and may drive the development of more person-focused remote measurement technology. However, these factors need further testing through carefully designed experimental studies. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42017060644; https://www.crd.york.ac.uk/PROSPERO/display\_record.php?RecordID=60644 (Archived by WebCite at http://www.webcitation.org/70K4mThTr) ",
doi="10.2196/10480",
url="http://www.jmir.org/2018/7/e10480/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30001997"
}


@Article{info:doi/10.2196/mhealth.9942,
author="Nes, Gon{\c{c}}alves Andr{\'e}a Aparecida
and van Dulmen, Sandra
and Brembo, Andreas Espen
and Eide, Hilde",
title="An mHealth Intervention for Persons with Diabetes Type 2 Based on Acceptance and Commitment Therapy Principles: Examining Treatment Fidelity",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Jul",
day="03",
volume="6",
number="7",
pages="e151",
keywords="diabetes mellitus type 2",
keywords="Acceptance and Commitment Therapy",
keywords="mobile phone",
keywords="Web-based",
keywords="treatment fidelity",
keywords="mHealth",
abstract="Background: Web-based interventions are becoming an alternative of treatment aimed to support behavioral changes and several advantages over traditional treatments are reported. New ways of delivering an intervention may result in new challenges regarding monitoring of treatment fidelity (TF) which is essential to ensure internal and external validity. Despite the importance of the theme, only a few studies in this field are reported. Objective: To examine TF of a mobile phone delivered intervention based on Acceptance and Commitment Therapy (ACT) with electronic diaries and written situational feedback for persons with diabetes mellitus type 2, the recommendations from the Behavior Change Consortium (BCC) established by The National Institutes of Health (NHI) were applied. To analyze fidelity, they recommend 5 areas to be investigated (1) design of the study, (2) provider training, (3) delivery of treatment, (4) receipt of treatment, and (5) enactment of treatment. In the current study, these areas were examined based on the analysis of therapists' adherence to the treatment protocol and participants' and therapists' experience with the intervention. Methods: To investigate the therapists' adherence to the treatment protocol, a total of 251 written feedback text messages were divided into text segments. Qualitative thematic analyses were then performed to examine how ACT and other therapeutic processes were used in the feedback by the therapists. For the therapists' and participants' experience analysis, participants answered a self-reported questionnaire and participated in 2 interviews. The therapists continuously reported their experiences to the researcher responsible for the project. Results: The results show high adherence to the TF strategies 20/21 (95\%) applicable items of the fidelity checklist recommended by NHI BCC were identified in the present study. Measured provider skill acquisition post-training was the only item absent in the fidelity checklist. The results also show high therapists' adherence to the treatment protocol. All ACT processes (values, committed action, acceptance, contact with the present moment, self as context and cognitive defusion) were found in the coded text segments of the feedback in addition to communication and motivation strategies. For 336/730 (46\%) of total possible text segments coded independently by 2 researchers, the interrater reliability measured by Cohen's kappa was .85. The evaluation of participants' and therapists' experience with the intervention was generally positive. Conclusions: Based on the analyses of therapists' adherence to the treatment protocol grounded by ACT-principles and participants' and therapists' experience with the intervention, the 5 areas of TF recommended by NHI BCC were analyzed indicating a high level of TF. These results ensure an appropriate level of internal and external validity of the study and reliable intervention results and facilitate a precise replication of this intervention concept. Web-based psychological interventions to support people with chronic conditions are becoming increasingly more common. This study supports the results from a previous study which indicated that ACT could be reliably delivered in a written web-based format. Trial Registration: ClinicalTrials.gov?NCT01297049;?https://clinicaltrials.gov/ct2/show/NCT01297049?(Archived by WebCite at?http://www.webcitation.org/70WC4Cm4T) ",
doi="10.2196/mhealth.9942",
url="http://mhealth.jmir.org/2018/7/e151/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29970357"
}


@Article{info:doi/10.2196/mhealth.9988,
author="Kim, Heejung
and Park, Eunhee
and Lee, Sangeun
and Kim, Mijung
and Park, Jeong Eun
and Hong, Soyun",
title="Self-Management of Chronic Diseases Among Older Korean Adults: An mHealth Training, Protocol, and Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Jun",
day="29",
volume="6",
number="6",
pages="e147",
keywords="mobile health",
keywords="feasibility study",
keywords="chronic disease",
keywords="eHealth Enhanced Chronic Care Model",
keywords="elderly",
keywords="community health service",
abstract="Background: Most training programs for self-management of chronic diseases in Korea currently involve face-to-face interactions primarily in a health care setting. Therefore, older Koreans living in the community continue to seek other training opportunities for the management of chronic diseases. This has led to the development of new training methods, such as mobile health (mHealth) care, which are valuable in community centers and homes. Objective: This feasibility study (1) developed an mHealth training protocol to empower community-dwelling elderly individuals to manage their chronic diseases; (2) examined the feasibility of delivering this mHealth training protocol to elderly individuals through mobile tablets and applications (apps); and (3) discussed the contextual and methodological challenges associated with the development of this protocol. Methods: The mHealth training protocol was developed based on the eHealth Enhanced Chronic Care Model and comprised of four phases. Phase 1 included standardized technology (mobile tablets) training using guidebooks, demonstrations, and guided practice. Phase 2 included provision of standardized information about disease management that was obtained from governmental and professional health care organizations. Phase 3 included provision of training on the use of high-quality mHealth apps that were selected based on individual diagnoses. Phase 4 included encouraging the patients to practice using self-selected mHealth apps based on their individual needs. Quantitative descriptive statistics and qualitative content analyses of user evaluations were used to assess the feasibility and user acceptance of this protocol. Results: Of the 27 older adults included in this study, 25 completed all 4 weeks of the mHealth training. The attrition rate was 7\% (2/27), and the reasons included time conflicts, emotional distress, and/or family discouragement. The men required little or no training for Phase 1, and in comparison with men, women seemed to depend more on the mHealth trainers in Phase 3. Gender, level of education, and previous experience of using smartphones were associated with the speed of learning, level of confidence, and overall competence. Conclusions: A tailored and personalized approach is required to develop mHealth training protocols for older adults. Self-management of chronic diseases via mHealth training requires careful consideration of the complex nature of human behavior, emotional responses, and familial influences. Therefore, integration of a theoretical, clinical, and technical approach is necessary for the successful development and implementation of an mHealth training program that targets older adults with chronic diseases in a community setting. ",
doi="10.2196/mhealth.9988",
url="http://mhealth.jmir.org/2018/6/e147/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29959109"
}


@Article{info:doi/10.2196/mhealth.9487,
author="Castens{\o}e-Seidenfaden, Pernille
and Husted, Reventlov Gitte
and Jensen, Kryger Andreas
and Hommel, Eva
and Olsen, Birthe
and Pedersen-Bjergaard, Ulrik
and Kensing, Finn
and Teilmann, Grete",
title="Testing a Smartphone App (Young with Diabetes) to Improve Self-Management of Diabetes Over 12 Months: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Jun",
day="26",
volume="6",
number="6",
pages="e141",
keywords="mHealth",
keywords="randomized controlled trial",
keywords="self-management",
keywords="diabetes",
keywords="young people",
keywords="transition",
abstract="Background: Young people often struggle to self-manage type 1 diabetes during the transition from childhood to adulthood. Mobile health (mHealth) apps may have the potential to support self-management, but evidence is limited and randomized controlled trials are needed. Objective: We assessed whether the mHealth app ``Young with Diabetes'' improved young people's self-management measured by glycated hemoglobin (HbA1c) and three self-reported psychometric scales. Methods: Young people (14-22 years) with inadequate glycemic control and their parents were enrolled in a randomized controlled trial and assigned either to Young with Diabetes and usual care (Young with Diabetes group) or to usual care alone (control). Young with Diabetes use was monitored; functions included a chat room, contact the health care provider, reminders, tips, information about the diabetes department and type 1 diabetes topics, carbohydrate counting, and a parents' section. Outcomes included HbA1c and three self-reported psychometric scales: Perceived Competence in Diabetes Scale; Health Care Climate Questionnaire; and Problem Areas In Diabetes care survey. Data were collected at baseline and at 2, 7, and 12 months. Results: A total of 151 young people were randomized (Young with Diabetes group=76, control=75) and 49 parents agreed to participate. At 12 months, HbA1c was significantly higher (4.1 mmol/mol; 0.4 \%) in the Young with Diabetes group, compared to the control group (P=.04); this finding did not occur when comparing app users (Young with Diabetes use ?5 days) with nonusers. Young people used Young with Diabetes on a mean of 10.5 days. They spent the most time chatting about alcohol and searching for information about sex. Most young people and half of the parents reported that Young with Diabetes helped them. More than 80\% would recommend Young with Diabetes to peers. Conclusions: Young with Diabetes did not improve HbA1c, but it may be a useful complement to self-management. Qualitative evaluation is needed to explore benefits and shortcomings of Young with Diabetes. Health care providers should address young peoples' knowledge about sensitive topics, provide them with peer support, and be aware of parents' need for information about how to support Trial Registration: ClinicalTrials.gov NCT02632383; https://clinicaltrials.gov/ct2/show/NCT02632383 (Archived by WebCite at http://www.webcitation.org/6zCK2u7xM) ",
doi="10.2196/mhealth.9487",
url="http://mhealth.jmir.org/2018/6/e141/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29945861"
}


@Article{info:doi/10.2196/10253,
author="Lindgreen, Pil
and Lomborg, Kirsten
and Clausen, Loa",
title="Patient Experiences Using a Self-Monitoring App in Eating Disorder Treatment: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Jun",
day="22",
volume="6",
number="6",
pages="e10253",
keywords="feeding and eating disorders",
keywords="anorexia nervosa",
keywords="bulimia nervosa",
keywords="mental health",
keywords="psychiatry",
keywords="mHealth",
keywords="mobile applications",
keywords="self-monitoring",
keywords="blended treatment",
keywords="eating disorder treatment",
abstract="Background: The Recovery Record smartphone app is a self-monitoring tool for individuals recovering from an eating disorder. Unlike traditional pen-and-paper meal diaries, which are often used in eating disorder treatment, the app holds novel features, such as meal reminders, affirmations, and patient-clinician in-app linkage, the latter allowing for clinicians to continuously monitor patients' app data. Objective: To explore patients' experiences with using Recovery Record as part of outpatient eating disorder treatment. Methods: A total of 41 patients from a Danish eating disorder treatment facility were included in the study. All 41 patients participated in participant observations of individual or group treatment sessions, and 26 were interviewed about their experiences with using the app in treatment. The data material was generated and analyzed concurrently, applying the inductive methodology of Interpretive Description. Results: The patients' experiences with Recovery Record depended on its app features, the impact of these features on patients, and their specific app usage. This patient-app interaction affected and was affected by changeable contexts making patients' experiences dynamic. The patient-app interaction affected patients' placement of specific Recovery Record app features along a continuum from supportive to obstructive of individual everyday life activities including the eating disorder treatment. As an example, some patients found it supportive being notified by their clinician when their logs had been monitored as it gave them a sense of relatedness. Contrarily, other patients felt under surveillance, which was obstructive, as it made them feel uneasy or even dismissing the app. Conclusions: Some patients experienced the app and its features as mostly supportive of their everyday life and the eating disorder treatment, while others experienced it primarily as obstructive. When applying apps in eating disorder treatment, we therefore recommend that patients and clinicians collaborate to determine how the app in question best fits the capacities, preferences, and treatment needs of the individual patient. Thus, we encourage patients and clinicians to discuss how specific features of the applied app affect the individual patient to increase the use of supportive features, while limiting the use of obstructive ones. ",
doi="10.2196/10253",
url="http://mhealth.jmir.org/2018/6/e10253/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29934285"
}


@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/jmir.9410,
author="Sano, Akane
and Taylor, Sara
and McHill, W. Andrew
and Phillips, JK Andrew
and Barger, K. Laura
and Klerman, Elizabeth
and Picard, Rosalind",
title="Identifying Objective Physiological Markers and Modifiable Behaviors for Self-Reported Stress and Mental Health Status Using Wearable Sensors and Mobile Phones: Observational Study",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="08",
volume="20",
number="6",
pages="e210",
keywords="mobile health",
keywords="mood",
keywords="machine learning",
keywords="wearable electronic devices",
keywords="smartphone",
keywords="mobile phone",
keywords="mental health",
keywords="psychological stress",
abstract="Background: Wearable and mobile devices that capture multimodal data have the potential to identify risk factors for high stress and poor mental health and to provide information to improve health and well-being. Objective: We developed new tools that provide objective physiological and behavioral measures using wearable sensors and mobile phones, together with methods that improve their data integrity. The aim of this study was to examine, using machine learning, how accurately these measures could identify conditions of self-reported high stress and poor mental health and which of the underlying modalities and measures were most accurate in identifying those conditions. Methods: We designed and conducted the 1-month SNAPSHOT study that investigated how daily behaviors and social networks influence self-reported stress, mood, and other health or well-being-related factors. We collected over 145,000 hours of data from 201 college students (age: 18-25 years, male:female=1.8:1) at one university, all recruited within self-identified social groups. Each student filled out standardized pre- and postquestionnaires on stress and mental health; during the month, each student completed twice-daily electronic diaries (e-diaries), wore two wrist-based sensors that recorded continuous physical activity and autonomic physiology, and installed an app on their mobile phone that recorded phone usage and geolocation patterns. We developed tools to make data collection more efficient, including data-check systems for sensor and mobile phone data and an e-diary administrative module for study investigators to locate possible errors in the e-diaries and communicate with participants to correct their entries promptly, which reduced the time taken to clean e-diary data by 69\%. We constructed features and applied machine learning to the multimodal data to identify factors associated with self-reported poststudy stress and mental health, including behaviors that can be possibly modified by the individual to improve these measures. Results: We identified the physiological sensor, phone, mobility, and modifiable behavior features that were best predictors for stress and mental health classification. In general, wearable sensor features showed better classification performance than mobile phone or modifiable behavior features. Wearable sensor features, including skin conductance and temperature, reached 78.3\% (148/189) accuracy for classifying students into high or low stress groups and 87\% (41/47) accuracy for classifying high or low mental health groups. Modifiable behavior features, including number of naps, studying duration, calls, mobility patterns, and phone-screen-on time, reached 73.5\% (139/189) accuracy for stress classification and 79\% (37/47) accuracy for mental health classification. Conclusions: New semiautomated tools improved the efficiency of long-term ambulatory data collection from wearable and mobile devices. Applying machine learning to the resulting data revealed a set of both objective features and modifiable behavioral features that could classify self-reported high or low stress and mental health groups in a college student population better than previous studies and showed new insights into digital phenotyping. ",
doi="10.2196/jmir.9410",
url="http://www.jmir.org/2018/6/e210/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29884610"
}


@Article{info:doi/10.2196/10422,
author="Clement, Innocent
and Lorenz, Andreas
and Ulm, Bernhard
and Plidschun, Anne
and Huber, Stephan",
title="Implementing Systematically Collected User Feedback to Increase User Retention in a Mobile App for Self-Management of Low Back Pain: Retrospective Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Jun",
day="06",
volume="6",
number="6",
pages="e10422",
keywords="low back pain",
keywords="app",
keywords="mHealth",
keywords="retrospective cohort study",
keywords="self-management",
keywords="user feedback",
keywords="quality management",
keywords="usability",
abstract="Background: Promising first results for Kaia, a mobile app digitalizing multidisciplinary rehabilitation for low back pain, were recently published. It remains unclear whether the implementation of user feedback in an updated version of this app leads to desired effects in terms of increased app usage and clinical outcomes. Objective: The aim is to elucidate the effect on user retention and clinical outcomes of an updated version of the Kaia app where user feedback was included during development. Methods: User feedback of the initial app versions (0.x) was collected in a quality management system and systematically analyzed to define requirements of a new version. For this study, the anonymized data of Kaia users was analyzed retrospectively and users were grouped depending on the available version at the time of the sign-up (0.x vs 1.x). The effect on the duration of activity of users in the app, the number of completed exercises of each type, and user-reported pain levels were compared. Results: Overall, data of 1251 users fulfilled the inclusion criteria, of which 196 users signed up using version 0.x and 1055 users signed up with version 1.x. There were significant differences in the demographic parameters for both groups. A log-rank test showed no significant differences for the duration of activity in the app between groups (P=.31). Users signing up during availability of the 1.x version completed significantly more exercises of each type in the app (physical exercises: 0.x mean 1.99, SD 1.61 units/week vs 1.x mean 3.15, SD1.72 units/week; P<.001; mindfulness exercises: 0.x mean 1.36, SD 1.43 units/week vs 1.x mean 2.42, SD 1.82 units/week; P<.001; educational content: 0.x mean 1.51, SD 1.42 units/week vs 1.x mean 2.71, SD 1.89 units/week; P<.001). This translated into a stronger decrease in user-reported pain levels in versions 1.x (F1,1233=7.084, P=.008). Conclusions: Despite the limitations of retrospective cohort studies, this study indicates that the implementation of systematically collected user feedback during development of updated versions can contribute to improvements in terms of frequency of use and potentially even clinical endpoints such as pain level. The clinical efficiency of the Kaia app needs to be validated in prospective controlled trials to exclude bias. ",
doi="10.2196/10422",
url="http://mhealth.jmir.org/2018/6/e10422/"
}


@Article{info:doi/10.2196/mhealth.8122,
author="Weatherall, James
and Paprocki, Yurek
and Meyer, M. Theresa
and Kudel, Ian
and Witt, A. Edward",
title="Sleep Tracking and Exercise in Patients With Type 2 Diabetes Mellitus (Step-D): Pilot Study to Determine Correlations Between Fitbit Data and Patient-Reported Outcomes",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Jun",
day="05",
volume="6",
number="6",
pages="e131",
keywords="Fitbit charge HR",
keywords="type 2 diabetes mellitus",
keywords="sleep",
keywords="health outcomes",
keywords="health behaviors",
abstract="Background: Few studies assessing the correlation between patient-reported outcomes and patient-generated health data from wearable devices exist. Objective: The aim of this study was to determine the direction and magnitude of associations between patient-generated health data (from the Fitbit Charge HR) and patient-reported outcomes for sleep patterns and physical activity in patients with type 2 diabetes mellitus (T2DM). Methods: This was a pilot study conducted with adults diagnosed with T2DM (n=86). All participants wore a Fitbit Charge HR for 14 consecutive days and completed internet-based surveys at 3 time points: day 1, day 7, and day 14. Patient-generated health data included minutes asleep and number of steps taken. Questionnaires assessed the number of days of exercise and nights of sleep problems per week. Means and SDs were calculated for all data, and Pearson correlations were used to examine associations between patient-reported outcomes and patient-generated health data. All respondents provided informed consent before participating. Results: The participants were predominantly middle-aged (mean 54.3, SD 13.3 years), white (80/86, 93\%), and female (50/86, 58\%). Use of oral T2DM medication correlated with the number of mean steps taken (r=.35, P=.001), whereas being unaware of the glycated hemoglobin level correlated with the number of minutes asleep (r=?.24, P=.04). On the basis of the Fitbit data, participants walked an average of 4955 steps and slept 6.7 hours per day. They self-reported an average of 2.0 days of exercise and 2.3 nights of sleep problems per week. The association between the number of days exercised and steps walked was strong (r=.60, P<.001), whereas the association between the number of troubled sleep nights and minutes asleep was weaker (r=.28, P=.02). Conclusions: Fitbit and patient-reported data were positively associated for physical activity as well as sleep, with the former more strongly correlated than the latter. As extensive patient monitoring can guide clinical decisions regarding T2DM therapy, passive, objective data collection through wearables could potentially enhance patient care, resulting in better patient-reported outcomes. ",
doi="10.2196/mhealth.8122",
url="http://mhealth.jmir.org/2018/6/e131/"
}


@Article{info:doi/10.2196/mhealth.7362,
author="Merchant, Rajan
and Inamdar, Rubina
and Henderson, Kelly
and Barrett, Meredith
and Su, G. Jason
and Riley, Jesika
and Van Sickle, David
and Stempel, David",
title="Digital Health Intervention for Asthma: Patient-Reported Value and Usability",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Jun",
day="04",
volume="6",
number="6",
pages="e133",
keywords="asthma",
keywords="mHealth",
keywords="surveys and questionnaires",
keywords="patient satisfaction",
keywords="perception",
keywords="self-management",
abstract="Background: Although digital health tools are increasingly recognized as effective in improving clinical outcomes such as asthma control and medication adherence, few studies have assessed patient experiences and perception of value. Objective: The aim of this study was to evaluate patient satisfaction, perception of usability and value, and desire to continue after 12 months of using a digital health intervention to support asthma management. Methods: Participants were enrolled in a randomized controlled study evaluating the impact of a digital health platform for asthma management. Participants used electronic inhaler sensors to track medication use and accessed their information in a digital health platform. Electronic surveys were administered to intervention arm participants aged 12 years and older after 12 months of use. The survey assessed asthma control, patient satisfaction with the sensor device, and perception of the usability and value of the digital health platform through closed-ended and open-ended questions. Logistic regression models were used to assess the impact of participants' characteristics on survey completion, satisfaction, and perception of value. Results: Of the 207 intervention arm participants aged 12 years and older, 89 submitted survey responses (42.9\% response rate). Of these 89 participants, 70 reported being very satisfied (79\%, 70/89) or somewhat satisfied (20\%, 18/89) with the inhaler sensor device. Moreover, 93\% (83/89) expressed satisfaction with the reports, and 90\% (80/89) found the information from the reports useful for learning about their asthma. In addition, 72\% (64/89) of the participants reported that they were interested in continuing to use the sensor and platform beyond the study. There were no significant differences in satisfaction with the device or the platform across participants' characteristics, including device type, age, sex, insurance type, asthma control, or syncing history; however, participants with smartphones and longer participation were more likely to take the survey. Conclusions: Electronic sensors and a digital health platform were well received by participants who reported satisfaction and perceived value. These results were consistent across multiple participants' characteristics. These findings can add to a limited literature to keep improving digital health interventions and ensure the meaningful and enduring impact on patient outcomes. ",
doi="10.2196/mhealth.7362",
url="http://mhealth.jmir.org/2018/6/e133/"
}


@Article{info:doi/10.2196/10512,
author="Giunti, Guido
and Guisado Fern{\'a}ndez, Estefan{\'i}a
and Dorronzoro Zubiete, Enrique
and Rivera Romero, Octavio",
title="Supply and Demand in mHealth Apps for Persons With Multiple Sclerosis: Systematic Search in App Stores and Scoping Literature Review",
journal="JMIR Mhealth Uhealth",
year="2018",
month="May",
day="23",
volume="6",
number="5",
pages="e10512",
keywords="multiple sclerosis",
keywords="mHealth",
keywords="fatigue",
keywords="fatigue management",
keywords="apps",
keywords="gamification",
keywords="user-centered design",
keywords="usability, physical activity",
keywords="eHealth",
keywords="chronic conditions",
abstract="Background: Multiple sclerosis (MS) is a non-curable chronic inflammatory disease of the central nervous system that affects more than 2 million people worldwide. MS-related symptoms impact negatively on the quality of life of persons with MS, who need to be active in the management of their health. mHealth apps could support these patient groups by offering useful tools, providing reliable information, and monitoring symptoms. A previous study from this group identified needs, barriers, and facilitators for the use of mHealth solutions among persons with MS. It is unknown how commercially available health apps meet these needs. Objective: The main objective of this review was to assess how the features present in MS apps meet the reported needs of persons with MS. Methods: We followed a combination of scoping review methodology and systematic assessment of features and content of mHealth apps. A search strategy was defined for the two most popular app stores (Google Play and Apple App Store) to identify relevant apps. Reviewers independently conducted a screening process to filter apps according to the selection criteria. Interrater reliability was assessed through the Fleiss-Cohen coefficient (k=.885). Data from the included MS apps were extracted and explored according to classification criteria. Results: An initial total of 581 potentially relevant apps was found. After removing duplicates and applying inclusion and exclusion criteria, 30 unique apps were included in the study. A similar number of apps was found in both stores. The majority of the apps dealt with disease management and disease and treatment information. Most apps were developed by small and medium-sized enterprises, followed by pharmaceutical companies. Patient education and personal data management were among the most frequently included features in these apps. Energy management and remote monitoring were often not present in MS apps. Very few contained gamification elements. Conclusions: Currently available MS apps fail to meet the needs and demands of persons with MS. There is a need for health professionals, researchers, and industry partners to collaborate in the design of mHealth solutions for persons with MS to increase adoption and engagement. ",
doi="10.2196/10512",
url="http://mhealth.jmir.org/2018/5/e10512/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29792295"
}


@Article{info:doi/10.2196/mhealth.8824,
author="Torbj{\o}rnsen, Astrid
and Sm{\aa}stuen, Cvancarova Milada
and Jenum, Karen Anne
and {\AA}rsand, Eirik
and Ribu, Lis",
title="Acceptability of an mHealth App Intervention for Persons With Type 2 Diabetes and its Associations With Initial Self-Management: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2018",
month="May",
day="21",
volume="6",
number="5",
pages="e125",
keywords="diabetes mellitus, type 2",
keywords="patient acceptance of health care",
keywords="acceptability of health care",
keywords="self-care",
keywords="mobile apps",
keywords="smartphone",
keywords="telemedicine",
keywords="regression analysis",
keywords="factor analysis",
keywords="statistical",
abstract="Background: Mobile health interventions are increasingly used in health care. The level of acceptability may indicate whether and how such digital solutions will be used. Objective: This study aimed to explore associations between the level of acceptability of a mobile diabetes app and initial ability of self-management for patients with type 2 diabetes. Methods: Participants with type 2 diabetes were recruited from primary health care settings to a 3-armed randomized controlled trial in the Norwegian study in the RENEWING HEALTH project. At the 1-year follow-up, 75 out of 101 participants from the intervention groups completed an acceptability questionnaire (The Service User Technology Acceptability Questionnaire). In the randomized controlled trial, the 2 intervention groups (n=101 in total) received a mobile phone with a diabetes diary app, and one of the groups received additional health counseling given by telephone calls from a diabetes specialist nurse (n=50). At baseline, we collected clinical variables from medical records, whereas demographic data and self-management (The Health Education Impact Questionnaire) measures were self-reported. Log data from the use of the app by self-monitoring were registered continuously. Associations between initial ability to self-manage at baseline and acceptability of the diabetes diary app after 1 year were analyzed using linear regression. Results: We found statistically significant associations between 5 of the 8 self-management domains and perceived benefit, one of the acceptability factors. However, when adjusting for age, gender, and frequency of use, only 1 domain, skill and technique acquisition, remained independently associated with perceived benefit. Frequency of use of the app was the factor that revealed the strongest association with the acceptability domain perceived benefit. Conclusions: Our findings indicate that persons with diabetes may accept the app, despite its perceived benefit being associated with only one of the 8 domains of their initial level of self-management. Trial Registration: ClinicalTrials.gov NCT01315756; https://clinicaltrials.gov/show/NCT01315756 (Archived by WebCite at http://www.webcitation.org/6z46qPhWl) ",
doi="10.2196/mhealth.8824",
url="http://mhealth.jmir.org/2018/5/e125/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29784635"
}


@Article{info:doi/10.2196/cancer.8951,
author="Ainsworth, Cole Matthew
and Pekmezi, Dori
and Bowles, Heather
and Ehlers, Diane
and McAuley, Edward
and Courneya, S. Kerry
and Rogers, Q. Laura",
title="Acceptability of a Mobile Phone App for Measuring Time Use in Breast Cancer Survivors (Life in a Day): Mixed-Methods Study",
journal="JMIR Cancer",
year="2018",
month="May",
day="14",
volume="4",
number="1",
pages="e9",
keywords="cancer",
keywords="technology",
keywords="time management",
keywords="mHealth",
keywords="physical activity",
abstract="Background: Advancements in mobile technology allow innovative data collection techniques such as measuring time use (ie, how individuals structure their time) for the purpose of improving health behavior change interventions. Objective: The aim of this study was to examine the acceptability of a 5-day trial of the Life in a Day mobile phone app measuring time use in breast cancer survivors to advance technology-based measurement of time use. Methods: Acceptability data were collected from participants (N=40; 100\% response rate) using a self-administered survey after 5 days of Life in a Day use. Results: Overall, participants had a mean age of 55 years (SD 8) and completed 16 years of school (SD 2). Participants generally agreed that learning to use Life in a Day was easy (83\%, 33/40) and would prefer to log activities using Life in a Day over paper-and-pencil diary (73\%, 29/40). A slight majority felt that completing Life in a Day for 5 consecutive days was not too much (60\%, 24/40) or overly time-consuming (68\%, 27/40). Life in a Day was rated as easy to read (88\%, 35/40) and navigate (70\%, 32/40). Participants also agreed that it was easy to log activities using the activity timer at the start and end of an activity (90\%, 35/39). Only 13\% (5/40) downloaded the app on their personal phone, whereas 63\% (19/30) of the remaining participants would have preferred to use their personal phone. Overall, 77\% (30/39) of participants felt that the Life in a Day app was good or very good. Those who agreed that it was easy to edit activities were significantly more likely to be younger when compared with those who disagreed (mean 53 vs 58 years, P=.04). Similarly, those who agreed that it was easy to remember to log activities were more likely to be younger (mean 52 vs 60 years, P<.001). Qualitative coding of 2 open-ended survey items yielded 3 common themes for Life in a Day improvement (ie, convenience, user interface, and reminders). Conclusions: A mobile phone app is an acceptable time-use measurement modality. Improving convenience, user interface, and memory prompts while addressing the needs of older participants is needed to enhance app utility. Trial Registration: ClinicalTrials.gov NCT00929617; https://clinicaltrials.gov/ct2/show/NCT00929617 (Archived by WebCite at http://www.webcitation.org/6z2bZ4P7X) ",
doi="10.2196/cancer.8951",
url="http://cancer.jmir.org/2018/1/e9/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29759953"
}


@Article{info:doi/10.2196/mhealth.8866,
author="Bl{\'a}zquez Mart{\'i}n, David
and De La Torre, Isabel
and Garcia-Zapirain, Begonya
and Lopez-Coronado, Miguel
and Rodrigues, Joel",
title="Managing and Controlling Stress Using mHealth: Systematic Search in App Stores",
journal="JMIR Mhealth Uhealth",
year="2018",
month="May",
day="09",
volume="6",
number="5",
pages="e111",
keywords="apps",
keywords="control",
keywords="management",
keywords="mHealth",
keywords="stress",
abstract="Background: Traditional stress management techniques have been proven insufficient to tackle the needs of today's population. Computational-based techniques and now mobile health (mHealth) apps are showing promise to enable ease of use and access while educating end users on self-management. Objective: The main aim of this paper was to put forward a systematic review of mHealth apps for stress management. Methods: The scenario chosen for this study consists of a sample of the most relevant mHealth apps found on the British and Spanish online stores of the two main mobile operating systems: iOS and Android. The apps have been categorized and scored base on their impact, presence, number of results, language, and operating system. Results: A total of 433 different mobile apps for stress management was analyzed. Of these apps, 21.7\% (94/433) belonged to the ``relaxing music'' category, 10.9\% (47/433) were in the ``draw and paint'' category, 1.2\% (5/433) belonged to the ``heart rate control'' category, and 1.2\% (5/433) fell under ``integral methodology.'' Only 2.0\% (8/433) of the apps qualified as high or medium interest while 98.0\% were low interest. Furthermore, 2.0\% (8/433) of the apps were available on both iOS and Android, and 98\% of apps ran on only one platform (iOS or Android). Conclusions: There are many low-value apps available at the moment, but the analysis shows that they are adding new functionalities and becoming fully integrated self-management systems with extra capabilities such as professional assistance services and online support communities. ",
doi="10.2196/mhealth.8866",
url="http://mhealth.jmir.org/2018/5/e111/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29743152"
}


@Article{info:doi/10.2196/resprot.9911,
author="Ware, Patrick
and Ross, J. Heather
and Cafazzo, A. Joseph
and Laporte, Audrey
and Seto, Emily",
title="Implementation and Evaluation of a Smartphone-Based Telemonitoring Program for Patients With Heart Failure: Mixed-Methods Study Protocol",
journal="JMIR Res Protoc",
year="2018",
month="May",
day="03",
volume="7",
number="5",
pages="e121",
keywords="heart failure",
keywords="telemedicine",
keywords="self-management",
keywords="health services research",
keywords="costs and cost analysis",
abstract="Background: Meta-analyses of telemonitoring for patients with heart failure conclude that it can lower the utilization of health services and improve health outcomes compared with the standard of care. A smartphone-based telemonitoring program is being implemented as part of the standard of care at a specialty care clinic for patients with heart failure in Toronto, Canada. Objective: The objectives of this study are to (1) evaluate the impact of the telemonitoring program on health service utilization, patient health outcomes, and their ability to self-care; (2) identify the contextual barriers and facilitators of implementation at the physician, clinic, and institutional level; (3) describe patient usage patterns to determine adherence and other behaviors in the telemonitoring program; and (4) evaluate the costs associated with implementation of the telemonitoring program from the perspective of the health care system (ie, public payer), hospital, and patient. Methods: The evaluation will use a mixed-methods approach. The quantitative component will include a pragmatic pre- and posttest study design for the impact and cost analyses, which will make use of clinical data and questionnaires administered to at least 108 patients at baseline and 6 months. Furthermore, outcome data will be collected at 1, 12, and 24 months to explore the longitudinal impact of the program. In addition, quantitative data related to implementation outcomes and patient usage patterns of the telemonitoring system will be reported. The qualitative component involves an embedded single case study design to identify the contextual factors that influenced the implementation. The implementation evaluation will be completed using semistructured interviews with clinicians, and other program staff at baseline, 4 months, and 12 months after the program start date. Interviews conducted with patients will be triangulated with usage data to explain usage patterns and adherence to the system. Results: The telemonitoring program was launched in August 2016 and patient enrollment is ongoing. Conclusions: The methods described provide an example for conducting comprehensive evaluations of telemonitoring programs. The combination of impact, implementation, and cost evaluations will inform the quality improvement of the existing program and will yield insights into the sustainability of smartphone-based telemonitoring programs for patients with heart failure within a specialty care setting. International Registered Report Identifier (IRRID): RR1-10.2196/resprot.9911 ",
doi="10.2196/resprot.9911",
url="http://www.researchprotocols.org/2018/5/e121/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29724704"
}


@Article{info:doi/10.2196/10057,
author="Athilingam, Ponrathi
and Jenkins, Bradlee",
title="Mobile Phone Apps to Support Heart Failure Self-Care Management: Integrative Review",
journal="JMIR Cardio",
year="2018",
month="May",
day="02",
volume="2",
number="1",
pages="e10057",
keywords="heart failure",
keywords="self-care management",
keywords="mobile health",
abstract="Background: With an explosive growth in mobile health, an estimated 500 million patients are potentially using mHealth apps for supporting health and self-care of chronic diseases. Therefore, this review focused on mHealth apps for use among patients with heart failure. Objective: The aim of this integrative review was to identify and assess the functionalities of mHealth apps that provided usability and efficacy data and apps that are commercially available without supporting data, all of which are to support heart failure self-care management and thus impact heart failure outcomes. Methods: A search of published, peer-reviewed literature was conducted for studies of technology-based interventions that used mHealth apps specific for heart failure. The initial database search yielded 8597 citations. After filters for English language and heart failure, the final 487 abstracts was reviewed. After removing duplicates, a total of 18 articles that tested usability and efficacy of mobile apps for heart failure self-management were included for review. Google Play and Apple App Store were searched with specified criteria to identify mHealth apps for heart failure. A total of 26 commercially available apps specific for heart failure were identified and rated using the validated Mobile Application Rating Scale. Results: The review included studies with low-quality design and sample sizes ranging from 7 to 165 with a total sample size of 847 participants from all 18 studies. Nine studies assessed usability of the newly developed mobile health system. Six of the studies included are randomized controlled trials, and 4 studies are pilot randomized controlled trials with sample sizes of fewer than 40. There were inconsistencies in the self-care components tested, increasing bias. Thus, risk of bias was assessed using the Cochrane Collaboration's tool for risk of selection, performance, detection, attrition, and reporting biases. Most studies included in this review are underpowered and had high risk of bias across all categories. Three studies failed to provide enough information to allow for a complete assessment of bias, and thus had unknown or unclear risk of bias. This review on the commercially available apps demonstrated many incomplete apps, many apps with bugs, and several apps with low quality. Conclusions: The heterogeneity of study design, sample size, intervention components, and outcomes measured precluded the performance of a systematic review or meta-analysis, thus introducing bias of this review. Although the heart failure--related outcomes reported in this review vary, they demonstrated trends toward making an impact and offer a potentially cost-effective solution with 24/7 access to symptom monitoring as a point of care solution, promoting patient engagement in their own home care. ",
doi="10.2196/10057",
url="http://cardio.jmir.org/2018/1/e10057/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31758762"
}


@Article{info:doi/10.2196/10173,
author="Lee, Ying-Li
and Cui, Yan-Yan
and Tu, Ming-Hsiang
and Chen, Yu-Chi
and Chang, Polun",
title="Mobile Health to Maintain Continuity of Patient-Centered Care for Chronic Kidney Disease: Content Analysis of Apps",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Apr",
day="20",
volume="6",
number="4",
pages="e10173",
keywords="mobile apps",
keywords="chronic kidney diseases",
keywords="self-management",
keywords="continuity of patient care",
keywords="patient-centered care",
abstract="Background: Chronic kidney disease (CKD) is a global health problem with a high economic burden, which is particularly prevalent in Taiwan. Mobile health apps have been widely used to maintain continuity of patient care for various chronic diseases. To slow the progression of CKD, continuity of care is vital for patients' self-management and cooperation with health care professionals. However, the literature provides a limited understanding of the use of mobile health apps to maintain continuity of patient-centered care for CKD. Objective: This study identified apps related to the continuity of patient-centered care for CKD on the App Store, Google Play, and 360 Mobile Assistant, and explored the information and frequency of changes in these apps available to the public on different platforms. App functionalities, like patient self-management and patient management support for health care professionals, were also examined. Methods: We used the CKD-related keywords ``kidney,'' ``renal,'' ``nephro,'' ``chronic kidney disease,'' ``CKD,'' and ``kidney disease'' in traditional Chinese, simplified Chinese, and English to search 3 app platforms: App Store, Google Play, and 360 Mobile Assistant. A total of 2 reviewers reached consensus on coding guidelines and coded the contents and functionalities of the apps through content analysis. After coding, Microsoft Office Excel 2016 was used to calculate Cohen kappa coefficients and analyze the contents and functionalities of the apps. Results: A total of 177 apps related to patient-centered care for CKD in any language were included. On the basis of their functionality and content, 67 apps were recommended for patients. Among them, the most common functionalities were CKD information and CKD self-management (38/67, 57\%), e-consultation (17/67, 25\%), CKD nutrition education (16/67, 24\%), and estimated glomerular filtration rate (eGFR) calculators (13/67, 19\%). In addition, 67 apps were recommended for health care professionals. The most common functionalities of these apps were comprehensive clinical calculators (including eGFR; 30/67; 45\%), CKD medical professional information (16/67, 24\%), stand-alone eGFR calculators (14/67, 21\%), and CKD clinical decision support (14/67, 21\%). A total of 43 apps with single- or multiple-indicator calculators were found to be suitable for health care professionals and patients. The aspects of patient care apps intended to support self-management of CKD patients were encouraging patients to actively participate in health care (92/110, 83.6\%), recognizing and effectively responding to symptoms (56/110, 50.9\%), and disease-specific knowledge (53/110, 48.2\%). Only 13 apps contained consulting management functions, patient management functions or teleconsultation functions designed to support health care professionals in CKD patient management. Conclusions: This study revealed that the continuity of patient-centered care for CKD provided by mobile health apps is inadequate for both CKD self-management by patients and patient care support for health care professionals. More comprehensive solutions are required to enhance the continuity of patient-centered care for CKD. ",
doi="10.2196/10173",
url="http://mhealth.jmir.org/2018/4/e10173/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29678805"
}


@Article{info:doi/10.2196/resprot.8771,
author="Wang, Penny
and Luo, Dee
and Lu, Fengxin
and Elias, S. Josephine
and Landman, B. Adam
and Michaud, D. Kaleb
and Lee, C. Yvonne",
title="A Novel Mobile App and Population Management System to Manage Rheumatoid Arthritis Flares: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2018",
month="Apr",
day="11",
volume="7",
number="4",
pages="e84",
keywords="arthritis, rheumatoid",
keywords="symptom flare up",
keywords="telemedicine",
keywords="mobile applications",
abstract="Background: Rheumatoid arthritis flares have a profound effect on patients, causing pain and disability. However, flares often occur between regularly scheduled health care provider visits and are, therefore, difficult to monitor and manage. We sought to develop a mobile phone app combined with a population management system to help track RA flares between visits. Objective: The objective of this study is to implement the mobile app plus the population management system to monitor rheumatoid arthritis disease activity between scheduled health care provider visits over a period of 6 months. Methods: This is a randomized controlled trial that lasts for 6 months for each participant. We aim to recruit 190 patients, randomized 50:50 to the intervention group versus the control group. The intervention group will be assigned the mobile app and be prompted to answer daily questionnaires sent to their mobile devices. Both groups will be assigned a population manager, who will communicate with the participants via telephone at 6 weeks and 18 weeks. The population manager will also communicate with the participants in the intervention group if their responses indicate a sustained increase in rheumatoid arthritis disease activity. To assess patient satisfaction, the primary outcomes will be scores on the Treatment Satisfaction Questionnaire for Medication as well as the Perceived Efficacy in Patient-Physician Interactions questionnaire at 6 months. To determine the effect of the mobile app on rheumatoid arthritis disease activity, the primary outcome will be the Clinical Disease Activity Index at 6 months. Results: The trial started in November 2016, and an estimated 2.5 years will be necessary to complete the study. Study results are expected to be published by the end of 2019. Conclusions: The completion of this study will provide important data regarding the following: (1) the assessment of validated outcome measures to assess rheumatoid arthritis disease activity with a mobile app between routinely scheduled health care provider visits, (2) patient engagement in monitoring their condition, and (3) communication between patients and health care providers through the population management system. Trial Registration: ClinicalTrials.gov NCT02822521, http://clinicaltrials.gov/ct2/show/NCT02822521 (Archived by WebCite?at http://www.webcitation.org/6xed3kGPd) ",
doi="10.2196/resprot.8771",
url="http://www.researchprotocols.org/2018/4/e84/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29643053"
}


@Article{info:doi/10.2196/resprot.9443,
author="Nelson, A. Lyndsay
and Wallston, A. Kenneth
and Kripalani, Sunil
and Greevy Jr, A. Robert
and Elasy, A. Tom
and Bergner, M. Erin
and Gentry, K. Chad
and Mayberry, S. Lindsay",
title="Mobile Phone Support for Diabetes Self-Care Among Diverse Adults: Protocol for a Three-Arm Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2018",
month="Apr",
day="10",
volume="7",
number="4",
pages="e92",
keywords="mobile health",
keywords="medication adherence",
keywords="type 2 diabetes",
keywords="text messaging",
keywords="self-care",
keywords="glycated hemoglobin",
abstract="Background: Nonadherence to self-care is common among patients with type 2 diabetes (T2D) and often leads to severe complications. Moreover, patients with T2D who have low socioeconomic status and are racial/ethnic minorities disproportionately experience barriers to adherence and poor outcomes. Basic phone technology (text messages and phone calls) provides a practical medium for delivering content to address patients' barriers to adherence; however, trials are needed to explore long-term and sustainable effects of mobile phone interventions among diverse patients. Objective: The aim of this study is to evaluate the effects of mobile phone--based diabetes support interventions on self-care and hemoglobin A1c (HbA1c) among adults with T2D using a 3-arm, 15-month randomized controlled trial with a Type 1 hybrid effectiveness-implementation approach. The intervention arms are (1) Rapid Encouragement/Education And Communications for Health (REACH) and (2) REACH + Family-focused Add-on for Motivating Self-care (FAMS). Methods: We recruited primary care patients with T2D (N=512) from Federally Qualified Health Centers and an academic medical center, prioritizing recruitment of publicly insured and minority patients from the latter. Eligible patients were prescribed daily diabetes medication and owned a cell phone with text messaging capability. We excluded patients whose most recent HbA1c result within 12 months was <6.8\% to support detection of intervention effects on HbA1c. Participants were randomly assigned to REACH only, REACH + FAMS, or the control condition. REACH provides text messages tailored to address patient-specific barriers to medication adherence based on the Information-Motivation-Behavioral skills model, whereas FAMS provides monthly phone coaching with related text message content focused on family and friend barriers to diet and exercise adherence. We collect HbA1c and self-reported survey data at baseline and at 3, 6, and 12 months, and again at 15 months to assess sustained changes. We will use generalized estimating equation models to test the effects of REACH (either intervention arm) on HbA1c relative to the control group, the potential additive effects of FAMS, and effects of either intervention on adherence to self-care behaviors and diabetes self-efficacy. Results: The trial is ongoing; recruitment closed December 2017. We plan to perform analyses on 6-month outcomes for FAMS in July 2018, and project to have 15-month data for REACH analyses in April 2019. Conclusions: Our study will be one of the first to evaluate a long-term, theory-based text messaging intervention to promote self-care adherence among racially/ethnically and socioeconomically diverse adults with T2D. Moreover, our study will assess the feasibility of a family-focused intervention delivered via mobile phones and compare the effects of text messaging alone versus text messaging plus phone coaching. Findings will advance our understanding of how interventions delivered by phone can benefit diverse patients with chronic conditions. Trial Registration: ClinicalTrials.gov NCT02409329; https://clinicaltrials.gov/ct2/show/NCT02409329 (Archived by WebCite at http://www.webcitation.org/6yHkg9SSl); NCT02481596; https://clinicaltrials.gov/ct2/show/NCT02481596 (Archived by WebCite at http://www.webcitation.org/6yHkj9XD4) ",
doi="10.2196/resprot.9443",
url="http://www.researchprotocols.org/2018/4/e92/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29636319"
}


@Article{info:doi/10.2196/mhealth.4478,
author="Wang, Jing
and Cai, Chunyan
and Padhye, Nikhil
and Orlander, Philip
and Zare, Mohammad",
title="A Behavioral Lifestyle Intervention Enhanced With Multiple-Behavior Self-Monitoring Using Mobile and Connected Tools for Underserved Individuals With Type 2 Diabetes and Comorbid Overweight or Obesity: Pilot Comparative Effectiveness Trial",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Apr",
day="10",
volume="6",
number="4",
pages="e92",
keywords="self-monitoring",
keywords="diabetes",
keywords="obesity",
keywords="mobile health",
keywords="behavior change",
keywords="connected health",
keywords="patient-generated health data",
keywords="lifestyle",
keywords="patient engagement",
keywords="comparative effectiveness trial",
abstract="Background: Self-monitoring is a cornerstone of behavioral lifestyle interventions for obesity and type 2 diabetes mellitus. Mobile technology has the potential to improve adherence to self-monitoring and patient outcomes. However, no study has tested the use of a smartphone to facilitate self-monitoring in overweight or obese adults with type 2 diabetes mellitus living in the underserved community. Objective: The aim of this study was to examine the feasibility of and compare preliminary efficacy of a behavioral lifestyle intervention using smartphone- or paper-based self-monitoring of multiple behaviors on weight loss and glycemic control in a sample of overweight or obese adults with type 2 diabetes mellitus living in underserved communities. Methods: We conducted a randomized controlled trial to examine the feasibility and preliminary efficacy of a behavioral lifestyle intervention. Overweight or obese patients with type 2 diabetes mellitus were recruited from an underserved minority community health center in Houston, Texas. They were randomly assigned to one of the three groups: (1) behavior intervention with smartphone-based self-monitoring, (2) behavior intervention with paper diary-based self-monitoring, and (3) usual care group. Both the mobile and paper groups received a total of 11 face-to-face group sessions in a 6-month intervention. The mobile group received an Android-based smartphone with 2 apps loaded to help them record their diet, physical activity, weight, and blood glucose, along with a connected glucometer, whereas the paper group used paper diaries for these recordings. Primary outcomes of the study included percentage weight loss and glycated hemoglobin (HbA1c) changes over 6 months. Results: A total of 26 patients were enrolled: 11 in the mobile group, 9 in the paper group, and 6 in the control group. We had 92\% (24/26) retention rate at 6 months. The sample is predominantly African Americans with an average age of 56.4 years and body mass index of 38.1. Participants lost an average of 2.73\% (mobile group) and 0.13\% (paper group) weight at 6 months, whereas the control group had an average 0.49\% weight gain. Their HbA1c changed from 8\% to 7 \% in mobile group, 10\% to 9\% in paper group, and maintained at 9\% for the control group. We found a significant difference on HbA1c at 6 months among the 3 groups (P=.01). We did not find statistical group significance on percentage weight loss (P=.20) and HbA1c changes (P=.44) overtime; however, we found a large effect size of 0.40 for weight loss and a medium effect size of 0.28 for glycemic control. Conclusions: Delivering a simplified behavioral lifestyle intervention using mobile health--based self-monitoring in an underserved community is feasible and acceptable and shows higher preliminary efficacy, as compared with paper-based self-monitoring. A full-scale randomized controlled trial is needed to confirm the findings in this pilot study. Trial Registration: ClinicalTrials.gov NCT02858648; https://clinicaltrials.gov/ct2/show/NCT02858648?(Archived by WebCite?at http://www.webcitation.org/6ySidjmT7) ",
doi="10.2196/mhealth.4478",
url="http://mhealth.jmir.org/2018/4/e92/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29636320"
}


@Article{info:doi/10.2196/mhealth.9319,
author="Jibb, A. Lindsay
and Stevens, J. Bonnie
and Nathan, C. Paul
and Seto, Emily
and Cafazzo, A. Joseph
and Johnston, L. Donna
and Hum, Vanessa
and Stinson, N. Jennifer",
title="Perceptions of Adolescents With Cancer Related to a Pain Management App and Its Evaluation: Qualitative Study Nested Within a Multicenter Pilot Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Apr",
day="06",
volume="6",
number="4",
pages="e80",
keywords="pain",
keywords="adolescent",
keywords="cancer",
keywords="supportive care",
keywords="mHealth",
keywords="qualitative",
abstract="Background: Pain in adolescents with cancer is common and negatively impacts health-related quality of life. The Pain Squad+ smartphone app, capable of providing adolescents with real-time pain management support, was developed to enhance pain management using a phased approach (ie, systematic review, consensus conference and vetting, iterative usability testing cycles). A 28-day Pain Squad+ pilot was conducted with 40 adolescents with cancer to evaluate the feasibility of implementing the app in a future clinical trial and to obtain estimates of treatment effect. Objective: The objective of our nested qualitative study was to elucidate the perceptions of adolescents with cancer to determine the acceptability and perceived helpfulness of Pain Squad+, suggestions for app improvement, and satisfaction with the pilot study protocol. Methods: Post pilot study participation, telephone-based, semistructured, and audio-recorded exit interviews were conducted with 20 adolescents with cancer (12-18 years). All interviews were transcribed and independently coded by 2 study team members. Content analysis was conducted to identify data categories and overarching themes. Results: Five major themes comprising multiple categories and codes emerged. These themes focused on the acceptability of the intervention, acceptability of the study, the perceived active ingredients of the intervention, the suitability of the intervention to adolescents' lives, and recommendations for intervention improvement. Conclusions: Overall, Pain Squad+ and the pilot study protocol were acceptable to adolescents with cancer. Suggestions for intervention and study improvements will be incorporated into the design of a future randomized clinical trial (RCT) aimed at assessing the effectiveness of Pain Squad+ on adolescents with cancer health outcomes. ",
doi="10.2196/mhealth.9319",
url="http://mhealth.jmir.org/2018/4/e80/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29625951"
}


@Article{info:doi/10.2196/mhealth.8849,
author="McWilliams, Andrew
and Reeves, Kelly
and Shade, Lindsay
and Burton, Elizabeth
and Tapp, Hazel
and Courtlandt, Cheryl
and Gunter, Andrew
and Dulin, F. Michael",
title="Patient and Family Engagement in the Design of a Mobile Health Solution for Pediatric Asthma: Development and Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Mar",
day="22",
volume="6",
number="3",
pages="e68",
keywords="engagement",
keywords="pediatric asthma",
keywords="shared decision-making",
keywords="health information technology",
abstract="Background: Asthma is a highly prevalent, chronic disease with significant morbidity, cost, and disparities in health outcomes. While adherence to asthma treatment guidelines can improve symptoms and decrease exacerbations, most patients receive care that is not guideline-based. New approaches that incorporate shared decision-making (SDM) and health information technology (IT) are needed to positively impact asthma management. Despite the promise of health IT to improve efficiency and outcomes in health care, new IT solutions frequently suffer from a lack of widespread adoption and do not achieve desired results, as a consequence of not involving end-users in design. Objective: To describe a case study of a pediatric asthma SDM health IT solution's development and demonstrate a methodology for engaging actual patients and families in IT development. Perspectives are shared from the vantage point of the research team and a parent of a child with asthma, who participated on the development team. Methods: We adapted user-centric design principles to engage actual users across three main development phases: project initiation, ideation, and usability testing. To facilitate the necessary level of user engagement, our approach included: (1) a Development Workgroup consisting of patients, caregivers, and providers who met regularly with the research team; and (2) ``real-world users'' consisting of patients, caregivers, and providers recruited from a variety of care locations, including safety-net clinics. Results: Using this methodology, we successful partnered with asthma patients and families to create an interactive, digital solution called Carolinas Asthma Coach. Carolinas Asthma Coach incorporates SDM principles to elicit patient information, including goals and preferences, and provides health-literate, tailored education with specific guideline-based recommendations for patients and their providers. Of the patients, caregivers, and providers surveyed, 100\% (n=60) said they would recommend Carolinas Asthma Coach to a friend or colleague. Qualitative feedback from users provided support for the usability and engaging nature of the app. Conclusions: This project demonstrates the feasibility and benefits of deploying user-centric design methods that engage real patients and caregivers throughout the health IT design process. ",
doi="10.2196/mhealth.8849",
url="http://mhealth.jmir.org/2018/3/e68/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29567637"
}


@Article{info:doi/10.2196/mhealth.9512,
author="Mackillop, Lucy
and Hirst, Elizabeth Jane
and Bartlett, Jane Katy
and Birks, Susan Jacqueline
and Clifton, Lei
and Farmer, J. Andrew
and Gibson, Oliver
and Kenworthy, Yvonne
and Levy, Cummings Jonathan
and Loerup, Lise
and Rivero-Arias, Oliver
and Ming, Wai-Kit
and Velardo, Carmelo
and Tarassenko, Lionel",
title="Comparing the Efficacy of a Mobile Phone-Based Blood Glucose Management System With Standard Clinic Care in Women With Gestational Diabetes: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Mar",
day="20",
volume="6",
number="3",
pages="e71",
keywords="gestational diabetes",
keywords="pregnancy",
keywords="digital health",
keywords="blood glucose monitoring",
keywords="app",
keywords="GDM",
abstract="Background: Treatment of hyperglycemia in women with gestational diabetes mellitus (GDM) is associated with improved maternal and neonatal outcomes and requires intensive clinical input. This is currently achieved by hospital clinic attendance every 2 to 4 weeks with limited opportunity for intervention between these visits. Objective: We conducted a randomized controlled trial to determine whether the use of a mobile phone-based real-time blood glucose management system to manage women with GDM remotely was as effective in controlling blood glucose as standard care through clinic attendance. Methods: Women with an abnormal oral glucose tolerance test before 34 completed weeks of gestation were individually randomized to a mobile phone-based blood glucose management solution (GDm-health, the intervention) or routine clinic care. The primary outcome was change in mean blood glucose in each group from recruitment to delivery, calculated with adjustments made for number of blood glucose measurements, proportion of preprandial and postprandial readings, baseline characteristics, and length of time in the study. Results: A total of 203 women were randomized. Blood glucose data were available for 98 intervention and 85 control women. There was no significant difference in rate of change of blood glucose (--0.16 mmol/L in the intervention and --0.14 mmol/L in the control group per 28 days, P=.78). Women using the intervention had higher satisfaction with care (P=.049). Preterm birth was less common in the intervention group (5/101, 5.0\% vs 13/102, 12.7\%; OR 0.36, 95\% CI 0.12-1.01). There were fewer cesarean deliveries compared with vaginal deliveries in the intervention group (27/101, 26.7\% vs 47/102, 46.1\%, P=.005). Other glycemic, maternal, and neonatal outcomes were similar in both groups. The median time from recruitment to delivery was similar (intervention: 54 days; control: 49 days; P=.23). However, there were significantly more blood glucose readings in the intervention group (mean 3.80 [SD 1.80] and mean 2.63 [SD 1.71] readings per day in the intervention and control groups, respectively; P<.001). There was no significant difference in direct health care costs between the two groups, with a mean cost difference of the intervention group compared to control of --{\textsterling}1044 (95\% CI --{\textsterling}2186 to {\textsterling}99). There were no unexpected adverse outcomes. Conclusions: Remote blood glucocse monitoring in women with GDM is safe. We demonstrated superior data capture using GDm-health. Although glycemic control and maternal and neonatal outcomes were similar, women preferred this model of care. Further studies are required to explore whether digital health solutions can promote desired self-management lifestyle behaviors and dietetic adherence, and influence maternal and neonatal outcomes. Digital blood glucose monitoring may provide a scalable, practical method to address the growing burden of GDM around the world. Trial Registration: ClinicalTrials.gov NCT01916694; https://clinicaltrials.gov/ct2/show/NCT01916694 (Archived by WebCite at http://www.webcitation.org/6y3lh2BOQ) ",
doi="10.2196/mhealth.9512",
url="http://mhealth.jmir.org/2018/3/e71/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29559428"
}


@Article{info:doi/10.2196/jmir.9515,
author="Levy, Koch Natalie
and Orzeck-Byrnes, A. Natasha
and Aidasani, R. Sneha
and Moloney, N. Dana
and Nguyen, H. Lisa
and Park, Agnes
and Hu, Lu
and Langford, T. Aisha
and Wang, Binhuan
and Sevick, Ann Mary
and Rogers, S. Erin",
title="Transition of a Text-Based Insulin Titration Program From a Randomized Controlled Trial Into Real-World Settings: Implementation Study",
journal="J Med Internet Res",
year="2018",
month="Mar",
day="19",
volume="20",
number="3",
pages="e93",
keywords="insulin/long-acting/administration \& dosage",
keywords="diabetes mellitus, type 2/drug therapy",
keywords="medically underserved area",
keywords="telemedicine",
keywords="healthcare disparities",
abstract="Background: The Mobile Insulin Titration Intervention (MITI) program helps patients with type 2 diabetes find their correct basal insulin dose without in-person care. Requiring only basic cell phone technology (text messages and phone calls), MITI is highly accessible to patients receiving care in safety-net settings. MITI was shown in a randomized controlled trial (RCT) to be efficacious at a New York City (NYC) safety-net clinic where patients often have challenges coming for in-person care. In 2016, MITI was implemented as usual care at Bellevue Hospital (the site of the original RCT) and at Gouverneur Health (a second NYC safety-net clinic) under 2 different staffing models. Objective: This implementation study examined MITI's transition into real-world settings. To understand MITI's flexibility, generalizability, and acceptability among patients and providers, we evaluated whether MITI continued to produce positive outcomes in expanded underserved populations, outside of an RCT setting. Methods: Patients enrolled in MITI received weekday text messages asking for their fasting blood glucose (FBG) values and a weekly titration call. The goal was for patients to reach their optimal insulin dose (OID), defined either as the dose of once-daily basal insulin required to achieve either an FBG of 80-130 mg/dL (4.4-7.2 mmol/L) or as the reaching of the maximum dose of 50 units. After 12 weeks, if OID was not reached, the patients were asked to return to the clinic for in-person care and titration. MITI program outcomes, clinical outcomes, process outcomes, and patient satisfaction were assessed. Results: MITI was successful at both sites, each with a different staffing model. Providers referred 170 patients to the program---129 of whom (75.9\%, 129/170) were eligible. Of these, 113 (87.6\%, 113/129) enrolled. Moreover, 84.1\% (95/113) of patients reached their OID, and they did so in an average of 24 days. Clinical outcomes show that mean FBG levels fell from 209 mg/dL (11.6 mmol/L) to 141 mg/dL (7.8 mmol/L), P<.001. HbA1c levels fell from 11.4\% (101 mmol/mol) to 10.0\% (86 mmol/mol), P<.001. Process outcomes show that 90.1\% of MITI's text message prompts received a response, nurses connected with patients 81.9\% of weeks to provide titration instructions, and 85\% of attending physicians made at least one referral to the MITI program. Satisfaction surveys showed that most patients felt comfortable sharing information over text and felt the texts reminded them to take their insulin, check their sugar, and make healthy food choices. Conclusions: This implementation study showed MITI to have continued success after transitioning from an RCT program into real-world settings. MITI showed itself to be flexible and generalizable as it easily fits into a second site staffed by general medical clinic--registered nurses and remained acceptable to patients and staff who had high levels of engagement with the program. ",
doi="10.2196/jmir.9515",
url="http://www.jmir.org/2018/3/e93/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29555621"
}


@Article{info:doi/10.2196/mhealth.8565,
author="Somers, J. Tamara
and Kelleher, A. Sarah
and Dorfman, S. Caroline
and Shelby, A. Rebecca
and Fisher, M. Hannah
and Rowe Nichols, Krista
and Sullivan, M. Keith
and Chao, J. Nelson
and Samsa, P. Gregory
and Abernethy, P. Amy
and Keefe, J. Francis",
title="An mHealth Pain Coping Skills Training Intervention for Hematopoietic Stem Cell Transplantation Patients: Development and Pilot Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Mar",
day="19",
volume="6",
number="3",
pages="e66",
keywords="stem cell transplantation",
keywords="hematopoietic stem cell",
keywords="cancer-related pain",
keywords="coping skills",
abstract="Background: Pain is a challenge for patients following hematopoietic stem cell transplantation (HCT). Objective: This study aimed to develop and test the feasibility, acceptability, and initial efficacy of a Web-based mobile pain coping skills training (mPCST) protocol designed to address the needs of HCT patients. Methods: Participants had undergone HCT and reported pain following transplant (N=68). To guide intervention development, qualitative data were collected from focus group participants (n=25) and participants who completed user testing (n=7). After their input was integrated into the mPCST intervention, a pilot randomized controlled trial (RCT, n=36) was conducted to examine the feasibility, acceptability, and initial efficacy of the intervention. Measures of acceptability, pain severity, pain disability, pain self-efficacy, fatigue, and physical disability (self-report and 2-min walk test [2MWT]) were collected. Results: Participants in the focus groups and user testing provided qualitative data that were used to iteratively refine the mPCST protocol. Focus group qualitative data included participants' experiences with pain following transplant, perspectives on ways to cope with pain, and suggestions for pain management for other HCT patients. User testing participants provided feedback on the HCT protocol and information on the use of videoconferencing. The final version of the mPCST intervention was designed to bridge the intensive outpatient (1 in-person session) and home settings (5 videoconferencing sessions). A key component of the intervention was a website that provided personalized messages based on daily assessments of pain and activity. The website also provided intervention materials (ie, electronic handouts, short videos, and audio files). The intervention content included pain coping advice from other transplant patients and instructions on how to apply pain coping skills while engaging in meaningful and leisure activities. In the RCT phase of this research, HCT patients (n=36) were randomized to receive the mPCST intervention or to proceed with the treatment as usual. Results revealed that the mPCST participants completed an average of 5 out of 6 sessions. The participants reported that the intervention was highly acceptable (mean 3/4), and they found the sessions to be helpful (mean 8/10) and easy to understand (mean 7/7). The mPCST participants demonstrated significant improvements in pre- to post-treatment pain, self-efficacy (P=.03, d=0.61), and on the 2MWT (P=.03, d=0.66), whereas the patients in the treatment-as-usual group did not report any such improvements. Significant changes in pain disability and fatigue were found in both groups (multiple P<.02); the magnitudes of the effect sizes were larger for the mPCST group than for the control group (pain disability: d=0.79 vs 0.69; fatigue: d=0.94 vs 0.81). There were no significant changes in pain severity in either group. Conclusions: Using focus groups and user testing, we developed an mPCST protocol that was feasible, acceptable, and beneficial for HCT patients with pain. Trial Registration: ClinicalTrials.gov NCT01984671; https://clinicaltrials.gov/ct2/show/NCT01984671 (Archived by WebCite at http://www.webcitation.org/6xbpx3clZ) ",
doi="10.2196/mhealth.8565",
url="http://mhealth.jmir.org/2018/3/e66/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29555620"
}


@Article{info:doi/10.2196/jmir.8712,
author="Desveaux, Laura
and Shaw, James
and Saragosa, Marianne
and Soobiah, Charlene
and Marani, Husayn
and Hensel, Jennifer
and Agarwal, Payal
and Onabajo, Nike
and Bhatia, Sacha R.
and Jeffs, Lianne",
title="A Mobile App to Improve Self-Management of Individuals With Type 2 Diabetes: Qualitative Realist Evaluation",
journal="J Med Internet Res",
year="2018",
month="Mar",
day="16",
volume="20",
number="3",
pages="e81",
keywords="telemedicine",
keywords="diabetes mellitus",
keywords="self-management",
keywords="qualitative research",
abstract="Background: The increasing use of Web-based solutions for health prevention and promotion presents opportunities to improve self-management and adherence to guideline-based therapy for individuals with type 2 diabetes (T2DM). Despite promising preliminary evidence, many users stop using Web-based solutions due to the burden of data entry, hidden costs, loss of interest, and a lack of comprehensive features. Evaluations tend to focus on effectiveness or impact and fail to evaluate the nuanced variables that may interact to contribute to outcome success (or failure). Objective: This study aimed to evaluate a Web-based solution for improving self-management in T2DM to identify key combinations of contextual variables and mechanisms of action that explain for whom the solution worked best and in what circumstances. Methods: A qualitative realist evaluation was conducted with one-on-one, semistructured telephonic interviews completed at baseline, and again toward the end of the intervention period (3 months). Topics included participants' experiences of using the Web-based solution, barriers and facilitators of self-management, and barriers and facilitators to effective use. Transcripts were analyzed using thematic analysis strategies, after which the key themes were used to develop statements of the relationships between the key contextual factors, mechanisms of action, and impact on the primary outcome (glycated hemoglobin, HbA1c). Results: Twenty-six interviews (14 baseline, 12 follow-up) were completed with 16 participants with T2DM, and the following 3 key groups emerged: the easiest fit, the best fit, and those who failed to activate. Self-efficacy and willingness to engage with the solution facilitated improvement in HbA1c, whereas competing priorities and psychosocial issues created barriers to engagement. Individuals with high baseline self-efficacy who were motivated, took ownership for their actions, and prioritized diabetes management were early and eager adopters of the app and recorded improvements in HbA1c over the intervention period. Individuals with moderate baseline self-efficacy and no competing priorities, who identified gaps in understanding of how their actions influence their health, were slow to adopt use but recorded the greatest improvements in HbA1c. The final group had low baseline self-efficacy and identified a range of psychosocial issues and competing priorities. These participants were uncertain of the benefits of using a Web-based solution to support self-management, ultimately resulting in minimal engagement and no improvement in HbA1c. Conclusions: Self-efficacy, competing priorities, previous behavior change, and beliefs about Web-based solutions interact to determine engagement and impact on the clinical outcomes. Considering the balance of these patient characteristics is likely to help health care providers identify individuals who are apt to benefit from a Web-based solution to support self-management of T2DM. Web-based solutions could be modified to incorporate the existing screening measures to identify individuals who are at risk of suboptimal adherence to inform the provision of additional support(s) as needed. ",
doi="10.2196/jmir.8712",
url="http://www.jmir.org/2018/3/e81/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29549070"
}


@Article{info:doi/10.2196/resprot.9147,
author="Hilliard, E. Marisa
and Eshtehardi, S. Sahar
and Minard, G. Charles
and Saber, Rana
and Thompson, Debbe
and Karaviti, P. Lefkothea
and Rojas, Yuliana
and Anderson, J. Barbara",
title="Strengths-Based Behavioral Intervention for Parents of Adolescents With Type 1 Diabetes Using an mHealth App (Type 1 Doing Well): Protocol for a Pilot Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2018",
month="Mar",
day="13",
volume="7",
number="3",
pages="e77",
keywords="adolescence",
keywords="type 1 diabetes",
keywords="parenting",
abstract="Background: Supportive parent involvement for adolescents' type 1 diabetes (T1D) self-management promotes optimal diabetes outcomes. However, family conflict is common and can interfere with collaborative family teamwork. Few interventions have used explicitly strengths-based approaches to help reinforce desired management behaviors and promote positive family interactions around diabetes care. Objective: The aim of this protocol was to describe the development of a new, strengths-based behavioral intervention for parents of adolescents with T1D delivered via a mobile-friendly Web app called Type 1 Doing Well. Methods: Ten adolescent-parent dyads and 5 diabetes care providers participated in a series of qualitative interviews to inform the design of the app. The 3- to 4-month pilot intervention will involve 82 parents receiving daily prompts to use the app, in which they will mark the diabetes-related strength behaviors (ie, positive attitudes or behaviors related to living with or managing T1D) their teen engaged in that day. Parents will also receive training on how to observe diabetes strengths and how to offer teen-friendly praise via the app. Each week, the app will generate a summary of the teen's most frequent strengths from the previous week based on parent reports, and parents will be encouraged to praise their teen either in person or from a library of reinforcing text messages (short message service, SMS). Results: The major outcomes of this pilot study will include intervention feasibility and satisfaction data. Clinical and behavioral outcomes will include glycemic control, regimen adherence, family relationships and conflict, diabetes burden, and health-related quality of life. Conclusions: This strengths-based, mobile health (mHealth) intervention aims to help parents increase their awareness of and efforts to support their adolescents' engagement in positive diabetes-related behaviors. If efficacious, this intervention has the potential to reduce the risk of family conflict, enhance collaborative family teamwork, and ultimately improve diabetes outcomes. Trial Registration: ClinicalTrials.gov NCT02877680; https://clinicaltrials.gov/ct2/show/NCT02877680 (Archived by WebCite at http://www.webcitation.org/6xTAMN5k2) ",
doi="10.2196/resprot.9147",
url="http://www.researchprotocols.org/2018/3/e77/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29535081"
}


@Article{info:doi/10.2196/humanfactors.9049,
author="Waite, Marion
and Martin, Clare
and Franklin, Rachel
and Duce, David
and Harrison, Rachel",
title="Human Factors and Data Logging Processes With the Use of Advanced Technology for Adults With Type 1 Diabetes: Systematic Integrative Review",
journal="JMIR Hum Factors",
year="2018",
month="Mar",
day="15",
volume="5",
number="1",
pages="e11",
keywords="adult",
keywords="type 1 diabetes mellitus",
keywords="T1D",
keywords="technology",
keywords="self-management",
keywords="self-care",
keywords="telehealth",
keywords="telemedicine",
keywords="reminder system",
keywords="continuous glucose monitoring",
keywords="Sensor-augmented pump therapy",
keywords="closed loop systems",
keywords="adherence",
keywords="compliance",
keywords="barrier",
keywords="usability",
abstract="Background: People with type 1 diabetes (T1D) undertake self-management to prevent short and long-term complications. Advanced technology potentially supports such activities but requires consideration of psychological and behavioral constructs and usability issues. Economic factors and health care provider capacity influence access and uptake of advanced technology. Previous reviews have focused upon clinical outcomes or were descriptive or have synthesized studies on adults with those on children and young people where human factors are different. Objective: This review described and examined the relationship between human factors and adherence with technology for data logging processes in adults with T1D. Methods: A systematic literature search was undertaken by using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Quality appraisal was undertaken and data were abstracted and categorized into the themes that underpinned the human factor constructs that were examined. Results: A total of 18 studies were included. A total of 6 constructs emerged from the data analysis: the relationship between adherence to data logging and measurable outcomes; satisfaction with the transition to advanced technology for self-management; use of advanced technology and time spent on diabetes-related activities; strategies to mediate the complexities of diabetes and the use of advanced technology; cognition in the wild; and meanings, views, and perspectives from the users of technology. Conclusions: Increased treatment satisfaction was found on transition from traditional to advanced technology use---insulin pump and continuous glucose monitoring (CGM); the most significant factor was when blood glucose levels were consistently <7.00 mmol/L (P ?.01). Participants spent considerable time on their diabetes self-care. Logging of data was positively correlated with increasing age when using an app that provided meaningful feedback (regression coefficient=55.8 recordings/year; P ?.01). There were benefits of CGM for older people in mediating complexities and fears of hypoglycemia with significant differences in well-being (P ?.001). Qualitative studies explored the contextual use and uptake of technology. The results suggested frustrations with CGM, continuous subcutaneous insulin infusion, calibration of devices, and alarms. Furthermore implications for ``body image'' and the way in which ``significant others'' impacted on the behavior and attitude of the individual toward technology use. There were wide variations in the normal use of and interaction with technology across a continuum of sociocultural contexts, which has implications for the way in which future technologies should be designed. Quantitative studies were limited by small sample sizes, making it difficult to generalize findings to other contexts. This was further limited by a sample that was predominantly white, well-controlled, and engaged with self-care. The use of critical appraisal frameworks demonstrated where research into human factors and data logging processes of individuals could be improved. This included engaging people in the design of the technology, especially hard-to-reach or marginalized groups. ",
doi="10.2196/humanfactors.9049",
url="http://humanfactors.jmir.org/2018/1/e11/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29535079"
}


@Article{info:doi/10.2196/resprot.8915,
author="El Shafie, A. Rami
and Bougatf, Nina
and Sprave, Tanja
and Weber, Dorothea
and Oetzel, Dieter
and Machmer, Timo
and Huber, E. Peter
and Debus, J{\"u}rgen
and Nicolay, H. Nils",
title="Oncologic Therapy Support Via Means of a Dedicated Mobile App (OPTIMISE-1): Protocol for a Prospective Pilot Trial",
journal="JMIR Res Protoc",
year="2018",
month="Mar",
day="06",
volume="7",
number="3",
pages="e70",
keywords="mHealth",
keywords="radiotherapy",
keywords="mobile application",
keywords="quality of life",
keywords="cancer",
keywords="Patient-Reported Outcome Measures (PROMs)",
abstract="Background: The increasing role of consumer electronics and Web-enabled mobile devices in the medical sector opens up promising possibilities for integrating novel technical solutions into therapy and patient support for oncologic illnesses. A recent survey carried out at Heidelberg University Hospital suggested a high acceptance among patients for an additional approach to patient care during radiotherapy based on patient-reported outcomes by a dedicated mobile app. Objective: The aim of this trial (OPTIMISE-1: Oncologic Therapy Support Via Means of a Dedicated Mobile App -- A Prospective Feasibility Evaluation) is to prospectively evaluate the feasibility of employing a mobile app for the systematic support of radiooncological patients throughout the course of their radiotherapy by monitoring symptoms and patient performance, and facilitating the background-exchange of relevant information between patient and physician. Methods: The present single-center, prospective, exploratory trial, conducted at Heidelberg University Hospital, assesses the feasibility of integrating an app-based approach into patient-care during radiotherapy. Patients undergoing curative radiotherapy for thoracic or pelvic tumors will be surveyed regarding general performance, treatment-related quality of life (QoL) and symptoms, and their need to personally consult a physician by means of a mobile app during treatment. The primary endpoint of feasibility will be reached when 80\% of the patients have successfully answered 80\% of their respective questions scheduled for each treatment day. Furthermore, treatment-related patient satisfaction and health-related QoL is assessed by the Patient Satisfaction Questionnaire Short Form (PSQ-18) and the European Organization for Research and Treatment of Cancer (EORTC) questionnaires at the beginning (baseline) and end of radiotherapy, and at the first follow-up. Results: This trial will recruit 50 patients over a period of 12 months. Follow-up will be completed after 18 months, and publication of results is planned at 24 months after trial initiation. Conclusions: This study will serve as a basis for future studies aiming to exploit the constant innovation in mobile medical appliances and integrate novel patient-centered concepts into patient care in the context of radiotherapy. Trial Registration: ClinicalTrials.gov NCT03168048; https://clinicaltrials.gov/ct2/show/NCT03168048 (Archived at WebCite http://www.webcitation.org/6wtWGgi0X) ",
doi="10.2196/resprot.8915",
url="https://www.researchprotocols.org/2018/3/e70/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29510971"
}


@Article{info:doi/10.2196/mhealth.8876,
author="Husted, Reventlov Gitte
and Weis, Janne
and Teilmann, Grete
and Castens{\o}e-Seidenfaden, Pernille",
title="Exploring the Influence of a Smartphone App (Young with Diabetes) on Young People's Self-Management: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Feb",
day="28",
volume="6",
number="2",
pages="e43",
keywords="mHealth",
keywords="diabetes mellitus, type 1",
keywords="youth",
keywords="self-management",
keywords="qualitative research",
abstract="Background: Adequate self-management is the cornerstone of preventing type 1 diabetes mellitus (T1DM) complications. However, T1DM self-management is challenging for young people, who often struggle during the transition from childhood to adulthood. The mobile health (mHealth) app Young with Diabetes (YWD) was developed in collaboration with young people to enhance their T1DM self-management during this transition. Objective: The purpose of this study was to explore the influence of YWD on young people's self-management during a 12-month period. Methods: A qualitative explorative approach was used, comprising a purposive sample of 20 young people (11 females and 9 males, ages 15 to 23 years, with app use of 3 to 64 days) from 3 pediatric and 3 adult departments. Participants were interviewed individually using a semistructured interview guide. Data were collected from January to March 2017 and analyzed using thematic analysis. Results: A total of 5 themes were identified: (1) not feeling alone anymore (``we are in this together''); (2) gaining competence by sharing experiences and practical knowledge (``they know what they are talking about''); (3) feeling safer (``it's just a click away''); (4) breaking the ice by starting to share thoughts and feelings and asking for help (``it is an outstretched hand''); and (5) lack of motivating factors (``done with the app''). Young people reported that YWD promoted self-management by peer-to-peer social support, exchanging messages with health care providers, and sharing YWD with parents. Participants recommended YWD as a supplement to self-management for newly diagnosed young people with T1DM and suggested improvements in app content and functionality. Conclusions: The mHealth app YWD has the potential to support self-management. In particular, peer-to-peer support reduced feelings of loneliness and helped young people to gain knowledge and skills for managing T1DM. A need exists for alternative ways to train health care providers in using YWD and to support collaboration between young people and their parents to further improve young people's self-management of T1DM. ",
doi="10.2196/mhealth.8876",
url="http://mhealth.jmir.org/2018/2/e43/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29490897"
}


@Article{info:doi/10.2196/humanfactors.8620,
author="Hohenstein, C. Jess
and Baumer, PS Eric
and Reynolds, Lindsay
and Murnane, L. Elizabeth
and O'Dell, Dakota
and Lee, Seoho
and Guha, Shion
and Qi, Yu
and Rieger, Erin
and Gay, Geri",
title="Supporting Accurate Interpretation of Self-Administered Medical Test Results for Mobile Health: Assessment of Design, Demographics, and Health Condition",
journal="JMIR Hum Factors",
year="2018",
month="Feb",
day="28",
volume="5",
number="1",
pages="e9",
keywords="mobile health",
keywords="health informatics",
keywords="patient-generated health data",
keywords="user-computer interface",
keywords="decision making",
keywords="patient-centered care",
abstract="Background: Technological advances in personal informatics allow people to track their own health in a variety of ways, representing a dramatic change in individuals' control of their own wellness. However, research regarding patient interpretation of traditional medical tests highlights the risks in making complex medical data available to a general audience. Objective: This study aimed to explore how people interpret medical test results, examined in the context of a mobile blood testing system developed to enable self-care and health management. Methods: In a preliminary investigation and main study, we presented 27 and 303 adults, respectively, with hypothetical results from several blood tests via one of the several mobile interface designs: a number representing the raw measurement of the tested biomarker, natural language text indicating whether the biomarker's level was low or high, or a one-dimensional chart illustrating this level along a low-healthy axis. We measured respondents' correctness in evaluating these results and their confidence in their interpretations. Participants also told us about any follow-up actions they would take based on the result and how they envisioned, generally, using our proposed personal health system. Results: We find that a majority of participants (242/328, 73.8\%) were accurate in their interpretations of their diagnostic results. However, 135 of 328 participants (41.1\%) expressed uncertainty and confusion about their ability to correctly interpret these results. We also find that demographics and interface design can impact interpretation accuracy, including false confidence, which we define as a respondent having above average confidence despite interpreting a result inaccurately. Specifically, participants who saw a natural language design were the least likely (421.47 times, P=.02) to exhibit false confidence, and women who saw a graph design were less likely (8.67 times, P=.04) to have false confidence. On the other hand, false confidence was more likely among participants who self-identified as Asian (25.30 times, P=.02), white (13.99 times, P=.01), and Hispanic (6.19 times, P=.04). Finally, with the natural language design, participants who were more educated were, for each one-unit increase in education level, more likely (3.06 times, P=.02) to have false confidence. Conclusions: Our findings illustrate both promises and challenges of interpreting medical data outside of a clinical setting and suggest instances where personal informatics may be inappropriate. In surfacing these tensions, we outline concrete interface design strategies that are more sensitive to users' capabilities and conditions. ",
doi="10.2196/humanfactors.8620",
url="http://humanfactors.jmir.org/2018/1/e9/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29490894"
}


@Article{info:doi/10.2196/mental.8551,
author="Kumar, Divya
and Tully, M. Laura
and Iosif, Ana-Maria
and Zakskorn, N. Lauren
and Nye, E. Kathleen
and Zia, Aqsa
and Niendam, Ann Tara",
title="A Mobile Health Platform for Clinical Monitoring in Early Psychosis: Implementation in Community-Based Outpatient Early Psychosis Care",
journal="JMIR Ment Health",
year="2018",
month="Feb",
day="27",
volume="5",
number="1",
pages="e15",
keywords="mHealth",
keywords="schizophrenia",
keywords="smartphone",
keywords="ecological momentary assessment",
keywords="experience sampling",
abstract="Background: A growing body of literature indicates that smartphone technology is a feasible add-on tool in the treatment of individuals with early psychosis (EP) . However, most studies to date have been conducted independent of outpatient care or in a research clinic setting, often with financial incentives to maintain user adherence to the technology. Feasibility of dissemination and implementation of smartphone technology into community mental health centers (CMHCs) has yet to be tested, and whether young adults with EP will use this technology for long periods of time without incentive is unknown. Furthermore, although EP individuals willingly adopt smartphone technology as part of their treatment, it remains unclear whether providers are amenable to integrating smartphone technology into treatment protocols. Objective: This study aimed to establish the feasibility of implementing a smartphone app and affiliated Web-based dashboard in 4 community outpatient EP clinics in Northern California. Methods: EP individuals in 4 clinics downloaded an app on their smartphone and responded to daily surveys regarding mood and symptoms for up to 5 months. Treatment providers at the affiliated clinics viewed survey responses on a secure Web-based dashboard in sessions with their clients and between appointments. EP clients and treatment providers filled out satisfaction surveys at study end regarding usability of the app. Results: Sixty-one EP clients and 20 treatment providers enrolled in the study for up to 5 months. Forty-one EP clients completed the study, and all treatment providers remained in the study for their duration in the clinic. Survey completion for all 61 EP clients was moderate: 40\% and 39\% for daily and weekly surveys, respectively. Completion rates were slightly higher in the participants who completed the study: 44\% and 41\% for daily and weekly surveys, respectively. Twenty-seven of 41 (66\%) EP clients who completed the study and 11 of 13 (85\%) treatment providers who responded to satisfaction surveys reported they would continue to use the app as part of treatment services. Six (15\%; 6/41) clients and 3 providers (23\%; 3/13) stated that technological glitches impeded their engagement with the platform. Conclusions: EP clients and treatment providers in community-based outpatient clinics are responsive to integrating smartphone technology into treatment services. There were logistical and technical challenges associated with enrolling individuals in CMHCs. To be most effective, implementing smartphone technology in CMHC EP care necessitates adequate technical staff and support for utilization of the platform. ",
doi="10.2196/mental.8551",
url="http://mental.jmir.org/2018/1/e15/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29487044"
}


@Article{info:doi/10.2196/cardio.8802,
author="De Ridder, Benjamin
and Van Rompaey, Bart
and Kampen, K. Jarl
and Haine, Steven
and Dilles, Tinne",
title="Smartphone Apps Using Photoplethysmography for Heart Rate Monitoring: Meta-Analysis",
journal="JMIR Cardio",
year="2018",
month="Feb",
day="27",
volume="2",
number="1",
pages="e4",
keywords="mobile applications",
keywords="heart rate",
keywords="photoplethysmography",
keywords="electrocardiography",
keywords="oximetry",
keywords="meta-analysis",
abstract="Background: Smartphone ownership is rising at a stunning rate. Moreover, smartphones prove to be suitable for use in health care due to their availability, portability, user-friendliness, relatively low price, wireless connectivity, far-reaching computing capabilities, and comprehensive memory. To measure vital signs, smartphones are often connected to a mobile sensor or a medical device. However, by using the white light-emitting diode as light source and the phone camera as photodetector, a smartphone could be used to perform photoplethysmography (PPG), enabling the assessment of vital signs. Objective: The objective of this meta-analysis was to evaluate the available evidence on the use of smartphone apps to measure heart rate by performing PPG in comparison with a validated method. Methods: PubMed and ISI Web of Knowledge were searched for relevant studies published between January 1, 2009 and December 7, 2016. The reference lists of included studies were hand-searched to find additional eligible studies. Critical Appraisal Skills Programme (CASP) Diagnostic Test Study checklist and some extra items were used for quality assessment. A fixed effects model of the mean difference and a random effects model of Pearson correlation coefficient were applied to pool the outcomes of the studies. Results: In total, 14 studies were included. The pooled result showed no significant difference between heart rate measurements with a smartphone and a validated method (mean difference ?0.32; 99\% CI ?1.24 to 0.60; P=.37). In adults, the Pearson correlation coefficient of the relation between heart rate measurement with a smartphone and a validated method was always ?.90. In children, the results varied depending on measuring point and heart rate. The pooled result showed a strong correlation that was significant (correlation coefficient .951; 95\% CI 0.906-0.975; P<.001). The reported limits of agreement showed good agreement between a smartphone and a validated method. There was a moderately strong significant negative correlation between the year of publication of the included studies and the mean difference (r=?.69; P<.001). Conclusions: Smartphone apps measuring heart rate by performing PPG appear to agree with a validated method in an adult population during resting sinus rhythm. In a pediatric population, the use of these apps is currently not validated. ",
doi="10.2196/cardio.8802",
url="http://cardio.jmir.org/2018/1/e4/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31758768"
}


@Article{info:doi/10.2196/resprot.9118,
author="Song, Lixin
and Dunlap, L. Kaitlyn
and Tan, Xianming
and Chen, C. Ronald
and Nielsen, E. Matthew
and Rabenberg, L. Rebecca
and Asafu-Adjei, K. Josephine
and Koontz, F. Bridget
and Birken, A. Sarah
and Northouse, L. Laurel
and Mayer, K. Deborah",
title="Enhancing Survivorship Care Planning for Patients With Localized Prostate Cancer Using a Couple-Focused mHealth Symptom Self-Management Program: Protocol for a Feasibility Study",
journal="JMIR Res Protoc",
year="2018",
month="Feb",
day="26",
volume="7",
number="2",
pages="e51",
keywords="survivorship",
keywords="prostate cancer",
keywords="symptom, randomized trial",
keywords="mHealth",
keywords="caregiver",
keywords="Patient Reported Outcome Measures",
abstract="Background: This project explores a new model of care that enhances survivorship care planning and promotes health for men with localized prostate cancer transitioning to posttreatment self-management. Survivorship care planning is important for patients with prostate cancer because of its high incidence rate in the United States, the frequent occurrence of treatment-related side effects, and reduced quality of life (QOL) for both men and their partners. A key component of comprehensive survivorship care planning is survivorship care plans (SCPs), documents that summarize cancer diagnosis, treatment, and plans for follow-up care. However, research concerning the effectiveness of SCPs on patient outcomes or health service use has thus far been inconclusive. SCPs that are tailored to individual patients' needs for information and care may improve effectiveness. Objective: This study aims to examine the feasibility of an enhanced survivorship care plan (ESCP) that integrates a symptom self-management mHealth program called Prostate Cancer Education and Resources for Couples (PERC) into the existing standardized SCP. The specific aims are to (1) examine the feasibility of delivering ESCPs and (2) to estimate the magnitude of benefit of ESCPs. Methods: We will use a two-group randomized controlled pretest-posttest design and collect data at baseline (T1) and 4 months later (T2) among 50 patients completing initial treatment for localized prostate cancer and their partners. First, we will assess the feasibility of ESCP by recruitment, enrollment, and retention rates; program satisfaction with the ESCP; and perceived ease of use of the ESCP. To achieve the secondary aim, we will compare the ESCP users with the standardized SCP users and assess their primary outcomes of QOL (overall, physical, emotional, and social QOL); secondary outcomes (reduction in negative appraisals and improvement in self-efficacy, social support, and health behaviors to manage symptoms); and number of visits to posttreatment care services between T1 and T2. We will assess the primary and secondary outcomes using measurements with sound psychometrical properties. We will use a qualitative and quantitative mixed methods approach to achieve the research aims. Results: This project is ongoing and will be completed by the end of 2018. Conclusions: The results from this study will help design a definitive randomized trial to test the efficacy of the ESCPs, a potentially scalable program, to enhance supportive care for prostate cancer patients and their families. ",
doi="10.2196/resprot.9118",
url="http://www.researchprotocols.org/2018/2/e51/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29483070"
}


@Article{info:doi/10.2196/biomedeng.9062,
author="Stubberud, Anker
and Omland, Moe Petter
and Tronvik, Erling
and Olsen, Alexander
and Sand, Trond
and Linde, Mattias",
title="Wireless Surface Electromyography and Skin Temperature Sensors for Biofeedback Treatment of Headache: Validation Study with Stationary Control Equipment",
journal="JMIR Biomed Eng",
year="2018",
month="Feb",
day="23",
volume="3",
number="1",
pages="e1",
keywords="biofeedback",
keywords="mobile phone",
keywords="app",
keywords="migraine",
keywords="pediatric",
abstract="Background: The use of wearables and mobile phone apps in medicine is gaining attention. Biofeedback has the potential to exploit the recent advances in mobile health (mHealth) for the treatment of headaches. Objectives: The aim of this study was to assess the validity of selected wireless wearable health monitoring sensors (WHMS) for measuring surface electromyography (SEMG) and peripheral skin temperature in combination with a mobile phone app. This proof of concept will form the basis for developing innovative mHealth delivery of biofeedback treatment among young persons with primary headache. Methods: Sensors fulfilling the following predefined criteria were identified: wireless, small size, low weight, low cost, and simple to use. These sensors were connected to an app and used by 20 healthy volunteers. Validity was assessed through the agreement with simultaneous control measurements made with stationary neurophysiological equipment. The main variables were (1) trapezius muscle tension during different degrees of voluntary contraction and (2) voluntary increase in finger temperature. Data were statistically analyzed using Bland-Altman plots, intraclass correlation coefficient (ICC), and concordance correlation coefficient (CCC). Results: The app was programmed to receive data from the wireless sensors, process them, and feed them back to the user through a simple interface. Excellent agreement was found for the temperature sensor regarding increase in temperature (CCC .90; 95\% CI 0.83-0.97). Excellent to fair agreement was found for the SEMG sensor. The ICC for the average of 3 repetitions during 4 different target levels ranged from .58 to .81. The wireless sensor showed consistency in muscle tension change during moderate muscle activity. Electrocardiography artifacts were avoided through right-sided use of the SEMG sensors. Participants evaluated the setup as usable and tolerable. Conclusions: This study confirmed the validity of wireless WHMS connected to a mobile phone for monitoring neurophysiological parameters of relevance for biofeedback therapy. ",
doi="10.2196/biomedeng.9062",
url="http://biomedeng.jmir.org/2018/1/e1/"
}


@Article{info:doi/10.2196/resprot.9168,
author="Miyamoto, Sheridan
and Dharmar, Madan
and Fazio, Sarina
and Tang-Feldman, Yajarayma
and Young, M. Heather",
title="mHealth Technology and Nurse Health Coaching to Improve Health in Diabetes: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2018",
month="Feb",
day="15",
volume="7",
number="2",
pages="e45",
keywords="randomized controlled trial",
keywords="study protocol",
keywords="mobile health",
keywords="health coaching",
keywords="motivational interviewing",
keywords="type 2 diabetes mellitus",
keywords="patient generated health data",
keywords="electronic health record",
keywords="patient engagement",
keywords="person-centered outcomes research",
abstract="Background: Chronic diseases, including diabetes mellitus, are the leading cause of mortality and disability in the United States. Current solutions focus primarily on diagnosis and pharmacological treatment, yet there is increasing evidence that patient-centered models of care are more successful in improving and addressing chronic disease outcomes. Objective: The objective of this clinical trial is to evaluate the impact of a mobile health (mHealth) enabled nurse health coaching intervention on self-efficacy among adults with type-2 diabetes mellitus. Methods: A randomized controlled trial was conducted at an academic health system in Northern California. A total of 300 participants with type-2 diabetes were scheduled to be enrolled through three primary care clinics. Participants were randomized to either usual care or intervention. All participants received training on use of the health system patient portal. Participants in the intervention arm received six scheduled health-coaching telephone calls with a registered nurse and were provided with an activity tracker and mobile application that integrated data into the electronic health record (EHR) to track their daily activity and health behavior decisions. All participants completed a baseline survey and follow-up surveys at 3 and 9 months. Primary and secondary outcomes include diabetes self-efficacy, hemoglobin A1c (HbA1c), and quality of life measures. Results: Data collection for this trial, funded by the Patient-Centered Outcomes Research Institute, will be completed by December 2017. Results from the trial will be available mid-2018. Conclusions: This protocol details a patient-centered intervention using nurse health coaching, mHealth technologies, and integration of patient-generated data into the EHR. The aim of the intervention is to enhance self-efficacy and health outcomes by providing participants with a mechanism to track daily activity by offering coaching support to set reasonable and attainable health goals, and by creating a complete feedback loop by bringing patient-generated data into the EHR. Trial Registration: ClinicalTrials.gov NCT02672176; https://clinicaltrials.gov/ct2/show/NCT02672176 (Archived by WebCite at http://www.webcitation.org/6xEQXe1M5) ",
doi="10.2196/resprot.9168",
url="http://www.researchprotocols.org/2018/2/e45/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29449200"
}


@Article{info:doi/10.2196/cardio.9000,
author="Baek, Hyunyoung
and Suh, Jung-Won
and Kang, Si-Hyuck
and Kang, Seungjin
and Lim, Ho Tae
and Hwang, Hee
and Yoo, Sooyoung",
title="Enhancing User Experience Through User Study: Design of an mHealth Tool for Self-Management and Care Engagement of Cardiovascular Disease Patients",
journal="JMIR Cardio",
year="2018",
month="Feb",
day="09",
volume="2",
number="1",
pages="e3",
keywords="cardiovascular disease",
keywords="mHealth",
keywords="mobile application",
keywords="app",
keywords="user-centered design",
abstract="Background: As patient communication, engagement, personal health data tracking, and up-to-date information became more efficient through mobile health (mHealth), cardiovascular diseases (CVD) and other diseases that require behavioral improvements in daily life are now capable of being managed and prevented more effectively. However, to increase patient engagement through mHealth, it is important for the initial design to consider functionality and usability factors and accurately assess user demands during the developmental process so that the app can be used continuously. Objective: The purpose of the study was to provide insightful information for developing mHealth service for patients with CVD based on user research to help enhance communication between patients and doctors. Methods: To drive the mobile functions and services needed to manage diseases in CVD patients, user research was conducted on patients and doctors at a tertiary general university hospital located in the Seoul metropolitan area of South Korea. Interviews and a survey were performed on patients (35 participants) and a focus group interview was conducted with doctors (5 participants). A mock-up mobile app was developed based on the user survey results, and a usability test was then conducted (8 participants) to identify factors that should be considered to improve usability. Results: The majority of patients showed a positive response in terms of their interest or intent to use an app for managing CVD. Functional features, such as communication with doctors, self-risk assessment, exercise, tailored education, blood pressure management, and health status recording had a score of 4.0 or higher on a 5-point Likert scale, showing that these functions were perceived to be useful to patients. The results of the mock-up usability test showed that inputting and visualizing blood pressure and other health conditions was required to be easier. The doctors requested a function that offered a comprehensive view of the patient's daily health status by linking the mHealth app data with the hospital's electronic health record system. Conclusions: Insights derived from a user study for developing an mHealth tool for CVD management, such as self-assessment and a communication channel between patients and doctors, may be helpful to improve patient engagement in care. ",
doi="10.2196/cardio.9000",
url="http://cardio.jmir.org/2018/1/e3/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31758783"
}


@Article{info:doi/10.2196/mhealth.8996,
author="Giunti, Guido
and Kool, Jan
and Rivera Romero, Octavio
and Dorronzoro Zubiete, Enrique",
title="Exploring the Specific Needs of Persons with Multiple Sclerosis for mHealth Solutions for Physical Activity: Mixed-Methods Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Feb",
day="09",
volume="6",
number="2",
pages="e37",
keywords="multiple sclerosis",
keywords="telemedicine",
keywords="fatigue",
keywords="mobile applications",
keywords="video games",
keywords="qualitative research",
keywords="exercise",
keywords="chronic disease",
abstract="Background: Multiple sclerosis (MS) is one of the world's most common neurologic disorders, with symptoms such as fatigue, cognitive problems, and issues with mobility. Evidence suggests that physical activity (PA) helps people with MS reduce fatigue and improve quality of life. The use of mobile technologies for health has grown in recent years with little involvement from relevant stakeholders. User-centered design (UCD) is a design philosophy with the goal of creating solutions specific to the needs and tasks of the intended users. UCD involves stakeholders early and often in the design process. In a preliminary study, we assessed the landscape of commercially available MS mobile health (mHealth) apps; to our knowledge, no study has explored what persons with MS and their formal care providers think of mHealth solutions for PA. Objective: The aim of this study was to (1) explore MS-specific needs for MS mHealth solutions for PA, (2) detect perceived obstacles and facilitators for mHealth solutions from persons with MS and health care professionals, and (3) understand the motivational aspects behind adoption of mHealth solutions for MS. Methods: A mixed-methods design study was conducted in Kliniken Valens, Switzerland, a clinic specializing in neurological rehabilitation. We explored persons with MS and health care professionals who work with them separately. The study had a qualitative part comprising focus groups and interviews, and a quantitative part with standardized tools such as satisfaction with life scale and electronic health (eHealth) literacy. Results: A total of 12 persons with relapsing-remitting MS and 12 health care professionals from different backgrounds participated in the study. Participants were well-educated with an even distribution between genders. Themes identified during analysis were MS-related barriers and facilitators, mHealth design considerations, and general motivational aspects. The insights generated were used to create MS personas for design purposes. Desired mHealth features were as follows: (1) activity tracking, (2) incentives for completing tasks and objectives, (3) customizable goal setting, (4) optional sociability, and (5) game-like attitude among others. Potential barriers to mHealth apps adoption were as follows: (1) rough on-boarding experiences, (2) lack of clear use benefits, and (3) disruption of the health care provider-patient relationship. Potential facilitators were identified: (1) endorsements from experts, (2) playfulness, and (3) tailored to specific persons with MS needs. A total of 4 MS personas were developed to provide designers and computer scientists means to help in the creation of future mHealth solutions for MS. Conclusions: mHealth solutions for increasing PA in persons with MS hold promise. Allowing for realistic goal setting and positive feedback, while minimizing usability burdens, seems to be critical for the adoption of such apps. Fatigue management is especially important in this population; more attention should be brought to this area. ",
doi="10.2196/mhealth.8996",
url="http://mhealth.jmir.org/2018/2/e37/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29426814"
}


@Article{info:doi/10.2196/diabetes.8357,
author="Bellfield, J. Edward
and Sharp, K. Lisa
and Xia, Yinglin
and Gerber, S. Ben",
title="Use of a Mobile App to Facilitate Blood Glucose Monitoring in Adolescents With Type 1 Diabetes: Single-Subject Nonrandomized Clinical Trial",
journal="JMIR Diabetes",
year="2018",
month="Feb",
day="07",
volume="3",
number="1",
pages="e3",
keywords="type 1 diabetes",
keywords="adolescence",
keywords="mobile health",
keywords="mHealth",
keywords="mobile phone",
abstract="Background: Cloud-based glucose monitoring programs allow users with diabetes to wirelessly synchronize their glucometers to their mobile phones. They also provide visualization and remote access of their data through its mobile app. There have been very few studies evaluating their effectiveness in managing diabetes among adolescents with type 1 diabetes (T1D). Objective: The purpose of this study was to assess the feasibility of using a mobile app to improve daily average blood glucose (BG) levels and increase BG monitoring frequency. Methods: We used an ABA single-subject prospective study design. We recruited five participants aged 13 to 17 years with uncontrolled T1D, glycated hemoglobin A1c 9.0\%-10.7\%, self-monitoring behavior of ?5 checks/day, and on multiple daily insulin injections. The study consisted of 4-week intervals of three phases: (1) phase A: usual glucose monitoring log (fax); (2) phase B: mobile app; and (3) phase A': second phase A. A certified diabetes educator and endocrinologist reviewed logs and provided recommendations weekly. Data were analyzed using a quasi-Poisson model to adjust for overdispersion among individual participants, and a generalized estimating equation model for overall intervention effect in aggregate. Results: For mean daily BG (mg/dL) levels, participant 1 had decreased values on the mobile app (298 to 281, P=.03) and maintained in phase A'. Participant 4 had an increase in mean daily BG in phase A' (175 to 185, P=.01), whereas participant 5 had a decrease in mean daily BG in phase A' (314 to 211, P=.04). For daily monitoring (checks/day), participant 3 increased in phase B (4.6 to 8.3, P=.01) and maintained in phase A'. Participant 5 also had increased daily monitoring at each phase (2.1 to 2.4, P=.01; 2.4 to 3.4, P=.02). For the five participants combined, the overall mean BG and BG checks per day in phase A were mean 254.8 (SD 99.2) and mean 3.6 (SD 2.0), respectively, mean 223.1 (SD 95.7) and mean 4.5 (SD 3.0) in phase B, and mean 197.5 (SD 81.3) and mean 3.7 (SD 2.1) in phase A'. Compared to phase A, mean glucose levels declined during phase B and remained lower during phase A' (P=.002). There was no overall change in BG checks by phase (P=.25). However, mean BG levels negatively correlated with daily BG checks (r=--.47, P<.001). Although all participants had positive opinions about the app, its utilization was highly variable. Conclusions: We demonstrated modest feasibility of adolescents with uncontrolled T1D utilizing a glucose monitoring mobile app. Further study is needed to better determine its effects on BG level and monitoring frequency. Psychosocial factors and motivational barriers likely influence adoption and continuous use of technology for diabetes management. ",
doi="10.2196/diabetes.8357",
url="http://diabetes.jmir.org/2018/1/e3/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30291085"
}


@Article{info:doi/10.2196/mhealth.9265,
author="Quinn, Connolly Charlene
and Butler, C. Erin
and Swasey, K. Krystal
and Shardell, D. Michelle
and Terrin, D. Michael
and Barr, A. Erik
and Gruber-Baldini, L. Ann",
title="Mobile Diabetes Intervention Study of Patient Engagement and Impact on Blood Glucose: Mixed Methods Analysis",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Feb",
day="02",
volume="6",
number="2",
pages="e31",
keywords="mobile health",
keywords="diabetes",
keywords="engagement",
keywords="randomized clinical trial",
keywords="qualitative",
keywords="digital health",
abstract="Background: Successful treatment of diabetes includes patient self-management behaviors to prevent or delay complications and comorbid diseases. On the basis of findings from large clinical trials and professional guidelines, diabetes education programs and health providers prescribe daily regimens of glucose monitoring, healthy eating, stress management, medication adherence, and physical activity. Consistent, long-term commitment to regimens is challenging. Mobile health is increasingly being used to assist patients with lifestyle changes and self-management behaviors between provider visits. The effectiveness of mobile health to improve diabetes outcomes depends on patient engagement with a technology, content, or interactions with providers. Objectives: In the current analysis, we aimed to identify patient engagement themes in diabetes messaging with diabetes providers and determine if differences in engagement in the Mobile Diabetes Intervention Study (MDIS) influenced changes in glycated hemoglobin A1c (HbA1c) over a 1-year treatment period (1.9\% absolute decrease in the parent study). Methods: In the primary MDIS study, 163 patients were enrolled into 1 of 3 mobile intervention groups or a usual care control group based on their physician cluster randomization assignment. The control group received care from their physicians as usual. Participants in each intervention group had access to a patient portal where they could record monitoring values for blood glucose, blood pressure, medication changes, or other self-management information while also assigned to varying levels of physician access to patient data. Intervention participants could choose to send and receive messages to assigned certified diabetes educators with questions or updates through the secure Web portal. For this secondary analysis, patient engagement was measured using qualitative methods to identify self-care themes in 4109 patient messages. Mixed methods were used to determine the impact of patient engagement on change in HbA1c over 1 year. Results: Self-care behavior themes that received the highest engagement for participants were glucose monitoring (75/107, 70.1\%), medication management (71/107, 66.4\%), and reducing risks (71/107, 66.4\%). The average number of messages sent per patient were highest for glucose monitoring (9.2, SD 14.0) and healthy eating (6.9, SD 13.2). Compared to sending no messages, sending any messages about glucose monitoring (P=.03) or medication (P=.01) led to a decrease in HbA1c of 0.62 and 0.72 percentage points, respectively. Sending any messages about healthy eating, glucose monitoring, or medication combined led to a decrease in HbA1c of 0.54 percentage points compared to not sending messages in these themes (P=.045). Conclusions: The findings from this study help validate the efficacy of the mobile diabetes intervention. The next step is to determine differences between patients who engage in mobile interventions and those who do not engage and identify methods to enhance patient engagement. Trial Registration: ClinicalTrials.gov: NCT01107015; https://clinicaltrials.gov/ct2/show/NCT01107015 (Archived by WebCite at http://www.webcitation.org/6wh4ekP4R) ",
doi="10.2196/mhealth.9265",
url="https://mhealth.jmir.org/2018/2/e31/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29396389"
}


@Article{info:doi/10.2196/mental.9041,
author="Hetrick, Elisabeth Sarah
and Robinson, Jo
and Burge, Eloise
and Blandon, Ryan
and Mobilio, Bianca
and Rice, M. Simon
and Simmons, B. Magenta
and Alvarez-Jimenez, Mario
and Goodrich, Simon
and Davey, G. Christopher",
title="Youth Codesign of a Mobile Phone App to Facilitate Self-Monitoring and Management of Mood Symptoms in Young People With Major Depression, Suicidal Ideation, and Self-Harm",
journal="JMIR Ment Health",
year="2018",
month="Jan",
day="23",
volume="5",
number="1",
pages="e9",
keywords="depression",
keywords="suicidal ideation",
keywords="suicide, attempted",
keywords="self-injurious behavior",
keywords="adolescent",
keywords="young adult",
keywords="cell phone",
abstract="Background: Effective treatment of depression in young people is critical, given its prevalence, impacts, and link to suicide. Clinical practice guidelines point to the need for regular monitoring of depression symptom severity and the emergence of suicidal ideation to track treatment progress and guide intervention delivery. Yet, this is seldom integrated in clinical practice. Objective: The objective of this study was to address the gap between guidelines about monitoring and real-world practice by codesigning an app with young people that allows for self-monitoring of mood and communication of this monitoring with a clinician. Methods: We engaged young people aged 18 to 25 years who had experienced depression, suicidal ideation including those who self-harm, as well as clinicians in a codesign process. We used a human-centered codesign design studio methodology where young people designed the features of the app first individually and then as a group. This resulted in a minimal viable product design, represented through low-fidelity hand-drawn wireframes. Clinicians were engaged throughout the process via focus groups. Results: The app incorporated a mood monitoring feature with innovative design aspects that allowed customization, and was named a ``well-being tracker'' in response to the need for a positive approach to this function. Brief personalized interventions designed to support young people in the intervals between face-to-face appointments were embedded in the app and were immediately available via pop-ups generated by a back-end algorithm within the well-being tracker. Issues regarding the safe incorporation of alerts generated by the app into face-to-face clinical services were raised by clinicians (ie, responding in a timely manner) and will need to be addressed during the full implementation of the app into clinical services. Conclusions: The potential to improve outcomes for young people via technology-based enhancement to interventions is enormous. Enhancing communication between young people and their clinicians about symptoms and treatment progress and increasing access to timely and evidence-based interventions are desirable outcomes. To achieve positive outcomes for young people using technology- (app) based interventions, it is critical to understand and incorporate, in a meaningful way, the expectations and motivations of both young people and clinicians. ",
doi="10.2196/mental.9041",
url="http://mental.jmir.org/2018/1/e9/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29362208"
}


@Article{info:doi/10.2196/mhealth.9179,
author="Waite-Jones, M. Jennifer
and Majeed-Ariss, Rabiya
and Smith, Joanna
and Stones, R. Simon
and Van Rooyen, Vanessa
and Swallow, Veronica",
title="Young People's, Parents', and Professionals' Views on Required Components of Mobile Apps to Support Self-Management of Juvenile Arthritis: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Jan",
day="19",
volume="6",
number="1",
pages="e25",
keywords="Adolescent",
keywords="young people",
keywords="juvenile arthritis",
keywords="mobile apps",
keywords="self-management",
keywords="qualitative research",
abstract="Background: There is growing evidence that supporting self-management of Juvenile Arthritis can benefit both patients and professionals. Young people with Juvenile Arthritis and their healthy peers increasingly use mobile technologies to access information and support in day-to-day life. Therefore, a user-led, rigorously developed and evaluated mobile app could be valuable for facilitating young people's self-management of Juvenile Arthritis. Objective: The objective of this study was to seek the views of young people with Juvenile Arthritis, their parents or carers, and health care professionals (HCPs) as to what should be included in a mobile app to facilitate young people's self-management of chronic Juvenile Arthritis. Methods: A qualitative approach was adopted with a purposeful sample of 9 young people aged 10-18 years with Juvenile Arthritis, 8 parents or carers, and 8 HCPs involved in their care. Data were gathered through semi-structured focus group and individual interviews with young people and their parents or carers and HCPs. Interview discussion was facilitated through demonstration of four existing health apps to explore participants' views on strengths and limitations of these, barriers and facilitators to mobile app use, preferred designs, functionality, levels of interaction, and data sharing arrangements. Data were analyzed using the framework approach. Results: Analysis revealed three interlinked, overarching themes: (1) purpose, (2) components and content, and (3) social support. Despite some differences in emphasis on essential content, general agreement was found between young people with Juvenile Arthritis their parents or carers, and professionals that a mobile app to aid self-management would be useful. Underpinning the themes was a prerequisite that young people are enabled to feel a sense of ownership and control of the app, and that it be an interactive, engaging resource that offers developmentally appropriate information and reminders, as well as enabling them to monitor their symptoms and access social support. Conclusions: Findings justify and pave the way for a future feasibility study into the production and preliminary testing of such an app. This would consider issues such as compatibility with existing technologies, costs, age, and cross-gender appeal as well as resource implications. ",
doi="10.2196/mhealth.9179",
url="http://mhealth.jmir.org/2018/1/e25/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29351898"
}


@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.9236,
author="Pustozerov, Evgenii
and Popova, Polina
and Tkachuk, Aleksandra
and Bolotko, Yana
and Yuldashev, Zafar
and Grineva, Elena",
title="Development and Evaluation of a Mobile Personalized Blood Glucose Prediction System for Patients With Gestational Diabetes Mellitus",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Jan",
day="09",
volume="6",
number="1",
pages="e6",
keywords="blood glucose prediction",
keywords="mHealth",
keywords="gestational diabetes mellitus",
keywords="recommender system",
keywords="personalized medicine",
keywords="mobile app",
abstract="Background: Personalized blood glucose (BG) prediction for diabetes patients is an important goal that is pursued by many researchers worldwide. Despite many proposals, only a few projects are dedicated to the development of complete recommender system infrastructures that incorporate BG prediction algorithms for diabetes patients. The development and implementation of such a system aided by mobile technology is of particular interest to patients with gestational diabetes mellitus (GDM), especially considering the significant importance of quickly achieving adequate BG control for these patients in a short period (ie, during pregnancy) and a typically higher acceptance rate for mobile health (mHealth) solutions for short- to midterm usage. Objective: This study was conducted with the objective of developing infrastructure comprising data processing algorithms, BG prediction models, and an appropriate mobile app for patients' electronic record management to guide BG prediction-based personalized recommendations for patients with GDM. Methods: A mobile app for electronic diary management was developed along with data exchange and continuous BG signal processing software. Both components were coupled to obtain the necessary data for use in the personalized BG prediction system. Necessary data on meals, BG measurements, and other events were collected via the implemented mobile app and continuous glucose monitoring (CGM) system processing software. These data were used to tune and evaluate the BG prediction model, which included an algorithm for dynamic coefficients tuning. In the clinical study, 62 participants (GDM: n=49; control: n=13) took part in a 1-week monitoring trial during which they used the mobile app to track their meals and self-measurements of BG and CGM system for continuous BG monitoring. The data on 909 food intakes and corresponding postprandial BG curves as well as the set of patients' characteristics (eg, glycated hemoglobin, body mass index [BMI], age, and lifestyle parameters) were selected as inputs for the BG prediction models. Results: The prediction results by the models for BG levels 1 hour after food intake were root mean square error=0.87 mmol/L, mean absolute error=0.69 mmol/L, and mean absolute percentage error=12.8\%, which correspond to an adequate prediction accuracy for BG control decisions. Conclusions: The mobile app for the collection and processing of relevant data, appropriate software for CGM system signals processing, and BG prediction models were developed for a recommender system. The developed system may help improve BG control in patients with GDM; this will be the subject of evaluation in a subsequent study. ",
doi="10.2196/mhealth.9236",
url="http://mhealth.jmir.org/2018/1/e6/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29317385"
}


@Article{info:doi/10.2196/humanfactors.8246,
author="Bosak, Kelly
and Park, Hye Shin",
title="Characteristics of Adults Seeking Health Care Provider Support Facilitated by Mobile Technology: Secondary Data Analysis",
journal="JMIR Hum Factors",
year="2017",
month="Dec",
day="21",
volume="4",
number="4",
pages="e33",
keywords="health technology",
keywords="health behavior",
keywords="health care provider",
keywords="cohort analysis",
abstract="Background: Mobile health technology is rapidly evolving with the potential to transform health care. Self-management of health facilitated by mobile technology can maximize long-term health trajectories of adults. Little is known about the characteristics of adults seeking Web-based support from health care providers facilitated by mobile technology. Objective: This study aimed to examine the following: (1) the characteristics of adults who seek human support from health care providers for health concerns using mobile technology rather than from family members and friends or others with similar health conditions and (2) the use of mobile health technology among adults with chronic health conditions. Findings of this study were interpreted in the context of the Efficiency Model of Support. Methods: We first described characteristics of adults seeking Web-based support from health care providers. Using chi-square tests for categorical variables and t test for the continuous variable of age, we compared adults seeking Web-based and conventional support by demographics. The primary aim was analyzed using multivariate logistic regression to examine whether chronic health conditions and demographic factors (eg, sex, income, employment status, race, ethnicity, education, and age) were associated with seeking Web-based support from health care providers. Results: The sample included adults (N=1453), the majority of whom were female 57.60\% (837/1453), white 75.02\% (1090/1453), and non-Hispanic 89.13\% (1295/1453). The age of the participants ranged from 18 to 92 years (mean 48.6, standard deviation [SD] 16.8). The majority 76.05\% (1105/1453) of participants reported college or higher level of education. A disparity was found in access to health care providers via mobile technology based on socioeconomic status. Adults with annual income of US \$30,000 to US \$100,000 were 1.72 times more likely to use Web-based methods to contact a health care provider, and adults with an annual income above US \$100,000 were 2.41 to 2.46 times more likely to access health care provider support on the Web, compared with those with an annual income below US \$30,000. After adjusting for other demographic covariates and chronic conditions, age was not a significant factor in Web-based support seeking. Conclusions: In this study, the likelihood of seeking Web-based support increased when adults had any or multiple chronic health conditions. A higher level of income and education than the general population was found to be related to the use of mobile health technology among adults in this survey. Future study is needed to better understand the disparity in Web-based support seeking for health issues and the clinicians' role in promoting access to and use of mobile health technology. ",
doi="10.2196/humanfactors.8246",
url="http://humanfactors.jmir.org/2017/4/e33/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29269337"
}


@Article{info:doi/10.2196/jmir.9046,
author="Low, A. Carissa
and Dey, K. Anind
and Ferreira, Denzil
and Kamarck, Thomas
and Sun, Weijing
and Bae, Sangwon
and Doryab, Afsaneh",
title="Estimation of Symptom Severity During Chemotherapy From Passively Sensed Data: Exploratory Study",
journal="J Med Internet Res",
year="2017",
month="Dec",
day="19",
volume="19",
number="12",
pages="e420",
keywords="patient reported outcome measures",
keywords="cancer",
keywords="mobile health",
abstract="Background: Physical and psychological symptoms are common during chemotherapy in cancer patients, and real-time monitoring of these symptoms can improve patient outcomes. Sensors embedded in mobile phones and wearable activity trackers could be potentially useful in monitoring symptoms passively, with minimal patient burden. Objective: The aim of this study was to explore whether passively sensed mobile phone and Fitbit data could be used to estimate daily symptom burden during chemotherapy. Methods: A total of 14 patients undergoing chemotherapy for gastrointestinal cancer participated in the 4-week study. Participants carried an Android phone and wore a Fitbit device for the duration of the study and also completed daily severity ratings of 12 common symptoms. Symptom severity ratings were summed to create a total symptom burden score for each day, and ratings were centered on individual patient means and categorized into low, average, and high symptom burden days. Day-level features were extracted from raw mobile phone sensor and Fitbit data and included features reflecting mobility and activity, sleep, phone usage (eg, duration of interaction with phone and apps), and communication (eg, number of incoming and outgoing calls and messages). We used a rotation random forests classifier with cross-validation and resampling with replacement to evaluate population and individual model performance and correlation-based feature subset selection to select nonredundant features with the best predictive ability. Results: Across 295 days of data with both symptom and sensor data, a number of mobile phone and Fitbit features were correlated with patient-reported symptom burden scores. We achieved an accuracy of 88.1\% for our population model. The subset of features with the best accuracy included sedentary behavior as the most frequent activity, fewer minutes in light physical activity, less variable and average acceleration of the phone, and longer screen-on time and interactions with apps on the phone. Mobile phone features had better predictive ability than Fitbit features. Accuracy of individual models ranged from 78.1\% to 100\% (mean 88.4\%), and subsets of relevant features varied across participants. Conclusions: Passive sensor data, including mobile phone accelerometer and usage and Fitbit-assessed activity and sleep, were related to daily symptom burden during chemotherapy. These findings highlight opportunities for long-term monitoring of cancer patients during chemotherapy with minimal patient burden as well as real-time adaptive interventions aimed at early management of worsening or severe symptoms. ",
doi="10.2196/jmir.9046",
url="http://www.jmir.org/2017/12/e420/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29258977"
}


@Article{info:doi/10.2196/mhealth.8549,
author="Xie, Bo
and Su, Zhaohui
and Zhang, Wenhui
and Cai, Run",
title="Chinese Cardiovascular Disease Mobile Apps' Information Types, Information Quality, and Interactive Functions for Self-Management: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Dec",
day="14",
volume="5",
number="12",
pages="e195",
keywords="mobile health",
keywords="mHealth",
keywords="cardiovascular disease",
keywords="CVD",
keywords="patient preferences",
keywords="information quality",
keywords="self-management",
keywords="mobile applications",
keywords="mobile apps",
keywords="China",
abstract="Background: China has a large population with cardiovascular disease (CVD) that requires extensive self-management. Mobile health (mHealth) apps may be a useful tool for CVD self-management. Little is currently known about the types and quality of health information provided in Chinese CVD mobile apps and whether app functions are conducive to promoting CVD self-management. Objective: We undertook a systematic review to evaluate the types and quality of health information provided in Chinese CVD mobile apps and interactive app functions for promoting CVD self-management. Methods: Mobile apps targeting end users in China with CVD conditions were selected in February 2017 through a multi-stage process. Three frameworks were used to evaluate the selected apps: (1) types of health information offered were assessed using our Health Information Wants framework, which encompasses 7 types of information; (2) quality of information provided in the apps was assessed using the 11 guidelines recommended by the National Library of Medicine of the National Institutes of Health; and (3) types of interactive app functions for CVD self-management were assessed using a 15-item framework adapted from the literature, including our own prior work. Results: Of 578 apps identified, 82 were eligible for final review. Among these, information about self-care (67/82, 82\%) and information specifically regarding CVD (63/82, 77\%) were the most common types of information provided, while information about health care providers (22/82, 27\%) and laboratory tests (5/82, 6\%) were least common. The most common indicators of information quality were the revealing of apps' providers (82/82, 100\%) and purpose (82/82, 100\%), while the least common quality indicators were the revealing of how apps' information was selected (1/82, 1\%) and app sponsorship (0/82, 0\%). The most common interactive functions for CVD self-management were those that enabled user interaction with the app provider (57/82, 70\%) and with health care providers (36/82, 44\%), while the least common interactive functions were those that enabled lifestyle management (13/82, 16\%) and psychological health management (6/82, 7\%). None of the apps covered all 7 types of health information, all 11 indicators of information quality, or all 15 interactive functions for CVD self-management. Conclusions: Chinese CVD apps are insufficient in providing comprehensive health information, high-quality information, and interactive functions to facilitate CVD self-management. End users should exercise caution when using existing apps. Health care professionals and app developers should collaborate to better understand end users' preferences and follow evidence-based guidelines to develop mHealth apps conducive to CVD self-management. ",
doi="10.2196/mhealth.8549",
url="http://mhealth.jmir.org/2017/12/e195/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29242176"
}


@Article{info:doi/10.2196/cardio.8543,
author="Magnani, W. Jared
and Schlusser, L. Courtney
and Kimani, Everlyne
and Rollman, L. Bruce
and Paasche-Orlow, K. Michael
and Bickmore, W. Timothy",
title="The Atrial Fibrillation Health Literacy Information Technology System: Pilot Assessment",
journal="JMIR Cardio",
year="2017",
month="Dec",
day="12",
volume="1",
number="2",
pages="e7",
keywords="atrial fibrillation",
keywords="mHealth",
keywords="health-related quality of life",
keywords="medication adherence",
abstract="Background: Atrial fibrillation (AF) is a highly prevalent heart rhythm condition that has significant associated morbidity and requires chronic treatment. Mobile health (mHealth) technologies have the potential to enhance multiple aspects of AF care, including education, monitoring of symptoms, and encouraging and tracking medication adherence. We have previously implemented and tested relational agents to improve outcomes in chronic disease and sought to develop a smartphone-based relational agent for improving patient-centered outcomes in AF. Objective: The objective of this study was to pilot a smartphone-based relational agent as preparation for a randomized clinical trial, the Atrial Fibrillation Health Literacy Information Technology Trial (AF-LITT). Methods: We developed the relational agent for use by a smartphone consistent with our prior approaches. We programmed the relational agent as a computer-animated agent to simulate a face-to-face conversation and to serve as a health counselor or coach specific to AF. Relational agent's dialogue content, informed by a review of literature, focused on patient-centered domains and qualitative interviews with patients with AF, encompassed AF education, common symptoms, adherence challenges, and patient activation. We established that the content was accessible to individuals with limited health or computer literacy. Relational agent content coordinated with use of the smartphone AliveCor Kardia heart rate and rhythm monitor. Participants (N=31) were recruited as a convenience cohort from ambulatory clinical sites and instructed to use the relational agent and Kardia for 30 days. We collected demographic, social, and clinical characteristics and conducted baseline and 30-day assessments of health-related quality of life (HRQoL) with the Atrial Fibrillation Effect on Quality of life (AFEQT) measure; self-reported medication adherence with the Morisky 8-item Medication Adherence Scale (MMAS-8); and patient activation with the Patient Activation Measure (PAM). Results: Participants (mean age 68 [SD 11]; 39\% [12/31] women) used the relational agent for an average 17.8 (SD 10.0) days. The mean number of independent log-ins was 19.6 (SD 10.7), with a median of 20 times over 30 days. The mean number of Kardia uses was 26.5 (SD 5.9), and participants using Kardia were in AF for 14.3 (SD 11.0) days. AFEQT scores improved significantly from 64.5 (SD 22.9) at baseline to 76.3 (SD 19.4) units at 30 days (P<.01). We observed marginal but statistically significant improvement in self-reported medication adherence (baseline: 7.3 [SD 0.9], 30 days: 7.7 [SD 0.5]; P=.01). Assessments of acceptability identified that most of the participants found the relational agent useful, informative, and trustworthy. Conclusions: We piloted a 30-day smartphone-based intervention that combined a relational agent with dedicated content for AF alongside Kardia heart rate and rhythm monitoring. Pilot participants had favorable improvements in HRQoL and self-reported medication adherence, as well as positive responses to the intervention. These data will guide a larger, enhanced randomized trial implementing the smartphone relational agent and the Kardia monitor system. ",
doi="10.2196/cardio.8543",
url="http://cardio.jmir.org/2017/2/e7/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29473644"
}


@Article{info:doi/10.2196/diabetes.8156,
author="Bender, S. Melinda
and Cooper, A. Bruce
and Park, G. Linda
and Padash, Sara
and Arai, Shoshana",
title="A Feasible and Efficacious Mobile-Phone Based Lifestyle Intervention for Filipino Americans with Type 2 Diabetes: Randomized Controlled Trial",
journal="JMIR Diabetes",
year="2017",
month="Dec",
day="12",
volume="2",
number="2",
pages="e30",
keywords="randomized controlled trial",
keywords="mobile health",
keywords="Filipino American",
keywords="type 2 diabetes",
keywords="weight loss",
keywords="physical activity",
keywords="diet",
abstract="Background: Filipino Americans have a high prevalence of obesity, type 2 diabetes (T2D), and cardiovascular disease compared with other Asian American subgroups and non-Hispanic whites. Mobile health (mHealth) weight loss interventions can reduce chronic disease risks, but these are untested in Filipino Americans with T2D. Objective: The objective of this study was to assess feasibility and potential efficacy of a pilot, randomized controlled trial (RCT) of a culturally adapted mHealth weight loss lifestyle intervention (Pilipino Americans Go4Health [PilAm Go4Health]) for overweight Filipino Americans with T2D. Methods: This was a 2-arm pilot RCT of the 3-month PilAm Go4Health intervention (phase 1) with an active waitlist control and 3-month follow-up (phase 2). The waitlist control received the PilAm Go4Health in phase 2, whereas the intervention group transitioned to the 3-month follow-up. PilAm Go4Health incorporated a Fitbit accelerometer, mobile app with diary for health behavior tracking (steps, food/calories, and weight), and social media (Facebook) for virtual social support, including 7 in-person monthly meetings. Filipino American adults ?18 years with T2D were recruited from Northern California. Feasibility was measured by rates of recruitment, engagement, and retention. Multilevel regression analyses assessed within and between group differences for the secondary outcome of percent weight change and other outcomes of weight (kg), body mass index (BMI), waist circumference, fasting plasma glucose, HbA1c, and steps. Results: A total of 45 Filipino American adults were enrolled and randomized. Mean age was 58 (SD 10) years, 62\% (28/45) were women, and mean BMI was 30.1 (SD 4.6). Participant retention and study completion were 100\%, with both the intervention and waitlist group achieving near-perfect attendance at all 7 intervention office visits. Groups receiving the PilAm Go4Health in phase 1 (intervention group) and phase 2 (waitlist group) had significantly greater weight loss, ?2.6\% (?3.9 to ?1.4) and ?3.3\% (?1.8 to ?4.8), respectively, compared with the nonintervention group, resulting in a moderate to small effect sizes (d=0.53 and 0.37, respectively). In phase 1, 18\% (4/22) of the intervention group achieved a 5\% weight loss, whereas 82\% (18/22) maintained or lost 2\% to 5\% of their weight and continued to maintain this weight loss in the 3-month follow-up. Other health outcomes, including waist circumference, BMI, and step counts, improved when each arm received the PilAm Go4Health, but the fasting glucose and HbA1c outcomes were mixed. Conclusions: The PilAm Go4Health was feasible and demonstrated potential efficacy in reducing diabetes risks in overweight Filipino Americans with T2D. This study supports the use of mHealth and other promising intervention strategies to reduce obesity and diabetes risks in Filipino Americans. Further testing in a full-scale RCT is warranted. These findings may support intervention translation to reduce diabetes risks in other at-risk diverse populations. Trial Registration: Clinicaltrials.gov NCT02290184; https://clinicaltrials.gov/ct2/show/NCT02290184 (Archived by WebCite at http://www.webcitation.org/6vDfrvIPp) ",
doi="10.2196/diabetes.8156",
url="http://diabetes.jmir.org/2017/2/e30/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30291068"
}


@Article{info:doi/10.2196/jmir.8888,
author="Slater, Helen
and Campbell, M. Jared
and Stinson, N. Jennifer
and Burley, M. Megan
and Briggs, M. Andrew",
title="End User and Implementer Experiences of mHealth Technologies for Noncommunicable Chronic Disease Management in Young Adults: Systematic Review",
journal="J Med Internet Res",
year="2017",
month="Dec",
day="12",
volume="19",
number="12",
pages="e406",
keywords="musculoskeletal pain",
keywords="health services research",
keywords="telemedicine",
keywords="noncommunicable disease",
keywords="chronic disease",
keywords="health policy",
abstract="Background: Chronic noncommunicable diseases (NCDs) such as asthma, diabetes, cancer, and persistent musculoskeletal pain impose an escalating and unsustainable burden on young people, their families, and society. Exploring how mobile health (mHealth) technologies can support management for young people with NCDs is imperative. Objective: The aim of this study was to identify, appraise, and synthesize available qualitative evidence on users' experiences of mHealth technologies for NCD management in young people. We explored the perspectives of both end users (young people) and implementers (health policy makers, clinicians, and researchers). Methods: A systematic review and meta-synthesis of qualitative studies. Eligibility criteria included full reports published in peer-reviewed journals from January 2007 to December 2016, searched across databases including EMBASE, MEDLINE (PubMed), Scopus, and PsycINFO. All qualitative studies that evaluated the use of mHealth technologies to support young people (in the age range of 15-24 years) in managing their chronic NCDs were considered. Two independent reviewers identified eligible reports and conducted critical appraisal (based on the Joanna Briggs Institute Qualitative Assessment and Review Instrument: JBI-QARI). Three reviewers independently, then collaboratively, synthesized and interpreted data through an inductive and iterative process to derive emergent themes across the included data. External validity checking was undertaken by an expert clinical researcher and for relevant content, a health policy expert. Themes were subsequently subjected to a meta-synthesis, with findings compared and contrasted between user groups and policy and practice recommendations derived. Results: Twelve studies met our inclusion criteria. Among studies of end users (N=7), mHealth technologies supported the management of young people with diabetes, cancer, and asthma. Implementer studies (N=5) covered the management of cognitive and communicative disabilities, asthma, chronic self-harm, and attention deficit hyperactivity disorder. Quality ratings were higher for implementer compared with end user studies. Both complementary and unique user themes emerged. Themes derived for end users of mHealth included (1) Experiences of functionality that supported self-management, (2) Acceptance (technical usability and feasibility), (3) Importance of codesign, and (4) Perceptions of benefit (self-efficacy and empowerment). For implementers, derived themes included (1) Characteristics that supported self-management (functional, technical, and behavior change); (2) Implementation challenges (systems level, service delivery level, and clinical level); (3) Adoption considerations for specific populations (training end users; specific design requirements); and (4) Codesign and tailoring to facilitate uptake and person-centered care. Conclusions: Synthesizing available data revealed both complementary and unique user perspectives on enablers and barriers to designing, developing, and implementing mHealth technologies to support young people's management of their chronic NCDs. Trial Registration: PROSPERO CRD42017056317; http://www.crd.york.ac.uk/PROSPERO/display\_record.asp?ID=CRD 42017056317 (Archived by WebCite at http://www.webcitation.org/6vZ5UkKLp) ",
doi="10.2196/jmir.8888",
url="http://www.jmir.org/2017/12/e406/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29233804"
}


@Article{info:doi/10.2196/mhealth.8624,
author="V{\"a}lim{\"a}ki, Maritta
and Anttila, Katriina
and Anttila, Minna
and Lahti, Mari",
title="Web-Based Interventions Supporting Adolescents and Young People With Depressive Symptoms: Systematic Review and Meta-Analysis",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Dec",
day="08",
volume="5",
number="12",
pages="e180",
keywords="Internet",
keywords="adolescent",
keywords="depression",
keywords="meta-analysis",
keywords="information and communication technology",
keywords="intervention",
keywords="systematic review",
keywords="treatment as usual",
abstract="Background: Although previous studies on information and communication technology (ICT)--based intervention on mental health among adolescents with depressive symptoms have already been combined in a number of systematic reviews, coherent information is still missing about interventions used, participants' engagement of these interventions, and how these interventions work. Objective: We conducted a systematic review and meta-analysis of trials to describe the effectiveness of Web-based interventions to support adolescents with depression or depressive symptoms, anxiety, and stress. We also explored the content of the interventions, as there has previously been a lack of coherent understanding of the detailed content of the Web-based interventions for these purposes. Methods: We included parallel randomized controlled trials targeted at adolescents, or young people in the age range of 10 and 24 years, with symptoms or diagnoses of depression and anxiety. The interventions were from original studies aimed to support mental health among adolescents, and they were delivered via Web-based information and communication technology. Results: Out of 2087 records identified, 27 papers (22 studies) met the inclusion criteria. On the basis of a narrative analysis of 22 studies, a variety of Web-based interventions were found; the most commonly used intervention was based on cognitive behavioral therapy. Meta-analysis was further conducted with 15 studies (4979 participants). At the end of the intervention, a statistically significant improvement was found in the intervention group (10 studies) regarding depressive symptoms (P=.02, median 1.68, 95\% CI 3.11-0.25) and after 6 months (3 studies; P=.01, median 1.78, 95\% CI 3.20-0.37). Anxiety symptoms (8 studies; P<.001, median 1.47, 95\% CI 2.36-0.59) and moods and feelings (2 studies; P=.04, median 5.55, 95\% CI 10.88-0.22) improved as well in the Web-based intervention group, but there was no difference in stress scores. However, adolescents in the intervention group left the study early more often, both in short-term studies (11 studies; P=.007, median 1.31, 95\% CI 1.08-1.58) and mid-term studies (3 studies; P=.02, median 1.65, 95\% CI 1.09-2.49). We did not find any studies that had assessed the costs of the Web-based interventions. Conclusions: Despite widely reported promises that information technology use is beneficial to adolescents with depression, the results of our review show only short-term effects on adolescents' mental well-being, whereas long-term effects remain questionable because of the limited number of studies reviewed. Information about the economic benefits of Web-based interventions is still lacking. The quality of the studies, especially biases related to attrition rates and selective reporting, still needs serious attention. ",
doi="10.2196/mhealth.8624",
url="http://mhealth.jmir.org/2017/12/e180/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29222079"
}


@Article{info:doi/10.2196/mhealth.8910,
author="Quinn, C. Charlene
and Swasey, K. Krystal
and Crabbe, F. J. Christopher
and Shardell, D. Michelle
and Terrin, L. Michael
and Barr, A. Erik
and Gruber-Baldini, L. Ann",
title="The Impact of a Mobile Diabetes Health Intervention on Diabetes Distress and Depression Among Adults: Secondary Analysis of a Cluster Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Dec",
day="07",
volume="5",
number="12",
pages="e183",
keywords="diabetes distress",
keywords="mobile health",
keywords="depression",
keywords="diabetes",
keywords="Diabetes Distress Scale",
keywords="Patient Health Questionnaire",
keywords="women",
keywords="emotional well-being",
abstract="Background: Diabetes is a complex, demanding disease that requires the constant attention of patients. The burden of self-management, including different medication regimens, routine self-care activities, and provider visits, has an impact on patients' emotional well-being. Diabetes distress and depression are two important components of emotional well-being that may negatively affect diabetes outcomes. Objective: The aim was to determine the impact of the 1-year Mobile Diabetes Intervention Study cluster randomized clinical trial on emotional well-being measured by diabetes distress and depression among adults with type 2 diabetes (T2D). Methods: A total of 163 adults with not-well-managed T2D were enrolled from community primary care practices. Primary care practices were cluster randomized into either a usual care control group or intervention group. Intervention participants were given a mobile phone with coaching software including a Web portal to communicate with providers. A priori established secondary outcomes included distress measured by the Diabetes Distress Scale (DDS), with subscales measuring emotional burden, interpersonal distress, physician-related distress, and regimen-related distress, as well as depression measured by the Patient Health Questionnaire (PHQ-9). Linear mixed models were used to calculate the effect of the intervention on diabetes distress levels over time, both overall and separately by sex, and to determine if the intervention affected distress or depression. The impact of total DDS on changes in HbA1c was also studied. Results: There were no significant treatment group effects for DDS total (baseline: P=.07; differences over time: P=.38) or for depression (P=.06 over time). Significant declines in total DDS were observed over the 12-month intervention period (P=.01). Regimen-related distress significantly decreased for all study participants (P<.001), but no significant change over time was observed for emotional burden (P=.83), interpersonal distress (P=.64), or physician-related distress (P=.73). Women in both the usual care and intervention groups were more likely to have higher overall DDS, emotional burden, physician-related distress, and regimen-related distress, but not interpersonal distress. Women also reported higher baseline depression compared to men (P=.006). Overall, depression decreased over the treatment period (P=.007), but remained unaffected by group assignment (P=.06) or by sex (P=.97). Diabetes distress had no effect on the change in HbA1c (P=.91) over the treatment period. Conclusions: Although we found no definitive overall or sex-specific effect of the intervention on diabetes distress or depression, this study makes an important contribution to the understanding of mobile health interventions and the impact on emotional health. Our study verified previous work that although diabetes distress and depression are highly correlated, these measures are not evaluating the same construct. Design of future mobile technology provides an opportunity to personalize, contextualize, and intervene in the emotional well-being of persons with diabetes. Trial Registration: Clinicaltrials.gov NCT01107015; https://clinicaltrials.gov/ct2/show/NCT01107015 (Archived by WebCite at http://www.webcitation.org/6vVgRCLAF) ",
doi="10.2196/mhealth.8910",
url="http://mhealth.jmir.org/2017/12/e183/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29217502"
}


@Article{info:doi/10.2196/mhealth.7886,
author="Dou, Kaili
and Yu, Ping
and Deng, Ning
and Liu, Fang
and Guan, YingPing
and Li, Zhenye
and Ji, Yumeng
and Du, Ningkai
and Lu, Xudong
and Duan, Huilong",
title="Patients' Acceptance of Smartphone Health Technology for Chronic Disease Management: A Theoretical Model and Empirical Test",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Dec",
day="06",
volume="5",
number="12",
pages="e177",
keywords="smartphone",
keywords="mobile health",
keywords="patients",
keywords="hypertension",
keywords="chronic disease",
keywords="disease management",
abstract="Background: Chronic disease patients often face multiple challenges from difficult comorbidities. Smartphone health technology can be used to help them manage their conditions only if they accept and use the technology. Objective: The aim of this study was to develop and test a theoretical model to predict and explain the factors influencing patients' acceptance of smartphone health technology for chronic disease management. Methods: Multiple theories and factors that may influence patients' acceptance of smartphone health technology have been reviewed. A hybrid theoretical model was built based on the technology acceptance model, dual-factor model, health belief model, and the factors identified from interviews that might influence patients' acceptance of smartphone health technology for chronic disease management. Data were collected from patient questionnaire surveys and computer log records about 157 hypertensive patients' actual use of a smartphone health app. The partial least square method was used to test the theoretical model. Results: The model accounted for .412 of the variance in patients' intention to adopt the smartphone health technology. Intention to use accounted for .111 of the variance in actual use and had a significant weak relationship with the latter. Perceived ease of use was affected by patients' smartphone usage experience, relationship with doctor, and self-efficacy. Although without a significant effect on intention to use, perceived ease of use had a significant positive influence on perceived usefulness. Relationship with doctor and perceived health threat had significant positive effects on perceived usefulness, countering the negative influence of resistance to change. Perceived usefulness, perceived health threat, and resistance to change significantly predicted patients' intentions to use the technology. Age and gender had no significant influence on patients' acceptance of smartphone technology. The study also confirmed the positive relationship between intention to use and actual use of smartphone health apps for chronic disease management. Conclusions: This study developed a theoretical model to predict patients' acceptance of smartphone health technology for chronic disease management. Although resistance to change is a significant barrier to technology acceptance, careful management of doctor-patient relationship, and raising patients' awareness of the negative effect of chronic disease can negate the effect of resistance and encourage acceptance and use of smartphone health technology to support chronic disease management for patients in the community. ",
doi="10.2196/mhealth.7886",
url="https://mhealth.jmir.org/2017/12/e177/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29212629"
}


@Article{info:doi/10.2196/mhealth.8741,
author="Rincon, Esther
and Monteiro-Guerra, Francisco
and Rivera-Romero, Octavio
and Dorronzoro-Zubiete, Enrique
and Sanchez-Bocanegra, Luis Carlos
and Gabarron, Elia",
title="Mobile Phone Apps for Quality of Life and Well-Being Assessment in Breast and Prostate Cancer Patients: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Dec",
day="04",
volume="5",
number="12",
pages="e187",
keywords="cancer",
keywords="mHealth",
keywords="app",
keywords="mobile phone",
keywords="quality of life",
keywords="well-being",
abstract="Background: Mobile phone health apps are increasingly gaining attention in oncological care as potential tools for supporting cancer patients. Although the number of publications and health apps focusing on cancer is increasing, there are still few specifically designed for the most prevalent cancers diagnosed: breast and prostate cancers. There is a need to review the effect of these apps on breast and prostate cancer patients' quality of life (QoL) and well-being. Objective: The purposes of this study were to review the scientific literature on mobile phone apps targeting breast or prostate cancer patients and involving QoL and well-being (anxiety and depression symptoms) and analyze the clinical and technological characteristics, strengths, and weaknesses of these apps, as well as patients' user experience with them. Methods: We conducted a systematic review of peer-reviewed literature from The Cochrane Library, Excerpta Medica Database, PsycINFO, PubMed, Scopus, and MEDLINE to identify studies involving apps focused on breast and/or prostate cancer patients and QoL and/or well-being published between January 1, 2000, and July 12, 2017. Only trial studies which met the inclusion criteria were selected. The systematic review was completed with a critical analysis of the apps previously identified in the health literature research that were available from the official app stores. Results: The systematic review of the literature yielded 3862 articles. After removal of duplicates, 3229 remained and were evaluated on the basis of title and abstract. Of these, 3211 were discarded as not meeting the inclusion criteria, and 18 records were selected for full text screening. Finally, 5 citations were included in this review, with a total of 644 patients, mean age 52.16 years. Four studies targeted breast cancer patients and 1 focused on prostate cancer patients. Four studies referred to apps that assessed QoL. Only 1 among the 5 analyzed apps was available from the official app store. In 3 studies, an app-related intervention was carried out, and 2 of them reported an improvement on QoL. The lengths of the app-related interventions varied from 4 to 12 weeks. Because 2 of the studies only tracked use of the app, no effect on QoL or well-being was found. Conclusions: Despite the existence of hundreds of studies involving cancer-focused mobile phone apps, there is a lack of rigorous trials regarding the QoL and/or well-being assessment in breast and/or prostate cancer patients. A strong and collective effort should be made by all health care providers to determine those cancer-focused apps that effectively represent useful, accurate, and reliable tools for cancer patients' disease management. Trial Registration: PROSPERO CRD42017073069; https://www.crd.york.ac.uk/PROSPERO/display\_record.asp?ID= CRD42017073069 (Archived by WebCite at http://www.webcitation.org/6v38Clb9T) ",
doi="10.2196/mhealth.8741",
url="http://mhealth.jmir.org/2017/12/e187/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29203459"
}


@Article{info:doi/10.2196/mhealth.8781,
author="Osborn, Y. Chandra
and van Ginkel, R. Joost
and Marrero, G. David
and Rodbard, David
and Huddleston, Brian
and Dachis, Jeff",
title="One Drop | Mobile on iPhone and Apple Watch: An Evaluation of HbA1c Improvement Associated With Tracking Self-Care",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Nov",
day="29",
volume="5",
number="11",
pages="e179",
keywords="type 1 diabetes",
keywords="type 2 diabetes",
keywords="mobile health",
keywords="mobile phone",
keywords="smartwatch",
keywords="glycated hemoglobin A1c",
keywords="HbA1c",
keywords="glycemic control",
keywords="self-care behavior",
abstract="Background: The One Drop | Mobile app supports manual and passive (via HealthKit and One Drop's glucose meter) tracking of self-care and glycated hemoglobin A1c (HbA1c). Objective: We assessed the HbA1c change of a sample of people with type 1 diabetes (T1D) or type 2 diabetes (T2D) using the One Drop | Mobile app on iPhone and Apple Watch, and tested relationships between self-care tracking with the app and HbA1c change. Methods: In June 2017, we identified people with diabetes using the One Drop | Mobile app on iPhone and Apple Watch who entered two HbA1c measurements in the app 60 to 365 days apart. We assessed the relationship between using the app and HbA1c change. Results: Users had T1D (n=65) or T2D (n=191), were 22.7\% (58/219) female, with diabetes for a mean 8.34 (SD 8.79) years, and tracked a mean 2176.35 (SD 3430.23) self-care activities between HbA1c entries. There was a significant 1.36\% or 14.9 mmol/mol HbA1c reduction (F=62.60, P<.001) from the first (8.72\%, 71.8 mmol/mol) to second HbA1c (7.36\%, 56.9 mmol/mol) measurement. Tracking carbohydrates was independently associated with greater HbA1c improvement (all P<.01). Conclusions: Using One Drop | Mobile on iPhone and Apple Watch may favorably impact glycemic control. ",
doi="10.2196/mhealth.8781",
url="http://mhealth.jmir.org/2017/11/e179/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29187344"
}


@Article{info:doi/10.2196/mhealth.8532,
author="Irace, Concetta
and Schweitzer, Axel Matthias
and Tripolino, Cesare
and Scavelli, Barbara Faustina
and Gnasso, Agostino",
title="Diabetes Data Management System to Improve Glycemic Control in People With Type 1 Diabetes: Prospective Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Nov",
day="21",
volume="5",
number="11",
pages="e170",
keywords="diabetes mellitus",
keywords="blood glucose self-monitoring",
keywords="smartphone",
keywords="internet",
abstract="Background: Smartphone and Web technology can improve the health care process, especially in chronic diseases. Objective: The aim of this study was to investigate whether the use of blood glucose (BG) data management system, which enables connection to smartphones, the Web, the cloud, and downloading, can improve glycemic control in subjects with type 1 diabetes mellitus (T1DM). Methods: This study was a prospective, single-arm, cohort feasibility study with 6 months of duration. T1DM subjects enrolled had experience in self-monitoring blood glucose, but were download data na{\"i}ve. Fasting BG and glycated hemoglobin (HbA1c) were collected at the enrollment and at follow-up. Subjects were divided into Downloader (DL) and No-downloader (NDL). Results: A total of 63 subjects were analyzed, of which 30 were classified as DL and 33 as NDL. At the end of the study, DL had significantly lower HbA1c, mean daily glucose, standard deviation, percentage of BG values above target, and pre- and postprandial (lunch and dinner) values compared with NDL (all P<.05). The percentage of BG values within treatment target was significantly higher in DL compared with NDL (47\% [SD 9] vs 37\% [SD 13]; P=.001). Conclusions: The findings suggest that, in T1DM, downloading of BG from data management system, which enables connection to smartphones, the Web, and the cloud, might be a valuable contributor to improved glycemic control. ",
doi="10.2196/mhealth.8532",
url="http://mhealth.jmir.org/2017/11/e170/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29162560"
}


@Article{info:doi/10.2196/mhealth.8162,
author="Druce, L. Katie
and McBeth, John
and van der Veer, N. Sabine
and Selby, A. David
and Vidgen, Bertie
and Georgatzis, Konstantinos
and Hellman, Bruce
and Lakshminarayana, Rashmi
and Chowdhury, Afiqul
and Schultz, M. David
and Sanders, Caroline
and Sergeant, C. Jamie
and Dixon, G. William",
title="Recruitment and Ongoing Engagement in a UK Smartphone Study Examining the Association Between Weather and Pain: Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Nov",
day="01",
volume="5",
number="11",
pages="e168",
keywords="epidemiology",
keywords="mHealth",
keywords="chronic pain",
keywords="methods",
abstract="Background: The huge increase in smartphone use heralds an enormous opportunity for epidemiology research, but there is limited evidence regarding long-term engagement and attrition in mobile health (mHealth) studies. Objective: The objective of this study was to examine how representative the Cloudy with a Chance of Pain study population is of wider chronic-pain populations and to explore patterns of engagement among participants during the first 6 months of the study. Methods: Participants in the United Kingdom who had chronic pain (?3 months) and enrolled between January 20, 2016 and January 29, 2016 were eligible if they were aged ?17 years and used the study app to report any of 10 pain-related symptoms during the study period. Participant characteristics were compared with data from the Health Survey for England (HSE) 2011. Distinct clusters of engagement over time were determined using first-order hidden Markov models, and participant characteristics were compared between the clusters. Results: Compared with the data from the HSE, our sample comprised a higher proportion of women (80.51\%, 5129/6370 vs 55.61\%, 4782/8599) and fewer persons at the extremes of age (16-34 and 75+). Four clusters of engagement were identified: high (13.60\%, 865/6370), moderate (21.76\%, 1384/6370), low (39.35\%, 2503/6370), and tourists (25.44\%, 1618/6370), between which median days of data entry ranged from 1 (interquartile range; IQR: 1-1; tourist) to 149 (124-163; high). Those in the high-engagement cluster were typically older, whereas those in the tourist cluster were mostly male. Few other differences distinguished the clusters. Conclusions: Cloudy with a Chance of Pain demonstrates a rapid and successful recruitment of a large, representative, and engaged sample of people with chronic pain and provides strong evidence to suggest that smartphones could provide a viable alternative to traditional data collection methods. ",
doi="10.2196/mhealth.8162",
url="http://mhealth.jmir.org/2017/11/e168/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29092810"
}


@Article{info:doi/10.2196/jmir.7279,
author="Rodr{\'i}guez, Iyubanit
and Herskovic, Valeria
and Gerea, Carmen
and Fuentes, Carolina
and Rossel, O. Pedro
and Marques, Ma{\'i}ra
and Campos, Mauricio",
title="Understanding Monitoring Technologies for Adults With Pain: Systematic Literature Review",
journal="J Med Internet Res",
year="2017",
month="Oct",
day="27",
volume="19",
number="10",
pages="e364",
keywords="systematic review",
keywords="pain",
keywords="technology",
keywords="patient monitoring",
keywords="ubiquitous and mobile computing",
abstract="Background: Monitoring of patients may decrease treatment costs and improve quality of care. Pain is the most common health problem that people seek help for in hospitals. Therefore, monitoring patients with pain may have significant impact in improving treatment. Several studies have studied factors affecting pain; however, no previous study has reviewed the contextual information that a monitoring system may capture to characterize a patient's situation. Objective: The objective of this study was to conduct a systematic review to (1) determine what types of technologies have been used to monitor adults with pain, and (2) construct a model of the context information that may be used to implement apps and devices aimed at monitoring adults with pain. Methods: A literature search (2005-2015) was conducted in electronic databases pertaining to medical and computer science literature (PubMed, Science Direct, ACM Digital Library, and IEEE Xplore) using a defined search string. Article selection was done through a process of removing duplicates, analyzing title and abstract, and then reviewing the full text of the article. Results: In the final analysis, 87 articles were included and 53 of them (61\%) used technologies to collect contextual information. A total of 49 types of context information were found and a five-dimension (activity, identity, wellness, environment, physiological) model of context information to monitor adults with pain was proposed, expanding on a previous model. Most technological interfaces for pain monitoring were wearable, possibly because they can be used in more realistic contexts. Few studies focused on older adults, creating a relevant avenue of research on how to create devices for users that may have impaired cognitive skills or low digital literacy. Conclusions: The design of monitoring devices and interfaces for adults with pain must deal with the challenge of selecting relevant contextual information to understand the user's situation, and not overburdening or inconveniencing users with information requests. A model of contextual information may be used by researchers to choose possible contextual information that may be monitored during studies on adults with pain. ",
doi="10.2196/jmir.7279",
url="http://www.jmir.org/2017/10/e364/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29079550"
}


@Article{info:doi/10.2196/mhealth.8230,
author="Lalloo, Chitra
and Shah, Ushma
and Birnie, A. Kathryn
and Davies-Chalmers, Cleo
and Rivera, Jordan
and Stinson, Jennifer
and Campbell, Fiona",
title="Commercially Available Smartphone Apps to Support Postoperative Pain Self-Management: Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Oct",
day="23",
volume="5",
number="10",
pages="e162",
keywords="pain, postoperative",
keywords="smartphone",
keywords="mobile applications",
keywords="review",
keywords="pain management",
keywords="self care",
abstract="Background: Recently, the use of smartphones to deliver health-related content has experienced rapid growth, with more than 165,000 mobile health (mHealth) apps currently available in the digital marketplace. With 3 out of 4 Canadians currently owning a smartphone, mHealth apps offer opportunities to deliver accessible health-related knowledge and support. Many individuals experience pain after surgery, which can negatively impact their health-related quality of life, including sleep, emotional, and social functioning. Smartphone apps that provide remote real-time monitoring and symptom management have the potential to improve self-management skills in patients experiencing postoperative pain. Increased confidence and practice of self-management skills could contribute to decreased postoperative pain and reduce risk of developing persistent pain. Published reviews of general pain self-management apps demonstrate a lack of evidence-based content, theoretical grounding, and health care professional involvement. However, no review to date has focused on the app marketplace specific for individuals with postoperative pain. Objective: The aim of this study was to characterize and critically appraise the content and functionality of commercially available postoperative pain self-management apps. Methods: An electronic search and extraction was conducted between December 2016 and March 2017 of the official Canadian app stores for the three major smartphone operating systems (iPhone operating system [iOS], Android, and Windows). Stores were searched separately using predetermined search terms. Two authors screened apps based on information provided in the public app description. Metadata from all included apps were abstracted into a standard spreadsheet. Two authors verified the data with reference to the apps and downloaded apps themselves. The content and functionality of each app as it pertained to postoperative pain self-management was rated. Results: A total of 10 apps met the inclusion criteria. All included apps were designed exclusively for the Android platform. Education was the most common self-management feature offered (8/10, 80\%), with none of the apps offering features related to goal setting or social support. Overall, no single app was comprehensive in terms of pain self-management content. Five (50\%) apps reported the involvement of a health care provider in their development. However, not a single app involved end users in their development, and none of the apps underwent scientific evaluation. Additionally, none of the apps were designed for use in pediatric patients. Conclusions: Currently available postoperative pain apps for patients lack evidence-based content, goal setting, and social support functions. There is a need to develop and test comprehensive theory-based apps to support patients with pain self-management care following surgery. ",
doi="10.2196/mhealth.8230",
url="http://mhealth.jmir.org/2017/10/e162/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29061558"
}


@Article{info:doi/10.2196/medinform.7117,
author="Johnson, S. Sara
and Levesque, A. Deborah
and Broderick, E. Lynne
and Bailey, G. Dustin
and Kerns, D. Robert",
title="Pain Self-Management for Veterans: Development and Pilot Test of a Stage-Based Mobile-Optimized Intervention",
journal="JMIR Med Inform",
year="2017",
month="Oct",
day="17",
volume="5",
number="4",
pages="e40",
keywords="pain management",
keywords="self-management",
keywords="mobile health",
keywords="mhealth",
abstract="Background: Chronic pain is a significant public health burden affecting more Americans than cardiovascular disease, diabetes, and cancer combined. Veterans are disproportionately affected by chronic pain. Among previously deployed soldiers and veterans, the prevalence of chronic pain is estimated between 44\% and 60\%. Objective: The objective of this research was to develop and pilot-test Health eRide: Your Journey to Managing Pain, a mobile pain self-management program for chronic musculoskeletal pain for veterans. Based on the transtheoretical model of behavior change, the intervention is tailored to veterans' stage of change for adopting healthy strategies for pain self-management and their preferred strategies. It also addresses stress management and healthy sleep, two components of promising integrated treatments for veterans with pain and co-occurring conditions, including posttraumatic stress disorder (PTSD) and traumatic brain injury. In addition, Health eRide leverages gaming principles, text messaging (short message service, SMS), and social networking to increase engagement and retention. Methods: Pilot test participants were 69 veterans recruited in-person and by mail at a Veterans Health Administration facility, by community outreach, and by a Web-based survey company. Participants completed a mobile-delivered baseline assessment and Health eRide intervention session. During the next 30 days, they had access to a Personal Activity Center with additional stage-matched activities and information and had the option of receiving tailored text messages. Pre-post assessments, administered at baseline and the 30-day follow-up, included measures of pain, pain impact, use of pain self-management strategies, PTSD, and percentage in the Action or Maintenance stage for adopting pain self-management, managing stress, and practicing healthy sleep habits. Global impressions of change and program acceptability and usability were also assessed at follow-up. Results: Among the 44 veterans who completed the 30-day post assessment, there were statistically significant pre-post reductions in pain (P<.001) and pain impact (P<.001); there was some reduction in symptoms of PTSD (P=.05). There were significant pre-post increases in the percentage of participants in the Action or Maintenance stage for adopting pain self-management (P=.01) and for managing stress (P<.001) but not for practicing healthy sleep habits (P=.11). The global impressions of change measure showed that a majority had experienced some level of improvement. User ratings of acceptability were quite high; ratings of usability fell slightly below the mean for digital programs. Conclusions: Preliminary data demonstrate the potential impact of the Health eRide program for chronic musculoskeletal pain for veterans. The results underscore that simultaneously addressing other behaviors may be a promising approach to managing pain and comorbid conditions. Additional formative research is required to complete development of the Health eRide program and to address areas of usability requiring improvement. A randomized trial with longer follow-up is needed to demonstrate the program's long-term effects on pain and pain self-management. ",
doi="10.2196/medinform.7117",
url="http://medinform.jmir.org/2017/4/e40/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29042341"
}


@Article{info:doi/10.2196/jmir.7814,
author="Bateman, R. Daniel
and Srinivas, Bhavana
and Emmett, W. Thomas
and Schleyer, K. Titus
and Holden, J. Richard
and Hendrie, C. Hugh
and Callahan, M. Christopher",
title="Categorizing Health Outcomes and Efficacy of mHealth Apps for Persons With Cognitive Impairment: A Systematic Review",
journal="J Med Internet Res",
year="2017",
month="Aug",
day="30",
volume="19",
number="8",
pages="e301",
keywords="mHealth",
keywords="mobile health",
keywords="applications",
keywords="Alzheimer disease",
keywords="dementia",
keywords="systematic review",
abstract="Background: Use of mobile health (mHealth) apps is growing at an exponential rate in the United States and around the world. Mild cognitive impairment (MCI), Alzheimer disease, and related dementias are a global health problem. Numerous mHealth interventions exist for this population, yet the effect of these interventions on health has not been systematically described. Objective: The aim of this study is to catalog the types of health outcomes used to measure effectiveness of mHealth interventions and assess which mHealth interventions have been shown to improve the health of persons with MCI, Alzheimer disease, and dementia. Methods: We searched 13 databases, including Ovid MEDLINE, PubMed, EMBASE, the full Cochrane Library, CINAHL, PsycINFO, Ei Compendex, IEEE Xplore, Applied Science \& Technology Source, Scopus, Web of Science, ClinicalTrials.gov, and Google Scholar from inception through May 2017 for mHealth studies involving persons with cognitive impairment that were evaluated using at least one quantitative health outcome. Proceedings of the Annual ACM Conferences on Human Factors in Computing Systems, the ACM User Interface Software and Technology Symposium, and the IEEE International Symposium on Wearable Computers were searched in the ACM Digital Library from 2012 to 2016. A hand search of JMIR Publications journals was also completed in July 2017. Results: After removal of duplicates, our initial search returned 3955 records. Of these articles, 24 met final inclusion criteria as studies involving mHealth interventions that measured at least one quantitative health outcome for persons with MCI, Alzheimer disease, and dementia. Common quantitative health outcomes included cognition, function, mood, and quality of life. We found that 21.2\% (101/476) of the fully reviewed articles were excluded because of a lack of health outcomes. The health outcomes selected were observed to be inconsistent between studies. For those studies with quantitative health outcomes, more than half (58\%) reported postintervention improvements in outcomes. Conclusions: Results showed that many mHealth app interventions targeting those with cognitive impairment lack quantitative health outcomes as a part of their evaluation process and that there is a lack of consensus as to which outcomes to use. The majority of mHealth app interventions that incorporated health outcomes into their evaluation noted improvements in the health of persons with MCI, Alzheimer disease, and dementia. However, these studies were of low quality, leading to a grade C level of evidence. Clarification of the benefits of mHealth interventions for people with cognitive impairment requires more randomized controlled trials, larger numbers of participants, and trial designs that minimize bias. Trial Registration: PROSPERO Registration: PROSPERO 2016:CRD42016033846; http://www.crd.york.ac.uk/PROSPERO/ display\_record.asp?ID=CRD42016033846 (Archived by WebCite at http://www.webcitation.org/6sjjwnv1M) ",
doi="10.2196/jmir.7814",
url="http://www.jmir.org/2017/8/e301/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28855146"
}


@Article{info:doi/10.2196/mhealth.7254,
author="Vandenberk, Thijs
and Stans, Jelle
and Mortelmans, Christophe
and Van Haelst, Ruth
and Van Schelvergem, Gertjan
and Pelckmans, Caroline
and Smeets, JP Christophe
and Lanssens, Dorien
and De Canni{\`e}re, H{\'e}l{\`e}ne
and Storms, Valerie
and Thijs, M. Inge
and Vaes, Bert
and Vandervoort, M. Pieter",
title="Clinical Validation of Heart Rate Apps: Mixed-Methods Evaluation Study",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Aug",
day="25",
volume="5",
number="8",
pages="e129",
keywords="heart rate",
keywords="software validation",
keywords="remote sensing technology",
abstract="Background: Photoplethysmography (PPG) is a proven way to measure heart rate (HR). This technology is already available in smartphones, which allows measuring HR only by using the smartphone. Given the widespread availability of smartphones, this creates a scalable way to enable mobile HR monitoring. An essential precondition is that these technologies are as reliable and accurate as the current clinical (gold) standards. At this moment, there is no consensus on a gold standard method for the validation of HR apps. This results in different validation processes that do not always reflect the veracious outcome of comparison. Objective: The aim of this paper was to investigate and describe the necessary elements in validating and comparing HR apps versus standard technology. Methods: The FibriCheck (Qompium) app was used in two separate prospective nonrandomized studies. In the first study, the HR of the FibriCheck app was consecutively compared with 2 different Food and Drug Administration (FDA)-cleared HR devices: the Nonin oximeter and the AliveCor Mobile ECG. In the second study, a next step in validation was performed by comparing the beat-to-beat intervals of the FibriCheck app to a synchronized ECG recording. Results: In the first study, the HR (BPM, beats per minute) of 88 random subjects consecutively measured with the 3 devices showed a correlation coefficient of .834 between FibriCheck and Nonin, .88 between FibriCheck and AliveCor, and .897 between Nonin and AliveCor. A single way analysis of variance (ANOVA; P=.61 was executed to test the hypothesis that there were no significant differences between the HRs as measured by the 3 devices. In the second study, 20,298 (ms) R-R intervals (RRI)--peak-to-peak intervals (PPI) from 229 subjects were analyzed. This resulted in a positive correlation (rs=.993, root mean square deviation [RMSE]=23.04 ms, and normalized root mean square error [NRMSE]=0.012) between the PPI from FibriCheck and the RRI from the wearable ECG. There was no significant difference (P=.92) between these intervals. Conclusions: Our findings suggest that the most suitable method for the validation of an HR app is a simultaneous measurement of the HR by the smartphone app and an ECG system, compared on the basis of beat-to-beat analysis. This approach could lead to more correct assessments of the accuracy of HR apps. ",
doi="10.2196/mhealth.7254",
url="http://mhealth.jmir.org/2017/8/e129/"
}


@Article{info:doi/10.2196/diabetes.8039,
author="Osborn, Y. Chandra
and van Ginkel, R. Joost
and Rodbard, David
and Heyman, Mark
and Marrero, G. David
and Huddleston, Brian
and Dachis, Jeff",
title="One Drop | Mobile: An Evaluation of Hemoglobin A1c Improvement Linked to App Engagement",
journal="JMIR Diabetes",
year="2017",
month="Aug",
day="24",
volume="2",
number="2",
pages="e21",
keywords="type 1 diabetes",
keywords="type 2 diabetes",
keywords="mobile app",
keywords="tracking",
keywords="self-care",
keywords="glycemic control",
abstract="Background: Three recent reviews evaluated 19 studies testing the hemoglobin A1c (HbA1c) benefit of 16 diabetes apps, including 5 publicly available apps. Most studies relied on small samples and did not link app engagement with outcomes. Objective: This study assessed both HbA1c change in a large sample of people using the One Drop | Mobile app and associations between app engagement and changes in HbA1c. Methods: The One Drop | Mobile app for iOS and Android is designed to manually and passively (via Apple HealthKit, Google Fit, and the One Drop | Chrome blood glucose meter) store, track, and share data. Users can schedule medication reminders, view statistics, set goals, track health outcomes, and get data-driven insights. In June 2017, we queried data on people with diabetes using the app who had entered at least 2 HbA1c values in the app >60 and ?365 days apart. Multiple imputation corrected for missing data. Unadjusted and adjusted mixed effects repeated measures models tested mean HbA1c change by time, diabetes type, and their interaction. Multiple regression models assessed relationships between using the app to track food, activity, blood glucose, and medications and HbA1c change. Results: The sample (N=1288) included people with type 1 diabetes (T1D) (n=367) or type 2 diabetes (T2D) (n=921) who were 35\% female, diagnosed with diabetes for a mean 9.4 (SD 9.9) years, and tracked an average 1646.1 (SD 3621.9) self-care activities in One Drop | Mobile between their first (mean 8.14\% [SD 2.06\%]) and second HbA1c entry (mean 6.98\% [SD 1.1\%]). HbA1c values were significantly associated with user-entered average blood glucose 90 days before the second HbA1c entry (rho=.73 to .75, P<.001). HbA1c decreased by an absolute 1.07\% (unadjusted and adjusted F=292.03, P<.001) from first to second HbA1c entry. There was a significant interaction between diabetes type and HbA1c. Both groups significantly improved, but users with T2D had a greater HbA1c decrease over time than users with T1D (F=10.54, P<.001). For users with T2D (n=921), HbA1c decreased by an absolute 1.27\% (F=364.50, P<.001) from first to second HbA1c entry. Finally, using One Drop | Mobile to record food was associated with greater HbA1c reductions even after adjusting for covariates and after also adjusting for insulin use for users with T2D (all P<.05). Conclusions: People with T1D and T2D reported a 1.07\% to 1.27\% absolute reduction in HbA1c during a median 4 months of using the One Drop | Mobile app. Using the app to track self-care was associated with improved HbA1c. More research is needed on the health benefits of publicly available diabetes apps, particularly studies associating app engagement with short- and long-term effects. ",
doi="10.2196/diabetes.8039",
url="http://diabetes.jmir.org/2017/2/e21/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30291059"
}


@Article{info:doi/10.2196/resprot.7676,
author="Theile, Gudrun
and Klaas, Vanessa
and Tr{\"o}ster, Gerhard
and Guckenberger, Matthias",
title="mHealth Technologies for Palliative Care Patients at the Interface of In-Patient to Outpatient Care: Protocol of Feasibility Study Aiming to Early Predict Deterioration of Patient's Health Status",
journal="JMIR Res Protoc",
year="2017",
month="Aug",
day="16",
volume="6",
number="8",
pages="e142",
keywords="mobile apps",
keywords="palliative care",
keywords="pain",
keywords="symptom assessment",
keywords="hospitalization",
keywords="aged",
abstract="Background: Palliative care patients are a particularly vulnerable population and one of the critical phases in patients' trajectories is discharge from specialized in-patient palliative care into outpatient care, where availability of a palliative care infrastructure is highly variable. A relevant number of potentially avoidable readmissions and emergency visits of palliative patients is observed due to rapid exacerbation of symptoms indicating the need for a closer patient monitoring. In the last years, different mHealth technology applications have been evaluated in many different patient groups. Objective: The aim of our study is to test feasibility of a remote physical and social tracking system in palliative care patients. Methods: A feasibility study with explorative, descriptive study design, comprised of 3 work packages. From the wards of the Clinic of Radiation-Oncology at the University Hospital Zurich, including the specialized palliative care ward, 30 patients will be recruited and will receive a mobile phone and a tracking bracelet before discharge. The aim of work package A is to evaluate if severely ill patients accept to be equipped with a tracking bracelet and a mobile phone (by semiquantitative questionnaires and guideline interviews). Work package B evaluates the technical feasibility and quality of the acquired electronic health data. Work package C will demonstrate whether physical activity parameters, such as step count, sleep duration, social activity patterns like making calls, and vital signs (eg, heart rate) do correlate with subjective health data and can serve as indicator to early detect and predict changes in patients' health status. Activity parameters will be extracted from the mobile phone's and wristband's sensor data using signal processing methods. Subjective health data is captured via electronic version of visual analog scale and Distress Thermometer as well as the European Organization for Research and Treatment of Cancer -- Quality of Life Questionnaire C30 in paper version. Results: Enrollment began in February 2017. First study results will be reported in the middle of 2018. Conclusions: Our project will deliver relevant data on patients' acceptance of activity and social tracking and test the correlation between subjective symptom assessment and objective activity in the vulnerable population of palliative care patients. The proposed study is meant to be preparatory work for an intervention study to test the effect of wireless monitoring of palliative care patients on symptom control and quality of life. ",
doi="10.2196/resprot.7676",
url="http://www.researchprotocols.org/2017/8/e142/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28814378"
}


@Article{info:doi/10.2196/mhealth.7229,
author="Cai, A. Ran
and Beste, Dominik
and Chaplin, Hema
and Varakliotis, Socrates
and Suffield, Linda
and Josephs, Francesca
and Sen, Debajit
and Wedderburn, R. Lucy
and Ioannou, Yiannakis
and Hailes, Stephen
and Eleftheriou, Despina",
title="Developing and Evaluating JIApp: Acceptability and Usability of a Smartphone App System to Improve Self-Management in Young People With Juvenile Idiopathic Arthritis",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Aug",
day="15",
volume="5",
number="8",
pages="e121",
keywords="juvenile idiopathic arthritis",
keywords="self-management",
keywords="adolescent",
keywords="young adult",
keywords="mobile applications",
keywords="qualitative research",
keywords="smartphone",
abstract="Background: Flare-ups in juvenile idiopathic arthritis (JIA) are characterized by joint pain and swelling and often accompanied with fatigue, negative emotions, and reduced participation in activities. To minimize the impact of JIA on the physical and psychosocial development and well-being of young people (YP), it is essential to regularly monitor disease activity and side effects, as well as to support self-management such as adherence to treatment plans and engagement in general health-promoting behaviors. Smartphone technology has the potential to engage YP with their health care through convenient self-monitoring and easy access to information. In addition, having a more accurate summary of self-reported fluctuations in symptoms, behaviors, and psychosocial problems can help both YP and health care professionals (HCPs) better understand the patient's condition, identify barriers to self-management, and assess treatment effectiveness and additional health care needs. No comprehensive smartphone app has yet been developed in collaboration with YP with JIA, their parents, and HCPs involved in their care. Objectives: The objective of this study was to design, develop, and evaluate the acceptability and usability of JIApp, a self-management smartphone app system for YP with JIA and HCPs. Methods: We used a qualitative, user-centered design approach involving YP, parents, and HCPs from the rheumatology team. The study was conducted in three phases: (1) phase I focused on developing consensus on the features, content, and design of the app; (2) phase II was used for further refining and evaluating the app prototype; and (3) phase III focused on usability testing of the app. The interview transcripts were analyzed using qualitative content analysis. Results: A total of 29 YP (aged 10-23, median age 17) with JIA, 7 parents, and 21 HCPs were interviewed. Major themes identified as the ones that helped inform app development in phase I were: (1) remote monitoring of symptoms, well-being, and activities; (2) treatment adherence; and (3) education and support. During phase II, three more themes emerged that informed further refinement of the app prototype. These included (4) adapting a reward system to motivate end users for using the app; (5) design of the app interface; and (6) clinical practice integration. The usability testing during phase III demonstrated high rates of overall satisfaction and further affirmed the content validity of the app. Conclusions: We present the development and evaluation of a smartphone app to encourage self-management and engagement with health care for YP with JIA. The app was found to have high levels of acceptability and usability among YP and HCPs and has the potential to improve health care and outcomes for this age group. Future feasibility testing in a prospective study will firmly establish the reliability, efficacy, and cost-effectiveness of such an app intervention for patients with arthritis. ",
doi="10.2196/mhealth.7229",
url="http://mhealth.jmir.org/2017/8/e121/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28811270"
}


@Article{info:doi/10.2196/mhealth.7297,
author="Saeb, Sohrab
and Lattie, G. Emily
and Kording, P. Konrad
and Mohr, C. David",
title="Mobile Phone Detection of Semantic Location and Its Relationship to Depression and Anxiety",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Aug",
day="10",
volume="5",
number="8",
pages="e112",
keywords="semantic location",
keywords="geographic positioning systems",
keywords="mobile phone",
keywords="classification",
keywords="decision tree ensembles",
keywords="extreme gradient boosting",
keywords="depression",
keywords="anxiety",
abstract="Background: Is someone at home, at their friend's place, at a restaurant, or enjoying the outdoors? Knowing the semantic location of an individual matters for delivering medical interventions, recommendations, and other context-aware services. This knowledge is particularly useful in mental health care for monitoring relevant behavioral indicators to improve treatment delivery. Local search-and-discovery services such as Foursquare can be used to detect semantic locations based on the global positioning system (GPS) coordinates, but GPS alone is often inaccurate. Mobile phones can also sense other signals (such as movement, light, and sound), and the use of these signals promises to lead to a better estimation of an individual's semantic location. Objective: We aimed to examine the ability of mobile phone sensors to estimate semantic locations, and to evaluate the relationship between semantic location visit patterns and depression and anxiety. Methods: A total of 208 participants across the United States were asked to log the type of locations they visited daily, using their mobile phones for a period of 6 weeks, while their phone sensor data was recorded. Using the sensor data and Foursquare queries based on GPS coordinates, we trained models to predict these logged locations, and evaluated their prediction accuracy on participants that models had not seen during training. We also evaluated the relationship between the amount of time spent in each semantic location and depression and anxiety assessed at baseline, in the middle, and at the end of the study. Results: While Foursquare queries detected true semantic locations with an average area under the curve (AUC) of 0.62, using phone sensor data alone increased the AUC to 0.84. When we used Foursquare and sensor data together, the AUC further increased to 0.88. We found some significant relationships between the time spent in certain locations and depression and anxiety, although these relationships were not consistent. Conclusions: The accuracy of location services such as Foursquare can significantly benefit from using phone sensor data. However, our results suggest that the nature of the places people visit explains only a small part of the variation in their anxiety and depression symptoms. ",
doi="10.2196/mhealth.7297",
url="http://mhealth.jmir.org/2017/8/e112/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28798010"
}


@Article{info:doi/10.2196/mhealth.7177,
author="Tinschert, Peter
and Jakob, Robert
and Barata, Filipe
and Kramer, Jan-Niklas
and Kowatsch, Tobias",
title="The Potential of Mobile Apps for Improving Asthma Self-Management: A Review of Publicly Available and Well-Adopted Asthma Apps",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Aug",
day="02",
volume="5",
number="8",
pages="e113",
keywords="asthma",
keywords="self care",
keywords="disease management",
keywords="mobile applications",
keywords="smartphone",
keywords="mHealth",
keywords="eHealth",
keywords="mobile health",
keywords="behavior and behavior mechanisms",
keywords="review",
abstract="Background: Effective disease self-management lowers asthma's burden of disease for both individual patients and health care systems. In principle, mobile health (mHealth) apps could enable effective asthma self-management interventions that improve a patient's quality of life while simultaneously reducing the overall treatment costs for health care systems. However, prior reviews in this field have found that mHealth apps for asthma lack clinical evaluation and are often not based on medical guidelines. Yet, beyond the missing evidence for clinical efficacy, little is known about the potential apps might have for improving asthma self-management. Objective: The aim of this study was to assess the potential of publicly available and well-adopted mHealth apps for improving asthma self-management. Methods: The Apple App store and Google Play store were systematically searched for asthma apps. In total, 523 apps were identified, of which 38 apps matched the selection criteria to be included in the review. Four requirements of app potential were investigated: app functions, potential to change behavior (by means of a behavior change technique taxonomy), potential to promote app use (by means of a gamification components taxonomy), and app quality (by means of the Mobile Application Rating Scale [MARS]). Results: The most commonly implemented functions in the 38 reviewed asthma apps were tracking (30/38, 79\%) and information (26/38, 68\%) functions, followed by assessment (20/38, 53\%) and notification (18/38, 47\%) functions. On average, the reviewed apps applied 7.12 of 26 available behavior change techniques (standard deviation [SD]=4.46) and 4.89 of 31 available gamification components (SD=4.21). Average app quality was acceptable (mean=3.17/5, SD=0.58), whereas subjective app quality lied between poor and acceptable (mean=2.65/5, SD=0.87). Additionally, the sum scores of all review frameworks were significantly correlated (lowest correlation: r36=.33, P=.04 between number of functions and gamification components; highest correlation: r36=.80, P<.001 between number of behavior change techniques and gamification components), which suggests that an app's potential tends to be consistent across review frameworks. Conclusions: Several apps were identified that performed consistently well across all applied review frameworks, thus indicating the potential mHealth apps offer for improving asthma self-management. However, many apps suffer from low quality. Therefore, app reviews should be considered as a decision support tool before deciding which app to integrate into a patient's asthma self-management. Furthermore, several research-practice gaps were identified that app developers should consider addressing in future asthma apps. ",
doi="10.2196/mhealth.7177",
url="http://mhealth.jmir.org/2017/8/e113/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28768606"
}


@Article{info:doi/10.2196/mhealth.7853,
author="Lucero, James Robert
and Frimpong, A. Jemima
and Fehlberg, A. Elizabeth
and Bjarnadottir, I. Ragnhildur
and Weaver, T. Michael
and Cook, Christa
and Modave, Francois
and Rathore, H. Mobeen
and Morano, P. Jamie
and Ibanez, Gladys
and Cook, L. Robert",
title="The Relationship Between Individual Characteristics and Interest in Using a Mobile Phone App for HIV Self-Management: Observational Cohort Study of People Living With HIV",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Jul",
day="27",
volume="5",
number="7",
pages="e100",
keywords="telemedicine",
keywords="self-care",
keywords="HIV",
abstract="Background: The human immunodeficiency virus (HIV) continues to be a major health issue in the United States, and an estimated 1.2 million people in the United States are living with HIV. As part of Healthy People 2020, the Office of Disease Prevention and Health Promotion has targeted the persistent demographic and geographic disparities in HIV prevalence and management. Preliminary evidence suggests that mobile health technology (smartphone apps) may be a promising way to support HIV self-management among vulnerable populations of people living with HIV (PLWH) who lack access to appropriate health care services. Objective: This study examines the association between individual characteristics of PLWH and level of interest in using a free mobile phone app for HIV self-management. Methods: This study was conducted using cross-sectional survey data collected in the Florida Cohort Study between 2014 and 2016 (N=766). Associations between individual characteristics of PLWH and level of interest in using a free mobile phone app for HIV self-management were examined using bivariate analysis and logistic regression. Results: Overall, 85.5\% (655/766) of respondents were interested in using a free mobile phone app that supports HIV self-management. Participants expressed the highest interest in app functions that facilitate communication with health care providers (568/740, 76.8\%) or help to identify relevant health care services (556/745 74.6\%). Age (OR 0.959, 95\% CI 0.936-0.982), education (OR 1.281, 95\% CI 1.027-1.598) and disability or inability to work (OR 0.296, 95\% CI 0.145-0.606) were all significantly associated with being interested in using a free mobile phone app for HIV self-management. Conclusions: This study indicates that a majority of PLWH are interested in using a free mobile phone app to self-manage their condition. The findings can inform the development of mobile phone apps that support effective HIV self-management. ",
doi="10.2196/mhealth.7853",
url="http://mhealth.jmir.org/2017/7/e100/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28751298"
}


@Article{info:doi/10.2196/mhealth.6829,
author="H{\"a}lleberg Nyman, Maria
and Frank, Catharina
and Langius-Ekl{\"o}f, Ann
and Blomberg, Karin
and Sundberg, Kay
and Wengstr{\"o}m, Yvonne",
title="Patients' Perspective on Participation in Care With or Without the Support of a Smartphone App During Radiotherapy for Prostate Cancer: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Jul",
day="26",
volume="5",
number="7",
pages="e107",
keywords="patient participation",
keywords="prostate cancer",
keywords="radiotherapy",
keywords="smartphone",
abstract="Background: Patients with prostate cancer are often cared for as outpatients during radiotherapy, which can be an aggravating circumstance for patient participation. There is a need to evaluate whether an interactive smartphone app could enable participation in care, specifically during treatment for prostate cancer. The interactive app (Interaktor) used in this study is developed in codesign with patients and health care professionals; it includes daily reports of symptoms, a risk assessment model, evidence-based self-care advice, along with the provision of immediate access to clinicians. Objective: The aim of this study was to explore how patients with prostate cancer perceived their participation with or without the support of the smartphone app during radiotherapy. Methods: A total of 28 prostate cancer patients receiving adjuvant radiotherapy were interviewed about their perceived participation in their own care. All the patients interviewed in this study participated in an intervention study where the control group received standard care that comprised having access to a contact nurse to turn to with any concerns during their treatment. In addition to standard care, the patients in the intervention group received the app downloaded in a smartphone. The patients' age ranged between 57 and 77 years; 17 patients used the smartphone app. The interviews were analyzed with directed qualitative content analysis. Results: The four dimensions of patient participation, which include mutual participation, fight for participation, requirement for participation, and participation in getting basic needs satisfied, were confirmed as valid perspectives in the interviews with the patients with prostate cancer, irrespective of whether they used the smartphone app. However, the patients who had used the smartphone app described it as a facilitating factor, especially for mutual participation. Conclusions: Using innovative ways to communicate with patients, such as an interactive app for symptom management with contact with health care in real time, can successfully help achieve increased patient participation in care. ",
doi="10.2196/mhealth.6829",
url="http://mhealth.jmir.org/2017/7/e107/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28747294"
}


@Article{info:doi/10.2196/diabetes.7910,
author="Peters, Mattson Robert
and Lui, Matt
and Patel, Kunjan
and Tian, Lewis
and Javaherian, Kavon
and Sink, Eric
and Xu, Ran
and Xu, Zhuchen
and Aung, Wint
and Zhou, Li
and Huynh, Justin
and Polites, Gregory
and Blanchard, Melvin
and Som, Avik
and Ross, Will
and Bernal-Mizrachi, Carlos",
title="Improving Glycemic Control With a Standardized Text-Message and Phone-Based Intervention: A Community Implementation",
journal="JMIR Diabetes",
year="2017",
month="Jul",
day="25",
volume="2",
number="2",
pages="e15",
keywords="diabetes mellitus",
keywords="glycemic control",
keywords="telemedicine",
keywords="electronic health (eHealth)",
keywords="mobile health (mHealth)",
keywords="telehealth",
keywords="SMS",
keywords="diabetes management",
abstract="Background: Type II diabetes mellitus (T2DM) presents a major disease burden in the United States. Outpatient glycemic control among patients with T2DM remains difficult. Telemedicine shows great potential as an adjunct therapy to aid in glycemic control in real-world settings. Objective: We aimed to explore the effectiveness of EpxDiabetes, a novel digital health intervention, in improving hemoglobin A1c (HbA1c) and fasting blood glucose (FBG) among patients with uncontrolled diabetes. Methods: We recruited 396 patients from a community clinic in St. Louis, Missouri, from a database of patients diagnosed with T2DM and with a most recent HbA1c >7\% as part of a quality improvement project. An automated call or text-messaging system was used to monitor patient-reported FBG. If determined to be elevated, care managers were notified by email, text, or electronic medical record alert. Participants self-reported their FBG data by replying to EpxDiabetes automated phone calls or text messages. Data were subsequently analyzed, triaged, and shared with providers to enable appropriate follow-up and care plan adjustments. Absolute HbA1c reduction, patient engagement, and absolute patient-reported FBG reduction were examined at approximately 6 months post implementation. Results: EpxDiabetes had an average 95.6\% patient response rate to messages at least once per month and an average 71.1\% response rate to messages at least once per week. Subsequent HbA1c drop with EpxDiabetes use over 4 months was -1.15\% (95\% CI -1.58 to -0.71) for patients with HbA1c >8\% at baseline compared to the change in HbA1c over 4 months prior to the implementation of EpxDiabetes of only -0.005 points (95\% CI -0.28 to 0.27), P=.0018. Conclusions: EpxDiabetes may help reduce HbA1c in patients with high HbA1c baselines (>8\%). The intervention demonstrates high patient engagement sustainable for at least 6 months. ",
doi="10.2196/diabetes.7910",
url="http://diabetes.jmir.org/2017/2/e15/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30291063"
}


@Article{info:doi/10.2196/mhealth.7346,
author="Bian, Jiang
and Guo, Yi
and Xie, Mengjun
and Parish, E. Alice
and Wardlaw, Isaac
and Brown, Rita
and Modave, Fran{\c{c}}ois
and Zheng, Dong
and Perry, T. Tamara",
title="Exploring the Association Between Self-Reported Asthma Impact and Fitbit-Derived Sleep Quality and Physical Activity Measures in Adolescents",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Jul",
day="25",
volume="5",
number="7",
pages="e105",
keywords="mobile health",
keywords="mHealth",
keywords="asthma",
keywords="Fitbit",
keywords="physical activity",
keywords="sleep",
keywords="sleep quality",
abstract="Background: Smart wearables such as the Fitbit wristband provide the opportunity to monitor patients more comprehensively, to track patients in a fashion that more closely follows the contours of their lives, and to derive a more complete dataset that enables precision medicine. However, the utility and efficacy of using wearable devices to monitor adolescent patients' asthma outcomes have not been established. Objective: The objective of this study was to explore the association between self?reported sleep data, Fitbit sleep and physical activity data, and pediatric asthma impact (PAI). Methods: We conducted an 8?week pilot study with 22 adolescent asthma patients to collect: (1) weekly or biweekly patient?reported data using the Patient-Reported Outcomes Measurement Information System (PROMIS) measures of PAI, sleep disturbance (SD), and sleep?related impairment (SRI) and (2) real-time Fitbit (ie, Fitbit Charge HR) data on physical activity (F-AM) and sleep quality (F?SQ). To explore the relationship among the self-reported and Fitbit measures, we computed weekly Pearson correlations among these variables of interest. Results: We have shown that the Fitbit-derived sleep quality F-SQ measure has a moderate correlation with the PROMIS SD score (average r=?.31, P=.01) and a weak but significant correlation with the PROMIS PAI score (average r=?.18, P=.02). The Fitbit physical activity measure has a negligible correlation with PAI (average r=.04, P=.62). Conclusions: Our findings support the potential of using wrist-worn devices to continuously monitor two important factors---physical activity and sleep---associated with patients' asthma outcomes and to develop a personalized asthma management platform. ",
doi="10.2196/mhealth.7346",
url="http://mhealth.jmir.org/2017/7/e105/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28743679"
}


@Article{info:doi/10.2196/mhealth.7178,
author="Sun, Yunheng
and Jiang, Feng
and Gu, J. Juan
and Wang, Ken Y.
and Hua, Hongwei
and Li, Jing
and Cheng, Zhijun
and Liao, Zhijun
and Huang, Qian
and Hu, Weiwei
and Ding, Gang",
title="Development and Testing of an Intelligent Pain Management System (IPMS) on Mobile Phones Through a Randomized Trial Among Chinese Cancer Patients: A New Approach in Cancer Pain Management",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Jul",
day="25",
volume="5",
number="7",
pages="e108",
keywords="cancer pain",
keywords="intelligent pain management system",
keywords="smart phone",
keywords="intervention",
abstract="Background: Cancer has become increasingly prevalent in China over the past few decades. Among the factors that determine the quality of life of cancer patients, pain has commonly been recognized as a most critical one; it could also lead to the ineffective treatment of the cancer. Driven by the need for better pain management for cancer patients, our research team developed a mobile-based Intelligent Pain Management System (IPMS). Objective: Our objective was to design, develop, and test the IPMS to facilitate real-time pain recording and timely intervention among cancer patients with pain. The system's usability, feasibility, compliance, and satisfaction were also assessed. Methods: A sample of 46 patients with cancer pain symptoms were recruited at the Oncology Center of Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Chongming Branch (hereinafter referred to as ``the Oncology Center''). In a pretest, participants completed a pain management knowledge questionnaire and were evaluated using the baseline cancer pain assessment and Karnofsky Performance Status (KPS) evaluation. The participants were then randomly assigned into two groups (the trial group and the control group). After a 14-day trial period, another round of cancer pain assessment, KPS evaluation and pain management knowledge assessment were repeated. In the trial group, the data were fully automatically collected by the IPMS. In the control group, the data were collected using conventional methods, such as phone interviews or door-to-door visits by physicians. The participants were also asked to complete a satisfaction questionnaire on the use of the IPMS. Results: All participants successfully completed the trial. First, the feasibility of IPMS by observing the number of daily pain assessments recorded among patients was assessed. Second, the users' satisfaction, effectiveness of pain management, and changes in the quality of their lives were evaluated. All the participants gave high satisfaction score after they used IMPS. Both groups reported similar pain scores and KPS scores at the baseline. At the end of the trial, the mean pain score of the trial group was significantly lower than of the control group (P<.001). The ending KPS score of the trial group was significantly higher than of the control group (P<.001). The improvement of pain management knowledge score in the trial group was more pronounced than that in the control group (P<.001). Conclusions: This study provided preliminary data to support the potentials of using IPMS in cancer pain communication between patients and doctors and to provide real-time supportive intervention on a convenient basis at a low cost. Overall, the IPMS can serve as a reliable and effective approach to control cancer pain and improve quality of life for patients with cancer pain. Trial Registration: Clinicaltrials.gov NCT02765269; http://clinicaltrials.gov/ct2/show/NCT02765269 (Archived by WebCite at?http://www.webcitation.org/6rnwsgDgv) ",
doi="10.2196/mhealth.7178",
url="http://mhealth.jmir.org/2017/7/e108/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28743681"
}


@Article{info:doi/10.2196/jmir.7006,
author="Dogan, Ezgi
and Sander, Christian
and Wagner, Xenija
and Hegerl, Ulrich
and Kohls, Elisabeth",
title="Smartphone-Based Monitoring of Objective and Subjective Data in Affective Disorders: Where Are We and Where Are We Going? Systematic Review",
journal="J Med Internet Res",
year="2017",
month="Jul",
day="24",
volume="19",
number="7",
pages="e262",
keywords="review",
keywords="mood disorders",
keywords="smartphone",
keywords="ecological momentary assessment",
abstract="Background: Electronic mental health interventions for mood disorders have increased rapidly over the past decade, most recently in the form of various systems and apps that are delivered via smartphones. Objective: We aim to provide an overview of studies on smartphone-based systems that combine subjective ratings with objectively measured data for longitudinal monitoring of patients with affective disorders. Specifically, we aim to examine current knowledge on: (1) the feasibility of, and adherence to, such systems; (2) the association of monitored data with mood status; and (3) the effects of monitoring on clinical outcomes. Methods: We systematically searched PubMed, Web of Science, PsycINFO, and the Cochrane Central Register of Controlled Trials for relevant articles published in the last ten years (2007-2017) by applying Boolean search operators with an iterative combination of search terms, which was conducted in February 2017. Additional articles were identified via pearling, author correspondence, selected reference lists, and trial protocols. Results: A total of 3463 unique records were identified. Twenty-nine studies met the inclusion criteria and were included in the review. The majority of articles represented feasibility studies (n=27); two articles reported results from one randomized controlled trial (RCT). In total, six different self-monitoring systems for affective disorders that used subjective mood ratings and objective measurements were included. These objective parameters included physiological data (heart rate variability), behavioral data (phone usage, physical activity, voice features), and context/environmental information (light exposure and location). The included articles contained results regarding feasibility of such systems in affective disorders, showed reasonable accuracy in predicting mood status and mood fluctuations based on the objectively monitored data, and reported observations about the impact of monitoring on clinical state and adherence of patients to the system usage. Conclusions: The included observational studies and RCT substantiate the value of smartphone-based approaches for gathering long-term objective data (aside from self-ratings to monitor clinical symptoms) to predict changes in clinical states, and to investigate causal inferences about state changes in patients with affective disorders. Although promising, a much larger evidence-base is necessary to fully assess the potential and the risks of these approaches. Methodological limitations of the available studies (eg, small sample sizes, variations in the number of observations or monitoring duration, lack of RCT, and heterogeneity of methods) restrict the interpretability of the results. However, a number of study protocols stated ambitions to expand and intensify research in this emerging and promising field. ",
doi="10.2196/jmir.7006",
url="http://www.jmir.org/2017/7/e262/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28739561"
}


@Article{info:doi/10.2196/mhealth.7871,
author="Rahman, Abidur Quazi
and Janmohamed, Tahir
and Pirbaglou, Meysam
and Ritvo, Paul
and Heffernan, M. Jane
and Clarke, Hance
and Katz, Joel",
title="Patterns of User Engagement With the Mobile App, Manage My Pain: Results of a Data Mining Investigation",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Jul",
day="12",
volume="5",
number="7",
pages="e96",
keywords="chronic pain",
keywords="mhealth",
keywords="opioid use",
keywords="data mining",
keywords="cluster analysis",
keywords="Manage My Pain",
keywords="pain management",
keywords="pain app",
abstract="Background: Pain is one of the most prevalent health-related concerns and is among the top 3 most common reasons for seeking medical help. Scientific publications of data collected from pain tracking and monitoring apps are important to help consumers and healthcare professionals select the right app for their use. Objective: The main objectives of this paper were to (1) discover user engagement patterns of the pain management app, Manage My Pain, using data mining methods; and (2) identify the association between several attributes characterizing individual users and their levels of engagement. Methods: User engagement was defined by 2 key features of the app: longevity (number of days between the first and last pain record) and number of records. Users were divided into 5 user engagement clusters employing the k-means clustering algorithm. Each cluster was characterized by 6 attributes: gender, age, number of pain conditions, number of medications, pain severity, and opioid use. Z tests and chi-square tests were used for analyzing categorical attributes. Effects of gender and cluster on numerical attributes were analyzed using 2-way analysis of variances (ANOVAs) followed up by pairwise comparisons using Tukey honest significant difference (HSD). Results: The clustering process produced 5 clusters representing different levels of user engagement. The proportion of males and females was significantly different in 4 of the 5 clusters (all P ?.03). The proportion of males was higher than females in users with relatively high longevity. Mean ages of users in 2 clusters with high longevity were higher than users from other 3 clusters (all P <.001). Overall, males were significantly older than females (P <.001). Across clusters, females reported more pain conditions than males (all P <.001). Users from highly engaged clusters reported taking more medication than less engaged users (all P <.001). Females reported taking a greater number of medications than males (P =.04). In 4 of 5 clusters, the percentage of males taking an opioid was significantly greater (all P ?.05) than that of females. The proportion of males with mild pain was significantly higher than that of females in 3 clusters (all P ?.008). Conclusions: Although most users of the app reported being female, male users were more likely to be highly engaged in the app. Users in the most engaged clusters self-reported a higher number of pain conditions, a higher number of current medications, and a higher incidence of opioid usage. The high engagement by males in these clusters does not appear to be driven by pain severity which may, in part, be the case for females. Use of a mobile pain app may be relatively more attractive to highly-engaged males than highly-engaged females, and to those with relatively more complex chronic pain problems. ",
doi="10.2196/mhealth.7871",
url="http://mhealth.jmir.org/2017/7/e96/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28701291"
}


@Article{info:doi/10.2196/diabetes.6468,
author="Martinez, Mark
and Park, Bin Su
and Maison, Isaac
and Mody, Vicky
and Soh, Sungkon Lewis
and Parihar, Singh Harish",
title="iOS Appstore-Based Phone Apps for Diabetes Management: Potential for Use in Medication Adherence",
journal="JMIR Diabetes",
year="2017",
month="Jul",
day="11",
volume="2",
number="2",
pages="e12",
keywords="diabetes",
keywords="telemedicine",
keywords="blood glucose self-monitoring glucose monitoring",
keywords="mobile applications",
keywords="self-care",
keywords="mobile health",
abstract="Background: Currently, various phone apps have been developed to assist patients. Many of these apps are developed to assist patients in the self-management of chronic diseases such as diabetes. It is essential to analyze these various apps to understand the key features that would potentially be instrumental in helping patients successfully achieve goals in disease self-management. Objective: The objective of this study was to conduct a review of all the available diabetes-related apps in the iOS App Store to evaluate which diabetic app is more interactive and offers a wide variety of operations such as monitoring glucose, water, carbohydrate intake, weight, body mass index (BMI), medication, blood pressure (BP) levels, reminders or push notifications, food database, charts, exercise management, email, sync between devices, syncing data directly to the prescribers, and other miscellaneous functions such as (Twitter integration, password protection, retina display, barcode scanner, apple watch functionality, and cloud syncing). Methods: Data was gathered using the iOS App Store on an iPad. The search term ``diabetes'' resulted in 1209 results. Many of the results obtained were remotely related to diabetes and focused mainly on diet, exercise, emergency services, refill reminders, providing general diabetes information, and other nontherapeutic options. We reviewed each app description and only included apps that were meant for tracking blood glucose levels. All data were obtained in one sitting by one person on the same device, as we found that carrying out the search at different times or on different devices (iPhones) resulted in varying results. Apps that did not have a feature for tracking glucose levels were excluded from the study. Results: The search resulted in 1209 results; 85 apps were retained based on the inclusion criteria mentioned above. All the apps were reviewed for average customer ratings, number of reviews, price, and functions. Of all the apps surveyed, 18 apps with the highest number of user ratings were used for in-depth analysis. Of these 18 apps, 50\% (9/18) also had a medication adherence function. Our analysis revealed that the Diabetes logbook used by the mySugr app was one of the best; it differentiated itself by introducing fun as a method of increasing adherence. Conclusions: A large variation was seen in patient ratings of app features. Many patient reviewers desired simplicity of app functions. Glucose level tracking and email features potentially helped patients and health care providers manage the disease more efficiently. However, none of the apps could sync data directly to the prescribers. Additional features such as graph customization, availability of data backup, and recording previous entries were also requested by many users. Thus, the use of apps in disease management and patient and health-care provider involvement in future app refinement and development should be encouraged. ",
doi="10.2196/diabetes.6468",
url="http://diabetes.jmir.org/2017/2/e12/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30291096"
}


@Article{info:doi/10.2196/jmir.6659,
author="Downing, Janelle
and Bollyky, Jenna
and Schneider, Jennifer",
title="Use of a Connected Glucose Meter and Certified Diabetes Educator Coaching to Decrease the Likelihood of Abnormal Blood Glucose Excursions: The Livongo for Diabetes Program",
journal="J Med Internet Res",
year="2017",
month="Jul",
day="11",
volume="19",
number="7",
pages="e234",
keywords="SMBG",
keywords="blood glucose self-monitoring",
keywords="diabetes remote monitoring",
keywords="diabetes management",
keywords="diabetes mellitus",
keywords="self-care",
abstract="Background: The Livongo for Diabetes Program offers members (1) a cellular technology-enabled, two-way messaging device that measures blood glucose (BG), centrally stores the glucose data, and delivers messages back to the individual in real time; (2) unlimited BG test strips; and (3) access to a diabetes coaching team for questions, goal setting, and automated support for abnormal glucose excursions. The program is sponsored by at-risk self-insured employers, health plans and provider organizations where it is free to members with diabetes or it is available directly to the person with diabetes where they cover the cost. Objective: The objective of our study was to evaluate BG data from 4544 individuals with diabetes who were enrolled in the Livongo program from October 2014 through December 2015. Methods: Members used the Livongo glucose meter to measure their BG levels an average of 1.8 times per day. We estimated the probability of having a day with a BG reading outside of the normal range (70-180 mg/dL, or 3.9-10.0 mmol/L) in months 2 to 12 compared with month 1 of the program, using individual fixed effects to control for individual characteristics. Results: Livongo members experienced an average 18.4\% decrease in the likelihood of having a day with hypoglycemia (BG <70 mg/dL) and an average 16.4\% decrease in hyperglycemia (BG >180 mg/dL) in months 2-12 compared with month 1 as the baseline. The biggest impact was seen on hyperglycemia for nonusers of insulin. We do not know all of the contributing factors such as medication or other treatment changes during the study period. Conclusions: These findings suggest that access to a connected glucose meter and certified diabetes educator coaching is associated with a decrease in the likelihood of abnormal glucose excursions, which can lead to diabetes-related health care savings. ",
doi="10.2196/jmir.6659",
url="http://www.jmir.org/2017/7/e234/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28698167"
}


@Article{info:doi/10.2196/mental.7911,
author="Torous, John
and Roux, Spencer",
title="Patient-Driven Innovation for Mobile Mental Health Technology: Case Report of Symptom Tracking in Schizophrenia",
journal="JMIR Ment Health",
year="2017",
month="Jul",
day="06",
volume="4",
number="3",
pages="e27",
keywords="schizophrenia",
keywords="mobile health technology",
keywords="smartphone",
keywords="mhealth",
keywords="serious mental illness",
keywords="apps",
doi="10.2196/mental.7911",
url="http://mental.jmir.org/2017/3/e27/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28684386"
}


@Article{info:doi/10.2196/jmir.7760,
author="Nightingale, Ruth
and Hall, Andrew
and Gelder, Carole
and Friedl, Simone
and Brennan, Eileen
and Swallow, Veronica",
title="Desirable Components for a Customized, Home-Based, Digital Care-Management App for Children and Young People With Long-Term, Chronic Conditions: A Qualitative Exploration",
journal="J Med Internet Res",
year="2017",
month="Jul",
day="04",
volume="19",
number="7",
pages="e235",
keywords="child",
keywords="adolescent",
keywords="long-term condition",
keywords="chronic condition",
keywords="self-management",
keywords="self-care",
keywords="mobile apps",
keywords="apps",
keywords="qualitative",
abstract="Background: Mobile apps for mobile phones and tablet devices are widely used by children and young people aged 0-18 years with long-term health conditions, such as chronic kidney disease (CKD), and their healthy peers for social networking or gaming. They are also poised to become a major source of health guidance. However, app development processes that are coproduced, rigorously developed, and evaluated to provide tailored, condition-specific, practical advice on day-to-day care management are seldom systematic or sufficiently described to enable replication. Furthermore, attempts to extrapolate to the real world are hampered by a poor understanding of the effects of key elements of app components. Therefore, effective and cost-effective novel, digital apps that will effectively and safely support care management are critical and timely. To inform development of such an app for children with CKD, a user requirements-gathering exercise was first needed. Objective: To explore the views of children with CKD, their parents, and health care professionals to inform future development of a child-focused, care-management app. Methods: Using age- and developmentally appropriate methods, we interviewed 36 participants: 5-10-year-olds (n=6), 11-14-year-olds (n=6), 15-18-year-olds (n=5), mothers (n=10), fathers (n=2), and health care professionals (n=7). Data were analyzed using Framework Analysis and behavior change theories. Results: Of the 27 interviews, 19 (70\%) interviews were individual and 8 (30\%) were joint---5 out of 8 (63\%) joint interviews were with a child or young person and their parent, 1 out of 8 (13\%) were with a child and both parents, and 2 out of 8 (25\%) were with 2 professionals. Three key themes emerged to inform development of a software requirement specification for a future home-based, digital care-management app intervention: (1) Gaps in current online information and support, (2) Difficulties experienced by children with a long-term condition, and (3) Suggestions for a digital care-management app. Reported gaps included the fact that current online information is not usually appropriate for children as it is ``dry'' and ``boring,'' could be ``scary,'' and was either hard to understand or not relevant to individuals' circumstances. For children, searching online was much less accessible than using a professional-endorsed mobile app. Children also reported difficulty explaining their condition to others, maintaining treatment adherence, coping with feeling isolated, and with trying to live a ``normal'' life. There was recognition that a developmentally appropriate, CKD-specific app could support the process of explaining the condition to healthy peers, reducing isolation, adhering to care-management plans, and living a ``normal'' life. Participants recommended a range of media and content to include in a tailored, interactive, age- and developmentally appropriate app. For example, the user would be able to enter their age and diagnosis so that only age-appropriate and condition-specific content is displayed. Conclusions: Future development of a digital app that meets the identified information and support needs and preferences of children with CKD will maximize its utility, thereby augmenting CKD caregiving and optimizing outcomes. ",
doi="10.2196/jmir.7760",
url="http://www.jmir.org/2017/7/e235/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28676470"
}


@Article{info:doi/10.2196/mhealth.7263,
author="Boyle, Leah
and Grainger, Rebecca
and Hall, M. Rosemary
and Krebs, D. Jeremy",
title="Use of and Beliefs About Mobile Phone Apps for Diabetes Self-Management: Surveys of People in a Hospital Diabetes Clinic and Diabetes Health Professionals in New Zealand",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Jun",
day="30",
volume="5",
number="6",
pages="e85",
keywords="mHealth, mobile applications",
keywords="telemedicine",
keywords="diabetes mellitus",
abstract="Background: People with diabetes mellitus (DM) are using mobile phone apps to support self-management. The numerous apps available to assist with diabetes management have a variety of functions. Some functions, like insulin dose calculators, have significant potential for harm. Objectives: The study aimed to establish (1) whether people with DM in Wellington, New Zealand, use apps for DM self-management and evaluate desirable features of apps and (2) whether health professionals (HPs) in New Zealand treating people with DM recommend apps to patients, the features HPs regard as important, and their confidence with recommending apps. Methods: A survey of patients seen at a hospital diabetes clinic over 12 months (N=539) assessed current app use and desirable features. A second survey of HPs attending a diabetes conference (n=286) assessed their confidence with app recommendations and perceived usefulness. Results: Of the 189 responders (35.0\% response rate) to the patient survey, 19.6\% (37/189) had used a diabetes app. App users were younger and in comparison to other forms of diabetes mellitus, users prominently had type 1 DM. The most favored feature of the app users was a glucose diary (87\%, 32/37), and an insulin calculator was the most desirable function for a future app (46\%, 17/37). In non-app users, the most desirable feature for a future app was a glucose diary (64.4\%, 98/152). Of the 115 responders (40.2\% response rate) to the HPs survey, 60.1\% (68/113) had recommended a diabetes app. Diaries for blood glucose levels and carbohydrate counting were considered the most useful app features and the features HPs felt most confident to recommend. HPs were least confident in recommending insulin calculation apps. Conclusions: The use of apps to record blood glucose was the most favored function in apps used by people with diabetes, with interest in insulin dose calculating function. HPs do not feel confident in recommending insulin dose calculators. There is an urgent need for an app assessment process to give confidence in the quality and safety of diabetes management apps to people with diabetes (potential app users) and HPs (potential app prescribers). ",
doi="10.2196/mhealth.7263",
url="http://mhealth.jmir.org/2017/6/e85/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28666975"
}


@Article{info:doi/10.2196/jmir.7045,
author="Holmen, Heidi
and Wahl, Klopstad Astrid
and Cvancarova Sm{\aa}stuen, Milada
and Ribu, Lis",
title="Tailored Communication Within Mobile Apps for Diabetes Self-Management: A Systematic Review",
journal="J Med Internet Res",
year="2017",
month="Jun",
day="23",
volume="19",
number="6",
pages="e227",
keywords="diabetes mellitus (MeSH)",
keywords="communication (MeSH)",
keywords="mobile apps",
keywords="self-management",
keywords="systematic review",
keywords="mHealth",
abstract="Background: The prevalence of diabetes is increasing and with the requirements for self-management and risk of late complications, it remains a challenge for the individual and society. Patients can benefit from support from health care personnel in their self-management, and the traditional communication between patients and health care personnel is changing. Smartphones and apps offer a unique platform for communication, but apps with integrated health care personnel communication based on patient data are yet to be investigated to provide evidence of possible effects. Objective: Our goal was to systematically review studies that aimed to evaluate integrated communication within mobile apps for tailored feedback between patients with diabetes and health care personnel in terms of (1) study characteristics, (2) functions, (3) study outcomes, (4) effects, and (5) methodological quality. Methods: A systematic literature search was conducted following our International Prospective Register of Systematic Reviews (PROSPERO) protocol, searching for apps with integrated communication for persons with diabetes tested in a controlled trial in the period 2008 to 2016. We searched the databases PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central, Excerpta Medica database (EMBASE), ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform. The search was closed in September 2016. Reference lists of primary articles and review papers were assessed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and we applied the Cochrane risk of bias tool to assess methodological quality. Results: We identified 2822 citations and after duplicate removal, we assessed 1128 citations. A total of 6 papers were included in this systematic review, reporting on data from 431 persons participating in small trials of short duration. The integrated communication features were mostly individualized as written non--real-time feedback. The number of functions varied from 2 to 9, and blood glucose tracking was the most common. HbA1c was the most common primary outcome, but the remaining reported outcomes were not standardized and comparable. Because of both the heterogeneity of the included trials and the poor methodological quality of the studies, a meta-analysis was not possible. A statistically significant improvement in the primary measure of outcome was found in 3 of the 6 included studies, of which 2 were HbA1c and 1 was mean daytime ambulatory blood pressure. Participants in the included trials reported positive usability or feasibility postintervention in 5 out of 6 trials. The overall methodological quality of the trials was, however, scored as an uncertain risk of bias. Conclusions: This systematic review highlights the need for more trials of higher methodological quality. Few studies offer an integrated function for communication and feedback from health care personnel, and the research field represents an area of heterogeneity with few studies of highly rigorous methodological quality. This, in combination with a low number of participants and a short follow-up, is making it difficult to provide reliable evidence of effects for stakeholders. ",
doi="10.2196/jmir.7045",
url="http://www.jmir.org/2017/6/e227/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28645890"
}


@Article{ref1,
url=""
}


@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.7116,
author="Farmer, Andrew
and Williams, Veronika
and Velardo, Carmelo
and Shah, Ahmar Syed
and Yu, Ly-Mee
and Rutter, Heather
and Jones, Louise
and Williams, Nicola
and Heneghan, Carl
and Price, Jonathan
and Hardinge, Maxine
and Tarassenko, Lionel",
title="Self-Management Support Using a Digital Health System Compared With Usual Care for Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2017",
month="May",
day="03",
volume="19",
number="5",
pages="e144",
keywords="pulmonary disease, chronic obstructive",
keywords="telehealth",
keywords="self-care",
keywords="randomized controlled trial",
abstract="Background: We conducted a randomized controlled trial of a digital health system supporting clinical care through monitoring and self-management support in community-based patients with moderate to very severe chronic obstructive pulmonary disease (COPD). Objective: The aim of this study was to determine the efficacy of a fully automated Internet-linked, tablet computer-based system of monitoring and self-management support (EDGE? sElf-management anD support proGrammE) in improving quality of life and clinical outcomes. Methods: We compared daily use of EDGE with usual care for 12 months. The primary outcome was COPD-specific health status measured with the St George's Respiratory Questionnaire for COPD (SGRQ-C). Results: A total of 166 patients were randomized (110 EDGE, 56 usual care). All patients were included in an intention to treat analysis. The estimated difference in SGRQ-C at 12 months (EDGE?usual care) was ?1.7 with a 95\% CI of ?6.6 to 3.2 (P=.49). The relative risk of hospital admission for EDGE was 0.83 (0.56-1.24, P=.37) compared with usual care. Generic health status (EQ-5D, EuroQol 5-Dimension Questionnaire) between the groups differed significantly with better health status for the EDGE group (0.076, 95\% CI 0.008-0.14, P=.03). The median number of visits to general practitioners for EDGE versus usual care were 4 versus 5.5 (P=.06) and to practice nurses were 1.5 versus 2.5 (P=.03), respectively. Conclusions: The EDGE clinical trial does not provide evidence for an effect on COPD-specific health status?in comparison with usual care, despite uptake of the intervention. However, there appears to be an overall benefit in generic health status; and?the effect sizes for improved depression score, reductions in hospital admissions, and general practice visits warrants further evaluation?and could make an important contribution to supporting people with COPD. Trial registration: International Standard Randomized Controlled Trial Number (ISRCTN): 40367841; http://www.isrctn.com/ISRCTN40367841 (Archived by WebCite at http://www.webcitation.org/6pmfIJ9KK) ",
doi="10.2196/jmir.7116",
url="http://www.jmir.org/2017/5/e144/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28468749"
}


@Article{info:doi/10.2196/mhealth.7168,
author="Miller, Lisa
and Sch{\"u}z, Benjamin
and Walters, Julia
and Walters, Haydn E.",
title="Mobile Technology Interventions for Asthma Self-Management: Systematic Review and Meta-Analysis",
journal="JMIR Mhealth Uhealth",
year="2017",
month="May",
day="02",
volume="5",
number="5",
pages="e57",
keywords="asthma",
keywords="mhealth",
keywords="medication adherence",
keywords="patient monitoring",
keywords="behavior and behavior mechanisms",
keywords="meta-analysis",
abstract="Background: Mobile technology interventions (MTI) are becoming increasingly popular in the management of chronic health behaviors. Most MTI allow individuals to monitor medication use, record symptoms, or store and activate disease-management action plans. Therefore, MTI may have the potential to improve low adherence to medication and action plans for individuals with asthma, which is associated with poor clinical outcomes. Objective: A systematic review and meta-analysis were conducted to evaluate the efficacy of MTI on clinical outcomes as well as adherence in individuals with asthma. As the use of evidence-based behavior change techniques (BCT) has been shown to improve intervention effects, we also conducted exploratory analyses to determine the role of BCT and engagement with MTI as moderators of MTI efficacy. Methods: We searched electronic databases for randomized controlled trials up until June 2016. Random effect models were used to assess the effect of MTI on clinical outcomes as well as adherence to preventer medication or symptom monitoring. Mixed effects models assessed whether the features of the MTI (ie, use of BCT) and how often a person engaged with MTI moderated the effects of MTI. Results: The literature search located 11 studies meeting the inclusion criteria, with 9 providing satisfactory data for meta-analysis. Compared with standard treatment, MTI had moderate to large effect sizes (Hedges g) on medication adherence and clinical outcomes. MTI had no additional effects on adherence or clinical outcomes when compared with paper-based monitoring. No moderator effects were found, and the number of studies was small. A narrative review of the two studies, which are not included in the meta-analysis, found similar results. Conclusions: This review indicated the efficacy of MTI for self-management in individuals with asthma and also indicated that MTI appears to be as efficacious as paper-based monitoring. This review also suggested a need for robust studies to examine the effects of BCT use and engagement on MTI efficacy to inform the evidence base for MTI in individuals with asthma. ",
doi="10.2196/mhealth.7168",
url="https://mhealth.jmir.org/2017/5/e57/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28465281"
}


@Article{info:doi/10.2196/resprot.7105,
author="Hayashi, Aki
and Yamaguchi, Satoko
and Waki, Kayo
and Fujiu, Katsuhito
and Hanafusa, Norio
and Nishi, Takahiro
and Tomita, Hyoe
and Kobayashi, Haruka
and Fujita, Hideo
and Kadowaki, Takashi
and Nangaku, Masaomi
and Ohe, Kazuhiko",
title="Testing the Feasibility and Usability of a Novel Smartphone-Based Self-Management Support System for Dialysis Patients: A Pilot Study",
journal="JMIR Res Protoc",
year="2017",
month="Apr",
day="20",
volume="6",
number="4",
pages="e63",
keywords="telemedicine",
keywords="mobile phone app",
keywords="hemodialysis",
keywords="self-management",
abstract="Background: Diet and fluid restrictions that need continuous self-management are among the most difficult aspects of dialysis treatment. Smartphone applications may be useful for supporting self-management. Objective: Our objective is to investigate the feasibility and usability of a novel smartphone-based self-management support system for dialysis patients. Methods: We developed the Self-Management and Recording System for Dialysis (SMART-D), which supports self-monitoring of three mortality-related factors that can be modified by lifestyle: interdialytic weight gain and predialysis serum potassium and phosphorus concentrations. Data is displayed graphically, with all data evaluated automatically to determine whether they achieve the values suggested by the Japanese Society for Dialysis Therapy guidelines. In a pilot study, 9 dialysis patients used SMART-D system for 2 weeks. A total of 7 of them completed questionnaires rating their assessment of SMART-D's usability and their satisfaction with the system. In addition, the Kidney Disease Quality of Life scale was compared before and after the study period. Results: All 9 participants were able to use SMART-D with no major problems. Completion rates for body weight, pre- and postdialysis weight, and serum potassium and phosphorus concentrations were, respectively, 89\% (SD 23), 95\% (SD 7), and 78\% (SD 44). Of the 7 participants who completed the usability survey, all were motivated by the sense of security derived from using the system, and 6 of the 7 (86\%) reported that using SMART-D helped improve their lifestyle and self-management. Conclusions: Using SMART-D was feasible, and the system was well regarded by patients. Further study with larger scale cohorts and longer study and follow-up periods is needed to evaluate the effects of SMART-D on clinical outcomes and quality of life. ",
doi="10.2196/resprot.7105",
url="http://www.researchprotocols.org/2017/4/e63/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28428168"
}


@Article{info:doi/10.2196/mhealth.6654,
author="Holtz, E. Bree
and Murray, M. Katharine
and Hershey, D. Denise
and Dunneback, K. Julie
and Cotten, R. Shelia
and Holmstrom, J. Amanda
and Vyas, Arpita
and Kaiser, K. Molly
and Wood, A. Michael",
title="Developing a Patient-Centered mHealth App: A Tool for Adolescents With Type 1 Diabetes and Their Parents",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Apr",
day="19",
volume="5",
number="4",
pages="e53",
keywords="mHealth",
keywords="qualitative research",
keywords="type 1 diabetes",
keywords="family",
abstract="Background: Type 1 diabetes (T1D) afflicts approximately 154,000 people under 20 years of age. Three-quarters of adolescents are not achieving glycosylated hemoglobin (HbA1c) targets, which leads to negative health outcomes. Mobile health (mHealth), the use of technology in health, has been used successfully to improve health in many chronic conditions, including diabetes. Objective: The purpose of this study was to use patient-centered research methods to inform and improve the design and functionality of our T1D app, MyT1DHero, and to provide insight for others who are designing a health app for adolescents and parents. Methods: This study included data from focus groups with participants recruited from the Juvenile Diabetes Research Foundation (JDRF) southeast Michigan's family network. All data collected during the sessions were audio-recorded, transcribed, and coded. Results: Four key themes were identified: (1) diabetes is unpredictable, (2) negative and frustrated communication, (3) motivations to use an app, and (4) feedback specific to our app. Conclusions: A patient-centered approach was used to assist in the development of an app for adolescents with T1D. Participants were satisfied with overall app design; customization, interactivity, and tangible rewards were identified as being necessary for continued use. Participants believed the app would help improve the communication between parents and adolescents. Many apps developed in the health context have not used a patient-centered design method or have seen vast improvements in health. This paper offers suggestions to others seeking to develop apps for adolescents and their parents. ",
doi="10.2196/mhealth.6654",
url="http://mhealth.jmir.org/2017/4/e53/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28428167"
}


@Article{info:doi/10.2196/mhealth.6544,
author="Nahum, Mor
and Van Vleet, M. Thomas
and Sohal, S. Vikaas
and Mirzabekov, J. Julie
and Rao, R. Vikram
and Wallace, L. Deanna
and Lee, B. Morgan
and Dawes, Heather
and Stark-Inbar, Alit
and Jordan, Thomas Joshua
and Biagianti, Bruno
and Merzenich, Michael
and Chang, F. Edward",
title="Immediate Mood Scaler: Tracking Symptoms of Depression and Anxiety Using a Novel Mobile Mood Scale",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Apr",
day="12",
volume="5",
number="4",
pages="e44",
keywords="mood disorders",
keywords="mobile",
keywords="ecological momentary assessment",
keywords="depression",
keywords="anxiety",
abstract="Background: Mood disorders are dynamic disorders characterized by multimodal symptoms. Clinical assessment of symptoms is currently limited to relatively sparse, routine clinic visits, requiring retrospective recollection of symptoms present in the weeks preceding the visit. Novel advances in mobile tools now support ecological momentary assessment of mood, conducted frequently using mobile devices, outside the clinical setting. Such mood assessment may help circumvent problems associated with infrequent reporting and better characterize the dynamic presentation of mood symptoms, informing the delivery of novel treatment options. Objectives: The aim of our study was to validate the Immediate Mood Scaler (IMS), a newly developed, iPad-deliverable 22-item self-report tool designed to capture current mood states. Methods: A total of 110 individuals completed standardized questionnaires (Patient Health Questionnaire, 9-item [PHQ-9]; generalized anxiety disorder, 7-Item [GAD-7]; and rumination scale) and IMS at baseline. Of the total, 56 completed at least one additional session of IMS, and 17 completed one additional administration of PHQ-9 and GAD-7. We conducted exploratory Principal Axis Factor Analysis to assess dimensionality of IMS, and computed zero-order correlations to investigate associations between IMS and standardized scales. Linear Mixed Model (LMM) was used to assess IMS stability across time and to test predictability of PHQ-9 and GAD-7 score by IMS. Results: Strong correlations were found between standard mood scales and the IMS at baseline (r=.57-.59, P<.001). A factor analysis revealed a 12-item IMS (``IMS-12'') with two factors: a ``depression'' factor and an ``anxiety'' factor. IMS-12 depression subscale was more strongly correlated with PHQ-9 than with GAD-7 (z=1.88, P=.03), but the reverse pattern was not found for IMS-12 anxiety subscale. IMS-12 showed less stability over time compared with PHQ-9 and GAD-7 (.65 vs .91), potentially reflecting more sensitivity to mood dynamics. In addition, IMS-12 ratings indicated that individuals with mild to moderate depression had greater mood fluctuations compared with individuals with severe depression (.42 vs .79; P=.04). Finally, IMS-12 significantly contributed to the prediction of subsequent PHQ-9 (beta=1.03, P=.02) and GAD-7 scores (beta =.93, P=.01). Conclusions: Collectively, these data suggest that the 12-item IMS (IMS-12) is a valid tool to assess momentary mood symptoms related to anxiety and depression. Although IMS-12 shows good correlation with standardized scales, it further captures mood fluctuations better and significantly adds to the prediction of the scales. Results are discussed in the context of providing continuous symptom quantification that may inform novel treatment options and support personalized treatment plans. ",
doi="10.2196/mhealth.6544",
url="http://mhealth.jmir.org/2017/4/e44/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28404542"
}


@Article{info:doi/10.2196/jmir.6994,
author="Peters, Dorian
and Davis, Sharon
and Calvo, Alejandro Rafael
and Sawyer, M. Susan
and Smith, Lorraine
and Foster, M. Juliet",
title="Young People's Preferences for an Asthma Self-Management App Highlight Psychological Needs: A Participatory Study",
journal="J Med Internet Res",
year="2017",
month="Apr",
day="11",
volume="19",
number="4",
pages="e113",
keywords="asthma",
keywords="mobile applications",
keywords="quality of life",
keywords="mental health",
keywords="adolescents",
keywords="chronic disease",
keywords="mhealth",
keywords="participatory design",
abstract="Background: Although the prevalence of mental illness among young people with asthma is known to be twice the rate of the wider population, none of the asthma apps reported have acknowledged or attempted to include psychological support features. This is perhaps because user involvement in the development of asthma apps has been scarce. User involvement, facilitated by participatory design methods, can begin to address these issues while contributing insights to our understanding of the psychological experience associated with asthma and how technology might improve quality of life. Objective: The goal of this participatory user research study was to explore the experience, needs, and ideas of young people with asthma while allowing them to define requirements for an asthma app that would be engaging and effective at improving their well-being. Methods: Young people aged 15-24 years with doctor-diagnosed asthma were invited to participate in a participatory workshop and to complete a workbook designed to elicit their thoughts and ideas about living with asthma, technology use, and the design of an app. Participants generated a number of artifacts (including collages, concept maps, and paper prototypes) designed to reify their ideas, tacit knowledge, and experience. Results: A total of 20 participants (mean age 17.8 years; 60\%, 12/20 female) representing a range from inadequately to well-controlled asthma completed a workbook and 13 of these also took part in a workshop (four workshops were held in total), resulting in 102 participant-generated artifacts. Theoretical thematic analysis resulted in a set of personal needs, feature ideas, and app characteristics considered relevant by young people for an asthma support app. The data revealed that psychological factors such as anxiety, and impediments to autonomy, competence, and relatedness (as consistent with self-determination theory [SDT]), were considered major influences on quality of life by young people with asthma. Furthermore, the incorporation of features pertaining to psychological experience was particularly valued by participants. Conclusions: In addition to practical features for asthma management, an app for young people with asthma should include support for the mental health factors associated with lived experience (ie, anxiety, lack of autonomy, and social disconnectedness). We show how support for these factors can be translated into design features of an app for asthma. In addition to informing the development of asthma-support technologies for young people, these findings could have implications for technologies designed to support people with chronic illness more generally. ",
doi="10.2196/jmir.6994",
url="http://www.jmir.org/2017/4/e113/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28400353"
}


@Article{info:doi/10.2196/mhealth.6496,
author="Reade, Samuel
and Spencer, Karen
and Sergeant, C. Jamie
and Sperrin, Matthew
and Schultz, M. David
and Ainsworth, John
and Lakshminarayana, Rashmi
and Hellman, Bruce
and James, Ben
and McBeth, John
and Sanders, Caroline
and Dixon, G. William",
title="Cloudy with a Chance of Pain: Engagement and Subsequent Attrition of Daily Data Entry in a Smartphone Pilot Study Tracking Weather, Disease Severity, and Physical Activity in Patients With Rheumatoid Arthritis",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Mar",
day="24",
volume="5",
number="3",
pages="e37",
keywords="smartphone",
keywords="mHealth",
keywords="attrition",
keywords="weather",
keywords="arthritis",
abstract="Background: The increasing ownership of smartphones provides major opportunities for epidemiological research through self-reported and passively collected data. Objective: This pilot study aimed to codesign a smartphone app to assess associations between weather and joint pain in patients with rheumatoid arthritis (RA) and to study the success of daily self-reported data entry over a 60-day period and the enablers of and barriers to data collection. Methods: A patient and public involvement group (n=5) and 2 focus groups of patients with RA (n=9) supported the codesign of the app collecting self-reported symptoms. A separate ``capture app'' was designed to collect global positioning system (GPS) and continuous raw accelerometer data, with the GPS-linking providing local weather data. A total of 20 patients with RA were then recruited to collect daily data for 60 days, with entry and exit interviews. Of these, 17 were loaned an Android smartphone, whereas 3 used their own Android smartphones. Results: Of the 20 patients, 6 (30\%) withdrew from the study: 4 because of technical challenges and 2 for health reasons. The mean completion of daily entries was 68\% over 2 months. Patients entered data at least five times per week 65\% of the time. Reasons for successful engagement included a simple graphical user interface, automated reminders, visualization of data, and eagerness to contribute to this easily understood research question. The main barrier to continuing engagement was impaired battery life due to the accelerometer data capture app. For some, successful engagement required ongoing support in using the smartphones. Conclusions: This successful pilot study has demonstrated that daily data collection using smartphones for health research is feasible and achievable with high levels of ongoing engagement over 2 months. This result opens important opportunities for large-scale longitudinal epidemiological research. ",
doi="10.2196/mhealth.6496",
url="http://mhealth.jmir.org/2017/3/e37/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28341616"
}


@Article{info:doi/10.2196/humanfactors.6481,
author="Alnosayan, Nagla
and Chatterjee, Samir
and Alluhaidan, Ala
and Lee, Edward
and Houston Feenstra, Linda",
title="Design and Usability of a Heart Failure mHealth System: A Pilot Study",
journal="JMIR Hum Factors",
year="2017",
month="Mar",
day="24",
volume="4",
number="1",
pages="e9",
keywords="mHealth",
keywords="telehealth",
keywords="heart failure",
keywords="human factors engineering",
keywords="self-management",
abstract="Background: Despite the advances in mobile health (mHealth) systems, little is known about patients' and providers' experiences using a new mHealth system design. Objective: This study aimed to understand challenges and provide design considerations for a personalized mHealth system that could effectively support heart failure (HF) patients after they transition into the home environment. Methods: Following exploratory interviews with nurses and preventive care physicians, an mHealth system was developed. Patients were asked to measure their weight, blood pressure, and blood glucose (if they had diabetes). They were also instructed to enter symptoms, view notifications, and read messages on a mobile app that we developed. A Bluetooth-enabled weight scale, blood pressure monitor, glucometer, and mobile phone was provided after an introductory orientation and training session. HF nurses used a dashboard to view daily measurements for each patient and received text and email alerts when risk was indicated. Observations of usage, cases of deterioration, readmissions, and metrics related to system usability and quality of life outcomes were used to determine overall effectiveness of the system, whereas focus group sessions with patients were conducted to elicit participants' feedback on the system's design. Results: A total of 8 patients with HF participated over a 6-month period. Overall, the mean users' satisfaction with the system ranked 73\%, which was above average. Quality of life improvement was 3.6. Patients and nurses used the system on a regular basis and were able to successfully identify and manage 8 health deteriorations, of which 5 were completely managed remotely. Focus groups revealed that, on one hand, the system was beneficial and helped patients with: recording and tracking readings; receiving encouragement and reassurance from nurses; spotting and solving problems; learning from past experiences; and communication. On the other hand, findings also highlighted design issues and recommendations for future systems such as the need to communicate via other media, personalize symptom questions and messages, integrate other health tracking technologies, and provide additional methods to analyze and visualize their data. Conclusions: Understanding users' experiences provides important design considerations that could complement existing design recommendations from the literature, and, when combined with physician and nurse requirements, have the potential to yield a feasible telehealth system that is effective in supporting HF self-care. Future studies will include these guidelines and use a larger sample size to validate the outcomes. ",
doi="10.2196/humanfactors.6481",
url="http://humanfactors.jmir.org/2017/1/e9/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28341615"
}


@Article{info:doi/10.2196/mhealth.6889,
author="Tian, Maoyi
and Zhang, Jing
and Luo, Rong
and Chen, Shi
and Petrovic, Djordje
and Redfern, Julie
and Xu, Roman Dong
and Patel, Anushka",
title="mHealth Interventions for Health System Strengthening in China: A Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Mar",
day="16",
volume="5",
number="3",
pages="e32",
keywords="mHealth",
keywords="China",
keywords="health care systems",
abstract="Background: With rapidly expanding infrastructure in China, mobile technology has been deemed to have the potential to revolutionize health care delivery. There is particular promise for mobile health (mHealth) to positively influence health system reform and confront the new challenges of chronic diseases. Objective: The aim of this study was to systematically review existing mHealth initiatives in China, characterize them, and examine the extent to which mHealth contributes toward the health system strengthening in China. Furthermore, we also aimed to identify gaps in mHealth development and evaluation. Methods: We systematically reviewed the literature from English and Chinese electronic database and trial registries, including PubMed, EMBASE, Cochrane, China National Knowledge of Infrastructure (CNKI), and World Health Organization (WHO) International Clinical Trials Registry Platform. We used the English keywords of mHealth, eHealth, telemedicine, telehealth, mobile phone, cell phone, text messaging, and China, as well as their corresponding Chinese keywords. All articles using mobile technology for health care management were included in the study. Results: A total of 1704 articles were found using the search terms, and eventually 72 were included. Overall, few high quality interventions were identified. Most interventions were found to be insufficient in scope, and their evaluation was of inadequate rigor to generate scalable solutions and provide reliable evidence of effectiveness. Most interventions focused on text messaging for consumer education and behavior change. There were a limited number of interventions that addressed health information management, health workforce issues, use of medicines and technologies, or leadership and governance from a health system perspective. Conclusions: We provide four recommendations for future mHealth interventions in China that include the need for the development, evaluation and trials examining integrated mHealth interventions to guide the development of future mHealth interventions, target disadvantaged populations with mHealth interventions, and generate appropriate evidence for scalable and sustainable models of care. ",
doi="10.2196/mhealth.6889",
url="http://mhealth.jmir.org/2017/3/e32/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28302597"
}


@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.6021,
author="Jung, Young Se
and Lee, Keehyuck
and Hwang, Hee
and Yoo, Sooyoung
and Baek, Young Hyun
and Kim, Jeehyoung",
title="Support for Sustainable Use of Personal Health Records: Understanding the Needs of Users as a First Step Towards Patient-Driven Mobile Health",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Feb",
day="23",
volume="5",
number="2",
pages="e19",
keywords="electronic health record",
keywords="medical informatics",
keywords="personal health record",
keywords="hospital information systems",
abstract="Background: The tethering of a personal health record (PHR) to an electronic medical record (EMR) may serve as a catalyst in accelerating the distribution of integrated PHRs. Creating shared health records for patients and their health care professionals using self-administered functions of EMR-tethered PHRs is crucial to support sustainable use of the system. Objective: This study assesses the factors related to active use of a self-administered function (Health Notes) in an EMR-tethered PHR (Health4U) in a tertiary academic hospital. Methods: This research is a cross-sectional study conducted in a tertiary academic hospital in South Korea. The enrollees included adults aged 19 years and older with experience accessing Health4U in the 13-month period after June 2013. The primary outcome was the adoption of Health Notes in accordance with the number of chronic diseases. Socio-demographic variables were included as confounding factors. Results: Subjects 71 years of age and older were less likely to become active users of Health Notes than those 30 years and younger. Moreover, compared with men, women had 44\% and 40\% lower tendencies to become Health Notes users and active users, respectively. Those who accessed the desktop page and/or mobile page had higher tendencies to become users of Health Notes. We found a consistent increase in the odds ratio as the number of chronic diseases increased in the active users. When considering specific diseases, patients who had cancer or chronic kidney disease had higher tendencies to become users of Health Notes. Conclusions: Patients with a greater number of chronic diseases tended to use PHR more actively, and used the self-administered function. Women and the elderly may have lower tendencies to actively use PHR. Therefore, items specific to the health of each demographic---women, the elderly, and those with chronic diseases---should be carefully considered to support sustainable use of PHRs. ",
doi="10.2196/mhealth.6021",
url="http://mhealth.jmir.org/2017/2/e19/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28232300"
}


@Article{info:doi/10.2196/mhealth.6956,
author="Grainger, Rebecca
and Townsley, Hermaleigh
and White, Bonnie
and Langlotz, Tobias
and Taylor, J. William",
title="Apps for People With Rheumatoid Arthritis to Monitor Their Disease Activity: A Review of Apps for Best Practice and Quality",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Feb",
day="21",
volume="5",
number="2",
pages="e7",
keywords="mHealth",
keywords="mobile applications",
keywords="telemedicine",
keywords="self-management",
keywords="rheumatoid arthritis",
abstract="Background: Rheumatoid arthritis (RA) is a chronic inflammatory arthritis requiring long-term treatment with regular monitoring by a rheumatologist to achieve good health outcomes. Since people with RA may wish to monitor their own disease activity with a smartphone app, it is important to understand the functions and quality of apps for this purpose. Objective: The aim of our study was to assess the features and quality of apps to assist people to monitor their RA disease activity by (1) summarizing the available apps, particularly the instruments used for measurement of RA disease activity; (2) comparing the app features with American College of Rheumatology and European League against Rheumatism (ACR and EULAR) guidelines for monitoring of RA disease activity; and (3) rating app quality with the Mobile App Rating Scale (MARS). Methods: Systematic searches of the New Zealand iTunes and Google Play app stores were used to identify all apps for monitoring of RA disease activity that could be used by people with RA. The apps were described by both key metadata and app functionality. App adherence with recommendations for monitoring of RA disease activity in clinical practice was evaluated by identifying whether apps included calculation of a validated composite disease activity measure and recorded results for future retrieval. App quality was assessed by 2 independent reviewers using the MARS. Results: The search identified 721 apps in the Google Play store and 216 in the iTunes store, of which 19 unique apps met criteria for inclusion (8 from both app stores, 8 iTunes, and 3 Google Play). In total, 14 apps included at least one validated instrument measuring RA disease activity; 7 of 11 apps that allowed users to enter a joint count used the standard 28 swollen and tender joint count; 8 apps included at least one ACR and EULAR-recommended RA composite disease activity (CDA) measure; and 10 apps included data storage and retrieval. Only 1 app, Arthritis Power, included both an RA CDA measure and tracked data, but this app did not include the standard 28 tender and swollen joint count. The median overall MARS score for apps was 3.41/5. Of the 6 apps that scored ?4/5 on the overall MARS rating, only 1 included a CDA score endorsed by ACR and EULAR; however, this app did not have a data tracking function. Conclusions: This review found a lack of high-quality apps for longitudinal assessment of RA disease activity. Current apps fall into two categories: simple calculators primarily for rheumatologists and data tracking tools for people with RA. The latter do not uniformly collect data using validated instruments or composite disease activity measures. There is a need for appropriate, high-quality apps for use by rheumatologists and patients together in co-management of RA. ",
doi="10.2196/mhealth.6956",
url="http://mhealth.jmir.org/2017/2/e7/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28223263"
}


@Article{info:doi/10.2196/diabetes.7221,
author="Dobson, Rosie
and Whittaker, Robyn
and Murphy, Rinki
and Khanolkar, Manish
and Miller, Steven
and Naylor, Joanna
and Maddison, Ralph",
title="The Use of Mobile Health to Deliver Self-Management Support to Young People With Type 1 Diabetes: A Cross-Sectional Survey",
journal="JMIR Diabetes",
year="2017",
month="Feb",
day="15",
volume="2",
number="1",
pages="e4",
keywords="mHealth",
keywords="diabetes mellitus",
keywords="mobile phone",
keywords="mobile applications",
keywords="text messages",
abstract="Background: Young people living with type 1 diabetes face not only the challenges typical of adolescence, but also the challenges of daily management of their health and evolving understanding of the impact of their diagnosis on their future. Adolescence is a critical time for diabetes self-management, with a typical decline in glycemic control increasing risk for microvascular diabetes complications. To improve glycemic control, there is a need for evidence-based self-management support interventions that address the issues pertinent to this population, utilizing platforms that engage them. Increasingly, mobile health (mHealth) interventions are being developed and evaluated for this purpose with some evidence supporting improved glycemic control. A necessary step to enhance effectiveness of such approaches is to understand young people's preferences for this mode of delivery. Objective: A cross-sectional survey was conducted to investigate the current and perceived roles of mHealth in supporting young people to manage their diabetes. Methods: Young adults (16-24 years) with type 1 diabetes in Auckland, New Zealand, were invited to take part in a survey via letter from their diabetes specialist. Results: A total of 115 young adults completed the survey (mean age 19.5 years; male 52/115, 45\%; European 89/115, 77\%), with all reporting they owned a mobile phone and 96\% (110/115) of those were smartphones. However, smartphone apps for diabetes management had been used by only 33\% (38/115) of respondents. The most commonly reported reason for not using apps was a lack of awareness that they existed. Although the majority felt they managed their diabetes well, 63\% (72/115) reported wanting to learn more about diabetes and how to manage it. A total of 64\% (74/115) respondents reported that they would be interested in receiving diabetes self-management support via text message (short message service, SMS). Conclusions: Current engagement with mHealth in this population appears low, although the findings from this study provide support for the use of mHealth in this group because of the ubiquity and convenience of mobile devices. mHealth has potential to provide information and support to this population, utilizing mediums commonplace for this group and with greater reach than traditional methods. ",
doi="10.2196/diabetes.7221",
url="http://diabetes.jmir.org/2017/1/e4/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30291057"
}


@Article{info:doi/10.2196/diabetes.6667,
author="Sahin, Cigdem
and Naylor, Patti-Jean",
title="Mixed-Methods Research in Diabetes Management via Mobile Health Technologies: A Scoping Review",
journal="JMIR Diabetes",
year="2017",
month="Feb",
day="06",
volume="2",
number="1",
pages="e3",
keywords="mHealth",
keywords="self-management",
keywords="methods",
keywords="review",
abstract="Background: Considering the increasing incidence and prevalence of diabetes worldwide and the high level of patient involvement it requires, diabetes self-management is a serious issue. The use of mobile health (mHealth) in diabetes self-management has increased, but so far research has not provided sufficient information about the uses and effectiveness of mHealth-based interventions. Alternative study designs and more rigorous methodologies are needed. Mixed-methods designs may be particularly useful because both diabetes self-management and mHealth studies require integrating theoretical and methodological approaches. Objective: This scoping review aimed to examine the extent of the use of mixed-methods research in mHealth-based diabetes management studies. The methodological approaches used to conduct mixed-methods studies were analyzed, and implications for future research are provided. Methods: Guided by Arksey and O'Malley's framework, this scoping review implemented a comprehensive search strategy including reviewing electronic databases, key journal searches, Web-based research and knowledge centers, websites, and handsearching reference lists of the studies. The studies focusing on mHealth technologies and diabetes management were included in the review if they were primary research papers published in academic journals and reported using a combination of qualitative and quantitative methods. The key data extracted from the reviewed studies include purpose of mixing, design type, stage of integration, methods of legitimation, and data collection techniques. Results: The final sample (N=14) included studies focused on the feasibility and usability of mHealth diabetes apps (n=7), behavioral measures related to the mHealth apps (n=6), and challenges of intervention delivery in the mHealth context (n=1). Reviewed studies used advanced forms of mixed-methods designs where integration occurred at multiple points and data were collected using multiple techniques. However, the majority of studies did not identify a specific mixed-methods design or use accepted terminology; nor did they justify using this approach. Conclusions: This review provided important insights into the use of mixed methods in studies focused on diabetes management via mHealth technologies. The prominent role of qualitative methods and tailored measures in diabetes self-management studies was confirmed, and the importance of using multiple techniques and approaches in this field was emphasized. This review suggests defining specific mixed-methods questions, using specific legitimation methods, and developing research designs that overcome sampling and other methodological problems in future studies. ",
doi="10.2196/diabetes.6667",
url="http://diabetes.jmir.org/2017/1/e3/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30291052"
}


@Article{info:doi/10.2196/humanfactors.7133,
author="Sage, Adam
and Roberts, Courtney
and Geryk, Lorie
and Sleath, Betsy
and Tate, Deborah
and Carpenter, Delesha",
title="A Self-Regulation Theory--Based Asthma Management Mobile App for Adolescents: A Usability Assessment",
journal="JMIR Hum Factors",
year="2017",
month="Feb",
day="01",
volume="4",
number="1",
pages="e5",
keywords="mHealth",
keywords="asthma",
keywords="mobile",
keywords="usability",
abstract="Background: Self-regulation theory suggests people learn to influence their own behavior through self-monitoring, goal-setting, feedback, self-reward, and self-instruction, all of which smartphones are now capable of facilitating. Several mobile apps exist to manage asthma; however, little evidence exists about whether these apps employ user-centered design processes that adhere to government usability guidelines for mobile apps. Objective: Building upon a previous study that documented adolescent preferences for an asthma self-management app, we employed a user-centered approach to assess the usability of a high-fidelity wireframe for an asthma self-management app intended for use by adolescents with persistent asthma. Methods: Individual interviews were conducted with adolescents (ages 11-18 years) with persistent asthma who owned a smartphone (N=8). Adolescents were asked to evaluate a PDF app wireframe consisting of 76 screen shots displaying app features, including log in and home screen, profile setup, settings and info, self-management features, and graphical displays for charting asthma control and medication. Preferences, comments, and suggestions for each set of screen shots were assessed using the audio-recorded interviews. Two coders reached consensus on adolescent evaluations of the following aspects of app features: (1) usability, (2) behavioral intentions to use, (3) confusing aspects, and (4) suggestions for improvement. Results: The app wireframe was generally well received, and several suggestions for improvement were recorded. Suggestions included increased customization of charts and notifications, reminders, and alerts. Participants preferred longitudinal data about asthma control and medication use to be displayed using line graphs. All participants reported that they would find an asthma management app like the one depicted in the wireframe useful for managing their asthma. Conclusions: Early stage usability tests guided by government usability guidelines (usability.gov) revealed areas for improvement for an asthma self-management app for adolescents. Addressing these areas will be critical to developing an engaging and effective asthma self-management app that is capable of improving adolescent asthma outcomes. ",
doi="10.2196/humanfactors.7133",
url="http://humanfactors.jmir.org/2017/1/e5/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28148471"
}


@Article{info:doi/10.2196/diabetes.6643,
author="Lithgow, Kirstie
and Edwards, Alun
and Rabi, Doreen",
title="Smartphone App Use for Diabetes Management: Evaluating Patient Perspectives",
journal="JMIR Diabetes",
year="2017",
month="Jan",
day="23",
volume="2",
number="1",
pages="e2",
keywords="type 1 diabetes",
keywords="mobile health",
keywords="smartphone",
abstract="Background: Finding novel ways to engage patients in chronic disease management has led to increased interest in the potential of mobile health technologies for the management of diabetes. There is currently a wealth of smartphone apps for diabetes management that are available for free download or purchase. However, the usability and desirability of these apps has not been extensively studied. These are important considerations, as these apps must be accepted by the patient population at a practical level if they are to be utilized. Objective: The purpose of this study was to gain insight into patient experiences related to the use of smartphone apps for the management of type 1 diabetes. Methods: Adults with type 1 diabetes who had previously (or currently) used apps to manage their diabetes were eligible to participate. Participants (n=12) completed a questionnaire in which they were required to list the names of preferred apps and indicate which app functions they had used. Participants were given the opportunity to comment on app functions that they perceived to be missing from the current technology. Participants were also asked whether they had previously paid for an app and whether they would be willing to do so. Results: MyFitnessPal and iBGStar were the apps most commonly listed as the best available on the market. Blood glucose tracking, carbohydrate counting, and activity tracking were the most commonly used features. Ten participants fulfilled all eligibility criteria, and indicated that they had not encountered any one app that included all of the functions that they had used. The ability to synchronize an app with a glucometer or insulin pump was the most common function that participants stated was missing from current app technology. One participant had previously paid for a diabetes-related app and the other 9 participants indicated that they would be willing to pay. Conclusions: Despite dissatisfaction with the currently available apps, there is interest in using these tools for diabetes management. Adapting existing technology to better meet the needs of this patient population may allow these apps to become more widely utilized. ",
doi="10.2196/diabetes.6643",
url="http://diabetes.jmir.org/2017/1/e2/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30291051"
}


@Article{info:doi/10.2196/mhealth.6445,
author="Singh, Karandeep
and Drouin, Kaitlin
and Newmark, P. Lisa
and Filkins, Malina
and Silvers, Elizabeth
and Bain, A. Paul
and Zulman, M. Donna
and Lee, Jae-Ho
and Rozenblum, Ronen
and Pabo, Erika
and Landman, Adam
and Klinger, V. Elissa
and Bates, W. David",
title="Patient-Facing Mobile Apps to Treat High-Need, High-Cost Populations: A Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Dec",
day="19",
volume="4",
number="4",
pages="e136",
keywords="review",
keywords="mobile apps",
keywords="mHealth",
keywords="chronic disease",
keywords="self-management",
abstract="Background: Self-management is essential to caring for high-need, high-cost (HNHC) populations. Advances in mobile phone technology coupled with increased availability and adoption of health-focused mobile apps have made self-management more achievable, but the extent and quality of the literature supporting their use is not well defined. Objective: The purpose of this review was to assess the breadth, quality, bias, and types of outcomes measured in the literature supporting the use of apps targeting HNHC populations. Methods: Data sources included articles in PubMed and MEDLINE (National Center for Biotechnology Information), EMBASE (Elsevier), the Cochrane Central Register of Controlled Trials (EBSCO), Web of Science (Thomson Reuters), and the NTIS (National Technical Information Service) Bibliographic Database (EBSCO) published since 2008. We selected studies involving use of patient-facing iOS or Android mobile health apps. Extraction was performed by 1 reviewer; 40 randomly selected articles were evaluated by 2 reviewers to assess agreement. Results: Our final analysis included 175 studies. The populations most commonly targeted by apps included patients with obesity, physical handicaps, diabetes, older age, and dementia. Only 30.3\% (53/175) of the apps studied in the reviewed literature were identifiable and available to the public through app stores. Many of the studies were cross-sectional analyses (42.9\%, 75/175), small (median number of participants=31, interquartile range 11.0-207.2, maximum 11,690), or performed by an app's developers (61.1\%, 107/175). Of the 175 studies, only 36 (20.6\%, 36/175) studies evaluated a clinical outcome. Conclusions: Most apps described in the literature could not be located on the iOS or Android app stores, and existing research does not robustly evaluate the potential of mobile apps. Whereas apps may be useful in patients with chronic conditions, data do not support this yet. Although we had 2-3 reviewers to screen and assess abstract eligibility, only 1 reviewer abstracted the data. This is one limitation of our study. With respect to the 40 articles (22.9\%, 40/175) that were assigned to 2 reviewers (of which 3 articles were excluded), inter-rater agreement was significant on the majority of items (17 of 30) but fair-to-moderate on others. ",
doi="10.2196/mhealth.6445",
url="http://mhealth.jmir.org/2016/4/e136/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27993761"
}


@Article{info:doi/10.2196/iproc.6119,
author="Northrup, Matthew C.
and Lantz, Johanna
and Hamlin, Theresa",
title="Wearable Stress Sensors for Children With Autism Spectrum Disorder With In Situ Alerts to Caregivers via a Mobile Phone",
journal="iproc",
year="2016",
month="Dec",
day="14",
volume="2",
number="1",
pages="e9",
keywords="mHealth",
keywords="wearable sensor",
keywords="stress",
keywords="autism",
keywords="app",
keywords="design",
abstract="Background: Children with autism spectrum disorder (ASD) often exhibit unexpected and difficult to manage self-injurious, aggressive, and/or disruptive and challenging behaviors. These behaviors can lead to restrictive care settings including hospitalizations and lifelong residential care placement. Because children with ASD have significant impairments in social communication skills including lack of facial expression, an inability to clearly articulate feelings, and atypical body language, caregivers could benefit tremendously by knowing when a child is becoming stressed. Objective: To develop a set of customized features in a wearable sensor and mobile app that monitors stress reactivity of children with autism in real time and automatically triggers in situ alerts to a caregiver via a mobile handheld device. Methods: The Center for Discovery (CFD) is a not-for-profit internationally recognized service provider for people with complex developmental disabilities, including a large population of children and adults with autism. Neumitra Inc., is a start-up technology vendor specializing in wearable stress monitoring. Neumitra's wearable sensor called neuma featured an embedded system with automated scoring of electrodermal activity, a well-established method for recording physiological stress responses. The sensor was accompanied by a mobile app for users to self-monitor their own stress levels. The app provided a 10-point color gradient scale as an interpretation of real-time stress and arousal levels. CFD collaborated with Neumitra's development team to develop a set of customized features amenable to the use case presented by caring for children with autism. The research team at CFD trialed the neuma system extensively, developed use case scenarios, and identified the features necessary to successfully implement in situ alerts to caregivers and track stress events to review for patterns of stress. Results: The resulting system is neuma-CFD, a coordinated technological system for in situ monitoring of stress levels to identify correlations in the user's stress increases and contextual events. The system delivers in situ alerts to caregivers via a smartphone or similar handheld devices. A new interface for the mobile app was customized to minimize user burden. The home screen now allows users to create high-frequency calendar events in only two taps. These events include common challenging behaviors and common intervention techniques. Thus, upon review, stress responses can be viewed relevant to both challenging behavioral episodes and intervention techniques. To enhance clinical review, the app now logs the detection of stress events into the calendar. Users can also access an increased granular review of electrodermal activity within a calendar event, such as behavior episodes or classroom routines. Conclusions: In field testing, in situ alerts were reported by caregivers to be beneficial. Furthermore, the integration of color-coding calendar events and routines in an intuitive interface allows multiple users to review the contextual events correlated to stress responses with minimal training. Wear tolerance, a challenging human factor common in ASD, can be addressed through behavioral shaping protocols. The hardware form factor was not amenable to this population due impulsive behaviors including pulling on the device to remove it, causing hardware damage. Exposure to water during handwashing was another challenge in hardware. These concerns are being revised in future versions of hardware. This system can also benefit other healthcare populations, such as patients with anxiety, posttraumatic stress disorder or any other condition for which understanding patterns of stress offers improved health outcomes. ",
doi="10.2196/iproc.6119",
url="http://www.iproc.org/2016/1/e9/"
}


@Article{info:doi/10.2196/diabetes.6662,
author="Modave, Fran{\c{c}}ois
and Bian, Jiang
and Rosenberg, Eric
and Mendoza, Tonatiuh
and Liang, Zhan
and Bhosale, Ravi
and Maeztu, Carlos
and Rodriguez, Camila
and Cardel, I. Michelle",
title="DiaFit: The Development of a Smart App for Patients with Type 2 Diabetes and Obesity",
journal="JMIR Diabetes",
year="2016",
month="Dec",
day="13",
volume="1",
number="2",
pages="e5",
keywords="mHealth",
keywords="diabetes",
keywords="obesity",
keywords="apps",
abstract="Background: Optimal management of chronic diseases, such as type 2 diabetes (T2D) and obesity, requires patient-provider communication and proactive self-management from the patient. Mobile apps could be an effective strategy for improving patient-provider communication and provide resources for self-management to patients themselves. Objective: The objective of this paper is to describe the development of a mobile tool for patients with T2D and obesity that utilizes an integrative approach to facilitate patient-centered app development, with patient and physician interfaces. Our implementation strategy focused on the building of a multidisciplinary team to create a user-friendly and evidence-based app, to be used by patients in a home setting or at the point-of-care. Methods: We present the iterative design, development, and testing of DiaFit, an app designed to improve the self-management of T2D and obesity, using an adapted Agile approach to software implementation. The production team consisted of experts in mobile health, nutrition sciences, and obesity; software engineers; and clinicians. Additionally, the team included citizen scientists and clinicians who acted as the de facto software clients for DiaFit and therefore interacted with the production team throughout the entire app creation, from design to testing. Results: DiaFit (version 1.0) is an open-source, inclusive iOS app that incorporates nutrition data, physical activity data, and medication and glucose values, as well as patient-reported outcomes. DiaFit supports the uploading of data from sensory devices via Bluetooth for physical activity (iOS step counts, FitBit, Apple watch) and glucose monitoring (iHealth glucose meter). The app provides summary statistics and graphics for step counts, dietary information, and glucose values that can be used by patients and their providers to make informed health decisions. The DiaFit iOS app was developed in Swift (version 2.2) with a Web back-end deployed on the Health Insurance Portability and Accountability Act compliant-ready Amazon Web Services cloud computing platform. DiaFit is publicly available on GitHub to the diabetes community at large, under the GNU General Public License agreement. Conclusions: Given the proliferation of health-related apps available to health consumers, it is essential to ensure that apps are evidence-based and user-oriented, with specific health conditions in mind. To this end, we have used a software development approach focusing on community and clinical engagement to create DiaFit, an app that assists patients with T2D and obesity to better manage their health through active communication with their providers and proactive self-management of their diseases. ",
doi="10.2196/diabetes.6662",
url="http://diabetes.jmir.org/2016/2/e5/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29388609"
}


@Article{info:doi/10.2196/resprot.5932,
author="Geryk, L. Lorie
and Roberts, A. Courtney
and Sage, J. Adam
and Coyne-Beasley, Tamera
and Sleath, L. Betsy
and Carpenter, M. Delesha",
title="Parent and Clinician Preferences for an Asthma App to Promote Adolescent Self-Management: A Formative Study",
journal="JMIR Res Protoc",
year="2016",
month="Dec",
day="06",
volume="5",
number="4",
pages="e229",
keywords="asthma",
keywords="self-management",
keywords="social support",
keywords="mHealth",
keywords="mobile apps",
keywords="adolescents",
keywords="parents",
keywords="clinicians",
abstract="Background: Most youth asthma apps are not designed with parent and clinician use in mind, and rarely is the app development process informed by parent or clinician input. Objective: This study was conducted to generate formative data on the use, attitudes, and preferences for asthma mHealth app features among parents and clinicians, the important stakeholders who support adolescents with asthma and promote adolescent self-management skills. Methods: We conducted a mixed-methods study from 2013 to 2014 employing a user-centered design philosophy to acquire feedback from a convenience sample of 20 parents and 6 clinicians. Participants were given an iPod Touch and asked to evaluate 10 features on 2 existing asthma apps. Participant experiences using the apps were collected from questionnaires and a thematic analysis of audio-recorded and transcribed (verbatim) interviews using MAXQDA. Descriptive statistics were calculated to characterize the study sample and app feature feedback. Independent samples t tests were performed to compare parent and clinician ratings of app feature usefulness (ratings: 1=not at all useful to 5=very useful). Results: All parents were female (n=20), 45\% were black, 20\% had an income ?US \$50,000, and 45\% had a bachelor's degree or higher education. The clinician sample included 2 nurses and 4 physicians with a mean practice time of 13 years. Three main themes provided an understanding of how participants perceived their roles and use of asthma app features to support adolescent asthma self-management: monitoring and supervision, education, and communication/information sharing. Parents rated the doctor report feature highest, and clinicians rated the doctor appointment reminder highest of all evaluated app features on usefulness. The peak flow monitoring feature was the lowest ranked feature by both parents and clinicians. Parents reported higher usefulness for the doctor report (t(10)=2.7, P<.02), diary (t(10)=2.7, P<.03), and self-check quiz (t(14)=2.5, P<.02) features than clinicians. Specific participant suggestions for app enhancements (eg, a tutorial showing correct inhaler use, refill reminders, pop-up messages tied to a medication log, evidence-based management steps) were also provided. Conclusions: Parent and clinician evaluations and recommendations can play an important role in the development of an asthma app designed to help support youth asthma management. Two-way asthma care communication between families and clinicians and components involving families and clinicians that support adolescent self-management should be incorporated into adolescent asthma apps. ",
doi="10.2196/resprot.5932",
url="http://www.researchprotocols.org/2016/4/e229/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27923777"
}


@Article{info:doi/10.2196/jmir.5778,
author="Alharbi, Sahal Nouf
and Alsubki, Nada
and Jones, Simon
and Khunti, Kamlesh
and Munro, Neil
and de Lusignan, Simon",
title="Impact of Information Technology--Based Interventions for Type 2 Diabetes Mellitus on Glycemic Control: A Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2016",
month="Nov",
day="25",
volume="18",
number="11",
pages="e310",
keywords="diabetes mellitus",
keywords="medical informatics applications",
keywords="technology",
abstract="Background: Information technology--based interventions are increasingly being used to manage health care. However, there is conflicting evidence regarding whether these interventions improve outcomes in people with type 2 diabetes. Objective: The objective of this study was to conduct a systematic review and meta-analysis of clinical trials, assessing the impact of information technology on changes in the levels of hemoglobin A1c (HbA1c) and mapping the interventions with chronic care model (CCM) elements. Methods: Electronic databases PubMed and EMBASE were searched to identify relevant studies that were published up until July 2016, a method that was supplemented by identifying articles from the references of the articles already selected using the electronic search tools. The study search and selection were performed by independent reviewers. Of the 1082 articles retrieved, 32 trials (focusing on a total of 40,454 patients) were included. A random-effects model was applied to estimate the pooled results. Results: Information technology--based interventions were associated with a statistically significant reduction in HbA1c levels (mean difference ?0.33\%, 95\% CI ?0.40 to ?0.26, P<.001). Studies focusing on electronic self-management systems demonstrated the largest reduction in HbA1c (0.50\%), followed by those with electronic medical records (0.17\%), an electronic decision support system (0.15\%), and a diabetes registry (0.05\%). In addition, the more CCM-incorporated the information technology--based interventions were, the more improvements there were in HbA1c levels. Conclusions: Information technology strategies combined with the other elements of chronic care models are associated with improved glycemic control in people with diabetes. No clinically relevant impact was observed on low-density lipoprotein levels and blood pressure, but there was evidence that the cost of care was lower. ",
doi="10.2196/jmir.5778",
url="http://www.jmir.org/2016/11/e310/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27888169"
}


@Article{info:doi/10.2196/mental.6202,
author="Rickard, Nikki
and Arjmand, Hussain-Abdulah
and Bakker, David
and Seabrook, Elizabeth",
title="Development of a Mobile Phone App to Support Self-Monitoring of Emotional Well-Being: A Mental Health Digital Innovation",
journal="JMIR Ment Health",
year="2016",
month="Nov",
day="23",
volume="3",
number="4",
pages="e49",
keywords="eHealth",
keywords="emotions",
keywords="mental health",
keywords="mobile phone",
keywords="feedback",
abstract="Background: Emotional well-being is a primary component of mental health and well-being. Monitoring changes in emotional state daily over extended periods is, however, difficult using traditional methodologies. Providing mental health support is also challenging when approximately only 1 in 2 people with mental health issues seek professional help. Mobile phone technology offers a sustainable means of enhancing self-management of emotional well-being. Objective: This paper aims to describe the development of a mobile phone tool designed to monitor emotional changes in a natural everyday context and in real time. Methods: This evidence-informed mobile phone app monitors emotional mental health and well-being, and it provides links to mental health organization websites and resources. The app obtains data via self-report psychological questionnaires, experience sampling methodology (ESM), and automated behavioral data collection. Results: Feedback from 11 individuals (age range 16-52 years; 4 males, 7 females), who tested the app over 30 days, confirmed via survey and focus group methods that the app was functional and usable. Conclusions: Recommendations for future researchers and developers of mental health apps to be used for research are also presented. The methodology described in this paper offers a powerful tool for a range of potential mental health research studies and provides a valuable standard against which development of future mental health apps should be considered. ",
doi="10.2196/mental.6202",
url="http://mental.jmir.org/2016/4/e49/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27881358"
}


@Article{info:doi/10.2196/jmir.6371,
author="Kim, Young Ju
and Wineinger, E. Nathan
and Taitel, Michael
and Radin, M. Jennifer
and Akinbosoye, Osayi
and Jiang, Jenny
and Nikzad, Nima
and Orr, Gregory
and Topol, Eric
and Steinhubl, Steve",
title="Self-Monitoring Utilization Patterns Among Individuals in an Incentivized Program for Healthy Behaviors",
journal="J Med Internet Res",
year="2016",
month="Nov",
day="17",
volume="18",
number="11",
pages="e292",
keywords="health behavior",
keywords="mobile health",
keywords="mobile apps",
keywords="reward",
keywords="self blood pressure monitoring",
keywords="blood glucose self-monitoring",
abstract="Background: The advent of digital technology has enabled individuals to track meaningful biometric data about themselves. This novel capability has spurred nontraditional health care organizations to develop systems that aid users in managing their health. One of the most prolific systems is Walgreens Balance Rewards for healthy choices (BRhc) program, an incentivized, Web-based self-monitoring program. Objective: This study was performed to evaluate health data self-tracking characteristics of individuals enrolled in the Walgreens' BRhc program, including the impact of manual versus automatic data entries through a supported device or apps. Methods: We obtained activity tracking data from a total of 455,341 BRhc users during 2014. Upon identifying users with sufficient follow-up data, we explored temporal trends in user participation. Results: Thirty-four percent of users quit participating after a single entry of an activity. Among users who tracked at least two activities on different dates, the median length of participating was 8 weeks, with an average of 5.8 activities entered per week. Furthermore, users who participated for at least twenty weeks (28.3\% of users; 33,078/116,621) consistently entered 8 to 9 activities per week. The majority of users (77\%; 243,774/315,744) recorded activities through manual data entry alone. However, individuals who entered activities automatically through supported devices or apps participated roughly four times longer than their manual activity-entering counterparts (average 20 and 5 weeks, respectively; P<.001). Conclusions: This study provides insights into the utilization patterns of individuals participating in an incentivized, Web-based self-monitoring program. Our results suggest automated health tracking could significantly improve long-term health engagement. ",
doi="10.2196/jmir.6371",
url="http://www.jmir.org/2016/11/e292/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27856407"
}


@Article{info:doi/10.2196/resprot.6194,
author="Anderson, Kevin
and Burford, Oksana
and Emmerton, Lynne",
title="App Chronic Disease Checklist: Protocol to Evaluate Mobile Apps for Chronic Disease Self-Management",
journal="JMIR Res Protoc",
year="2016",
month="Nov",
day="04",
volume="5",
number="4",
pages="e204",
keywords="health",
keywords="mobile applications",
keywords="app",
keywords="smartphones",
keywords="self-management",
keywords="protocol",
keywords="usability checklist",
keywords="self-care",
keywords="chronic disease",
abstract="Background: The availability of mobile health apps for self-care continues to increase. While little evidence of their clinical impact has been published, there is general agreement among health authorities and authors that consumers' use of health apps assist in self-management and potentially clinical decision making. A consumer's sustained engagement with a health app is dependent on the usability and functionality of the app. While numerous studies have attempted to evaluate health apps, there is a paucity of published methods that adequately recognize client experiences in the academic evaluation of apps for chronic conditions. Objective: This paper reports (1) a protocol to shortlist health apps for academic evaluation, (2) synthesis of a checklist to screen health apps for quality and reliability, and (3) a proposed method to theoretically evaluate usability of health apps, with a view towards identifying one or more apps suitable for clinical assessment. Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram was developed to guide the selection of the apps to be assessed. The screening checklist was thematically synthesized with reference to recurring constructs in published checklists and related materials for the assessment of health apps. The checklist was evaluated by the authors for face and construct validity. The proposed method for evaluation of health apps required the design of procedures for raters of apps, dummy data entry to test the apps, and analysis of raters' scores. Results: The PRISMA flow diagram comprises 5 steps: filtering of duplicate apps; eliminating non-English apps; removing apps requiring purchase, filtering apps not updated within the past year; and separation of apps into their core functionality. The screening checklist to evaluate the selected apps was named the App Chronic Disease Checklist, and comprises 4 sections with 6 questions in each section. The validity check verified classification of, and ambiguity in, wording of questions within constructs. The proposed method to evaluate shortlisted and downloaded apps comprises instructions to attempt set-up of a dummy user profile, and dummy data entry to represent in-range and out-of-range clinical measures simulating a range of user behaviors. A minimum score of 80\% by consensus (using the Intraclass Correlation Coefficient) between raters is proposed to identify apps suitable for clinical trials. Conclusions: The flow diagram allows researchers to shortlist health apps that are potentially suitable for formal evaluation. The evaluation checklist enables quantitative comparison of shortlisted apps based on constructs reported in the literature. The use of multiple raters, and comparison of their scores, is proposed to manage inherent subjectivity in assessing user experiences. Initial trial of the combined protocol is planned for apps pertaining to the self-monitoring of asthma; these results will be reported elsewhere. ",
doi="10.2196/resprot.6194",
url="http://www.researchprotocols.org/2016/4/e204/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27815233"
}


@Article{info:doi/10.2196/mhealth.5716,
author="Huerta-Ramos, Elena
and Escobar-Villegas, Soledad Maria
and Rubinstein, Katya
and Unoka, Szabolcs Zsolt
and Grasa, Eva
and Hospedales, Margarita
and J{\"a}{\"a}skel{\"a}inen, Erika
and Rubio-Abadal, Elena
and Caspi, Asaf
and Bitter, Istv{\'a}n
and Berdun, Jesus
and Sepp{\"a}l{\"a}, Jussi
and Ochoa, Susana
and Fazekas, Kata
and 
and Corripio, Iluminada
and Usall, Judith",
title="Measuring Users' Receptivity Toward an Integral Intervention Model Based on mHealth Solutions for Patients With Treatment-Resistant Schizophrenia (m-RESIST): A Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Sep",
day="28",
volume="4",
number="3",
pages="e112",
keywords="mHealth solution",
keywords="treatment-resistant schizophrenia",
keywords="intervention model",
keywords="qualitative research",
keywords="needs assessment",
abstract="Background: Despite the theoretical potential of mHealth solutions in the treatment of patients with schizophrenia, there remains a lack of technological tools in clinical practice. Objective: The aim of this study was to measure the receptivity of patients, informal carers, and clinicians to a European integral intervention model focused on patients with persistent positive symptoms: Mobile Therapeutic Attention for Patients with Treatment-Resistant Schizophrenia (m-RESIST). Methods: Before defining the system requirements, a qualitative study of the needs of outpatients with treatment-resistant schizophrenia was carried out in Spain, Israel, and Hungary. We analyzed the opinions of patients, informal carers, and clinicians concerning the services originally intended to be part of the solution. A total of 9 focus groups (72 people) and 35 individual interviews were carried out in the 3 countries, using discourse analysis as the framework. Results: A webpage and an online forum were perceived as suitable to get both reliable information on the disease and support. Data transmission by a smart watch (monitoring), Web-based visits, and instant messages (clinical treatment) were valued as ways to improve contact with clinicians. Alerts were appreciated as reminders of daily tasks and appointments. Avoiding stressful situations for outpatients, promoting an active role in the management of the disease, and maintaining human contact with clinicians were the main suggestions provided for improving the effectiveness of the solution. Conclusions: Positive receptivity toward m-RESIST services is related to its usefulness in meeting user needs, its capacity to empower them, and the possibility of maintaining human contact. ",
doi="10.2196/mhealth.5716",
url="http://mhealth.jmir.org/2016/3/e112/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27682896"
}


@Article{info:doi/10.2196/resprot.4348,
author="Alanzi, Turki
and Istepanian, Robert
and Philip, Nada",
title="Design and Usability Evaluation of Social Mobile Diabetes Management System in the Gulf Region",
journal="JMIR Res Protoc",
year="2016",
month="Sep",
day="26",
volume="5",
number="3",
pages="e93",
keywords="mobile health",
keywords="mobile diabetes management",
keywords="social networking for health care",
keywords="diabetes mellitus",
keywords="telemedicine",
keywords="electronic health",
keywords="Kingdom of Saudi Arabia",
abstract="Background: The prevalence of diabetes in the Gulf States is one of the highest globally. It is estimated that 20\% of the population in the region has been diagnosed with diabetes and according to the International Diabetes Federation (IDF), five of the IDF's ``top 10'' countries for diabetes prevalence in 2011 and projected for 2030 are in this region. In recent years, there have been an increasing number of clinical studies advocating the use of mobile phone technology for diabetes self-management with improved clinical outcomes. However, there are few studies to date addressing the application of mobile diabetes management in the Gulf region, particularly in the Kingdom of Saudi Arabia (KSA), where there is exponential increase in mobile phone usage and access to social networking. Objective: The objective of this paper is to present the design and development of a new mobile health system for social behavioral change and management tailored for Saudi patients with diabetes called Saudi Arabia Networking for Aiding Diabetes (SANAD). A usability study for the SANAD system is presented to validate the acceptability of using mobile technologies among patients with diabetes in the KSA and the Gulf region. Methods: The SANAD system was developed using mobile phone technology with diabetes management and social networking modules. For the usability study the Questionnaire for User Interaction Satisfaction was used to evaluate the usability aspect of the SANAD system. A total of 33 users with type 2 diabetes participated in the study. Results: The key modules of the SANAD system consist of (1) a mobile diabetes management module; (2) a social networking module; and (3) a cognitive behavioral therapy module for behavioral change issues. The preliminary results of the usability study indicated general acceptance of the patients in using the system with higher usability rating in patients with type 2 diabetes. Conclusions: We found that the acceptability of the system was high among Saudi patients with diabetes, and ongoing work in this research area is underway to conduct a clinical pilot study in the KSA for patients with type 2 diabetes. The wide deployment of such a system is timely and required in the Gulf region due to the wide use of mobile phones and social networking mediums. ",
doi="10.2196/resprot.4348",
url="http://www.researchprotocols.org/2016/3/e93/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27670696"
}


@Article{info:doi/10.2196/mhealth.5960,
author="Wahle, Fabian
and Kowatsch, Tobias
and Fleisch, Elgar
and Rufer, Michael
and Weidt, Steffi",
title="Mobile Sensing and Support for People With Depression: A Pilot Trial in the Wild",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Sep",
day="21",
volume="4",
number="3",
pages="e111",
keywords="depression",
keywords="mHealth",
keywords="?activities of daily living",
keywords="classification",
keywords="context awareness",
keywords="cognitive behavioral therapy",
abstract="Background: Depression is a burdensome, recurring mental health disorder with high prevalence. Even in developed countries, patients have to wait for several months to receive treatment. In many parts of the world there is only one mental health professional for over 200 people. Smartphones are ubiquitous and have a large complement of sensors that can potentially be useful in monitoring behavioral patterns that might be indicative of depressive symptoms and providing context-sensitive intervention support. Objective: The objective of this study is 2-fold, first to explore the detection of daily-life behavior based on sensor information to identify subjects with a clinically meaningful depression level, second to explore the potential of context sensitive intervention delivery to provide in-situ support for people with depressive symptoms. Methods: A total of 126 adults (age 20-57) were recruited to use the smartphone app Mobile Sensing and Support (MOSS), collecting context-sensitive sensor information and providing just-in-time interventions derived from cognitive behavior therapy. Real-time learning-systems were deployed to adapt to each subject's preferences to optimize recommendations with respect to time, location, and personal preference. Biweekly, participants were asked to complete a self-reported depression survey (PHQ-9) to track symptom progression. Wilcoxon tests were conducted to compare scores before and after intervention. Correlation analysis was used to test the relationship between adherence and change in PHQ-9. One hundred twenty features were constructed based on smartphone usage and sensors including accelerometer, Wifi, and global positioning systems (GPS). Machine-learning models used these features to infer behavior and context for PHQ-9 level prediction and tailored intervention delivery. Results: A total of 36 subjects used MOSS for ?2 weeks. For subjects with clinical depression (PHQ-9?11) at baseline and adherence ?8 weeks (n=12), a significant drop in PHQ-9 was observed (P=.01). This group showed a negative trend between adherence and change in PHQ-9 scores (rho=?.498, P=.099). Binary classification performance for biweekly PHQ-9 samples (n=143), with a cutoff of PHQ-9?11, based on Random Forest and Support Vector Machine leave-one-out cross validation resulted in 60.1\% and 59.1\% accuracy, respectively. Conclusions: Proxies for social and physical behavior derived from smartphone sensor data was successfully deployed to deliver context-sensitive and personalized interventions to people with depressive symptoms. Subjects who used the app for an extended period of time showed significant reduction in self-reported symptom severity. Nonlinear classification models trained on features extracted from smartphone sensor data including Wifi, accelerometer, GPS, and phone use, demonstrated a proof of concept for the detection of depression superior to random classification. While findings of effectiveness must be reproduced in a RCT to proof causation, they pave the way for a new generation of digital health interventions leveraging smartphone sensors to provide context sensitive information for in-situ support and unobtrusive monitoring of critical mental health states. ",
doi="10.2196/mhealth.5960",
url="http://mhealth.jmir.org/2016/3/e111/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27655245"
}


@Article{info:doi/10.2196/resprot.5959,
author="Goyal, Shivani
and Lewis, Gary
and Yu, Catherine
and Rotondi, Michael
and Seto, Emily
and Cafazzo, A. Joseph",
title="Evaluation of a Behavioral Mobile Phone App Intervention for the Self-Management of Type 2 Diabetes: Randomized Controlled Trial Protocol",
journal="JMIR Res Protoc",
year="2016",
month="Aug",
day="19",
volume="5",
number="3",
pages="e174",
keywords="diabetes mellitus",
keywords="type 2",
keywords="telemedicine",
keywords="evaluation",
keywords="self-care",
keywords="randomized controlled trial",
keywords="mobile applications",
keywords="motivation",
keywords="blood glucose",
abstract="Background: Patients with type 2 diabetes mellitus (T2DM) struggle with the management of their condition due to difficulty relating lifestyle behaviors with glycemic control. While self-monitoring of blood glucose (SMBG) has proven to be effective for those treated with insulin, it has been shown to be less beneficial for those only treated with oral medications or lifestyle modification. We hypothesized that the effective self-management of non-insulin treated T2DM requires a behavioral intervention that empowers patients with the ability to self-monitor, understand the impact of lifestyle behaviors on glycemic control, and adjust their self-care based on contextualized SMBG data. Objective: The primary objective of this randomized controlled trial (RCT) is to determine the impact of bant2, an evidence-based, patient-centered, behavioral mobile app intervention, on the self-management of T2DM. Our second postulation is that automated feedback delivered through the mobile app will be as effective, less resource intensive, and more scalable than interventions involving additional health care provider feedback. Methods: This study is a 12-month, prospective, multicenter RCT in which 150 participants will be randomly assigned to one of two groups: the control group will receive current standard of care, and the intervention group will receive the mobile phone app system in addition to standard of care. The primary outcome measure is change in glycated hemoglobin A1c from baseline to 12 months. Results: The first patient was enrolled on July 28, 2015, and we anticipate completing this study by September, 2018. Conclusions: This RCT is one of the first to evaluate an evidence-based mobile app that focuses on facilitating lifestyle behavior change driven by contextualized and structured SMBG. The results of this trial will provide insights regarding the usage of mobile tools and consumer-grade devices for diabetes self-care, the economic model of using incentives to motivate behavior change, and the consumption of test strips when following a rigorously structured approach for SMBG. Trial Registration: ClinicalTrials.gov NCT02370719; https://clinicaltrials.gov/ct2/show/NCT02370719 (Archived at http://www.webcitation.org/6jpyjfVRs) ",
doi="10.2196/resprot.5959",
url="http://www.researchprotocols.org/2016/3/e174/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27542325"
}


@Article{info:doi/10.2196/resprot.5940,
author="Jones, Donald
and Skrepnik, Nebojsa
and Toselli, M. Richard
and Leroy, Bruno",
title="Incorporating Novel Mobile Health Technologies Into Management of Knee Osteoarthritis in Patients Treated With Intra-Articular Hyaluronic Acid: Rationale and Protocol of a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2016",
month="Aug",
day="09",
volume="5",
number="3",
pages="e164",
keywords="mHealth",
keywords="osteoarthritis",
keywords="pain",
keywords="physical therapy",
abstract="Background: Osteoarthritis (OA) of the knee is one of the leading causes of disability in the United States. One relatively new strategy that could be helpful in the management of OA is the use of mHealth technologies, as they can be used to increase physical activity and promote exercise, which are key components of knee OA management. Objective: Currently, no published data on the use of a mHealth approach to comprehensively monitor physical activity in patients with OA are available, and similarly, no data on whether mHealth technologies can impact outcomes are available. Our objective is to evaluate the effectiveness of mHealth technology as part of a tailored, comprehensive management strategy for patients with knee OA. Methods: The study will assess the impact of a smartphone app that integrates data from a wearable activity monitor (thereby both encouraging changes in mobility as well as tracking them) combined with education about the benefits of walking on patient mobility. The results from the intervention group will be compared with data from a control group of individuals who are given the same Arthritis Foundation literature regarding the benefits of walking and wearable activity monitors but who do not have access to the data from those monitors. Activity monitors will capture step count estimates and will compare those with patients' step goals, calories burned, and distance walked. Patients using the novel smartphone app will be able to enter information on their daily pain, mood, and sleep quality. The relationships among activity and pain, activity and mood, and sleep will be assessed, as will patient satisfaction with and adherence to the mobile app. Results: We present information on an upcoming trial that will prospectively assess the ability of a mobile app to improve mobility for knee OA patients who are treated with intra-articular hyaluronic acid. Conclusions: We anticipate the results of this study will support the concept that mHealth technologies provide continuous, real-time feedback to patients with OA on their overall level of activity for a more proactive, personalized approach to treatment that may help modify behavior and assist with self-management through treatment support in the form of motivational messages and reminders. ",
doi="10.2196/resprot.5940",
url="http://www.researchprotocols.org/2016/3/e164/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27506148"
}


@Article{info:doi/10.2196/jmir.5598,
author="Kim, Junetae
and Lim, Sanghee
and Min, Ha Yul
and Shin, Yong-Wook
and Lee, Byungtae
and Sohn, Guiyun
and Jung, Hae Kyung
and Lee, Jae-Ho
and Son, Ho Byung
and Ahn, Hyun Sei
and Shin, Soo-Yong
and Lee, Won Jong",
title="Depression Screening Using Daily Mental-Health Ratings from a Smartphone Application for Breast Cancer Patients",
journal="J Med Internet Res",
year="2016",
month="Aug",
day="04",
volume="18",
number="8",
pages="e216",
keywords="depression",
keywords="smartphone applications",
keywords="mental health",
keywords="breast cancer (neoplasms)",
abstract="Background: Mobile mental-health trackers are mobile phone apps that gather self-reported mental-health ratings from users. They have received great attention from clinicians as tools to screen for depression in individual patients. While several apps that ask simple questions using face emoticons have been developed, there has been no study examining the validity of their screening performance. Objective: In this study, we (1) evaluate the potential of a mobile mental-health tracker that uses three daily mental-health ratings (sleep satisfaction, mood, and anxiety) as indicators for depression, (2) discuss three approaches to data processing (ratio, average, and frequency) for generating indicator variables, and (3) examine the impact of adherence on reporting using a mobile mental-health tracker and accuracy in depression screening. Methods: We analyzed 5792 sets of daily mental-health ratings collected from 78 breast cancer patients over a 48-week period. Using the Patient Health Questionnaire-9 (PHQ-9) as the measure of true depression status, we conducted a random-effect logistic panel regression and receiver operating characteristic (ROC) analysis to evaluate the screening performance of the mobile mental-health tracker. In addition, we classified patients into two subgroups based on their adherence level (higher adherence and lower adherence) using a k-means clustering algorithm and compared the screening accuracy between the two groups. Results: With the ratio approach, the area under the ROC curve (AUC) is 0.8012, indicating that the performance of depression screening using daily mental-health ratings gathered via mobile mental-health trackers is comparable to the results of PHQ-9 tests. Also, the AUC is significantly higher (P=.002) for the higher adherence group (AUC=0.8524) than for the lower adherence group (AUC=0.7234). This result shows that adherence to self-reporting is associated with a higher accuracy of depression screening. Conclusions: Our results support the potential of a mobile mental-health tracker as a tool for screening for depression in practice. Also, this study provides clinicians with a guideline for generating indicator variables from daily mental-health ratings. Furthermore, our results provide empirical evidence for the critical role of adherence to self-reporting, which represents crucial information for both doctors and patients. ",
doi="10.2196/jmir.5598",
url="http://www.jmir.org/2016/8/e216/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27492880"
}


@Article{info:doi/10.2196/jmir.4863,
author="Spanakis, G. Emmanouil
and Santana, Silvina
and Tsiknakis, Manolis
and Marias, Kostas
and Sakkalis, Vangelis
and Teixeira, Ant{\'o}nio
and Janssen, H. Joris
and de Jong, Henri
and Tziraki, Chariklia",
title="Technology-Based Innovations to Foster Personalized Healthy Lifestyles and Well-Being: A Targeted Review",
journal="J Med Internet Res",
year="2016",
month="Jun",
day="24",
volume="18",
number="6",
pages="e128",
keywords="mHealth",
keywords="eHealth",
keywords="lifestyle",
keywords="health promotion",
keywords="health behavior",
keywords="persuasive technologies",
keywords="cloud computing",
keywords="personalized health monitoring",
keywords="interoperability",
keywords="wellness programs",
abstract="Background: New community-based arrangements and novel technologies can empower individuals to be active participants in their health maintenance, enabling people to control and self-regulate their health and wellness and make better health- and lifestyle-related decisions. Mobile sensing technology and health systems responsive to individual profiles combined with cloud computing can expand innovation for new types of interoperable services that are consumer-oriented and community-based. This could fuel a paradigm shift in the way health care can be, or should be, provided and received, while lessening the burden on exhausted health and social care systems. Objective: Our goal is to identify and discuss the main scientific and engineering challenges that need to be successfully addressed in delivering state-of-the-art, ubiquitous eHealth and mHealth services, including citizen-centered wellness management services, and reposition their role and potential within a broader context of diverse sociotechnical drivers, agents, and stakeholders. Methods: We review the state-of-the-art relevant to the development and implementation of eHealth and mHealth services in critical domains. We identify and discuss scientific, engineering, and implementation-related challenges that need to be overcome to move research, development, and the market forward. Results: Several important advances have been identified in the fields of systems for personalized health monitoring, such as smartphone platforms and intelligent ubiquitous services. Sensors embedded in smartphones and clothes are making the unobtrusive recognition of physical activity, behavior, and lifestyle possible, and thus the deployment of platforms for health assistance and citizen empowerment. Similarly, significant advances are observed in the domain of infrastructure supporting services. Still, many technical problems remain to be solved, combined with no less challenging issues related to security, privacy, trust, and organizational dynamics. Conclusions: Delivering innovative ubiquitous eHealth and mHealth services, including citizen-centered wellness and lifestyle management services, goes well beyond the development of technical solutions. For the large-scale information and communication technology-supported adoption of healthier lifestyles to take place, crucial innovations are needed in the process of making and deploying usable empowering end-user services that are trusted and user-acceptable. Such innovations require multidomain, multilevel, transdisciplinary work, grounded in theory but driven by citizens' and health care professionals' needs, expectations, and capabilities and matched by business ability to bring innovation to the market. ",
doi="10.2196/jmir.4863",
url="http://www.jmir.org/2016/6/e128/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27342137"
}


@Article{info:doi/10.2196/jmir.5429,
author="Kim, Young Ju
and Wineinger, E. Nathan
and Steinhubl, R. Steven",
title="The Influence of Wireless Self-Monitoring Program on the Relationship Between Patient Activation and Health Behaviors, Medication Adherence, and Blood Pressure Levels in Hypertensive Patients: A Substudy of a Randomized Controlled Trial",
journal="J Med Internet Res",
year="2016",
month="Jun",
day="22",
volume="18",
number="6",
pages="e116",
keywords="patient participation",
keywords="blood pressure self-monitoring",
keywords="wireless technology",
keywords="telemedicine",
keywords="health behavior",
keywords="medication adherence",
abstract="Background: Active engagement in the management of hypertension is important in improving self-management behaviors and clinical outcomes. Mobile phone technology using wireless monitoring tools are now widely available to help individuals monitor their blood pressure, but little is known about the conditions under which such technology can effect positive behavior changes or clinical outcomes. Objective: To study the influence of wireless self-monitoring program and patient activation measures on health behaviors, medication adherence, and blood pressure levels as well as control of blood pressure in hypertensive patients. Methods: We examined a subset of 95 hypertensive participants from a 6-month randomized controlled trial designed to determine the utility of a wireless self-monitoring program (n=52 monitoring program, n=43 control), which consisted of a blood pressure monitoring device connected with a mobile phone, reminders for self-monitoring, a Web-based disease management program, and a mobile app for monitoring and education, compared with the control group receiving a standard disease management program. Study participants provided measures of patient activation, health behaviors including smoking, drinking, and exercise, medication adherence, and blood pressure levels. We assessed the influence of wireless self-monitoring as a moderator of the relationship between patient activation and health behaviors, medication adherence, and control of blood pressure. Results: Improvements in patient activation were associated with improvements in cigarette smoking (beta=?0.46, P<.001) and blood pressure control (beta=0.04, P=.02). This relationship was further strengthened in reducing cigarettes (beta=?0.60, P<.001), alcohol drinking (beta=?0.26, P=.01), and systolic (beta=?0.27, P=.02) and diastolic blood pressure (beta=?0.34, P=.007) at 6 months among individuals participating in the wireless self-monitoring program. No differences were observed with respect to medication adherence. Conclusions: Participation in a wireless self-monitoring program provides individuals motivated to improve their health management with an added benefit above and beyond that of motivation alone. Hypertensive individuals eager to change health behaviors are excellent candidates for mobile health self-monitoring.. Trial Registration: ClinicalTrials.gov NCT01975428, https://clinicaltrials.gov/ct2/show/NCT01975428 (Archived by WebCite at http://www.webcitation.org/6iSO5OgOG) ",
doi="10.2196/jmir.5429",
url="http://www.jmir.org/2016/6/e116/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27334418"
}


@Article{info:doi/10.2196/mhealth.5485,
author="Wijsman, W. Liselotte
and Richard, Edo
and Cachucho, Ricardo
and de Craen, JM Anton
and Jongstra, Susan
and Mooijaart, P. Simon",
title="Evaluation of the Use of Home Blood Pressure Measurement Using Mobile Phone-Assisted Technology: The iVitality Proof-of-Principle Study",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Jun",
day="13",
volume="4",
number="2",
pages="e67",
keywords="mobile phone",
keywords="home-based measurements",
keywords="hypertension",
keywords="dementia",
abstract="Background: Mobile phone-assisted technologies provide the opportunity to optimize the feasibility of long-term blood pressure (BP) monitoring at home, with the potential of large-scale data collection. Objective: In this proof-of-principle study, we evaluated the feasibility of home BP monitoring using mobile phone-assisted technology, by investigating (1) the association between study center and home BP measurements; (2) adherence to reminders on the mobile phone to perform home BP measurements; and (3) referrals, treatment consequences and BP reduction after a raised home BP was diagnosed. Methods: We used iVitality, a research platform that comprises a Website, a mobile phone-based app, and health sensors, to measure BP and several other health characteristics during a 6-month period. BP was measured twice at baseline at the study center. Home BP was measured on 4 days during the first week, and thereafter, at semimonthly or monthly intervals, for which participants received reminders on their mobile phone. In the monthly protocol, measurements were performed during 2 consecutive days. In the semimonthly protocol, BP was measured at 1 day. Results: We included 151 participants (mean age [standard deviation] 57.3 [5.3] years). BP measured at the study center was systematically higher when compared with home BP measurements (mean difference systolic BP [standard error] 8.72 [1.08] and diastolic BP 5.81 [0.68] mm Hg, respectively). Correlation of study center and home measurements of BP was high (R=0.72 for systolic BP and 0.72 for diastolic BP, both P<.001). Adherence was better in participants measuring semimonthly (71.4\%) compared with participants performing monthly measurements (64.3\%, P=.008). During the study, 41 (27.2\%) participants were referred to their general practitioner because of a high BP. Referred participants had a decrease in their BP during follow-up (mean difference final and initial [standard error] ?5.29 [1.92] for systolic BP and ?2.93 [1.08] for diastolic BP, both P<.05). Conclusion: Mobile phone-assisted technology is a reliable and promising method with good adherence to measure BP at home during a 6-month period. This provides a possibility for implementation in large-scale studies and can potentially contribute to BP reduction. ",
doi="10.2196/mhealth.5485",
url="http://mhealth.jmir.org/2016/2/e67/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27296628"
}


@Article{info:doi/10.2196/jmir.4963,
author="Koufopoulos, T. Justin
and Conner, T. Mark
and Gardner, H. Peter
and Kellar, Ian",
title="A Web-Based and Mobile Health Social Support Intervention to Promote Adherence to Inhaled Asthma Medications: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2016",
month="Jun",
day="13",
volume="18",
number="6",
pages="e122",
keywords="Internet",
keywords="telemedicine",
keywords="social support",
keywords="asthma",
keywords="adherence",
keywords="attrition",
keywords="engagement",
keywords="randomized controlled trial",
keywords="online community",
keywords="social health network",
abstract="Background: Online communities hold great potential as interventions for health, particularly for the management of chronic illness. The social support that online communities can provide has been associated with positive treatment outcomes, including medication adherence. There are few studies that have attempted to assess whether membership of an online community improves health outcomes using rigorous designs. Objective: Our objective was to conduct a rigorous proof-of-concept randomized controlled trial of an online community intervention for improving adherence to asthma medicine. Methods: This 9-week intervention included a sample of asthmatic adults from the United Kingdom who were prescribed an inhaled corticosteroid preventer. Participants were recruited via email and randomized to either an ``online community'' or ``no online community'' (diary) condition. After each instance of preventer use, participants (N=216) were required to report the number of doses of medication taken in a short post. Those randomized to the online community condition (n=99) could read the posts of other community members, reply, and create their own posts. Participants randomized to the no online community condition (n=117) also posted their medication use, but could not read others' posts. The main outcome measures were self-reported medication adherence at baseline and follow-up (9 weeks postbaseline) and an objective measure of adherence to the intervention (visits to site). Results: In all, 103 participants completed the study (intervention: 37.8\%, 39/99; control: 62.2\%, 64/117). MANCOVA of self-reported adherence to asthma preventer medicine at follow-up was not significantly different between conditions in either intention-to-treat (P=.92) or per-protocol (P=.68) analysis. Site use was generally higher in the control compared to intervention conditions. Conclusions: Joining an online community did not improve adherence to preventer medication for asthma patients. Without the encouragement of greater community support or more components to sustain engagement over time, the current findings do not support the use of an online community to improve adherence. ClinicalTrial: International Standard Randomized Controlled Trial Number (ISRCTN): 29399269; http://www.isrctn.com/ISRCTN29399269/29399269 (Archived by WebCite at http://www.webcitation.org/6fUbEuVoT) ",
doi="10.2196/jmir.4963",
url="http://www.jmir.org/2016/6/e122/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27298211"
}


@Article{info:doi/10.2196/mhealth.5426,
author="Drott, Jenny
and Vilhelmsson, Maria
and Kjellgren, Karin
and Berter{\"o}, Carina",
title="Experiences With a Self-Reported Mobile Phone-Based System Among Patients With Colorectal Cancer: A Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Jun",
day="09",
volume="4",
number="2",
pages="e66",
keywords="cancer",
keywords="conventional content analysis",
keywords="informatics technology systems",
keywords="mHealth",
keywords="self-reported mobile phone-based system",
keywords="symptom monitoring",
abstract="Background: In cancer care, mobile phone-based systems are becoming more widely used in the assessment, monitoring, and management of side effects. Objective: To explore the experiences of patients with colorectal cancer on using a mobile phone-based system for reporting neurotoxic side effects. Methods: Eleven patients were interviewed (ages 44-68 years). A semistructured interview guide was used to perform telephone interviews. The interviews were transcribed verbatim and analyzed with qualitative content analysis. Results: The patients' experiences of using a mobile phone-based system were identified and constructed as: ``being involved,'' ``pacing oneself,'' and ``managing the questions.'' ``Being involved'' refers to their individual feelings. Patients were participating in their own care by being observant of the side effects they were experiencing. They were aware that the answers they gave were monitored in real time and taken into account by health care professionals when planning further treatment. ``Pacing oneself'' describes how the patients can have an impact on the time and place they choose to answer the questions. Answering the questionnaire was easy, and despite the substantial number of questions, it was quickly completed. ``Managing the questions'' pointed out that the patients needed to be observant because of the construction of the questions. They could not routinely answer all the questions. Patients understood that side effects can vary during the cycles of treatment and need to be assessed repeatedly during treatment. Conclusions: This mobile phone-based system reinforced the patients' feeling of involvement in their own care. The patients were comfortable with the technology and appreciated that the system was not time consuming. ",
doi="10.2196/mhealth.5426",
url="http://mhealth.jmir.org/2016/2/e66/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27282257"
}


@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/resprot.5389,
author="Newman, Craig
and Shankar, Rohit
and Hanna, Jane
and McLean, Brendan
and Osland, Alex
and Milligan, Cathryn
and Ball, Abbie
and Jory, Caryn
and Walker, Matthew",
title="Developing an Evidence-Based Epilepsy Risk Assessment eHealth Solution: From Concept to Market",
journal="JMIR Res Protoc",
year="2016",
month="Jun",
day="07",
volume="5",
number="2",
pages="e82",
keywords="eHealth",
keywords="mhealth",
keywords="mobile app",
keywords="epilepsy",
keywords="SUDEP",
keywords="self-management",
keywords="self-monitoring",
keywords="smartphone",
abstract="Introduction: Sudden unexpected death in epilepsy (SUDEP) is possibly the most common cause of death as a result of complications from epilepsy. The need to educate and regularly review risk for all patients with epilepsy is paramount, but rarely delivered in actual clinical practice. Evidence suggests that education around SUDEP and modifiable risk variables translate into better self-management of epilepsy. Objective: We aimed to develop and implement an eHealth solution to support education and self-management of risks, in epilepsy. Methods: We undertook an innovation pathways approach, including problem identification, feasibility assessment, design, implementation, and marketing. People with epilepsy were provided a smartphone-based app (Epilepsy Self-Monitor, EpSMon), which translates the clinical risk assessment tool into an educational and self-monitoring platform, for the self-management of epilepsy. Results: Results include the success of the marketing campaign, and in what areas, with an estimated reach of approximately 38 million people. EpSMon has proved a success in academic and clinical circles, attracting awards and nominations for awards. The number of users of EpSMon, after 3 months, turned out to be lower than expected (N=221). A 4-month trial of the app in use in the United Kingdom, and the success of the marketing strategy, point to necessary changes to the model of delivery and marketing, summarized in this paper. These include the marketing message, user cost model, and need for the availability of an Android version. Conclusions: EpSMon has proven a success in respect to its reception by academics, clinicians, stakeholder groups, and the patients who use it. There is work needed to promote the model and increase its acceptability/attractiveness, including broadening the marketing message, increasing its availability, and reducing its cost. Future development and promotion of the tool will hopefully inform iterative design of its core features for a receptive audience and lead to increased uptake as it is launched worldwide in 2016. ",
doi="10.2196/resprot.5389",
url="http://www.researchprotocols.org/2016/2/e82/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27269382"
}


@Article{info:doi/10.2196/mhealth.5331,
author="Steele Gray, Carolyn
and Gill, Ashlinder
and Khan, Irfan Anum
and Hans, Kaur Parminder
and Kuluski, Kerry
and Cott, Cheryl",
title="The Electronic Patient Reported Outcome Tool: Testing Usability and Feasibility of a Mobile App and Portal to Support Care for Patients With Complex Chronic Disease and Disability in Primary Care Settings",
journal="JMIR mHealth uHealth",
year="2016",
month="Jun",
day="02",
volume="4",
number="2",
pages="e58",
keywords="eHealth",
keywords="mHealth",
keywords="multimorbidity",
keywords="primary care",
keywords="usability",
keywords="feasibility",
keywords="pilot",
abstract="Background: People experiencing complex chronic disease and disability (CCDD) face some of the greatest challenges of any patient population. Primary care providers find it difficult to manage multiple discordant conditions and symptoms and often complex social challenges experienced by these patients. The electronic Patient Reported Outcome (ePRO) tool is designed to overcome some of these challenges by supporting goal-oriented primary care delivery. Using the tool, patients and providers collaboratively develop health care goals on a portal linked to a mobile device to help patients and providers track progress between visits. Objectives: This study tested the usability and feasibility of adopting the ePRO tool into a single interdisciplinary primary health care practice in Toronto, Canada. The Fit between Individuals, Fask, and Technology (FITT) framework was used to guide our assessment and explore whether the ePRO tool is: (1) feasible for adoption in interdisciplinary primary health care practices and (2) usable from both the patient and provider perspectives. This usability pilot is part of a broader user-centered design development strategy. Methods: A 4-week pilot study was conducted in which patients and providers used the ePRO tool to develop health-related goals, which patients then monitored using a mobile device. Patients and providers collaboratively set goals using the system during an initial visit and had at least 1 follow-up visit at the end of the pilot to discuss progress. Focus groups and interviews were conducted with patients and providers to capture usability and feasibility measures. Data from the ePRO system were extracted to provide information regarding tool usage. Results: Six providers and 11 patients participated in the study; 3 patients dropped out mainly owing to health issues. The remaining 8 patients completed 210 monitoring protocols, equal to over 1300 questions, with patients often answering questions daily. Providers and patients accessed the portal on an average of 10 and 1.5 times, respectively. Users found the system easy to use, some patients reporting that the tool helped in their ability to self-manage, catalyzed a sense of responsibility over their care, and improved patient-centered care delivery. Some providers found that the tool helped focus conversations on goal setting. However, the tool did not fit well with provider workflows, monitoring questions were not adequately tailored to individual patient needs, and daily reporting became tedious and time-consuming for patients. Conclusions: Although our study suggests relatively low usability and feasibility of the ePRO tool, we are encouraged by the early impact on patient outcomes and generally positive responses from both user groups regarding the potential of the tool to improve care for patients with CCDD. As is consistent with our user-centered design development approach, we have modified the tool based on user feedback, and are now testing the redeveloped tool through an exploratory trial. ",
doi="10.2196/mhealth.5331",
url="http://mhealth.jmir.org/2016/2/e58/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27256035"
}


@Article{info:doi/10.2196/jmir.5250,
author="Berry, Natalie
and Lobban, Fiona
and Emsley, Richard
and Bucci, Sandra",
title="Acceptability of Interventions Delivered Online and Through Mobile Phones for People Who Experience Severe Mental Health Problems: A Systematic Review",
journal="J Med Internet Res",
year="2016",
month="May",
day="31",
volume="18",
number="5",
pages="e121",
keywords="mHealth",
keywords="eHealth",
keywords="severe mental health",
keywords="psychosis",
keywords="bipolar disorder",
keywords="personality disorder",
keywords="severe mental health problems (SMI)",
keywords="acceptability",
abstract="Background: Psychological interventions are recommended for people with severe mental health problems (SMI). However, barriers exist in the provision of these services and access is limited. Therefore, researchers are beginning to develop and deliver interventions online and via mobile phones. Previous research has indicated that interventions delivered in this format are acceptable for people with SMI. However, a comprehensive systematic review is needed to investigate the acceptability of online and mobile phone-delivered interventions for SMI in depth. Objective: This systematic review aimed to 1) identify the hypothetical acceptability (acceptability prior to or without the delivery of an intervention) and actual acceptability (acceptability where an intervention was delivered) of online and mobile phone-delivered interventions for SMI, 2) investigate the impact of factors such as demographic and clinical characteristics on acceptability, and 3) identify common participant views in qualitative studies that pinpoint factors influencing acceptability. Methods: We conducted a systematic search of the databases PubMed, Embase, PsycINFO, CINAHL, and Web of Science in April 2015, which yielded a total of 8017 search results, with 49 studies meeting the full inclusion criteria. Studies were included if they measured acceptability through participant views, module completion rates, or intervention use. Studies delivering interventions were included if the delivery method was online or via mobile phones. Results: The hypothetical acceptability of online and mobile phone-delivered interventions for SMI was relatively low, while actual acceptability tended to be high. Hypothetical acceptability was higher for interventions delivered via text messages than by emails. The majority of studies that assessed the impact of demographic characteristics on acceptability reported no significant relationships between the two. Additionally, actual acceptability was higher when participants were provided remote online support. Common qualitative factors relating to acceptability were safety and privacy concerns, the importance of an engaging and appealing delivery format, the inclusion of peer support, computer and mobile phone literacy, technical issues, and concerns about the impact of psychological state on intervention use. Conclusions: This systematic review provides an in-depth focus on the acceptability of online and mobile phone-delivered interventions for SMI and identified the need for further research in this area. Based on the results from this review, we recommend that researchers measure both hypothetical and actual acceptability to identify whether initial perceptions of online and mobile phone-delivered interventions change after access. In addition, more focus is needed on the potential impact of demographic and clinical characteristics on acceptability. The review also identified issues with module completion rates and intervention use as measures of acceptability. We therefore advise researchers to obtain qualitative reports of acceptability throughout each phase of intervention development and testing. Further implications and opportunities for future research are discussed. ",
doi="10.2196/jmir.5250",
url="http://www.jmir.org/2016/5/e121/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27245693"
}


@Article{info:doi/10.2196/jmir.4883,
author="Whitehead, Lisa
and Seaton, Philippa",
title="The Effectiveness of Self-Management Mobile Phone and Tablet Apps in Long-term Condition Management: A Systematic Review",
journal="J Med Internet Res",
year="2016",
month="May",
day="16",
volume="18",
number="5",
pages="e97",
keywords="mobile phone",
keywords="apps",
keywords="telemedicine",
keywords="mHealth",
keywords="self-management",
keywords="chronic disease",
keywords="diabetes mellitus",
keywords="cardiovascular diseases",
keywords="lung diseases",
keywords="systematic review",
abstract="Background: Long-term conditions and their concomitant management place considerable pressure on patients, communities, and health care systems worldwide. International clinical guidelines on the majority of long-term conditions recommend the inclusion of self-management programs in routine management. Self-management programs have been associated with improved health outcomes; however, the successful and sustainable transfer of research programs into clinical practice has been inconsistent. Recent developments in mobile technology, such as mobile phone and tablet computer apps, could help in developing a platform for the delivery of self-management interventions that are adaptable, of low cost, and easily accessible. Objective: We conducted a systematic review to assess the effectiveness of mobile phone and tablet apps in self-management of key symptoms of long-term conditions. Methods: We searched PubMed, Embase, EBSCO databases, the Cochrane Library, and The Joanna Briggs Institute Library for randomized controlled trials that assessed the effectiveness of mobile phone and tablet apps in self-management of diabetes mellitus, cardiovascular disease, and chronic lung diseases from 2005--2016. We searched registers of current and ongoing trials, as well as the gray literature. We then checked the reference lists of all primary studies and review papers for additional references. The last search was run in February 2016. Results: Of the 9 papers we reviewed, 6 of the interventions demonstrated a statistically significant improvement in the primary measure of clinical outcome. Where the intervention comprised an app only, 3 studies demonstrated a statistically significant improvement. Interventions to address diabetes mellitus (5/9) were the most common, followed by chronic lung disease (3/9) and cardiovascular disease (1/9). A total of 3 studies included multiple intervention groups using permutations of an intervention involving an app. The duration of the intervention ranged from 6 weeks to 1 year, and final follow-up data ranged from 3 months to 1 year. Sample size ranged from 48 to 288 participants. Conclusions: The evidence indicates the potential of apps in improving symptom management through self-management interventions. The use of apps in mHealth has the potential to improve health outcomes among those living with chronic diseases through enhanced symptom control. Further innovation, optimization, and rigorous research around the potential of apps in mHealth technology will move the field toward the reality of improved health care delivery and outcomes. ",
doi="10.2196/jmir.4883",
url="http://www.jmir.org/2016/5/e97/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27185295"
}


@Article{info:doi/10.2196/jmir.5414,
author="Schoot, S. Tessa
and Weenk, Mariska
and van de Belt, H. Tom
and Engelen, JLPG Lucien
and van Goor, Harry
and Bredie, JH Sebastian",
title="A New Cuffless Device for Measuring Blood Pressure: A Real-Life Validation Study",
journal="J Med Internet Res",
year="2016",
month="May",
day="05",
volume="18",
number="5",
pages="e85",
keywords="hypertension",
keywords="cuffless blood pressure monitor",
keywords="wearable device",
keywords="cardiovascular risk management",
keywords="patient empowerment",
abstract="Background: Cuffless blood pressure (BP) monitoring devices, based on pulse transit time, are being developed as an easy-to-use, more convenient, fast, and relatively cheap alternative to conventional BP measuring devices based on cuff occlusion. Thereby they may provide a great alternative to BP self-measurement. Objective: The objective of our study was to evaluate the performance of the first release of the Checkme Health Monitor (Viatom Technology), a cuffless BP monitor, in a real-life setting. Furthermore, we wanted to investigate whether the posture of the volunteer and the position of the device relative to the heart level would influence its outcomes. Methods: Study volunteers fell into 3 BP ranges: high (>160 mmHg), normal (130--160 mmHg), and low (<130 mmHg). All requirements for test environment, observer qualification, volunteer recruitment, and BP measurements were met according to the European Society of Hypertension International Protocol (ESH-IP) for the validation of BP measurement devices. After calibrating the Checkme device, we measured systolic BP with Checkme and a validated, oscillometric reference BP monitor (RM). Measurements were performed in randomized order both in supine and in sitting position, and with Checkme at and above heart level. Results: We recruited 52 volunteers, of whom we excluded 15 (12 due to calibration failure with Checkme, 3 due to a variety of reasons). The remaining 37 volunteers were divided into low (n=14), medium (n=13), and high (n=10) BP ranges. There were 18 men and 19 women, with a mean age of 54.1 (SD 14.5) years, and mean recruitment systolic BP of 141.7 (SD 24.7) mmHg. BP results obtained by RM and Checkme correlated well. In the supine position, the difference between the RM and Checkme was >5 mmHg in 17 of 37 volunteers (46\%), of whom 9 of 37 (24\%) had a difference >10 mmHg and 5 of 37 (14\%) had a difference >15 mmHg. Conclusions: BP obtained with Checkme correlated well with RM BP, particularly in the position (supine) in which the device was calibrated. These preliminary results are promising for conducting further research on cuffless BP measurement in the clinical and outpatient settings. ",
doi="10.2196/jmir.5414",
url="http://www.jmir.org/2016/5/e85/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27150527"
}


@Article{info:doi/10.2196/resprot.5450,
author="Schlosser, Danielle
and Campellone, Timothy
and Kim, Daniel
and Truong, Brandy
and Vergani, Silvia
and Ward, Charlie
and Vinogradov, Sophia",
title="Feasibility of PRIME: A Cognitive Neuroscience-Informed Mobile App Intervention to Enhance Motivated Behavior and Improve Quality of Life in Recent Onset Schizophrenia",
journal="JMIR Res Protoc",
year="2016",
month="Apr",
day="28",
volume="5",
number="2",
pages="e77",
keywords="schizophrenia",
keywords="mobile app",
keywords="smartphone",
keywords="motivation",
keywords="technology-based intervention",
keywords="social networking",
keywords="coaching",
keywords="negative symptoms",
keywords="quality of life",
abstract="Background: Despite improvements in treating psychosis, schizophrenia remains a chronic and debilitating disorder that affects approximately 1\% of the US population and costs society more than depression, dementia, and other medical illnesses across most of the lifespan. Improving functioning early in the course of illness could have significant implications for long-term outcome of individuals with schizophrenia. Yet, current gold-standard treatments do not lead to clinically meaningful improvements in outcome, partly due to the inherent challenges of treating a population with significant cognitive and motivational impairments. The rise of technology presents an opportunity to develop novel treatments that may circumvent the motivational and cognitive challenges observed in schizophrenia. Objective: The purpose of this study was two-fold: (1) to evaluate the feasibility and acceptability of implementing a Personalized Real-Time Intervention for Motivation Enhancement (PRIME), a mobile app intervention designed to target reward-processing impairments, enhance motivation, and thereby improve quality of life in recent onset schizophrenia, and (2) evaluate the empirical benefits of using an iterative, user-centered design (UCD) process. Methods: We conducted two design workshops with 15 key stakeholders, followed by a series of in-depth interviews in collaboration with IDEO, a design and innovation firm. The UCD approach ultimately resulted in the first iteration of PRIME, which was evaluated by 10 RO participants. Results from the Stage 1 participants were then used to guide the next iteration that is currently being evaluated in an ongoing RCT. Participants in both phases were encouraged to use the app daily with a minimum frequency of 1/week over a 12-week period. Results: The UCD process resulted in the following feature set: (1) delivery of text message (short message service, SMS)-based motivational coaching from trained therapists, (2) individualized goal setting in prognostically important psychosocial domains, (3) social networking via direct peer-to-peer messaging, and (4) community ``moments feed'' to capture and reinforce rewarding experiences and goal achievements. Users preferred an experience that highlighted several of the principles of self-determination theory, including the desire for more control of their future (autonomy and competence) and an approach that helps them improve existing relationships (relatedness). IDEO, also recommended an approach that was casual, friendly, and nonstigmatizing, which is in line with the recovery model of psychosis. After 12-weeks of using PRIME, participants used the app, on average, every other day, were actively engaged with its various features each time they logged in and retention and satisfaction was high (20/20, 100\% retention, high satisfaction ratings). The iterative design process lead to a 2- to 3-fold increase in engagement from Stage 1 to Stage 2 in almost each aspect of the platform. Conclusions: These results indicate that the neuroscience-informed mobile app, PRIME, is a feasible and acceptable intervention for young people with schizophrenia. ",
doi="10.2196/resprot.5450",
url="http://www.researchprotocols.org/2016/2/e77/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27125771"
}


@Article{info:doi/10.2196/diabetes.4475,
author="Li, Ying
and Tan, Jin
and Shi, Bozhi
and Duan, Xiaolian
and Zhong, Daidi
and Li, Xiaoling
and Qu, Jianning",
title="Information and Communication Technology-Powered Diabetes Self-Management Systems in China: A Study Evaluating the Features and Requirements of Apps and Patents",
journal="JMIR Diabetes",
year="2016",
month="Apr",
day="06",
volume="1",
number="1",
pages="e2",
keywords="apps",
keywords="diabetes",
keywords="information and communication technology",
keywords="self-monitoring of blood glucose",
keywords="patents",
abstract="Background: For patients with diabetes, the self-monitoring of blood glucose (SMBG) is a recommended way of controlling the blood glucose level. By leveraging the modern information and communication technology (ICT) and the corresponding infrastructure, engineers nowadays are able to merge the SMBG activities into daily life and to dramatically reduce patient's burden. Such type of ICT-powered SMBG had already been marketed in the United States and the European Union for a decade, but was introduced into the Chinese market only in recent years. Although there is no doubt about the general need for such type of SMBG in the Chinese market, how it could be adapted to the local technical and operational environment is still an open question. Objective: Our overall goal is to understand the local requirements and the current status of deploying ICT-powered SMBG to the Chinese market. In particular, we aim to analyze existing domestic SMBG mobile apps and relevant domestic patents to identify their various aspects, including the common functionalities, innovative feature, defects, conformance to standards, prospects, etc. In the long run, we hope the outcome of this study could help the decision making on how to properly adapt ICT-powered SMBG to the Chinese market. Methods: We identified 289 apps. After exclusion of irrelevant apps, 78 apps remained. These were downloaded and analyzed. A total of 8070 patents related to glucose were identified from patent database. Irrelevant materials and duplicates were excluded, following which 39 patents were parsed to extract the important features. These apps and patents were further compared with the corresponding requirements derived from relevant clinical guidelines and data standards. Results: The most common features of studied apps were blood health data recording, notification, and decision supporting. The most common features of studied patents included mobile terminal, server, and decision supporting. The main difference between patents and apps is that the patents had 2 specific features, namely, interface to the hospital information system and recording personal information, which were not mentioned in the app. The other major finding is that, in general, in terms of the components of the features, although the features identified in both apps and patents conform to the requirements of the relevant clinical guidelines and data standards, upon looking into the details, gaps exist between the features of the identified apps and patents and the relevant clinical guidelines and data standards. In addition, the social media feature that the apps and patents have is not included in the standard requirements list. Conclusions: The development of Chinese SMBG mobile apps and relevant patents is still in the primitive stage. Although the functionalities of most apps and patents can meet the basic requirements of SMBG, gaps have been identified when comparing the functionalities provided by apps and patents with the requirements necessitated by the standards. One of the most important gaps is that only a small portion of the studied apps provides the automatic data transmission and exchange feature, which may hamper the overall performance. The clinical guidelines can thus be further developed to leverage new features provided by ICT-powered SMBG apps (eg, the social media feature, which may help to improve the social intervention of patients with diabetes). ",
doi="10.2196/diabetes.4475",
url="http://diabetes.jmir.org/2016/1/e2/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30291083"
}


@Article{info:doi/10.2196/diabetes.4506,
author="Wayne, Noah
and Cercone, Nick
and Li, Jiye
and Zohar, Ariel
and Katz, Joel
and Brown, Patrick
and Ritvo, Paul",
title="Data Mining of a Remote Behavioral Tracking System for Type 2 Diabetes Patients: A Prospective Cohort Study",
journal="JMIR Diabetes",
year="2016",
month="Apr",
day="06",
volume="1",
number="1",
pages="e1",
keywords="diabetes mellitus, type 2",
keywords="health coaching",
keywords="mhealth",
keywords="telehealth",
keywords="data mining",
abstract="Background: Complications from type 2 diabetes mellitus can be prevented when patients perform health behaviors such as vigorous exercise and glucose-regulated diet. The use of smartphones for tracking such behaviors has demonstrated success in type 2 diabetes management while generating repositories of analyzable digital data, which, when better understood, may help improve care. Data mining methods were used in this study to better understand self-monitoring patterns using smartphone tracking software. Objective: Associations were evaluated between the smartphone monitoring of health behaviors and HbA1c reductions in a patient subsample with type 2 diabetes who demonstrated clinically significant benefits after participation in a randomized controlled trial. Methods: A priori association-rule algorithms, implemented in the C language, were applied to app-discretized use data involving three primary health behavior trackers (exercise, diet, and glucose monitoring) from 29 participants who achieved clinically significant HbA1c reductions. Use was evaluated in relation to improved HbA1c outcomes. Results: Analyses indicated that nearly a third (9/29, 31\%) of participants used a single tracker, half (14/29, 48\%) used two primary trackers, and the remainder (6/29, 21\%) of the participants used three primary trackers. Decreases in HbA1c were observed across all groups (0.97-1.95\%), but clinically significant reductions were more likely with use of one or two trackers rather than use of three trackers (OR 0.18, P=.04). Conclusions: Data mining techniques can reveal relevant coherent behavior patterns useful in guiding future intervention structure. It appears that focusing on using one or two trackers, in a symbolic function, was more effective (in this sample) than regular use of all three trackers. ",
doi="10.2196/diabetes.4506",
url="http://diabetes.jmir.org/2016/1/e1/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30291054"
}


@Article{info:doi/10.2196/jmir.5505,
author="Asselbergs, Joost
and Ruwaard, Jeroen
and Ejdys, Michal
and Schrader, Niels
and Sijbrandij, Marit
and Riper, Heleen",
title="Mobile Phone-Based Unobtrusive Ecological Momentary Assessment of Day-to-Day Mood: An Explorative Study",
journal="J Med Internet Res",
year="2016",
month="Mar",
day="29",
volume="18",
number="3",
pages="e72",
keywords="affect",
keywords="data mining",
keywords="ecological momentary assessment",
keywords="experience sampling",
keywords="mobile phone sensing",
abstract="Background: Ecological momentary assessment (EMA) is a useful method to tap the dynamics of psychological and behavioral phenomena in real-world contexts. However, the response burden of (self-report) EMA limits its clinical utility. Objective: The aim was to explore mobile phone-based unobtrusive EMA, in which mobile phone usage logs are considered as proxy measures of clinically relevant user states and contexts. Methods: This was an uncontrolled explorative pilot study. Our study consisted of 6 weeks of EMA/unobtrusive EMA data collection in a Dutch student population (N=33), followed by a regression modeling analysis. Participants self-monitored their mood on their mobile phone (EMA) with a one-dimensional mood measure (1 to 10) and a two-dimensional circumplex measure (arousal/valence, --2 to 2). Meanwhile, with participants' consent, a mobile phone app unobtrusively collected (meta) data from six smartphone sensor logs (unobtrusive EMA: calls/short message service (SMS) text messages, screen time, application usage, accelerometer, and phone camera events). Through forward stepwise regression (FSR), we built personalized regression models from the unobtrusive EMA variables to predict day-to-day variation in EMA mood ratings. The predictive performance of these models (ie, cross-validated mean squared error and percentage of correct predictions) was compared to naive benchmark regression models (the mean model and a lag-2 history model). Results: A total of 27 participants (81\%) provided a mean 35.5 days (SD 3.8) of valid EMA/unobtrusive EMA data. The FSR models accurately predicted 55\% to 76\% of EMA mood scores. However, the predictive performance of these models was significantly inferior to that of naive benchmark models. Conclusions: Mobile phone-based unobtrusive EMA is a technically feasible and potentially powerful EMA variant. The method is young and positive findings may not replicate. At present, we do not recommend the application of FSR-based mood prediction in real-world clinical settings. Further psychometric studies and more advanced data mining techniques are needed to unlock unobtrusive EMA's true potential. ",
doi="10.2196/jmir.5505",
url="http://www.jmir.org/2016/3/e72/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27025287"
}


@Article{info:doi/10.2196/mhealth.5009,
author="Simons, Lucy
and Valentine, Z. Althea
and Falconer, J. Caroline
and Groom, Madeleine
and Daley, David
and Craven, P. Michael
and Young, Zoe
and Hall, Charlotte
and Hollis, Chris",
title="Developing mHealth Remote Monitoring Technology for Attention Deficit Hyperactivity Disorder: A Qualitative Study Eliciting User Priorities and Needs",
journal="JMIR mHealth uHealth",
year="2016",
month="Mar",
day="23",
volume="4",
number="1",
pages="e31",
keywords="attention deficit hyperactivity disorder",
keywords="mHealth",
keywords="eMental Health",
keywords="remote monitoring technology",
keywords="mental health services",
keywords="qualitative methods",
keywords="feasibility testing",
keywords="user requirements",
abstract="Background: Guidelines in the United Kingdom recommend that medication titration for attention deficit hyperactivity disorder (ADHD) should be completed within 4-6 weeks and include regular reviews. However, most clinicians think that weekly clinic contact is infeasible, and audits have shown that this timeline is rarely achieved. Thus, a more effective monitoring and review system is needed; remote monitoring technology (RMT) may be one way to improve current practice. However, little is known about whether patients with ADHD, their families, and clinicians would be interested in using RMT. Objective: To explore patients', parents', and health care professionals' views and attitudes toward using digital technology for remote monitoring during titration for ADHD. Methods: This was a qualitative study, and data were collected through 11 focus groups with adults and young people with ADHD, parents of children with ADHD, and health care professionals (N=59). Results: All participant groups were positive about using RMT in the treatment of ADHD, but they were also aware of barriers to its use, especially around access to technology and integrating RMT into clinical care. They identified that RMT had the most potential for use in the ongoing management and support of ADHD, rather than during the distinct titration period. Participants identified features of RMT that could improve the quality of consultations and support greater self-management. Conclusions: RMT has the potential to augment support and care for ADHD, but it needs to go beyond the titration period and offer more to patients and families than monitoring through outcome measures. Developing and evaluating an mHealth app that incorporates the key features identified by end users is required. ",
doi="10.2196/mhealth.5009",
url="http://mhealth.jmir.org/2016/1/e31/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27009498"
}


@Article{info:doi/10.2196/mhealth.4569,
author="Hacking, Damian
and Haricharan, J. Hanne
and Brittain, Kirsty
and Lau, Kwan Yan
and Cassidy, Tali
and Heap, Marion",
title="Hypertension Health Promotion via Text Messaging at a Community Health Center in South Africa: A Mixed Methods Study",
journal="JMIR mHealth uHealth",
year="2016",
month="Mar",
day="10",
volume="4",
number="1",
pages="e22",
keywords="telemedicine",
keywords="health knowledge, attitudes, practice",
keywords="developing countries",
keywords="hypertension",
abstract="Background: The use of mobile phones to deliver health care (mHealth) is increasing in popularity due to the high prevalence of mobile phone penetration. This is seen in developing countries, where mHealth may be particularly useful in overcoming traditional access barriers. Non-communicable diseases may be particularly amenable to mHealth interventions, and hypertension is one with an escalating burden in the developing world. Objective: The objective of this study was to test whether the dissemination of health information via a short message service (SMS) led to improvements in health knowledge and self-reported health-related behaviors. Methods: A mixed methods study was carried out among a cohort of 223 hypertension clinic patients, in a resource-poor setting in Cape Town, South Africa, in 2012. Hypertensive outpatients were recruited at the clinic and administered a baseline questionnaire to establish existing knowledge of hypertension. Participants were then randomly assigned to intervention or control groups. The intervention group received 90 SMSes over a period of 17 weeks. Thereafter, the baseline questionnaire was readministered to both groups to gauge if any improvements in health knowledge had occurred. Those who received SMSes were asked additional questions about health-related behavior changes. A focus group was then conducted to obtain in-depth feedback about participants' experience with, and response to, the SMS campaign. Results: No statistically significant changes in overall health knowledge were observed between the control and intervention groups. The intervention group had positive increases in self-reported behavior changes. These were reaffirmed by the focus groups, which also revealed a strong preference for the SMS campaign and the belief that the SMSes acted as a reminder to change, as opposed to providing new information. Conclusions: Although the content of the SMSes was not new, and did not improve health knowledge, SMSes were effective in motivating positive self-reported behavior change among hypertensive patients. Trial Registration: Pan African Clinical Trials Registry Number: PACTR201412000968462. Registered 18 December 2014 (Archived by WebCite at http://www.webcitation.org/6fhtyLRcO). ",
doi="10.2196/mhealth.4569",
url="http://mhealth.jmir.org/2016/1/e22/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26964505"
}


@Article{info:doi/10.2196/mental.4984,
author="Bakker, David
and Kazantzis, Nikolaos
and Rickwood, Debra
and Rickard, Nikki",
title="Mental Health Smartphone Apps: Review and Evidence-Based Recommendations for Future Developments",
journal="JMIR Mental Health",
year="2016",
month="Mar",
day="01",
volume="3",
number="1",
pages="e7",
keywords="mobile phones",
keywords="mental health",
keywords="smartphones",
keywords="apps",
keywords="mobile apps",
keywords="depression",
keywords="anxiety",
keywords="cognitive behavior therapy",
keywords="cognitive behavioral therapy",
keywords="clinical psychology",
abstract="Background: The number of mental health apps (MHapps) developed and now available to smartphone users has increased in recent years. MHapps and other technology-based solutions have the potential to play an important part in the future of mental health care; however, there is no single guide for the development of evidence-based MHapps. Many currently available MHapps lack features that would greatly improve their functionality, or include features that are not optimized. Furthermore, MHapp developers rarely conduct or publish trial-based experimental validation of their apps. Indeed, a previous systematic review revealed a complete lack of trial-based evidence for many of the hundreds of MHapps available. Objective: To guide future MHapp development, a set of clear, practical, evidence-based recommendations is presented for MHapp developers to create better, more rigorous apps. Methods: A literature review was conducted, scrutinizing research across diverse fields, including mental health interventions, preventative health, mobile health, and mobile app design. Results: Sixteen recommendations were formulated. Evidence for each recommendation is discussed, and guidance on how these recommendations might be integrated into the overall design of an MHapp is offered. Each recommendation is rated on the basis of the strength of associated evidence. It is important to design an MHapp using a behavioral plan and interactive framework that encourages the user to engage with the app; thus, it may not be possible to incorporate all 16 recommendations into a single MHapp. Conclusions: Randomized controlled trials are required to validate future MHapps and the principles upon which they are designed, and to further investigate the recommendations presented in this review. Effective MHapps are required to help prevent mental health problems and to ease the burden on health systems. ",
doi="10.2196/mental.4984",
url="http://mental.jmir.org/2016/1/e7/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26932350"
}


@Article{info:doi/10.2196/jmir.4890,
author="Wolf, Axel
and Fors, Andreas
and Ulin, Kerstin
and Thorn, J{\"o}rgen
and Swedberg, Karl
and Ekman, Inger",
title="An eHealth Diary and Symptom-Tracking Tool Combined With Person-Centered Care for Improving Self-Efficacy After a Diagnosis of Acute Coronary Syndrome: A Substudy of a Randomized Controlled Trial",
journal="J Med Internet Res",
year="2016",
month="Feb",
day="23",
volume="18",
number="2",
pages="e40",
keywords="person-centred care: telemedicine",
keywords="mobile health",
keywords="eHealth",
keywords="patient-centered care",
keywords="self-efficacy",
keywords="acute coronary syndrome",
abstract="Background: Patients  with cardiovascular diseases managed by a person-centered care (PCC) approach have been observed to have better treatment outcomes and satisfaction than with traditional care. eHealth may facilitate the often slow transition to more person-centered health care by increasing patients' beliefs in their own capacities (self-efficacy) to manage their care trajectory. eHealth is being increasingly used, but most studies continue to focus on health care professionals' logic of care. Knowledge is lacking regarding the effects of an eHealth tool on self-efficacy when combined with PCC for patients with chronic heart diseases. Objective: The objective of our study was to investigate the effect of an eHealth diary and symptom-tracking tool in combination with PCC for patients with acute coronary syndrome (ACS). Methods: This was a substudy of a randomized controlled trial investigating the effects of PCC in patients hospitalized with ACS. In total, 199 patients with ACS aged <75 years were randomly assigned to a PCC intervention (n=94) or standard treatment (control group, n=105) and were followed up for 6 months. Patients in the intervention arm could choose to use a Web-based or mobile-based eHealth tool, or both, for at least 2 months after hospital discharge. The primary end point was a composite score of changes in general self-efficacy, return to work or prior activity level, and rehospitalization or death 6 months after discharge. Results: Of the 94 patients in the intervention arm, 37 (39\%) used the eHealth tool at least once after the index hospitalization. Most of these (24/37, 65\%) used the mobile app and not the Web-based app as the primary source of daily self-rating input. Patients used the eHealth tool a mean of 38 times during the first 8 weeks (range 1--118, SD 33) and 64 times over a 6-month period (range 1--597, SD 104). Patients who used the eHealth tool in combination with the PCC intervention had a 4-fold improvement in the primary end point compared with the control group (odds ratio 4.0, 95\% CI 1.5--10.5; P=.005). This improvement was driven by a significant increase in general self-efficacy compared with the control group (P=.011). Patients in the PCC group who did not use the eHealth tool (n=57) showed a nonsignificant composite score improvement compared with those in the control group (n=105) (odds ratio 2.0, 95\% CI 0.8--5.2; P=.14). Conclusions: We found a significant effect on improved general self-efficacy and the composite score for patients using an eHealth diary and symptom-tracking tool in combination with PCC compared with traditional care. Trial Registration: Swedish registry, Researchweb.org, ID NR 65 791. ",
doi="10.2196/jmir.4890",
url="http://www.jmir.org/2016/2/e40/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26907584"
}


@Article{info:doi/10.2196/resprot.5204,
author="Steele Gray, Carolyn
and Khan, Irfan Anum
and Kuluski, Kerry
and McKillop, Ian
and Sharpe, Sarah
and Bierman, S. Arlene
and Lyons, F. Renee
and Cott, Cheryl",
title="Improving Patient Experience and Primary Care Quality for Patients With Complex Chronic Disease Using the Electronic Patient-Reported Outcomes Tool: Adopting Qualitative Methods Into a User-Centered Design Approach",
journal="JMIR Res Protoc",
year="2016",
month="Feb",
day="18",
volume="5",
number="1",
pages="e28",
keywords="eHealth development",
keywords="mobile apps",
keywords="multi-morbidity",
keywords="complex patients",
keywords="primary care",
abstract="Background: Many mHealth technologies do not meet the needs of patients with complex chronic disease and disabilities (CCDDs) who are among the highest users of health systems worldwide. Furthermore, many of the development methodologies used in the creation of mHealth and eHealth technologies lack the ability to embrace users with CCDD in the specification process. This paper describes how we adopted and modified development techniques to create the electronic Patient-Reported Outcomes (ePRO) tool, a patient-centered mHealth solution to help improve primary health care for patients experiencing CCDD. Objective: This paper describes the design and development approach, specifically the process of incorporating qualitative research methods into user-centered design approaches to create the ePRO tool.  Key lessons learned are offered as a guide for other eHealth and mHealth research and technology developers working with complex patient populations and their primary health care providers. Methods: Guided by user-centered design principles, interpretive descriptive qualitative research methods were adopted to capture user experiences through interviews and working groups. Consistent with interpretive descriptive methods, an iterative analysis technique was used to generate findings, which were then organized in relation to the tool design and function to help systematically inform modifications to the tool. User feedback captured and analyzed through this method was used to challenge the design and inform the iterative development of the tool. Results: Interviews with primary health care providers (n=7) and content experts (n=6), and four focus groups with patients and carers (n=14) along with a PICK analysis---Possible, Implementable, (to be) Challenged, (to be) Killed---guided development of the first prototype. The initial prototype was presented in three design working groups with patients/carers (n=5), providers (n=6), and experts (n=5).  Working group findings were broken down into categories of what works and what does not work to inform modifications to the prototype. This latter phase led to a major shift in the purpose and design of the prototype, validating the importance of using iterative codesign processes. Conclusions: Interpretive descriptive methods allow for an understanding of user experiences of patients with CCDD, their carers, and primary care providers. Qualitative methods help to capture and interpret user needs, and identify contextual barriers and enablers to tool adoption, informing a redesign to better suit the needs of this diverse user group. This study illustrates the value of adopting interpretive descriptive methods into user-centered mHealth tool design and can also serve to inform the design of other eHealth technologies. Our approach is particularly useful in requirements determination when developing for a complex user group and their health care providers. ",
doi="10.2196/resprot.5204",
url="http://www.researchprotocols.org/2016/1/e28/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26892952"
}


@Article{info:doi/10.2196/resprot.4838,
author="Wilhide III, C. Calvin
and Peeples, M. Malinda
and Anthony Kouyat{\'e}, C. Robin",
title="Evidence-Based mHealth Chronic Disease Mobile App Intervention Design: Development of a Framework",
journal="JMIR Res Protoc",
year="2016",
month="Feb",
day="16",
volume="5",
number="1",
pages="e25",
keywords="mHealth",
keywords="mobile applications",
keywords="mobile app design",
keywords="chronic disease",
keywords="diabetes",
keywords="mHealth framework",
keywords="behavioral intervention",
keywords="intervention design",
keywords="mHealth implementation",
keywords="telemedicine",
abstract="Background: Mobile technology offers new capabilities that can help to drive important aspects of chronic disease management at both an individual and population level, including the ability to deliver real-time interventions that can be connected to a health care team. A framework that supports both development and evaluation is needed to understand the aspects of mHealth that work for specific diseases, populations, and in the achievement of specific outcomes in real-world settings. This framework should incorporate design structure and process, which are important to translate clinical and behavioral evidence, user interface, experience design and technical capabilities into scalable, replicable, and evidence-based mobile health (mHealth) solutions to drive outcomes. Objective: The purpose of this paper is to discuss the identification and development of an app intervention design framework, and its subsequent refinement through development of various types of mHealth apps for chronic disease. Methods: The process of developing the framework was conducted between June 2012 and June 2014. Informed by clinical guidelines, standards of care, clinical practice recommendations, evidence-based research, best practices, and translated by subject matter experts, a framework for mobile app design was developed and the refinement of the framework across seven chronic disease states and three different product types is described. Results: The result was the development of the Chronic Disease mHealth App Intervention Design Framework. This framework allowed for the integration of clinical and behavioral evidence for intervention and feature design. The application to different diseases and implementation models guided the design of mHealth solutions for varying levels of chronic disease management. Conclusions: The framework and its design elements enable replicable product development for mHealth apps and may provide a foundation for the digital health industry to systematically expand mobile health interventions and validate their effectiveness across multiple implementation settings and chronic diseases. ",
doi="10.2196/resprot.4838",
url="http://www.researchprotocols.org/2016/1/e25/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26883135"
}


@Article{info:doi/10.2196/mhealth.4874,
author="Con, Danny
and De Cruz, Peter",
title="Mobile Phone Apps for Inflammatory Bowel Disease Self-Management: A Systematic Assessment of Content and Tools",
journal="JMIR mHealth uHealth",
year="2016",
month="Feb",
day="01",
volume="4",
number="1",
pages="e13",
keywords="IBD",
keywords="apps",
keywords="eHealth",
keywords="smartphone",
keywords="mhealth",
abstract="Background: The rising incidence of inflammatory bowel disease (IBD) over the past decade has resulted in increased health care utilization and longer IBD outpatient waiting lists. Self-management is recognized as an important aspect of chronic disease management but its application to IBD has been limited. The age of IBD onset in a majority of patients is in their 20s to 30s. Mobile phone apps are a technology familiar to young adults and represent an opportunity to explore self-management as a new model of health care delivery for IBD. Objective: The aim of this study was to explore the content and tools of existing IBD apps to identify functionalities that may facilitate patient self-management. Methods: We systematically assessed apps targeted at IBD patients via searches of Google (Android devices) and Apple (iOS devices) app stores with pre-defined inclusion and exclusion criteria. Apps were assessed for specific functionalities; presence of professional medical involvement; consistency with international IBD guidelines based on ``complete,'' ``partial,'' or ``absent'' coverage of consensus statements derived from the European Crohn's and Colitis Organisation, American College of Gastroenterology, and the Gastroenterology Society of Australia; comprehensiveness of data that could be entered; and average pricing. Results: Of the 238 apps screened, 26 apps were assessed, including 10 available on Android platforms, 8 on iOS platforms, and 8 on both. Over half (14/26, 54\%) of the apps had diary functionalities; over a third (10/26, 39\%) provided health information about IBD. None of the apps offered decision support to facilitate the self-initiation of medical therapy. Five of 26 (19\%) had professional medical involvement in their design. Apps demonstrated ``complete'' coverage of only 38\% of the international consensus statements explored. The average price of the apps was AUD\$1.37. Conclusions: Apps may provide a useful adjunct to the management of IBD patients. However, a majority of current apps suffer from a lack of professional medical involvement and limited coverage of international consensus guidelines. Future studies and app design for IBD should include professional medical involvement, evidence-based guidelines, and functionalities with decision support that are specifically tailored to patient self-management. ",
doi="10.2196/mhealth.4874",
url="http://mhealth.jmir.org/2016/1/e13/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26831935"
}


@Article{info:doi/10.2196/mhealth.4231,
author="Birney, J. Amelia
and Gunn, Rebecca
and Russell, K. Jeremy
and Ary, V. Dennis",
title="MoodHacker Mobile Web App With Email for Adults to Self-Manage Mild-to-Moderate Depression: Randomized Controlled Trial",
journal="JMIR mHealth uHealth",
year="2016",
month="Jan",
day="26",
volume="4",
number="1",
pages="e8",
keywords="depression",
keywords="cognitive behavioral therapy",
keywords="behavioral activation",
keywords="positive psychology",
keywords="mobile apps",
keywords="Internet",
keywords="computers",
abstract="Background: Worldwide, depression is rated as the fourth leading cause of disease burden and is projected to be the second leading cause of disability by 2020. Annual depression-related costs in the United States are estimated at US \$210.5 billion, with employers bearing over 50\% of these costs in productivity loss, absenteeism, and disability. Because most adults with depression never receive treatment, there is a need to develop effective interventions that can be more widely disseminated through new channels, such as employee assistance programs (EAPs), and directly to individuals who will not seek face-to-face care. Objective: This study evaluated a self-guided intervention, using the MoodHacker mobile Web app to activate the use of cognitive behavioral therapy (CBT) skills in working adults with mild-to-moderate depression. It was hypothesized that MoodHacker users would experience reduced depression symptoms and negative cognitions, and increased behavioral activation, knowledge of depression, and functioning in the workplace. Methods: A parallel two-group randomized controlled trial was conducted with 300 employed adults exhibiting mild-to-moderate depression. Participants were recruited from August 2012 through April 2013 in partnership with an EAP and with outreach through a variety of additional non-EAP organizations. Participants were blocked on race/ethnicity and then randomly assigned within each block to receive, without clinical support, either the MoodHacker intervention (n=150) or alternative care consisting of links to vetted websites on depression (n=150). Participants in both groups completed online self-assessment surveys at baseline, 6 weeks after baseline, and 10 weeks after baseline. Surveys assessed (1) depression symptoms, (2) behavioral activation, (3) negative thoughts, (4) worksite outcomes, (5) depression knowledge, and (6) user satisfaction and usability. After randomization, all interactions with subjects were automated with the exception of safety-related follow-up calls to subjects reporting current suicidal ideation and/or severe depression symptoms. Results: At 6-week follow-up, significant effects were found on depression, behavioral activation, negative thoughts, knowledge, work productivity, work absence, and workplace distress. MoodHacker yielded significant effects on depression symptoms, work productivity, work absence, and workplace distress for those who reported access to an EAP, but no significant effects on these outcome measures for those without EAP access. Participants in the treatment arm used the MoodHacker app an average of 16.0 times (SD 13.3), totaling an average of 1.3 hours (SD 1.3) of use between pretest and 6-week follow-up. Significant effects on work absence in those with EAP access persisted at 10-week follow-up. Conclusions: This randomized effectiveness trial found that the MoodHacker app produced significant effects on depression symptoms (partial eta2 = .021) among employed adults at 6-week follow-up when compared to subjects with access to relevant depression Internet sites. The app had stronger effects for individuals with access to an EAP (partial eta2 = .093). For all users, the MoodHacker program also yielded greater improvement on work absence, as well as the mediating factors of behavioral activation, negative thoughts, and knowledge of depression self-care. Significant effects were maintained at 10-week follow-up for work absence. General attenuation of effects at 10-week follow-up underscores the importance of extending program contacts to maintain user engagement. This study suggests that light-touch, CBT-based mobile interventions like MoodHacker may be appropriate for implementation within EAPs and similar environments. In addition, it seems likely that supporting MoodHacker users with guidance from counselors may improve effectiveness for those who seek in-person support. Trial Registration: ClinicalTrials.gov NCT02335554; https://clinicaltrials.gov/ct2/show/NCT02335554 (Archived by WebCite at http://www.webcitation.org/6dGXKWjWE) ",
doi="10.2196/mhealth.4231",
url="http://mhealth.jmir.org/2016/1/e8/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26813737"
}


@Article{info:doi/10.2196/mental.5023,
author="Price, Matthew
and Sawyer, Tyler
and Harris, Madison
and Skalka, Christian",
title="Usability Evaluation of a Mobile Monitoring System to Assess Symptoms After a Traumatic Injury: A Mixed-Methods Study",
journal="JMIR Mental Health",
year="2016",
month="Jan",
day="11",
volume="3",
number="1",
pages="e3",
keywords="mobile phone",
keywords="trauma",
keywords="posttraumatic stress disorder",
keywords="usability",
abstract="Background: Victims of trauma are at high risk for mental health conditions such as posttraumatic stress disorder and depression. Regular assessment of mental health symptoms in the post-trauma period is necessary to identify those at greatest risk and provide treatment. The multiple demands of the acute post-trauma period present numerous barriers to such assessments. Mobile apps are a method by which to overcome these barriers in order to regularly assess symptoms, identify those at risk, and connect patients to needed services. Objective: The current study conducted a usability evaluation of a system to monitor mental health symptoms after a trauma. The system was developed to promote ease of use and facilitate quick transmission of data. Methods: A sample of 21 adults with a history of trauma completed a standardized usability test in a laboratory setting followed by a qualitative interview. Results: Usability testing indicated that the app was easy to use and that patients were able to answer several questions in less than 1 minute (mean [SD] 29.37 [7.53]; range 15-57). Qualitative analyses suggested that feedback should be included in such an app and recommendations for the type of feedback were offered. Conclusions: The results of the current study indicate that a mobile app to monitor post-trauma mental health symptoms would be well received by victims. Personalized feedback to the user was identified as critical to promote the usability of the software. ",
doi="10.2196/mental.5023",
url="http://mental.jmir.org/2016/1/e3/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26753673"
}


@Article{info:doi/10.2196/mental.4560,
author="Beiwinkel, Till
and Kindermann, Sally
and Maier, Andreas
and Kerl, Christopher
and Moock, J{\"o}rn
and Barbian, Guido
and R{\"o}ssler, Wulf",
title="Using Smartphones to Monitor Bipolar Disorder Symptoms: A Pilot Study",
journal="JMIR Mental Health",
year="2016",
month="Jan",
day="06",
volume="3",
number="1",
pages="e2",
keywords="smartphone",
keywords="sensor technology",
keywords="bipolar disorder",
keywords="monitoring",
keywords="phase transitions",
keywords="communication patterns",
keywords="activity patterns",
abstract="Background: Relapse prevention in bipolar disorder can be improved by monitoring symptoms in patients' daily life. Smartphone apps are easy-to-use, low-cost tools that can be used to assess this information. To date, few studies have examined the usefulness of smartphone data for monitoring symptoms in bipolar disorder. Objective: We present results from a pilot test of a smartphone-based monitoring system, Social Information Monitoring for Patients with Bipolar Affective Disorder (SIMBA), that tracked daily mood, physical activity, and social communication in 13 patients. The objective of this study was to investigate whether smartphone measurements predicted clinical symptoms levels and clinical symptom change. The hypotheses that smartphone measurements are (1) negatively related to clinical depressive symptoms and (2) positively related to clinical manic symptoms were tested. Methods: Clinical rating scales were administered to assess clinical depressive and manic symptoms. Patients used a smartphone with the monitoring app for up to 12 months. Random-coefficient multilevel models were computed to analyze the relationship between smartphone data and externally rated manic and depressive symptoms. Overall clinical symptom levels and clinical symptom changes were predicted by separating between-patient and within-patient effects. Using established clinical thresholds from the literature, marginal effect plots displayed clinical relevance of smartphone data. Results: Overall symptom levels and change in clinical symptoms were related to smartphone measures. Higher overall levels of clinical depressive symptoms were predicted by lower self-reported mood measured by the smartphone (beta=-.56, P<.001). An increase in clinical depressive symptoms was predicted by a decline in social communication (ie, outgoing text messages: beta=-.28, P<.001) and a decline in physical activity as measured by the smartphone (ie, cell tower movements: beta=-.11, P=.03). Higher overall levels of clinical manic symptoms were predicted by lower physical activity on the smartphone (ie, distance travelled: beta=-.37, P<.001), and higher social communication (beta=.48, P=.03). An increase in clinical manic symptoms was predicted by a decrease in physical activity on the smartphone (beta=-.17, P<.001). Conclusions: Clinical symptoms were related to some objective and subjective smartphone measurements, but not all smartphone measures predicted the occurrence of bipolar symptoms above clinical thresholds. Thus, smartphones have the potential to monitor bipolar disorder symptoms in patients' daily life. Further validation of monitoring tools in a larger sample is needed. Conclusions are limited by the low prevalence of manic and depressive symptoms in the study sample. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 05663421;  http://www.controlled-trials.com/ISRCTN05663421 (Archived by WebCite at http://www.webcitation.org/6d9wsibJB) ",
doi="10.2196/mental.4560",
url="http://mental.jmir.org/2016/1/e2/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26740354"
}


@Article{info:doi/10.2196/ijmr.4504,
author="Vaala, E. Sarah
and Hood, K. Korey
and Laffel, Lori
and Kumah-Crystal, A. Yaa
and Lybarger, K. Cindy
and Mulvaney, A. Shelagh",
title="Use of Commonly Available Technologies for Diabetes Information and Self-Management Among Adolescents With Type 1 Diabetes and Their Parents: A Web-Based Survey Study",
journal="Interact J Med Res",
year="2015",
month="Dec",
day="29",
volume="4",
number="4",
pages="e24",
keywords="diabetes mellitus, Type 1",
keywords="adolescent",
keywords="technology",
keywords="adoption",
keywords="self-management",
keywords="self-care",
abstract="Background: For individuals with Type 1 diabetes (T1D), following a complicated daily medical regimen is critical to maintaining optimal health. Adolescents in particular struggle with regimen adherence. Commonly available technologies (eg, diabetes websites, apps) can provide diabetes-related support, yet little is known about how many adolescents with T1D use them, why they are used, or relationships between use and self-management. Objective: This study examined adolescent and parent use of 5 commonly available technologies for diabetes, including proportions who use each technology, frequency of use, and number of different technologies used for diabetes. Analyses also investigated the reasons adolescents reported for using or not using technologies for diabetes, and factors correlated with adolescents' technology use. Finally, this study examined relationships between the type and number of technologies adolescents use for diabetes and their self-management and glycemic control. Methods: Adolescents (12-17 years) and their parents (N=174 pairs), recruited from a pediatric diabetes clinic (n=134) and the Children with Diabetes community website (n=40), participated in this Web-based survey study. Glycosylated hemoglobin (A1C) values were obtained from medical records for pediatric clinic patients. Adolescents reported their use of 5 commonly available technologies for diabetes (ie, social networking, diabetes websites, mobile diabetes apps, text messaging, and glucometer/insulin pump software), reasons for use, and self-management behavior (Self-Care Inventory-Revised, SCI-R). Results: Most adolescents and parents used at least one of the 5 technologies for diabetes. Among adolescents, the most commonly used technology for diabetes was text messaging (53\%), and the least commonly used was diabetes websites (25\%). Most adolescents who used diabetes apps, text messaging, or pump/glucometer software did so more frequently (?2 times per week), compared to social networking and website use (?1 time per week). The demographic, clinical, and parent-technology use factors related to adolescents' technology use varied by technology. Adolescents who used social networking, websites, or pump/glucometer software for diabetes had better self-management behavior (SCI-R scores: beta=.18, P=.02; beta=.15, P=.046; beta=.15, P=.04, respectively), as did those who used several technologies for diabetes (beta=.23, P=.003). However, use of diabetes websites was related to poorer glycemic control (A1C: beta=.18, P=.01). Conclusions: Adolescents with T1D may be drawn to different technologies for different purposes, as individual technologies likely offer differing forms of support for diabetes self-management (eg, tracking blood glucose or aiding problem solving). Findings suggest that technologies that are especially useful for adolescents' diabetes problem solving may be particularly beneficial for their self-management. Additional research should examine relationships between the nature of technology use and adolescents' T1D self-management over time. ",
doi="10.2196/ijmr.4504",
url="http://www.i-jmr.org/2015/4/e24/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26715191"
}


@Article{info:doi/10.2196/jmir.5043,
author="Majeed-Ariss, Rabiya
and Baildam, Eileen
and Campbell, Malcolm
and Chieng, Alice
and Fallon, Debbie
and Hall, Andrew
and McDonagh, E. Janet
and Stones, R. Simon
and Thomson, Wendy
and Swallow, Veronica",
title="Apps and Adolescents: A Systematic Review of Adolescents' Use of Mobile Phone and Tablet Apps That Support Personal Management of Their Chronic or Long-Term Physical Conditions",
journal="J Med Internet Res",
year="2015",
month="Dec",
day="23",
volume="17",
number="12",
pages="e287",
keywords="adolescents",
keywords="asthma",
keywords="mobile or tablet apps",
keywords="arthritis",
keywords="cancer",
keywords="chronic disease or condition",
keywords="diabetes",
keywords="long-term condition",
keywords="personal or self-management",
keywords="review",
keywords="young people",
abstract="Background: The prevalence of physical chronic or long-term conditions in adolescents aged 10-24 years is rising. Mobile phone and tablet mobile technologies featuring software program apps are widely used by these adolescents and their healthy peers for social networking or gaming. Apps are also used in health care to support personal condition management and they have considerable potential in this context. There is a growing body of literature on app use in health contexts, thereby making a systematic review of their effectiveness very timely. Objective: To systematically review the literature on the effectiveness of mobile apps designed to support adolescents' management of their physical chronic or long-term conditions. Methods: We conducted a review of the English-language literature published since 2003 in five relevant bibliographical databases using key search terms. Two independent reviewers screened titles and abstracts using data extraction and quality assessment tools. Results: The search returned 1120 hits. Of the 19 eligible full-text papers, four met our review criteria, reporting one pilot randomized controlled trial and three pretest/post-test studies.  Samples ranged from 4 to 18 participants, with a combined sample of 46 participants. The apps reported were targeted at type 1 diabetes, asthma, and cancer.  Two papers provided data for calculating effect size. Heterogeneity in terms of study design, reported outcomes, follow-up times, participants' ages, and health conditions prevented meta-analyses. There was variation in whether adolescents received guidance in using the app or were solely responsible for navigating the app. Three studies reported some level of patient involvement in app design, development, and/or evaluation. Health professional involvement in the modelling stages of apps was reported in all studies, although it was not always clear whether specific clinical (as opposed to academic) expertise in working with adolescents was represented. The dearth of studies and the small overall sample size emphasizes the need for future studies of the development, evaluation, use, and effectiveness of mobile apps to support adolescents' personal management of their conditions. Conclusions: A key finding of the review is the paucity of evidence-based apps that exist, in contrast to the thousands of apps available on the app market that are not evidence-based or user or professional informed. Although we aimed to assess the effectiveness of apps, the dearth of studies meeting our criteria meant that we were unable to be conclusive in this regard. Based on the available evidence, apps may be considered feasible health interventions, but more studies involving larger sample sizes, and with patient and health professional input at all stages, are needed to determine apps' acceptability and effectiveness. This review provides valuable findings and paves the way for future rigorous development and evaluation of health apps for adolescents with chronic or long-term conditions. ",
doi="10.2196/jmir.5043",
url="http://www.jmir.org/2015/12/e287/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26701961"
}


@Article{info:doi/10.2196/mhealth.4930,
author="Firth, Joseph
and Torous, John",
title="Smartphone Apps for Schizophrenia: A Systematic Review",
journal="JMIR mHealth uHealth",
year="2015",
month="Nov",
day="06",
volume="3",
number="4",
pages="e102",
keywords="eHealth",
keywords="fitness",
keywords="mHealth",
keywords="psychosis",
keywords="schizophrenia",
keywords="smartphones",
keywords="technology",
keywords="wearables",
abstract="Background: There is increasing interest in using mobile technologies such as smartphones for improving the care of patients with schizophrenia. However, less is known about the current clinical evidence for the feasibility and effectiveness of smartphone apps in this population. Objective: To review the published literature of smartphone apps  applied for the care of patients with schizophrenia and other psychotic disorders. Methods: An electronic database search of Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, Health Technology Assessment Database, Allied and Complementary Medicine, Health and Psychosocial Instruments, PsycINFO, and Embase was conducted on May 24, 2015. All eligible studies were systematically reviewed, and proportional meta-analyses were applied to pooled data on recruitment, retention, and adherence to examine the overall feasibility of smartphone interventions for schizophrenia. Results: Our search produced 226 results from which 7 eligible articles were identified, reporting on 5 studies of smartphone apps for patients with schizophrenia. All examined feasibility, and one assessed the preliminary efficacy of a smartphone intervention for schizophrenia. Study lengths varied between 6 and 130 days. Overall retention was 92\% (95\% CI 82-98\%). Participants consistently used the smartphone apps on more than 85\% of days during the study period, averaging 3.95 interactions per person per day. Furthermore, participants responded to 71.9\% of automated prompts (95\% CI 65.7-77.8\%). Participants reported a range of potential benefits from the various interventions, and user experience was largely positive. Conclusions: Although small, the current published literature demonstrates strong evidence for the feasibility of using smartphones to enhance the care of people with schizophrenia. High rates of engagement and satisfaction with a broad range of apps suggest the nascent potential of this mobile technology. However, there remains limited data on the efficacy of such interventions. ",
doi="10.2196/mhealth.4930",
url="http://mhealth.jmir.org/2015/4/e102/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26546039"
}


@Article{info:doi/10.2196/jmir.4975,
author="Rhee, Hyekyun
and Belyea, J. Michael
and Sterling, Mark
and Bocko, F. Mark",
title="Evaluating the Validity of an Automated Device for Asthma Monitoring for Adolescents: Correlational Design",
journal="J Med Internet Res",
year="2015",
month="Oct",
day="16",
volume="17",
number="10",
pages="e234",
keywords="asthma",
keywords="adolescent",
keywords="ambulatory monitoring",
keywords="device",
keywords="cough",
keywords="validity",
abstract="Background: Symptom monitoring is a cornerstone of asthma self-management. Conventional methods of symptom monitoring have fallen short in producing objective data and eliciting patients' consistent adherence, particularly in teen patients. We have recently developed an Automated Device for Asthma Monitoring (ADAM) using a consumer mobile device as a platform to facilitate continuous and objective symptom monitoring in adolescents in vivo. Objective: The objectives of the study were to evaluate the validity of the device using spirometer data, fractional exhaled nitric oxide (FeNO), existing measures of asthma symptoms/control and health care utilization data, and to examine the sensitivity and specificity of the device in discriminating asthma cases from nonasthma cases. Methods: A total of 84 teens (42 teens with a current asthma diagnosis; 42 without asthma) aged between 13 and 17 years participated in the study. All participants used ADAM for 7 consecutive days during which participants with asthma completed an asthma diary two times a day. ADAM recorded the frequency of coughing for 24 hours throughout the 7-day trial. Pearson correlation and multiple regression were used to examine the relationships between ADAM data and asthma control, quality of life, and health care utilization at the time of the 7-day trial and 3 months later. A receiver operating characteristic (ROC) curve analysis was conducted to examine sensitivity and specificity based on the area under the curve (AUC) as an indicator of the device's capacity to discriminate between asthma versus nonasthma cases. Results: ADAM data (cough counts) were negatively associated with forced expiratory volume in first second of expiration (FEV1) (r=--.26, P=.05), forced vital capacity (FVC) (r=--.31, P=.02), and overall asthma control (r=--.41, P=.009) and positively associated with daily activity limitation (r=.46, P=.01), nighttime (r=.40, P=.02) and daytime symptoms (r=.38, P=.02), and health care utilization (r=.61, P<.001). Device data were also a significant predictor of asthma control ($\beta$=--.48, P=.003), quality of life ($\beta$=--.55, P=.001), and health care utilization ($\beta$=.74, P=.004) after 3 months. The ROC curve analysis for the presence of asthma diagnosis had an AUC of 0.71 (95\% CI 0.58-0.84), which was significantly different from chance ($\chi$21=9.7, P=.002), indicating the device's discriminating capacity. The optimal cutoff value of the device was 0.56 with a sensitivity of 51.3\% and a specificity of 72.7\%. Conclusions: This study demonstrates validity of ADAM as a symptom-monitoring device in teens with asthma. ADAM data reflect the current status of asthma control and predict asthma morbidity and quality of life for the near future. A monitoring device such as ADAM can increase patients' awareness of the patterns of cough for early detection of worsening asthma and has the potential for preventing serious and costly future consequences of asthma. ",
doi="10.2196/jmir.4975",
url="http://www.jmir.org/2015/10/e234/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26475634"
}


@Article{info:doi/10.2196/jmir.4871,
author="Wayne, Noah
and Perez, F. Daniel
and Kaplan, M. David
and Ritvo, Paul",
title="Health Coaching Reduces HbA1c in Type 2 Diabetic Patients From a Lower-Socioeconomic Status Community: A Randomized Controlled Trial",
journal="J Med Internet Res",
year="2015",
month="Oct",
day="05",
volume="17",
number="10",
pages="e224",
keywords="diabetes mellitus, type 2",
keywords="health coaching",
keywords="mHealth",
keywords="telehealth",
keywords="randomized controlled trial",
keywords="RCT",
abstract="Background: Adoptions of health behaviors are crucial for maintaining good health after type 2 diabetes mellitus (T2DM) diagnoses. However, adherence to glucoregulating behaviors like regular exercise and balanced diet can be challenging, especially for people living in lower-socioeconomic status (SES) communities. Providing cost-effective interventions that improve self-management is important for improving quality of life and the sustainability of health care systems. Objective: To evaluate a health coach intervention with and without the use of mobile phones to support health behavior change in patients with type 2 diabetes. Methods: In this noninferiority, pragmatic randomized controlled trial (RCT), patients from two primary care health centers in Toronto, Canada, with type 2 diabetes and a glycated hemoglobin/hemoglobin A1c (HbA1c) level of ?7.3\% (56.3 mmol/mol) were randomized to receive 6 months of health coaching with or without mobile phone monitoring support. We hypothesized that both approaches would result in significant HbA1c reductions, although health coaching with mobile phone monitoring would result in significantly larger effects. Participants were evaluated at baseline, 3 months, and 6 months. The primary outcome was the change in HbA1c from baseline to 6 months (difference between and within groups). Other outcomes included weight, waist circumference, body mass index (BMI), satisfaction with life, depression and anxiety (Hospital Anxiety and Depression Scale [HADS]), positive and negative affect (Positive and Negative Affect Schedule [PANAS]), and quality of life (Short Form Health Survey-12 [SF-12]). Results: A total of 138 patients were randomized and 7 were excluded for a substudy; of the remaining 131, 67 were allocated to the intervention group and 64 to the control group. Primary outcome data were available for 97 participants (74.0\%). While both groups reduced their HbA1c levels, there were no significant between-group differences in change of HbA1c at 6 months using intention-to-treat (last observation carried forward [LOCF]) (P=.48) or per-protocol (P=.83) principles. However, the intervention group did achieve an accelerated HbA1c reduction, leading to a significant between-group difference at 3 months (P=.03). This difference was reduced at the 6-month follow-up as the control group continued to improve, achieving a reduction of 0.81\% (8.9 mmol/mol) (P=.001) compared with a reduction of 0.84\% (9.2 mmol/mol)(P=.001) in the intervention group. Intervention group participants also had significant decreases in weight (P=.006) and waist circumference (P=.01) while controls did not. Both groups reported improvements in mood, satisfaction with life, and quality of life. Conclusions: Health coaching with and without access to mobile technology appeared to improve glucoregulation and mental health in a lower-SES, T2DM population. The accelerated improvement in the mobile phone group suggests the connectivity provided may more quickly improve adoption and adherence to health behaviors within a clinical diabetes management program. Overall, health coaching in primary care appears to lead to significant benefits for patients from lower-SES communities with poorly controlled type 2 diabetes. Trial Registration: ClinicalTrials.gov NCT02036892; http://clinicaltrials.gov/ct2/show/NCT02036892 (Archived by WebCite at http://www.webcitation.org/6b3cJYJOD) ",
doi="10.2196/jmir.4871",
url="http://www.jmir.org/2015/10/e224/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26441467"
}


@Article{info:doi/10.2196/mhealth.4532,
author="Hale, Kelli
and Capra, Sandra
and Bauer, Judith",
title="A Framework to Assist Health Professionals in Recommending High-Quality Apps for Supporting ChronicDisease Self-Management: Illustrative Assessment of Type 2 Diabetes Apps",
journal="JMIR mHealth uHealth",
year="2015",
month="Sep",
day="14",
volume="3",
number="3",
pages="e87",
keywords="mobile apps",
keywords="chronic disease",
keywords="patient-centered care",
keywords="technology",
abstract="Background: This paper presents an approach to assist health professionals in recommending high quality apps for supporting chronic disease self-management. Most app reviews focus on popularity, aesthetics, functionality, usability, and information quality.  There is no doubt these factors are important in selecting trustworthy apps which are appealing to users, but behavioral theory may be also be useful in matching the apps to user needs. Objective: The framework developed aims to be methodologically sound, capable of selecting popular apps which include content covered by evidence-based programs, consistent with behavioral theory, as well as a patient-centered approach for matching apps to patients' individual needs. Methods: A single disease---type 2 diabetes---was selected to illustrate how the framework can be applied as this was deemed to represent the types of strategies used in many chronic diseases.  A systematic approach based on behavioral theory and recommendations from best practice guidelines was developed for matching apps to patients' needs.  In March 2014, a series of search strategies was used to identify top-rated iPhone and Android health apps, representing 29 topics from five categories of type 2 diabetes self-management strategies. The topics were chosen from published international guidelines for the management of diabetes.  The senior author (KH) assessed the most popular apps found that addressed these topics using the Behavioral Theory Content Survey (BTS), which is based on traditional behavioral theory. A tool to assist decision making when using apps was developed and trialed with health professionals for ease of use and understanding. Results: A total of 14 apps were assessed representing all five topic categories of self-management. Total theoretical scores (BTS scores) were less than 50 on a 100-point scale for all apps. Each app scored less than 50\% of the total possible BTS score for all four behavioral theories and for most of the 20 behavioral strategies; however, apps scored higher than 50\% of the total possible BTS score for specific strategies related to their primary focus. Our findings suggest that the apps studied would be more effective when used in conjunction with therapy than as stand-alone apps.  Apps were categorized according to topic and core intervention strategies.  A framework for matching apps to identified patient needs was developed based on app categorization and principles of patient-centered care.  The approach was well accepted and understood by a convenience sample of health practitioners. Conclusions: The framework presented can be used by health practitioners to better match apps with client needs. Some apps incorporate highly interactive strategies of behavioral theory, and when used as an adjunct may increase patient participation and the effectiveness of therapy. ",
doi="10.2196/mhealth.4532",
url="http://mhealth.jmir.org/2015/3/e87/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26369346"
}


@Article{info:doi/10.2196/jmir.4456,
author="Boeldt, L. Debra
and Wineinger, E. Nathan
and Waalen, Jill
and Gollamudi, Shreya
and Grossberg, Adam
and Steinhubl, R. Steven
and McCollister-Slipp, Anna
and Rogers, A. Marc
and Silvers, Carey
and Topol, J. Eric",
title="How Consumers and Physicians View New Medical Technology: Comparative Survey",
journal="J Med Internet Res",
year="2015",
month="Sep",
day="14",
volume="17",
number="9",
pages="e215",
keywords="digital revolution",
keywords="healthcare",
keywords="medical technology",
keywords="physician and consumer attitudes",
keywords="electronic health record",
keywords="mobile health",
abstract="Background: As a result of the digital revolution coming to medicine, a number of new tools are becoming available and are starting to be introduced in clinical practice. Objective: We aim to assess health care professional and consumer attitudes toward new medical technology including smartphones, genetic testing, privacy, and patient-accessible electronic health records. Methods: We performed a survey with 1406 health care providers and 1102 consumer responders. Results: Consumers who completed the survey were more likely to prefer new technologies for a medical diagnosis (437/1102, 39.66\%) compared with providers (194/1406, 13.80\%; P<.001), with more providers (393/1406, 27.95\%) than consumers (175/1102, 15.88\%) reporting feeling uneasy about using technology for a diagnosis. Both providers and consumers supported genetic testing for various purposes, with providers (1234/1406, 87.77\%) being significantly more likely than consumers (806/1102, 73.14\%) to support genetic testing when planning to have a baby (P<.001). Similarly, 91.68\% (1289/1406) of providers and 81.22\% (895/1102) of consumers supported diagnosing problems in a fetus (P<.001). Among providers, 90.33\% (1270/1406) were concerned that patients would experience anxiety after accessing health records, and 81.95\% (1149/1406) felt it would lead to requests for unnecessary medical evaluations, but only 34.30\% (378/1102; P<.001) and 24.59\% (271/1102; P<.001) of consumers expressed the same concerns, respectively. Physicians (137/827, 16.6\%) reported less concern about the use of technology for diagnosis compared to medical students (21/235, 8.9\%; P=.03) and also more frequently felt that patients owned their medical record (323/827, 39.1\%; and 30/235, 12.8\%, respectively; P<.001). Conclusions: Consumers and health professionals differ significantly and broadly in their views of emerging medical technology, with more enthusiasm and support expressed by consumers. ",
doi="10.2196/jmir.4456",
url="http://www.jmir.org/2015/9/e215/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26369254"
}


@Article{info:doi/10.2196/mhealth.4649,
author="Jaensson, Maria
and Dahlberg, Karuna
and Eriksson, Mats
and Gr{\"o}nlund, {\AA}ke
and Nilsson, Ulrica",
title="The Development of the Recovery Assessments by Phone Points (RAPP): A Mobile Phone App for Postoperative Recovery Monitoring and Assessment",
journal="JMIR mHealth uHealth",
year="2015",
month="Sep",
day="11",
volume="3",
number="3",
pages="e86",
keywords="cellular phone",
keywords="postoperative recovery",
keywords="day care",
abstract="Background: In Sweden, day surgery is performed in almost 2 million patients per year. Patient satisfaction is closely related to potential adverse events during the recovery process. A way to empower patients and give them the opportunity to affect care delivery is to let them evaluate their recovery process.  The most common evaluation method is a follow-up telephone call by a nurse one or two days after surgery. In recent years, mHealth apps have been used to evaluate the nurse-patient relationship for self-management in chronic diseases or to evaluate pain after surgery. To the best of our knowledge, no previous research has explored the recovery process after day surgery via mobile phone in a Swedish cohort. Objective: The objective of the study is to describe the process of developing a mobile phone app using a Swedish Web-based Quality of Recovery (SwQoR) questionnaire to evaluate postoperative recovery after day surgery. Methods: The development process included five steps: (1) setting up an interdisciplinary task force, (2) evaluating the potential needs of app users, (3) developing the Swedish Web version of a QoR questionnaire, (4) constructing a mobile phone app, and (5) evaluating the interface and design by staff working in a day-surgery department and patients undergoing day surgery. A task force including specialists in information and communication technology, eHealth, and nursing care worked closely together to develop a Web-based app. Modifications to the QoR questionnaire were inspired by instruments used in the field of recovery for both children and adults. The Web-based app, Recovery Assessment by Phone Points (RAPP) consists of two parts: (1) a mobile app installed on the patient's private mobile phone, and (2) an administrator interface for the researchers. Results: The final version of the SwQoR questionnaire, which includes 31 items, was successfully installed in RAPP. The interface and the design were evaluated by asking for user opinions about the design and usefulness of the app with 10 day surgery patients. Some minor adjustments were made concerning text size and screen color. Conclusions: Taking advantage of joint expertise, a useable Web-based app adaptable to different technical platforms was constructed. In addition, the SwQoR was successfully transferred into digital format for use on mobile phones. ",
doi="10.2196/mhealth.4649",
url="http://mhealth.jmir.org/2015/3/e86/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26362403"
}


@Article{info:doi/10.2196/jmir.4364,
author="Chung, Chia-Fang
and Cook, Jonathan
and Bales, Elizabeth
and Zia, Jasmine
and Munson, A. Sean",
title="More Than Telemonitoring: Health Provider Use and Nonuse of Life-Log Data in Irritable Bowel Syndrome and Weight Management",
journal="J Med Internet Res",
year="2015",
month="Aug",
day="21",
volume="17",
number="8",
pages="e203",
keywords="life logs",
keywords="behavioral self-monitoring",
keywords="clinical care",
keywords="chronic disease",
keywords="health",
keywords="wellness",
keywords="personal informatics",
keywords="quantified self",
abstract="Background: The quantified self, self-monitoring or life-logging movement is a trend to incorporate technology into data acquisition on aspects of a person's daily life in terms of inputs (eg food consumed), states (eg mood), and performance (mental and physical). Consumer self-monitoring mobile phone apps have been widely studied and used to promote healthy behavior changes. Data collected through life-logging apps also have the potential to support clinical care. Objective: We sought to develop an in-depth understanding of providers' facilitators and barriers to successfully integrating life-log data into their practices and creating better experiences. We specifically investigated three research questions: How do providers currently use patient-collected life-log data in clinical practice? What are provider concerns and needs with respect to this data? What are the constraints for providers to integrate this type of data into their workflows? Methods: We interviewed 21 health care providers---physicians, dietitians, a nurse practitioner, and a behavioral psychologist---who work with obese and irritable bowel syndrome patients. We transcribed and analyzed interviews according to thematic analysis and an affinity diagramming process. Results: Providers reported using self-monitoring data to enhance provider-patient communication, develop personalized treatment plans, and to motivate and educate patients, in addition to using them as diagnostic and adherence tools. However, limitations associated with current systems and workflows create barriers to regular and effective review of this data. These barriers include a lack of time to review detailed records, questions about providers' expertise to review it, and skepticism about additional benefits offered by reviewing data. Current self-monitoring tools also often lack flexibility, standardized formats, and mechanisms to share data with providers. Conclusions: Variations in provider needs affect tracking and reviewing needs. Systems to support diagnosis might require better reliability and resolution, while systems to support interaction should support collaborative reflection and communication. Automatic synthesis of data logs could help providers focus on educational goals while communication of contextual information might help providers better understand patient values. We also discuss how current mobile apps and provider systems do, and do not, support these goals, and future design opportunities to realize the potential benefits of using life-logging tools in clinical care. ",
doi="10.2196/jmir.4364",
url="http://www.jmir.org/2015/8/e203/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26297627"
}


@Article{info:doi/10.2196/jmir.4209,
author="Ancker, S. Jessica
and Witteman, O. Holly
and Hafeez, Baria
and Provencher, Thierry
and Van de Graaf, Mary
and Wei, Esther",
title="``You Get Reminded You're a Sick Person'': Personal Data Tracking and Patients With Multiple Chronic Conditions",
journal="J Med Internet Res",
year="2015",
month="Aug",
day="19",
volume="17",
number="8",
pages="e202",
keywords="medical informatics",
keywords="consumer health information",
keywords="health knowledge, attitudes, practices",
keywords="self-care",
keywords="chronic disease",
abstract="Background: Consumer health information technologies (HIT) that encourage self-tracking, such as diet and fitness tracking apps and disease journals, are attracting widespread interest among technology-oriented consumers (such as ``quantified self'' advocates), entrepreneurs, and the health care industry. Such electronic technologies could potentially benefit the growing population of patients with multiple chronic conditions (MCC). However, MCC is predominantly a condition of the elderly and disproportionately affects the less affluent, so it also seems possible that the barriers to use of consumer HIT would be particularly severe for this patient population. Objective: Our aim was to explore the perspectives of individuals with MCC using a semistructured interview study. Our research questions were (1) How do individuals with MCC track their own health and medical data? and (2) How do patients and providers perceive and use patient-tracked data? Methods: We used semistructured interviews with patients with multiple chronic diseases and providers with experience caring for such patients, as well as participation in a diabetes education group to triangulate emerging themes. Data were analyzed using grounded theory and thematic analysis. Recruitment and analysis took place iteratively until thematic saturation was reached. Results: Interviews were conducted with 22 patients and 7 health care providers. The patients had an average of 3.5 chronic conditions, including type 2 diabetes, heart disease, chronic pain, and depression, and had regular relationships with an average of 5 providers. Four major themes arose from the interviews: (1) tracking this data feels like work for many patients, (2) personal medical data for individuals with chronic conditions are not simply objective facts, but instead provoke strong positive and negative emotions, value judgments, and diverse interpretations, (3) patients track for different purposes, ranging from sense-making to self-management to reporting to the doctor, and (4) patients often notice that physicians trust technologically measured data such as lab reports over patients' self-tracked data. Conclusions: Developers of consumer health information technologies for data tracking (such as diet and exercise apps or blood glucose logs) often assume patients have unlimited enthusiasm for tracking their own health data via technology. However, our findings potentially explain relatively low adoption of consumer HIT, as they suggest that patients with multiple chronic illnesses consider it work to track their own data, that the data can be emotionally charged, and that they may perceive that providers do not welcome it. Similar themes have been found in some individual chronic diseases but appeared more complex because patients often encountered ``illness work'' connected to multiple diseases simultaneously and frequently faced additional challenges from aging or difficult comorbidities such as chronic pain, depression, and anxiety. We suggest that to make a public health impact, consumer HIT developers should engage creatively with these pragmatic and emotional issues to reach an audience that is broader than technologically sophisticated early adopters. Novel technologies are likely to be successful only if they clearly reduce patient inconvenience and burden, helping them to accomplish their ``illness work'' more efficiently and effectively. ",
doi="10.2196/jmir.4209",
url="http://www.jmir.org/2015/8/e202/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26290186"
}


@Article{info:doi/10.2196/mhealth.3785,
author="Appelboom, Geoff
and Taylor, E. Blake
and Bruce, Eliza
and Bassile, C. Clare
and Malakidis, Corinna
and Yang, Annie
and Youngerman, Brett
and D'Amico, Randy
and Bruce, Sam
and Bruy{\`e}re, Olivier
and Reginster, Jean-Yves
and Dumont, PL Emmanuel
and Connolly Jr, Sander E.",
title="Mobile Phone-Connected Wearable Motion Sensors to Assess Postoperative Mobilization",
journal="JMIR mHealth uHealth",
year="2015",
month="Jul",
day="28",
volume="3",
number="3",
pages="e78",
keywords="mobilization",
keywords="activity tracking",
keywords="postoperative",
keywords="physiotherapy",
keywords="functional recovery",
keywords="physical therapy",
keywords="gait",
keywords="neurorehabilitation",
abstract="Background: Early mobilization after surgery reduces the incidence of a wide range of complications. Wearable motion sensors measure movements over time and transmit this data wirelessly, which has the potential to monitor patient recovery and encourages patients to engage in their own rehabilitation. Objective: We sought to determine the ability of off-the-shelf activity sensors to remotely monitor patient postoperative mobility. Methods: Consecutive subjects were recruited under the Department of Neurosurgery at Columbia University. Patients were enrolled during physical therapy sessions. The total number of steps counted by the two blinded researchers was compared to the steps recorded on four activity sensors positioned at different body locations. Results: A total of 148 motion data points were generated. The start time, end time, and duration of each walking session were accurately recorded by the devices and were remotely available for the researchers to analyze. The sensor accuracy was significantly greater when placed over the ankles than over the hips (P<.001). Our multivariate analysis showed that step length was an independent predictor of sensor accuracy. On linear regression, there was a modest positive correlation between increasing step length and increased ankle sensor accuracy (r=.640, r2=.397) that reached statistical significance on the multivariate model (P=.03). Increased gait speed also correlated with increased ankle sensor accuracy, although less strongly (r=.444, r2=.197). We did not note an effect of unilateral weakness on the accuracy of left- versus right-sided sensors. Accuracy was also affected by several specific measures of a patient's level of physical assistance, for which we generated a model to mathematically adjust for systematic underestimation as well as disease severity. Conclusions: We provide one of the first assessments of the accuracy and utility of widely available and wirelessly connected activity sensors in a postoperative patient population. Our results show that activity sensors are able to provide invaluable information about a patient's mobility status and can transmit this data wirelessly, although there is a systematic underestimation bias in more debilitated patients. ",
doi="10.2196/mhealth.3785",
url="http://mhealth.jmir.org/2015/3/e78/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26220691"
}


@Article{info:doi/10.2196/jmir.4273,
author="Saeb, Sohrab
and Zhang, Mi
and Karr, J. Christopher
and Schueller, M. Stephen
and Corden, E. Marya
and Kording, P. Konrad
and Mohr, C. David",
title="Mobile Phone Sensor Correlates of Depressive Symptom Severity in Daily-Life Behavior: An Exploratory Study",
journal="J Med Internet Res",
year="2015",
month="Jul",
day="15",
volume="17",
number="7",
pages="e175",
keywords="depression",
keywords="mobile health (mHealth)",
keywords="activities of daily living",
keywords="cluster analysis",
keywords="classification",
abstract="Background: Depression is a common, burdensome, often recurring mental health disorder that frequently goes undetected and untreated. Mobile phones are ubiquitous and have an increasingly large complement of sensors that can potentially be useful in monitoring behavioral patterns that might be indicative of depressive symptoms. Objective: The objective of this study was to explore the detection of daily-life behavioral markers using mobile phone global positioning systems (GPS) and usage sensors, and their use in identifying depressive symptom severity. Methods: A total of 40 adult participants were recruited from the general community to carry a mobile phone with a sensor data acquisition app (Purple Robot) for 2 weeks. Of these participants, 28 had sufficient sensor data received to conduct analysis. At the beginning of the 2-week period, participants completed a self-reported depression survey (PHQ-9). Behavioral features were developed and extracted from GPS location and phone usage data. Results: A number of features from GPS data were related to depressive symptom severity, including circadian movement (regularity in 24-hour rhythm; r=-.63, P=.005), normalized entropy (mobility between favorite locations; r=-.58, P=.012), and location variance (GPS mobility independent of location; r=-.58, P=.012). Phone usage features, usage duration, and usage frequency were also correlated (r=.54, P=.011, and r=.52, P=.015, respectively). Using the normalized entropy feature and a classifier that distinguished participants with depressive symptoms (PHQ-9 score ?5) from those without (PHQ-9 score <5), we achieved an accuracy of 86.5\%. Furthermore, a regression model that used the same feature to estimate the participants' PHQ-9 scores obtained an average error of 23.5\%. Conclusions: Features extracted from mobile phone sensor data, including GPS and phone usage, provided behavioral markers that were strongly related to depressive symptom severity. While these findings must be replicated in a larger study among participants with confirmed clinical symptoms, they suggest that phone sensors offer numerous clinical opportunities, including continuous monitoring of at-risk populations with little patient burden and interventions that can provide just-in-time outreach. ",
doi="10.2196/jmir.4273",
url="http://www.jmir.org/2015/7/e175/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26180009"
}


@Article{info:doi/10.2196/mhealth.4393,
author="Nazneen, Nazneen
and Rozga, Agata
and Smith, J. Christopher
and Oberleitner, Ron
and Abowd, D. Gregory
and Arriaga, I. Rosa",
title="A Novel System for Supporting Autism Diagnosis Using Home Videos: Iterative Development and Evaluation of System Design",
journal="JMIR mHealth uHealth",
year="2015",
month="Jun",
day="17",
volume="3",
number="2",
pages="e68",
keywords="asynchronous telemedicine system",
keywords="in-home behavior recording",
keywords="naturalistic observation diagnostic assessment",
keywords="NODA Connect",
keywords="NODA smartCapture",
keywords="remote autism diagnosis",
abstract="Background: Observing behavior in the natural environment is valuable to obtain an accurate and comprehensive assessment of a child's behavior, but in practice it is limited to in-clinic observation. Research shows significant time lag between when parents first become concerned and when the child is finally diagnosed with autism. This lag can delay early interventions that have been shown to improve developmental outcomes. Objective: To develop and evaluate the design of an asynchronous system that allows parents to easily collect clinically valid in-home videos of their child's behavior and supports diagnosticians in completing diagnostic assessment of autism. Methods: First, interviews were conducted with 11 clinicians and 6 families to solicit feedback from stakeholders about the system concept. Next, the system was iteratively designed, informed by experiences of families using it in a controlled home-like experimental setting and a participatory design process involving domain experts. Finally, in-field evaluation of the system design was conducted with 5 families of children (4 with previous autism diagnosis and 1 child typically developing) and 3 diagnosticians. For each family, 2 diagnosticians, blind to the child's previous diagnostic status, independently completed an autism diagnosis via our system. We compared the outcome of the assessment between the 2 diagnosticians, and between each diagnostician and the child's previous diagnostic status. Results: The system that resulted through the iterative design process includes (1) NODA smartCapture, a mobile phone-based application for parents to record prescribed video evidence at home; and (2) NODA Connect, a Web portal for diagnosticians to direct in-home video collection, access developmental history, and conduct an assessment by linking evidence of behaviors tagged in the videos to the Diagnostic and Statistical Manual of Mental Disorders criteria. Applying clinical judgment, the diagnostician concludes a diagnostic outcome. During field evaluation, without prior training, parents easily (average rating of 4 on a 5-point scale) used the system to record video evidence. Across all in-home video evidence recorded during field evaluation, 96\% (26/27) were judged as clinically useful, for performing an autism diagnosis. For 4 children (3 with autism and 1 typically developing), both diagnosticians independently arrived at the correct diagnostic status (autism versus typical). Overall, in 91\% of assessments (10/11) via NODA Connect, diagnosticians confidently (average rating 4.5 on a 5-point scale) concluded a diagnostic outcome that matched with the child's previous diagnostic status. Conclusions: The in-field evaluation demonstrated that the system's design enabled parents to easily record clinically valid evidence of their child's behavior, and diagnosticians to complete a diagnostic assessment. These results shed light on the potential for appropriately designed telehealth technology to support clinical assessments using in-home video captured by families. This assessment model can be readily generalized to other conditions where direct observation of behavior plays a central role in the assessment process. ",
doi="10.2196/mhealth.4393",
url="http://mhealth.jmir.org/2015/2/e68/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26085230"
}


@Article{info:doi/10.2196/jmir.4550,
author="Piette, D. John
and Striplin, Dana
and Marinec, Nicolle
and Chen, Jenny
and Trivedi, B. Ranak
and Aron, C. David
and Fisher, Lawrence
and Aikens, E. James",
title="A Mobile Health Intervention Supporting Heart Failure Patients and Their Informal Caregivers: A Randomized Comparative Effectiveness Trial",
journal="J Med Internet Res",
year="2015",
month="Jun",
day="10",
volume="17",
number="6",
pages="e142",
keywords="telehealth",
keywords="mobile health",
keywords="heart failure",
keywords="disease management",
keywords="self-management",
abstract="Background: Mobile health (mHealth) interventions may improve heart failure (HF) self-care, but standard models do not address informal caregivers' needs for information about the patient's status or how the caregiver can help. Objective: We evaluated mHealth support for caregivers of HF patients over and above the impact of a standard mHealth approach. Methods: We identified 331 HF patients from Department of Veterans Affairs outpatient clinics. All patients identified a ``CarePartner'' outside their household. Patients randomized to ``standard mHealth'' (n=165) received 12 months of weekly interactive voice response (IVR) calls including questions about their health and self-management. Based on patients' responses, they received tailored self-management advice, and their clinical team received structured fax alerts regarding serious health concerns. Patients randomized to ``mHealth+CP'' (n=166) received an identical intervention, but with automated emails sent to their CarePartner after each IVR call, including feedback about the patient's status and suggestions for how the CarePartner could support disease care. Self-care and symptoms were measured via 6- and 12-month telephone surveys with a research associate. Self-care and symptom data also were collected through the weekly IVR assessments. Results: Participants were on average 67.8 years of age, 99\% were male (329/331), 77\% where white (255/331), and 59\% were married (195/331). During 15,709 call-weeks of attempted IVR assessments, patients completed 90\% of their calls with no difference in completion rates between arms. At both endpoints, composite quality of life scores were similar across arms. However, more mHealth+CP patients reported taking medications as prescribed at 6 months (8.8\% more, 95\% CI 1.2-16.5, P=.02) and 12 months (13.8\% more, CI 3.7-23.8, P<.01), and 10.2\% more mHealth+CP patients reported talking with their CarePartner at least twice per week at the 6-month follow-up (P=.048). mHealth+CP patients were less likely to report negative emotions during those interactions at both endpoints (both P<.05), were consistently more likely to report taking medications as prescribed during weekly IVR assessments, and also were less likely to report breathing problems or weight gains (all P<.05). Among patients with more depressive symptoms at enrollment, those randomized to mHealth+CP were more likely than standard mHealth patients to report excellent or very good general health during weekly IVR calls. Conclusions: Compared to a relatively intensive model of IVR monitoring, self-management assistance, and clinician alerts, a model including automated feedback to an informal caregiver outside the household improved HF patients' medication adherence and caregiver communication. mHealth+CP may also decrease patients' risk of HF exacerbations related to shortness of breath and sudden weight gains. mHealth+CP may improve quality of life among patients with greater depressive symptoms. Weekly health and self-care monitoring via mHealth tools may identify intervention effects in mHealth trials that go undetected using typical, infrequent retrospective surveys. Trial Registration: ClinicalTrials.gov NCT00555360; https://clinicaltrials.gov/ct2/show/NCT00555360 (Archived by WebCite at http://www.webcitation.org/6Z4Tsk78B). ",
doi="10.2196/jmir.4550",
url="http://www.jmir.org/2015/6/e142/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26063161"
}


@Article{info:doi/10.2196/mhealth.4071,
author="Knight-Agarwal, Catherine
and Davis, Lee Deborah
and Williams, Lauren
and Davey, Rachel
and Cox, Robert
and Clarke, Adam",
title="Development and Pilot Testing of the Eating4two Mobile Phone App to Monitor Gestational Weight Gain",
journal="JMIR mHealth uHealth",
year="2015",
month="Jun",
day="05",
volume="3",
number="2",
pages="e44",
keywords="pregnancy",
keywords="mobile phone",
keywords="antenatal care",
keywords="maternal obesity",
keywords="intervention",
abstract="Background: The number of pregnant women with a body mass index (BMI) of 30kg/m2 or more is increasing, which has important implications for antenatal care. Various resource-intensive interventions have attempted to assist women in managing their weight gain during pregnancy with limited success. A mobile phone app has been proposed as a convenient and cost-effective alternative to face-to-face interventions. Objective: This paper describes the process of developing and pilot testing the Eating4Two app, which aims to provide women with a simple gestational weight gain (GWG) calculator, general dietary information, and the motivation to achieve a healthy weight gain during pregnancy. Methods: The project involved the development of app components, including a graphing function that allows the user to record their weight throughout the pregnancy and to receive real-time feedback on weight gain progress and general information on antenatal nutrition. Stakeholder consultation was used to inform development. The app was pilot tested with 10 pregnant women using a mixed method approach via an online survey, 2 focus groups, and 1 individual interview. Results: The Eating4Two app took 7 months to develop and evaluate. It involved several disciplines--including nutrition and dietetics, midwifery, public health, and information technology--at the University of Canberra. Participants found the Eating4Two app to be a motivational tool but would have liked scales or other markers on the graph that demonstrated exact weight gain. They also liked the nutrition information; however, many felt it should be formatted in a more user friendly way. Conclusions: The Eating4Two app was viewed by participants in our study as an innovative support system to help motivate healthy behaviors during pregnancy and as a credible resource for accessing nutrition-focused information. The feedback provided by participants will assist with refining the current prototype for use in a clinical intervention trial. ",
doi="10.2196/mhealth.4071",
url="http://mhealth.jmir.org/2015/2/e44/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26048313"
}


@Article{info:doi/10.2196/mhealth.3879,
author="Huguet, Anna
and McGrath, J. Patrick
and Wheaton, Michael
and Mackinnon, P. Sean
and Rozario, Sharlene
and Tougas, E. Michelle
and Stinson, N. Jennifer
and MacLean, Cathy",
title="Testing the Feasibility and Psychometric Properties of a Mobile Diary (myWHI) in Adolescents and Young Adults With Headaches",
journal="JMIR mHealth uHealth",
year="2015",
month="May",
day="08",
volume="3",
number="2",
pages="e39",
keywords="headache",
keywords="diary",
keywords="smartphone",
keywords="feasibility",
keywords="psychometric properties",
abstract="Background: Headaches are prevalent among teens and young adults. Self-monitoring is essential for managing headaches and can be accomplished with the help of electronic headache diaries. An increasing number of electronic headache diaries exist, yet the absence of quality standards compromises their use for research and clinical purposes. Objective: Our goal was to develop and test the usability, feasibility, and psychometric properties of an electronic diary iPhone application for self-monitoring by adolescents and young adults with headaches. Methods: We used an iterative participatory design to develop and test our electronic headache diary. Participants aged 14-28 years old with recurrent headaches were recruited internationally. Screening and consent were conducted online. Following completion of an online pre-questionnaire, participants downloaded the diary to use in their natural environment for 14 days. An online post-questionnaire was completed following testing. The diary's usability and feasibility were tested first and determined to be complete when improvements to the diary did not result in a statistically significant impact on indicators of feasibility and adherence. Interviews were conducted with participants of usability and feasibility testing. The psychometric properties of the diary were then tested, and a case study analysis of one participant was completed. Results: Three cycles to test the usability and feasibility were conducted. Each cycle included 11-19 unique participants ranging in age from 16 to 28 years. Following the testing period for each cycle, 15\% to 25\% of participants took part in the post-cycle interview. Participants perceived the final version of the diary as useful, easy to learn, and efficient to use. Psychometric properties were then tested with a sample of 65 participants (6 aged 14-17 years old; 59 aged 18-28 years old). All items in the diary had substantial between- and within-subjects variability (percent of variance for the two participant groups ranged from 20.64 to 75.60 and 23.74 to 79.21, respectively). Moreover, the Migraine Disability Assessment (MIDAS) included in the diary had adequate between-subjects reliability (R1F=0.66, RKF=0.98), but low within-subjects reliability (RC=0.51). Critical elements of the diary demonstrated adequate convergent and concurrent validity, particularly in the older age group (18-28 years). The validity of some critical elements of the diary could not be explored in the younger age group due to the small subgroup size. The case study provides an example of the potential utility of the diary. Conclusions: Our electronic headache diary was shown to be a usable and feasible self-monitoring tool when used by adolescents and young adults with headaches for 14 days. This study provides preliminary support of its psychometric properties. Our diary has the potential for helping users to better understand their headaches and, consequently, to change behaviors to improve self-management of their headaches. Its effectiveness as a component of an intervention will be the focus of future research. ",
doi="10.2196/mhealth.3879",
url="http://mhealth.jmir.org/2015/2/e39/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25956377"
}


@Article{info:doi/10.2196/resprot.4159,
author="Majeed-Ariss, Rabiya
and Hall, G. Andrew
and McDonagh, Janet
and Fallon, Deborah
and Swallow, Veronica",
title="Mobile Phone and Tablet Apps to Support Young People's Management of Their Physical Long-Term Conditions: A Systematic Review Protocol",
journal="JMIR Res Protoc",
year="2015",
month="Apr",
day="07",
volume="4",
number="2",
pages="e40",
keywords="mobile app",
keywords="mobile phone",
keywords="protocol",
keywords="smartphone",
keywords="tablets",
keywords="young people",
keywords="long-term conditions",
keywords="chronic conditions",
keywords="management",
keywords="systematic review",
abstract="Background: The prevalence of long-term or chronic conditions that limit activity and reduce quality of life in young people aged 10-24 years is rising. This group has distinct health care needs and requires tailored support strategies to facilitate increasing personal responsibility for the management of their condition wherever possible, as they mature. Mobile phone and tablet mobile technologies featuring software program apps are already well used by young people for social networking or gaming. They have also been utilized in health care to support personal condition management, using condition-specific and patient-tailored software. Such apps have much potential, and there is an emerging body of literature on their use in a health context making this review timely. Objective: The objective of this paper is to develop a systematic review protocol focused on identifying and assessing the effectiveness of mobile phone and tablet apps that support young people's management of their chronic conditions. Methods: The search strategy will include a combination of standardized indexed search terms and free-text terms related to the key concepts of young people; long-term conditions and mobile technology. Peer-reviewed journal articles published from 2003 that meet the inclusion and exclusion criteria will be identified through searching the generated hits from 5 bibliographical databases. Two independent reviewers will screen the titles and abstracts to determine which articles focus on testing interventions identified as a mobile phone or tablet apps, and that have been designed and delivered to support the management of long-term conditions in young people aged 10-24 years. Data extraction and quality assessment tools will be used to facilitate consistent analysis and synthesis. It is anticipated that several studies will meet the selection criteria but that these are likely to be heterogeneous in terms of study design, reported outcomes, follow-up times, participants' age, and health condition. Sub-group analyses will be undertaken and where possible meta-analyses will take place. Results: This review will synthesize available knowledge surrounding tablet and mobile phone apps that support management of long term physical health conditions in young people. The findings will be synthesized to determine which elements of the technologies were most effective for this population. Conclusions: This systematic review aims to synthesize existing literature in order to generate findings that will facilitate the development of an app intervention. The review will form the first phase of development and evaluation of a complex intervention as recommended by the United Kingdom Medical Research Council. The knowledge gained from the review will be verified in subsequent phases, which will include primary qualitative work with health professionals and young people with long term conditions as research participants. Young people living with long-term conditions will be involved as co-researchers and consumer advisors in all subsequent phases to develop and evaluate an app to support the management of long-term physical health conditions. Trial Registration: PROSPERO International prospective register of systematic reviews: CRD42014015418; http://www.crd.york.ac.uk/PROSPERO/display\_record.asp?ID=CRD42014015418\#.VRqCpTpnL8E (Archived by Webcite at http://www.webcitation.org/6XREcWqQY). ",
doi="10.2196/resprot.4159",
url="http://www.researchprotocols.org/2015/2/e40/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25854293"
}


@Article{info:doi/10.2196/mhealth.3789,
author="Zan, Shiyi
and Agboola, Stephen
and Moore, A. Stephanie
and Parks, A. Kimberly
and Kvedar, C. Joseph
and Jethwani, Kamal",
title="Patient Engagement With a Mobile Web-Based Telemonitoring System for Heart Failure Self-Management: A Pilot Study",
journal="JMIR mHealth uHealth",
year="2015",
month="Apr",
day="01",
volume="3",
number="2",
pages="e33",
keywords="heart failure",
keywords="disease self-management",
keywords="remote monitoring",
keywords="telemonitoring",
keywords="interactive voice response system",
keywords="mobile health",
keywords="Web portal",
keywords="patient engagement",
keywords="quality of life",
abstract="Background: Intensive remote monitoring programs for congestive heart failure have been successful in reducing costly readmissions, but may not be appropriate for all patients. There is an opportunity to leverage the increasing accessibility of mobile technologies and consumer-facing digital devices to empower patients in monitoring their own health outside of the hospital setting. The iGetBetter system, a secure Web- and telephone-based heart failure remote monitoring program, which leverages mobile technology and portable digital devices, offers a creative solution at lower cost. Objective: The objective of this pilot study was to evaluate the feasibility of using the iGetBetter system for disease self-management in patients with heart failure. Methods: This was a single-arm prospective study in which  21 ambulatory, adult heart failure patients used the intervention for heart failure self-management over a 90-day study period. Patients were instructed to take their weight, blood pressure, and heart rate measurements each morning using a WS-30 bluetooth weight scale, a self-inflating blood pressure cuff (Withings LLC, Issy les Moulineaux, France), and an iPad Mini tablet computer (Apple Inc, Cupertino, CA, USA) equipped with cellular Internet connectivity to view their measurements on the Internet. Outcomes assessed included usability and satisfaction, engagement with the intervention, hospital resource utilization, and heart failure-related quality of life. Descriptive statistics were used to summarize data, and matched controls identified from the electronic medical record were used as comparison for evaluating hospitalizations. Results: There were 20 participants (mean age 53 years) that completed the study. Almost all participants (19/20, 95\%) reported feeling more connected to their health care team and more confident in performing care plan activities, and 18/20 (90\%) felt better prepared to start discussions about their health with their doctor. Although heart failure-related quality of life improved from baseline, it was not statistically significant (P=.55). Over half of the participants had greater than 80\% (72/90 days) weekly and overall engagement with the program, and 15\% (3/20) used the interactive voice response telephone system exclusively for managing their care plan. Hospital utilization did not differ in the intervention group compared to the control group (planned hospitalizations P=.23, and unplanned hospitalizations P=.99). Intervention participants recorded shorter average length of hospital stay, but no significant differences were observed between intervention and control groups (P=.30). Conclusions: This pilot study demonstrated the feasibility of a low-intensive remote monitoring program leveraging commonly used mobile and portable consumer devices in augmenting care for a fairly young population of ambulatory patients with heart failure. Further prospective studies with a larger sample size and within more diverse patient populations is necessary to determine the effect of mobile-based remote monitoring programs such as the iGetBetter system on clinical outcomes in heart failure. ",
doi="10.2196/mhealth.3789",
url="http://mhealth.jmir.org/2015/2/e33/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25842282"
}


@Article{info:doi/10.2196/jmir.3687,
author="Wildevuur, E. Sabine
and Simonse, WL Lianne",
title="Information and Communication Technology--Enabled Person-Centered Care for the ``Big Five'' Chronic Conditions: Scoping Review",
journal="J Med Internet Res",
year="2015",
month="Mar",
day="27",
volume="17",
number="3",
pages="e77",
keywords="patient-centered care",
keywords="person-centered care",
keywords="telemedicine",
keywords="chronic disease",
keywords="neoplasms",
keywords="cardiovascular diseases",
keywords="chronic respiratory tract diseases",
keywords="diabetes mellitus",
keywords="stroke",
keywords="disease management",
keywords="self-care",
keywords="decision making",
keywords="eHealth",
abstract="Background: Person-centered information and communication technology (ICT) could encourage patients to take an active part in their health care and decision-making process, and make it possible for patients to interact directly with health care providers and services about their personal health concerns. Yet, little is known about which ICT interventions dedicated to person-centered care (PCC) and connected-care interactions have been studied, especially for shared care management of chronic diseases. The aim of this research is to investigate the extent, range, and nature of these research activities and identify research gaps in the evidence base of health studies regarding the ``big 5'' chronic diseases: diabetes mellitus, cardiovascular disease, chronic respiratory disease, cancer, and stroke. Objective: The objective of this paper was to review the literature and to scope the field with respect to 2 questions: (1) which ICT interventions have been used to support patients and health care professionals in PCC management of the big 5 chronic diseases? and (2) what is the impact of these interventions, such as on health-related quality of life and cost efficiency? Methods: This research adopted a scoping review method. Three electronic medical databases were accessed: PubMed, EMBASE, and Cochrane Library. The research reviewed studies published between January 1989 and December 2013. In 5 stages of systematic scanning and reviewing, relevant studies were identified, selected, and charted. Then we collated, summarized, and reported the results. Results: From the initial 9380 search results, we identified 350 studies that qualified for inclusion: diabetes mellitus (n=103), cardiovascular disease (n=89), chronic respiratory disease (n=73), cancer (n=67), and stroke (n=18). Persons with one of these chronic conditions used ICT primarily for self-measurement of the body, when interacting with health care providers, with the highest rates of use seen in chronic respiratory (63\%, 46/73) and cardiovascular (53\%, 47/89) diseases. We found 60 relevant studies (17.1\%, 60/350) on person-centered shared management ICT, primarily using telemedicine systems as personalized ICT. The highest impact measured related to the increase in empowerment (15.4\%, 54/350). Health-related quality of life accounted for 8\%. The highest impact connected to health professionals was an increase in clinical outcome (11.7\%, 41/350). The impacts on organization outcomes were decrease in hospitalization (12.3\%, 43/350) and increase of cost efficiency (10.9\%, 38/350). Conclusions: This scoping review outlined ICT-enabled PCC in chronic disease management. Persons with a chronic disease could benefit from an ICT-enabled PCC approach, but ICT-PCC also yields organizational paybacks. It could lead to an increase in health care usage, as reported in some studies. Few interventions could be regarded as ``fully'' addressing PCC. This review will be especially helpful to those deciding on areas where further development of research or implementation of ICT-enabled PCC may be warranted. ",
doi="10.2196/jmir.3687",
url="http://www.jmir.org/2015/3/e77/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25831199"
}


@Article{info:doi/10.2196/mhealth.3956,
author="Pan, Di
and Dhall, Rohit
and Lieberman, Abraham
and Petitti, B. Diana",
title="A Mobile Cloud-Based Parkinson's Disease Assessment System for Home-Based Monitoring",
journal="JMIR mHealth uHealth",
year="2015",
month="Mar",
day="26",
volume="3",
number="1",
pages="e29",
keywords="mHealth",
keywords="Smartphone",
keywords="Mobile App",
keywords="Cloud application",
keywords="Parkinson's Disease",
keywords="Home based monitoring",
keywords="Telemedicine",
keywords="Decision marking",
keywords="Tremor",
keywords="Gait difficulty",
abstract="Background: Parkinson's disease (PD) is the most prevalent movement disorder of the central nervous system, and affects more than 6.3 million people in the world. The characteristic motor features include tremor, bradykinesia, rigidity, and impaired postural stability. Current therapy based on augmentation or replacement of dopamine is designed to improve patients' motor performance but often leads to levodopa-induced adverse effects, such as dyskinesia and motor fluctuation. Clinicians must regularly monitor patients in order to identify these effects and other declines in motor function as soon as possible. Current clinical assessment for Parkinson's is subjective and mostly conducted by brief observations made during patient visits. Changes in patients' motor function between visits are hard to track and clinicians are not able to make the most informed decisions about the course of therapy without frequent visits. Frequent clinic visits increase the physical and economic burden on patients and their families. Objective: In this project, we sought to design, develop, and evaluate a prototype mobile cloud-based mHealth app, ``PD Dr'', which collects quantitative and objective information about PD and would enable home-based assessment and monitoring of major PD symptoms. Methods: We designed and developed a mobile app on the Android platform to collect PD-related motion data using the smartphone 3D accelerometer and to send the data to a cloud service for storage, data processing, and PD symptoms severity estimation. To evaluate this system, data from the system were collected from 40 patients with PD and compared with experts' rating on standardized rating scales. Results: The evaluation showed that PD Dr could effectively capture important motion features that differentiate PD severity and identify critical symptoms. For hand resting tremor detection, the sensitivity was .77 and accuracy was .82. For gait difficulty detection, the sensitivity was .89 and accuracy was .81. In PD severity estimation, the captured motion features also demonstrated strong correlation with PD severity stage, hand resting tremor severity, and gait difficulty. The system is simple to use, user friendly, and economically affordable. Conclusions: The key contribution of this study was building a mobile PD assessment and monitoring system to extend current PD assessment based in the clinic setting to the home-based environment. The results of this study proved feasibility and a promising future for utilizing mobile technology in PD management. ",
doi="10.2196/mhealth.3956",
url="http://mhealth.jmir.org/2015/1/e29/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25830687"
}


@Article{info:doi/10.2196/mental.3889,
author="Torous, John
and Staples, Patrick
and Shanahan, Meghan
and Lin, Charlie
and Peck, Pamela
and Keshavan, Matcheri
and Onnela, Jukka-Pekka",
title="Utilizing a Personal Smartphone Custom App to Assess the Patient Health Questionnaire-9 (PHQ-9) Depressive Symptoms in Patients With Major Depressive Disorder",
journal="JMIR Mental Health",
year="2015",
month="Mar",
day="24",
volume="2",
number="1",
pages="e8",
keywords="medical informatics",
keywords="mobile health",
keywords="depression",
abstract="Background: Accurate reporting of patient symptoms is critical for diagnosis and therapeutic monitoring in psychiatry. Smartphones offer an accessible, low-cost means to collect patient symptoms in real time and aid in care. Objective: To investigate adherence among psychiatric outpatients diagnosed with major depressive disorder in utilizing their personal smartphones to run a custom app to monitor Patient Health Questionnaire-9 (PHQ-9) depression symptoms, as well as to examine the correlation of these scores to traditionally administered (paper-and-pencil) PHQ-9 scores. Methods: A total of 13 patients with major depressive disorder, referred by their clinicians, received standard outpatient treatment and, in addition, utilized their personal smartphones to run the study app to monitor their symptoms. Subjects downloaded and used the Mindful Moods app on their personal smartphone to complete up to three survey sessions per day, during which a randomized subset of PHQ-9 symptoms of major depressive disorder were assessed on a Likert scale. The study lasted 29 or 30 days without additional follow-up. Outcome measures included adherence, measured by the percentage of completed survey sessions, and estimates of daily PHQ-9 scores collected from the smartphone app, as well as from the traditionally administered PHQ-9. Results: Overall adherence was 77.78\% (903/1161) and varied with time of day. PHQ-9 estimates collected from the app strongly correlated (r=.84) with traditionally administered PHQ-9 scores, but app-collected scores were 3.02 (SD 2.25) points higher on average. More subjects reported suicidal ideation using the app than they did on the traditionally administered PHQ-9. Conclusions: Patients with major depressive disorder are able to utilize an app on their personal smartphones to self-assess their symptoms of major depressive disorder with high levels of adherence. These app-collected results correlate with the traditionally administered PHQ-9.  Scores recorded from the app may potentially be more sensitive and better able to capture suicidality than the traditional PHQ-9. ",
doi="10.2196/mental.3889",
url="http://mental.jmir.org/2015/1/e8/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26543914"
}


@Article{info:doi/10.2196/jmir.3951,
author="Hamine, Saee
and Gerth-Guyette, Emily
and Faulx, Dunia
and Green, B. Beverly
and Ginsburg, Sarah Amy",
title="Impact of mHealth Chronic Disease Management on Treatment Adherence and Patient Outcomes: A Systematic Review",
journal="J Med Internet Res",
year="2015",
month="Feb",
day="24",
volume="17",
number="2",
pages="e52",
keywords="telemedicine",
keywords="mHealth",
keywords="mobile health",
keywords="patient compliance",
keywords="patient adherence",
keywords="chronic disease",
keywords="diabetes mellitus",
keywords="cardiovascular diseases",
keywords="lung diseases",
abstract="Background: Adherence to chronic disease management is critical to achieving improved health outcomes, quality of life, and cost-effective health care. As the burden of chronic diseases continues to grow globally, so does the impact of non-adherence. Mobile technologies are increasingly being used in health care and public health practice (mHealth) for patient communication, monitoring, and education, and to facilitate adherence to chronic diseases management. Objective: We conducted a systematic review of the literature to evaluate the effectiveness of mHealth in supporting the adherence of patients to chronic diseases management (``mAdherence''), and the usability, feasibility, and acceptability of mAdherence tools and platforms in chronic disease management among patients and health care providers. Methods: We searched PubMed, Embase, and EBSCO databases for studies that assessed the role of mAdherence in chronic disease management of diabetes mellitus, cardiovascular disease, and chronic lung diseases from 1980 through May 2014. Outcomes of interest included effect of mHealth on patient adherence to chronic diseases management, disease-specific clinical outcomes after intervention, and the usability, feasibility, and acceptability of mAdherence tools and platforms in chronic disease management among target end-users. Results: In all, 107 articles met all inclusion criteria. Short message service was the most commonly used mAdherence tool in 40.2\% (43/107) of studies. Usability, feasibility, and acceptability or patient preferences for mAdherence interventions were assessed in 57.9\% (62/107) of studies and found to be generally high. A total of 27 studies employed randomized controlled trial (RCT) methods to assess impact on adherence behaviors, and significant improvements were observed in 15 of those studies (56\%). Of the 41 RCTs that measured effects on disease-specific clinical outcomes, significant improvements between groups were reported in 16 studies (39\%). Conclusions: There is potential for mHealth tools to better facilitate adherence to chronic disease management, but the evidence supporting its current effectiveness is mixed. Further research should focus on understanding and improving how mHealth tools can overcome specific barriers to adherence. ",
doi="10.2196/jmir.3951",
url="http://www.jmir.org/2015/2/e52/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25803266"
}


@Article{info:doi/10.2196/resprot.4042,
author="Atreja, Ashish
and Khan, Sameer
and Rogers, D. Jason
and Otobo, Emamuzo
and Patel, P. Nishant
and Ullman, Thomas
and Colombel, Fred Jean
and Moore, Shirley
and Sands, E. Bruce
and ",
title="Impact of the Mobile HealthPROMISE Platform on the Quality of Care and Quality of Life in Patients With Inflammatory Bowel Disease: Study Protocol of a Pragmatic Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2015",
month="Feb",
day="18",
volume="4",
number="1",
pages="e23",
keywords="medical informatics",
keywords="patient reported outcome",
keywords="mHealth",
keywords="engagement",
abstract="Background: Inflammatory bowel disease (IBD) is a chronic condition of the bowel that affects over 1 million people in the United States. The recurring nature of disease makes IBD patients ideal candidates for patient-engaged care that is centered on enhanced self-management and improved doctor-patient communication. In IBD, optimal approaches to management vary for patients with different phenotypes and extent of disease and past surgical history. Hence, a single quality metric cannot define a heterogeneous disease such as IBD, unlike hypertension and diabetes. A more comprehensive assessment may be provided by complementing traditional quality metrics with measures of the patient's quality of life (QOL) through an application like HealthPROMISE. Objective: The objective of this pragmatic randomized controlled trial is to determine the impact of the HealthPROMISE app in improving outcomes (quality of care [QOC], QOL, patient adherence, disease control, and resource utilization) as compared to a patient education app. Our hypothesis is that a patient-centric self-monitoring and collaborative decision support platform will lead to sustainable improvement in overall QOL for IBD patients. Methods: Participants will be recruited during face-to-face visits and randomized to either an interventional (ie, HealthPROMISE) or control (ie, education app). Patients in the HealthPROMISE arm will be able to update their information and receive disease summary, quality metrics, and a graph showing the trend of QOL (SIBDQ) scores and resource utilization over time. Providers will use the data for collaborative decision making and quality improvement interventions at the point of care. Patients in the control arm will enter data at baseline, during office visits, and at the end of the study but will not receive any decision support (trend of QOL, alert, or dashboard views). Results: Enrollment in the trial will be starting in first quarter of 2015. It is intended that up to 300 patients with IBD will be recruited into the study (with 1:1 allocation ratio). The primary endpoint is number of quality indicators met in HealthPROMISE versus control arm. Secondary endpoints include decrease in number of emergency visits due to IBD, decrease in number of hospitalization due to IBD, change in generic QOL score from baseline, proportion of patients in each group who meet all eligible outpatient quality metrics, and proportion of patients in disease control in each group. In addition, we plan to conduct protocol analysis of intervention patients with adequate HealthPROMISE utilization (more than 6 log-ins with data entry from week 0 through week 52) achieving above mentioned primary and secondary endpoints. Conclusions: HealthPROMISE is a unique cloud-based patient-reported outcome (PRO) and decision support tool that empowers both patients and providers. Patients track their QOL and symptoms, and providers can use the visual data in real time (integrated with electronic health records [EHRs]) to provide better care to their entire patient population. Using pragmatic trial design, we hope to show that IBD patients who participate in their own care and share in decision making have appreciably improved outcomes when compared to patients who do not. Trial Registration: ClinicalTrials.gov NCT02322307; https://clinicaltrials.gov/ct2/show/NCT02322307 (Archived by WebCite at http://www.webcitation.org/6W8PoYThr). ",
doi="10.2196/resprot.4042",
url="http://www.researchprotocols.org/2015/1/e23/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25693610"
}


@Article{info:doi/10.2196/jmir.3130,
author="Irvine, Blair A.
and Russell, Holly
and Manocchia, Michael
and Mino, E. David
and Cox Glassen, Terri
and Morgan, Rebecca
and Gau, M. Jeff
and Birney, J. Amelia
and Ary, V. Dennis",
title="Mobile-Web App to Self-Manage Low Back Pain: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2015",
month="Jan",
day="02",
volume="17",
number="1",
pages="e1",
keywords="low back pain",
keywords="Internet",
keywords="mobile",
keywords="app",
keywords="computers",
keywords="prevention",
keywords="self-treatment",
abstract="Background: Nonspecific low back pain (NLBP) is the diagnosis for individuals with back pain that has no underlying medical cause (eg, tumor, infection, fracture, herniated disc, spinal stenosis). The American College of Physicians (ACP) and American Pain Society (APS) recommend multidisciplinary treatments for NLBP that lasts more than 4 weeks. This approach, however, is impractical for many physicians to implement, and relatively few providers offer NLBP treatment that meets the joint ACP-APS guidelines. Objective: This study evaluated the efficacy of a mobile-Web intervention called ``FitBack'' to help users implement self-tailored strategies to manage and prevent NLBP occurrences. Methods: A total of 597 adults were recruited, screened, consented, and assessed online at baseline, at 2 months (T2), and at 4 months (T3). After baseline assessments, participants were randomized into three groups: FitBack intervention, alternative care group that received 8 emails urging participants to link to six Internet resources for NLBP, and control group. The FitBack group also received weekly email reminder prompts for 8 weeks plus emails to do assessments. The control group was only contacted to do assessments. Results: Users of the FitBack program showed greater improvement compared to the control group in every comparison of the critical physical, behavioral, and worksite outcome measures at 4-month follow-up. In addition, users of the FitBack program performed better than the alternative care group on current back pain, behavioral, and worksite outcomes at 4-month follow-up. For example, subjects in the control group were 1.7 times more likely to report current back pain than subjects in the FitBack group; subjects in the alternative care group were 1.6 times more likely to report current back pain at 4-month follow-up. Further, the users of the FitBack program showed greater improvement compared to both the control and alternative care groups at 4-month follow-up on patient activation, constructs of the Theory of Planned Behavior, and attitudes toward pain. Conclusions: This research demonstrated that a theoretically based stand-alone mobile-Web intervention that tailors content to users' preferences and interests can be an effective tool in self-management of low back pain. When viewed from the RE-AIM perspective (ie, reach, efficacy/effectiveness, adoption, implementation fidelity, and maintenance), this study supports the notion that there is considerable value in this type of intervention as a potentially cost-effective tool that can reach large numbers of people. The results are promising considering that the FitBack intervention was neither supported by professional caregivers nor integrated within a health promotion campaign, which might have provided additional support for participants. Still, more research is needed on how self-guided mobile-Web interventions will be used over time and to understand factors associated with continuing user engagement. Trial Registration: Clinicaltrials.gov NCT01950091; http://clinicaltrials.gov/ct2/show/NCT01950091 (Archived by WebCite at http://www.webcitation.org/6TwZucX77). ",
doi="10.2196/jmir.3130",
url="http://www.jmir.org/2015/1/e1/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25565416"
}


@Article{info:doi/10.2196/mental.4004,
author="Torous, John
and Chan, Richard Steven
and Yee-Marie Tan, Shih
and Behrens, Jacob
and Mathew, Ian
and Conrad, J. Erich
and Hinton, Ladson
and Yellowlees, Peter
and Keshavan, Matcheri",
title="Patient Smartphone Ownership and Interest in Mobile Apps to Monitor Symptoms of Mental Health Conditions: A Survey in Four Geographically Distinct Psychiatric Clinics",
journal="JMIR Mental Health",
year="2014",
month="Dec",
day="23",
volume="1",
number="1",
pages="e5",
keywords="psychiatry",
keywords="mobile health",
keywords="smartphone",
abstract="Background: Despite growing interest in mobile mental health and utilization of smartphone technology to monitor psychiatric symptoms, there remains a lack of knowledge both regarding patient ownership of smartphones and their interest in using such to monitor their mental health. Objective: To provide data on psychiatric outpatients' prevalence of smartphone ownership and interest in using their smartphones to run applications to monitor their mental health. Methods: We surveyed 320 psychiatric outpatients from four clinics around the United States in order to capture a geographically and socioeconomically diverse patient population. These comprised a state clinic in Massachusetts (n=108), a county clinic in California (n=56), a hybrid public and private clinic in Louisiana (n=50), and a private/university clinic in Wisconsin (n=106). Results: Smartphone ownership and interest in utilizing such to monitor mental health varied by both clinic type and age with overall ownership of 62.5\% (200/320), which is slightly higher than the average United States' rate of ownership of 58\% in January 2014. Overall patient interest in utilizing smartphones to monitor symptoms was 70.6\% (226/320). Conclusions: These results suggest that psychiatric outpatients are interested in using their smartphones to monitor their mental health and own the smartphones capable of running mental healthcare related mobile applications. ",
doi="10.2196/mental.4004",
url="http://mental.jmir.org/2014/1/e5/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26543905"
}


@Article{info:doi/10.2196/mhealth.3882,
author="Holmen, Heidi
and Torbj{\o}rnsen, Astrid
and Wahl, Klopstad Astrid
and Jenum, Karen Anne
and Sm{\aa}stuen, Cvancarova Milada
and {\AA}rsand, Eirik
and Ribu, Lis",
title="A Mobile Health Intervention for Self-Management and Lifestyle Change for Persons With Type 2 Diabetes, Part 2: One-Year Results From the Norwegian Randomized Controlled Trial RENEWING HEALTH",
journal="JMIR mHealth uHealth",
year="2014",
month="Dec",
day="11",
volume="2",
number="4",
pages="e57",
keywords="self-care",
keywords="mobile applications",
keywords="cellular phone",
keywords="telemedicine",
keywords="counseling",
keywords="motivational interviewing",
keywords="diabetes mellitus, type 2",
keywords="hemoglobin A1c protein, human",
abstract="Background: Self-management is crucial in the daily management of type 2 diabetes. It has been suggested that mHealth may be an important method for enhancing self-management when delivered in combination with health counseling. Objective: The objective of this study was to test whether the use of a mobile phone--based self-management system used for 1 year, with or without telephone health counseling by a diabetes specialist nurse for the first 4 months, could improve glycated hemoglobin A1c (HbA1c) level, self-management, and health-related quality of life compared with usual care. Methods: We conducted a 3-arm prospective randomized controlled trial involving 2 intervention groups and 1 control group. Eligible participants were persons with type 2 diabetes with an HbA1c level ?7.1\% (?54.1 mmol/mol) and aged ?18 years. Both intervention groups received the mobile phone--based self-management system Few Touch Application (FTA). The FTA consisted of a blood glucose--measuring system with automatic wireless data transfer, diet manual, physical activity registration, and management of personal goals, all recorded and operated using a diabetes diary app on the mobile phone. In addition, one intervention group received health counseling based on behavior change theory and delivered by a diabetes specialist nurse for the first 4 months after randomization. All groups received usual care by their general practitioner. The primary outcome was HbA1c level. Secondary outcomes were self-management (heiQ), health-related quality of life (SF-36), depressive symptoms (CES-D), and lifestyle changes (dietary habits and physical activity). Data were analyzed using univariate methods (t test, ANOVA) and multivariate linear and logistic regression. Results: A total of 151 participants were randomized: 51 to the FTA group, 50 to the FTA-health counseling (FTA-HC) group, and 50 to the control group. Follow-up data after 1 year were available for 120 participants (79\%). HbA1c level decreased in all groups, but did not differ between groups after 1 year. The mean change in the heiQ domain skills and technique acquisition was significantly greater in the FTA-HC group after adjusting for age, gender, and education (P=.04). Other secondary outcomes did not differ between groups after 1 year. In the FTA group, 39\% were substantial users of the app; 34\% of the FTA-HC group were substantial users. Those aged ?63 years used the app more than their younger counterparts did (OR 2.7; 95\% CI 1.02-7.12; P=.045). Conclusions: The change in HbA1c level did not differ between groups after the 1-year intervention. Secondary outcomes did not differ between groups except for an increase in the self-management domain of skill and technique acquisition in the FTA-HC group. Older participants used the app more than the younger participants did. ",
doi="10.2196/mhealth.3882",
url="http://mhealth.jmir.org/2014/4/e57/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25499872"
}


@Article{info:doi/10.2196/mhealth.3535,
author="Torbj{\o}rnsen, Astrid
and Jenum, Karen Anne
and Sm{\aa}stuen, Cvancarova Milada
and {\AA}rsand, Eirik
and Holmen, Heidi
and Wahl, Klopstad Astrid
and Ribu, Lis",
title="A Low-Intensity Mobile Health Intervention With and Without Health Counseling for Persons With Type 2 Diabetes, Part 1: Baseline and Short-Term Results From a Randomized Controlled Trial in the Norwegian Part of RENEWING HEALTH",
journal="JMIR mHealth uHealth",
year="2014",
month="Dec",
day="11",
volume="2",
number="4",
pages="e52",
keywords="self-care",
keywords="quality of life",
keywords="diabetes mellitus, type 2",
keywords="randomized controlled trials",
keywords="telemedicine",
keywords="mHealth",
keywords="mobile apps",
keywords="counseling",
keywords="complex intervention",
keywords="life style",
abstract="Background: Self-management support for people with type 2 diabetes is essential in diabetes care. Thus, mobile health technology with or without low-intensity theory-based health counseling could become an important tool for promoting self-management. Objectives: The aim was to evaluate whether the introduction of technology-supported self-management using the Few Touch Application (FTA) diabetes diary with or without health counseling improved glycated hemoglobin (HbA1c) levels, self-management, behavioral change, and health-related quality of life, and to describe the sociodemographic, clinical, and lifestyle characteristics of the participants after 4 months. Methods: A 3-armed randomized controlled trial was conducted in Norway during 2011-2013. In the 2 intervention groups, participants were given a mobile phone for 1 year, which provided access to the FTA diary, a self-help tool that recorded 5 elements: blood glucose, food habits, physical activity, personal goal setting, and a look-up system for diabetes information. One of the intervention groups was also offered theory-based health counseling with a specialist diabetes nurse by telephone for 4 months from baseline. Both intervention groups and the control group were provided usual care according to the national guidelines. Adults with type 2 diabetes and HbA1c ?7.1\% were included (N=151). There were 3 assessment points: baseline, 4 months, and 1 year. We report the short-term findings after 4 months. HbA1c was the primary outcome and the secondary outcomes were self-management (Health Education Impact Questionnaire, heiQ), behavioral change (diet and physical activity), and health-related quality of life (SF-36 questionnaire). The data were analyzed using univariate methods (ANOVA), multivariate linear, and logistic regression. Results: Data were analyzed from 124 individuals (attrition rate was 18\%). The groups were well balanced at baseline. There were no differences in HbA1c between groups after 4 months, but there was a decline in all groups. There were changes in self-management measured using the health service navigation item in the heiQ, with improvements in the FTA group compared to the control group (P=.01) and in the FTA with health counseling group compared with both other groups (P=.04). This may indicate an improvement in the ability of patients to communicate health needs to their health care providers. Furthermore, the FTA group reported higher scores for skill and technique acquisition at relieving symptoms compared to the control group (P=.02). There were no significant changes in any of the domains of the SF-36. Conclusions: The primary outcome, HbA1c, did not differ between groups after 4 months. Both of the intervention groups had significantly better scores than the control group for health service navigation and the FTA group also exhibited improved skill and technique acquisition. ",
doi="10.2196/mhealth.3535",
url="http://mhealth.jmir.org/2014/4/e52/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25499592"
}


@Article{info:doi/10.2196/mhealth.3599,
author="Hilliard, E. Marisa
and Hahn, Amy
and Ridge, K. Alana
and Eakin, N. Michelle
and Riekert, A. Kristin",
title="User Preferences and Design Recommendations for an mHealth App to Promote Cystic Fibrosis Self-Management",
journal="JMIR mHealth uHealth",
year="2014",
month="Oct",
day="24",
volume="2",
number="4",
pages="e44",
keywords="cystic fibrosis",
keywords="qualitative research",
keywords="mobile health",
abstract="Background: mHealth apps hold potential to provide automated, tailored support for treatment adherence among individuals with chronic medical conditions. Yet relatively little empirical research has guided app development and end users are infrequently involved in designing the app features or functions that would best suit their needs. Self-management apps may be particularly useful for people with chronic conditions like cystic fibrosis (CF) that have complex, demanding regimens. Objective: The aim of this mixed-methods study was to involve individuals with CF in guiding the development of engaging, effective, user-friendly adherence promotion apps that meet their preferences and self-management needs. Methods: Adults with CF (n=16, aged 21-48 years, 50\% male) provided quantitative data via a secure Web survey and qualitative data via semi-structured telephone interviews regarding previous experiences using apps in general and for health, and preferred and unwanted features of potential future apps to support CF self-management. Results: Participants were smartphone users who reported sending or receiving text messages (93\%, 14/15) or emails (80\%, 12/15) on their smartphone or device every day, and 87\% (13/15) said it would be somewhat or very hard to give up their smartphone. Approximately one-half (53\%, 8/15) reported having health apps, all diet/weight-related, yet many reported that existing nutrition apps were not well-suited for CF management. Participants wanted apps to support CF self-management with characteristics such as having multiple rather than single functions (eg, simple alarms), being specific to CF, and minimizing user burden. Common themes for desired CF app features were having information at one's fingertips, automation of disease management activities such as pharmacy refills, integration with smartphones' technological capabilities, enhancing communication with health care team, and facilitating socialization within the CF community. Opinions were mixed regarding gamification and earning rewards or prizes. Participants emphasized the need for customization options to meet individual preferences and disease management goals. Conclusions: Unique capabilities of emerging smartphone technologies (eg, social networking integration, movement and location detection, integrated sensors, or electronic monitors) make many of these requests possible. Involving end users in all stages of mHealth app development and collaborating with technology experts and the health care system may result in apps that maintain engagement, improve integration and automation, and ultimately impact self-management and health outcomes. ",
doi="10.2196/mhealth.3599",
url="http://mhealth.jmir.org/2014/4/e44/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25344616"
}


@Article{info:doi/10.2196/mhealth.3452,
author="Hundert, S. Amos
and Huguet, Anna
and McGrath, J. Patrick
and Stinson, N. Jennifer
and Wheaton, Mike",
title="Commercially Available Mobile Phone Headache Diary Apps: A Systematic Review",
journal="JMIR mHealth uHealth",
year="2014",
month="Aug",
day="19",
volume="2",
number="3",
pages="e36",
keywords="headache",
keywords="diary",
keywords="apps",
keywords="smartphone",
keywords="mobile phone",
keywords="technology",
keywords="mHealth",
keywords="review",
abstract="Background: Headache diaries are often used by headache sufferers to self-monitor headaches. With advances in mobile technology, mobile electronic diary apps are becoming increasingly common. Objective: This review aims to identify and evaluate all commercially available mobile headache diary apps for the two most popular mobile phone platforms, iOS and Android. Methods: The authors developed a priori a set of 7 criteria that define an ideal headache diary app intended to help headache sufferers better understand and manage their headaches, while providing relevant data to health professionals. The app criteria were intended as minimum requirements for an acceptable headache diary app that could be prescribed by health care professionals. Each app was evaluated and scored against each criterion. Results: Of the 38 apps identified, none of the apps met all 7 app criteria. The 3 highest scoring apps, meeting 5 of the app criteria, were iHeadache (developed by Better QOL), ecoHeadache (developed by ecoTouchMedia), and Headache Diary Pro (developed by Froggyware). Only 18\% of the apps were created with scientific or clinical headache expertise and none of the apps reported on psychometric properties. Conclusions: Despite the growing market and demand, there is a concerning lack of scientific expertise and evidence base associated with headache diary apps. ",
doi="10.2196/mhealth.3452",
url="http://mhealth.jmir.org/2014/3/e36/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25138438"
}


@Article{info:doi/10.2196/mhealth.3118,
author="Rhee, Hyekyun
and Miner, Sarah
and Sterling, Mark
and Halterman, S. Jill
and Fairbanks, Eileen",
title="The Development of an Automated Device for Asthma Monitoring for Adolescents: Methodologic Approach and User Acceptability",
journal="JMIR mHealth uHealth",
year="2014",
month="Jun",
day="19",
volume="2",
number="2",
pages="e27",
keywords="asthma",
keywords="adolescents",
keywords="symptom monitoring",
keywords="symptom algorithm",
keywords="mobile device",
abstract="Background: Many adolescents suffer serious asthma related morbidity that can be prevented by adequate self-management of the disease. The accurate symptom monitoring by patients is the most fundamental antecedent to effective asthma management. Nonetheless, the adequacy and effectiveness of current methods of symptom self-monitoring have been challenged due to the individuals' fallible symptom perception, poor adherence, and inadequate technique. Recognition of these limitations led to the development of an innovative device that can facilitate continuous and accurate monitoring of asthma symptoms with minimal disruption of daily routines, thus increasing acceptability to adolescents. Objective: The objectives of this study were to: (1) describe the development of a novel symptom monitoring device for teenagers (teens), and (2) assess their perspectives on the usability and acceptability of the device. Methods: Adolescents (13-17 years old) with and without asthma participated in the evolution of an automated device for asthma monitoring (ADAM), which comprised three phases, including development (Phase 1, n=37), validation/user acceptability (Phase 2, n=84), and post hoc validation (Phase 3, n=10). In Phase 1, symptom algorithms were identified based on the acoustic analysis of raw symptom sounds and programmed into a popular mobile system, the iPod. Phase 2 involved a 7 day trial of ADAM in vivo, and the evaluation of user acceptance using an acceptance survey and individual interviews. ADAM was further modified and enhanced in Phase 3. Results: Through ADAM, incoming audio data were digitized and processed in two steps involving the extraction of a sequence of descriptive feature vectors, and the processing of these sequences by a hidden Markov model-based Viterbi decoder to differentiate symptom sounds from background noise. The number and times of detected symptoms were stored and displayed in the device. The sensitivity (true positive) of the updated cough algorithm was 70\% (21/30), and, on average, 2 coughs per hour were identified as false positive. ADAM also kept track of the their activity level throughout the day using the mobile system's built in accelerometer function. Overall, the device was well received by participants who perceived it as attractive, convenient, and helpful. The participants recognized the potential benefits of the device in asthma care, and were eager to use it for their asthma management. Conclusions: ADAM can potentially automate daily symptom monitoring with minimal intrusiveness and maximal objectivity. The users' acceptance of the device based on its recognized convenience, user-friendliness, and usefulness in increasing symptom awareness underscores ADAM's potential to overcome the issues of symptom monitoring including poor adherence, inadequate technique, and poor symptom perception in adolescents. Further refinement of the algorithm is warranted to improve the accuracy of the device. Future study is also needed to assess the efficacy of the device in promoting self-management and asthma outcomes. ",
doi="10.2196/mhealth.3118",
url="http://mhealth.jmir.org/2014/2/e27/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25100184"
}


@Article{info:doi/10.2196/mhealth.2799,
author="Liddle, Jacki
and Ireland, David
and McBride, J. Simon
and Brauer, G. Sandra
and Hall, M. Leanne
and Ding, Hang
and Karunanithi, Mohan
and Hodges, W. Paul
and Theodoros, Deborah
and Silburn, A. Peter
and Chenery, J. Helen",
title="Measuring the Lifespace of People With Parkinson's Disease Using Smartphones: Proof of Principle",
journal="JMIR Mhealth Uhealth",
year="2014",
month="Mar",
day="12",
volume="2",
number="1",
pages="e13",
keywords="Parkinson's disease",
keywords="community",
keywords="telemedicine",
keywords="mHealth",
abstract="Background: Lifespace is a multidimensional construct that describes the geographic area in which a person lives and conducts their activities, and reflects mobility, health, and well-being. Traditionally, it has been measured by asking older people to self-report the length and frequency of trips taken and assistance required. Global Positioning System (GPS) sensors on smartphones have been used to measure Lifespace of older people, but not with people with Parkinson's disease (PD). Objective: The objective of this study was to investigate whether GPS data collected via smartphones could be used to indicate the Lifespace of people with PD. Methods: The dataset was supplied via the Michael J Fox Foundation Data Challenge and included 9 people with PD and 7 approximately matched controls. Participants carried smartphones with GPS sensors over two months. Data analysis compared the PD group and the control group. The impact of symptom severity on Lifespace was also investigated. Results: Visualization methods for comparing Lifespace were developed including scatterplots and heatmaps. Lifespace metrics for comparison included average daily distance, percentage of time spent at home, and number of trips into the community. There were no significant differences between the PD and the control groups on Lifespace metrics. Visual representations of Lifespace were organized based on the self-reported severity of symptoms, suggesting a trend of decreasing Lifespace with increasing PD symptoms. Conclusions: Lifespace measured by GPS-enabled smartphones may be a useful concept to measure the progression of PD and the impact of various therapies and rehabilitation programs. Directions for future use of GPS-based Lifespace are provided. ",
doi="10.2196/mhealth.2799",
url="http://mhealth.jmir.org/2014/1/e13/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25100206"
}


@Article{info:doi/10.2196/mhealth.2576,
author="Garcia, Carolyn
and Hardeman, R. Rachel
and Kwon, Gyu
and Lando-King, Elizabeth
and Zhang, Lei
and Genis, Therese
and Brady, S. Sonya
and Kinder, Elizabeth",
title="Teenagers and Texting: Use of a Youth Ecological Momentary Assessment System in Trajectory Health Research With Latina Adolescents",
journal="JMIR Mhealth Uhealth",
year="2014",
month="Jan",
day="24",
volume="2",
number="1",
pages="e3",
keywords="texting",
keywords="data collection",
keywords="intervention research",
keywords="longitudinal",
keywords="trajectory",
abstract="Background: Adolescent females send and receive more text messages than any others, with an average of 4050 texts a month. Despite this technological inroad among adolescents, few researchers are utilizing text messaging technology to collect real time, contextualized data. Temporal variables (ie, mood) collected regularly over a period of time could yield useful insights, particularly for evaluating health intervention outcomes. Use of text messaging technology has multiple benefits, including capacity of researchers to immediately act in response to texted information. Objective: The objective of our study was to custom build a short messaging service (SMS) or text messaging assessment delivery system for use with adolescents. The Youth Ecological Momentary Assessment System (YEMAS) was developed to collect automated texted reports of daily activities, behaviors, and attitudes among adolescents, and to examine the feasibility of YEMAS. This system was created to collect and transfer real time data about individual- and social-level factors that influence physical, mental, emotional, and social well-being. Methods: YEMAS is a custom designed system that interfaces with a cloud-based communication system to automate scheduled delivery of survey questions via text messaging; we designed this university-based system to meet data security and management standards. This was a two-phase study that included development of YEMAS and a feasibility pilot with Latino adolescent females. Relative homogeneity of participants was desired for the feasibility pilot study; adolescent Latina youth were sought because they represent the largest and fastest growing ethnic minority group in the United States. Females were targeted because they demonstrate the highest rate of text messaging and were expected to be interested in participating. Phase I involved development of YEMAS and Phase II involved piloting of the system with Latina adolescents. Girls were eligible to participate if they were attending one of the participating high schools and self-identified as Latina. We contacted 96 adolescents; of these, 24 returned written parental consent forms, completed assent processes, and enrolled in the study. Results: YEMAS was collaboratively developed and implemented. Feasibility was established with Latina adolescents (N=24), who responded to four surveys daily for two two-week periods (four weeks total). Each survey had between 12 and 17 questions, with responses including yes/no, Likert scale, and open-ended options. Retention and compliance rates were high, with nearly 18,000 texts provided by the girls over the course of the pilot period. Conclusions: Pilot results support the feasibility and value of YEMAS, an automated SMS-based text messaging data collection system positioned within a secure university environment. This approach capitalizes on immediate data transfer protocols and enables the documentation of participants' thoughts, feelings, and behaviors in real time. Data are collected using mobile devices that are familiar to participants and nearly ubiquitous in developed countries. ",
doi="10.2196/mhealth.2576",
url="http://www.mhealth.jmir.org/2014/1/e3/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25098355"
}


@Article{info:doi/10.2196/mhealth.2994,
author="Torous, John
and Friedman, Rohn
and Keshavan, Matcheri",
title="Smartphone Ownership and Interest in Mobile Applications to Monitor Symptoms of Mental Health Conditions",
journal="JMIR mHealth uHealth",
year="2014",
month="Jan",
day="21",
volume="2",
number="1",
pages="e2",
keywords="psychiatry",
keywords="mobile",
keywords="smartphone",
keywords="depression",
keywords="technology",
keywords="applications",
abstract="Background: Patient retrospective recollection is a mainstay of assessing symptoms in mental health and psychiatry. However, evidence suggests that these retrospective recollections may not be as accurate as data collection though the experience sampling method (ESM), which captures patient data in ``real time'' and ``real life.'' However, the difficulties in practical implementation of ESM data collection have limited its impact in psychiatry and mental health. Smartphones with the capability to run mobile applications may offer a novel method of collecting ESM data that may represent a practical and feasible tool for mental health and psychiatry. Objective: This paper aims to provide data on psychiatric patients' prevalence of smartphone ownership, patterns of use, and interest in utilizing mobile applications to monitor their mental health conditions. Methods: One hundred psychiatric outpatients at a large urban teaching hospital completed a paper-and-pencil survey regarding smartphone ownership, use, and interest in utilizing mobile applications to monitor their mental health condition. Results: Ninety-seven percent of patients reported owning a phone and 72\% reported that their phone was a smartphone. Patients in all age groups indicated greater than 50\% interest in using a mobile application on a daily basis to monitor their mental health condition. Conclusions: Smartphone and mobile applications represent a practical opportunity to explore new modalities of monitoring, treatment, and research of psychiatric and mental health conditions. ",
doi="10.2196/mhealth.2994",
url="http://mhealth.jmir.org/2014/1/e2/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25098314"
}


@Article{info:doi/10.2196/jmir.2588,
author="Kirwan, Morwenna
and Vandelanotte, Corneel
and Fenning, Andrew
and Duncan, J. Mitch",
title="Diabetes Self-Management Smartphone Application for Adults With Type 1 Diabetes: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2013",
month="Nov",
day="13",
volume="15",
number="11",
pages="e235",
keywords="type 1 diabetes",
keywords="mobile health",
keywords="mobile phone",
keywords="text message",
keywords="education",
abstract="Background: Persistently poor glycemic control in adult type 1 diabetes patients is a common, complex, and serious problem initiating significant damage to the cardiovascular, renal, neural, and visual systems. Currently, there is a plethora of low-cost and free diabetes self-management smartphone applications available in online stores. Objective: The aim of this study was to examine the effectiveness of a freely available smartphone application combined with text-message feedback from a certified diabetes educator to improve glycemic control and other diabetes-related outcomes in adult patients with type 1 diabetes in a two-group randomized controlled trial. Methods: Patients were recruited through an online type 1 diabetes support group and letters mailed to adults with type 1 diabetes throughout Australia. In a 6-month intervention, followed by a three-month follow-up, patients (n=72) were randomized to usual care (control group) or usual care and the use of a smartphone application (Glucose Buddy) with weekly text-message feedback from a Certified Diabetes Educator (intervention group). All outcome measures were collected at baseline and every three months over the study period. Patients' glycosylated hemoglobin levels (HbA1c) were measured with a blood test and diabetes-related self-efficacy, self-care activities, and quality of life were measured with online questionnaires. Results: The mean age of patients was 35.20 years (SD 10.43) (28 male, 44 female), 39\% (28/72) were male, and patients had been diagnosed with type 1 diabetes for a mean of 18.94 years (SD 9.66). Of the initial 72 patients, 53 completed the study (25 intervention, 28 control group). The intervention group significantly improved glycemic control (HbA1c) from baseline (mean 9.08\%, SD 1.18) to 9-month follow-up (mean 7.80\%, SD 0.75), compared to the control group (baseline: mean 8.47\%, SD 0.86, follow-up: mean 8.58\%, SD 1.16). No significant change over time was found in either group in relation to self-efficacy, self-care activities, and quality of life. Conclusions: In adjunct to usual care, the use of a diabetes-related smartphone application combined with weekly text-message support from a health care professional can significantly improve glycemic control in adults with type 1 diabetes. Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12612000132842; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12612000132842 (Archived by WebCite at http://www.webcitation.org/6Kl4jqn5u). ",
doi="10.2196/jmir.2588",
url="http://www.jmir.org/2013/11/e235/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24225149"
}


@Article{info:doi/10.2196/med20.2874,
author="Okazaki, Shintaro
and Casta{\~n}eda, Alberto Jos{\'e}
and Sanz, Silvia",
title="Clinicians' Assessment of Mobile Monitoring: A Comparative Study in Japan and Spain",
journal="Med 2.0",
year="2013",
month="Sep",
day="18",
volume="2",
number="2",
pages="e11",
keywords="comparative study",
keywords="health monitoring",
keywords="personal innovativeness",
keywords="smartphone",
keywords="psychic distance",
abstract="Background: The gradual but steady shift toward telemedicine during the past decades is a clear response to important health problems that most industrialized countries have been facing. The growing elderly population and changing dietary habits have led to an increase in people with chronic diseases and overall health care expenditures. As more consumers use their mobile device as their preferred information and communication technology (ICT) device, mobile health monitoring has been receiving increasing attention in recent years. Objective: This study examines clinicians' perception of factors determining mobile health monitoring acceptance in Japan and Spain. The study proposes a causal model consisting of innovation seeking, new ICT attributes (perceived value, time-place flexibility, and compatibility), and usage intention. In addition, cross-country differences are posited for the hypothesized relationships among the proposed constructs. Methods: A questionnaire survey was performed to test our research model and hypotheses. The sample consisted of clinicians from various medical specialties. In total, 471 and 497 usable responses were obtained in Japan and Spain, respectively. Results: In both countries, the collected data fit the model well with all the hypothesized paths among the constructs being supported. Furthermore, the moderating effects of psychic distance were observed in most of the paths. Conclusions: Our study demonstrates the importance of new ICT attributes, namely perceived value, time-place flexibility, and compatibility, in the clinicians' adoption of mobile health monitoring. In particular, our results clearly indicated that perceived medical value and ubiquitous nature of the tool are the two main benefits clinicians are likely to perceive (and appreciate) in both countries. This tendency will be stronger for those with a greater propensity to seek innovation in ICT. In terms of cross-country comparison, the strength of the path from innovation seeking to perceived value was greater in Japan than in Spain. Since the number of clinicians per 10,000 residents is substantially fewer in Japan compared with Spain, clinicians with a greater propensity to seek innovation in ICT may have perceived greater value in using mobile health monitoring to improve remote patient care. ",
doi="10.2196/med20.2874",
url="http://www.medicine20.com/2013/2/e11/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25075234"
}


@Article{info:doi/10.2196/resprot.2768,
author="Ribu, Lis
and Holmen, Heidi
and Torbj{\o}rnsen, Astrid
and Wahl, Klopstad Astrid
and Gr{\o}ttland, Astrid
and Sm{\aa}stuen, Cvancarova Milada
and Elind, Elisabeth
and Bergmo, Strand Trine
and Breivik, Elin
and {\AA}rsand, Eirik",
title="Low-Intensity Self-Management Intervention for Persons With Type 2 Diabetes Using a Mobile Phone-Based Diabetes Diary, With and Without Health Counseling and Motivational Interviewing: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2013",
month="Aug",
day="26",
volume="2",
number="2",
pages="e34",
keywords="self-management",
keywords="empowerment",
keywords="health-related quality of life",
keywords="acceptability",
keywords="type 2 diabetes",
keywords="lifestyle intervention",
keywords="complex intervention",
keywords="mHealth",
keywords="telemedicine",
keywords="motivation",
keywords="health counseling",
keywords="mixed methods",
abstract="Background: The present study protocol is designed to cover the Norwegian part of the European Union Collaborative Project---REgioNs of Europe WorkINg together for HEALTH (RENEWING HEALTH). Self-management support is an important element of care for persons with type 2 diabetes (T2D) for achieving metabolic control and positive lifestyle changes. Telemedicine (TM) with or without health counseling may become an important technological aid for self-management and may provide a user-centered model of care. In spite of many earlier studies on TM, there remains a lack of consensus in research findings about the effect of TM interventions. Objective: The aim of RENEWING HEALTH is to validate and evaluate innovative TM tools on a large scale through a common evaluation, making it easier for decision makers to choose the most efficient and cost-effective technological interventions. The Norwegian pilot study evaluates whether the introduction of a mobile phone with a diabetes diary application together with health counseling intervention produces benefits in terms of the desired outcomes, as reflected in the hemoglobin A1c level, health-related quality of life, behavior change, and cost-effectiveness. Methods: The present study has a mixed-method design comprising a three-armed prospective randomized controlled trial and qualitative interviews with study data collected at three time points: baseline, after 4 months, and after 1 year. The patients' registrations on the application are recorded continuously and are sent securely to a server. Results: The inclusion of patients started in March 2011, and 100\% of the planned sample size is included (N=151). Of all the participants, 26/151 patients (17.2\%) are lost to follow-up by now, and 11/151 patients (7.3\%) are still in the trial. Results of the study protocol will be presented in 2014. Conclusions: The key goals of this trial are to investigate the effect of an electronic diabetes diary app with and without health counseling, and to determine whether health counseling is important to the continued use of the application and the patients' health competence and acceptability. Research within this area is needed because few studies have investigated the effectiveness of apps used in long-term interventions with this degree of self-management. Trial Registration: Clinicaltrials.gov NCT01315756; http://clinicaltrials.gov/ct2/show/NCT01315756 (Archived by WebCite at http://www.webcitation/6BTyuRMpH). ",
doi="10.2196/resprot.2768",
url="http://www.researchprotocols.org/2013/2/e34/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23978690"
}


@Article{info:doi/10.2196/mhealth.2567,
author="Pulman, Andy
and Taylor, Jacqui
and Galvin, Kathleen
and Masding, Mike",
title="Ideas and Enhancements Related to Mobile Applications to Support Type 1 Diabetes",
journal="JMIR Mhealth Uhealth",
year="2013",
month="Jul",
day="25",
volume="1",
number="2",
pages="e12",
keywords="patient education",
keywords="type 1 diabetes",
keywords="mobile",
keywords="apps",
keywords="sociotechnical design",
keywords="lifeworld",
keywords="humanising healthcare",
keywords="patient voice",
keywords="empathy",
keywords="ideas",
keywords="enhancements",
abstract="Background: Mobile devices have become increasingly important to young people who now use them to access a wide variety of health-related information. Research and policy related to the integration of health information and support with this technology do not effectively consider the viewpoint of a younger patient. Views of young people with type 1 diabetes are vital in developing quality services and improving their own health-related quality of life (HRQOL), yet research on their lifestyle and use of Web and mobile technology to support their condition and in non--health-related areas is sparse. Objective: To develop insight into young people with type 1 diabetes and their current use of Web and mobile technology and its potential impact on HRQOL. This can be achieved by constructing an in-depth picture of their day-to-day experiences from qualitative interviewing and exploring how they make use of technology in their lives and in relation to their condition and treatment. The goal was then to build something to help them, using the researcher's technical expertise and seeking users' opinions during the design and build, utilizing sociotechnical design principles. Methods: Data were collected by semistructured, in-depth qualitative interviews (N=9) of young people with type 1 diabetes aged 18-21. Interviews were transcribed and loaded onto NVivo for theme identification. Data analysis was undertaken during initial interviews (n=4) to locate potential ideas and enhancements for technical development. Latter interviews (n=5) assisted in the iterative sociotechnical design process of the development and provided additional developmental ideas. Results: Six themes were identified providing an understanding of how participants lived with and experienced their condition and how they used technology. Four technological suggestions for improvement were taken forward for prototyping. One prototype was developed as a clinically approved app. A number of ideas for new mobile apps and enhancements to currently existing apps that did not satisfactorily cater to this age group's requirements for use in terms of design and functionality were suggested by interviewees but were not prototyped. Conclusions: This paper outlines the nonprototyped suggestions from interviewees and argues that young people with type 1 diabetes have a key role to play in the design and implementation of new technology to support them and improve HRQOL. It is vital to include and reflect on their suggestions as they have a radically different view of technology than either their parents or practitioners. We need to consider the relationship to technology that young people with type 1 diabetes have, and then reflect on how this might make a difference to them and when it might not be a suitable mechanism to use. ",
doi="10.2196/mhealth.2567",
url="http://mhealth.jmir.org/2013/2/e12/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25100684"
}


@Article{info:doi/10.2196/jmir.2413,
author="Mulvaney, A. Shelagh
and Ho, Yun-Xian
and Cala, M. Cather
and Chen, Qingxia
and Nian, Hui
and Patterson, L. Barron
and Johnson, B. Kevin",
title="Assessing Adolescent Asthma Symptoms and Adherence Using Mobile Phones",
journal="J Med Internet Res",
year="2013",
month="Jul",
day="17",
volume="15",
number="7",
pages="e141",
keywords="asthma",
keywords="adherence",
keywords="mobile technology",
keywords="adolescent",
keywords="assessment",
abstract="Background: Self-report is the most common method of measuring medication adherence but is influenced by recall error and response bias, and it typically does not provide insight into the causes of poor adherence. Ecological momentary assessment (EMA) of health behaviors using mobile phones offers a promising alternative to assessing adherence and collecting related data that can be clinically useful for adherence problem solving. Objective: To determine the feasibility of using EMA via mobile phones to assess adolescent asthma medication adherence and identify contextual characteristics of adherence decision making. Methods: We utilized a descriptive and correlational study design to explore a mobile method of symptom and adherence assessment using an interactive voice response system. Adolescents aged 12-18 years with a diagnosis of asthma and prescribed inhalers were recruited from an academic medical center. A survey including barriers to mobile phone use, the Illness Management Survey, and the Pediatric Asthma Quality of Life Questionnaire were administered at baseline. Quantitative and qualitative assessment of asthma symptoms and adherence were conducted with daily calls to mobile phones for 1 month. The Asthma Control Test (ACT) was administered at 2 study time points: baseline and 1 month after baseline. Results: The sample consisted of 53 adolescents who were primarily African American (34/53, 64\%) and female (31/53, 58\%) with incomes US\$40K/year or lower (29/53, 55\%). The majority of adolescents (37/53, 70\%) reported that they carried their phones with them everywhere, but only 47\% (25/53) were able to use their mobile phone at school. Adolescents responded to an average of 20.1 (SD 8.1) of the 30 daily calls received (67\%). Response frequency declined during the last week of the month (b=-0.29, P<.001) and was related to EMA-reported levels of rescue inhaler adherence (r= 0.33, P=.035). Using EMA, adolescents reported an average of 0.63 (SD 1.2) asthma symptoms per day and used a rescue inhaler an average of 70\% of the time (SD 35\%) when they experienced symptoms. About half (26/49, 53\%) of the instances of nonadherence took place in the presence of friends. The EMA-measured adherence to rescue inhaler use correlated appropriately with asthma control as measured by the ACT (r=-0.33, P=.034). Conclusions: Mobile phones provided a feasible method to assess asthma symptoms and adherence in adolescents. The EMA method was consistent with the ACT, a widely established measure of asthma control, and results provided valuable insights regarding the context of adherence decision making that could be used clinically for problem solving or as feedback to adolescents in a mobile or Web-based support system. ",
doi="10.2196/jmir.2413",
url="http://www.jmir.org/2013/7/e141/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23864345"
}


@Article{info:doi/10.2196/mhealth.2391,
author="Parmanto, Bambang
and Pramana, Gede
and Yu, Xie Daihua
and Fairman, D. Andrea
and Dicianno, E. Brad
and McCue, P. Michael",
title="iMHere: A Novel mHealth System for Supporting Self-Care in Management of Complex and Chronic Conditions",
journal="JMIR Mhealth Uhealth",
year="2013",
month="Jul",
day="11",
volume="1",
number="2",
pages="e10",
keywords="mobile health",
keywords="mhealth",
keywords="self-care",
keywords="clinician-directed self-care",
keywords="self-management",
keywords="telehealth",
keywords="telemedicine",
keywords="smartphone",
keywords="chronic disease management",
keywords="spina bifida",
keywords="patient-clinician communications",
abstract="Background: Individuals with chronic conditions are vulnerable to secondary complications that can be prevented with adherence to self-care routines. They benefit most from receiving effective treatments beyond acute care, usually in the form of regular follow-up and self-care support in their living environments. One such population is individuals with spina bifida (SB), the most common permanently disabling birth defect in the United States. A Wellness Program at the University of Pittsburgh in which wellness coordinators supervise the care of individuals with chronic disease has produced remarkably improved outcomes. However, time constraints and travel costs have limited its scale. Mobile telehealth service delivery is a potential solution for improving access to care for a larger population. Objective: The project's goal was to develop and implement a novel mHealth system to support complex self-care tasks, continuous adherence to regimens, monitoring of adherence, and secure two-way communications between patients and clinicians. Methods: We developed and implemented a novel architecture of mHealth system called iMHere (iMobile Health and Rehabilitation) consisting of smartphone apps, a clinician portal, and a two-way communication protocol connecting the two.  The process of implementing iMHere consisted of: (1) requirement analysis to identify clinically important functions that need to be supported, (2) design and development of the apps and the clinician portal, (3) development of efficient real-time bi-directional data exchange between the apps and the clinician portal, (4) usability studies on patients, and (5) implementation of the mHealth system in a clinical service delivery. Results: There were 9 app features identified as relevant, and 5 apps were considered priority. There were 5 app features designed and developed to address the following issues: medication, skin care, bladder self-catheterization, bowel management, and mental health. The apps were designed to support a patient's self-care tasks, send adherence data to the clinician portal, and receive personalized regimens from the portal. The Web-based portal was designed for clinicians to monitor patients' conditions and to support self-care regimens. The two-way communication protocol was developed to facilitate secure and efficient data exchange between the apps and the portal. The 3 phases of usability study discovered usability issues in the areas of self-care workflow, navigation and interface, and communications between the apps and the portal. The system was used by 14 patients in the first 6 months of the clinical implementation, with 1 drop out due to having a poor wireless connection. The apps have been highly utilized consistently by patients, even those addressing complex issues such as medication and skincare. The patterns of utilization showed an increase in use in the first month, followed by a plateau. Conclusions: The system was capable of supporting self-care and adherence to regimen, monitoring adherence, supporting clinician engagement with patients, and has been highly utilized. ",
doi="10.2196/mhealth.2391",
url="http://mhealth.jmir.org/2013/2/e10/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25100682"
}


@Article{info:doi/10.2196/mhealth.2536,
author="Aztiria, Asier
and Farhadi, Golnaz
and Aghajan, Hamid",
title="User Behavior Shift Detection in Ambient Assisted Living Environments",
journal="JMIR Mhealth Uhealth",
year="2013",
month="Jun",
day="18",
volume="1",
number="1",
pages="e6",
keywords="shift detection",
keywords="intelligent environments",
keywords="disease detection",
doi="10.2196/mhealth.2536",
url="http://mhealth.jmir.org/2013/1/e6/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25100679"
}


@Article{info:doi/10.2196/med20.2014,
author="Elias, Pierre
and Rajan, O. Nithin
and McArthur, Kara
and Dacso, C. Clifford",
title="InSpire to Promote Lung Assessment in Youth: Evolving the Self-Management Paradigms of Young People With Asthma",
journal="Med 2.0",
year="2013",
month="May",
day="21",
volume="2",
number="1",
pages="e1",
keywords="pediatric asthma",
keywords="chronic disease management",
keywords="mobile phones",
keywords="spirometry",
keywords="gamification",
abstract="Background: Asthma is the most common chronic disease in childhood, disproportionately affecting urban, minority, and disadvantaged children. Individualized care plans supported by daily lung-function monitoring can reduce morbidity and mortality. However, despite 20 years of interventions to increase adherence, only 50\% of US youth accurately follow their care plans, which leads to millions of preventable hospitalizations, emergency room visits, and sick days every year. We present a feasibility study of a novel, user-centered approach to increasing young people's lung-function monitoring and asthma self-care. Promoting Lung Assessment in Youth (PLAY) helps young people become active managers of their asthma through the Web 2.0 principles of participation, cocreation, and information sharing. Specifically, PLAY combines an inexpensive, portable spirometer with the motivational power and convenience of mobile phones and virtual-community gaming. Objective: The objective of this study was to develop and pilot test InSpire, a fully functional interface between a handheld spirometer and an interactive game and individualized asthma-care instant-messaging system housed on a mobile phone. Methods: InSpire is an application for mobile smartphones that creates a compelling world in which youth collaborate with their physicians on managing their asthma. Drawing from design-theory on global timer mechanics and role playing, we incentivized completing spirometry maneuvers by making them an engaging part of a game young people would want to play. The data can be sent wirelessly to health specialists and return care recommendations to patients in real-time. By making it portable and similar to applications normally desired by the target demographic, InSpire is able to seamlessly incorporate asthma management into their lifestyle. Results: We describe the development process of building and testing the InSpire prototype. To our knowledge, the prototype is a first-of-its kind mobile one-stop shop for asthma management. Feasibility testing in children aged 7 to 14 with asthma assessed likability of the graphical user interface as well as young people's interest in our incentivizing system. Nearly 100\% of children surveyed said they would play games like those in PLAY if they involved breathing into a spirometer. Two-thirds said they would prefer PLAY over the spirometer alone, whereas 1/3 would prefer having both. No children said they would prefer the spirometer over PLAY. Conclusions: Previous efforts at home-monitoring of asthma in children have experienced rapid decline in adherence. An inexpensive monitoring technology combined with the computation, interactive communication, and display ability of a mobile phone is a promising approach to sustainable adherence to lung-function monitoring and care plans. An exciting game that redefines the way youth conduct health management by inviting them to collaborate in their health better can be an incentive and a catalyst for more far-reaching goals. ",
doi="10.2196/med20.2014",
url="http://www.medicine20.com/2013/1/e1/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25075232"
}


@Article{info:doi/10.2196/mhealth.2432,
author="Tatara, Naoe
and {\AA}rsand, Eirik
and Skr{\o}vseth, Olav Stein
and Hartvigsen, Gunnar",
title="Long-Term Engagement With a Mobile Self-Management System for People With Type 2 Diabetes",
journal="JMIR Mhealth Uhealth",
year="2013",
month="Mar",
day="27",
volume="1",
number="1",
pages="e1",
keywords="Type 2 diabetes",
keywords="self-management",
keywords="user-involved design process",
keywords="mobile phone",
keywords="usage",
keywords="usability",
keywords="mHealth",
abstract="Background: In a growing number of intervention studies, mobile phones are used to support self-management of people with Type 2 diabetes mellitus (T2DM). However, it is difficult to establish knowledge about factors associated with intervention effects, due to considerable differences in research designs and outcome measures as well as a lack of detailed information about participants' engagement with the intervention tool. Objective: To contribute toward accumulating knowledge about factors associated with usage and usability of a mobile self-management application over time through a thorough analysis of multiple types of investigation on each participant's engagement. Methods: The Few Touch application is a mobile-phone--based self-management tool for patients with T2DM. Twelve patients with T2DM who have been actively involved in the system design used the Few Touch application in a real-life setting from September 2008 until October 2009. During this period, questionnaires and semistructured interviews were conducted. Recorded data were analyzed to investigate usage trends and patterns. Transcripts from interviews were thematically analyzed, and the results were further analyzed in relation to the questionnaire answers and the usage trends and patterns. Results: The Few Touch application served as a flexible learning tool for the participants, responsive to their spontaneous needs, as well as supporting regular self-monitoring. A significantly decreasing (P<.05) usage trend was observed among 10 out of the 12 participants, though the magnitude of the decrease varied widely. Having achieved a sense of mastery over diabetes and experiences of problems were identified as reasons for declining motivation to continue using the application. Some of the problems stemmed from difficulties in integrating the use of the application into each participant's everyday life and needs, although the design concepts were developed in the process where the participants were involved. The following factors were identified as associated with usability and/or usage over time: Integration with everyday life; automation; balance between accuracy and meaningfulness of data with manual entry; intuitive and informative feedback; and rich learning materials, especially about foods. Conclusion: Many grounded design implications were identified through a thorough analysis of results from multiple types of investigations obtained through a year-long field trial of the Few Touch application. The study showed the importance and value of involving patient-users in a long-term trial of a tool to identify factors influencing usage and usability over time. In addition, the study confirmed the importance of detailed analyses of each participant's usage of the provided tool for better understanding of participants' engagement over time. ",
doi="10.2196/mhealth.2432",
url="http://mhealth.jmir.org/2013/1/e1/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25100649"
}


@Article{info:doi/10.2196/jmir.2350,
author="Stinson, N. Jennifer
and Jibb, A. Lindsay
and Nguyen, Cynthia
and Nathan, C. Paul
and Maloney, Marie Anne
and Dupuis, Lee L.
and Gerstle, Ted J.
and Alman, Benjamin
and Hopyan, Sevan
and Strahlendorf, Caron
and Portwine, Carol
and Johnston, L. Donna
and Orr, Mike",
title="Development and Testing of a Multidimensional iPhone Pain Assessment Application for Adolescents with Cancer",
journal="J Med Internet Res",
year="2013",
month="Mar",
day="08",
volume="15",
number="3",
pages="e51",
keywords="neoplasms",
keywords="pain",
keywords="child",
keywords="adolescent",
keywords="youth",
keywords="cellular phone",
keywords="game",
abstract="Background: Pain is one of the most common and distressing symptoms reported by adolescents with cancer. Despite advancements in pain assessment and management research, pain due to cancer and/or its treatments continues to be poorly managed. Our research group has developed a native iPhone application (app) called Pain Squad to tackle the problem of poorly managed pain in the adolescent with cancer group. The app functions as an electronic pain diary and is unique in its ability to collect data on pain intensity, duration, location, and the impact pain has on an adolescent's life (ie, relationships, school work, sleep, mood). It also evaluates medications and other physical and psychological pain management strategies used. Users are prompted twice daily at configurable times to complete 20 questions characterizing their pain and the app transmits results to a database for aggregate reporting through a Web interface. Each diary entry represents a pain case filed by an adolescent with cancer and a reward system (ie, moving up through law-enforcement team ranks, built-in videotaped acknowledgements from fictitious officers) encourages consistent use of the diary. Objective: Our objective was to design, develop, and test the usability, feasibility, compliance, and satisfaction of a game-based smartphone pain assessment tool for adolescents with cancer. Methods: We used both low- and high-fidelity qualitative usability testing with qualitative semi-structured, audio-taped interviews and iterative cycles to design and refine the iPhone based Pain Squad app. Qualitative thematic analysis of interviews using constant comparative methodology captured emergent themes related to app usability. Content validity was assessed using question importance-rating surveys completed by participants. Compliance and satisfaction data were collected following a 2-week feasibility trial where users were alarmed to record their pain twice daily on the app. Results: Thematic analysis of usability interviews showed the app to be appealing overall to adolescents. Analyses of both low- and high-fidelity testing resulted in minor revisions to the app to refine the theme and improve its usability. Adolescents resoundingly endorsed the game-based nature of the app and its virtual reward system. The importance of app pain diary questions was established by content validity analysis. Compliance with the app, assessed during feasibility testing, was high (mean 81\%, SD 22\%) and adolescents from this phase of the study found the app likeable, easy to use, and not bothersome to complete. Conclusions: A multifaceted usability approach demonstrated how the Pain Squad app could be made more appealing to children and adolescents with cancer. The game-based nature and built-in reward system of the app was appealing to adolescents and may have resulted in the high compliance rates and satisfaction ratings observed during clinical feasibility testing. ",
doi="10.2196/jmir.2350",
url="http://www.jmir.org/2013/3/e51/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23475457"
}


@Article{info:doi/10.2196/resprot.2175,
author="Baggott, Christina
and Gibson, Faith
and Coll, Beatriz
and Kletter, Richard
and Zeltzer, Paul
and Miaskowski, Christine",
title="Initial Evaluation of an Electronic Symptom Diary for Adolescents with Cancer",
journal="JMIR Res Protoc",
year="2012",
month="Dec",
day="11",
volume="1",
number="2",
pages="e23",
keywords="mHealth, eHealth, patient-reported outcomes, symptom assessment, adolescent, cancer",
abstract="Background: The delivery of optimal care depends on accurate communication between patients and clinicians regarding untoward symptoms. Documentation of patients' symptoms necessitates reliance on memory, which is often imprecise. We developed an electronic diary (eDiary) for adolescents and young adults (AYAs) with cancer to record symptoms. Objective: The purpose of this paper is to describe the utility of an eDiary designed for AYAs with cancer, including dependability of the mobile application, the reasons for any missing recorded data, patients' adherence rates to daily symptom queries, and patients' perceptions of the usefulness and acceptability of symptom data collection via mobile phones. Methods: Our team developed an electronic symptom diary based on interviews conducted with AYAs with cancer and their clinicians. This diary included daily severity ratings of pain, nausea, vomiting, fatigue, and sleep. The occurrence of other selected physical sequelae was assessed daily. Additionally, patients selected descriptors of their mood. A 3-week trial of the eDiary was conducted with 10 AYA cancer patients. Mobile phones with service plans were loaned to patients who were instructed to report their symptoms daily. Patients completed a brief questionnaire and were interviewed to elicit their perceptions of the eDiary and any technical difficulties encountered. Results: Overall adherence to daily symptom reports exceeded 90\%. Young people experienced few technical difficulties and reported benefit from daily symptom reports. Symptom occurrence rates were high and considerable inter- and intra-patient variability was noted in symptom and mood reports. Conclusions: We demonstrated the utility of an eDiary that may contribute insight into patients' symptom patterns to promote effective symptom management. ",
doi="10.2196/resprot.2175",
url="http://www.researchprotocols.org/2012/2/e23/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23612521"
}